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

Decision Making on Caries Management in Children and Adolescents Among Thai Dentists

BACKGROUND

The International Caries Classification and Management System (ICCMS) advocates for nonsurgical approaches in early carious lesions and minimally invasive restorations in advanced cases.

AIM

This study investigated Thai dentists' adherence to ICCMS guidelines for managing caries in children and adolescents and explored factors influencing their decisions.

DESIGN

A web-based questionnaire collected demographic information and routine treatment preferences for various stages of carious lesions from participants. Descriptive statistics and regression analyses were employed to examine relationships between management strategies and demographics.

RESULTS

A total of 442 dentists participated. Their agreement with ICCMS guidelines for occlusal caries ICDAS 2, 3, and 4 in primary dentition was 39.6%, 53.9%, and 42.5%, respectively, and in permanent dentition was 34.4%, 46.8%, and 39.6%, respectively. The agreement rate with ICCMS guidelines for approximal caries RA1, RA2, RA3, and RB4 in primary dentition was 69.6%, 78.0%, 12.4%, and 99.5%, respectively, and in permanent dentition was 70.8%, 68.3%, 19.0%, and 97.7%, respectively. Factors associated with restorative treatment decisions included years since graduation, postgraduate education, and practice type.

CONCLUSIONS

Participants did not comply well with ICCMS recommendations for occlusal caries, some employed destructive techniques instead of noninvasive approaches. However, most participants followed ICCMS guidelines for approximal caries, except for RA3 stage.

Underlying Dentin Shadows (ICDAS 4) in Occlusal Surface of Permanent Teeth Have Low Progression Rate after 1-2 Years

The aim of this prospective cohort study was to assess the radiographic progression of underlying dentin shadows (UDS) on the occlusal surfaces of permanent posterior teeth of adolescents and young adults over 1-2 years and to identify possible risk factors. A total of 149 UDS lesions (from 101 individuals) were included at baseline. Each participant had to present at least one UDS to be considered eligible for the study. Data collection included the application of a questionnaire, clinical examination, and bilateral bitewing radiographs, performed at baseline and after 1-2 years. The association between possible predictors and UDS progression (defined radiographically as an increase in the radiographic score from baseline to follow-up) was assessed using Weibull regression models. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were estimated. A total of 81 individuals (mean age: 24.0, standard deviation: 8.03) were reexamined after 1-2 years (742 occlusal surfaces, of which 118 were UDS). The overall progression rate was 8.6% after 1-2 years, being 12.6% for UDS without baseline radiolucency and 20% for UDS with baseline radiolucency. The risk analysis showed that UDS without radiolucency at baseline had a similar likelihood of progression (adjusted HR = 1.71, 95% CI = 0.68-4.32, p = 0.26) while UDS with radiolucency at baseline were more likely to progress (adjusted HR = 2.96, 95% CI = 1.06-8.26, p = 0.04) than the reference category (sound occlusal surfaces without radiolucency). These estimates were adjusted for caries prevalence, tooth type, and arch. This study showed low progression rates of UDS after 1-2 years. The presence of radiolucency at baseline was found to predict UDS progression.

Prevalence, extent, risk indicators, and intraoral distribution of underlying dentin shadows (ICDAS 4) among 15-19-year-old South Brazilian adolescents

Background and Objective

This study aimed to assess the prevalence, extent, risk indicators, and intraoral distribution of underlying dentin shadows (UDS) in the occlusal surfaces of the permanent posterior teeth.

Subjects and Methods

A total of 1197 adolescents were included in the study (participation rate of 72.3%). The association between the independent variables, on the one hand, and the prevalence and extent of UDS were assessed using multilevel Poisson regression models. The prevalence ratios (PR), rate ratios (RR), and 95% confidence intervals (95% CIs) were estimated. The overall prevalence of UDS was 8.8% (95% CI = 6.0-11.5), with an overall mean of 0.13 (95% CI = 0.08-0.17) lesions per individual. Those with UDS exhibited a mean of 1.45 (95% CI = 1.28-1.62) lesions.

Results

Lower family income (PR = 1.58; 95% CI = 1.03-2.41) and caries activity (PR = 1.53; 95% CI = 1.01-2.31) were significantly associated with UDS prevalence, while age ≥17 years (RR = 1.43; 95% CI = 1.03-1.99) and caries activity (RR = 1.63; 95% CI = 1.55-2.30) were significantly associated with caries extent. The most commonly affected teeth were lower first molars, followed by upper first molars and lower second molars.

Conclusion

This study found a low prevalence and extent of UDS in the occlusal surface. Sociodemographic variables and caries activity were associated with the occurrence of UDS.

The stamp technique for direct restoration in a ICDAS 4 carious lesion: A 4-year follow-up

OBJECTIVE

This case report described the use of a stamping technique associated with a bulk fill composite to restore an ICDAS 4 carious lesion on a posterior tooth. The 4-year follow-up is also presented.

CLINICAL CONSIDERATIONS

A 32-year-old patient presented a carious lesion on tooth 36 with an underlying dark shadow at the dentin seen from the noncavitated enamel occlusal surface, which was compatible with an ICDAS 4 carious lesion. The lesion was radiographically detected and the caries disease was treated with dietary and hygiene habits orientations. Before accessing the lesion and selectively removing the carious tissue, an occlusal stamp was made by applying a flowable resin composite to copy the anatomy of the noncavitated enamel surface. The cavity was restored using a bulk fill resin composite (Opus Bulk Fill, FGM) with 4-mm-thick increments. Before curing the last increment, a Teflon band was adapted at the uncured bulk fill composite surface and the occlusal stamp made with the flowable composite was pressed against it to reproduce the natural characteristics and initial occlusal anatomy. The top surface was light-activated for 40 s. After 4 years, small wear could be seen in the restoration, but still within clinically acceptable levels.

