Permanent Posterior Teeth Research Articles

In vivo performance of near-infrared light transillumination for dentine proximal caries detection in permanent teeth

ObjectiveThe purpose of this in vivo study was to confirm the detection of proximal caries using near-infrared light transillumination (NILTI) (DIAGNOcam) device, and to compare the diagnostic performance of the device with other caries detection methods, including visual examination using the International Caries Detection and Assessment System (ICDAS), bitewing radiography (BW), an LED-based device (Midwest Caries I.D.), and a laser fluorescence device (LFpen). MethodsA total of 974 proximal surface of permanent posterior teeth from 34 patients (19 females and 15 males between the ages of 22–55) were evaluated in the present study. After clinical examination of each proximal surface by an experienced examiner, they were coded according to the ICDAS criteria and subsequently with BW, the NILTI, LED, and LFpen. The proximal dentin caries of 106 were opened based on the combination of visual, NILTI and radiographic assessment and validated; and were treated with restorative materials. The data were analyzed with descriptive statistics and calculation of the sensitivity, specificity, and area under curve (AUC). ResultsThe highest sensitivity values were recorded from NILTI readings (99.1%), followed by BW scores (86.8%). The highest specificity values were recorded from ICDAS (100%). The best AUC values were found from the NILTI readings (0.97), followed by BW (0.93) and ICDAS (0.87). ConclusionThe NILTI device exhibited the best performance in terms of detecting proximal dentin caries.

Amalgam and Composite Use among Dental Students in Saudi Arabia

Aim: The aim of this study was to detect the use of resin composite and amalgam restorations placed inpermanent posterior teeth by undergraduate dental students in university dental hospitals in Saudi Arabia.Materials and Methods: 276 patients aged ≥8 years were randomly selected and clinically examined foramalgam and resin composite restorations placed in permanent posterior teeth with living pulps byundergraduate dental students in university dental hospitals in Saudi Arabia. The restorations were placedin teeth preparations Class I and Class II. Also, bitewing and or periapical radiographs were used to definethe depth of the cavity. The data obtained were documented in a patient examination form then statisticallyanalyzed using Chi-Square Test or Fisher-Freeman-Halton Test.Results: Composite was the main kind of restoration placed by dental students. There was an insignificantrelationship between the kind of restoration (amalgam or composite) and the tooth type(maxillary/mandibular premolar and maxillary/mandibular molar), the class of tooth preparation, the cavitydepth, the age of the patient, and the gender of the patient p > 0.05.Conclusion: Composite was the most commonly restorative material used by dental students. Gradualreduction in the use of amalgam should be evidence-based. Students should obtain the necessarycompetencies for decision making according to each individual case.

Fluorescence-aided Composite Removal in Directly Restored Permanent Posterior Teeth.

The aim of this study was to quantitatively compare conventional composite removal and composite removal supported by the fluorescence-aided identification technique (FIT) regarding the completeness, selectivity, and duration of the procedure in directly restored permanent posterior teeth. Two operators removed standardized direct class II composite restorations (n=32 per operator) in human tooth models under simulated clinical conditions. According to a randomized allocation scheme, removal was performed with either the conventional technique (contra-angle handpiece) or supported by FIT. The duration of each removal procedure was recorded. The completeness and selectivity were volumetrically assessed through superimposition of three-dimensional surface scans. Statistical significance was tested by examining the overlap of 95% confidence intervals (CI). Multiple comparison was performed with Tukey tests for each variable. Compared with the conventional technique, composite removal with FIT was faster (329 seconds [95% confidence interval (CI): 268-390 seconds] vs 179 seconds [95% CI: 150-208 seconds]), generated less tooth substance loss (4.53 mm3 [95% CI: 3.77-5.30 mm3] vs 2.77 mm3 [95% CI: 2.11-3.43 mm3]), and left behind less composite residue (1.58 mm3 [95% CI: 1.23-1.94 mm3] vs 0.53 mm3 [95% CI: 0.39-0.67 mm3]). Within the limitations of this in vitro study, FIT facilitated the selective and expeditious removal of tooth-colored composites in directly restored posterior teeth.

