Caries Depth Research Articles

Construction of a predictive model for the transition from irreversible pulpitis to periodontal-involved disease.

Irreversible pulpitis can develop into pulp necrosis, causing apical periodontitis (AP). The progression of apical periodontitis is always accompanied by periodontal disease. Many similar inflammatory response pathways are involved in both apical periodontitis (AP) and periodontal disease. The infiltration of specific immune cells and the activation of immune responses are thought to play important roles in the transition from irreversible pulpitis to AP and periodontal-related diseases. This study explored immune response characteristics during the transformation of pulpitis to periodontal disease. The study also constructed a predictive model by combining known clinical and imaging indicators related to this transformation. Gene expression data related to irreversible pulpitis, apical periodontitis, and periodontal disease were extracted from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were compared and identified. KEGG(Kyoto Encyclopedia of Genes and Genomes)enrichment analysis was performed to identify immune-related pathways. Key gene signatures were screened, and a retrospective research strategy was used to collect 80 samples from patients with irreversible pulpitis. Information about pulp sensation test indicators, caries depth, root canal curvature, and inflammation indices of the patients were combined, and a logistic regression model of clinical periodontal disease was created. Receiver-operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the model. Five genes were identified as common gene signatures during the transition from pulpitis to apical periodontitis and periodontal-involved disease. Following regression and ROC analyses revealed the expression of four genes, and the electric pulp test (EPT) value formed a predictive model with the best specificity and sensitivity in predicting the occurrence of apical periodontitis. A prognostic model was constructed and evaluated for predicting the transition from pulpitis to periodontal disease.

Association between lesion depth and placement technique with failures requiring extraction of preformed metal crowns in primary molars. A retrospective study.

The aim of the present study was to evaluate the factors associated with failure requiring extraction after placement of preformed metal crowns (PMCs) in primary molars. Radiographic caries depth at baseline (initial/moderate and severe) and placement technique (Conventional and Hall technique) and other patient-related variables were analysed. Clinical and radiographic records from children aged 2-10years who had at least one primary molar treated with PMCs between 2011 and 2019 were evaluated. Chi-square test, Fisher exact tests and logistic regression analysis (α = 5%) were performed to verify the relationship between the primary outcome and categorical variables (caries depth, restorative teachnique, jaw, tooth type and gender). A total of 244 teeth treated in 165 children were included in the analysis. A total of 18 failures were observed (7.4%), of which 17 were in deep caries lesions and in which 15 had the PMC placed according to the conventional technique. Both caries lesion depth and restorative technique were associated with treatment failure (p < 0.05). Taking into account the limitations of this retrospective study, treatment failures requiring extraction occurred more often in deep caries lesions when treated with preformed metal crowns (PMCs) following the conventional technique when compared to the Hall Technique.

Diagnostic performance of approximal caries in bitewing radiographs from different monitors and room illuminances.

To compare the accuracy, duration, and certainty of diagnosing approximal caries in bitewing radiographs displayed in three monitors under two luminance conditions. A total of 39 teeth without evident caries were selected from 11 patients undergoing partial jaw resection. Before the operation, 13 bitewing radiographs were captured by a digital imaging system. Eight observers evaluated the images under the dark (9 lux) and bright (200 lux) conditions, using two medical-grade monitors and a commercial monitor. Using histological results as the gold standard, the areas under the receiver operating characteristic curves under different conditions were compared using the Z-test. Multivariate analysis of variance was conducted to assess the impact of various factors on diagnostic duration, while ordinal logistic regression was used to examine factors influencing diagnostic certainty level. It was considered significant when P＜0.05. No significant difference was found in the diagnostic accuracy or duration for diagnosis approximal caries under two luminance conditions with the three distinct monitors (P > 0.05). Ambient light, clinical experience and the pathological grade of approximal caries have influence on the degree of diagnostic confidence (P＜0.05). Different monitors and ambient luminance didn't influence the diagnostic accuracy or evaluation duration. Ambient luminance, clinical experience, and the depth of caries affect the degree of diagnostic confidence. The study employing bitewing radiographs from real patients indicates that ambient luminance, clinical experience, and the depth of caries affect the degree of diagnostic confidence.

The impact of animated video cartoons as a distraction technique on anticipatory anxiety levels among children during class I GIC restoration procedures.