CONCLUSION

The occlusal stamp technique allows reproduction of the natural anatomy of teeth affected by ICDAS 4 carious lesions with good clinical longevity over 4 years.

CLINICAL SIGNIFICANCE

This case report presents the use of the stamp technique to restore a tooth affected by an ICDAS 4 lesion, in which a carious process reached the dentin and the enamel anatomy was still preserved. The bulk fill resin composite associated with the occlusal stamp was chosen to quickly restore the cavity with clinical predictability. Bulk fill composites allow the insertion of up to 4-mm-thick increments and offer lower shrinkage stress, good clinical longevity and a less time-consuming procedure in cases of posterior teeth, especially if associated with the stamp technique.

Chitosan-induced biomodification on demineralized dentin to improve the adhesive interface

Objectives

Metalloproteinase-inhibiting agents, such as chitosan, can prevent collagen degradation in demineralized dental substrates, thereby improving the adhesive interface. This study evaluated the bond strength (BS) and chemical and morphological characterization of the adhesive interface after applying chitosan solution to demineralized dentin.

Materials and Methods

The 80 third molars were selected. Forty teeth underwent caries induction using the pH cycling method. The teeth were divided according to the treatment: distilled water (control) and 2.5% chitosan solution. The surfaces were restored using adhesive and composite resins. Half of the specimens in each group were aged, and the other half underwent immediate analyses. The teeth were sectioned and underwent the microtensile bond strength test (µTBS), and chemical and morphological analyses using energy-dispersive spectroscopy and scanning electron microscopy, respectively. Data analysis was performed using 3-way analysis of variance.

Results

For µTBS, sound dentin was superior to demineralized dentin (p < 0.001), chitosan-treated specimens had higher bond strength than the untreated ones (p < 0.001), and those that underwent immediate analysis had higher values than the aged specimens (p = 0.019). No significant differences were observed in the chemical or morphological compositions.

Conclusions

Chitosan treatment improved bond strength both immediately and after aging, even in demineralized dentin.

Prevalence and risk indicators for underlying dentin shadows among 12-year-old southern Brazilian schoolchildren

This study aimed to assess the prevalence, extent, and associated factors of underlying dentin shadows (UDS) in the occlusal surfaces of permanent posterior teeth among 12-year-old schoolchildren from southern Brazil. A population-based cross-sectional study that included a representative sample of 1,528 schoolchildren was conducted in Porto Alegre, southern Brazil (participation rate: 83.2%). A questionnaire on sociodemographic characteristics, behavioral habits, and access to dental services was sent to parents/legal guardians of each student selected. Caries examination included the recording of non-cavitated and cavitated lesions, including the presence of UDS, as defined by the ICDAS Group (i.e., a shadow of discolored dentin visible through an apparently intact enamel surface that may or may not show signs of localized breakdown - ICDAS Code 4). The association between predictor variables and UDS prevalence was assessed using survey Poisson regression models. The prevalence of UDS was 6.3% (95%CI = 1.2 -11.3). The mean number of affected teeth among the schoolchildren presenting UDS was 1.51 (95%CI = 1.40 -1.61), ranging from 1 to 6. Type of school (public, PR = 2.23, 95%CI = 1.22 -4.07) and caries experience (DMFT 1-2, PR = 2.41, 95%CI = 1.15 -5.04; DMFT ≥ 3, PR = 3.09, 95%CI = 1.52 -6.27) were significantly associated with UDS prevalence. In conclusion, this population-based cross-sectional study found a low prevalence of UDS in the occlusal surfaces of the permanent posterior teeth of 12-year-old southern Brazilian schoolchildren. Overall caries experience and type of school were associated with UDS in this population.

Radiographic pattern of inactive occlusal enamel lesions and its relationship with caries progression over 4-5 years

OBJECTIVE

To assess the radiographic pattern of inactive enamel caries lesions (IECL) in the occlusal surfaces of permanent molars and to investigate whether the presence of radiolucency at baseline could predict lesion progression over 4-5 years.

METHODS

A prospective cohort study followed 193 schoolchildren from southern Brazil. At baseline, clinical and radiographic examinations were performed. After 4-5 years, clinical examination was repeated following the same protocol. Logistic regression models were used to investigate the relationship between the presence of radiolucency at baseline and caries progression.

RESULTS

This study included 916 permanent molars, classified as sound occlusal surfaces (n = 434), non-cavitated IECL (n = 438), or cavitated IECL (n = 44) at baseline. The proportion of lesions with radiolucency increased as lesion severity increased (p<0.001, chi-square test). The proportion of cases that progressed was significantly higher among teeth showing radiolucency at baseline than among teeth without radiolucency (p<0.001, chi-square test). The presence of radiolucency at baseline was found to be a predictor of caries progression (activity criteria, adjusted OR=3.37, 95%CI=1.66-6.82, p<0.001; severity criteria, adjusted OR=4.01, 95%CI=1.85-8.72, p<0.001).

CONCLUSION

Occlusal surfaces (either sound or with IECL) presenting radiolucency at baseline were more likely to progress over 4-5 years of monitoring and should be monitored more closely.

CLINICAL RELEVANCE

Bitewing radiographs, when available, may be used to identify which surfaces/lesions are more likely to progress and thus, to define proper recall intervals for patient monitoring.