This study has three main objectives: Study 1) test the reproducibility and accuracy of the ICDAS I and ICDAS II caries detection systems;Study 2) validate a new impression material (Clinpro, 3M ESPE), which is said to detect lactic acid in plaque fermenting sucrose; Study 3) devise and test a scoring system for the assessment of caries activity of coronal lesions. Study 1): 141 extracted teeth were examined by two examiners using the ICDAS I and ICDAS II caries detection systems and validated against a histological classification system. Study 2): The accuracy of the impression material in predicting plaque with pH lower/higher than 5.5 was determined in an in situ study of 45 root dentin specimens by comparing the color change in the impression with the actual pH of the plaque, determined with a pH meter. Study 3): A scoring system to assess lesion activity was devised based on the predictive power of the visual appearance of the lesion (ICDAS II system), location of the lesion in a plaque stagnation area and, finally, the tactile feeling, rough/soft or smooth/hard, when running a perio-probe over the lesion. The accuracy was tested in a clinical The results from this study indicate that it is possible to predict lesion depth and assess the activity of primary coronal caries lesions accurately by using the combined knowledge obtained from the visual appearance, location of the lesion and tactile sensation during probing. Study 1): Intra-and inter-examiner reproducibility was found to be excellent (Kappa-values >0.82) and the associations strong (Spearmans correlation coefficients >0.90). Study 2): The Clinpro impression material was found to be acceptable as compared to the results of a pH meter, the combined sensitivity and specificity was 1.63. Study 3): ROC analysis showed that the devised classification system for determining lesion activity had acceptable accuracy (area under curve = 0.84 and the highest combined sum of specificity and sensitivity was 1.67).Thus, it is possible to predict lesion depth and assess the activity of primary coronal caries lesions accurately by using the combined knowledge obtained from visual appearance, location of the lesion and tactile sensation during probing.

The aims of the present study were to investigate the ability of 3 experienced clinicians to detect occlusal carious lesions, assess their depth, diagnose their activity and define a logical management for each lesion. The material consisted of 35 third molars scheduled for extraction or surgical removal making it possible to validate the accuracy of the clinical recordings histologically. Examinations were carried out at baseline and after 4 months in order to monitor lesion progression. At the first visit a radiograph was taken; the number of filled surfaces was counted and the oral hygiene assessed generally and by disclosing occlusal plaque of the tooth under examination. After cleaning the occlusal surface caries was recorded in a selected investigation site using a visual ranked caries scoring system, as well as an electrical conductance recording (ECM). Apart from counting fillings and taking new radiographs the same procedure was performed at the second visit, which then was followed by extraction of the tooth. After sectioning the tooth lesion depth was recorded, and lesion activity, based on acid production, was assessed using methyl red dye. Lesion activity was also judged by means of polarized light microscopic examinations of the sections. Results showed strong relationships between the visual, ECM and radiographic assessments and both lesion depth and lesion activity. In contrast, all other parameters were poorly related to lesion activity. Changes in visual assessments and in conductance readings from first to second examination were poorly associated with lesion activity. In conclusion, clinicians are able to detect lesions, predict activity and severity and define a logical management of occlusal caries on the basis of a single examination.

In the present study, multivariate analyses were performed on clinical and treatment variables that may influence the outcome of endodontic treatment. Data collected in a previous clinical-radiographic follow-up study were used. Of 810 treated, 675 roots in 498 teeth were followed for 6 months to 4 yr. Of these, 192 (the CAP group) had pre-existing, chronic apical periodontitis and 483 (the NAP group) had not. Root canal treatment followed a standard procedure with one of three sealers chosen at random. Demographic, clinical and radiographic variables were recorded at the start of, and during treatment. The periapical index (PAI) score was used to record the outcome of treatment, and applied in two different endpoint modes (END1 and END2) as the dependent variable for multivariate statistical analyses using logistic regression and the general model. The modes reflected increasing PAI scores (END1) and conventional success/failure assessment (END2). Dropouts were largely similar to the cases followed up. A total of 10 preoperative and peroperative variables were found to be significantly associated with treatment outcome by the multivariate analyses of either the total material or the NAP or CAP subgroups. Several of these were not significant in univariate analyses (e.g. the effect of sealer). Conventional success/failure analyses (END2) identified fewer of the influential variables and had low explanatory power, whereas PAI scores on an ordinal scale (END1) were most sensitive in identifying variables of influence on the treatment outcome.

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The purpose of this randomized, clinical study was to evaluate the clinical performance of composite resin materials used for fillings and indirect inlays. Twenty-eight sets of five class II restorations (two fillings, three inlays) were placed in 88 premolars and 52 molars in 28 adults. Brilliant Dentin and Estilux Posterior were used for both fillings and inlays, and SR-Isosit for inlays only. After 11 years, 27 sets of restorations (96%) were evaluated clinically using modified United States Public Health Service criteria. Replaced or repaired restorations were observed in 16% of the fillings and 17% of the inlays, and a further 5% of the restorations were replaced for reasons not related to the restoration. The remaining 107 restorations exhibited optimal ratings in 30% of the fillings and 12% of the inlays (P<0.05) and acceptable ratings in 70% and 88%, respectively. The reasons for failure were fracture of restoration (four fillings, five inlays), secondary caries (two fillings, four inlays), fracture of tooth (two inlays), loss of proximal contact (two fillings), and loss of restoration (one inlay). Failures were seen more frequently in molar than premolar restorations (P<0.05), with no significant difference between fillings and inlays or between the five types of restoration (P>0.05).

Objectives (1) Quantify at which carious lesion depths dentists intervene surgically for cases of varying caries penetration and caries risk; (2) Identify characteristics that are associated with surgical intervention. Methods Dentists in a practice-based research network who reported doing at least some restorative dentistry were surveyed. Dentists were asked to indicate whether they would surgically intervene in a series of cases depicting occlusal caries. Each case included a photograph of an occlusal surface displaying typical characteristics of caries penetration, and a written description of a patient at a specific level of caries risk. Using logistic regression, we analyzed associations of surgical treatment with dentist and practice characteristics, and patient caries risk levels. Results 519 DPBRN practitioner-investigators responded, of whom 63% indicated that they would surgically restore lesions located on inner enamel surfaces, and 90% of lesions located in outer dentin surfaces in a low caries risk individual. Regarding individuals at high caries risk, 77% reported that they would surgically restore inner enamel lesions and 94% reported restoring lesions located on the outer dentin surface. Dentists who did not assess caries risk were more likely to intervene on dentin lesions (p=.004). Practitioner-investigators who were in private practice were significantly more likely to intervene surgically on enamel lesions, compared to dentists from large group practices (p<.001). Conclusion Most dentists chose to provide some treatment to lesions that were within the enamel surface. Decisions to intervene surgically in the caries process differ by caries lesion depth, patient caries risk, assessment of caries risk, type of practice model, and percent of patients who self-pay.

This study aimed at examining whether tactile examination with an explorer may produce traumatic defects in occlusal fissures. The study was carried out in 10 young male adults each of whom was due to have one pair of newly erupted third molars to be extracted. One randomly selected molar in each pair was clinically examined with a dental explorer and the teeth extracted after 1 week. The teeth were serially sectioned and a total of 196 ground sections were examined in a stereomicroscope. Defects were observed in 60% of the sections from experimental teeth in contrast to 7% in the control sections. There was a positive correlation between the size of the defect and the area of enamel opacity which again was associated with the surface morphology. Results indicate that classical use of sharp explorers may produce irreversible traumatic defects in demineralized areas in occlusal fissures favouring conditions for isolated lesion progression.

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