Depth Of Carious Lesions Research Articles

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.

Enamel Caries Lesion Depth Obtained by Optical Coherence Tomography and Transverse Microradiography: A Comparative Study

Introduction: Visual imaging of subsurface caries lesions is of vital interest in dentistry, which can be obtained by invasive radiography technique as well as by available non-destructive imaging approaches. Thus, as a first step toward the development of a new innovative approach, Spectral-domain optical coherence tomography (SD-OCT) was applied to detect the lesion depth in comparison to the established reference technique (transverse microradiography [TMR]). Methods: Bovine enamel specimens were demineralized for 5 days, following previous studies. For OCT, the resulting artificial lesions were scanned three-dimensionally (SD-OCT) and semi-automated measured (CarLQuant). For TMR, specimens were sectioned and the lesion depth was manually determined (Inspektor Research System). Results: The range of lesion depth detected with OCT was 24.0–174.0 μm (mouth rinse study), 18.0–178.0 μm (toothpastes study) and with TMR 59.2–198.0 μm (mouth rinse study), 33.2–133.4 μm (toothpastes study). We found a strong correlation between both methods in terms of lesion depth (Spearman rankwith outlierp < 0.001, Rho = 0.75, Spearman rankwithout outlierp = 0.001, Rho = 0.79). The two methods produce similar results (Passing-Bablok regression, 1.16). As deeper is the lesion, the smallest is the difference between both methods as indicated by Bland-Altman-plots. Conclusion: Especially in the case of deep lesions, the values obtained by both methods are in agreement, and OCT can potentially substitute TMR to detect and assess lesion depth with the benefit of being non-destructive.

Remineralization potential of apacider gel on enamel and cementum surrounding margin of ceramic restoration.

Modern management of carious lesions has been targeted upon using remineralizing agents. This study investigated the remineralization potential of apacider gel (AG) and casein phosphopeptide-amorphous calcium fluoride phosphate (CA) on enamel and cementum around the cavosurface area of the ceramic margin. Seventy-five extracted human mandibular molars were sectioned at 0.8 mm above and below the cemento-enamel junction (CEJ) to remove the CEJ portions and replaced them with glass ceramic disks by bonding them to the crown and root portions with resin cement. The enamel and cementum area of 4x4 mm2 surrounding ceramic was demineralized with Carbopol-907. The demineralized surfaces were treated with either AG or CA, while one group was left with no treatment (NT) and served as control. Vickers microhardness was determined before-, after demineralization, and after remineralization. The percentage of hardness recovery (%HR), and remineralization potential (%RP) were analyzed with ANOVA and Bonferroni's test (α=0.05). Polarized light microscopy (PLM) was assessed for lesion depth. Scanning electron microscopy (SEM) was investigated for surface alterations. Significant differences in remineralization were found upon various remineralizing agents compared to NT for both enamel and cementum (p<0.05). No significant difference in %HR and %RP was observed between AG and CA (p>0.05). However, AG signified greater decrease in lesion depth and better improvement in surface characteristics for both enamel and cementum than CA. AG possesses comparable remineralization ability to CA. However, decreasing in carious lesion depth was evinced with using AG more than CA. AG was recommended as a potential remineralization material for handling initial caries for both enamel and cementum. Key words:Apacider, artificial carious lesion, CCP-ACFP, remineralizationCare Team.

Caries preventive efficacy of 2-,3-,4-aminophenylacetic acids hexafluorosilicates

