Occlusal Surfaces Of Primary Molars Research Articles

Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment in arresting dentin caries lesions in preschoolers: a randomized clinical trial.

To compare the efficacy of silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) in arresting caries lesions. Variables such as treatment time, adverse effects/parental aesthetic perception, anxiety and patients' behavior were also evaluated. Children (3.53 ± 1.03 years) with dentin caries lesions on the occlusal surface of primary molars were randomized into test (SDF) and control (ART) groups. To determine the presence of caries, dmf-t and ICDAS indexes were used. Caries lesions were also classified according to activity (active or inactive). The time required to perform treatments was recorded and the children's anxiety was assessed by a Facial Image Scale. The adverse events/aesthetic perception were registered by the operator and caregivers. The Frankl Behavioral Scale assessed patients' behavior. The chi-square/Fisher's exact and Mann-Whitney tests were used for comparisons between the groups. Of the 118 participants who received treatment (SDF, n = 59; ART, n = 59), after 12-month follow-up, 91.5% (43/47) of caries lesions in the SDF and 90.2% (46/51) in the ART group were arrested (p = 1.000). After 24 months, 72% (18/25) were arrested in the SDF group and 95.2% (20/21) in the ART. The treatment times were 6.08 ± 1.72 and 13.58 ± 4.83, for SDF and ART, respectively (p < 0.001). No statistically significant difference of adverse effects, aesthetic perception, anxiety, and patients' behavior were found between the groups. SDF was similar to ART in arresting caries lesion but required less time for treatment. The anxiety, adverse effects/aesthetic perception and patients' behavior were also similar between the groups. CLINICAL RELEVANCE: The use of SDF may be a faster and less invasive alternative for the treatment of caries lesions. Clinical trial registration number and date of registration: NCT03063307. September 2016.

Arresting Active Carious Lesions Using Minimal Intervention Dentistry among a Group of Preschool Children: A Randomized Controlled Clinical Trial.

This clinical trial investigated the effectiveness of three minimal intervention dentistry protocols in arresting dentin caries in primary molars of preschool children. Treatment time, anxiety in children, adverse events, and parents' esthetic perception were all assessed. One hundred thirty-five 3-5-year-old children with active dentin caries lesions on the occlusal surface of primary molars were randomly allocated to the control group receiving atraumatic restorative treatment (ART) and two test groups receiving 38% silver diamine fluoride (SDF) or ultraconservative treatment (UCT). The existence and activity of caries were assessed using the International Caries Detection and Assessment System II (ICDAS II) criteria. Children were followed up at 3, 6, and 12 months. The time required to perform the treatments was recorded, and a facial image scale (FIS) was applied to assess anxiety. Questions posed to caregivers were used to investigate adverse events and esthetic assessment. After a year, the overall success rates of UCT, SDF, and ART were 61.6, 87.2, and 84.6%, respectively, with a statistically significant difference (p < 0.05). The time required to treat with SDF was significantly lower than that needed for ART and UCT (p < 0.01). Anxiety levels were significantly lower in the SDF group (p = 0.003). There was no difference in the percentage of adverse events and parental esthetic perception (p = 0.604). After 3 months, the arrest rates of ART, SDF, and UCT were similar. However, after 1 year, the arrest rate of UCT was significantly lower. Silver diamine fluoride takes significantly less chair time and has success rates comparable to ART. Ultraconservative treatment has a short-term successful application. It was confirmed that there were no variations in adverse events between SDF, ART, and UCT. NCT05314660. Hamza BE, Attia NM, Abdellatif AM, et al. Arresting Active Carious Lesions Using Minimal Intervention Dentistry among a Group of Preschool Children: A Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2024;17(9):1018-1024.

Morphology of the occlusal surface of primary molars as a risk factor for caries.

Impact of primary molars is a significant problem for children with early caries, as they are the ones that predominate in the structure of damage to primary teeth. The goal of our study was to investigate the peculiarities of the primary molars occlusal surfaces with the study of their types and possibilities of caries occurrence in them. To study the odontoglyphics of primary molars, a clinical preventive dental examination of 335 children of preschool institutions in the city of Poltava and Poltava region was conducted with the written consent of their parents. As a part of this examination, the occlusal surface of primary molars was studied according to the classic dental examination method with the examination card of each examined child being filled in. After a detailed study of odontoglyphic patterns of occlusal surfaces, photoprotocoling was carried out. A total of 2484 primary molars were examined: 622 maxillary first molars, 634 maxillary second molars, 608 mandibular first molars, and 620 mandibular second molars. We found that both maxillary and mandibular primary molars which have a complex relief of the occlusal surface are most often affected by caries. The obtained data indicate that the primary molars of the upper and lower jaw, which have a complex pattern of the chewing surface, are most often affected. However, there is a need for preventive measures in children with such types of structure of the chewing surface.

