The Minimally Invasive Management of Early Occlusal Caries: A Practical Guide

2014 ◽  
Vol 3 (2) ◽  
pp. 34-41 ◽  
Author(s):  
Louis Mackenzie ◽  
Avijit Banerjee
Keyword(s):  
Minimally Invasive ◽  
Operative Management ◽  
Dental Amalgam ◽  
Occlusal Caries ◽  
Management Options ◽  
Posterior Teeth ◽  
Carious Lesions ◽  
Occlusal Surfaces ◽  
Wide Range ◽  
Invasive Management

Pits and fissures on the occlusal surfaces of posterior teeth are sites affected commonly by demineralisation caused by the caries process. Clinicians face daily challenges in detecting these lesions, accurately diagnosing their activity and choosing from a range of management options. Traditionally, the detection of an active (or potentially active) occlusal lesion invariably resulted in the preparation of a standardised occlusal cavity, often extending beyond the confines of diseased tissue, followed by the insertion of a direct restorative material, most commonly dental amalgam. The overwhelming weight of contemporary evidence now favours minimally invasive (MI) operative management when required (usually after non-operative prevention has failed), and a wide range of equipment, materials and operative techniques is available to help operators to preserve the maximum amount of healthy/repairable tooth tissue and to allow restoration with more biologically respectful, tooth-preserving materials. This paper aims to provide clinicians with practical guidance in the prevention, early detection, predictable diagnosis and minimally invasive management of early occlusal carious lesions.

Comparative Study of Different Materials for Occlusal Matrix Technique in Posterior Teeth

2016 ◽  
Vol 695 ◽  
pp. 50-54
Author(s):  
Adriana Maria Monea ◽  
K. Ivacson A. Csinszka ◽  
Bukhari Csilla ◽  
Gabriela Bereșescu
Keyword(s):  
Dental Materials ◽  
Acrylic Resin ◽  
Ease Of Use ◽  
Resin Cement ◽  
Occlusal Surface ◽  
Posterior Teeth ◽  
Surface Anatomy ◽  
Carious Lesions ◽  
Occlusal Surfaces ◽  
Component Material

Posterior composite restorations are difficult to contour and polish due to their occlusal anatomy and opposing occlusion. Our study describes a technique for duplicating occlusal surface anatomy, using different dental materials that are able to copy anatomic details. The aim of the study was to evaluate the efficiency of occlusal matrix technique, by comparing technical ease of different dental materials. The study was conducted on extracted teeth which had intact occlusal surfaces or initial carious lesions at this level. An impression of the occlusal surface was made prior to cavity preparation, with four different dental materials: a flow composite, a dual-cure resin cement, a temporary acrylic resin (powder and liquid) and a temporary crown and bridge two-component material in a Unidose®. When the last layer of composite has been placed, the occlusal matrix was forced into the uncured composite to replicate the original occlusal surface, instead of performing manual curing and shaping as in the standard approach. Time needed for complete finishing the case, the hardness of each occlusal matrix and the final morphology obtained were evaluated. The main benefits of the occlusal matrix technique are the technical ease of use due to its simplicity and its high accuracy in reconstructing occlusal morphology. Although the shortest time needed for occlusal matrix preparation was for the dual-cure resin cement, the best oclusssal matrix was obtained with the temporary acrylic resin (powder and liquid).

Decision analysis of minimally invasive management options for cholecysto-choledocholithiasis

2020 ◽  
Vol 34 (12) ◽  
pp. 5211-5222
Author(s):  
Alison Bradley ◽  
Sharukh Sami ◽  
Niroshini Hemadasa ◽  
Anne Macleod ◽  
Leo R. Brown ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Decision Analysis ◽  
Management Options ◽  
Invasive Management

scholarly journals DIAGNOdent Measurements and Correlation with the Depth and Volume of Minimally Invasive Cavity Preparations

10.2341/05-47 ◽  
2006 ◽  
Vol 31 (3) ◽  
pp. 291-296 ◽  
Author(s):  
J. C. Hamilton ◽  
W. A. Gregory ◽  
J. B. Valentine
Keyword(s):  
Minimally Invasive ◽  
Clinical Relevance ◽  
Strongly Correlated ◽  
Posterior Teeth ◽  
Carious Lesions ◽  
Pits And Fissures