In recent years, ammonium hexafluorosilicates have been actively studied as new potential anti-caries agents, which may compete with traditional fluoride preparations in the future. The pharmacological potential of hexafluorosilicates with substituted phenylammonium cations remains unexplored. The purpose of the work is to study the caries-prophylactic effectiveness of 2-,3-,4-aminophenylacetic acids hexafluorosilicates in the experiment on a model of experimental caries.&#x0D; 2-,3-,4-aminophenylacetic acids hexafluorosilicates (I–III, respectively) were synthesized according to the previously proposed method, reference drugs – NaF and (NH4)2SiF6. The studied drugs were applied to the teeth and gums of rats as part of a gel based on Na-salt of carboxymethylcellulose. The activity of alkaline and acid phosphatases was determined and the mineralization index was calculated in the pulp of incisors. The number and depth of carious lesions of the teeth were calculated and the caries prevention efficiency was calculated. The concentration of calcium ions was determined in the alveolar bone homogenate, the level of malondialdehyde, the activity of elastase, urease, and lysozyme was determined in the mucous membrane of the oral cavity homogenate.&#x0D; It was established that the caries-prophylactic efficiency of NaF, (NH4)2SiF6, I–III is 38.1%, 33.3%, 28.6%, 59.5%, 64.3%, that is, the anti-caries effect of compounds II and III exceeds the similar indicator of NaF by more than 1,6 and 1,7 times, respectively. The results of determining the phosphatases activity in the pulp of incisors showed that I–III almost completely normalize the mineralizing index. Compounds I–III provide an effective reduction of inflammatory markers, and the maximum effect is achieved when using gels with the participation of compounds II and III. The studied fluoropreparations reduce the activity of urease; the effect of all hexafluorosilicates is more effective compared to the reference drug – NaF. All hexafluorosilicates significantly return lysozyme activity to the control level compared to NaF, with compounds II and III being the most effective. Calculations using the PASS online method demonstrate an increased probability of anti-inflammatory (intestinal), anti-infectious, antiviral (influenza), antiseptic activity in the case of 3-,4-aminophenylacetic acids in the composition of salts II and III, which can lead to potentiation of their joint action and strengthening of anti-caries effect of these compounds. It is planned to continue research on the biological activity of 3-,4-aminophenylacetic acids hexafluorosilicates as potential means of caries treatment and prevention.

Selective Removal to Soft Dentine versus Full Pulpotomy for Management of Proximal Deep Carious Lesions: A Randomized Controlled Non-Inferiority Trial

The management of the deep carious lesion with reversible pulpitis is a dilemma for the dentist. The current study compared selective removal to soft dentine (SRSD) and full pulpotomy (FP) for treating proximal deep carious lesions in teeth with reversible pulpitis. Visual-tactile examination and bitewing radiographs were used to determine the depth of carious lesion, and American Association of Endodontists recommendations were used to formulate pulp diagnosis. Sixty mandibular molar teeth from healthy patients between the ages of 16–35 years and a diagnosis of proximal deep carious lesion with reversible pulpitis were included. Teeth were randomly allocated to two study groups. SRSD group (n = 30): soft dentine was preserved over the pulpal aspect. A hard-setting calcium hydroxide cement liner and resin-modified glass ionomer cement base were applied over the remaining soft carious dentine. FP group (n = 30): complete caries removal followed by mineral trioxide aggregate FP was performed. The teeth in both groups were restored with composite resin restoration. The established criteria for outcome assessment of SRSD and pulpotomy were used. Accordingly, only asymptomatic teeth with no radiological evidence of periapical rarefaction were considered successful at the 12-month follow-up. Two-sample t test, Pearson χ² test/Fisher’s exact test, and percentage agreement were used for statistical evaluation. According to the per-protocol analysis, the success rate of both SRSD and FP treatment was 95.45% and 95.65%, respectively, and the actual difference between the two treatments was 1% (95% CI: [−10, 9]). The data suggests that both treatments (SRSD and FP) appear to have a good success rate (>95%) when used to manage permanent mandibular molar teeth with proximal deep carious lesion and reversible pulpitis. As SRSD is a noninvasive procedure, it should be favored over FP in these instances.

Remineralization potential of apacider mangosteen adhesive pastes on artificial carious lesions

Background/purposeAttention to caries administration has altered toward an early finding of lesions and targeted to noninvasive management with a remineralizing agent. This study compared the remineralization potential of apacider mangosteen adhesive pastes (AMAP), 500-ppm fluoride toothpaste (FT500), and 1000-ppm fluoride toothpaste (FT1000) on artificial caries. Materials and methodsArtificial caries were generated to enamel of eighty extracted human premolars. The specimens were allocated to four groups and subjected to pH-cycling with the application of testing agents (2 min each, for 10 days): (1) AMAP, dairy, (2) FT500, twice a day, (3) FT1000, twice a day, and (4) no treatment (NT). The surface microhardness was determined before demineralization, after demineralization, and after application of pH-cycling. The hardness, percent of hardness recovery (%HR), and percent of remineralization potential (%RP) were analyzed with ANOVA and Bonferroni's test (α = 0.05). Polarized light microscopy (PLM) was assessed for lesion depth. ResultsSignificant differences in remineralization were observed upon various agents compared to NT (P < 0.05). A significant difference in remineralization was found among AMAP, FT1000, and FT500 (P < 0.05). No significant difference in %HR and %RP was observed between AMAP and FT1000 (P > 0.05). PLM signified greater decrease in depth for AMAP, compared to FT1000 and FT500, but no depth reduction for NT. ConclusionAMAP possesses comparable remineralization ability to FT1000. However, decreasing in depth of carious lesions was evinced with using AMAP more than FT1000 and FT500. AMAP was recommended as a potential remineralization material for handling initial caries.

