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Background: The purpose of this study was to evaluate the validity of near-infrared light reflection for detecting different depths of proximal caries in posterior teeth and to compare it with commonly used clinical oral examinations and bitewing radiography images., Methods: Twenty-six patients with a total of 516 proximal surfaces were included in this study. The ground truth of the proximal caries was determined through a consensus reached by two experienced dentists after an intraoral examination assisted by bitewing radiographs. Two general dentists assessed the condition of proximal caries on posterior teeth on near-infrared light reflection images. Accuracy, sensitivity, and specificity were evaluated to determine the diagnostic efficacy of near-infrared light reflection for detecting proximal caries in posterior teeth., Results: For posterior teeth, the accuracy of near-infrared light reflection was 0.78, with a sensitivity of 0.44 and a specificity of 0.83. Cohen's kappa showed poor consistency between the two diagnostic methods, near-infrared light reflection and bitewing radiography., Conclusion: Near-infrared light reflection is an effective clinical tool for detecting proximal caries in posterior teeth, yet this method does not demonstrate superiority over traditional methods such as bitewing radiography., Trial Registration: The clinical trial was registered with the China Clinical Trial Registry ( https://www.chictr.org.cn/ ) on 18 August 2023 under the trial number ChiCTR2300074877., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval: This study protocol was reviewed and approved by [Ethics Committee of Zhejiang Provincial People’s Hospital, China], approval number [QT2023172]. Consent for publication: Not applicable. Consent to participate: All data collection and recordings were performed anonymously, and written informed consent was obtained from all patients before they underwent the examination. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: This study aimed to determine the correlation between proximal caries and the extent and site of pulp canal obliteration (PCO) in cone-beam computed tomographic (CBCT) scans of mandibular molar teeth., Methods: A total of 1491 CBCT scans of patients 18-49 years of age were selected from the database (2002-2022). From them, 328 teeth with proximal caries and satisfying inclusion criteria were evaluated by 2 calibrated evaluators. PCO was observed in the sagittal and coronal planes. PCO and proximal caries were compared concerning different age groups, sexes, and sites using an independent sample t test., Results: The prevalence of PCO among patients with proximal caries is 47%. In mesial proximal caries, the extent of PCO is significantly greater in the distal root canal (73.4%), whereas in distal proximal caries, PCO is more often found in the mesial canal (77.3%). The mean extent of intraradicular calcification was higher in the distal canal (P < .001). Moreover, mesial proximal caries showed a greater extent of intraradicular obliteration (P < .001). The probability of developing PCO was significantly higher in females (P = .003)., Conclusions: Within the limitations of this study, it can be concluded that the extent of calcification is more common on the opposite side of the location of the proximal caries. Moreover, such intraradicular calcification is greater in a distal canal compared to a mesial canal. Sex plays a significant role in the calcification process, showing higher predilection in females compared to males., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: proximal enamel caries lesions (PEC) are believed to initiate and progress to cavitation below the proximal contact area (PCA), but no evidence exists on the location of initial carious cavitation on the proximal surface with functional PCA. This study aimed to test the association of anatomical areas of the proximal surface with the severity of PEC and the frequency of cavitation in PEC in primary molars DESIGN: laboratory, observational, transversal study. Exfoliated primary molars (n = 33) with functional PCA (biofilm-free PCA surrounded by biofilm) had their proximal surfaces (one/tooth) divided anatomically into up to nine areas: 3 areas based on the occlusal/cervical PCA boundaries (areas I, II, and III; occluso-cervically) and 3 areas based on the bucco/lingual PCA boundaries (A, B, and C), with area IIB representing the PCA and area IIIB as the sub-PCA (below the PCA). PEC (ICDAS scores 1 and 2-3) and cavitation in PEC were quantified in all areas using stereomicroscopy and microCT. PEC volume was quantified in areas IIB and IIIB under microCT RESULTS: PEC severity increased occluso-cervically. PCA and sub-PCA presented different PEC severities (higher in sub-PCA) and similar PCE volumes, but the odds of carious cavitation were much higher (Odds ratio = 197.4; 95 % CI: 8.7/4480.7) in the PCA than in the sub-PCA (no cavitation)., Conclusion: PCA presented lower PEC severity and similar PEC volume compared to sub-PCA, but PCA concentrated all cavitations in PEC, supporting a new model for the pathogenesis of PEC., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to assess the accuracy of ultra-low dose (ULD) cone-beam CT (CBCT) for detection of proximal caries., Methods: This in vitro study evaluated 104 molar and premolar teeth. The teeth were mounted in dry skulls and underwent CBCT with 4 protocols of high-resolution (HR), normal (NORM), ULD-HR, and ULD-NORM; 78 CBCT images were scored by 3 observers for the presence and penetration depth of caries twice with a 2-week interval using a 5-point Likert scale. The teeth were then sectioned and observed under a stereomicroscope (gold standard). The 4 protocols were compared with each other and with the gold standard. The receiver operating characteristic curve was drawn, and the area under the curve (AUC) was calculated and compared by the Chi-square test (alpha = .05)., Results: The interobserver agreement ranged from 0.5233 to 0.6034 for ULD-NORM, 0.5380 to 0.6279 for NORM, 0.5856 to 0.6300 for ULD-HR, and 0.6614 to 0.7707 for HR images. The intra-observer agreement ranged from 0.6027 to 0.8812 for ULD-HR, 0.7083 to 0.7556 for HR, 0.6076 to 0.9452 for ULD-NORM, and 0.7012 to 0.9221 for NORM images. Comparison of AUC revealed no significant difference between NORM and ULD-NORM (P > .05), or HR and ULD-HR (P > .05). The highest AUC belonged to HR (0.8529) and the lowest to NORM (0.7774)., Conclusions: Considering the significant reduction in radiation dose in ULD CBCT and its acceptable diagnostic accuracy for detection of proximal caries, this protocol may be used for detection of proximal carious lesions and assessment of their depth., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology and the International Association of Dentomaxillofacial Radiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: Intraoral scanners commonly used in orthodontic offices now offer near-infrared imaging (NIRI) technology, advertised as a screening tool to identify interproximal caries. This study aimed to evaluate the reliability and validity of NIRI detection of interproximal carious lesions in a common intraoral scanner (iTero Element 5D; Align Technology, San Jose, Calif) with and without bitewing radiograph complement, compared with a microcomputed tomography (micro-CT) reference standard., Methods: Extracted human posterior teeth (premolars and molars) were selected for early (noncavitated) interproximal carious lesions (n = 39) and sound control surfaces (n = 47). The teeth were scanned via micro-CT for evaluation by 2 blinded evaluators using consensus scoring. The teeth were mounted to simulate anatomic interproximal contacts and underwent a NIRI scan using iTero Element 5D and bitewing radiographs. Two trained, calibrated examiners independently evaluated (1) near-infrared images alone with clinical photograph, (2) bitewing radiograph alone with clinical photograph, and (3) near-infrared images with bitewing radiograph and clinical photograph in combination, after at least a 10-day washout period between each evaluation., Results: Interrater reliability was highest for NIRI alone (k = 0.533) compared with bitewing radiograph alone (k = 0.176) or in combination (k = 0.256). NIRI alone showed high specificity (0.83-0.96) and moderate sensitivity (0.42-0.63) compared with a micro-CT reference standard. Dentin lesions were significantly more reliably detected than enamel lesions., Conclusions: After rigorous training and calibration, NIRI can be used with moderate reliability, high specificity, and moderate sensitivity to detect noncavitated interproximal carious lesions., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: Radiographs are an integral part of detecting proximal caries. The aim of this study was to evaluate the effect of contrast, brightness, noise, sharpness, and γ adjustment of digital intraoral radiographs on the diagnosis of proximal caries., Materials and Methods: In this in vitro study, 40 extracted teeth including 20 premolars and 20 molars with enamel lesions (white spot or dentin discoloration seen through the enamel) were mounted together in groups of eight inside the skull. Bitewing radiographic images of each dental group were obtained by a photostimulable phosphor plate sensor with exposure conditions of 8 mA, 70 kV, and 0.2 s. The images were reconstructed by the built-in software and examined by two oral and maxillofacial radiologists in various settings of contrast, brightness, sharpness, noise, and γ. The teeth were then cut mesiodistally and the presence or absence of caries was confirmed by an oral and maxillofacial pathologist using a stereomicroscope. The data were then analyzed using the κ agreement coefficient, sensitivity, specificity, and accuracy (α = .05)., Results: Adjustment of brightness and contrast led to higher diagnostic performance with an accuracy of 82.5% and 83.8 (for observers 1 and 2, respectively) and 82.5% (for both observers), respectively. Noise adjustment was the least helpful approach for diagnosis of proximal dental caries among other adjustments, with an accuracy of 78.8% and 77.5% for observers 1 and 2, respectively., Conclusion: Brightness and contrast setting was more efficient in improving the diagnostic potential of bitewing radiographs compared to other adjustments., (© 2024 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Purpose: To evaluate the proximal caries progression in primary molars using the radiographic International Caries Detection and Assessment System (ICDAS)., Methods: A study was conducted on 196 children aged 3-9 years old who underwent the clinical examination and bitewing radiography during baseline and 6-month (and over) follow-up visits. The primary molars bitewing radiographs with initial enamel caries (RA1 and RA2) or outer dentine caries (RA3) of proximal surfaces were included. Caries advancement was scored using ICDAS criteria and statistical analyses with the chi-square test. Median survival time was evaluated using Kaplan-Meier survival curves and log-rank tests., Results: A total of 439 surfaces of primary molars were included in this study and an averaged follow-up period of enamel and dentine caries group were 18.3 ± 9.6 months and 16.5 ± 9.5 months respectively. The progression of proximal enamel lesions significantly differed between primary maxillary and mandibular molars (p = 0.002) and among each patient's primary mandibular second molar and the others (p = 0.002). On the contrary, the outer dentine caries of each group of primary molars was not different. The median survival time of the initial enamel proximal caries (23.30 months) was non-significantly longer than that of the dentine (20.80 months)., Conclusions: Progressions of the initial enamel proximal caries were significantly different among primary molars at the average 18.3-month follow-up. The median survival period of the enamel proximal caries was more extended than that of dentine but without statistical difference. These results provide essential information for dentists regarding an appropriate appointment for bitewing examinations., (© 2024. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

