Non-cavitated Occlusal Caries Lesions Research Articles

Occlusal Caries Detection and Diagnosis Using Visual ICDAS Criteria, Laser Fluorescence Measurements, and Near-Infrared Light Transillumination Images

Objective: Current diagnostic tools for non-cavitated occlusal caries are not very reliable. For this reason, newer systems need to be developed. The aim of this study was to compare the performance of visual inspection (ICDAS-II), laser fluorescence (DIAGNOdent pen), and the near-infrared transillumination technique (DIAGNOcam) in the detection of non-cavitated occlusal caries lesions under clinical and laboratory conditions in 90 third molar teeth planned for extraction. Materials and Methods:Ninety third molar teeth were firstly examined in clinical conditions, scored according to ICDAS-II criteria, and examined with DIAGNOdent pen and DIAGNOcam devices. After finishing the clinical examination, the teeth were re-evaluated shortly after the extractions with the same methods. Then, the teeth were sectioned for histological validation according to Downer’s criteria. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic (ROC) curves were calculated based on the histological results. Results: For the D₀–D_1–4 threshold, the area under the ROC curve values ranged between 0.754 and 0.881 for all systems. Sensitivity values ranged between 80.5 and 96.1%, and specificity values ranged between 61.5 and 84.6% for the three caries detection methods. DIAGNOcam had the best correlation value (0.616) according to histological observations and demonstrated a sensitivity rate of 96.1%, a specificity rate of 61.5%, and an accuracy rate of 91.1%. Conclusions: DIAGNOcam was found to be the most effective method for the diagnosis of occlusal caries without cavitation in permanent molar teeth.

Barriers to sealant guideline implementation within a multi-site managed care dental practice

BackgroundThe purpose of this study was to identify barriers frequently endorsed by dentists in a large, multi-site dental practice to implementing the American Dental Association’s recommendation for sealing noncavitated occlusal carious lesions as established in their 2016 pit-and-fissure sealant clinical practice guideline. Although previous research has identified barriers to using sealants perceived by dentists in private practice, barriers frequently endorsed by dentists in large, multi-site dental practices have yet to be identified. Identifying barriers for these dentists is important, because it is expected that in the future, the multi-site group practice configuration will comprise more dental practices.MethodsWe anonymously surveyed the 110 general and pediatric dentists at a multi-site dental practice in the U.S. The survey assessed potential barriers in three domains: practice environment, prevailing opinion, and knowledge and attitudes. Results were summarized using descriptive statistics.ResultsThe response rate to the survey was 62%. The principal barrier characterizing the practice environment was concern regarding liability; endorsed by 33% of the dentists. Many barriers of prevailing opinion were frequently endorsed. These included misunderstanding the standard of practice (59%), being unaware of the expectations of opinion leaders (56%) including being unaware of the guideline itself (67%), and being unaware of what is currently being taught in dental schools (58%). Finally, barriers of knowledge and attitudes were frequently endorsed. These included having suboptimal skill in applying sealants (23% - 47%) and lacking knowledge regarding the relative efficacy of the different ways to manage noncavitated occlusal carious lesions (50%).ConclusionsWe identified barriers frequently endorsed by dentists in a large, multi-site dental practice relating to the practice environment, prevailing opinion, and knowledge and attitudes. All the barriers we identified have the potential to be addressed by implementation strategies. Future studies should devise and test implementation strategies to target these barriers.

Impact of Magnifying Loupes on Interexaminer Agreement in the Detection of Noncavitated Occlusal Carious Lesions.

This study aimed to assess the impact of using magnifying loupes on interexaminer agreement in the detection of noncavitated occlusal carious lesions. A total of 155 permanent molars with no frank cavitation were selected for the study. Five examiners with different specialties and experience each examined the occlusal surfaces twice using International Caries Assessment and Detection System (ICDAS) criteria. The first examination used no magnification. The second examination, performed 4 weeks after the first, used 2.5X magnifying loupes. Later, the teeth were sectioned and inspected for caries using a stereomicroscope. The data were analysed using statistical analysis software to calculate intra-examiner reproducibility and interexaminer agreement as well as univariate marginal distribution and marginal homogeneity maximum Kappa (Kmax) statistics with and without the loupes. The Kmax scores for 4 of the 5 examiners showed bias compared to the histological results, with a greater likelihood of diagnosing a tooth as sound in the presence of caries (Kmax 0.26-0.73 and 0.19-0.65 with and without the loupes, respectively). For intra-examiner reproducibility, the linear weighted kappa ranged from (0.34-0.65) . Interexaminer agreement was poor both with and without the loupes. The use of magnifying loupes did not improve interexaminer agreement in ICDAS scores for noncavitated occlusal carious lesions.