Nanohybrid and microfilled composite resin in Class II restoration of permanent molar teeth

The aim of this study was to compare the clinical performance of nanohybrid composite resin in Class II restorations placed with a one-step self-etch adhesive with that of microfilled composite resin of permanent posterior molar teeth. A total of 100 participants who received Class II restorations either with nanohybrid composite resin bonded with a single step self-etch adhesive or conventional microfilled composite bonded with a single step self-etch adhesive. All restorations were evaluated by using slightly modified USPHS criteria at baseline and after 3, 6 and 12 months. The results revealed that nanohybrid composite resin showed better clinical outcome than that of the conventional microfilled composite resin restorations in respect to retention and marginal adaptation at 12 months observation period. It can be concluded that nanohybrid is superior to conventional microfilled composite resin in respect to retention, and marginal adaptation of Class II restorations of permanent molar teeth.

Survival of multiple-surface ART restorations using a zinc-reinforced glass-ionomer restorative after 2 years: A randomized triple-blind clinical trial

ObjectiveTo investigate the effectiveness of a new zinc-reinforced glass-ionomer in comparison to a common high-viscous glass-ionomer cement (HVGIC) used in multiple-surface ART-prepared cavities. The hypothesis tested was that the cumulative survival percentage of the new HVGIC is higher than that of the common HVGIC over 2 years. MethodsA randomized triple-blind parallel group clinical trial was used. A total of 218 participants, average age 15.4 years (SD=0.2), with an occluso-proximal carious lesion in a permanent (pre-) molar were included. Restorations using test (ChemFil Rock) and control (Fuji IX GP) restoratives were placed according to the ART method by four calibrated operators. Restorations were evaluated after one week (baseline), and at 6-, 12-, 18- and 24 months from replicas and coloured photographs according to the ART restoration assessment criteria by two independent evaluators. Restoration survival curves were estimated using the Kaplan–Meier method and difference between dependent and independent variables tested with a Wald (chi-square) test. ResultsThere was a statistically significant difference in cumulative survival percentages between the two types of restorations at 2 years (P=0.02). A higher percentage of multiple-surface restorations of Fuji IX GP (95.4%) than ChemFil Rock (85.3%) survived. Gender (P=0.64), operator (P=0.56) and cavity size (P=0.81) had no effect on the survival of the type of restoration observed. Type of tooth (P=0.004) and type of jaw (P=0.05) showed an effect. Severe wear was the major reason for restoration failure (ChemFil Rock=7; Fuji IX GP=1). SignificanceChemFil Rock appears not to be a viable alternative to Fuji IX GP in restoring ART multiple-surface cavities in permanent posterior teeth.

Prevalence of Pulp Stones in Libyan Subpopulation: A Panoramic Radiographic Study

The aims of this study were to evaluate the prevalence of pulp stones in permanent posterior teeth of a group of adult Libyan dental patients using digital panoramic radiographs. Materials and Methods: Panoramic radiographs of 1200 adult patients (600 females and 600 males) were examined retrospectively to determine the prevalence and distribution of the pulp stones. All posterior teeth were investigated except third molars, and the data obtained were recorded as present or absent according to gender, tooth types, dental arches, sides and dental status (intact, restored, or carious). The Chi-square test was used for difference comparisons (P<0.05). Results: Of the 1200 patients, 363 (30.2%) had one or more teeth that contained pulp stones. Pulp stones were detected in 1402 of the 16738 teeth, to give a tooth prevalence of 8.4%. Pulp stones were discovered in 9.2% of females and 7.5% of males, with a highly significant difference between the genders (P<0.0001). Pulp stones were more prevalent in the maxillary arch (10.3%) than in the mandibular arch (6.5%), with a significant difference between arches. Pulp stones were most frequently occurring in right maxillary first molars (24.6%) and least occurring in left maxillary first premolars (0.1%). Pulp stones prevalence was significantly more common in the first molars than second molars, in the molars than premolars in each dental arch, and in the first maxillary molar than first mandibular molars. Pulp stones were detected more frequently in the intact teeth than in carious and restored teeth. Conclusion: The occurrence of pulp stones in this study was significantly higher in females than males, in maxillary teeth than in mandibular teeth, molars than premolars, first maxillary molars than mandibular molars and in intact teeth than restored and carious teeth.

