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Background: Bitewing radiography is an important modality useful for the evaluation of teeth in patients of various ages and in different stages of tooth eruption. Clinical examination of proximal surfaces for caries may result in false negative results, especially in tight contact areas. Thus, radiography, as an adjunct to clinical examination, is used as a routine diagnostic modality for caries detection., Objectives: The objective of this study was to assess the in vitro effect of changing the horizontal angulation of X-ray beam on the detection of proximal enamel caries in bitewing radiographs., Material and Methods: This in vitro study was conducted on 150 caries-free human premolars (code: p/16/35/9/210). The teeth were randomly divided into 3 groups (n = 50). Group 1 served as the control group and no carious lesions were induced in this group. Teeth in groups 2 and 3 were immersed in demineralizing solution for 2 and 4 months, respectively. After induction of caries and its radiographic confirmation, the teeth were mounted in wax in groups of 3 and bitewing radiographs were obtained at 0°, 5°, 10° and 15° horizontal angles., Results: The sensitivity values of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles were 88%, 90%, 88%, 92% in group 2 and 88%, 94%, 94% and 94% in group 3, respectively. The specificity values of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles were 92%, 86%, 84% and 76%. The accuracy of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles was 89.3%, 90%, 88.7% and 87.3%, respectively. The highest diagnostic accuracy was obtained at 5° horizontal angle for caries detection; however, the difference in this regard among the tested horizontal angles was not statically significant (p = 0.846)., Conclusions: Based on the results of this study, changing the horizontal angulation has no significant effect on the detection of proximal enamel caries in bitewing radiographs.

Objectives: Detection of approximal caries lesions can be difficult due to their anatomical position. This study aimed to assess the ability of the quantitative light-induced fluorescence- digital (QLF-D) in detecting approximal caries, and to compare the performance with those of the International Caries Detection and Assessment System II (ICDAS II) and digital radiography (DR). Methods: Extracted permanent teeth (n = 100) were selected and mounted in pairs. The simulation pairs were assessed by one calibrated dentist using each detection method. After all the examinations, the teeth (n = 95) were sectioned and examined histologically as gold standard. The modalities were compared in terms of sensitivity, specificity, areas under receiver operating characteristic curves (AUROC) for enamel (D1) and dentine (D3) levels. The intra-examiner reliability was assessed for all modalities. Results: At D1 threshold, the ICDAS II presented the highest sensitivity (0.80) while the DR showed the highest specificity (0.89); however, the methods with the greatest AUC values at D1 threshold were DR and QLF-D (0.80 and 0.80 respectively). At D3 threshold, the methods with the highest sensitivity were ICDAS II and QLF-D (0.64 and 0.64 respectively) while the method with the lowest sensitivity was DR (0.50). However, with regard to the AUC values at D3 threshold, the QLF-D presented the highest value (0.76). All modalities showed to have excellent intra-examiner reliability. Conclusions: The newly developed QLF-D was not only able to detect proximal caries, but also showed to have comparable performance to the visual inspection and radiography in detecting proximal caries. Clinical significance: QLF-D has the potential to be a useful detection method for proximal caries. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To compare the performance of LFpen (DIAGNOdent pen) with two different wedge-shaped tips to conventional bitewing radiography (BW) for detecting proximal secondary caries at the cervical margin of amalgam restorations in vitro. Methods: Seventy-five molars with class II amalgam restorations were selected. Depending on the marginal filling extension, data was subdivided into a crown group (C), when the filling ended in enamel, and into a root group (R), when the filling ended beyond the cementum-enamel junction. Bayesian analysis including calculation of the area under the receiver operating curve (AUC) was performed. Furthermore, Spearman correlations between caries and cofactors, such as presence of plaque or stain, occlusal ditching, marginal gap size, filling overhangs, and shortfalls, were calculated. Additionally, for group R the correlation coefficient between LFpen measurements and lesion depth was calculated. Histology served as gold standard. Results: In group C both at the D1 and D3 levels, LFpen with two different tips showed a better performance than bitewing radiography (AUC at D1: 0.83/0.79 (LFpen) and 0.63 (BW); at D3: 0.66/0.66 (LFpen) and 0.53 (BW)). In group R, the respective AUC values were 0.53/0.56 (LF) and 0.59 (BW). A significant medium correlation was observed for occlusal ditching and proximal caries. Stain accumulation at the restoration margins especially in combination with filling overhangs interfered with LFpen readings, resulting in false positive measurements. Conclusions: Compared to BW, LFpen enhances the detection of secondary caries lesions at the cervical margin of amalgam restorations that do not extend below the cementum-enamel junction. [Copyright &y& Elsevier]