Investigating the effect of visual distraction using animated video cartoons (AVCs) on anxiety of children during class I class I glass-ionomer cement (GIC) restoration procedures. This randomized clinical trial, 42 children between the ages of 5-6years were enrolled. These participants were divided into two groups: Group 1, consisting of 21 individuals (AVCs), who were exposed to a cartoon as a visual distraction tool, and Group 2, a control group with 21 participants who did not receive any form of distraction during their first visit. Both groups underwent class I GIC restoration procedures that were conducted in a consistent manner. To evaluate the anxiety levels of the children, measurements of their pulse rate (PR) were taken at the beginning and end of the treatment. Additionally, patient behavior was assessed using the Frankl behavior rating scale (FBRS) as well as validated self-reported dental anxiety scale, the Visual Analog Scale - Anxiety (VAS-A) score. In the control group, postoperative PR increased significantly, while the AVC group experienced a decrease compared to their preoperative PR levels. Additionally, audio-visual distraction had a notable impact on FBRS scores compared to the standard approach. Similarly, the VAS-A score displayed a significant reduction when patients received audio-visual distraction compared to the control condition. Subgroup analysis by gender showed that girls tended to be more responsive to AVCs than boys when evaluated by PR and FBRS, but such findings were not observed using VAS-A. Patients with deeper caries had higher VAS-A scores than those with shallower ones. Despite the caries depth, those who received AVC seemed to be calmer, especially to those with deeper lesions, as indicated lower postoperative VAS-A scores compared to their preoperative levels, unlike the control group. Our study suggests that the use of AVCs can be an effective method for reducing anxiety in children undergoing class I GIC restoration procedures.

The effectiveness of partial pulpotomy compared with full pulpotomy in managing deep caries in vital permanent teeth with a diagnosis of non-traumatic pulpitis.

Pulpitis may be pain free or alternatively characterized by mild to severe pain and associated symptoms. Evidence has recently emerged that patients presenting with carious pulp exposure range of symptoms can be treated effectively with pulpotomy. The current systematic review aimed to answer the following research question: "In patients with deep caries lesions in permanent teeth associated with no symptoms, reversible pulpitis or signs and symptoms indicative of irreversible pulpitis (P), is partial pulpotomy (I) as effective as full pulpotomy (C), in terms of a combination of patient and clinical reported outcomes (O), with "tooth survival" as the most critical outcome? The systematic literature search was conducted in the following electronic databases: OVID, Scopus, PubMed (Including MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL) supplemented with Grey literature and hand searching of relevant journals. The English language clinical trials comparing the patient and clinical reported outcomes between partial and full/complete were included. After a structured literature search, two authors independently performed study selection, extracted data and performed a risk of bias assessment; a third reviewer resolved disagreements. As there were only two studies with different exclusion criteria, no meta-analysis was performed and the quality of evidence was assessed by the GRADE approach. After study selection a total of two randomised clinical trials with a total of 156 teeth were included both for the management of teeth with irreversible pulpitis. There were no studies for asymptomatic teeth or teeth with reversible pulpitis. A "Low" risk of bias was noted for both studies with a high level of overall evidence. A meta-analysis was not carried out due to differences in inclusion criteria between the studies related principally to caries depth. Both studies reported a high rate of clinical success for pulpotomy with a pooled unadjusted success rate for full pulpotomy of 90% and 83% partial pulpotomy of at 1-year; however, no significant difference between the treatments was noted in either study. There was significantly reduced postoperative pain reported in the full pulpotomy group over 1-week compared with the partial pulpotomy in one but not in the other study. Pulpotomy as a definitive treatment modality is as effective in managing teeth exhibiting signs and symptoms indicative of irreversible pulpitis and challenges the established protocols to manage this condition. Although based on only two RCTs with a limited number of patients, no difference was shown in terms of clinical or radiographic outcome or postoperative pain between groups. Further well designed randomised clinical trials of longer duration are required in this area to improve the evidence available. There is no consistent difference in patient-reported pain between partial and full pulpotomy at day 7 postoperatively and the clinical success rate was similar after 1 year for both treatment modalities.