This paper introduces a novel application of the laser speckle technique in dentistry, focusing on assessing the efficiency of dental excavation methods used to remove decayed tooth structure. The aim is to evaluate the efficiency of two chemo-mechanical agents and the high-speed drill using the laser speckle technique, which offers objective, non-invasive, and real-time evaluation capabilities. Extracted human primary molars with active occlusal carious lesions were sectioned into three parts, with each part allocated to one of three groups: Group 1 (Brix3000 ® ), Group 2 (Papacarie DUO ® ), and Group 3 (High-speed drill mechanical caries removal). Caries removal was performed using the designated agent or method for each group. After caries excavation, speckle imaging using a 632.8 nm laser was conducted. Additionally, SEM was used to acquire micro-photographs of the surface morphology of the treated samples. The findings reveal insights into the comparative efficiency of the three dental excavation agents and methods using the laser speckle technique. The speckle parameters extracted from speckle patterns generated by treated teeth provide valuable information for evaluating the performance of the excavation methods. The scanning electron microscopy images also offer detailed visual evidence to support the analysis. This paper demonstrates the potential of the laser speckle technique for assessing the efficiency of dental excavation methods. The objective, non-invasive, and real-time evaluation provided offers advantages over subjective visual assessment and manual measurements., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Objectives: The trial aimed to compare the clinical performance and radiographic success of ACTIVA BioACTIVE versus Compomer in restoring class-II cavities of primary molars., Materials and Methods: A non-inferior split-mouth design was considered. A pre-calculated sample size of 96 molars (48 per group) with class-2 cavities of twenty-one children whose ages ranged from 5 to 10 years were randomly included in the trial. Pre-operative Plaque Index (PI), DMFT/dmft scores and the time required to fill the cavity were recorded. Over 24 months, the teeth were clinically evaluated every six months and radiographically every 12 months by two calibrated and blinded evaluators using the United States public health service (USPHS)-Ryge criteria. The two-sided 95% confidence interval (CI) for the difference in success rate was considered to assess non-inferiority, and the margin was set at -18%. The linear mixed model and Firth's logistic regression model were used for data analysis (P < 0.05)., Results: After 24 months, 86 teeth (43 per group) were evaluated. The mean PI score was 1.1(± 0.9), while DMFT/dmft was 0.35 (± 0.74) and 6.55 (± 2.25) respectively. The clinical and radiographic success rate of Dyract vs. ACTIVA was 95.3% and 88.3% vs. 93% and 86%, respectively. The two-sided 95% CI for the difference in success rate (-2.3%) was - 3.2 to 1.3% and didn't reach the predetermined margin of -18% which had been anticipated as the non-inferiority margin. Clinically, ACTIVA had a significantly better colour match (P = 0.002) but worse marginal discolouration (P = 0.0143). There were no significant differences regarding other clinical or radiographic criteria (P > 0.05). ACTIVA took significantly less placement time than Dyract, with a mean difference of 2.37 (± 0.63) minutes (P < 0.001)., Conclusion: The performance of ACTIVA was not inferior to Dyract and both materials had a comparable high clinical and radiographic performance in children with high-caries experience. ACTIVA had a significantly better colour match but more marginal discolouration. It took significantly less time to be placed in the oral cavity., Trial Registration: The study was registered at ClinicalTrials.gov on 4 May 2018 (#NCT03516838)., (© 2024. The Author(s).)

