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PubMedDate not supplied

Radiographic versus clinical extension of Class II carious lesions using an F-speed film.

This study investigated the difference in the apparent radiographic and true clinical extension of Class II carious lesions. Sixty-two lesions in both maxillary and mandibular premolars and molars were radiographed using Insight bitewing film. Class II lesions were scored independently by two masked examiners using an 8-point lesion severity scale. During the restoration process the lesions were dissected in a stepwise fashion from the occlusal aspect. Intraoperative photographs (2x) of the lesions were made, utilizing a novel measurement device in the field as a point of reference. Subsequently, the lesions were all given clinical scores using the same 8-point scale. Statistical analysis showed a significant difference between the true clinical extension of the lesions compared to the radiographic score. "Aggressive" and "Conservative" radiographic diagnoses underestimated the true clinical extent by 0.66 mm and 0.91 mm, respectively. No statistical difference was found between premolars and molars or maxillary and mandibular arches. The results of this study help to define the parameters for making restorative treatment decisions involving Class II carious lesions.

Bicuspid↗

PubMed2002

Caries, bitewings, and treatment decisions.

BACKGROUND: The most common adjunct to the visual and tactile clinical examination for dental caries is the bitewing radiograph. The aim of this study was to report on treatment planning decisions made by Victorian dentists when given a range of predetermined radiographic scenarios. METHODS: A postal survey was conducted to obtain data from 550 dentists selected systematically (every fourth dentist) from the register of the Dental Board of Victoria (1996). RESULTS: The survey response rate was 64 per cent. Fifty per cent of responding dentists selected an operative intervention for radiographic lesions confined to enamel. CONCLUSIONS: A review of current dental literature does not support this approach because a large proportion of proximal tooth surfaces that have associated radiolucencies confined to enamel are not cavitated. This study supports the need for continuing education programmes on the management of dental caries; such programmes should follow an evidence-based model.

Attitude of Health Personnel↗

PubMed2001

Clinical performance of resin-modified glass ionomer cement restorations in primary teeth. A retrospective evaluation.

BACKGROUND: The authors retrospectively evaluated the clinical performance of one resin-modified glass ionomer cement as a restorative material in Class I, Class II, Class III and Class V restorations in primary teeth. METHODS: A total of 306 patients who had received a total of 864 resin-modified glass ionomer restorations, which had been in their mouths for a minimum of three years, were included in this evaluation. The authors assessed the clinical observations recorded in patients' records and used bitewing radiographs to assess Class II restorations. RESULTS: The authors found an overall restoration success rate of 93.0 percent, with Class I restorations having a 92.6 percent success rate, Class II restorations having a 93.3 percent success rate, Class III restorations having a 100 percent success rate, and Class V restorations having a 98.0 percent success rate. CONCLUSIONS: The resin-modified glass ionomer cement functioned well as a Class I, Class II, Class III and Class V restorative material in primary teeth. CLINICAL IMPLICATIONS: Resin-modified glass ionomer restorative cement is a durable and reliable material to use for Class I, Class II, Class III and Class V restorations in primary teeth. Therefore, dentists have a proven alternative to silver amalgam and resin-based composite for primary tooth restoration.

Child↗

PubMed1992

Progression of proximal caries in primary teeth in relation to radiographic scoring codes.

The posterior bitewing radiographs of 50 children from a Duraphat clinical trial were re-examined to compare the information provided on progression of caries of two scoring systems, that of Murray & Majid (1) and that of Pitts (2). Pitts' scoring system (Method 1), by recording the disease process at an earlier stage, and by avoiding the unnecessary loss of data, provided a more complete overall picture of the carious process than the scoring system used by Murray & Majid (Method 2). The progression rates were found to be significantly faster with Method 2 (P less than 0.05). With Method 1, a mean of 60% of enamel lesions per subject had remained confined to enamel 12 months later, the corresponding figure for Method 2 was 37%. Method 2, by excluding outer enamel lesions and overlapped surfaces, introduces biases which favour overestimating the proportion of lesions deemed to have progressed. The diagnostic criteria used by Murray & Majid lead to an overestimation of the rate of progression of caries in primary teeth.

Child↗

PubMed2002

The evolution of dental health in dental students at the University of Barcelona.