The Influence of Carious Lesion and Bleeding Time on the Success of Partial Pulpotomy in Permanent Molars with Irreversible Pulpitis: A Prospective Study.

This prospective study aimed to evaluate the success rate of partial pulpotomy using mineral trioxide aggregate (MTA), in permanent molars with symptomatic irreversible pulpitis. Moreover, this study aimed to investigate the effect of carious lesion depth and activity and bleeding time on the outcome of partial pulpotomy. Forty permanent molars with deep and extremely deep carious lesions clinically diagnosed with symptomatic irreversible pulpitis were included. The status of the carious lesion was evaluated clinically and radiographically to determine its activity (rapidly or slowly progressing) and depth (deep or extremely deep). A partial pulpotomy was performed and MTA was used. Clinical and radiographic analysis were performed at 3, 6 and 12 months. Chi-square analysis and Fisher's exact test were used. Scanning electron microscope and energy dispersive X-rays were used to investigate the crystalline structures and their chemical composition onto MTA surfaces after immersion in several conditions. The partial pulpotomy was 88.9% successful, with no significant difference in outcome between deep and extremely deep carious lesions (p = 0.22) or between rapidly and slowly progressing lesions (p = 0.18). Nevertheless, all failed cases were associated with rapidly progressing lesions and extremely deep lesions. All failures occurred when the bleeding time was more than 3 min (p = 0.10). Different crystalline structures were detected on MTA surfaces, with higher calcium percentages in PBS conditions. Within the limitations of the present study, favorable results demonstrated that MTA might be recommended as a suitable agent for partial pulpotomy in permanent molars with irreversible pulpitis. The depth and activity of the carious lesion as well as the bleeding time are important factors in the success of partial pulpotomy treatment. The prolonged bleeding time and the extremely deep rapidly progressing caries could be related with the failure cases in partial pulpotomy treatment of irreversible pulpitis.

A STUDY OF THE INFLUENCE OF JUVENILE ADJUVANT ARTHRITIS ON DENTAL HARD TISSUES CONDITION IN EXPERIMENTAL ANIMALS.

The aim: To study the intensity and depth of carious tooth lesions in rats with experimental juvenile adjuvant-induced arthritis. Materials and methods: An experimental study on a model of juvenile adjuvant arthritis (JAA) in 10 one-month-old rats induced by method of A.M. Bendele was carried out. 10 rats of the same age were intact. Injection of adjutant in rats of experimental group led to the development of acute local reaction and then caused generalized joint reaction of autoimmune origin. The performed basic therapy of JAA promoted transition of acute autoimmune process to chronic. Rats were withdrawn from the experiment in 58 days and the dental-jaw blocks were made, in which the intensity and depth of carious lesions of the masticatory group of teeth were determined. Results: The course of JAA was accompanied by the development of dental caries in 100% of experimental animals. It was found that the intensity of carious teeth lesions in terms of the number of carious teeth and cavities is probably higher than in intact rats (respectively 4.3 ± 0.3 vs. 2.2 ± 0.6 and 4.5 ± 0.3 vs. 2.3 ± 0.7, p <0.001). In rats with JAA, mostly middle and deep carious cavities were revealed, at the same time in intact rats - superficial and middle carious cavities were observed. Conclusions: It has been established that adjuvant arthritis is accompanied by 100% prevalence of dental caries, high intensity of carious process, presence of middle and deep carious cavities, that confirm the negative influence of autoimmune disease on the condition of the hard tooth tissues.