Aim: To evaluate the presence and status of retained DM2 without permanent successors in relation to age., Background: Preservation of retained deciduous second molars (DM2) can be applied to treat congenital absence of second premolars (PM2). However, the consequences of caries and progressing root resorption or infraocclusion may affect their survival., Methods: Panoramic radiographs of individuals >10 years of age with agenesis of at least one PM2 were evaluated and divided into three groups according to age. The presence and location of retained DM2, caries/restorations, infraocclusion and root resorption were investigated., Results: A total of 131 subjects with PM2 agenesis were included (mean age: 13 years 11 months). The majority were missing one or two PM2. In total, 174 retained DM2 were present (33%), and their incidence was higher in the younger age groups. Caries/restorations were found in 88 (50.6%) and infraocclusion in 21 (12%) retained DM2. The roots were resorbed mostly for ½ of the root length (35%)., Conclusion: Long-term prognosis of retained DM2 without permanent successors seems uncertain, especially within the younger age group. In individuals older than 17 years, the prognosis for a healthy DM2 is favorable, if no distinct infraocclusion or extensive root resorption is present.

Background: Most studies assessing the sensitivity and specificity of caries detection methods have been performed in vitro using the histological method as the gold standard showing inconsistent values. The aim of this study was to compare the sensitivity and specificity in detecting occlusal caries using the International Caries Detection and Assessment System (ICDAS II) with the radiographic method (RM), while using the Spectra™ Caries Detection System (SCDS) as the reference test., Methods: One hundred sixty children, ages 7-12 years, participated in the study. Five zones in the occlusal surfaces of 859 primary and 632 first permanent molars were examined visually using ICDAS-II, the RM using bitewing radiographs and SCDS. The descriptive statistics of sensitivity and specificity were calculated and compared., Results: For all molars combined and for primary molars only, the sensitivity of ICDAS II was higher for detecting total caries (p < 0.001), caries in enamel (p < 0.001), and caries in dentin (p = 0.016), but it was not different for detecting caries in the dentin of permanent first molars (p = 0.214), and primary second molars (p = 0.761). The specificity of RM was higher for detecting total caries, caries in enamel for all molars combined and for permanent first molars (p < 0.001). For caries in dentin, the specificity of ICDAS II was higher for all molars combined and for primary molars only (p < 0.001). For total caries in primary molars only, and caries in dentin of permanent first molars only, the specificity was not different (p = 0.156 and p = 0.181 respectively)., Conclusions: The sensitivity and specificity of ICDAS II and RM changes depending on whether the carious lesion compromises the enamel or dentin, and if the caries detection is performed in the primary molars or permanent first molars., (© 2023. The Author(s).)

Purpose: With success rates comparable to that of root canal treatment, vital pulp therapy (VPT) has gained clinical interest and has been used in the management of young permanent teeth with inflamed pulps. The aim of the present study was to retrospectively evaluate the radiographic success of VPT in young first permanent molars 24 months post-treatment and correlate findings with tooth and treatment-related characteristics., Materials and Methods: Dental records of all patients with first permanent molars which received VPT in the Department of Paediatric Dentistry (National and Kapodistrian University of Athens) were retrieved. Demographic characteristics and data regarding the treatment performed were recorded. Patients' radiographs were evaluated at 6, 12 and 24 months post-treatment by two qualified paediatric dentists blinded regarding the treatment performed. Radiographic success, reasons for failure and continuation of root development were evaluated. Differences were tested using the Χ2 and Student's t-test, and possible correlations were determined by calculating the odds ratio., Results: Overall radiographic success rate at 24 months was 77%, ranging between 50% for direct pulp capping and 92% for full pulpotomy. Differences were not statistically significant. Continuation of root development was recorded in almost 1/3 of the teeth and completion in almost 1/5. No statistically significant association was recorded between the outcome and any tooth and treatment-related variables., Conclusion: VPT seems to be a reliable option in the long term for the treatment of deep carious lesions in young permanent molars.