Resin infiltration of deproteinised natural occlusal subsurface lesions improves initial quality of fissure sealing

The aim of this ex vivo study was to evaluate the infiltration capability and rate of microleakage of a low-viscous resin infiltrant combined with a flowable composite resin (RI/CR) when used with deproteinised and etched occlusal subsurface lesions (International Caries Detection and Assessment System code 2). This combined treatment procedure was compared with the exclusive use of flowable composite resin (CR) for fissure sealing. Twenty premolars and 20 molars revealing non-cavitated occlusal carious lesions were randomly divided into two groups and were meticulously cleaned and deproteinised using NaOCl (2%). After etching with HCl (15%), 10 premolar and 10 molar lesions were infiltrated (Icon/DMG; rhodamine B isothiocyanate (RITC)-labelled) followed by fissure sealing (G-ænial Flo/GC; experimental group, RI/CR). In the control group (CR), the carious fissures were only sealed. Specimens were cut perpendicular to the occlusal surface and through the area of the highest demineralisation (DIAGNOdent pen, KaVo). Using confocal laser-scanning microscopy, the specimens were assessed with regard to the percentage of caries infiltration, marginal adaption and internal integrity. Within the CR group, the carious lesions were not infiltrated. Both premolar (57.9%±23.1%) and molar lesions (35.3%±22.1%) of the RI/CR group were uniformly infiltrated to a substantial extent, albeit with significant differences (P=0.034). Moreover, microleakage (n=1) and the occurrence of voids (n=2) were reduced in the RI/CR group compared with the CR group (5 and 17 specimens, respectively). The RI/CR approach increases the initial quality of fissure sealing and is recommended for the clinical control of occlusal caries.

OCT assessment of non-cavitated occlusal carious lesions by variation of incidence angle of probe light and refractive index matching

ObjectivesThis study evaluated (1) the detection and assessment of non-cavitated occlusal carious lesions by spectral domain optical coherence tomography (SD-OCT) and (2) the impact of varying angle of incidence (AI) of probe light and refractive index matching (RIM). MethodsNine extracted human molars with 18 occlusal lesions (ICDAS code 2) were visually selected. 18 regions of interest (ROI) were imaged with SD-OCT under varying AI (0°, ±5°, ±10°, ±15°) and with/without application of glycerine at 0°. X-ray micro computed tomography (μCT) was used as a validation standard. μCT and OCT signals were categorized according to the lesion extent: 1-sound, 2-lesion limited to half of enamel, 3-lesion limited to enamel, 4-lesion into dentin. Agreement between both methods was assessed. Intra- and inter-examiner reproducibility analyses were conducted. Statistics: Cohen’s kappa coefficient (κ), Spearman’s rho correlation (rs) and Wilcoxon test (α=0.05). ResultsSlight to moderate agreement (κ=0.153) between μCT and OCT was obtained at an AI of 0° (Wilcoxon: p=0.02). With variation of Al a substantial agreement (κ=0.607) was observed (p=0.74). Spearman’s correlation between both methods was 0.428 at 0°, 0.75 with varying AI and 0.573 with glycerine. Kappa values for intra-and inter-examiner analysis ranged between 0.81 and 0.88 and between 0.25 and 0.73, respectively. ConclusionVariation of AI improves the detectability of non-cavitated occlusal carious lesions. RIM can enhance signal-to-noise ratio. Clinical relevanceOCT could provide additional diagnostic information in single and longitudinal assessments of occlusal carious lesions.

Effect of a resin-based and a glass-ionomer sealant on the treatment of noncavitated occlusal caries lesions in teenagers

Abstract Objectives: The aim of the study was to use clinical outcomes and digital radiographs to compare the effects of two types of sealant materials on the treatment of noncavitated occlusal caries lesions regarding their progression or arrest in teenage permanent molars. Methods: The sample consisted of 28 teeth from 20 patients aged 11-15 years with random distribution to receive either a resin-based sealant (Fluroshield ®, Dentsply, Philadelphia, PA, USA; Gres group) or a glass-ionomer sealant (RIVA Protect ®, SDI, São Paulo, Brazil; Ggis group). Caries progression was monitored by clinical evaluation and radiographic examination. Clinical outcomes were analyzed using the Mann-Whitney and Fisher′s exact test, and radiographic data were analyzed by Student′s t-test for paired data (P ≤ 0.05). Results: There were no significant differences between the clinical outcomes of both groups regarding the sealant retention, thermal sensitivity, and development of new caries lesions adjacent to the sealed surface. There was an increase in the radiographic density coefficient (carious dentin density/sound dentin density) at the end of the study for the Gres group (P = 0.003), but the coefficient for the Ggis group was similar for both time points (P = 0.49). Conclusions: Radiographic features showed an increase in the mineralization of the caries lesions when the teeth were sealed with a resin-based sealant; however, both techniques may be considered an adequate clinical approach for controlling the progression of the lesions.

