Cross-sectional visual comparison of remineralization efficacy of various agents on early smooth surface caries of primary teeth with swept source optical coherence tomography

Purpose

Sweptsource optical coherence tomography (SS-OCT) permits cross-sectional observation of surface/subsurface characteristics of enamel including early carious lesions (ECL) or remineralization non-invasively.This study aimed to visually compare the cross-sectional remineralizing efficacy of various agents on ICDAS-II scores-1&2 by using SS-OCT and histology.

Methods

Baseline SS-OCT (grey-scale/false-colour) and histology was performed on the randomly selected two samples with scores-1&2. Four remineralizing agents [fluoride-varnish (FV), CPP-ACP, nanohydroxy-paste (NHP) and silver-diamine-fluoride (SDF)]were evaluated for 2-or 6-weeks post-remineralization using SS-OCT and histology.

Results

Score-1&2 baseline SS-OCT images showed a linear-shaped demineralization with dentino-enamel junction (DEJ) visible; and bowl-shaped demineralization with DEJ invisible respectively. Remineralizing agents were assessed on the basis of their ability to remineralize the surface, subsurface and made visualize the DEJ in score-2. SS-OCT showed an outer growth layer in post-remineralization score-1, 2-weeks samples with FV and NHP. All the agents showed progressive subsurface remineralization in 6 weeks. Active lesions showed rapid uptake of minerals on surface. Subsurface mineralization in pigmented score-2 matched sound enamel with NHP and SDF. Surface remineralization was comparable in FV and SDF followed by NHP. SDF demonstrated deeper subsurface remineralization followed by NHP and CPP-ACP.

Conclusion

SS-OCT images correlated to histology. SS-OCT could monitor surface/subsurface in-situde/remineralization activity non-invasively.

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

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.

Occlusal Caries Detection and Diagnosis Using Visual ICDAS Criteria, Laser Fluorescence Measurements, and Near-Infrared Light Transillumination Images

OBJECTIVE

Current diagnostic tools for non-cavitated occlusal caries are not very reliable. For this reason, newer systems need to be developed. The aim of this study was to compare the performance of visual inspection (ICDAS-II), laser fluorescence (DIAGNOdent pen), and the near-infrared transillumination technique (DIAGNOcam) in the detection of non-cavitated occlusal caries lesions under clinical and laboratory conditions in 90 third molar teeth planned for extraction.

MATERIALS AND METHODS

Ninety third molar teeth were firstly examined in clinical conditions, scored according to ICDAS-II criteria, and examined with DIAGNOdent pen and DIAGNOcam devices. After finishing the clinical examination, the teeth were re-evaluated shortly after the extractions with the same methods. Then, the teeth were sectioned for histological validation according to Downer's criteria. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic (ROC) curves were calculated based on the histological results.

RESULTS

For the D0-D1-4 threshold, the area under the ROC curve values ranged between 0.754 and 0.881 for all systems. Sensitivity values ranged between 80.5 and 96.1%, and specificity values ranged between 61.5 and 84.6% for the three caries detection methods. DIAGNOcam had the best correlation value (0.616) according to histological observations and demonstrated a sensitivity rate of 96.1%, a specificity rate of 61.5%, and an accuracy rate of 91.1%.

CONCLUSIONS

DIAGNOcam was found to be the most effective method for the diagnosis of occlusal caries without cavitation in permanent molar teeth.

Differences in Caries Status and Risk Factors among Privileged and Unprivileged Children in Colombia

Objective

The objective of this study was to compare the ICDAS-II caries status and caries-related factors among children from rural and urban schools in Pasto, Colombia.

Materials and Methods

The study included 120 children (4 - 6 year- old children) from rural (privileged) and urban (unprivileged) schools. Caries was evaluated using the ICDAS-II criteria. A survey about the factors related to the presence of caries was applied. Chi-square and Fisher’s tests were used to assess the differences in each study variable between the two groups. A Mann–Whitney U test was used to compare the number of teeth, per ICDAS-II category, between the groups. Negative binomial regression was used to estimate the percentage change in the mean number of teeth, per ICDAS-II category, among the rural and urban students.