Objectives: The aim of this study was to validate the near-infrared imaging (NIRI) in comparison with visual inspection (VI) for early detection of proximal caries in primary molars., Methods: VI and intraoral scans were performed on 126 patients aged 3-12 years with at least one non-cavitied and non-restored proximal tooth surface, who were scheduled for bite wing radiography (BWR) as part of their standard care. Teeth with signs of proximal cavities, restorations or residual caries were excluded in this study. BWR, a gold standard to diagnose proximal caries in primary molars, was used to validate the findings of NIRI and VI. The accuracy, sensitivity, specificity and the area under the curve (AUC) of NIRI and VI were calculated., Results: The accuracy, sensitivity and specificity of NIRI were 82.89%, 74.10% and 90.97%, while those of VI were 71.64%, 43.88% and 97.14%, respectively. NIRI showed higher accuracy and sensitivity, and lower specificity (P < 0.001). The AUC of NIRI was higher than that of VI (0.826 vs 0.706; P < 0.05)., Conclusions: NIRI showed higher sensitivity and lower specificity compared with VI when detecting proximal caries in primary molars. Therefore, it is recommended to use NIRI in combination with BWR to improve the detection rate of proximal caries in primary molars., Clinical Significance: In children, there is a high incidence of proximal caries in primary molars, which require high technical sensitivity for detection. NIRI shows high sensitivity in detecting proximal caries, which may improve their detection rate in primary molars., The Clinical Trial Registration Number: ChiCTR2300070916., Competing Interests: Declaration of Competing Interest The Authors deny any conflict of interest related to this study/manuscript., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Permanent first molars with severe dental caries, developmental defects, or involved in oral pathologies are at risk of poor prognosis in children. Accordingly, using the third molar to replace the first molar can be a good treatment option when third molar agenesis is predicted early. Thus, this retrospective cohort study aimed to develop criteria for early detection of mandibular third molar (L8) agenesis based on the developmental stages of mandibular canine (L3), first premolar (L4), second premolar (L5), and second molar (L7)., Method: Overall, 1,044 and 919 panoramic radiographs of 343 males and 317 females, respectively, taken between the ages of 6 and 12 years were included. All developmental stages of L3, L4, L5, L7, and L8 were analyzed based on the dental age, as suggested by Demirjian et al. The independent t-test was used to assess age differences between males and females. The rank correlation coefficients were examined using Kendall's tau with bootstrap analysis and Bonferroni's correction to confirm the teeth showing developmental stages most similar to those of L8s. Finally, a survival analysis was performed to determine the criteria for the early diagnosis of mandibular third molar agenesis., Results: Some age differences were found in dental developmental stages between males and females. Correlation coefficients between all stages of L3, L4, L5, and L7 and L8 were high. In particular, the correlation coefficient between L7 and L8 was the highest, whereas that between L3 and L8 was the lowest., Conclusion: If at least two of the following criteria (F stage of L3, F stage of L4, F stage of L5, and E stage of L7) are met in the absence of L8 crypt, agenesis of L8 can be confirmed., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: The aim of this study was to evaluate the influence of the extensive use of a photostimulable phosphor (PSP) receptor on the diagnosis of proximal carious lesions., Study Design: Forty posterior teeth were paired and mounted in 20 phantoms. Using a PSP receptor of the Express intraoral system, 1 radiograph of each phantom was acquired, totaling 20 radiographs (group 1). After 400 acquisitions, another radiograph of each phantom was obtained, totaling 20 new radiographs (group 2). This procedure was also done after 800 (group 3), 1,200 (group 4), and 1,600 (group 5) acquisitions, resulting in 100 radiographs. Another 40 radiographs (20 phantoms × 2 groups) were obtained with a second PSP sensor to evaluate the diagnostic replicability of the receptors. All 140 radiographs were assessed independently by 5 examiners for the presence of proximal caries. Area under the receiver operating characteristic curve, sensitivity, and specificity were calculated and compared among the groups by analysis of variance. The Student t test evaluated the diagnostic replicability of the receptors. The significance level was set at 5% (P < .05)., Results: The diagnostic outcomes for proximal caries did not differ among the groups (P ≥ .37). The diagnostic values did not differ among the radiographs acquired with the 2 PSP receptors (P ≥ .75)., Conclusions: The diagnosis of proximal carious lesions was not affected by extensive use of the PSP receptor., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To develop clinically applicable methods to characterize occlusal topography and assess possible associations between morphology and caries incidence and development., Design: In this retrospective clinical study, we evaluated caries presence and severity pre- and post-orthodontic treatment for first molars of 147 patients (384 teeth). These teeth were previously scanned using a clinical intraoral scanner, and the obtained digital elevation models were used to 1) analyze the 3D occlusal surface parameters (n = 384) and 2) quantitatively characterize the mandibular molars' (n = 166) fissure patterns using three novel methods. Pearson correlation coefficients were calculated to evaluate the associations among the measurements, and presence/severity of caries pre- and post-treatment were assessed using generalized linear mixed-effects models., Results: Robust quantitative fissure characterizations were developed, and reliable occlusal surface parameters were obtained. In the studied population, none of the parametric measurements (Slope: p = 0.62 for presence, p = 0.96 for severity; Relief Index (RFI): p = 0.36, p = 0.84; Orientation Patch Count rotated (OPCr): p = 0.48, p = 0.13; Dirichlet Normal Energy (DNE): p = 0.91, p = 0.15) or the fissure morphological measurements (Mesial Angle: p = 0.43; Distal Angle: p = 0.86; Average Angle: p = 0.52; Area Difference: p = 0.83; Percent Fissure: p = 0.68) were found to be significantly associated with caries status or severity., Conclusion: Despite the lack of correlation in the limited studied sample, the tools developed to characterize occlusal surface topography and fissure morphology have the potential to be used in more comprehensive clinical evaluations., Competing Interests: Conflict of Interest All the authors have declared no conflict of interest, (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to evaluate the clinical and radiographic outcomes of direct pulp capping (DPC) using calcium hydroxide (CH), mineral trioxide aggregate (MTA), and premedicated DPC with formocresol (FC) in primary teeth. Methods: Sixty primary mandibular second molars with pulp exposures in children aged four to eight years old were treated using DPC. The molars were randomly divided into three groups (n equals 20 per group). Pulp exposures in the CH and MTA groups were capped directly using CH and MTA pastes, respectively, while those in the FC group were premedicated with FC and then capped with zinc oxide eugenol (ZOE) cement. All teeth were finally restored with stainless steel crowns, and clinical and radiographic evaluations were carried out at baseline and three, six, and 12 months after restoration. Fisher's exact test was performed to define the significance between the groups and follow-up periods. Results: The clinical and radiographic findings showed no significant difference between the three groups. The overall success in the CH, MTA, and FC groups were 88.2 percent, 100 percent, and 73.3 percent, respectively. However, these differences were not statistically significant (P>0.05). Conclusion: All three materials examined in this study exhibited clinical and radiographical efficacy when used as direct pulp capping materials.

Background: Lately, a paradigm shift from radical to conservative approach has popularized the selective caries removal over complete excavation in deep caries. Indirect pulp therapy over pulpotomy is being preferred due to risk of questionable pulp vitality in carious exposure of pulp. Silver diamine fluoride can be a useful tool for noninvasive caries management due to its antimicrobial and remineralization properties. Aim: The study aims to evaluate the success of minimum intervention approach using silver-modified atraumatic restorative technique (SMART) as indirect pulp treatment compared to conventional vital pulp therapy in symptomless deep carious lesions of primary molars. Materials and Methods: In this comparative, prospective, double-blinded, clinical interventional study, 60 asymptomatic primary molar teeth with international caries detection and assessment system score 4-6 were selected in children aged 4-8 years and were randomly allocated into SMART and conventional groups. The success of the treatment approach was assessed using clinical and radiographic criteria at baseline, 3, 6, and 12 months interval. Results: Data were analyzed using Pearson Chi-Square test at a significance level of 0.05. Conventional group showed 100% and SMART observed 96.15% clinical success at 12 months follow up (P > 0.05). One radiographic failure due to internal resorption at 6 months in SMART and one in the conventional group at 12 months was reported though the difference was insignificant (P > 0.05). Conclusion: Removal of all infected dentin in deep carious lesions is not required for successful caries treatment and SMART can be recommended as a potential biologic approach to manage asymptomatic deep dentinal lesions, based on optimal case selection.

When complete caries removal will lead to pulp exposure, partial caries removal may be considered as an alternative treatment option. Various techniques can be used in such situations to preserve pulp vitality. Incomplete removal of carious dentin and subsequent carious dentin sealing has been found to result in the arrest of carious lesions in deciduous and permanent teeth. This case report documents the treatment a young patient who presented with a mandibular left first molar that exhibited active coronal caries that had reached the apical third of the dentin. With a high risk of pulp exposure, the case demonstrates the use of conservative procedures that produced effective results in preserving pulp vitality.

