The International Caries Classification and Management System (ICCMS™) An Example of a Caries Management Pathway

Ismaïl, Amid I.; Pitts, Nigel; Téllez, Marisol

doi:10.1186/1472-6831-15-s1-s9

Cited by 173 publications

(173 citation statements)

References 78 publications

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“…43 From a scientific perspective, it is well accepted that any surgical restorative intervention should be regarded as a last resort only, 29 and timely recommendations for the type of lesions included in the current study unambiguously opt for a microinvasive sealing regimen. 8, 9, 29, 44 …”

Section: Discussionmentioning

confidence: 90%

Resin infiltration of deproteinised natural occlusal subsurface lesions improves initial quality of fissure sealing

et al. 2017

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The aim of this ex vivo study was to evaluate the infiltration capability and rate of microleakage of a low-viscous resin infiltrant combined with a flowable composite resin (RI/CR) when used with deproteinised and etched occlusal subsurface lesions (International Caries Detection and Assessment System code 2). This combined treatment procedure was compared with the exclusive use of flowable composite resin (CR) for fissure sealing. Twenty premolars and 20 molars revealing non-cavitated occlusal carious lesions were randomly divided into two groups and were meticulously cleaned and deproteinised using NaOCl (2%). After etching with HCl (15%), 10 premolar and 10 molar lesions were infiltrated (Icon/DMG; rhodamine B isothiocyanate (RITC)-labelled) followed by fissure sealing (G-ænial Flo/GC; experimental group, RI/CR). In the control group (CR), the carious fissures were only sealed. Specimens were cut perpendicular to the occlusal surface and through the area of the highest demineralisation (DIAGNOdent pen, KaVo). Using confocal laser-scanning microscopy, the specimens were assessed with regard to the percentage of caries infiltration, marginal adaption and internal integrity. Within the CR group, the carious lesions were not infiltrated. Both premolar (57.9%±23.1%) and molar lesions (35.3%±22.1%) of the RI/CR group were uniformly infiltrated to a substantial extent, albeit with significant differences (P=0.034). Moreover, microleakage (n=1) and the occurrence of voids (n=2) were reduced in the RI/CR group compared with the CR group (5 and 17 specimens, respectively). The RI/CR approach increases the initial quality of fissure sealing and is recommended for the clinical control of occlusal caries.

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Section: Discussionmentioning

confidence: 90%

Resin infiltration of deproteinised natural occlusal subsurface lesions improves initial quality of fissure sealing

et al. 2017

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“…It may be very difficult to decide visually if a noncavitated lesion is deep in the enamel or just into the dentine, which suggests it may be best to use enamel lesion or dentine lesion limited to the outer third versus deeper dentine lesion as the threshold [Ekstrand et al, 2007[Ekstrand et al, , 2011. This threshold may boost the accuracy of the system, but is relevant for managing the lesion, as surgical intervention should mainly be restricted to lesions deeper than the outer third of the dentine [Ismail et al, 2015]. The variety of reference systems could be one additional explanation for the high level of heterogeneity observed among the studies.…”

Section: Publication Bias (Both Reviews)mentioning

confidence: 99%

The International Caries Detection and Assessment System – ICDAS: A Systematic Review

et al. 2018

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The aims of this study were: (1) to evaluate the overall reproducibility and accuracy of the International Caries Detection and Assessment System (ICDAS) for assessing coronal caries lesions, and (2) to investigate the use of systems associated with the ICDAS for activity assessment of coronal caries lesions. Specific search strategies were adopted to identify studies published up to 2016. For the first objective, we selected studies that assessed primary coronal caries lesions using the ICDAS as a reference standard. A total of 54 studies were included. Meta-analyses summarized the results concerning reproducibility and accuracy (correlation with histology, summary ROC curves [SROC], and diagnostic odds ratio [DOR]). The latter 2 were expressed at D1/D3 levels. The heterogeneity of the studies was also assessed. Reproducibility values (pooled) were > 0.65. The ICDAS mostly presented a good overall performance as most areas under SROC were > 0.75 at D1 and > 0.90 at D3; DOR ≥6. For the second objective, we selected studies investigating activity assessment associated with the ICDAS. The meta-analyses pooled results based on the same methodology and parameters as above. Longitudinal findings regarding caries progression were described to estimate the validity of these systems. On average, the systems for activity assessment of caries lesions showed moderate values concerning reproducibility and overall performance. Active caries lesions were more prone to progress than inactive ones after 2 years. In conclusion, the ICDAS presented a substantial level of reproducibility and accuracy for assessing primary coronal caries lesions. Additional systems associated with the ICDAS that classify caries lesion activity can be useful as they are moderately reproducible and accurate.

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“…However, as part of a modern caries management concept, assessment of the caries activity state is required in addition to caries lesion staging [Ismail et al, 2015] in order to estimate whether there is higher or lower likelihood of progress of a lesion. An active lesion is considered to have a greater likelihood of transition (progress, arrest, or regress) than an inactive lesion, and an inactive or arrested lesion is considered to have a lesser likelihood of transition than an active lesion [Pitts et al, 2014].…”

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confidence: 99%

Diagnostic Accuracy of a Bioluminescence System for the Assessment of Caries Activity on Occlusal Surfaces

et al. 2018

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Objective: Assessment of caries lesion activity is usually performed using visual-tactile criteria. A new approach is to use a system consisting of a photoprotein, which is specific for free calcium ions, along with an integrated camera that visualizes the elevated calcium ions on the lesion as a light signal (bioluminescence). This study aimed to evaluate the reproducibility and diagnostic accuracy of a newly developed bioluminescence system to assess caries lesion activity on occlusal surfaces in vitro. Materials and Methods: Ninety-four extracted permanent teeth with sound surfaces and both active and inactive caries lesions were included. The extent and activity of the investigation sites were classified visually according to the International Caries Detection and Assessment System. Digital images of the teeth were produced by the bioluminescence system and the images were analyzed for the presence of caries activity (the bioluminescent areas at the investigation sites). The images were reanalyzed after 4 weeks. Teeth were hemisected and methyl red dye was applied on the sections to validate lesion activity histologically. Results: Agreement between the bioluminescence readings was shown by κ values of 0.802–0.917. A significant positive correlation (p < 0.001) was found across all methods (r_s 0.618–0.811). Sensitivity and specificity for activity assessment using histology as the gold standard (cut-off: active/inactive) were, respectively, 83.6 and 85.0% for the visual assessment, and 92.5 and 90.0% for the bioluminescence method. Comparison of areas under the receiver-operating characteristic curves showed no significant difference between the visual and bioluminescence systems (p = 0.094). Conclusion: The bioluminescence system demonstrated high in vitro reproducibility and good diagnostic accuracy for activity assessment of caries lesions on occlusal surfaces which were not significantly different from the values obtained in the visual assessment.

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The International Caries Classification and Management System (ICCMS™) An Example of a Caries Management Pathway

Cited by 173 publications

References 78 publications

Resin infiltration of deproteinised natural occlusal subsurface lesions improves initial quality of fissure sealing

Resin infiltration of deproteinised natural occlusal subsurface lesions improves initial quality of fissure sealing

The International Caries Detection and Assessment System – ICDAS: A Systematic Review

Diagnostic Accuracy of a Bioluminescence System for the Assessment of Caries Activity on Occlusal Surfaces

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