OROFUNCTIONAL MANIFESTATIONS IN CHILDREN WITH MICROCEPHALY: CASE REPORTS

The study aimed to describe the clinical and dental features of 2 children diagnosed with severe microcephaly. Brazilian children of both sexes with brownish skin color and complete primary dentition presented oral hygiene difficulties as the main complaint. During anamnesis, 3 dimension (3D) cephalic perimeter reduction in occipitofrontal circumference at birth, intellectual deficit with history of respiratory complications, controlled seizures, and motor and visual impairments were reported. Extraoral clinical and functional examinations verified predominantly oral breathing, with no passive lip sealing and atypical lingual interposition. Intraoral examination revealed grinding of teeth, the presence of a biofilm, chewing on the left side, and deterioration of the occlusal surfaces of primary molars. Knowledge of facial morphology and orofunctional disorders of patients with special care needs in early childhood will allow health professionals to perform preventive and interceptive procedures in these individuals, essential points for defining a prognosis and the elaboration of a health care protocol.

Sealants for preventing dental caries in primary teeth.

Sealants for preventing dental caries in primary teeth.

Glass Ionomer Sealant versus Fluoride Varnish Application to Prevent Occlusal Caries in Primary Second Molars among Preschool Children: A Randomized Controlled Trial

Fissure sealant is a recommended preventive measure on permanent molars, but its efficacy on primary molars in preschool children is still in doubt. Sodium fluoride varnish (NaFV) enhances remineralization and is effective in preventing caries in smooth surfaces, but limited information is available regarding its use on occlusal surfaces of primary molars. The present study aimed to compare the efficacy of glass ionomer sealant (GIS) versus topical application of 5% NaFV in preventing and arresting occlusal caries in primary second molars among preschool children. One calibrated examiner examined children aged 3–4 years for visible plaque index (VPI), decayed-missing-filled primary surface (dmfs) index, and extent of carious lesions by the International Caries Detection and Assessment System (ICDAS). Subjects with 1 or more primary second molars that were sound or with incipient lesions (ICDAS 0–1), with distinct visual enamel changes (ICDAS 2), or with localized enamel breakdown (ICDAS 3) were recruited. The children were randomly assigned to either NaFV group – application of 5% NaFV at 3-monthly intervals or GIS group – 1 single placement of GIS. A parental questionnaire was used to collect information on the children’s sociodemographic background and oral health-related habits. Two blinded examiners conducted clinical examinations after 6 and 12 months to evaluate the development of occlusal caries and the retention of GIS. Negative binomial regression using generalized estimating equations was employed to adjust for the clustering effect and evaluate the influence of selected variables on the development of occlusal caries into dentin at 12 months. A total of 323 children with 1,159 primary second molars received the respective preventive measures at baseline. At 12 months, 280 children with 989 molars were evaluated. Caries had developed or progressed into dentin in 7.8% and 8.0% of the molars in the NaFV and GIS groups, respectively, with no significant difference between the groups (p = 0.913). The overall retention rates of GIS were 24.6% and 13.5% at 6 and 12 months, respectively. Regression analyses showed only baseline caries experience, and an ICDAS code had a significant association with occlusal caries progression. Quarterly NaFV application and single GIS placement showed similar effectiveness in the prevention of occlusal caries development among preschool children.

How combining different caries lesions characteristics may be helpful in short-term caries progression\xa0prediction: model development on occlusal surfaces of primary teeth