Dental cavity liners for Class I and Class II resin-based composite restorations.

Resin-based composite (RBC) is currently accepted as a viable material for the restoration of caries for posterior permanent teeth requiring surgical treatment. Despite the fact that the thermal conductivity of the RBC restorative material closely approximates that of natural tooth structure, postoperative hypersensitivity is sometimes still an issue. Dental cavity liners have historically been used to protect the pulp from the toxic effects of some dental restorative materials and to prevent the pain of thermal conductivity by placing an insulating layer between restorative material and the remaining tooth structure. This is an update of the Cochrane Review first published in 2016. The objective of this review was to assess the effects of using dental cavity liners in the placement of Class I and Class II resin-based composite posterior restorations in permanent teeth in children and adults. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 12 November 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 10) in the Cochrane Library (searched 12 November 2018), MEDLINE Ovid (1946 to 12 November 2018), Embase Ovid (1980 to 12 November 2018) and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 12 November 2018). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We included randomized controlled trials assessing the effects of the use of liners under Class I and Class II posterior resin-based composite restorations in permanent teeth (in both adults and children). We included both parallel and split-mouth designs. We utilized standard methodological procedures prescribed by Cochrane for data collection and analysis. Two review authors screened the search results and assessed the eligibility of studies for inclusion against the review inclusion criteria. We conducted risk of bias assessments and data extraction independently and in duplicate. Where information was unclear we contacted study authors for clarification. Eight studies, recruiting over 700 participants, compared the use of dental cavity liners to no liners for Class I and Class II resin-based composite restorations.Seven studies evaluated postoperative hypersensitivity measured by various methods. All studies were at unclear or high risk of bias. There was inconsistent evidence regarding postoperative hypersensitivity (either measured using cold response or patient-reported), with a benefit shown at some, but not all, time points (low-quality evidence).Four trials measured restoration longevity. Two of the studies were judged to be at high risk and two at unclear risk of bias. No difference in restoration failure rates were shown at 1 year follow-up, with no failures reported in either group for three of the four studies; the fourth study had a risk ratio (RR) 1.00 (95% confidence interval (CI) 0.07 to 15.00) (low-quality evidence). Three studies evaluated restoration longevity at 2 years follow-up and, again, no failures were shown in either group.No adverse events were reported in any of the included studies. There is inconsistent, low-quality evidence regarding the difference in postoperative hypersensitivity subsequent to placing a dental cavity liner under Class I and Class II posterior resin-based composite restorations in permanent posterior teeth in adults or children 15 years or older. Furthermore, no evidence was found to demonstrate a difference in the longevity of restorations placed with or without dental cavity liners.

Systematic reviews in restorative dentistry: discussing relevant aspects.

This article aims to discuss key aspects of systematic reviews (SR) focusing on the improvement of the conduct and reporting. Important aspects of SRs, such as prospective registration of the review protocol, basic structure, inclusion criteria, use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, confidence in the results and future directions are discussed. To determine relevant aspects, a search was conducted without date limitations in PubMed (October 15th, 2017) to identify SRs written in English evaluating clinical performance of direct composite resin restoration in permanent posterior teeth or comparing direct composite resin with other material/techniques. The quality of SRs included was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 tool. Fifteen SRs were included. The overall confidence in the results of SRs was classified as critically low. Some aspects should be highlighted: SRs of in vitro studies are an important tool in restorative dentistry, and initiatives such as the PRISMA Statement and PROSPERO should be considered a standard code of practice. The compliance with and awareness of the discussed aspects may be a significant feature of the improvement of SR quality in the dentistry. Initiatives such as the PRISMA Statement and PROSPERO should be taken in account by systematic reviewers in dentistry to improve the conduct and reporting of SRs, and to make their reviews are more clinically helpful.

