This split-mouth study aimed to assess the efficacy of resin-infiltrated lesions covered by fluoride varnish (FV) versus FV treatment only of proximal lesions on deciduous molar teeth. The study lasted for 1 year. Children with 2 or more superficial proximal lesions on deciduous molar teeth detected on bitewing radiographs were included. After written parental consent, two lesions in each of 50 children were randomly allocated to one of two treatments: resin infiltration followed by FV (2.26% F) application (test lesion) versus only FV (control lesion). The ICDAS scores of the selected lesions were recorded by 2 clinicians before the treatments (weighted kappa for inter- and intra-examiner agreement >0.79). FV was applied to both test and control lesions 6 and 12 months after the first treatment. After 1 year ICDAS scores were obtained for 42 children and radiographs for 39. One external examiner not familiar with the study scored the radiographs twice (weighted kappa 0.88). Baseline mean age of the children was 7.17 ± (SD) 0.68 and mean def-s was 8.1 ± (SD) 6.9. After 1 year the ICDAS scores of 31% of the test lesions and 67% of the control lesions had progressed (p < 0.01). Radiographically, 23% of the test lesions and 62% of the control lesions had progressed (p < 0.01). Thus, the clinical and radiographic therapeutic effect of both resin infiltration/FV over FV alone was >35% and significant. To conclude, resin infiltration in conjunction with fluoride varnish seems promising for controlling proximal lesion progression on deciduous molar teeth.

The management of occlusal caries still remains a major challenge for researchers as well as for general practitioners. The present paper reviews and discusses the most up-to-date knowledge and evidence of the biological principles guiding diagnosis, risk assessment, and management of the caries process on occlusal surfaces. In addition, it considers the whole spectrum of the caries process on occlusal surfaces, ranging from the molecular ecology of occlusal biofilms to the management of deep occlusal caries lesions. Studies using molecular methods with focus on biofilms in relation to occlusal caries should explore the relationship between the function and the structural composition of these biofilms to understand the role of occlusal biofilms in caries development. State-of-the-art measures to evaluate risk for occlusal caries lesion activity, caries incidence, and progression should include the assessment of the occlusal biofilm and the stage of tooth eruption. Careful clinical examination of non-cavitated lesions, including assessment of the lesion activity status, remains the major tool to determine the immediate treatment need and to follow on the non-operative treatment outcome. Even medium occlusal caries lesions in the permanent dentition may be treated by non-invasive fissure sealing. By extending the criteria for non-invasive treatments, traditional restoration of occlusal surfaces can be postponed or even avoided, and the dental health in children and adolescents can be improved. Selective removal (incomplete) to soft dentin in deep carious lesions has greater success rates than stepwise excavation. Selective (complete) removal to firm dentin has a lower success rate due to increased pulp exposure.

The aim of this study was to assess the possibility to arrest occlusal caries lesions in adults by sealant as well as to assess the presence of radiographic progression, arrest, and regression of the sealed lesions. Seventy-two occlusal caries lesions in 52 adult patients referred to restorative treatment by senior lecturers at School of Dentistry, Copenhagen, Denmark were included. In case the patient had more than one occlusal caries lesion, randomization between sealing and restoration was made; otherwise, the lesion was sealed. In total, 60 resin sealants and 12 composite restorations were made. Follow-up period was 25-38 months (mean = 33 months). Data were analyzed using non-parametric statistics including kappa statistics. After 2-3 years, the dropout rate was 15%; two patients did not show up for control and nine previously sealed lesions were restored by the patients' general practitioners. All 12 restorations and 39 of the remaining 49 sealants were well functioning, seven (14%) sealants were repaired/replaced due to failure, and three (6%) sealed lesions were restored due to caries progression (p > 0.05). The radiographic assessment showed caries progression beneath five (10%) sealants, caries regression beneath one (2%) sealant, and unchanged depth beneath 43 (88%) sealants and all restorations (p > 0.05). The majority of the referred lesions were successfully arrested by sealants, indicating the possibility for extending the criteria for sealing occlusal caries lesions in adults. However, a longer observation period is needed for final conclusion. Extending the criteria of therapeutic sealing of occlusal caries lesions in adults will lead to increased dental health.