Reliability of impedance spectroscopy versus digital radiograph and ICDAS-II in occlusal caries detection: a prospective clinical trial

The traditional methods in early caries detection had many limitations. So, this study aimed to evaluate the clinical performance of alternating current impedance spectroscopy ACIST in comparison with digital radiograph and ICDAS-II in detection of occlusal carious lesions. Occlusal surfaces of molar and premolar teeth from 40 adult participants were examined by two observers using three diagnostic methods: (1) international caries detection and assessment system (ICDAS-II) (2) digital radiograph (DR) and (3) Cariescan Pro device (ACIST). Agreement analysis and the difference in sensitivities and specificities were evaluated. The results showed an excellent agreement in the different groups. The difference from the visual tactile against ACIST scoring for enamel caries detection, was statistically significant (p = 0.012) and the agreement was moderate (k = 0.509). For dentinal caries the difference was not statistically significant (p > 0.05) and the agreement was similarly moderate (k < 0.6). The difference from the digital radiograph against ACIST scoring, for enamel caries, digital radiography had significantly higher sensitivity and specificity than ACIST (p < 0.001) while for dentinal caries detection and overall, ACIST had higher sensitivity and digital radiography had higher specificity and the difference was statistically significant (p < 0.001). Visual-tactile examination is a considered as feasible and valid technique for occlusal caries detection, digital radiography is superior to ACIST in diagnosing enamel caries, but it could underestimate the caries depth, ACIST is a reliable tool for detecting occlusal caries in dentin.

In vitro accuracy of ultra-low dose cone-beam CT for detection of proximal caries.

This study aimed to assess the accuracy of ultra-low dose (ULD) cone-beam CT (CBCT) for detection of proximal caries. This in vitro study evaluated 104 molar and premolar teeth. The teeth were mounted in dry skulls and underwent CBCT with 4 protocols of high-resolution (HR), normal (NORM), ULD-HR, and ULD-NORM; 78 CBCT images were scored by 3 observers for the presence and penetration depth of caries twice with a 2-week interval using a 5-point Likert scale. The teeth were then sectioned and observed under a stereomicroscope (gold standard). The 4 protocols were compared with each other and with the gold standard. The receiver operating characteristic curve was drawn, and the area under the curve (AUC) was calculated and compared by the Chi-square test (alpha = .05). The interobserver agreement ranged from 0.5233 to 0.6034 for ULD-NORM, 0.5380 to 0.6279 for NORM, 0.5856 to 0.6300 for ULD-HR, and 0.6614 to 0.7707 for HR images. The intra-observer agreement ranged from 0.6027 to 0.8812 for ULD-HR, 0.7083 to 0.7556 for HR, 0.6076 to 0.9452 for ULD-NORM, and 0.7012 to 0.9221 for NORM images. Comparison of AUC revealed no significant difference between NORM and ULD-NORM (P > .05), or HR and ULD-HR (P > .05). The highest AUC belonged to HR (0.8529) and the lowest to NORM (0.7774). Considering the significant reduction in radiation dose in ULD CBCT and its acceptable diagnostic accuracy for detection of proximal caries, this protocol may be used for detection of proximal carious lesions and assessment of their depth.

Developing the Benchmark: Establishing a Gold Standard for the Evaluation of AI Caries Diagnostics.

Background/Objectives: The aim of this study was to establish a histology-based gold standard for the evaluation of artificial intelligence (AI)-based caries detection systems on proximal surfaces in bitewing images. Methods: Extracted human teeth were used to simulate intraoral situations, including caries-free teeth, teeth with artificially created defects and teeth with natural proximal caries. All 153 simulations were radiographed from seven angles, resulting in 1071 in vitro bitewing images. Histological examination of the carious lesion depth was performed twice by an expert. A total of thirty examiners analyzed all the radiographs for caries. Results: We generated in vitro bitewing images to evaluate the performance of AI-based carious lesion detection against a histological gold standard. All examiners achieved a sensitivity of 0.565, a Matthews correlation coefficient (MCC) of 0.578 and an area under the curve (AUC) of 76.1. The histology receiver operating characteristic (ROC) curve significantly outperformed the examiners' ROC curve (p < 0.001). All examiners distinguished induced defects from true caries in 54.6% of cases and correctly classified 99.8% of all teeth. Expert caries classification of the histological images showed a high level of agreement (intraclass correlation coefficient (ICC) = 0.993). Examiner performance varied with caries depth (p ≤ 0.008), except between E2 and E1 lesions (p = 1), while central beam eccentricity, gender, occupation and experience had no significant influence (all p ≥ 0.411). Conclusions: This study successfully established an unbiased dataset to evaluate AI-based caries detection on bitewing surfaces and compare it to human judgement, providing a standardized assessment for fair comparison between AI technologies and helping dental professionals to select reliable diagnostic tools.