Natural enamel caries, dentine reactions, dentinal fluid and biofilm

It is believed that penetration of dentinal fluid into natural enamel caries (NEC) is negligible because of the barrier created by underlying sclerotic dentine, but there are conflicting evidences on whether dentine subjacent to NEC is sclerotic or demineralized. This study aimed at investigating the relationship between NEC, subjacent dentine reactions, modification of dentinal fluid, and composition of cariogenic biofilm formed on the NEC surface. Proximal NEC (PNEC) lesions of human permanent posterior teeth were included in five experiments. Histologically, microradiographic analysis with contrast solution (MRC) in dentine revealed a decreased proportion of sclerotic dentine and an increased proportion of deep dentine demineralization compared to the classical stereomicroscopic histological analysis based on dentin color and translucency. Real-time MRC and 3D optical profilometry, and 3D microtomographic analysis evidenced a facilitated transport of modified dentinal fluid towards PNEC lesions. Cariogenic biofilm formed in vitro on the PNEC surface presented lower amounts of insoluble and soluble matrix polysaccharides when 2% chlorexidine was inserted in the pulp chamber. In conclusion, this study evidenced that dentine subjacent to PNEC is mostly demineralized, providing facilitated pathway for dentinal fluid to penetrate into PNEC and alter the composition of the biofilm formed on the PNEC surface.

Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth

Objective: To contribute with information on cost-effectiveness of pulp capping and root canal treatment of posterior permanent vital teeth in children and adolescents with pulp exposures due to caries.Material and methods: Cost-effectiveness by means of a Markov simulation model was studied in a Scandinavian setting. In a simulated 12-year-old patient, treatment of pulpal exposure of a permanent tooth, either by the initial treatment pulp capping or root canal treatment, was followed for 9 years until the patient was 21. The model was based on outcome data obtained from published literature and cost data based on reference prices.Results: In the simulated case, with the annual failure probalility (AFP) of 0.034 for pulp capping, the total cost for an initial treatment with pulp capping and any anticipated following treatments during the 9 years, was 367 EUR lower than for a root canal treatment as the initial treatment. After an initial treatment with pulp capping 10.4% fewer teeth, compared with initial root canal treatment, were anticipated to be extracted. Pulp capping was thus considered to be the cost-effective alternative. The sensitivity analyses showed that the AFP of a tooth requiring a root canal treatment after an initial pulp capping needed to be 0.2 before root canal treatment may be considered being the cost-effective treatment.Conclusions: This model analysis indicated initial treatment by pulp capping to be cost-effective compared to root canal treatment in children and adolescents with pulp exposures due to caries.

Radiographic pattern of underlying dentin lesions (ICDAS 4) in permanent teeth.

To assess the radiographic pattern of underlying dentine shadows (UDS) in the occlusal surfaces of permanent teeth. A total of 282 permanent posterior teeth pertaining to 91 individuals, 142 UDS and 140 non-cavitated enamel lesions (NCEL), were included for comparison. UDS was defined as shadows of discolored dentin visible through the enamel surface which may or may not show signs of localized enamel breakdown, classified as code 4 by the International Caries Detection and Assessment System group. Data collection included the application of a questionnaire, clinical examination, and bilateral bitewing radiographs. The risk for presenting radiolucency was estimated using logistic regression model with generalized estimating equations. Approximately 79% of UDS exhibited no radiolucency. The proportion of teeth exhibiting a radiolucency restricted to the enamel-dentin junction was 20.4% for UDS and 3.6% for NCEL (p < 0.001, chi-square test). UDS had a sixfold increased risk for exhibiting radiolucency compared with NCEL (OR = 5.78, 95% CI = 2.73-12.22, p < 0.001). Despite this finding, it is important to highlight that virtually all cases were located at the enamel-dentin junction, and only one tooth in each category of clinical status exhibited radiolucency at the outer one half of dentin. No tooth exhibited radiolucency reaching the deep dentin. The present study showed that UDS presented radiolucency in very few cases. The vast majority of lesions showed no radiolucency. Our findings suggest that only a small proportion of UDS would demand restorative treatment.