BackgroundFew studies have addressed the clinical parameters' predictive power related to caries lesion associated with their progression. This study assessed the predictive validity and proposed simplified models to predict short-term caries progression using clinical parameters related to caries lesion activity status.MethodsThe occlusal surfaces of primary molars, presenting no frank cavitation, were examined according to the following clinical predictors: colour, luster, cavitation, texture, and clinical depth. After one year, children were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as the outcome to be predicted. Univariate multilevel Poisson models were fitted to test each of the independent variables (clinical features) as predictors of short-term caries progression. The multimodel inference was made based on the Akaike Information Criteria and C statistic. Afterwards, plausible interactions among some of the variables were tested in the models to evaluate the benefit of combining these variables when assessing caries lesions.Results205 children (750 surfaces) presented no frank cavitations at the baseline. After one year, 147 children were reassessed (70%). Finally, 128 children (733 surfaces) presented complete baseline data and had included primary teeth to be reassessed. Approximately 9% of the reassessed surfaces showed caries progression. Among the univariate models created with each one of these variables, the model containing the surface integrity as a predictor had the lowest AIC (364.5). Univariate predictive models tended to present better goodness-of-fit (AICs < 388) and discrimination (C:0.959–0.966) than those combining parameters (AIC:365–393, C:0.958–0.961). When only non-cavitated surfaces were considered, roughness compounded the model that better predicted the lesions' progression (AIC = 217.7, C:0.91).ConclusionsUnivariate model fitted considering the presence of cavitation show the best predictive goodness-of-fit and discrimination. For non-cavitated lesions, the simplest way to predict those lesions that tend to progress is by assessing enamel roughness. In general, the evaluation of other conjoint parameters seems unnecessary for all non-frankly cavitated lesions.

Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of preschool children: A 12-months parallel randomized controlled clinical trial

ObjectivesThis clinical trial investigated the efficacy of silver diamine fluoride (SDF) in arresting dentine caries in primary molars of preschoolers. Time required for treatment, adverse effects, parental aesthetic perception, anxiety and oral health related to quality of life (OHRQoL) was evaluated. Materials and methodsChildren, 2–5 years old, with active dentine caries lesions on the occlusal surface of primary molars were randomly allocated to test group (SDF) or control group (atraumatic restorative treatment/ART). The dmf-t/DMF-T and ICDAS indexes determined the presence of caries and activity. The main outcome after 3, 6 and 12-month follow-up was assessed by a blind examiner. The time required to perform the treatments was recorded and a facial image scale was applied to assess anxiety before and after treatment. Adverse events and aesthetic perception were assessed through questions addressed to caregivers; and the OHRQoL through the B-ECOHIS questionnaire. ResultsIn 68 patients that were randomized, the mean number of treated teeth per child was 2.42(1.04) and 2.09(1.18) in the SDF and ART groups (p = 0.074), respectively. The mean difference of arrested lesions between the groups after 12 months was -0,07(0.05; - 0.17-0.30). The time required to treat with SDF was lower than the ART (p < 0.001). There was no difference in the percentage of adverse events + aesthetic perception (p = 0.709), and the change in anxiety (p = 0.155). There was a less impact in OHRQoL after ART treatment, but only when the parents' distress subscale was considered (p = 0.012). ConclusionSDF requires much less chair-time and have similar results as ART in arresting caries lesion, anxiety, adverse effects, aesthetic perception and quality of life.

Performance of Preventive Methods Applied to the Occlusal Surface of Primary Teeth: A Randomized Clinical Study

Objective: To evaluate the clinical performance of three preventive materials on the occlusal surfaces of primary molars over a 36-month period. Material and Methods: The study was conducted with a split-mouth design involving four experimental groups: G1 – resin-modified glass ionomer cement (Vitremer ® ); G2 - resin sealant (Alpha Seal Light ® ); G3 - silver diamine fluoride (Cariostatic ® ); and G4 - control group without material. Thirty-two children aged 36 to 60 months, attending a pediatric clinic, with a deft index ≥ 1 and four primary second molars participated in the study. The material retention was evaluated in G1 and G2, and the presence of incipient caries was evaluated in all groups. Data were submitted to the Wilcoxon test and survival test (α = 5%). Results: At three, six, 12, 24 and 36 months, G2 exhibited greater material loss (maximum loss: 44%) in comparison to G1 (maximum loss: 35%), but this difference did not achieve statistical significance (p = 0.214). The highest incidence of incipient caries occurred in G3 (20%), but no significant differences were found between groups at any evaluation time (p = 0.154). Conclusion: There were no statistically significant differences between the evaluated products regarding material retention and dental caries, although there was more material loss in teeth that received the Alpha Seal ® sealant resin, and a greater number of carious lesions in the Cariostatic® group (silver diamine fluoride).