A comparative study of two chemical models for creating subsurface caries lesions on aprismatic and prismatic enamel.

To investigate the mineral density and lesion depth of artificial caries lesions on aprismatic enamel and prismatic enamel created by lactic acid and acetic acid buffers. Forty bovine enamel blocks were allocated to: aprismatic enamel (Group A) and prismatic enamel (Group C) in acetic acid buffer for 192 h and aprismatic enamel (Group B) and prismatic enamel (Group D) in lactic acid buffer for 96 h. The mineral loss and lesion depth were measured using micro-computed tomography. A significant difference (P = 0.01) was observed in the mineral loss (%) in the lesions on aprismatic enamel and prismatic enamel treated with lactic acid buffer while no significant difference (P = 0.51) was observed in the mineral loss (%) in the lesions on aprismatic enamel and prismatic enamel treated with acetic acid buffer. No significant difference was noted in the mean lesion depth of lesions on aprismatic enamel and prismatic enamel treated with acetic acid and lactic acid buffers (P > 0.05). Aprismatic enamel and prismatic enamel have similar mineral loss in acetic acid while prismatic enamel showed more mineral loss compared to aprismatic enamel in lactic acid.

Insights on the role of cytokines in carious lesions

Objectives: The dentin-pulp immune response to caries pathogenesis is still poorly understood due to the complexinterplay of the involving processes. The aim of this review was to explore the role of cytokines and its relevance inthe pathogenesis of dental caries. Results: Dental caries can result in a host inflammatory response in the dentalpulp, characterized by the accumulation of inflammatory cells leading to the release of inflammatory cytokinessuch as Interleukin-4 (IL-4), Interleukin (IL-6), Interleukin-8 (IL-8) and Tumor necrosis factor–a (TNF-a). IL-4seems to be correlated to the depth of carious lesions; IL-6 is strongly correlated to caries disease and is considereda potent biomarker; IL-8 can be a potent biomarker for both caries and other changes present in the pulp and,its release is correlated to TNF-a and IL-6; TNF-a plays an important role not only in caries progression, but alsoin other pathological processes. Conclusion: Specific mediators have a great potential to serve as biomarkersalluding to the presence and progress of caries disease, urging further investigations in the field. KEYWORDSBiomarkers; Cytokines; Dental caries; Dental pulp; Interleukins.

The effect of different doses of octenidine hexafluorosilicate on the development of dental caries in rats

At present, ammonium hexafluorosilicate and hexafluorosilicates of organic amonium cations are actively studied as potential anticaries agents, which demonstrate certain advantages over traditional compounds of fluorine. Previously, it was shown that hexafluorosilicates with bactericidal cations of chlorhexidine, polyhexamethyleneguanidine and cetylpyridinium effectively reduce the number and depth of carious lesions of teeth in rats and at the same time significantly improve the biochemical parameters of the pulp of the teeth.&#x0D; The aim of the work – to study the effect of different doses of octenidine hexafluorosilicate (OHFS) on the incidence of dental caries in rats fed a cariogenic diet (CD).&#x0D; OHFC preparations were applied to the teeth and gums of rats in the composition of phytogels based on Na-salt of carboxymethylcellulose. In the incisor pulp, the activity of alkaline (ALP) and acidic (ACP) phosphatases, elastase, lysozyme was determined, and the mineralizing index (MI) was calculated. The number and depth of dental caries lesions were calculated and caries prophylactic efficacy (CPE) was calculated. The activity of elastase, catalase, lysozyme and urease was determined in the gums, and the degree of atrophy of the alveolar process was determined.&#x0D; Determination of dental caries lesions shows that CD does not increase the number of carious lesions, and after the application of gels with OHFS, their number significantly decreases. The most effective was the concentration of the OHFS gel, equal to 2 mg/ml, although the concentration of the OHFS gel 1 mg/ml showed a decrease by 33.3%. The calculated CPE is 33.3% for a gel with 1 mg/ml OHFS, 36.4% for a gel with 2 mg/ml and 24.2% for a gel with 4 mg/ml. It has been shown that in rats receiving CD, the ALP activity significantly decreases and the ACP activity significantly increases, which gives a significant decrease in MI from 43.9 to 28.9. Application of gels with OHFS returns the activity of both phosphatases to the control level and almost completely normalizes MI, and the concentration of OHFS gel of 2 mg/ml turned out to be the most effective. Application of gels with 1 mg/ml and 2 mg/ml OHFS reduced elastase activity by 6% and 12%, respectively, whereas application of a gel with 4 mg/ml OHFS did not result in a decrease in elastase activity. From the results of determining the degree of dysbiosis in the blood serum of rats, it can be seen that CD causes the development of generalized dysbiosis. Application of gels with OHFS significantly reduce the degree of dysbiosis, especially gels with OHFS concentrations of 1 and 2 mg/ml.&#x0D; Oral application of gels containing OHFS reduces the incidence of caries on the teeth, increases the mineralizing activity of the pulp and reduces the degree of generalized dysbiosis. The most effective concentration of the OHFS gel is 2 mg/ml, which corresponds to a dose of 2.2 mg/kg.