Clinical Relevance Measurements from DIAGNOdent were not strongly correlated with the depth or volume of cavity preparations that resulted from carious lesions in the pits and fissures of posterior teeth.

scholarly journals Specifics of proximal caries and their diagnostics in posterior teeth

2015 ◽  
Vol 28 (2) ◽  
pp. 92-96 ◽  
Author(s):  
Ilona Wojcik-Checinska ◽  
Agnieszka Mojsym ◽  
Agnieszka Loj-Maczulska ◽  
Renata Chalas
Keyword(s):  
Current Literature ◽  
Early Stage ◽  
Diagnostic Methods ◽  
Caries Risk ◽  
Posterior Teeth ◽  
Proximal Caries ◽  
Advanced Technologies ◽  
Carious Lesions ◽  
Occlusal Surfaces ◽  
Carious Process

Abstract Proximal surfaces are the second in turn after the occlusal surfaces, as being the most exposed places to the carious process. The specificity of changes and location makes the diagnostic of approximal cavities difficult. The aim of the study was to collect information on possibilities of detection, monitoring and assessment of carious lesions located on proximal surfaces, starting from the early stage. On the base of current literature, chosen methods of diagnosis, from conventional, to advanced technologies were presented. Current literature also suggests that none of the diagnostic methods exclude the possibility of misdiagnosis of proximal caries. Therefore, during the diagnosing of doubtful cases, it is advisable to employ several methods of assessment, with simultaneous individual appraisal of caries risk factors, such as oral hygiene, frequency of eating sweets or the number of active caries foci.

scholarly journals Clinical effectiveness of fluorescence, digital images and ICDAS for detecting occlusal caries

2017 ◽  
Vol 46 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Cristina Dupim PRESOTO ◽  
Tamara Carolina TREVISAN ◽  
Maria Costa de ANDRADE ◽  
Andrea Abi-Rached DANTAS ◽  
Juliana Alvares Duarte Bonini CAMPOS ◽  
...  
Keyword(s):  
Likelihood Ratio ◽  
Roc Curve ◽  
Digital Images ◽  
Assessment System ◽  
Caries Detection ◽  
Occlusal Caries ◽  
Posterior Teeth ◽  
Occlusal Surfaces ◽  
Discrimination Capacity ◽  
Caries Lesions

Abstract Introduction The detection of small caries lesions is still a challenge for dental professionals who in their clinical practice have a wide variety of methods to detect caries on occlusal surfaces. Objective To clinically assess the effectiveness of the Vista Proof fluorescence camera, the Vista Cam digital intraoral micro camera and the International Caries Detection and Assessment System (ICDAS) visual criterion for detecting caries lesions on occlusal surfaces of permanent teeth. Material and method One hundred and seven posterior teeth from adult patients were examined visually and by means of digital radiographs by an examiner who rated them according to the presence or absence of occlusal caries. The teeth were then assessed by the other examiner using ICDAS, fluorescence and magnified digital images. The effectiveness of the methods was measured based on sensitivity, specificity, positive and negative likelihood ratio. For each method, the Receiver Operating Characteristic (ROC) curve and the Area Under the ROC curve (AUROC) were estimated. Result There was exceptional discrimination capacity for the intraoral images (AUROC=.93) and the ICDAS (AUROC=.91), with no significant statistical difference between them (z=.35, p=.73). The fluorescence exhibited an acceptable discrimination capacity (AUROC=0.78), although it was lower than the others. The positive likelihood ratio for the fluorescence was only 2.32, compared to 20.58 for the intraoral image and 58.11 for the ICDAS. Conclusion Both methods and the ICDAS exhibited an adequate clinical performance, although the ICDAS and intraoral image were more effective than the fluorescence.

scholarly journals Detection of Non-Cavitated Occlusal Caries with Impedance Spectroscopy and Laser Fluorescence: an In Vitro Study

2014 ◽  
Vol 8 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Diana Mortensen ◽  
Katrine Dannemand ◽  
Svante Twetman ◽  
Mette Kirstine Keller
Keyword(s):  
Impedance Spectroscopy ◽  
Laser Fluorescence ◽  
In Vivo Studies ◽  
Permanent Teeth ◽  
Occlusal Caries ◽  
Posterior Teeth ◽  
Diagnodent Pen ◽  
Occlusal Surfaces ◽  
Caries Lesions