The aim of this research was to study the evolution of dental health of dental students during their academic training and to assess the extent to which the knowledge acquired was reflected in their own dental care. A sample of 107 students at the schools of dentistry and medicine (the latter as a comparison group) of the University of Barcelona, Spain, underwent an oral examination and completed a questionnaire during their training in the third and fifth academic years. The oral examinations were limited to the status of teeth. Bitewing radiographs were used for both posterior sectors, and these were interpreted using the criteria proposed by Pitts (1984). The data were analyzed using the SPSS package. At the end of the study, medical students had more teeth present than dental students (29.80 vs. 28.94 [p = 0.022]) and a lower DMFT index of 4.33 vs. 5.91 (p=0.038), with an FT component of 2.44 and 5.23 (p = 0.011), respectively. All dental students underwent more treatment of all types than medical students, and dental health habits and knowledge were superior in dental students. The third year was the key year for decision making with regard to the student's dental health. We conclude that dental students are highly motivated about maintaining their dental health and their dental education experiences appear to have had a clear influence on this behavior.

Adult↗

PubMed2004

The value of bitewing radiographs in epidemiological caries research: a systematic review of the literature.

OBJECTIVE: To assess whether radiographic examinations are necessary to evaluate (trends in) the prevalence of caries, a summary was made of data from epidemiological studies comparing the results of clinical and radiographic examinations in young populations. METHOD: A literature search yielded seven studies that met the inclusion criteria. A two-by-two table of radiographic versus clinical data was constructed for each study. These data were used to assess the radiographic and clinical prevalences and to find a conversion factor to calculate the total prevalence from the clinical prevalence. RESULTS: In the approximal surfaces the radiographic prevalence was considerably higher than the clinical prevalence. The conversion factors to calculate the total prevalence from the clinical prevalence varied considerably across studies. In the occlusal surfaces the radiographic and clinical prevalences were about similar, but extra lesions were detected with both methods. CONCLUSION: To study trends in the prevalence of caries, radiographic examinations are not necessary but to assess the prevalence of caries they do have unknown additional value. To obtain a valid conversion factor for relevant patient categories, agreement between the results of radiographic and clinical examinations should be investigated in sub samples of epidemiological studies.

Adolescent↗

PubMed1992

Variation in restorative treatment decisions: application of Receiver Operating Characteristic curve (ROC) analysis.

It has been evident for many years that dentists, when planning treatment for patients, do not act in a standard manner, and previous research has shown there to be wide variations in treatment planning amongst groups of dentists. Signal detection theory and Receiver Operating Characteristic (ROC) analysis allows measurement of an observer's ability to detect a lesion, while at the same time allowing examination of how a lesion, once perceived, is judged to be in need of treatment. An ROC curve is constructed by plotting the sensitivity (or true positive rate) of decisions made, against the false positive rate (equivalent to 1-specificity) when various decision attitudes, from interventionist to non-interventionist, are held. Fifteen pairs of simulated bitewing radiographs were shown to 20 dentists, who were asked to specify, for each approximal lesion, whether or not they would place a conventional restoration. The 7200 decisions made by the dentists were validated by sectioning and microscopically examining the teeth. The mean sensitivity of the dentists' decisions, when the strictest operating thresholds were held and caries into dentine was the validating criterion, was 0.26 and the mean specificity was 0.96. ROC analysis shows that when operating at the strictest threshold, the dentists were implying that specificity was weighted as being 2.7 times more important than sensitivity. ROC analysis leads to insight into how dentists differentially weight the true and false, positive and negative, outcomes of their decisions and thus allows explanation of why two dentists would rarely make exactly the same treatment plan for one patient, and also why different treatments might be offered to two patients exhibiting the same levels of disease.

Decision Support Techniques↗

PubMed1995

Effect of image magnification of digitized bitewing radiographs on approximal caries detection: an in vitro study.

OBJECTIVE: To evaluate whether or not image magnification of digitized bitewing radiographs had an effect on approximal caries detection. METHODS: Twenty general dental practitioners (GDPs) rated a total of 140 digital images (28 approximal surfaces at five different magnifications, x3, x6, x12, x18 and x30) for caries on a 5-point confidence scale. The observations were compared with the state of the approximal surfaces on visual inspection. For each GDP the average response rate was calculated. Paired t-tests were used to compare the diagnostic response at the five different image magnifications. RESULTS: The mean response rates obtained at x18 and x30 magnifications were significantly inferior to those at the three smaller magnifications (p < 0.007). CONCLUSION: Digital image magnification has a significant influence on observer performance in the detection of approximal caries, with an upper limit beyond which diagnostic accuracy may be reduced. Further research is needed to determine limits for various different diagnostic tasks so as to give GDPs guidelines on the appropriate magnifications to use.