ASSESSMENT OF DENTAL CARIOUS LESIONS BY ICDAS II

Introduction. The largest amount of information about the dental caries is provided by the International Caries Detection and Assessment II system (ICDAS II), which is known as evidence-based approach to clinical visual detection of dental caries and enables to detect the stage and depth of carious lesions from the slightest changes in dental enamel to visible cavities affecting dentin. This system has been developed by the group of leading experts in the field of cariology. The results obtained by determining the ICDAS II index contribute to making right clinical decision in the choice of prevention and treatment methods, as well as to predicting the carious progression. The aim of the study is to assess the prevalence and intensity of initial dental caries in people using the ICDAS II index. Materials and methods. A total of 32 patients aged 12 to 25 years were examined. During the dental examination, we assessed the prevalence of dental caries using the ICDAS II. Clinical findings were recorded in oral follow-up charts proposed by the ICDAS Foundation for Epidemiological Studies, which allow us to record dental hard tissue status using six codes: three for assessing carious changes in enamel and three for assessing carious changes in dentine in a sequence of growing severity. Statistical processing of the findings was performed using Student's t-test. Results. Carious lesions were detected in all study participants, their total number was 285, of which 140 (49.1%) had the code 1 and 145 (50.8%) had the code 2 according to the ICDAS II. On average, each of the participants had 9.28 ± 0.67 foci of enamel demineralization. The average number of lesions with codes 1 and 2 by the ICDAS II was respectively 4.54 ± 0.51 and 4.74 ± 0.38 (p&gt; 0.05). The average intensity of dental caries increased with age from 8.29 ± 0.83 in 12-15 year old individuals to 9.39 ± 1.20 in 18-25 year old individuals (p&gt; 0.05), mainly by the growth of the average number of the mean number of caries lesions with the code 1 according to the ICDAS II. Mostly carious lesions are found on the masticatory surfaces, their total number made up 159 (55.7%). 101 (35.4%) caries lesions were found on the vestibular and oral parts of the tooth surfaces, and 25 (8.9%) average lesions were detected on the proximal surfaces. The average intensity of caries detected on the chewing surfaces of the teeth was 5.15 ± 0.49 and was significantly higher than on the vestibular and oral (3.33 ± 0.57, p &lt;0.05) and proximal (0.79 ± 0, 20, p &lt;0.001) surfaces. Conclusion. The obtained results showed a high intensity of carious lesions, with their predominance in the active stages in the two age groups under the study. This proves the appropriateness of using diagnostic ICDAS criteria for early detection of initial caries and its proper treatment.

Effect of S. mutans combinations with bifidobacteria/lactobacilli on biofilm and enamel demineralization.

The present study evaluated the ability of Bifidobacterium and Lactobacillus species associated with streptococci to increase insoluble extracellular polysaccharide (EPS) production and initial caries lesion progression. Bovine enamel blocks (n = 190; 4 mm x 4 mm) were prepared, selected according to initial surface hardness (SH), and divided into two groups: a) double combinations: S. mutans with Bifidobacterium or Lactobacillus, and b) triple combinations: S. mutans and S. sobrinus with Bifidobacterium or Lactobacillus species. The blocks were exposed to the bacterial associations for 7 days. Subsequently, quantity of EPS from biofilms and caries lesion depth were determined by means of colorimetric and cross-sectional enamel hardness (ΔKHN) analysis. The data were submitted to one-way analysis of variance, followed by the Bonferroni test (p < 0.05). S. mutans with B. animalis or B. dentium produced a higher quantity of EPS; S. mutans + B. animalis led to the highest ∆KHN. S. mutans + S. sobrinus + B. longum induced greater EPS and ∆KHN values. In conclusion, associations of B. animalis and B. longum with streptococci promoted EPS production and caries lesion progression.