Abstract: Objectives: The aim of this randomised clinical trial was to investigate if a laser fluorescence device is able to discriminate between sound and carious approximal sites and between enamel and dentinal lesions, as well as to find appropriate cut-off values. Methods: One hundred and seventeen sound or uncavitated carious sites in permanent molars were visually and radiographically examined, then either opened or not, after which their laser fluorescence was measured. Forty-three lesions were opened, the caries removed and the clinically identified caries depths were registered in addition to the radiographical scoring. Seventy-four sites were radiographically deemed sound or had enamel caries and were not opened. Here, the radiographical scorings were registered. Results: Taking the radiographic scoring as gold standard for all investigated approximal sites, sound sites (D 0, n =40) showed significantly lower laser fluorescence measurements than carious sites (D 1–4, n =77) (Mann–Whitney test, P <0.025) suggesting a cut-off at 7 (sensitivity=0.68, specificity=0.7). Comparing measurements of D 0–2 (n =74) and D 3,4 (n =43), the results were also different by a statistically significant amount (P <0.025) and the cut-off calculated to be 16 (sensitivity=0.6, specificity=0.84). A fair positive correlation between laser fluorescence values and radiographical scoring was found (rho=+0.47, P <0.01). Analysing the 43 opened lesions with their clinically found lesion depths as gold standard, there was a fair positive correlation to the laser fluorescence values (rho=+0.34, P =0.03) and a moderately strong correlation to the radiographic scoring (rho=+0.67, P <0.01). Conclusion: The device may be an adjunct tool in the approximal detection of caries along with established procedures. [ABSTRACT FROM AUTHOR]

The aim was to study the effect of three fluoride-releasing restorative materials on sound enamel of approximal teeth under cariogenic conditions intraorally. Bovine enamel slabs were paired with four hemispherical samples from each of three test materials (Ketac Molar, ESPE; Vitremer, F-2000, both from 3M) and one control material (Pertac II, ESPE). Their curved surface touched enamel at a contact point allowing space for plaque accumulation. Pairs were inserted in the buccal flanges of 2 lower dentures for 70 days. Initially and upon dismantling, enamel surface microhardness was measured and the increase in length of indentation in micrometers was recorded at a distance of 0, 0.4, 0.8 and 1.2 mm from the contact point. Respective values were: Pertac II: 16.0±7.5, 27.6±15.4, 38.6±23.3, 47.8±25.2; F-2000: 11.89±9.6, 15.8±14.2, 21.0±15.0, 25.1±15.2; Ketac Molar: 6.6±6.8, 9.4±7.0, 9.5±8.0), 13.4±9.4; Vitremer: 2.7±4.1, 3.5±3.5, 3.6±4.5), 7.4±5.2. Caries protection was Vitremer 82% > Ketac Molar 69% >F-2000 42% in relation to Pertac II (p<0.001). Sections of the slabs examined with polarized light showed typical subsurface lesions only in the Pertac II group, areas of pseudoisotropy in the F-2000 and Ketac Molar groups and no signs of lesion in the Vitremer group. [ABSTRACT FROM AUTHOR]

The objective was to assess the influence on the caries rate for the mesial surface of the first permanent molar (6m) of the caries status of the distal surface of the second primary molar (05d) in children from 6 to 12 years of age. The study design was retrospective and included 374 children with an average of 5 sets of bite-wing radiographs. The mean age of the children was 6.7 years when the first bite-wing radiographs were taken and 11.5 years at the time of the latest radiographs included in the study. The approximal surfaces were classified according to a scoring system: 0 = no visible radiolucency, 1= radiolucency in the outer half of the enamel, 2 = radiolucency in the inner half up to the enamel-dentin border, 3 = radiolucency with a broken enamel-dentin border but with no obvious involvement of the dentin, 4 = radiolucency with obvious spread in the outer half of the dentin, and score 5 = radiolucency in the inner half of the dentin. The influence of the status of 05d on the caries rate for 6m (state ≥2) was assessed by using a model for dependence between the two neighbouring surfaces. Presence or absence of approximal caries in the distal surface of the first primary molars (04d) and/or the mesial surface of the second primary molars (05m) at the time of eruption of 6m was also related to the caries rate for 6m. The caries rate for 6m was 15 times higher if 05d had developed enamel/enamel-dentin border caries (state 2 or 3) compared to a radiographically sound 05d (state 0 or 1). No significant increase in the caries rate for 6m was found when 05d had deeper unrestored dentin caries than when 05d had superficial caries (state 2 or 3). Furthermore, for preventing caries in 6m, no benefit could be found from restoring an 05d with dentin caries with amalgam as opposed to leaving the carious lesion unrestored until exfoliation. The caries rates for 6m and 05d were 3.4 and 2.7 times higher, respectively, in the presence of dentin caries/restoration in 04d/05m compared to absence of dentin caries in these molar surfaces at the time of eruption of 6m. In conclusion, the caries rate for 6m depended on the status of 05d and increased 15 times if 05d had enamel/enamel-dentin border caries compared to a sound 05d. Deeper unrestored or restored dentin lesions in 05d did not result in a higher caries rate for 6m compared with more shallow carious lesions in 05d. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the effect of two different dental varnishes on approximal caries incidence in teenagers with proven caries susceptibility during a 3-year period. Two hundred 13- to 14-year-old subjects exhibiting at least two approximal enamel caries lesions were selected to take part in the study. One hundred and eighty subjects participated after informed consent and were randomly assigned to two equally sized groups. One group was treated with a fluoride varnish (FV, Fluor Protector) containing 0.1% F every 3rd month and the participants of the other group were treated in the same mode with a chlorhexidine varnish (CV, Cervitec®) containing 1% chlorhexidine and 1% thymol. In total, each subject was treated 12 times during the experimental period. Approximal caries including enamel lesions (DMFSappr) were recorded from four bitewing radiographs exposed at the start and end of the study. The mean (±SD) caries prevalence at baseline was 2.2±3.4 in the FV group and 2.5±4.0 in the CV group. After 3 years, the average approximal caries incidence was 2.7±3.1 and 3.1±3.5 in the FV and CV groups, respectively. The differences at baseline and after 3 years were not statistically significant. In conclusion, treatments every 3rd month with either a fluoride- or a chlorhexidine/thymol-containing varnish showed a promising effect with low approximal caries incidence and progression in teenagers with proven caries suceptibility. [ABSTRACT FROM AUTHOR]