Objectives: This two-arm, parallel-group, tooth-randomised, controlled noninferiority clinical trial aimed to compare survival rates between the sealing and restoring of cavitated occlusal carious lesions in dentine [International Caries Detection and Assessment System (ICDAS) 5] of deciduous molars using resin-modified glass-ionomer cement (RMGIC) and to assess caries progression radiographically., Materials and Methods: A total of 68 molars with ICDAS 5 occlusal lesions were randomly allocated into two groups, a sealing group (n = 31), in which RMGIC was placed directly over the carious lesion, and a restoration group (n = 37), in which a restoration with the same material was placed after selective caries removal. During the baseline and follow-up visits, dental caries was registered and caries activity was assessed according to a visuotactile criterion. At baseline, patient caries status (dmf-t) and cavity depth and extent (mesiodistal and buccolingual) were measured before RMGIC placement. An independent and blinded examiner evaluated the treated teeth using the USPHS criteria after one and two years. Standardised interproximal radiographs were taken for caries progression assessments., Results: During the follow-up period, no lesion progression was observed radiographically. After one year (n = 60; 27 sealed and 33 restored) and two years (n = 48; 23 sealed and 25 restored) of follow-up, the treatment success rates were 78.8% and 76.0% in the restoration group and 59.3% and 47.8% in the sealing group, respectively. Multivariate Cox regression showed that lesions smaller than 2 mm in the mesiodistal extent were less prone to fail after one year (p = 0.03). However, survival curves (log-rank test) were statistically significantly different only after two years (p < 0.001)., Conclusions: Sealing ICDAS 5 occlusal lesions of deciduous molars using RMGIC achieved lower survival rates than restorations. Both sealing and restoration effectively arrested caries progression for two years. Clinical relevance Sealing dentine carious lesions can be effective for treating lesions involving the inner and outer half of the dentine. Ultraconservative treatments can arrest carious lesions presenting obvious cavitation in primary molars., Trial Registration: ReBEC Register no. RBR-225n35., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This retrospective study aimed to (i) survey the correlation between decayed, missing, filled teeth (DMFT), and presence of first permanent molars (FPMs) with poor prognosis and (ii) evaluate the treatment requirements., Materials and Methods: Seven hundred seventy-three children with fully erupted FPMs were included in this study. DMFT for the permanent dentition, FPMs, and Global DMFT were evaluated based on clinical and radiographic evaluation. The ratio of deep dentin caries (DDC) and apical lesion presence among FPMs, including treatment requirements, were analysed. Spearman rank correlation coefficient and t tests were used for statistical analysis., Results: The caries prevalence was found at 61.4%, where the mean DMFT was calculated as 1.89 ± 2.15. There was a positive correlation between DMFT values and age (r s  = 0.27). On the other hand, there was a negative correlation between global DMFT values and age (r s  =  - 0.29). Regarding treatment needs of FPM with poor prognosis, 12.03% of the teeth needed pulpectomy, 8.93% pulpotomy, 8.93% pulp capping, and 5.3% extraction. Having higher DMFT values was correlated significantly (p < 0.01) with the presence of DDC (r s  = 0.50) and apical lesion (r s  = 0.34). Susceptibility to DDC and apical lesions was significantly higher at mandible than maxilla (p < 0.01). The correlation was significant between DMFT values and apical lesion presence (p < 0.01)., Conclusion: The ratio of FPMs with poor prognosis was found high in the study group. Treatment requirements of FPMs increased with age, and pulp interventions often took part in the majority. This study successfully concluded that higher DMFT values were correlated with the presence of DDC and apical lesion., Clinical Relevance: FPMs with poor prognosis demonstrate a risk factor for apical lesion presence., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The aim of this study was to determine the effect of simulated occlusal loading on wall lesion development in cervical gaps of class II composite restorations in vitro. Sixty-four extracted human molars received standardized (4.0 × 4.2 × 3.0 mm) box preparations. The teeth were randomly assigned to one of two restoration groups: restoration with a normal or a low E-modulus composite material (CLEARFIL AP-X: E-modulus 16.8 GPa or CLEARFIL MAJESTY ES Flow: E-modulus 6.6 GPa). A metal matrix was placed at the bottom of the box for each restoration, creating a cervical gap of about 100 μm wide. Samples were exposed to simulated caries lesion development in a lactic acid solution (pH 4.8) for 8 weeks in a Rub&Roll device. Half of the samples were subjected to 90 N cyclic loading. After demineralization, the teeth were sectioned. Wall lesion development was measured using microradiography (transversal wavelength-independent microradiography) in two different locations (location 1: 1,000 μm and location 2: 1,600 μm from the gap entrance) and recorded in lesion depth (LD) (μm) and mineral loss (μm × vol%). Linear regression modeling was used to estimate the effect of loading and material on wall lesion development. Mean wall LD in location 1 across all groups was 150.83 μm with a standard deviation (SD) of 61.83 μm. In location 2, mean overall wall LD was 102.98 μm with an SD of 64.92 μm. Linear regression showed no significant effect of either loading or material on wall lesion development. Occlusal loading had no significant effect on secondary caries lesion development in composite class II restoration in this in vitro study., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Introduction: This study evaluated the relative abundance and ribosomal activity of selected bacteria in carious dentin of teeth with different pulp conditions., Methods: Thirty healthy patients with class I occlusal caries in molars were categorized into 3 groups based on the pulp diagnosis: normal pulp (NP, n = 10) with caries extending less than half the thickness of dentin (as assessed radiographically), reversible pulpitis (n = 10), and symptomatic irreversible pulpitis (n = 10) with caries extending more than two thirds of the thickness of dentin. Carious dentin samples were collected from the deepest part of the cavity and stored in RNAlater solution (Ambion Inc, Austin, TX). Eight bacterial taxa were evaluated from the samples: Streptococcus mutans, Lactobacillus fermentum, Veillonella, Actinomyces, Rothia dentocariosa, Olsenella profusa, Prevotella intermedia, and Bifidobacterium dentium. The 16S ribosomal RNA (rRNA) gene and 16S rRNA were quantified by real-time polymerase chain reaction and used to calculate the relative genome abundance and relative ribosomal abundance. The Fisher exact test was used to compare proportions between groups. The mean rank difference between the various groups was assessed using the Kruskal-Wallis test with the Bonferroni-Holm correction., Results: The reversible pulpitis group had significantly higher 16S rRNA gene and rRNA counts of Actinomyces (P < .001 and P = .002) and B. dentium (P = .005 and P = .007) relative to the NP group. The symptomatic irreversible pulpitis group had significantly higher 16S rRNA gene and rRNA counts of L. fermentum (P < .001 and P < .001), Actinomyces (P < .001 and P < .001), O. profusa (P < .001 and P < .001), P. intermedia (P = .001 and P = .002), and Bifidobacterium (P < .001 and P < .001) relative to the NP group., Conclusions: Specific bacterial activity varies in carious dentin of teeth with different pulp conditions., (Copyright © 2021 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Ectopic eruption of permanent first molar is a developmental disturbance, leading to many local problems, such as premature loss of the second primary molars, space loss, increased prevalence of dental caries, supraeruption of the opposing molars, mesial inclination of the permanent maxillary first molars and class II molar relationship. We report the case of a seven-and-a-half-year-old girl with ectopic eruption of permanent maxillary and mandibular first molar, treated by orthodontic separators and slicing the distal surface of the adjacent primary second molar separately. Regular examination and timely interception are important during oral health management of children and is of great significance in alleviating the side effects of ectopic eruption.