Pulp survival after composite resin restoration of caries lesions in adults.

Minimal intervention is generally achieved by using direct composite resin (CR) restorations. However, deep caries lesions may lead to pulpal complications. This study evaluated the risk of endodontic complications after CR restoration in relation to depth of caries lesions. Data on 507 teeth from 316 adults treated with CR were analyzed. Caries depth was expressed as a percentage of the distance between the outer edge of the dental enamel and the pulp base on preoperative radiographs. The interval between CR restoration and follow-up root canal treatment was obtained from electronic treatment records for a period of 24 months. A Cox proportional hazards model was used to investigate the association between risk of endodontic complications and caries depth. Sixteen teeth (3.2%) required root canal treatment within 24 months. No root canal treatment was required after CR treatment for caries affecting <50% of the outer edge of enamel and pulp. As compared with CR treatment of caries lesions with a size of <80%, there was a significantly higher risk of root canal treatment for caries lesions with a size of 80% to 89% (hazard ratio, [95% CI]: 34.68 [4.23-284.11]) and ≥90% (92.01 [10.36-817.41], respectively).

Accuracy of in vitro radiographs in determining the remaining dentin thickness below deep dentin caries in deciduous molars

Background/Aim: The determination of remaining dentin thickness (RDT) is quite critical in providing appropriate treatment indications especially in deciduous molars. The aim of this study was to investigate the accuracy of in vitro pre-operative radiographs before caries removal in RDT measurement. Material and Methods: This in vitro study was conducted with 30 lower deciduous second molars with deep approximal dentinal caries. Following the standardized digital radiographs were obtained, RDT was measured by determining the closest distance between the carious lesion and the pulp chamber on the computer software. After caries removal, the samples were sectioned in mesio-distal direction and photographed. RDT was measured on photographs similarly to radiographic measurements. In statistical analysis, Interclass Correlation Coefficient (ICC), Wilcoxon-Signed and Bland Altman Plot (BAP) tests were performed to determine the agreement and statistically difference. Results: The mean RDT value in photographs was found to be 10% higher than measured on radiographs. Although, correlation coefficient was within confidence interval, both RDT values showed good but not excellent agreement (correlation coefficient= 0.812). Also, BAP test did not demonstrate strong agreement. In descriptive statistics, significant difference was found between two measurements (p&lt;0.05). Conclusions: Pre-operative radiological examination can not alone provide reliable results regarding the accurate determination depth of caries lesions. Clinicians should also consider operative diagnostic criteria for appropriate treatment options in deciduous teeth.

Detection of Approximal Caries Lesions in Adults: A Cross-sectional Study.

Detection and management of posterior approximal caries lesions are still problematic. Inspection of approximal surfaces is challenging, and bitewing radiographs are used when direct vision is not possible. Unfortunately, there is no definite radiographic appearance to identify lesion cavitation with absolute certainty. Many lesions detected radiographically within the outer half of dentin are not cavitated, often resulting in unnecessary restorative treatment. Our study compared radiographic depth of approximal caries lesions with presence of cavitation in adults using visual inspection following temporary tooth separation (TTS). We conducted this observational descriptive cross-sectional study at two dental schools in two cities in Chile. Clinicians were unaware of radiographic depths of lesions and examined 147 participants (57.3% female and 42.7% male) following TTS. Using the common classification system that consists of E0 (no lesion), E1 (lesion within the outer half of enamel), E2 (lesion within the inner half of enamel), D1 (lesion within the outer third of dentin), D2 (lesion within the middle third of dentin), and D3 (lesion within the inner third of dentin), a trained dentist evaluated all the processed films. Cavitation was detected in only three sites (0.22%) within the E0 category, seven sites (3.41%) in E1, five sites (14.8%) in E2, four sites (14.8%) in D1, six sites (50%) in D2, and eight sites (61.5%) in D3. Considering that restorative treatment should be indicated strictly for cavitated lesions, our findings support indication for restorative treatment for D3 lesions and the rationale for TTS for D1-D2 caries lesions to allow direct visual inspection to determine whether there is surface cavitation.