Clinical Evaluation Of Direct Composite Resin And Indirect Micro Ceramic Composite Resin Restorations In Class-I Cavity Of Permanent Posterior Teeth

Background:Previous studies have indicated that the clinical performance of direct composite restoration mainly depends on the polymerization shrinkage. The use of micro ceramic inlay technique has proved to be elegant approach to overcome the polymerization shrinkage and improve the marginal adaptation, reduce wear and leakage of posterior restorations.Objectives:To compare the clinical performance between direct composite restorations and indirect micro ceramic composite restorations in occlusal surface of permanent posterior teethof class-I cavity. Results: The result of this study showed that there was no statisticallysignificant difference between two groups in the treatment of occlusal surface ofclass-I cavity of permanent posterior teeth (p &gt; 0.05). It was concluded that indirect micro ceramic composite resin shows no better clinical efficacy than that of direct composite resin in occlusal surface of class-I cavity of permanent posterior teethInternational Journal of Human and Health Sciences Vol. 03 No. 02 April’19. Page: 109-115

Evaluation of micro leakage of two direct esthetic restorations with different preparation techniques

ObjectivesIn recent times, the term “minimal intervention dentistry” has coined to describe a new approach to the treatment of the disease of caries. This study was carried out to evaluate the marginal integrity of class V cavity in permanent posterior teeth prepared with different air abrasion parameters compared with classical rotary cavity preparation. MethodsA total number of 150 sound caries for free human posterior teeth were used in this study. Teeth were extracted for periodontal disease or orthodontic reasons and the average age of patients between 20 and 35 years. Teeth were divided according to the type of restoration into two main groups: Group I (n = 75) restored with low shrinkable posterior composite (P90) and Group II (n = 75) restored with Ketac nano ionomer (N100). Each main group was divided into five groups (n = 15), then each group was further subdivided into three subgroups (n = 5) according to the storage time (immediately, three months, and six months). All teeth would be tested at both occlusal and gingival margins of prepared class V cavity according to the method of cavity preparation. ResultsA high significant difference was found in the mean ranks of micro-leakage at both occlusal enamel and gingival dentin walls among Groups 1–5 (p-value of <0.05). For main groups that restored with low shrinkable composite resin material (P90) and Ketac nano ionimer (N100), results revealed that scores of micro-leakage between (P90) or (N100) and both occlusal enamel or gingival dentin walls were significantly higher in group (AS1P1) than those in groups (B), (AS1P2), and (AS2P2) respectively. While no statistical significant difference was detected between groups (AS1P1) and (AS2P1). High scores of micro-leakage were detected at groups with six months, three months and immediately storage time respectively. ConclusionLow shrinkable silorane based composite yielded better results of micro-leakage scores along the occlusal enamel and gingival dentin walls when the cavity of class V was prepared with air abrasion technique with large size alumina particles under high pressure at immediate storage time as compared with Ketac N100.

Histological validation of the automated caries detection system (ACDS) in classifying occlusal caries with the ICDAS II system in vitro.

To compare the diagnostic performance of the automated caries detection system (ACDS) for the detection and diagnosis of occlusal caries with the histological appearance of the lesions. Eighteen posterior permanent teeth were used, out of which 40 sections were made and 53 areas were evaluated. Teeth with hypoplastic and/or hypomineralised areas or sealants on the occlusal surfaces were excluded from the study. The teeth that were used for this study were a subgroup of the teeth used in the study that introduced ACDS system. This subgroup consisted of teeth having in their occlusal surfaces early carious lesions classified as international caries detection and scoring system (ICDAS) 0, 1, 2 and 3 after clinical examination by the examiners. Histological preparations were classified by experienced examiners based on the Ekstrand, Ricketts and Kidd (ERK) system and for the respective occlusal surfaces by the ACDS system based on ICDAS II system. There were two threshold limits considered as carious in either system ICDAS ≥ 2 or ≥ 3 and ERK index ≥ 2 or ≥ 3 and all possible combinations were analysed. Statistical methods of weighted version of kappa coefficient, Kendall's tau-b correlation coefficient and p-values using the Fisher's exact method were used at the confidence level of 0.05. Intra-examiner kappa coefficient agreement was 0.87 and 0.89 while the inter-examiner for the two trials were 0.87 and 0.92. The ICDAS3-ERK3 combination between the ACDS and histological sections presented the best agreement with kappa coefficient 0.76, agreement 92.5%, sensitivity 100% and specificity 91.1%. ICDAS3-ERK3 combination between the optical examination of the examiners compared to the histological preparations showed kappa coefficient 0.87, agreement 96.2%, sensitivity 100%, Specificity 95.6%. The evidence supports the view that ACDS classification of occlusal surfaces based on the ICDAS system are comparable with classification to that of an examiner and with the histology of the lesion. The use of ACDS has the distinct advantage though of removing the subjectivity of the examiner since it performs the classification without any intervention by him.

Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis.

The aim of the present study is to update the results of two previous meta-analyses, published in 2006 and 2012, on the survival percentages of atraumatic restorative treatment (ART) restorations and ART sealants. The current meta-analysis includes Chinese publications not investigated before. Until February 2017, six databases were interrogated (two English, one Portuguese, one Spanish and two Chinese). Using six exclusion criteria, a group of six independent reviewers selected 43 publications from a total of 1958 potentially relevant studies retrieved. Confidence intervals and/or standard errors were calculated and the heterogeneity variance of the survival rates was estimated. The survival percentages and standard errors of single-surface and multiple-surface ART restorations in primary posterior teeth over the first 2years were 94.3% (± 1.5) and 65.4% (± 3.9), respectively; for single-surface ART restorations in permanent posterior teeth over the first 3years, they were 87.1% (± 3.2); and for multiple-surface ART restorations in permanent posterior teeth over the first 5years, they were 77% (± 9.0). The mean annual dentine-carious-lesion-failure percentages in previously sealed pits and fissures using ART sealants in permanent posterior teeth over the first 3 and 5years were 0.9 and 1.9%, respectively. ART single-surface restorations presented high survival percentages in both primary and permanent posterior teeth, whilst ART multiple-surface restorations presented lower survival percentages. ART sealants presented a high-caries-preventive effect. ART is an effective evidence-based option for treating and preventing carious lesions in primary and permanent posterior teeth.

Endodontic and Restorative Treatment Patterns of Pulpally Involved Immature Permanent Posterior Teeth.

Objective The study aims at investigating the treatment patterns for young permanent posterior teeth with pulp involvement. Materials and Methods A random sample of 1793 dental records of patients aged 6–18 years old who had received dental treatment was investigated. 663 permanent posterior treated teeth had pulp involvement. Demographic and treatment data were gathered from patients' records. Results Prevalence of young permanent teeth with pulp involvement was 36.9%. Treatments received significantly increased as patients' age increased (P=0.001). The first mandibular molar had the most pulp involvement among all teeth (43.89%). Temporary restoration was the most received restoration (59%). The most common pulpal diagnosis, leading to treatment, was irreversible pulpitis (43.04%). Only 19.8% of treated teeth received completed root canal treatment. Conclusion There is a high percentage of children and adolescents with immature permanent posterior teeth with pulp involvement. Similarly, a variety of treatment patterns is present, with a small percentage of completed root canal treatment. Clinical Relevance The study has identified the need to provide guidelines to provide high-quality root canal treatments for young permanent posterior teeth that have pulpal involvement. Only 21.8% of root canal treatments were completed, while 24% of teeth were extracted, and 59% of patients received temporary restorative treatments. This suggests that there might be several factors that might prevent completion of the dental treatment, such as patient preference, insurance coverage, or dentist capability. These factors and guidelines for patient care should be investigated and resolved.