Dental Caries↗

PubMed2000

Clinical evaluation of polyacid-modified resin composite posterior restorations: one-year results.

OBJECTIVE: The aim of this investigation was to evaluate the clinical performance of a new compomer restorative system, Dyract AP, placed in combination with Non-Rinse Conditioner and Prime & Bond NT in permanent posterior teeth. METHOD AND MATERIALS: Fifty Class II and 41 Class I restorations were placed in 39 patients by 1 dentist. The restorations were evaluated directly, with modified US Public Health Service criteria, and indirectly, with color slides and polyvinyl siloxane impressions, at baseline and 6 months and 1 year after placement. Preoperative and 1-year postoperative bitewing radiographs were also taken. RESULTS: All 82 restorations available for 1-year evaluation were in situ. No postoperative sensitivity or pulpal problems were reported. Four Class II restorations (4.9%) failed because of partial fracture or recurrent caries. The percentages of Alfa score for each criterion were color match, 95.1%; marginal discoloration, 57.3%; marginal integrity, 35.4%; anatomic form, 98.8%; and surface texture, 91.5%. The average wear rate of Dyract AP was low (18.5 +/- 11.7 microns at 6 months and 35.7 +/- 13.6 microns at 12 months). CONCLUSION: The excellent handling characteristics, the good clinical performance, and the improved wear resistance suggest that this compomer will provide reliable direct tooth-colored restorations in stress-bearing areas.

Acid Etching, Dental↗

PubMed2003

A simple method to estimate restoration volume as a possible predictor for tooth fracture.

STATEMENT OF PROBLEM: Many dentists cite the fracture risk posed by a large existing restoration as a primary reason for their decision to place a full-coverage restoration. However, there is poor agreement among dentists as to when restoration placement is necessary because of the inability to make objective measurements of restoration size. PURPOSE: The purpose of this study was to compare a new method to estimate restoration volumes in posterior teeth with analytically determined volumes. MATERIAL AND METHODS: True restoration volume proportion (RVP) was determined for 96 melamine typodont teeth: 24 each of maxillary second premolar, mandibular second premolar, maxillary first molar, and mandibular first molar. Each group of 24 was subdivided into 3 groups to receive an O, MO, or MOD amalgam preparation design. Each preparation design was further subdivided into 4 groups of increasingly larger size. The density of amalgam used was calculated according to ANSI/ADA Specification 1. The teeth were weighed before and after restoration with amalgam. Restoration weight was calculated, and the density of amalgam was used to calculate restoration volume. A liquid pycnometer was used to calculate coronal volume after sectioning the anatomic crown from the root horizontally at the cementoenamel junction. True RVP was calculated by dividing restoration volume by coronal volume. An occlusal photograph and a bitewing radiograph were made of each restored tooth to provide 2 perpendicular views. Each image was digitized, and software was used to measure the percentage of the anatomic crown restored with amalgam. Estimated RVP was calculated by multiplying the percentage of the anatomic crown restored from the 2 views together. Pearson correlation coefficients were used to compare estimated RVP with true RVP. RESULTS: The Pearson correlation coefficient of true RVP with estimated RVP was 0.97 overall (P</=.0001). Coefficients for comparisons stratified by tooth type, restoration type, and restoration size groups were all greater than 0.90 (P</=.0001). CONCLUSION: Within the limitations of this study, the high correlation between estimated RVP and true RVP indicated that estimated RVP was an accurate method to quantify the relative volume of restorative material in coronal tooth structure. The fact that it can be done in a nondestructive manner makes it attractive for clinical situations.

Bicuspid↗

PubMed1990

An evaluation of bitewing radiographs in 5-year-old children.

Bitewing radiographs remain the most universally accepted aid in the detection of approximal caries in posterior teeth. The aim of this study was to evaluate their use in 5-year-old children. A total of 435 selected sets of films were read and the numbers of readable and unreadable surfaces were recorded. Of the total, 57 per cent of the sets of films were wholly readable; out of a maximum of 8700, 7490 readable surfaces were seen. Of the 248 wholly readable sets of films, 172 (69 per cent) had no evidence of caries, fillings or extracted teeth. The most common reason for loss of information was that surfaces were absent from the film (accounting for 7 per cent of all surfaces). Blurring of the surface affected 4 per cent of surfaces and overlaps a further 3 per cent. Despite the deficiencies seen, caries was diagnosed from more than one-third of all sets of films.