Cariesprophylactic and periodontoprotective action of octenidine hexafluorosilicate in rats obtained with cariesogenic ration

In recent years, ammonium hexafluorosilicate and hexafluorosilicates of organic amonium cations are actively studied, which demonstrate certain advantages over traditional compounds of fluorine. Previously, it was shown that hexafluorosilicates with bactericidal cations of chlorhexidine, polyhexamethyleneguanidine and cetylpyridinium effectively reduce the number and depth of carious lesions of teeth in rats and at the same time significantly improve the biochemical parameters of the pulp of the teeth.&#x0D; The aim of the work – study of the cariesprophylactic and periodontoprotective effectiveness of octenidine hexafluorosilicate.&#x0D; The investigated preparations were applied to the teeth and gums of rats in the composition of phyto-gels based on Na-salt of carboxymethylcellulose. In the slurry of the incisors, the activity of alkaline (ALP) and acidic (ACP) phosphatases, elastase, lysozyme was determined and the mineralizing index (MI) was calculated. The number and depth of carious lesions of the teeth were counted and caries of prophylactic efficacy (CPE) were calculated. In the gums, the level of malonic dialdehyde (MDA), activity of elastase, catalase, lysozyme and urease was determined. The degree of dysbiosis and the antioxidant-prooxidant index of the API were calculated. The degree of atrophy of the alveolar process was determined and the periodontitis protective efficiency (PPE) was calculated.&#x0D; The effect of octenidine hexafluorosilicate on the damage to the caries of the teeth of rats receiving CGR was shown. It has been shown that octenidine hexafluorosilicate has caries prophylactic action, as evidenced by its stronger anti-carious effect in comparison with NaF. The results of the determination of the depth of carious lesions in the slurry of the incisors and the activity of phosphatase showed that octenidine hexafluorosilicate significantly increases the activity of ALP and ACP but has no effect on the mineralizing index of MI. Octenidine hexafluorosilicate significantly increases the activity of elastase in the pulp and reduces the activity of lysozyme. CPE of octenidine hexafluorosilicate is higher than that of NaF by more than 1.7 times. In the gingival rats of octenidine hexafluorosilicate causes a significant decrease in the marker of inflammation – elastase. The degree of dysbiosis in the gums of rats receiving CGR increases by 1.73 times and decreases to practically intact rats after octenidine hexafluorosilicate gel applications and vice versa, catalase activity and API index significantly decrease in CGR, and when gel application is increased to intact rats. It is shown that the sucrose diet significantly increases the degree of atrophy (by 31%), and octenidine hexafluorosilicate reduces the degree of atrophy by 17%. It has been established that octenidine hexafluorosilicate has a significant (54.7%) PPE.&#x0D; The results of studying the properties of octenidine hexafluorosilicate indicate its rather high cariesprophylactic efficacy and periodontal protective effect, which makes it possible to treat it as a potential treatment and prevention of caries and periodontal diseases.

Correlation of Visual and Radiographic Caries Diagnosis using the ICDAS in Permanent Molars of a Group of Egyptian Children

ICDAS (International Caries Detection and Assessment System) is an evidence-based detection and assessment system classifying stages of the caries process on the basis of histological extent and activity. The ICDAS measures the visual surface changes which corresponds to the potential histological depth of carious lesions. In addition, it proposes the ICDAS radiographic scoring system, which categorizes lesions according to the depth of caries demineralization into enamel and dentin represented by a radiolucency on the radiographs. In this study, the aim was to assess the relationship between clinical and radiographic caries diagnoses among 12 to 14-year-old Egyptians using the ICDAS scoring system which differentiates between cavitated and non-cavitated caries lesions.

Assessment of the Depth of Clinically Detected Approximal Caries Lesions Using Digital Imaging Fiber-Optic Transillumination in Comparison to Periapical Radiographs.