Objective: To evaluate the performance of an impedance spectroscopy technology for detecting non-cavitated occlusal caries lesions in permanent teeth in vitro. The method was compared with a commonly used laser fluorescence device and validated against histology. Material and Methodology: A non-cavitated sample of 100 extracted posterior teeth was randomly selected and assessed for caries on enamel and dentin level with aid of CarioScan PRO (ACIS) and DIAGNOdent pen (LF pen) by three examiners. After the measurements, the extension of the lesion was histologically determined as gold standard. Sensitivity, specificity, accuracy and receiver-operating curves were calculated. Intra- and inter-examiner reproducibility was expressed by intra class correlation coefficients. Results: The histological caries prevalence was 99% and 41% exhibited dentin caries. The ACIS technique displayed high specificities but almost negligible sensitivities at readings >50. A similar pattern was noted for the LF pen at readings >30. The intra- and inter-examiner reproducibility varied between 0.47 and 0.98 and the values were generally lower for the ACIS technique than for the LF pen. The inter-examiner agreement reached excellent levels with both methods. Conclusions: In vitro, the ACIS technique showed a low ability to disclose occlusal caries lesions in the enamel and/or dentin of non-cavitated permanent molars. However, further in vivo studies of permanent occlusal surfaces are needed to mirror the clinical situation.

scholarly journals Diagnostic Drama. Use of ICDAS II and Fluorescence-Based Intraoral Camera in Early Occlusal Caries Detection: A Clinical Study

2020 ◽  
Vol 17 (8) ◽  
pp. 2937
Author(s):  
Marta Mazur ◽  
Maciej Jedliński ◽  
Artnora Ndokaj ◽  
Denise Corridore ◽  
Antonello Maruotti ◽  
...  
Keyword(s):  
Subjective Evaluation ◽  
Assessment System ◽  
Diagnostic Methods ◽  
Caries Detection ◽  
Kappa Statistics ◽  
Occlusal Caries ◽  
Posterior Teeth ◽  
Invasive Approach ◽  
Occlusal Surfaces ◽  
Icdas Ii

Background: Early diagnosis of occlusal caries is of paramount importance for a minimally invasive approach in dentistry. The aim of the present in vivo clinical prospective study was to compare the diagnostic outcomes of visual subjective evaluation between the International Caries Detection and Assessment System (ICDAS-II) and an intraoral fluorescence-based camera (VistaCam iX Proof, Dürr Dental, Bietigheim-Bissingen, Germany) for the detection of pits and fissures in early caries lesions of posterior teeth. Methods: The study included 1011 posterior teeth in 255 patients aged 13–20 years (mean age 16 ± 2.2 years). Two blinded operators evaluated all the occlusal surfaces and the first assigned an ICDAS-II code, while the second assessed the VistaCam score: sound enamel (score 0–1.2); initial enamel decay (score 1.2–1.5); dentine caries (score 1.5–3). Results: Some 283 (28%) of the assessed teeth were ICDAS-II code 0; 334 (33%) code 1; 189 (18.7%) code 2; 176 (17.4%) code 3; and 29 (2.9%) code 4. The level of agreement between the two procedures was expressed by using Cohen’s and Fleiss’ kappa statistics and performing McNemar’s test. VistaCam assessed in 513 (50.7%) sound enamel; in 292 (28.9%) initial enamel decay; and in 206 (20.4%) dentine caries. Conclusions: This comparative study showed a poor agreement between the two diagnostic methods, especially between ICDAS-II 0, 1 and 2 codes and fluorescence assessments.

scholarly journals Possibilities of non-operative and minimally invasive organ-preserving spleen injuries management in blunt abdominal injuries in adults

2021 ◽  
Vol 180 (4) ◽  
pp. 18-27
Author(s):  
Y. V. Gavrishuk ◽  
V. A. Manukovskiy ◽  
A. N. Tulupov ◽  
A. E. Demko ◽  
E. A. Kolchanov ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Severe Traumatic Brain Injury ◽  
Operative Management ◽  
Massive Blood Loss ◽  
Prospective Group ◽  
Non Operative Management ◽  
Invasive Management