The influence of film type and processing method on radiographic density for occlusal caries diagnosis

Objectives: This study aimed to investigate the influence of the radiographic processing method on the radiographic density of two types of film. Radiographs from non-cavitated occlusal caries lesions obtained in a previous study were used. Methods: We analyzed 28 films from 12 patients that were obtained with the same X-ray device. Seven Ektaspeed (Kodak Eastman Kodak Co, Rochester, NY, USA) and seven Ultraspeed (Kodak Eastman Kodak Co) films were manually processed, while seven Ektaspeed and seven Ultraspeed films were automatically processed. The angle of incidence of the X-ray beam and the distances between the apparatus, the tooth and the film were standardized. Therefore, the study comprised four groups: GE1: Ektaspeed manually processed; GE2: Ektaspeed automatically processed; GU1: Ultraspeed manually processed; and GU2: Ultraspeed automatically processed. The images were digitized (G40450 Scan Jet C/T, Hewlett-Packard) and analyzed using Digora for Windows 2.7 (Soredex Medical Systems) to obtain the average radiographic density, and the data were analyzed using the Student’s t test for paired data (Bioestat 5.3). Results: Only the Ektaspeed film showed statistically significant differences between radiographic densities with different processing methods (p = 0.0037). Conclusions: The Ektaspeed film automatic pocessed is better suited for the early diagnosis of caries lesions.

Association between two visual criteria in assessing non-cavitated caries lesion activity on occlusal surfaces of permanent molars.

This study aimed to evaluate the association between two visual criteria in assessing non-cavitated caries lesion activity on occlusal surfaces of permanent molars. Thirty-nine patients with at least one permanent molar with non-cavitated caries lesion on the occlusal surface were selected. Molars were assessed according to their activity status following two criteria: ICDAS-LAA and a qualitative criterion based on clinical characteristics. The results showed that the LAA criterion seems to overestimate caries activity. A weak association between both criteria in assessing caries lesion activity and low specificity for ICDAS-LAA was observed. The ICDAS-LAA criterion is not suitable to assess non-cavitated caries lesion activity on occlusal surfaces of permanent molars because it assesses the lesions to be active more frequently than the qualitative criterion. The determination of caries lesion activity is a key decision point in the treatment of caries disease. This study discusses the best option to assess the activity of non-cavitated occlusal caries lesions.

Diagnostic Accuracy of Cone Beam Computed Tomography Compared with Intraoral Radiography for the Detection of Noncavitated Occlusal Carious Lesions

The aim of this study was to evaluate the accuracy of cone beam computed tomography (CBCT) in the detection of noncavitated occlusal caries lesions and to compare this accuracy with that observed with conventional radiographs. 135 human teeth, 67 premolars and 68 molars with macroscopically intact occlusal surfaces, were examined by two independent observers using the CBCT system: NewTom 3G (Quantitative Radiology) and intraoral conventional film (Kodak Insight). The true lesion diagnosis was established by histological examination. The detection methods were compared by means of sensitivity, specificity, predictive values and accuracy. To assess intra- and interobserver agreement, weighted kappa coefficients were computed. Analyses were performed separately for caries reaching into dentin and for all noncavitated lesions. For the detection of occlusal lesions extending into dentin, sensitivity values were lower for film (0.45) when compared with CBCT (0.51), but the differences were not statistically significant (p > 0.19). For all occlusal lesions sensitivity values were 0.32 and 0.22, respectively, for CBCT and film. The specificity scores were high for both modalities. Interobserver agreement amounted to 0.93 for the CBCT system and to 0.87 for film. It was concluded that the use of the 9-inch field of view NewTom CBCT unit for the diagnosis of noncavitated occlusal caries cannot be recommended.

Systematic review of noninvasive treatments to arrest dentin non-cavitated caries lesions.