Using annual bite-wing radiographs, the incidence and progression of approximal caries (4d-7m) were assessed longitudinally in teenagers and adolescents whose treatment had been based on remineralizing rather than restorative strategies. A closed cohort of 536 children initially was followed from 11 to 22 years of age. The scoring system was: 0 = no visible radiolucency; 1-2 = radiolucency in the enamel up to the enamel-dentin border; 3 = radiolucency with a broken enamel-dentin border but with no obvious progression in the dentin; 4 = radiolucency with obvious spread in the outer half of the dentin, and 5 = radiolucency in the inner half of the dentin. Caries rates were estimated as the number of new lesions/100 tooth surface-years, and the Kaplan-Meier estimate was used to calculate the cumulative survival time of each approximal surface. Three events were used: the transitions from states 0 to 2, 2 to 4 and 3 to 4. The results showed a considerable variation between the surfaces in both caries rates and survival time. For all surfaces combined, the median caries rate from state 0 to 2 was 3.9 new lesions/100 tooth surface-years; from state 2 to 4, the rate was 5.4, and from state 3 to 4 it was 20.3. Of the sound surfaces (state 0), 75% survived 6.3 years without reaching state 2. Given state 2, 75% survived 4.8 years without reaching the outer half of the dentin (state 4), while given a lesion at the enamel-dentin border (state 3), 75% survived 1.3 years without doing the same. The median survival time of lesions from state 3 to 4 was 3.1 years. The group with DMFSappr>1 at the age of 11-12 years had a risk of new approximal enamel lesions (state 0-2) that was 2.5 times greater than that of the group with DMFSappr = 0-1. [ABSTRACT FROM AUTHOR]

The aim of this investigation was to study the effect of the interproximal use of fluoride (F)-impregnated and non-impregnated birch toothpicks on the degree of de- and remineralization of enamel and dentine in situ. Ten volunteers with complete dentures in the upper jaw participated. Each subject had four specimens: (1) sound enamel, (2) demineralized enamel, (3) sound dentine and (4) demineralized dentine; placed pairwise at two approximal sites (15/16 and 25/26) of the maxillary prosthesis. The study involved three test periods (A, B and C), each lasting 4 weeks. In A, the subjects used F toothpicks (impregnated in 4% NaF) and, in B, nonimpregnated toothpicks 3 times daily. During period C, no toothpicks were used. Dentifrice or other F-containing products were not allowed during the 4-week periods. Transversal microradiography was used to determine lesion depth (ld) and mineral loss (ΔZ). The results revealed that all the sound samples lost mineral during the three experimental periods; ΔZ for both enamel and dentine was less for A and B compared with C (p<0.01) and less for A compared with B and C for dentine (p<0.05, p<0.01). The demineralized samples also lost mineral, apart from dentine, during periods A and B, i.e. when F-impregnated and non-impregnated toothpicks were used; ld for enamel and ΔZ for dentine were less for A compared with C (p<0.05). Four weeks' use of toothpicks, especially F-impregnated toothpicks, thus reduces the demineralization of enamel and dentine at approximal sites in situ. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate the diagnostic accuracy of approximal carious lesions among five CBCT systems and to assess the effect of detector types employed by different CBCT systems on the accuracy of approximal caries diagnosis. Materials and methods: Thirty-nine extracted non-cavitated human permanent teeth were employed in the study. Seven observers evaluated 78 approximal surfaces of the teeth with respect to caries by the images from the following five CBCT systems: (1) NewTom 9000; (2) Accuitomo 3DX; (3) Kodak 9000 3D; (4) ProMax 3D; and (5) DCT PRO, respectively. The lesions were validated by histological examination. The area under receiver operating characteristic (ROC) curve (A z ) was used to evaluate the diagnostic accuracy. Results: Microscopy of approximal surfaces found 47.4% sound, 39.8% enamel and 12.8% dentin lesions. The differences of A z values among the five CBCT systems were not statistically significant (p =0.348). No significant difference was found between the two detector types of CBCT systems (p =0.47). Conclusions: The five CBCT systems employed in the study showed no significant difference in the in vitro approximal caries detection. Neither the detector nor the FOV employed by the CBCT systems has an impact on the detection accuracy of approximal caries. [Copyright &y& Elsevier]