Results

Significant differences were found between the rural and urban students for the ICDAS-II 0 and 3-6 categories (p<0.001). The mean number of teeth with moderate-to-severe caries status increased 233% in children from the rural school compared to those attending the urban school (p=0.0). Toothbrushing frequency (p=0.006), cariogenic diet, time elapsed from last dental visit, socioeconomic status, and type of health regime (p<0.001) were among the significant factors related to the rural and urban schools.

Conclusions

This was the first study to compare ICDAS-II caries status between rural and urban students in Colombia. A worse caries status was found in rural students. This study identified the socioeconomic and clinical factors to guide specific interventions for rural children by modifying the available oral health promotion and disease prevention programs.

Multi-Centre Clinical Evaluation of Photothermal Radiometry and Luminescence Correlated with International Benchmarks for Caries Detection

INTRODUCTION

A clinical study was initiated to investigate a caries detection device (The Canary System (CS)), based on photothermal radiometry and modulated luminescence (PTR-LUM). The primary objective of this study was to determine if PTR-LUM values (in the form of Canary Numbers; CN) correlate with International Caries Diagnostic and Assessment System (ICDAS II) scores and clinical situations. The secondary objectives of this study were to monitor the safety of PTR-LUM, and collect data to determine how CN values could be used to differentiate healthy from decayed tooth surfaces on a normalized scale.

METHODS

The trial was a four site, non-blinded study. Data was collected from 92 patients, resulting in 842 scanned tooth surfaces over multiple appointments. Surfaces were assessed according to ICDAS II, and further stratified into five clinical situation categories: 1) healthy surface, 2) non-cavitated white and/or brown spots; 3) caries lesions; 4) cavitation and 5) teeth undergoing remineralization therapy.CN data was analyzed separately for smooth and occlusal surfaces. Using a semi-logarithmic graph to plot raw CN (rCN) and normalized (CN) values, rCN data was normalized into a scale of 0-100.

RESULTS

Linear correlations (R2) between CN and ICDAS II groupings for smooth and occlusal surfaces were calculated as 0.9759 and 0.9267, respectively. The mean CN values derived from smooth (20.2±0.6) and occlusal (19±1.0) surfaces identified as healthy had significantly lower CN values (P<0.05) compared with the values from the other clinical situation categories. No adverse events were reported.

CONCLUSION

The present study demonstrated the safety of PTR-LUM for clinical application and its ability to distinguish sound from carious tooth surfaces. A clear shift from the baseline in both PTR and LUM in carious enamel was observed depending on the type and nature of the lesion, and correlated to ICDAS II classification codes, which enabled the preliminary development of a Canary Scale.

A pilot study of dentists' assessment of caries detection and staging systems applied to early caries: PEARL Network findings

The International Caries Detection and Assessment System (ICDAS II) and the Caries Classification System (CCS) are caries stage description systems proposed for adoption into clinical practice. This pilot study investigated clinicians' training in and use of these systems for detection of early caries and recommendations for individual tooth treatment. Patient participants (N = 8) with a range of noncavitated lesions (CCS ranks 2 and 4 and ICDAS II ranks 2-4) identified by a team of calibrated examiners were recruited from the New York University College of Dentistry clinic. Eighteen dentists-8 from the Practitioners Engaged in Applied Research and Learning (PEARL) Network and 10 recruited from the Academy of General Dentistry-were randomly assigned to 1 of 3 groups: 5 dentists used only visual-tactile (VT) examination, 7 were trained in the ICDAS II, and 6 were trained in the CCS. Lesion stage for each tooth was determined by the ICDAS II and CCS groups, and recommended treatment was decided by all groups. Teeth were assessed both with and without radiographs. Caries was detected in 92.7% (95% CI, 88%-96%) of the teeth by dentists with CCS training, 88.8% (95% CI, 84%-92%) of the teeth by those with ICDAS II training, and 62.3% (95% CI, 55%-69%) of teeth by the VT group. Web-based training was acceptable to all dentists in the CCS group (6 of 6) but fewer of the dentists in the ICDAS II group (5 of 7). The modified CCS translated clinically to more accurate caries detection, particularly compared to detection by untrained dentists (VT group). Moreover, the CCS was more accepted than was the ICDAS II, but dentists in both groups were open to the application of these systems. Agreement on caries staging requires additional training prior to a larger validation study.