Practical Tips for Successful Bitewing Radiographs in Children

Bitewings are a fundamental tool for treatment decision-making in young patients as they provide essential information on caries depth, the presence of a dentine bridge and pulp retraction, radiographic signs of pulp necrosis and presence of a permanent successor. The article updates the practitioner on the use of bitewing radiographs for primary molars and provides hints and tips for maximizing success in children. CPD/Clinical Relevance: The correct use of bitewing radiographs is essential for clinical decision-making in children.

Encapsulation of a novel peptide derived from histatin-1 in liposomes against initial enamel caries in vitro and in vivo.

Biomimetic mineralization mediated by proteins and peptides is a promising strategy for enamel repair, and its specific application model needs more research. In this work, we exploited a liposomal delivery system for a novel peptide (DK5) derived from histatin-1 (DK5-Lips) as a new biomimetic mineralization strategy against initial enamel caries. The DK5-Lips was prepared using calcium acetate gradient method and then the in vitro release, salivary stability, and cytotoxicity were studied. Initial enamel caries was created in bovine enamel blocks and subjected to pH-cycling model treated with DK5-Lips. Surface microhardness testing, polarized light microscopy (PLM), and transverse microradiography (TMR) were analyzed. Then the biocompatibility of DK5-Lips was evaluated in the caries model of Sprague-Dawley rats, and the anti-caries effect was assessed using Micro-CT analysis, Keyes scores, and PLM in vivo. DK5-Lips provided a mean particle size of (97.63 ± 4.94)nm and encapsulation efficiency of (61.46 ± 1.44)%, exhibiting a sustained release profile, excellent stability in saliva, and no significant toxicity on human gingival fibroblasts (HGFs). The DK5-Lips group had higher surface microhardness recovery, shallower caries depth, and less mineral loss in bovine enamel. Animal experiments showed higher volume and density values of residual molar enamel, lower Keyes score, and shallower lesion depth of the DK5-Lips group with good biocompatibility. As a safe and effective application model, DK5-Lips could significantly promote the remineralization of initial enamel caries both in vitro and in vivo. The potential of liposome utilization as vehicle for oral delivery of functional peptides may provide a new way for enamel restoration.

Diagnostic and Prognostic Predictors for the Success of Pulpotomy in Permanent Mature Posterior Teeth with Moderate to Severe Pulpitis: A Scoping Review

A partial or complete pulpotomy is a type of vital pulp therapy (VPT) that aims to remove the inflamed, infected pulp, leaving behind healthy, vital pulp that is capable of healing. VPT has gained renewed popularity as a treatment option in permanent mature posterior teeth with irreversible, moderate to severe pulpitis; its high success rates matching that of root canal treatment (RCT). There is currently no consensus regarding diagnostic and prognostic predictors of success of pulpotomies for managing such cases. Therefore, we conducted a scoping review to identify and analyze how these factors affect the outcome of treatment. A literature search using the PRISMA guidelines was undertaken using PubMed and Scopus on 7 July 2023. A total of 22 studies met the inclusion criteria and were qualitatively analyzed by two reviewers. The following diagnostic and prognostic factors were recognized and discussed; presenting signs and symptoms, periapical diagnosis, bleeding time, indicators of inflammation (bleeding time, concentration of inflammatory biomarkers), patient age and medical status, the depth, activity and location of caries, and restorative factors. Based on the studies assessed, there is limited evidence to support their prognostic value. Further research is necessary to identify solid predictors of outcome.

Gambaran Karies dan Evaluasi Perawatan pada Siswa di Kawasan Puskesmas Ikur Koto, Padang, Sumatera Barat

Caries are still a significant problem in oral and dental health worldwide, including Indonesia. Various efforts must continue to be made to reduce the incidence of caries, both promotive and preventive, as well as curative and rehabilitative. Based on the Riset Kesehatan Dasar 2018, 36.71% of the people of Padang City have cavities/injured/toothache. Of the youth aged 15-24, 37.45% had cavities/injured/toothache. This program aims to get an overview of caries classification and provide appropriate treatment. The overview of caries classification can become data on the pattern of caries development so that strategies for dealing with earlier caries can be carried out appropriately, effectively, and efficiently. The implementation of the present program was carried out through a thorough and comprehensive examination of the oral cavity; then, treatment was carried out according to the complaints and cases found. The post-treatment evaluation was carried out by distributing questionnaires to participants afterward. Based on the depth of caries treated, 57.14% were dentin caries. Caries classification based on G.V. Black showed that Class I cavity was the highest incidence (64.29%). Mount and Hume's classification presented class 1.3 (39.28%) as the highest, while based on the ICDAS classification, it was class D3 (46.44%). The post-treatment evaluation showed that all participants (100%) stated that the condition of the teeth improved and that there were no complaints/discomfort after treatment.