To systematically review the literature on the efficacy of noninvasive methods of arresting the progression of non-cavitated occlusal carious lesions in dentin. The Medline/PubMed, LILACS, SciELO and Scopus databases were searched to identify relevant publications through to November 2013. Only clinical trials evaluating the ability of noninvasive methods to arrest the progression of occlusal non-cavitated carious lesions in dentin were included. Screening, data extraction and quality assessment were conducted independently and in duplicate. Of 167 citations identified, nine full text articles were screened and five were included in the analysis. All papers reported on occlusal fissure sealing using a self-curing glass ionomer (n = 1) or resin-based (n = 4) sealant. Only the use of resin-based sealant to obliterate occlusal fissures arrested the progression of non-cavitated occlusal carious lesions in dentin. Occlusal fissure sealing with a resin-based sealant may arrest the progression of non-cavitated occlusal dentinal caries. Further clinical trials with longer follow-up times should be performed to increase scientific evidence.

Progression of non-cavitated lesions in dentin through a nonsurgical approach: a preliminary 12-month clinical observation

Considering the minimally invasive approach to dentistry, the scientific community has focused on non-invasive treatments for caries lesions. The aim of this study was to evaluate the efficacy of a nonsurgical approach to arrest occlusal non-cavitated dentin lesions through glass ionomer sealing. In this controlled clinical trial, 51 teeth with clinically non-cavitated occlusal caries radiographically located beneath the enamel-dentine junction (radiolucent area) were selected among patients presenting a moderate to high risk of caries. The teeth were randomly divided into two groups: an experimental group receiving an application of Vidrion-R (SS White) glass ionomer and a control group not submitted to any clinical intervention. Caries progression was monitored by clinical and radiographic examination at 4-monthly intervals over a period of one year. In addition, marginal integrity of the sealant was evaluated in the experimental group. Clinical examination showed no statistical difference between the groups (P=.13). On the other hand, sealed teeth presented lower caries progression when analyzed by radiographic examination (P=.004). A glass ionomer sealant over non-cavitated occlusal caries lesions in dentin may not be sufficiently effective in arresting their progression.

Assessment of the Ozone-Mediated Killing of Bacteria in Infected Dentine Associated with Non-Cavitated Occlusal Carious Lesions

The ability of ozone to kill micro-organisms associated with non-cavitated occlusal caries was investigated. The occlusal surfaces were treated with ozone (n = 53) or air (n = 49) for 40 s, and the underlying infected dentine was exposed. There was no significant difference between the number of bacteria recovered from the ozone-treated and the control sites (p > 0.1). Treatment of the exposed dentine with ozone resulted in a just significant (p = 0.044) reduction in bacterial counts. Ozone treatment of non-cavitated occlusal lesions for 40 s failed to significantly reduce the numbers of viable bacteria in infected dentine beneath the demineralized enamel.

Comparison of two laser fluorescence devices for the detection of occlusal caries in vivo

Laser fluorescence measurements have been shown to be well suited for caries diagnosis. The aim of this study was to compare two laser fluorescence devices and to correlate the respective values with the visual and radiographic assessment and with the extent of the carious lesion. Ninety-four clinically non-cavitated occlusal carious lesions in the premolars and molars of 82 patients were examined. Laser fluorescence values on the surface were measured with a conventional laser fluorescence system and a novel laser fluorescence pen device. When operative intervention at a site was indicated, the extent of caries was determined after its removal. Readings obtained with both systems were significantly different with an interdevice factor of 0.64. Sensitivity and specificity for operative care were 92.6% and 53.7%, respectively, for the conventional, and 88.9% and 53.7%, respectively, for the pen device. For both devices, a correlation between laser fluorescence values and the visual and radiographic assessment and with the extent of the lesion was shown. The study indicates that the novel laser fluorescence device seems to be suitable for occlusal caries diagnosis. However, proposed guidelines for the clinical use of laser fluorescence readings of the conventional device cannot be transferred to the novel pen system.

Correlation between visual and radiographic examinations of non-cavitated occlusal caries lesions -- an in vivo study.

The aim of this study was to conduct an in vivo investigation of the correlation between the visual and radiographic scoring systems by Ekstrand et al.7 (1997) for the diagnosis of occlusal caries lesions. The study sample comprised 147 occlusal sites from 23 patients. Two trained and experienced examiners performed the clinical visual examinations. A third examiner, which was also trained, experienced and blind to the results of the visual clinical examination, performed the analysis of the bitewing radiographs. The correlation between visual and radiographic scores was assessed by Goodman & Kruskal's gamma correlation coefficient. Results showed a strong correlation between the scores for occlusal caries found in the visual and radiographic diagnosis systems used in this study.