Effectiveness of Visual-Tactile Examination and DIAGNOdent Pen in Detecting Early Enamel Caries and Its Remineralisation: An In Vitro Study

Background. The caries preventive effect of Colgate Duraphat® and GC Tooth Mousse Plus® has been widely studied, but the remineralisation potential of initial occlusal caries using these two remineralisation materials remains unclear. Aim. This study is aimed at evaluating and comparing the remineralisation of early enamel caries on the occlusal surface of permanent posterior teeth using ICDAS II caries scoring system and DIAGNOdent Pen (DDPen) after remineralisation with Colgate Duraphat® and GC Tooth Mousse Plus®. Materials and Methods. Extracted posterior teeth ( N = 120 ) with incipient occlusal caries were included in this study. The occlusal surface of each tooth was scored using DDPen and ICDAS II scoring before remineralisation. Then, remineralisation of the teeth of the experimental group was carried out using either CPP-ACP-F or fluoride varnish. After the remineralisation procedures, the occlusal surface of each tooth was again scored using DDPen and ICDAS II scoring. The teeth were then fixed in dental stone blocks and sectioned longitudinally for histological examination using a stereomicroscope. Statistical analysis was performed to calculate the sensitivity and specificity of DDPen and ICDAS II to detect remineralisation and compare with the gold standard histological examination. Results. According to ICDAS-II scores, a significant difference was noted in GC Tooth Mousse Plus® and Duraphat® study samples, whereas the difference between the pre-and post-remineralisation of the control group was not significant. According to the DDPen score criteria, a statistically significant difference was noted among all study groups; however, a greater significance level was noted in the GC Tooth Mousse Plus® and Duraphat® study samples compared with the control group. The Spearman’s rank correlation of ICDAS-II and DDPen with Downer’s histological score (gold standard) revealed a higher association of DDPen score (.738) as compared to ICDAS-II scores (.430). Conclusion. The study concluded that both ICDAS II and DDPen could detect remineralisation of early enamel occlusal caries. DDPen was more sensitive than ICDAS-II to detect remineralisation compared with the Downers histological scores.

Sensitivity and Specificity of Different Diagnostic Methods in Occlusal Caries Detection of Permanent Teeth among Paediatric Patients

Dental caries is a commonly progressive disease that proceeds through various degrees of severity that a dentist can detect. The aims of the in vivo study were to assess the accuracy of the individual model (near-infrared light transillumination [NILT] device, visual and radiographic examinations) in detecting occlusal caries, and to evaluate the performance of visual and NILT device combination for occlusal caries detection in deciding the treatment options. Fifty-two non-cavitated occlusal surfaces from 16 patients were assessed with three different diagnostic devices in random order. Identified lesions were prepared and validated. Logistic regression analysis was performed for each method. The sensitivity and specificity values for each method and the combined models were statistically measured using RStudio version 0.97.551. At the enamel level, visual detection was the most sensitive method (0.88), while NILT was the most specific (0.93). NILT scored the highest for sensitivity (0.93) at the dentine level and visual detection scored the highest for specificity (0.88). Visual detection + NILT model was significantly better (p = 0.04) compared to visual detection or NILT alone (df = 1). The visual-NILT combination is a superior model in detecting occlusal caries on permanent teeth. The model provided surplus value in caries detection hence improving the treatment decision-making in occlusal surfaces.

Effectiveness of Silver Diamine Fluoride in Preventing Occlusal Caries in Primary Teeth of Preschool Children: a Study Protocol for a Randomized Clinical Trial (Preprint)