Description of the Caries Pattern of Stunted Toddlers in Panduman Village, Jelbuk District, Jember Regency, East Java

Introduction: Stunting is a disruption of growth in toddlers, namely the height of toddlers is lower than the standard of age which is based on the body's long index compared to the age (PB / U) or height compared to the age (TB / U) with a zscore of less than -2 SD. Stunting can increase the risk of caries in the deciduous teeth because it cause atrophy in saliva and it also impairs the normal function of the salivary gland. The purpose of this study was to analyze the pattern of stunting children caries in Panduman Village, Jember, East Java. Methods: This study used an descriptive observasional with cross sectional approach. Samples were chosen using purposive sampling, amounted to 45 children. Result: The most commonly found caries were on occlusal surface of mandibular primary molar tooth with a profunda caries depth. It was found that 23 samples had caries on the occlusal surface of mandibulary molar teeth with 11 samples having profunda caries depth. Conclusion: The pattern of stunting children is most commonly found in mandibular primary molar on the occlusal surfaces with profunda caries depth.

The diagnostic performance of the Java-based software colorization tool in the diagnosis of dental caries: an in vitro study.

This in vitro study aimed to compare the diagnostic outcomes of caries detection in premolar and molar teeth on digital periapical radiographs viewed as grayscale images and in the Java-based software (JBS) pseudocolor spectrum. The study comprised 92 premolar or molar human teeth (n = 46 with caries and n = 46 without clinical caries). For each tooth, digital periapical radiographic images (DPRIs), JBS pseudocolor images, and stereomicroscope images were collected, and caries presence and depth were recorded. In JBS pseudocolor images, regions of interest (ROIs) were detected, and ROI values for caries area (ROI1), non-caries area (ROI2), mesial area (ROI3), and distal area (ROI4) were obtained. The degree of inter-observer agreement was determined using the kappa coefficient, and the sensitivity and specificity of the methods were assessed using ROC analysis. While neither method was consistent with stereomicroscopy in determining caries depth (P < .005), for both observers the kappa value of JBS pseudocolor images were slightly higher than those for DPRIs. ROI1 was found to be significantly lower than ROI2 (P < .001), whereas no difference was found between ROI3 and ROI4 (P = .877). For both observers, the sensitivity and specificity obtained from JBS pseudocolor were above 89%. JBS pseudocolor images can be used for caries detection and offer high sensitivity and specificity.

Impact of angle on photothermal radiometry and modulated luminescence (PTR/LUM) value

ObjectiveTo evaluate the impact of scanning angles to detect/quantify non-cavitated caries by photothermal-radiometry and modulated-luminescence (PTR/LUM, Canary System) and to evaluate the association of PTR/LUM value with lesion depth (LD), including sound tissue thickness under the lesion (ST). MethodsThirty human extracted premolars were selected based on micro-computed tomography [μ-CT: sound (n=12), lesions into outer-half of enamel (n=6), lesions into inner-half of enamel (n=6), lesions into outer one-third of dentine (n=6)]. Each tooth sample was scanned 90° directly contacted to the center of non-cavitated lesion or sound smooth surface, and tilted 10° and 20° in four directions: buccal/lingual/occlusal/cervical. The procedure was repeated 48 h later. Lesion depth and ST [ST=5000 µm (maximum PTR/LUM scanning depth)-LD] were measured at the same scanning direction on μ-CT images. Sensitivity, specificity, area under the Receiver Operating Characteristic curve (AUC), and intraclass correlation coefficients (ICC) for different scanning angles were calculated. Sensitivity was further evaluated based on lesion extensions. Relationships between PTR/LUM value and lesion depth, and between PTR/LUM value and LD/ST-Ratio were evaluated. ResultsPTR/LUM value showed significant differences among scanning angles. Overall sensitivity (78%–89%), specificity (66%–87%), AUC (0.86–0.92) and ICC (0.89–0.99), sensitivity based on lesion extensions presented no significant differences among angles. PTR/LUM value showed moderate correlations (0.56–0.74) with deepest lesion depth and LD/ST-Ratios. ConclusionThe scanning angle within 20° increments might impact PTR/LUM value statistically; however, it did not affect PTR/LUM detection performance. PTR/LUM values were positively correlated with non-cavitated lesion depth, and not affected by sound tissue thickness under the lesion. Clinical significance: Clinically, it is challenging to measure/scan at the same location and same angle longitudinally, however, it is important to standardize these parameters. Scanning within 20° deviation from perpendicular did not affect detection performance of PTR/LUM, and PTR/LUM value showed positive moderate correlation with caries depth.