Chi-Square Distribution↗

PubMed2004

Examiner agreement in the replacement decision of Class I amalgam restorations.

The aim of this study was to investigate interexaminer and intraexaminer agreement in the replacement decision for Class I amalgam restorations. Three examiners evaluated the restorations clinically and with bitewing radiographs. One hundred and twelve restorations were evaluated for secondary caries, body fracture, deficient anatomic form (contour), ditched margins, and marginal overhangs. After one month, the assessments were repeated by the same examiners under the same conditions. Cohen's Kappa analysis was used to analyze the data. The number of replacement decisions varied from 12 to 27 and from 6 to 14 at the first and second evaluations, respectively. The Kappa statistics indicated "moderate" to "substantial" consistency for interexaminer and intraexaminer agreement in the replacement decisions based on clinical and radiographical examinations. Restorations with deficient anatomic form and marginal overhangs presented the most frequent diagnostic difficulties and lead to disagreement among examiners. The most frequently mentioned reasons for replacement were the restorations had ditched margins at both clinical evaluation periods and secondary caries was detected during radiographical evaluations. In the absence of agreement among examiners, clinical and radiographic guidelines are necessary for replacing Class I amalgam restorations.

Adolescent↗

PubMed1997

An evaluation of the diagnostic yield from bitewing radiographs of small approximal and occlusal carious lesions in a low prevalence sample in vitro using different film types and speeds.

AIM: To compare diagnostic yield in caries diagnosis from D- and E-speed films. DESIGN: A laboratory study. SETTING: A UK dental school between 1992 and 1994. MATERIALS AND METHODS: 96 extracted teeth containing approximal and occlusal lesions, but representing a low caries prevalence sample, were set in occluding dental arches. Bitewing radiographs were taken and interpreted by 5 examiners for the presence or absence of caries. Each examiner was also asked which film image he or she subjectively liked best. MAIN OUTCOME MEASURES: The teeth were subsequently sectioned and histologically examined to validate diagnostic decisions. RESULTS: For all film types the percentage of lesions with caries histologically in dentine correctly identified radiologically (sensitivity) was low (approximal caries 8-22%; occlusal caries 0-30%). The number of sound dentine sites correctly identified (specificity) was high (approximal caries 98-100%; occlusal caries 79-100%). There were no significant differences between D- and E-speed films. Sensitivity was unaffected by each examiner's subjective preference for a particular film. The variation in sensitivity of diagnosis was due to differences between examiners. CONCLUSIONS: The reluctance of many GDPs to use E-speed film because they 'do not like the image' cannot be endorsed or supported. Both E-speed film types examined can be recommended for use in general practice.

Analysis of Variance↗

PubMed1997

Decisions on diagnosis and management of approximal caries by final-year dental students.

OBJECTIVES: To investigate the decision-making processes for dental caries from bitewing radiographs of final-year dental students in Mexico City. METHODS: Five sets of radiographs were converted to slides and projected on a screen under standardized conditions. 143 students were asked to determine separately the presence of all proximal caries, of proximal lesions to be restored in the present course of treatment, and of unreadable surfaces due to technical deficiencies. A gold standard was obtained from two expert clinicians who examined the radiographs under similar conditions. RESULTS: Misdiagnoses were common. Overdiagnoses became evident at the treatment planning stage where many surfaces were incorrectly planned for restoration. Subjective appraisals of presence of lesions, unreadable surfaces, and surfaces planned for restoration showed substantial variation. CONCLUSIONS: Students' overall assessment of lesions detected did not differ between restored and unrestored surfaces. However, when compared with the gold standard, their decision-making was found to be better on surfaces which had not been restored previously as opposed to those already restored, both in terms of identification of lesions and in terms of treatment planned for deeper lesions.

Adult↗

PubMed1994

Relationship between clinical periodontal condition and the radiological appearance at 1st molar sites in adolescents. A 3-year study.

There has been considerable controversy about the incidence of periodontal disease in adolescents. It is noteworthy that there is disagreement between workers as to be radiological features that should be used to detect the earliest signs of periodontitis, and variation in the choice of criteria may have influenced the results of previous studies. The present project represents a 3-year longitudinal assessment into the periodontal condition, assessed clinically and radiologically, of a group of adolescents. The radiographic investigations were carried out using vertical bitewing radiographs and, to reduce potential error caused by variation in film placement and tube alignment, individual impressions were used so that the film could be positioned accurately at repeat assessments. It was found that several of the radiographic features, such as the width of the periodontal ligament space and the angle of the interproximal bone crest relative to the tooth, similar to those previously attributed to the commencement of destructive periodontal changes, were found to be correlated with the maturation changes associated with the eruption of the adjoining permanent teeth. In spite of the use of impressions, some of the series of radiographs showed variation in tube alignment, and several of the above radiological features were also found to correlate with errors in radiographic technique. It was concluded that the various eruptive and maturation changes taking place during this stage in the adolescent dentition must be allowed for when looking for the earliest signs of periodontal destruction.