Aim: To determine the bilateral occurrence of caries lesions in 5-12-year-old children, and to assess whether one bitewing photograph can predict caries size and occurrence in the homologous tooth on the other side of the mouth., Study Design: The study was carried out on 222 medical files of children 5-12 years old who were first examined in the university dental clinic. The presence and size of the caries lesions in the first and second primary molars and first permanent molars were recorded., Results: No correlation was found when comparing the caries lesion distribution of each tooth's proximal surface. Seventy-one of the X-rays demonstrated a single caries lesion in a first or second primary molar or in a first permanent molar on one side of the mouth, of which 21.3% demonstrated a single caries lesion in the collateral side, 43.6% demonstrated 2 or more lesions, and 35.21% did not have any caries lesion on the collateral side of the mouth., Conclusion: One bitewing cannot determine the presence and size of a caries lesion on the same site of the homologous tooth.

Introduction Bitewing radiographs (BWs) are under-utilised for children, and reliance on visual diagnosis alone is likely to under-diagnose caries. Quantification of the level of the under-reporting of caries and the vital role of BWs would be beneficial when providing dental care to the paediatric population.Aim To quantify the diagnostic value of bitewings in the management of proximal caries in primary molars.Design Cross-sectional study.Materials and methods Thirty children (mean age 6.2 ± 1.3 years) were recruited. A visual inspection (VI) of the primary molars was carried out and bitewings were taken. Radiographic assessment (RA) for primary molar proximal caries was completed separately. VI and RA were compared statistically against three caries thresholds, using the Fisher's exact test. A p value <0.05 was considered statistically significant. Sensitivity and specificity analyses were performed.Results A total of 480 proximal surfaces were assessed. Bitewings detected 44.6% of additional proximal carious lesions (p <0.0001). At d 3 threshold, VI under-reported 51.2% proximal caries (p <0.0001) and 34.1% dentinal proximal caries (p = 0.0012). VI showed high specificity (99%) and low sensitivity (53%).Conclusion Bitewings play a vital role in proximal caries diagnoses of primary molars., (© 2021. The Author(s), under exclusive licence to the British Dental Association.)

Objective: To assess the radiographic pattern of inactive enamel caries lesions (IECL) in the occlusal surfaces of permanent molars and to investigate whether the presence of radiolucency at baseline could predict lesion progression over 4-5 years., Methods: A prospective cohort study followed 193 schoolchildren from southern Brazil. At baseline, clinical and radiographic examinations were performed. After 4-5 years, clinical examination was repeated following the same protocol. Logistic regression models were used to investigate the relationship between the presence of radiolucency at baseline and caries progression., Results: This study included 916 permanent molars, classified as sound occlusal surfaces (n = 434), non-cavitated IECL (n = 438), or cavitated IECL (n = 44) at baseline. The proportion of lesions with radiolucency increased as lesion severity increased (p<0.001, chi-square test). The proportion of cases that progressed was significantly higher among teeth showing radiolucency at baseline than among teeth without radiolucency (p<0.001, chi-square test). The presence of radiolucency at baseline was found to be a predictor of caries progression (activity criteria, adjusted OR=3.37, 95%CI=1.66-6.82, p<0.001; severity criteria, adjusted OR=4.01, 95%CI=1.85-8.72, p<0.001)., Conclusion: Occlusal surfaces (either sound or with IECL) presenting radiolucency at baseline were more likely to progress over 4-5 years of monitoring and should be monitored more closely., Clinical Relevance: Bitewing radiographs, when available, may be used to identify which surfaces/lesions are more likely to progress and thus, to define proper recall intervals for patient monitoring., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: The aim of this retrospective study was to evaluate the outcome of preformed metallic crowns (PMC) utilizing the HT in carious primary molars for children treated within public dental clinics across the Sydney region., Materials and Methods: A retrospective cohort study was designed, whereby two investigators evaluated 113 primary molars treated with HT PMCs involving 71 participants (aged between 5 and 11 years) after a minimum of 6 months post treatment. The mean time elapsed between crown placement (treatment) and the review was 1.42 years (17 months). The outcome of the HT was assessed by clinical and radiographic criteria., Results: One hundred thirteen HT PMCs were reviewed from 71 participants. The overall success rate of PMCs placed utilizing the HT was 99%, with only one case presenting with confirmed failure., Conclusions: HT PMCs have an overall high success rate as a treatment option in carious primary molars., (© 2021 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background: Pulpal involvement, secondary to dental caries, is not uncommon and is a challenging task for pediatric dentists. Morphological differences in root canal of deciduous teeth increases the complexity of management. The aim of this study was to compare two rotary file systems and hand instrumentation for root canal preparation in regard to canal transportation, centering ability ratio, and dentin thickness using cone-beam computed tomography (CBCT)., Methods: A total of 72 canals from 24 freshly extracted mandibular deciduous second molars were divided into a set of 8 teeth, then prepared using 2 rotary files systems: the Kedo-S pediatric file system (Group A) and Pro AF Baby Gold file system (Group B) were compared to hand instrumentation (Group C). CBCT scans before and after root canal preparation were used to evaluate tested parameters. Instrumentation time for all three techniques was also measured using a chronometer., Results: Although rotary file systems have shown superior results in root canal preparation as compared to hand instrumentation, no significant differences were observed between all the groups for canal transportation and dentin thickness at all three levels of prepared canals. A comparison of centering ability ratio between all the groups was found to be statistically significant only at the cervical level. A significant difference was observed between hand instrumentation using K-files (117.3 s) and both rotary systems (Kedo-S (81 s) and Pro AF Baby Gold (81.5 s)) in terms of canal preparation time (P < 0.001)., Conclusions: Both tested rotary systems and hand instrumentation demonstrated comparable canal preparation results, with differences that were statistically non-significant in most tested parameters, without shaping errors. However, both the rotary systems were more efficient and faster than hand instrumentation., Competing Interests: None