The Prevalence of Early Childhood Caries among 24 to 36 Months Old Children of Iran: Using the Novel ICDAS-II Method

STATEMENT OF THE PROBLEM

Early childhood caries is an important oral health issue. Finding its prevalence would predict the need for oral health promotion disciplines for specific age groups.

PURPOSE

The aim of this study was to assess the caries experience of children living in Tehran, Iran. It also would evaluate the impact of gender, ethnicity, and socioeconomic status (SES) on this oral condition.

MATERIALS AND METHOD

This epidemiological cross-sectional study was based upon stratified cluster random sampling. The samples consisted of 239 children (2- to 3- years old) registered in Tehran's public healthcare centers for "Healthy Child Program". Mothers of the recruited children were interviewed for the background data; then children were examined for the oral health status according to ICDAS-II (International Caries Detection and Assessment System) and WHO (World Health Organization) criteria. Statistical analyses were conducted using STATA.11 for SES classification considering six socioeconomic variables, and SPSS.21 for descriptive/analytical analyses.

RESULTS

Primary Component Analysis (PCA) demonstrated five classes of SES ranging from the lowest to the highest. The distribution of caries-free (CF) children was 10.87%, non-cavitated enamel caries (codes 01-02) were 28.03%, and about 61.1% had cavitated caries (codes 03-06). There was no significant difference in caries experience between the two genders. Cavitated lesions were more prevalent among Kurdish, who also had the least CF children. Caries prevalence, especially code 02, was more among children from 3(rd) class SES (moderate level). Gender, ethnicity, or SES had no impact on the CF status of the children; however, ethnicity showed significant impact on the prevalence of extensive caries (codes 05-06).

CONCLUSION

The result of the present study is indicative of high caries prevalence among 2 to 3 years old children residing in Tehran. It highlights the need for comprehensive oral health promotion disciplines for this age group.

Proximal caries lesion detection using the Canary Caries Detection System: an in vitro study

OBJECTIVE

This study investigated the accuracy of the Canary System (CS) to detect proximal caries lesions in vitro, and compared it with conventional methods: International Caries Detection and Assessment System (ICDAS) II and bitewing radiography (BW).

METHODS

Visible proximal surfaces of extracted human teeth were assessed by ICDAS-II before setting them in five manikin mouth models. Then contacting proximal surfaces in mouth models were assessed by BW and CS. Histological validation with polarized-light microscopy served as a gold standard. Pairwise comparisons were performed on area under the curve (AUC), sensitivity, and specificity of the three methods, and corrected using Bonferroni's method. Sensitivities and specificities were compared using a test of proportions and AUC values were compared using DeLong's method.

RESULTS

The CS presented significantly higher sensitivity (0.933) than ICDAS-II (0.733, P = 0.01) and BW (0.267, P < 0.001), and ICDAS-II higher sensitivity than BW (P < 0.001). There were no significant differences between their specificity values: 0.825 (CS), 0.65 (ICDAS-II), and 0.875 (BW). The AUC of CS (0.862) was significantly higher than of ICDAS-II (0.681, P < 0.001) and BW (0.577, P < 0.001).

CONCLUSION

The CS demonstrated greater accuracy in detecting proximal lesions than ICDAS-II and BW, although without significantly higher specificity.