ABSTRACTObjectivesThe aim of present prospective clinical trial was to assess the depth of clinically detected approximal caries lesions using digital imaging fiber-optic transillumination in comparison to periapical radiographs.Material and MethodsOne calibrated examiner diagnosed 31 approximal carious lesions in 10 patients with a mean age of 21.8 (SD 1.1) years. The lesions were assessed using digital imaging fiber-optic transillumination (DIFOTI) and digital periapical radiographs (PA). Depending on the depth of the lesions, scores for demineralisation in PA (R) and DIFOTI (F) images were given by two examiners: R0/F0 - no demineralisation, R1/F1 - demineralisation confined to the outer half of the enamel, R2/F2 - into the inner half of the enamel, 3/3 - along the amelodentinal junction, R3/F3 - into the outer half of dentine, R4/F4 - into the inner part of the dentine. Spearman’s rank correlation coefficient and kappa were calculated.ResultsSpearman’s rank correlation coefficient between DIFOTI and PA was 0.031 (P > 0.05), kappa was 0.077. In 26% of the cases, DIFOTI showed higher scores of demineralisation, relative to PA. In 36% of the cases, PA showed higher scores of demineralisation than DIFOTI. PA showed demineralisation into the outer and inner half of the dentine in 89% of the cases with underlying shadow and in 70% of the cases with opacities.ConclusionsDigital imaging fibre optic transillumination and periapical radiographs produce evaluations of the depth of approximal caries lesions that do not match.

Ammonium hexafluorosilicates: a new type of anti-caries agents

It is known that dental caries is one of the most common diseases; for children, this pathology ranks first among chronic diseases and has the character of a pandemic. In the modern arsenal of means for the treatment and prevention of caries, fluoride preparations – sodium, potassium fluoride, tin difluoride, sodium monofluoridephosphate, diammine silver fluoride – occupy the leading positions. In recent decades, ammonium hexafluorosilicate and hexafluorosilicates of organic ammonium cations, which have certain advantages over traditional fluoride preparations, have been actively studied as promising anti-caries and hypo-sensitive agents.&#x0D; The aim of this review is to systematize and analyze literature data, reflecting existing experience in the field of synthesis methods, studying the structure, physicochemical properties and biological activity of ammonium hexafluorosilicates as potential anti-caries agents.&#x0D; The general method for the synthesis of ammonium hexafluorosilicates is the interaction of the corresponding base, or its salt, in methanol, ethanol or another solvent with stoichiometric or excess amount of hydrofluoric acid. The structure of ammonium hexafluorosilicates, which are typical supramolecular compounds, is described. Using the example of pyridinium hexafluorosilicates, the relationship between water solubility and structural characteristics of salts was demonstrated. Identification methods have been proposed for the combination of cetylpyridinium hexafluorosilicate. The results of determination of acute toxicity for a number of hexafluorosilicates in animal experiments are given. Studies of the antibacterial activity of hexafluorosilicates are described. It is shown that hexafluorosilicates significantly reduce the number of carious lesions and their depth, and significantly exceed sodium fluoride in all indicators. The feasibility of their use for the prevention of periodontitis is demonstrated. A technological scheme for obtaining a gel containing cetylpyridinium hexafluoro silicate has been proposed.&#x0D; General methods for the synthesis of ammonium hexafluorosilicates include the interaction of an organic base or the corresponding hydrochloride in a solvent medium with an excess of hydrofluoric acid silica. In the crystal structures of hexafluorosilicates, hydrogen bond systems with the participation of fluorine ligands and H-donor fragments of cations perform the main structure-forming and stabilizing function. The solubility of hexafluorosilicates in water varies widely, which is determined by the nature of the ammonium cation and, in the case of pyridinium salts, is antibatically correlated with the number of strong and medium H-bonds in the salt structure. The degree of hydrolysis of hexafluoro silicates in 1×10–4 М aqueous solutions is high and in some cases reaches practically quantitative values. The results of the determination of the acute toxicity of ammonium hexafluorosilicates make it possible to classify these compounds as moderately toxic substances. All studied ammonium hexafluorosilicates exhibit high caries preventive activity, significantly reducing the number and depth of carious lesions, while simultaneously significantly improving the biochemical parameters of dental pulp and periodontal bone tissue. Ammonium hexafluorosilicates can be used as new effective anti-caries and hypo-sensitive agents.