The Influence of Braille Flashcards as a Counseling Media on Various Depths of Dental Caries on the Knowledge of Children with Blind Disabilities Groups

Imperfection of the sense of sight causes obstacles in taking action to maintain dental and oral hygiene. Provision of dental and oral health knowledge using a directed and structured plan in order to change bad habits and especially in dental and oral hygiene. One of them is by using Braille text. This study aims to determine the effect of the use of braille flashcards as a media for counseling about the depth of dental caries on the knowledge of children with disabilities in the blind group. The research method is pre-experimental with the one group pretest-posttest design approach which will be carried out in 2022. A sample of 20 people uses a purposive sampling technique. The average result of knowledge before counseling was 51.50 while the result after counseling was 86.75. In conclusion, there is an influence of braille flashcard media in increasing knowledge for the blind.

Subgingival microbiome at different levels of cognition

ABSTRACT Oral health and declining cognition may have a bi-directional association. We characterized the subgingival microbiota composition of subjects from normal cognition to severe cognitive decline in two cohorts. Memory and Periodontitis (MINOPAR) include 202 home-living participants (50–80 years) in Sweden. Finnish Oral Health Studies in Older Adults (FINORAL) include 174 participants (≥65 years) living in long-term care in Finland. We performed oral examination and assessed the cognitive level with Mini Mental State Examination (MMSE). We sequenced the 16S-rRNA gene (V3-V4 regions) to analyse the subgingival bacterial compositions. The microbial diversities only tended to differ between the MMSE categories, and the strongest determinants were increased probing pocket depth (PPD) and presence of caries. However, abundances of 101 taxa were associated with the MMSE score. After adjusting for age, sex, medications, PPD, and caries, only eight taxa retained the significance in the meta-analyses of the two cohorts. Especially Lachnospiraceae [XIV] at the family, genus, and species level increased with decreasing MMSE. Cognitive decline is associated with obvious changes in the composition of the oral microbiota. Impaired cognition is accompanied with poor oral health status and the appearance of major taxa of the gut microbiota in the oral cavity. Good oral health-care practices require special deliberations among older adults.

Comparison of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro study.

To investigate the cariostatic and remineralizing effect of two commercial silver diamine fluoride (SDF) preparations on enamel and dentinal caries using a bacterial plaque model. A total of 32 extracted primary molars were divided into two groups (n = 16), group I (FAgamin), and group II (SDF). Plaque bacterial model was used to induce caries on enamel and dentin. Preoperative evaluation of samples was done using confocal laser microscopy (CLSM) and energy-dispersive X-ray spectroscopy-scanning electron microscope (EDX-SEM). All samples were treated with test materials and evaluated for postoperative remineralization quantification. Energy-dispersive X-ray spectroscopy (EDX) revealed that mean preoperative levels (in weight %) of silver (Ag) and fluoride (F2) in carious enamel lesions were 0.0 and 0.0, which increased postoperatively to 11.40 and 31.05 for FAgamin and 13.61 and 31.87 for SDF, respectively. For dentinal caries, EDX revealed mean preoperative levels (in weight %) of Ag and F2 were 0.0 and 0.0, which increased to 11.47 and 48.71 for FAgamin and 10.16 and 47.82 for SDF, respectively postoperatively. Both the groups showed evident demineralization with exposed collagen under SEM. The mean value of enamel lesion depth for the group I and II were 38.64 and 39.30 µm, that reduced to 28.02 and 28.70 µm while for dentinal caries, the mean depth from 38.05 and 38.29 µm that reduced significantly to 28.96 and 30.10 µm, respectively (p < 0.001). Caries depth declined significantly after the application of both FAgamin and SDF (p < 0.001). FAgamin and SDF show similar cariostatic and remineralization potential for dental caries. The bacterial plaque model used in this study is an efficient method to induce artificial carious lesions in teeth. A comparative evaluation of these two cariostatic and remineralizing agents will aid in identifying the efficacy of both commercial products in treating initial caries lesions in an effective noninvasive and child-friendly manner. Kale YJ, Misal S, Dadpe MV, et al. Comparison of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro study. Int J Clin Pediatr Dent 2022;15(6):643-651.