Adolescent↗

PubMed2003

Comparative radiographic evaluation of the alveolar bone crest after orthodontic treatment.

This study evaluated and compared the heights of the alveolar bone crests (AC) among orthodontic patients treated with either the simplified standard edgewise technique (group 1, n = 30), the edgewise straight-wire system (group 2, n = 30), or bioefficient therapy (group 3, n = 26). These 3 groups were compared with an untreated control group (group 4, n = 30). A comparison by sex of AC height was also conducted. The first premolars were extracted in every treated patient, and measurements were performed on bitewing radiographs taken after a mean posttreatment period of 2.17 years. The distances from the AC to the cementoenamel junction (CEJ) on the mesial and distal surfaces of the first molars and second premolars and on the distal surface of the canines were measured; the larger the distance, the greater the alveolar bone loss. The data were analyzed by 1-way analysis of variance and the Newman-Keuls test (P <.05) for comparison among the groups. Sex differences of the AC height were evaluated with the t test. All treated groups had larger, statistically significant CEJ-AC distances than the untreated group, primarily at the extraction areas. There were no consistent statistically significant differences in the areas among the treated groups. Mean distances of the CEJ-AC in boys were larger than or similar to those in girls. The patients in the treated groups showed a greater number of proximal surfaces with statistically significant differences between sexes, compared with the control subjects.

Adolescent↗

PubMed2002

Laser fluorescence detection of occlusal caries.

PURPOSE: This study compared six diagnostic methods with a histologic standard, including diode laser fluorescence, caries detection dye, and an operating microscope. MATERIALS AND METHODS: Diagnosis groups included: visual only (VO); visual and bitewing radiograph (VX); visual, bitewing radiograph and explorer (VXE); Global Protege operating microscope at x10 (S); caries detection dye (CDD); diode laser fluorescence (DLF). Three examiners individually evaluated five independent sites on 29 extracted human molars using the above methods. Teeth were sectioned and evaluated histologically. Response Operating Characteristic (ROC) analysis was used to descriptively and inferentially assess the relationship between occlusal caries and the six diagnostic methods. RESULTS: In this in vitro study, the resulting AUCs (areas under the ROC curve) showed that the DLF method appeared to be superior, when compared to traditional methods (VO, VX, VXE) and caries detection dye. While caries detection with DLF ranked higher than use of an operating scope, they were not statistically different although the difference tended toward significance (P = 0.0511). Furthermore, the AUC for CDD would be ranked lower in accuracy than the other diagnostic methods tested and could result in over treatment of sound teeth. DLF use offers improved detection of suspected hidden caries that have not become radiographically evident.

Analysis of Variance↗

PubMedDate not supplied

Clinical evaluation of visual, radiographic, and laser fluorescence methods for detection of occlusal caries.

The aim of this clinical study was to test cut-offs for occlusal caries detection by the laser fluorescence device DIAGNOdent (DD) in comparison to visual-ranked inspection (VI) and bitewing radiographs (BW) under condition of a general dental practice. 281 occlusal surfaces of permanent molars from 97 patients were examined with VI, DD and BW. Caries extent was verified by bioptical intervention (gold standard) of 248 molars. Upon biopsy no molar was assessed as caries free, 24 teeth had caries confined to enamel and 224 teeth revealed dentine caries. For dentine caries detection DD achieved the highest values for sensitivity (0.93), specificity (0.63) and agreement (0.89) followed by BW with figures of 0.70, 0.96 and 0.69, respectively. VI exhibited the lowest sensitivity (0.25) and agreement (0.25), but the highest specificity (1.00). It is advised to assess occlusal surfaces by a meticulous VI followed by the use of DD and/or BW as additional diagnostic tool of second choice. A DD value of > 20 could be confirmed as a sensitive cut-off for detection of occlusal dentine caries in first and second permanent molars. For the detection of early signs of enamel caries the DD seems to be less suitable.

Adolescent↗