The Objective was to assess and improve the treatment results of victims with spleen injury in blunt abdominal trauma by using high-tech minimally invasive methods of diagnosis and treatment.Methods and materials. The article analyzed the results of treatment of 86 patients with isolated and combined blunt spleen injuries who received conventional surgery, and 52 similar patients who were treated in accordance with the new algorithm. This algorithm included conventional splenectomy for unstable hemodynamics and non-operative and minimally invasive management for stable hemodynamics after MSCT. In the absence of CT signs of ongoing bleeding, non-operative management was performed, if ongoing bleeding signs were detected, angiography with selective angioembolization was performed.Results. In both groups, most of the victims with blunt spleen injury were admitted to the trauma center after traffic accidents and catatraumas. There were no statistically significant differences in the injury severity (ISS, Tsibin scales), and the condition severity (VPH-SP). The tactics of non-operative and minimally invasive management was applied in 31 patients of the prospective group with stable hemodynamics. Non-operative management was performed on 16 patients of the prospective group. Four patients of this group underwent angiography and selective embolization of the branches of the splenic artery. In the retrospective group, there was a greater number of local complications compared to the prospective group (p=0.006). The decrease in the number of visceral and generalized complications was statistically insignificant (p>0.05). In the retrospective group, 21 victims died. Of these, 12 patients died from severe combined trauma and massive blood loss during the first 24 hours. In the prospective group, the total number of deaths was 10 patients. Of these, 6 died from polytrauma with acute massive blood loss, 1 – from severe traumatic brain injury, 1 – from PE, 2 – from sepsis. In the prospective group, among the patients with stable hemodynamics who had conservative treatment of abdominal trauma, 2 deaths were observed in the long-term period due to severe traumatic brain injury and PE.Conclusion. Organ-preserving management was carried out in 26 of 52 (50 %) patients, the number of performed diagnostic laparocenteses was reduced by 50.6 %, laparoscopies – by 16.5 %, laparotomies – by 60.7 %, the duration of inpatient treatment of surviving patients was more than for 7 days, mortality – by 5.2 %.

scholarly journals Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology

2021 ◽  
Vol 9 ◽  
pp. 205031212110225
Author(s):  
Mark A Pianka ◽  
Joseph Serino ◽  
Steven F DeFroda ◽  
Blake M Bodendorfer
Keyword(s):  
Wide Spectrum ◽  
Pain Syndrome ◽  
Operative Management ◽  
Hip Pain ◽  
Greater Trochanteric Pain Syndrome ◽  
Trochanteric Bursitis ◽  
Treatment Indications ◽  
Careful Clinical Examination ◽  
Wide Range ◽  
Tendon Pathology

Greater trochanteric pain syndrome is a common cause of lateral hip pain, encompassing a spectrum of disorders, including trochanteric bursitis, abductor tendon pathology, and external coxa saltans. Greater trochanteric pain syndrome is primarily a clinical diagnosis, and careful clinical examination is essential for accurate diagnosis and treatment. A thorough history and physical exam may be used to help differentiate greater trochanteric pain syndrome from other common causes of hip pain, including osteoarthritis, femoroacetabular impingement, and lumbar stenosis. Although not required for diagnosis, plain radiographs and magnetic resonance imaging may be useful to exclude alternative pathologies or guide treatment of greater trochanteric pain syndrome. The majority of patients with greater trochanteric pain syndrome respond well to conservative management, including physical therapy, non-steroidal anti-inflammatory drugs, and corticosteroid injections. Operative management is typically indicated in patients with chronic symptoms refractory to conservative therapy. A wide range of surgical options, both open and endoscopic, are available and should be guided by the specific etiology of pain. The purpose of this review is to highlight pertinent clinical and radiographic features used in the diagnosis and management of greater trochanteric pain syndrome. In addition, treatment indications, techniques, and outcomes are described.

scholarly journals Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jan E. Clarkson ◽  
Craig R. Ramsay ◽  
David Ricketts ◽  
Avijit Banerjee ◽  
Chris Deery ◽  
...  
Keyword(s):  
Dental Health ◽  
Controlled Clinical Trial ◽  
Trial Registry ◽  
Posterior Teeth ◽  
Carious Lesions ◽  
Randomised Controlled Clinical Trial ◽  
Deep Carious Lesions ◽  
Caries Removal ◽  
Randomised Controlled ◽  
Selective Caries Removal

Abstract Background Dental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth. Method This is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes. Discussion SCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making. Trial Registration Trial registry: ISRCTN. Trial registration number: ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search.

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