A clinical and microbiological comparative study of deep carious lesion treatment in deciduous and young permanent molars

The aim of this study was to compare one-visit indirect pulp treatment (IPT), two-visit IPT, and direct complete excavation (DCE) of deciduous and young permanent molars with deep carious lesions from clinical and microbiological points of view. One hundred thirty-five teeth (83 deciduous molars and 52 young permanent molars) were included in the study. The teeth were randomly selected and treated either with one-visit IPT, two-visit IPT, or DCE. For two-visit IPT, the final excavation was performed after a period of 3 months. The color, consistency, and humidity of the dentin at the cavity floor were recorded for clinical assessment, and dentin samples were obtained from all teeth. Dentin samples were microbiologically investigated for the total number of colony forming units, mutans streptococci, and lactobacilli. The results showed bacterial growth in 63.8% of the dentin samples in one-visit IPT, while in two-visit IPT, bacterial growth was observed in all of the samples (100%) after the first excavation. When the cavities were reopened before the final excavation, the number of samples with positive growth had decreased significantly (44.4%), and after the final excavation, the number of the samples with positive growth had decreased to 2.2%. In the DCE group, only 25.6% of the samples revealed bacterial growth. No statistical difference was found between deciduous and permanent molars in any of the treatment groups in terms of microbiologic results (p > 0.05). In conclusion, although none of the treatment methods completely eliminated the viable microorganisms during the initial excavations, a dramatic reduction in bacterial growth was detected during the treatment stages of two-visit IPT.     

The clinical assessment of deep carious lesions.

Guidelines as to the depth and potential effect on the pulp of deep carious lesions are given. These guidelines are divided into the influence of the speed of progress, the value of pain symptoms and tooth vitality, the information obtained from radiographs and finally direct observation of the depth and character of the carious lesion during operative procedures.     

An in vitro study of the correlation between clinical and radiographic examinations of proximal carious lesions in primary molars

The present in vitro study assessed the correlation between clinical and interproximal radiographic examinations in diagnosing proximal caries of primary molars. A total of 223 mesial and distal surfaces, from 125 primary teeth, were evaluated clinically and radiographically. The results demonstrated a strong correlation between the increase of depth of radiolucency in radiographic examination and the clinical stage of lesions The interproximal radiographic examination presented an excellent capability for discriminating surfaces with and without cavities in primary molars.     

Validity of MicroCT for in vitro detection of proximal carious lesions in primary molars

Objective

This study aimed to validate the MicroCT for detection of proximal carious lesions in primary molars, using histology as the gold standard.

Methods

Forty-eight proximal surfaces of primary molars were examined. Two calibrated examiners conducted the examinations independently. Proximal surfaces were visually scored, using ICDAS. Bitewing radiographs, Micro-CT and histological analyses used caries scores: 0 = sound; 1 = outer enamel; 2 = inner enamel; 3 = not spread dentine; 4 = outer dentine; 5 = inner dentine. Axial and sagital images were used for Micro-CT analysis, whilst for histology, tooth sections (400 μm) were analyzed stereomicroscopically (×15).

Results

Inter-examiner agreement ranged from 0.87 to 0.93 kappa coefficient (k). Histological analysis revealed a frequency of sound tooth surfaces (18.8%) enamel carious lesions (E1) (48%) and dentine carious lesions (D1) (33.3%). MicroCT showed high correlation with histology (r_s0.88). At both diagnostic thresholds (E1 and D1), sensitivity and accuracy were higher for MicroCT. Inter-device agreement between MicroCT and histology was k = 0.81. No difference was found between MicroCT and histology as gold standards for detecting carious lesions using ICDAS.

Conclusion

MicroCT can be used as a gold standard for detecting carious lesions in proximal surfaces in primary molars.     

Caries removal strategies for deep carious lesions in primary teeth: Systematic review

The study aimed to compare the efficacy of three caries removal techniques—complete caries removal (CCR), selective caries removal (SCR), and stepwise caries removal (SWR)—for deep carious lesions in vital temporary teeth by conducting a systematic review and meta‐analysis of randomized controlled trials (RCTs). Electronic databases (PubMed [MEDLINE], Cochrane Library, EMBASE) were searched for corresponding references up to 31 May 2019. Possible outcomes were pulp exposure, pulpo‐periodontal complications, or restorative failures . Three reviewers independently selected studies, extracted data, and assessed the risk of bias using RoB 2. Meta‐analyses for intention‐to‐treat and per‐protocol scenarios were performed using Revman5. Of 1374 potentially eligible articles, ten relevant references corresponding to eight studies were included. Pooled results showed decreased risk of pulp exposure after SCR (OR: 0.10, 95% CI [0.04, 0.25]) or SWR (OR: 0.20, 95% CI [0.09, 0.44]), compared with CCR. There was a higher risk of composite restorative failure (OR: 2.61, 95% CI [1.05, 6.49]) using USPHS criteria, after SCR compared with CCR only in intention‐to‐treat analysis. Risk of clinical or radiographic failure of pulpo‐periodontal complications was unchanged when compared with SCR and CCR or SWR. SCR and SWR may result in lower pulp exposure risk than CCR. RCTs with lower risk of bias, higher power, and longer follow‐up are required to choose between these three caries removal techniques for deep carious lesions in vital temporary teeth.     

Effect of ozone on non-cavitated fissure carious lesions in permanent molars. A controlled prospective clinical study

PURPOSE: To investigate, with a randomized controlled clinical study, the effect of ozone on non-cavitated initial occlusal fissure caries compared with untreated contra-lateral control lesions (split mouth) considering the patient's current caries risk. METHODS: Forty-one patients with 57 pairs of lesions were enrolled in the study (mean age 7.7 +/- 2.2 years; upper jaw n=29, lower jaw n=28). Gaseous ozone (HealOzone) was applied once for 40 seconds to the randomly assigned test molar of each pair without the use of remineralizing solutions. Lesion progression or reversal was monitored by the laser fluorescence system DIAGNOdent for up to 3 months and the deterioration or improvement compared between the ozone-treated lesions and the untreated control lesions (in pairs). This was done for the whole study population and a subgroup of patients with high current caries risk (lesion pairs n=26). RESULTS: After 3 months, explorative data analysis revealed that the ozone-treated lesions showed significantly more caries reversal or reduced caries progression than the untreated control lesions within the group of patients at high current caries risk (Wilcoxon-Test, P= 0.035). There was no statistical significance examining the whole study population. From the data it can be concluded that ozone application significantly improved non-cavitated initial fissure caries in patients at high caries risk over a 3-month period.     

非龋性磨牙急性牙髓炎的诊断分析

目的 为了进一步提高非龋性磨牙急性牙髓炎的诊断水平。方法 收集我科208例非龋性磨牙急性牙髓炎病例的临床诊治情况，进行总结分析。结果 非龋性磨牙急性牙髓炎发病年龄多在31-60岁，发病原因以隐裂牙较多。结论 非龋性磨牙急性牙髓炎虽诊断较难，但是只在仔细综合检查，一般还是可以确诊的。