BACKGROUND Tooth decay is a significant public health problem globally. The caries-arrest effectiveness of 38% silver diamine fluoride (SDF) has been well documented. However, information on the caries preventive effect of SDF on primary teeth is insufficient. OBJECTIVE The aim of this trial is to investigate the effectiveness of semi-annual application of 38% SDF and that of 5% sodium fluoride (NaF) varnish when compared to placebo control in preventing occlusal caries in primary molars of preschool children over 30 months. METHODS This three-arm, parallel design, double-blind, randomised controlled trial involves 791 preschool children. Children are randomly allocated to receive one of the three interventions as follows; Group 1) 38% SDF, Group 2) 5% NaF varnish, and Group 3) placebo control with tonic water. The intervention and dental examination will be carried out every 6 months. A parent-administered questionnaire including the children’s demographic background and oral health-related behaviours has been collected at baseline. Follow-up examinations to detect new caries development will be conducted every 6 months by a masked examiner. Caries development will be diagnosed at the cavitation level. Chi-square tests and logistic regression analyses will be adopted. A two-level logistic regression analysis will be performed to investigate the effects of the study interventions and other potential confounding factors on the development of occlusal caries. RESULTS Result: To date, a total of 791 children are participating in the study. CONCLUSIONS If SDF application is more effective than NaF varnish in preventing caries on occlusal surfaces of primary teeth, it can be a preferred choice for caries prevention in a kindergarten-based program. Results of this trial will provide valuable clinical evidence for the development of oral health strategies and policy on promotion of child oral health CLINICALTRIAL ClinicalTrials.gov NCT05084001

THE STAMP TECHNIQUE FOR DIRECT COMPOSITE RESTORATIONS

Intoduction: A high level of aestheticscanonlybeachieved by refiningold techniques and introducing new ones. One of the mostrecent techniques is the stamptechnique.Thisis a relatively new methodthat manages to restore the occlusal anatomyalmostperfectly. Althoughitispractical, it has been adopted by only a smallpercentage of practitioners. Methods:This technique wasused on two patients with occlusal caries of differentseverity, whichallowed for an estheticfillingwith a close approximation of the natural dental anatomy. Results:An estheticrestorationwithoutretouching andwithoutoverbiteallowing a hormonal integration in the occlusion. Discussion:This isbecausemanualrestoration in esthetic direct composite is a technique thatrequiresskill and finesse and finishingthatis essential for the longevity of the restoration. With the buffer technique the overall time isreduced and the degree of porosity in the restorationisconsiderablyreduced. The purpose of this article is to clarifythis technique, to discussits limitations and indications as to illustrateitsprotocolthrough a clinical case.

Automated caries detection in vivo using a 3D intraoral scanner

The use of 3D intraoral scanners (IOS) and software that can support automated detection and objective monitoring of oral diseases such as caries, tooth wear or periodontal diseases, is increasingly receiving attention from researchers and industry. This study clinically validates an automated caries scoring system for occlusal caries detection and classification, previously defined for an IOS system featuring fluorescence (TRIOS 4, 3Shape TRIOS A/S, Denmark). Four algorithms (ALG1, ALG2, ALG3, ALG4) are assessed for the IOS; the first three are based only on fluorescence information, while ALG4 also takes into account the tooth color information. The diagnostic performance of these automated algorithms is compared with the diagnostic performance of the clinical visual examination, while histological assessment is used as reference. Additionally, possible differences between in vitro and in vivo diagnostic performance of the IOS system are investigated. The algorithms show comparable in vivo diagnostic performance to the visual examination with no significant difference in the area under the ROC curves ($$p>0.05$$ p > 0.05 ). Only minor differences between their in vitro and in vivo diagnostic performance are noted but no significant differences in the area under the ROC curves, ($$p>0.05$$ p > 0.05 ). This novel IOS system exhibits encouraging performance for clinical application on occlusal caries detection and classification. Different approaches can be investigated for possible optimization of the system.

Estimating the Effects of Dental Caries and Its Restorative Treatment on Periodontal Inflammatory and Oxidative Status: A Short Controlled Longitudinal Study