Comparative Evaluation of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations Using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro Study.

To investigate the cariostatic and remineralizing effect of two commercial silver diamine fluoride (SDF) preparations on enamel and dentinal caries using a plaque bacterial model. Thirty-two extracted primary molars were divided into two groups (n = 16) as group I (Advantage Arrest) and group II (e-SDF). Plaque bacterial model was used to induce caries on enamel and dentin. Preoperative evaluation of samples was done using confocal laser scanning microscopy (CLSM) and energy-dispersive X-ray spectroscopy-scanning electron microscope (EDX-SEM). All samples were treated with test materials and evaluated for postoperative remineralization quantification. EDX revealed that mean preoperative levels (in weight%) of silver (Ag) and fluoride (F) in enamel carious lesions were 0.0 and 0.0, which increased postoperatively to 11.40 and 31.05 for Advantage Arrest and 13.61 and 31.87 for e-SDF, respectively. For dentinal caries, EDX revealed mean preoperative levels (in weight%) of Ag and F were 0.0 and 0.0, which increased to 11.47 and 48.71 for Advantage Arrest and 10.16 and 47.82 for e-SDF, respectively postoperatively. Both groups showed evident demineralization with exposed collagen under SEM. The mean values of enamel lesion depth for the group I and II were 38.64 and 39.30 µm, that reduced to 28.02 and 28.70 µm, while for dentinal caries, the mean depth from 38.05 to 38.29 µm that reduced significantly to 28.96 and 30.10 µm, respectively (p < 0.001). Caries depth declined significantly after the application of both Advantage Arrest and e-SDF (p < 0.001). Advantage arrest and e-SDF show similar cariostatic and remineralization potential for dental caries. The plaque bacterial model used in this study is an efficient method to induce artificial carious lesions in teeth. Kale YJ, Misal S, Dadpe M, et al. Comparative Evaluation of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations Using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(4):442-449.

Factors that influence the outcome of pulpotomy in permanent teeth.

The promotion of minimally invasive treatments focussed on the maintenance of pulp vitality has become a priority area in Endodontics. These vital pulp treatments (VPT) include partial and full pulpotomy, during which diseased coronal pulp tissue is removed prior to placement of a capping biomaterial and restoration. Traditionally, pulpotomies were confined to the treatment of carious primary and traumatized permanent teeth. However, these treatments have now been proposed as definitive solutions for cariously exposed permanent teeth with mild symptoms or even symptoms indicative of irreversible disease. Until recently, it was recommended that carious exposure of mature permanent teeth be managed by root canal treatment. The promotion of pulpotomy as an alternative treatment has opened up a wave of laboratory and clinical research aimed at improving therapies or evaluating clinical outcomes. In modern evidence-based endodontics, it is imperative that the outcomes of both partial and full pulpotomy are considered and important prognostic factors identified, so that improvements can be made to aid clinical decision-making and to direct new research. In this narrative review, the outcomes of partial and full pulpotomy are discussed, before analysis of patient, intraoperative and postoperative factors that influence the outcome of the pulpotomy procedure. The review highlights that although partial and full pulpotomy for the treatment of even pulpal disease are highly successful procedures, this is based on low-quality evidence with a lack of prospective, comparative trials investigating potential prognostic factors. Based on current evidence, it appears that age, gender, tooth type, root development and intraoperative pulpal haemorrhage do not impact significantly on pulpotomy outcome, whilst others such as caries depth, inflammatory status of the pulp, capping material, level of inflammatory pulpal-biomarkers and the final restoration integrity do. Other factors, including the influence of exposure type, periodontal condition, pulpal lavage, magnification, operator experience, isolation of the operating field and type of pulpotomy, require further experimental investigation before definitive conclusions can be made relating to the success of the pulpotomy procedure. Finally, there is not only a need for future well-designed prospective research addressing these issues but also a widening of our understanding of outcome to include patient-reported as well as clinician-reported outcomes.