Aim: To assess the influence of occlusal and proximal deep carious lesions on the outcome of full pulpotomy performed in mandibular teeth with pulpal diagnosis of symptomatic partial irreversible pulpitis., Methodology: Eighty deep carious mandibular molar teeth with clinical and radiographic diagnosis of symptomatic partial irreversible pulpitis without periapical rarefaction from patients of either gender between the age of 16-35 years were included. Depending upon the location of deep carious lesion, the teeth were distributed equally into occlusal (n = 40) and proximal caries groups (n = 40). Full pulpotomy was performed under local anaesthesia and aseptic conditions. The pulp tissue was removed until the root canal orifices, and 2.5% sodium hypochlorite (NaOCl) was applied to arrest pulpal bleeding. Mineral trioxide aggregate (MTA) was compacted over the radicular pulp. Teeth were restored with resin-modified glass ionomer cement (RMGIC) and bulk-fill composite resin. Pre- and post-operative pain was assessed at 24, 48 and 72 h using a 11-point Numerical Rating Scale (NRS). Patients were followed at 6 and 12 months for clinical and radiographic evaluation. Asymptomatic teeth without any radiographic evidence of periapical rarefaction were considered successful. The data were analysed using the Shapiro-Wilk W test, two-sample Wilcoxon rank-sum test, Pearson chi-square test, Fisher's exact test and Kappa coefficient. The significance level was predetermined at p < .05., Result: An intergroup comparison revealed that the pre- and post-operative pain scores at 24, 48 and 72 h were not significantly different (p > .05). At the end of follow-up period (12 months), success of full pulpotomy in occlusal and proximal caries group was 95% and 92.5%, respectively (p = .644). For both groups, the combined success rate of full pulpotomy was 93.75%., Conclusion: The site of carious lesions (i.e., occlusal or proximal) did not affect the clinical and radiographic outcome of full pulpotomy performed in mature permanent mandibular teeth with symptomatic partial irreversible pulpitis., (© 2021 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the sensitivity and specificity of the near-infrared light transillumination caries detection method by using DEXIS CariVu (DCV) for imaging of interproximal primary molar surfaces (IPMS).
Methods: A retrospective evaluation of patient records at a university pediatric dentistry (PD) clinic identified 22 patients with unrestored IPMS, which had images of both bitewing radiography (BW) and DCV. A scoring system (no caries, incipient caries, dentinal caries) was developed for the study. Two investigators (pediatric dental faculty) identically scored 90 IPMS in both BW and DCV images, establishing benchmark IPMS scores. The 180 images were then compiled in a randomized order in a questionnaire, which was answered by 24 raters (PD residents and faculty) using the study caries scoring system. Data analysis included raters and experts' percent agreement, Vassar Stats for sensitivity and specificity, and Kendall's correlation coefficient for interrater reliability.
Results: The overall agreement between raters and experts for DCV images was 48 percent (54 percent for no caries, 23 percent for incipient caries, and 68 percent for dentinal caries). The DCV's sensitivity and specificity to detect any caries were, respectively, 0.72 and 0.54, 0.60 and 0.53 for incipient caries, and 0.82 and 0.53 for dentinal caries. The BW's sensitivity and specificity to detect any caries were respectively, 0.82 and 0.87, 0.98 and 0.86 for incipient caries, and 0.99 and 0.87 for dentinal caries. The overall interrater reliability was 0.48 (95 percent confidence interval equals 0.46 to 0.50).
Conclusion: The use of DCV as a stand-alone caries detection method for IPMS is limited.

The prophylactic removal of asymptomatic third molars is a common but controversial procedure often rationalized as necessary to prevent future disease on adjacent teeth. Our objective in this retrospective cohort study of adult men was to examine whether second-molar loss differed by baseline status of the adjacent third molar, taking into account the individual's overall state of oral hygiene, caries, and periodontitis. We analyzed data from participants of the VA Dental Longitudinal Study who had at least 1 second molar present at baseline and 2 or more triennial dental examinations between 1969 and 2007. We classified second molars by third-molar status in the same quadrant: unerupted, erupted, or absent. Tooth loss and alveolar bone loss were confirmed radiographically. Caries and restorations, calculus, and probing depth were assessed on each tooth. We estimated the hazards of second-molar loss with proportional hazards regression models for correlated data, controlling for age, smoking, education, absence of the first molar, and whole-mouth indices of calculus, caries, and periodontitis. The analysis included 966 men and 3024 second molar/first molar pairs. Follow-up was 22 ± 11 y (median 24, range 3-38 y). At baseline, 163 third molars were unerupted, 990 were erupted, and 1871 were absent. The prevalence of periodontitis on the second molars did not differ by third-molar status. The prevalence of distal caries was highest on the second molars adjacent to the erupted third molars and lowest on the second molars adjacent to the unerupted third molars. Relative to the absent third molars, adjusted hazards of loss of second molars were not significantly increased for those adjacent to erupted (hazard ratio [HR] = 0.96, 95% confidence interval [CI] = 0.79-1.16) or unerupted (HR = 1.25, 95% CI = 0.91-1.73) third molars. We found similar results when using alveolar bone loss as the periodontitis indicator. Our findings suggest that retained third molars are not associated with an increased risk of second-molar loss in adult men.