Sealant versus Fluoride in Primary Molars of Kindergarten Children Regularly Receiving Fluoride Varnish: One-Year Randomized Clinical Trial Follow-Up

Objectives: The objectives of this study were to measure the caries preventive effect of sealants applied to occlusal surfaces of primary molars compared to fluoride varnish applications, and to assess the retention rate of sealants after 1 year. Methods: 147 first-grade pupils from two kindergarten schools in Kuwait, whose parents gave their written consent, were included. The children were examined by one dentist using the International Caries Detection and Assessment System. After the examination, sealants and fluoride varnish were applied on the selected occlusal surfaces of primary molars by another dentist. The jaw quadrant for intervention was selected randomly; molars on the contralateral side of the mouth received the contralateral intervention. Examinations and intervention were provided on the school premises in the mobile dental unit with a portable spotlight. Moisture was controlled by cotton rolls, suction and air drying. The follow-up examinations were conducted after 1 year. All children received fluoride varnish before and 6 months after the intervention. Results: From 267 matched pairs of occlusal surfaces of primary molars, varnished surfaces were significantly more likely to develop new caries lesions than the sealed ones (odds ratio = 2.92; 95% confidence interval = 1.82-4.71) during the 1-year follow-up. The majority (73.0%) of the sealants were completely retained and 15.1% partially. Conclusions: Sealing fissures seems to be better in preventing occlusal caries lesions in primary molars than applying only fluoride varnish. After 1 year, the majority of sealants were retained sound.

The Performance of ICDAS-II Using Low-Powered Magnification with Light-Emitting Diode Headlight and Alternating Current Impedance Spectroscopy Device for Detection of Occlusal Caries on Primary Molars

Early detection of occlusal caries in children is challenging for the dentists, because of the morphology of pit and fissures. The aim of this study was to compare in vitro the diagnostic performance of low-powered magnification with light-emitting diode headlight (LPMLED) using ICDAS-II criteria and AC Impedance Spectroscopy (ACIS) device, on occlusal surfaces of primary molars. The occlusal surfaces of 18 extracted primary molars were examined blindly by two examiners. The teeth were sectioned and examined under light microscopy using Downer's histological criteria as gold standard. Good to excellent inter- and intraexaminer reproducibility, higher sensitivity, specificity, and AUC values were achieved by LPMLED at D1 threshold. Also the relationship between histology and LPMLED was statistically significant. In conclusion visual aids have the potential to improve the performance of early caries detection and clinical diagnostics in children. Despite its potential, ACIS device should be considered as an adjunct method in detecting caries on primary teeth.

Ion concentration adjacent to glass-ionomer restorations in primary molars

ObjectivesThe aim was to compare the levels of fluoride, calcium and phosphorus in enamel and dentin alongside glass-ionomer-based restorations over time. MethodsThis CCT consisted of children with cavities in the occlusal surface of primary molars that were restored with either a high-viscosity (Fuji IX GP®) or a resin-modified glass-ionomer (Vitremer®), being the test groups. Sound teeth (controls) were harvested from the children belonging to the test groups. Sampled teeth were cut in half and the ion concentration measured using EPMA. ANOVAs, and Newman–Keuls tests were performed to analyze the data. The study sample consisted of 35 children having 29 teeth per group available for analyses. ResultsAlthough statistically significantly higher, the mean ion-concentration of calcium in enamel and dentin, and that of phosphorous in dentin hardly differed between the tests and control groups. The mean fluoride concentration in enamel (0.20ppm×103 and 0.24ppm×103) and dentin (0.71ppm×103 and 0.78ppm×103) surrounding the Fuji IX GP® and Vitremer® restored teeth, respectively was statistically significantly higher than in enamel (0.12ppm×103) and dentin (0.12ppm×103) for the control teeth. SignificanceThe present in vivo investigation showed that fluoride ions are released from high-viscosity and resin-modified glass-ionomer primary restoration into the restorations’ surrounding enamel and, and in particular, dentin.

Influence of cross-infection control methods on performance of pen-type laser fluorescence in detecting occlusal caries lesions in primary teeth

The aim of this in vitro study was to determine the influence of cross-infection control methods, as probe tip autoclaving and polyvinyl chloride (PVC) wrapping, on the performance of laser fluorescence device (DIAGNOdent pen--LFpen) on occlusal surfaces of primary molars. One experienced examiner carried out all examinations (n = 78). For the probe tip autoclaving study, 62 sites (sample A, 40 teeth) were used. The sites were assessed with LFpen using tips in six different conditions: without autoclaving and after autoclaving for 10, 20, 30, 40, and 50 cycles of 10 min. For the PVC wrapping study, we selected other 58 sites (sample B, 38 teeth). The sites were assessed with the LFpen device in two conditions: with and without PVC wrapping. The teeth were sectioned and histologically assessed for caries depth. LFpen values, sensitivity, and specificity were compared among the different conditions. The LF readings were slightly higher after successive examinations, independently of autoclaving. In both studies, no statistical differences in the sensitivity and specificity were observed for all conditions. In conclusion, probe tip autoclaving and PVC wrapping do not influence the performance of LFpen device on occlusal surfaces of primary molars.