Dental caries and periodontitis are among the most common health conditions that are currently recognized as growing socio-economic problems relating to their increasing prevalence, negative socio-economic impact, and harmful effects on systemic health. So far, the exact effects of caries and standard restorative materials on periodontal inflammatory and oxidative status are not established. The present study aimed to investigate the effect of caries and its restoration using standard temporary and permanent filling materials on a panel of 16 inflammatory and oxidative markers in gingival crevicular fluid (GCF) of periodontally healthy individuals, 7 (D7) and 30 (D30) days post-restoration, while the intact teeth represented the control. One hundred ninety systemically and periodontally healthy patients with occlusal caries underwent standard cavity preparation and restorations with one of six standard temporary or permanent restorative material according to indication and randomization scheme. Interleukin (IL)-2, IFN- γ, IL-12, IL-17A, IL-13, IL-9, IL-10, IL-6, IL-5, IL-4, IL-22, TNF-α, IL1- β, thiobarbituric acid reactive substances, superoxide dismutase, and reduced form of glutathione were measured in GCF samples by flowcytometry and spectrophotometry in aid of commercial diagnostic assays. Caries affected teeth exhibited significantly increased IL-1 β, IL-17, IL-22, and TBARS and decreased IL-9 concentrations compared to healthy controls. Treatment generally resulted in an increased antioxidant capacity with exception of zinc-polycarboxylate cement showing distinctive inflammatory pattern. Comparison of inflammatory and oxidative profiles in temporary and permanent restorations showed material-specific patterning which was particularly expressed in temporary materials plausibly related to greater caries extension. Caries affected teeth exhibited a balanced inflammatory pattern in GCF, with a general tendency of homeostatic re-establishment following treatment. Restorative materials did not provide specific pathological effects, although some material groups did exhibit significantly elevated levels of inflammatory and oxidative markers compared to healthy controls, while the material-specific patterning was observed as well.

A Comparative Analysis of Penetration and Adaptation of Two Types of Light Cure Pit and Fissure Sealants: An In-vitro Study

Background: Pit and fissure sealants are well-known for their ability to prevent occlusal caries. Given the difficulties of maintaining complete isolation for longer periods of time when treating young patients, a streamlined sealant application process is needed. As a result, the goal of the present study is to compare the penetration and adaption of 2 types of light cure sealants. Objectives: To evaluate the adaptation and penetration of Conseal f ‘pit and fissure sealant’. To evaluate the adaptation and penetration of PF seal SE ‘pit and fissure sealant’. To evaluate comparison of adaptation and penetration between two types of light cure sealants. Methodology: This will be an in-vitro comparative study, which will consist of 2 categories - Group I (acid-etch fissure sealant, Conseal f) and Group II (self-etch fissure sealant, PF seal SE). A total of 20 extracted permanent teeth will then be classified into 2 groups of 10 teeth respectively and stereomicroscope will be used to compare the penetration and adaptation between two types of light cure pit and fissure sealants. Expected Results: The study will evaluate the penetration and adaptation of two types of light cure sealants on the tooth surface which will provide the efficacy of the sealant. Conclusion: The study will determine the sealing and penetration and adaption capacity of the sealant by the light cure method. And the sealants are beneficial and biocompatible in preventing, stopping the advancement of non-cavitated carious lesions. Additional study is needed to determine the relative advantages of the various categories of sealant material. In practice, the benefits of sealing should be examined locally, and practitioners should follow specific standards.

Management of Compromised First Permanent Molar with Triple Antibiotic Paste in a 12-year-old Child: A Case Report

In teeth with pulpal and periapical infection, various group of microorganisms are present. Inhibition of the growth of these microorganisms and suppression of their antimicrobial activity play a crucial role in the success of the endodontic management. Triple antibiotic paste has been reported to have an excellent antimicrobial efficacy and it can be useful in management of teeth with severe infection. A 12-year-old female child reported with pain and swelling in relation with a lower left first permanent molar. Clinical examination of the tooth revealed deep occlusal caries and dentoalveolar abscess. Radiographically, the carious lesion was seen involving the pulp with periodontal ligament widening and inter-radicular bone loss was observed (endo-perio lesion). Considering the position of the tooth and its strategic importance, a conservative approach to salvage the tooth using Triple Antibiotic Paste (TAP) as a medicament was employed with complete radiographic healing by 12 weeks. Subsequent obturation using lateral condensation with gutta percha followed by composite restoration and preformed stainless steel crown was performed. This case report focuses on the endodontic management of perforated first permanent molar with compromised periodontal support and significant bone loss TAP as medicament and Mineral Trioxide Aggregate (MTA) as perforation repair material. Based on the results it can be concluded that Triple Anitibiotic Paste (TAP) can be effective in the disinfection and sterilization of the root canals and repair of complex lesions.