Appraisal of agreement between treatment procedures on deep caries lesions in the posterior permanent teeth of adults

Appraisal of agreement between treatment procedures on deep caries lesions in the posterior permanent teeth of adults

In vitro performance of the DIAGNOcam for detecting proximal carious lesions adjacent to composite restorations

ObjectivesTo assess the accuracy of near-infrared-light transillumination (DIAGNO) compared to visual-tactile (VT) and radiographic (RA) evaluation of proximal carious lesions adjacent to composite restorations in vitro. MethodsTwo hundred extracted posterior permanent human teeth with occluso-proximal composite restorations were allocated to 50 groups of four posterior teeth, and mounted in a pilot-tested diagnostic model in a dummy head. The teeth were independently assessed by two examiners. Transverse microradiography and visual assessment served as reference tests to detect any lesions (prevalence 24%) and cavitated lesions (18%), respectively, adjacent to restorations. Sensitivity, specificity, positive and negative predictive values and the area under the receiver-operating-characteristics curve (AUC) were calculated. ResultsTo detect any proximal carious lesions adjacent to composite, the mean sensitivity/specificity were 0.63/0.95 for DIAGNO, 0.70/0.88 for RA when lesions radiographically extending into enamel and dentin were considered, 0.26/0.98 for RA when only lesions extending into dentin were considered, and 0.31/0.96 for VT. For cavitated lesions adjacent to proximal composite restorations, these values were RA (enamel and dentin) 0.84/0.88, RA (dentin) 0.34/0.99, DIAGNO 0.69/0.94 and VT 0.40/0.97. AUC did not differ significantly between RA and DIAGNO, while VT showed significantly lower values (p < 0.05). ConclusionWithin the limitations of this study, DIAGNO seems useful for detecting proximal carious lesions adjacent to restorations. Clinical relevanceNear-infrared-light transillumination could be used as a radiation-free adjunct or alternative to RA for detecting carious lesions adjacent to composite restorations.

Relationship between depth of approximal caries lesions and presence of bacteria in the dentine in primary and permanent posterior teeth: a radiographic examination with microbiological evaluation

Objectives: We aimed to determine the relation between the radiographical depth of approximal lesions and the presence of bacteria in the dentine in posterior teeth in both dentitions.Material and methods: Sample 1 consisted of 34 approximal lesions in primary molars in children aged 5–7 years old. Sample 2 consisted of 48 approximal lesions in molars and premolars in adult patients aged 18–67 years old. All lesions were in need of restorative treatment according to the dentists. During the operative interventions dentine biopsies were collected with a sterile bur just pulpally of the enamel–dentin junction. Two authors evaluated the presence/absence of bacterial colonies. The lesions depth on bitewing radiographs (RSCORING) were assessed independently by two examiners twice using the ICCMS classification system: RI=initial-; RM=moderate-; RE=extensive caries.Results: In sample 1, the RSCORING was distributed as follows: RI=15; RM=12; RE = 7. In 9 cases the lesions were clinically cavitated. Bacteria were visible on the agar plates in one case (7%) of the RI lesion, 86% of the RM lesions and in all the RE lesions, (p < .001). In sample 2, RSCORING was distributed as follows RI=14; RM=23; RE=9. In 15 cases, the lesions were clinically cavitated. In 2 cases (14%), there were visible bacteria on the agar plates among the RI lesions, while this was the case in 86% of RM lesions and in 100% of RE lesions (p < .001).Conclusions: RM and RE lesions seem to harbor bacteria in the dentine and are candidates for invasive treatment. In contrast, RI lesions should in general be managed non-invasively.

Post-and-Core Restoration of Severely Damaged Permanent Posterior Teeth in Young Adolescents.

This retrospective study evaluated the survival rates of postendodontic severely decayed posterior permanent teeth in young adolescents. A total of 48 teeth (patient age range: 8.8-16.9 years) restored with a Kurer post- and core-system (Anchor System, Kurer K4) were assessed. Follow-up appointments 1 to 6 years posttreatment included radiographs and a clinical examination. A total of 5 teeth (10.4%) were extracted, and 13 restorations (27%) required repair. Average restoration-to-failure time was 27 months (SD 12.2 months). In view of these findings, clinicians should consider post-and-core restorations an alternative to extractions of endodontically treated severely damaged teeth in adolescents.