Performance of fluorescence‐based and conventional methods of occlusal caries detection in primary molars – an in vitro study

This in vitro study aimed to test the performance of fluorescence-based methods in detecting occlusal caries lesions in primary molars compared to conventional methods. Two examiners assessed 113 sites on 77 occlusal surfaces of primary molars using three fluorescence devices: DIAGNOdent (LF), DIAGNOdent pen (LFpen), and fluorescence camera (VistaProof-FC). Visual inspection (ICDAS) and radiographic methods were also evaluated. One examiner repeated the evaluations after one month. As reference standard method, the lesion depth was determined after sectioning and evaluation in stereomicroscope. The area under the ROC curve (Az), sensitivity, specificity, and accuracy of the methods were calculated at enamel (D1) and dentine caries (D3) lesions thresholds. The intra and interexaminer reproducibility were calculated using the intraclass correlation coefficient (ICC) and kappa statistics. At D1, visual inspection presented higher sensitivities (0.97-0.99) but lower specificities (0.18-0.25). At D3, all the methods demonstrated similar performance (Az values around 0.90). Visual and radiographic methods showed a slightly higher specificity (values higher than 0.96) than the fluorescence based ones (values around 0.88). In general, all methods presented high reproducibility (ICC higher than 0.79). Although fluorescence-based and conventional methods present similar performance in detecting occlusal caries lesions in primary teeth, visual inspection alone seems to be sufficient to be used in clinical practice.

Bond strength and morphology of resin materials applied to the occlusal surface of primary molars

Hydrophilic adhesives may be used as pit and fissure sealants (sealants), but there is concern about the ability of self-etching adhesives to bond sealants to enamel. To study the bond strength (BS) and morphology of adhesive systems used as sealants. OptiBond FL, OptiBond All-in-One, combined OptiBond All-in-One+OptiBond FL adhesive, and Fluroshield were applied to the occlusal surfaces of 16 primary molars (n = 4). Teeth were stored in distilled water (24 h at 37°C) and sectioned through the interface to obtain sticks (0.8 mm(2) ) tested under a tensile load (0.5 mm/min). Failure modes were observed. Data were analysed by ANOVA and Tukey's tests (α = 5%). The morphology of 12 primary molars was examined in terms of the etching pattern and resin reproduction. Differences in the BS were found (P = 0.001), with OptiBond FL showing the highest (36.84 ± 5.7 MPa), Fluroshield (24.26 ± 2.13 MPa) and OptiBond All-in-One (17.12 ± 4.97 MPa) similar, and OptiBond All-in-One + OptiBond FL adhesive the lowest (9.8 ± 2.94 MPA). OptiBond FL showed the best results in terms of morphology. Under the conditions of this study, OptiBond FL was the best material to be used for sealing.

Parameters associated with active caries lesions assessed by two different visual scoring systems on occlusal surfaces of primary molars – a multilevel approach

The aim of this in vivo study was to evaluate the association between several parameters related to children and to their teeth, and the presence of active carious lesions assessed by two different visual indices on occlusal surfaces of primary molars. Occlusal surfaces of 757 primary molars in 139 children (3-12 years old) were classified as sound, or having inactive or active carious lesions using the Nyvad criteria (NY) and the International Caries Detection and Assessment System (ICDAS-II) and a supplemental lesion activity assessment system (ICDAS-LAA). Several parameters related to the tooth and to the child were recorded. Associations between these parameters and the presence of active carious lesions on occlusal surfaces were evaluated using logistic multilevel analysis. Second primary molar teeth and children with high caries experience were more frequently with active occlusal carious lesions compared to sound and inactive occlusal carious lesions classified by both visual scoring systems. Teeth with a mature dental plaque on the occlusal surface and younger children had more active caries than inactive occlusal carious lesions (excluding sound teeth in the analysis). A previous visit to a dentist was related to a lower frequency of active occlusal carious lesions classified by NY only, and upper primary molars presented with higher numbers of active occlusal carious lesions classified by ICDAS-LAA. Presence of mature dental plaque and tooth type are tooth-related variables associated with active carious lesions on occlusal surfaces of primary teeth, as well as anterior caries experience and age are variables related to the child.