<b><i>Objectives:</i></b> To develop an automated fluorescence-based caries scoring system for an intraoral scanner and to<i></i>test the performance of the system compared to state-of-the-art methods. <b><i>Methods:</i></b> Seventy-three permanent posterior teeth were scanned with a three-dimensional (3D) intraoral scanner prototype which emitted light at 415 nm. An overlay representing the fluorescence signal from the tissue was mapped onto 3D models of the teeth. Multiple examination sites (<i>n</i> = 139) on the occlusal surfaces were chosen, and their red and green fluorescence signal components were extracted. These components were used to calculate 4 mathematical functions upon which a caries scoring system for the scanner prototype could be based. Visual-tactile (International Caries Detection and Assessment System, ICDAS), radiographic (ICDAS), and histological assessments were conducted on the same examination sites. <b><i>Results:</i></b> Most index tests showed significant correlation with histology. The strongest correlation was observed for the visual-tactile examination (<i>r</i>_s = 0.80) followed by the scanner supported by the caries classification function that quantifies the overall fluorescence compared to sound surfaces (<i>r</i>_s = 0.78). Additionally, this function resulted in the highest intra-examiner reliability (κ = 0.964), and the highest sum of sensitivity (SE) and specificity (SP) (sum SE-SP: 1.60–1.84) at the 2 histological levels where the comparison with visual-tactile assessment was possible (κ = 0.886, sum SE-SP = 1.57–1.81) and at the 3 out of 4 histological levels where the comparison with radiographic assessment was possible (κ = 0.911, sum SE-SP = 1.37–1.78); the only exception was for the lesions in the outer third of dentin, where the radiographic assessment showed the highest sum SE-SP (1.78). <b><i>Conclusion:</i></b> A fluorescence-based caries scoring system was developed for the intraoral scanner showing promising performance compared to state-of-the-art caries detection methods. The intraoral scanner accompanied by an automated caries scoring system may improve objective caries detection and increase the efficiency and effectiveness of oral examinations. Furthermore, this device has the potential to support reliable monitoring of early caries lesions.

Aim: To develop a measurement method to quantify the depth and width of occlusal caries lesions. Material and Methods: One hundred and ten extracted permanent molars with occlusal caries lesions were selected, then visually scored by ICDAS scoring system and then sectioned mesiodistally, resulting in a facial and a lingual fraction. Digital photos and radiographs were taken from each section. By randomization, one of the sections was chosen for further examinations. First digital photos were taken. Depth and width of the lesions were marked with arrows on the images both before (H_un-col) and after coloring (H_col) the sections. The same types of measurements were done on the radiographs (R). The relative dentinal depth and width of the lesions were measured in the same order. Results: Weighted intra- and interexaminer kappa value for ICDAS scorings varied between 0.85 and 0.90. Intraexaminer kappa for dentinal depth in 36 randomized selected teeth was calculated to 0.75 (H_un-col), 0.91 (H_col), 0.79 (R) and for dentinal width to 0.84 (H_un-col), 0.96 (H_col), 0.84 (R). Significant correlations were found between ICDAS scorings and the measurements of depth and width of lesions in H_un-col, H_col, and R (p < 0.000). The lowest difference was measured between H_un-col and H_col in both relative depth and width of the lesion with maximum differences up to 45% (H_un-col–H_col) and 73% (H_col–R). Conclusion: It is possible to measure depth and width of occlusal caries lesions by means of histological and radiographic technique with acceptably high reproducibility using this method.

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Proximal sealing and proximal infiltration may have a place in the treatment of non-cavitated proximal lesions. Proximal caries is a problem in both primary and permanent dentitions. Proximal sealants or lesion infiltration are possible treatments.

Infiltration and sealing occlusal surfaces with initial caries lesions on primary molar teeth showed a high efficacy in arresting caries progression, significant for the I+F or borderline significant for the S+F compared with the F group.