A Clinical Study of Caries Diagnosis With a Laser Fluorescence System

The authors conducted an in vivo study to compare a laser fluorescence system with a visual system for occlusal caries diagnosis in children's primary and permanent molars. The authors selected for evaluation 320 untreated, cavity-free primary and permanent molars in healthy children aged 6 through 14 years. Two of the authors conducted the laser fluorescence evaluation. Another of the authors completed the clinical evaluation. The kappa value was 0.68. The authors compared sensitivity, specificity, predictive values, odds ratio and receiver operating characteristic (ROC) curves for the laser fluorescence system. For the whole sample, the sensitivity and specificity of the laser fluorescence system were 0.79 and 0.87, respectively. The positive and negative odds ratios for the whole sample were 6.33 and 0.23. The positive and negative predictive values for the whole sample were 33.9 percent and 98.1 percent. The value of the area beneath the ROC curve (AUC) was 0.92 for the whole sample. The laser fluorescence system was more precise than visual evaluation in identifying lesions without cavities and healthy surfaces in primary and permanent molars. In daily practice, dentists can consider the laser fluorescence system a complementary tool in the visual exploration of occlusal surfaces of primary molars and permanent first molars.

Micro-tensile bond strength of adhesive systems applied on occlusal primary enamel.

The aim of this study was to evaluate the micro-tensile bond strength of adhesive systems (OptiBond Solo, Kerr; Prime & Bond NT, Dentsply) on occlusal surface of primary molars. The adhesives were tested under manufacturers' specifications and after contamination of the bonding site with saliva. Hourglass cylindrical-shaped samples were obtained and subjected to a tensile force. No significant difference was observed among the groups. OptiBond Solo and Prime & Bond NT showed similar values of bond strengths when applied on occlusal enamel of primary molar under either saliva contamination or not.

Morphological characterization of the resin-dentin interface in primary teeth.

The effects of self-etching adhesives on primary teeth were evaluated. Reports in the literature suggest differences between the first and second dentition regarding the composition and the morphology and, therefore, a possible difference in the performance of dental adhesives. The purpose of this study was to evaluate the effects of self-etching adhesives on primary dentin. Eight dentin disks were obtained from the occlusal surface of primary molars. The disks were divided between four dental adhesives [Prompt L-PoP (LP), Clearfil SE BOND (SE), Etch&Prime 3.0 (EP) and Prime&Bond NT (PB) + H(3)PO(4) (Control) and "restored" with a composite (Pertac II)]. After sectioning, fixation and HMDS drying, specimens were polished and Field Emission SEM examinations were carried out. Clearly visible hybrid layer formation was found for PB, LP and EP. An undoubtedly detectable interdiffusion zone was not evident after the use of SE. A clearly visible adhesive layer was recognizable for PB, EP and SE, but not continuously detectable for LP. Debonded regions were observed for all systems evaluated, but distinct differences in the failure mode were detected. The evaluated dental adhesives did not generate completely sealed interfaces between the composite resin and the dentin of primary teeth in vitro.

Occlusal caries: wherefore art thou?

Objective To compare the accuracy and repeatability of three diagnostic systems (DIAGNOdent, visual and radiographic) for occlusal caries diagnosis in primary molars. Design Two examiner, in vitro, blinded study. Histological gold standard. Materials and methods 58 occlusal surfaces of primary molars examined in turn by two examiners using each of three diagnostic systems (DIAGNOdent, visual and radiographic). These results were compared with a histological gold standard. Sensitivity and specificity were calculated for each diagnostic system at a range of thresholds. Inter- and intra- examiner repeatability were calculated for each diagnostic system using the kappa statistic. Main outcome measures Sensitivity, specificity, inter and intra examiner repeatability for each diagnostic system. Results The highest sensitivity values were provided by DIAGNOdent (0.77 and 0.80, examiners 1 and 2 respectively) however this was offset by a lower specificity (0.82 and 0.85) than all other systems with the exception of examiner 1 at V1 visual threshold. The DIAGNOdent gave the highest values of kappa for intra- and inter- examiner repeatability with the exception of intra-examiner repeatability for examiner 2 where visual diagnosis had the highest value of kappa. Conclusion The DIAGNOdent was the most accurate system tested for the detection of occlusal dentine caries in primary molars. The performance of the DIAGNOdent systems was not statistically significantly better than that achieved using visual examination for non-cavitated teeth (V1 and V2 threshold). DIAGNOdent may prove useful as a predictive clinical tool, however with appropriate training visual examination may offer similar results without the need for additional equipment.