Background: Pulpotomy is a vital pulp therapy performed in carious pulp exposures in teeth in which the inflamed coronal pulp is removed and medicament is placed to conserve the vital root pulps. Recently, simvastatin which is a cholesterol-lowering drug has been found to be associated with the pulp regenerative potential., Aim: The aim of this parallel two-arm randomized control trial was to evaluate and compare the clinical and radiographic efficacy of diode laser (DL) and simvastatin gel (SG) in pulpotomy of carious primary molars., Methods: Hundred primary molars (in 98 children, 65 males, 33 females with age 4-8 years) requiring pulpotomy were randomized into the DL or SG group. Pulpotomy was performed as per the standardized protocol; thereafter, all teeth were restored with resin modified glass ionomer cement followed by stainless steel crowns. Follow-up evaluations were done at 3 and 12 months using clinical and radiographic criteria. Statistical analysis was done using Chi-square test at a significance level of 0.05., Results: At 12 months, out of 92 teeth available for clinical and radiographic evaluation by blinded evaluators, DL group showed clinical and radiographic success rates of 76.1% and 52.1%, while SG group showed 80.4% and 65.2% success rates, respectively. There was no statistically significant difference between the efficacy of two techniques clinically (P = 0.49) or radiographically (P = 0.30)., Conclusions: Both SG and DL had similar efficacy for primary tooth pulpotomy, clinically and radiographically after 12 months. Considering its ease of application and low-cost, SG can be recommended as a potential pulpotomy medicament in primary molars., Competing Interests: None

Objectives: To compare the effectiveness of visual examination, radiographic examination and fluorescence-aided caries excavation (FACE) in detecting occlusal caries in first permanent molars in 150 children aged 6-14 years with intact occlusal surface with caries lesions without cavitation, or with darkened or deep fissures that had no clear diagnosis., Study Design: Two dentists independently performed a visual oral examination, FACE and bitewing radiography. The inter-rater reliability of each detection method was determined and their specificity and sensitivity., Results: All caries detection methods showed high inter-rater reliability with absolute agreement between raters above 90%. Most caries lesions were detected by visual (75.8%) and FACE (79.1%), while only 28.8% of lesions were detected by radiography. Detection by visual examination was strongly correlated with detection by FACE (X2=37.9, Phi=0.498, p<0.001). A lower, yet statistically significant, correlation was found between visual examination and X-ray radiography (X2=5.53, Phi=0.190, p<0.001). FACE had higher sensitivity (87%) and specificity (65%) for detecting occlusal caries in comparison with radiography (60% specificity and 55% sensitivity)., Conclusion: Although visual examination remains the best method to detect occlusal caries in young permanent molars in children, FACE is an effective and accurate diagnostic tool that may aid in detection and treatment decisions.

Background: The Hall Technique (HT) is a method of restoring decayed primary teeth using stainless steel crowns (SSCs) without tooth preparation, caries removal, or local anaesthetic., Aim: To investigate the ultrastructural, biomechanical, and chemical characteristics of teeth managed with the Hall Technique in comparison with conventional SSC (controls)., Design: Twelve HT-treated primary molars and four controls were analysed. Teeth were dehydrated in ethanol, embedded in methylmethacrylate, mesio-distally sectioned, X-rayed, mounted, and polished. Biomechanical, ultrastructural, and chemical characterisation was performed for carious lesion and sound areas of each specimen., Results: Pre-treatment and post-treatment X-rays showed evidence of little to no caries progression over time. In carious lesions, mean hardness and elastic modulus values were lower in HT-treated teeth than in controls. In both controls and HT-treated teeth, carious lesions had the lowest %wt of Ca and P of all tissues sampled., Conclusions: Although the retained carious tissue was biomechanically more compromised in HT-treated teeth, the Ca and P values were higher than reported elsewhere for carious lesions in primary molars, suggesting remineralisation may have occurred in caries in HT-treated teeth. Future investigations will help elucidate the processes involved with carious lesion arrest under SSC., (© 2020 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Dental caries is a multifactorial disease that causes reversible decalcification and cavitation of susceptible teeth exposed to sugary substrates over a period of time in the oral cavity. It gives clinical and social burdens to the child patients and their parents/carers. Stainless steel crown (SSC) restoration is one of the restorative treatment options in the management of carious primary molars., Aims: The Hall technique is a biologic method of managing primary teeth by sealing in the caries with preformed metal crowns (SSCs). The objectives of this study were to assess and compare the primary and secondary treatment outcomes of stainless steel crown restorations using the conventional method and the Hall technique in primary molars immediately after placement and over a 12-month period using both clinical and radiological parameters., Methods: The study was a randomized control clinical trial using a split mouth approach. A total of 25 stainless steel crown restorations using the conventional method and 25 stainless steel crown restorations using the Hall technique were placed in 25 subjects aged 3-8 years with a pair or pairs of unrestored enamel or dentinal carious primary molars matched for tooth type, dental arch, and extent of caries. All subjects were monitored and reviewed every 3 months for 12 months., Results: Twenty three subjects returned for follow-up. There was no statistically significant difference (P-value > 0.05) between the conventional SSC restoration and the Hall technique for both the primary outcomes/major failures (irreversible pulpitis, dental abscess, peri-radicular radiolucency, and crown loss with tooth unrestorable) and secondary outcomes/minor failures (crown loss and tooth restorable, crown perforation, secondary/marginal caries, and reversible pulpitis). But, there was a statistical significant difference in the average time taken for the placement of the restorations between the two groups (P-value 0.001)., Conclusion: Both the conventional SSC restorations and the Hall technique can be provided for all the subjects in this study. The Hall Technique compared favorably well with the conventional SSC restoration in clinical and radiological outcomes. The Hall Technique appears to offer an effective treatment option for managing dental caries in primary molar teeth especially in a resource challenged environment where electricity and treatment under general aaesthesia can sometimes be a problem., Competing Interests: None

Objectives: To determine different combinations of marginal ridge shape (MRS) and contact extents in nature of the contact between primary molars and its correlation with the presence of carious lesions on radiographic examination of approximal surfaces., Study Design: Retrospective study of 347 clinical records, including photographs and bitewing radiographs, were assessed for intact MRS and caries extent. The carious lesions were scored (0-5, Mejàre scoring system) radiographically and correlated to the intact MRS on clinical photographs, and strength of associations quantified using logistic regression analysis and chi-square tests., Results: Primary molars, 848(contact extent), and 757(MRS) were analyzed. Combination of straight-convex(35.4%) MRS was more common (p<0.001). None of the approximal surfaces were caries-free for straight and straight MRS with 36.4% of both approximal surfaces exhibiting caries in enamel, and 38.2% of one approximal surface exhibiting caries in dentin. Approximately 90% of the primary molars with substantial contacts exhibited carious lesions in the enamel and 80% with light contacts exhibited carious lesions in the dentin (p<0.001)., Conclusion: Six different combinations of intact MRS were identified. Combination of concave-convex shapes exhibited caries extending into dentin. Substantial and/or light contacts between primary molars showed higher caries experience in the approximal surfaces.

Objectives: Arresting active initial caries lesions is part of the modern caries controlling system. Resin infiltration (RI) system has been found a promising method in arresting interproximal initial lesions. The aim was to investigate whether RI arrests progression of active caries lesions., Materials and Methods: Participants (n = 20) of the retrospective study were patients in the Dental Teaching Unit, City of Oulu, Finland, mean age 26 years (SD5.2). Indication for RI was radiographically diagnosed progressing (ICDAS 1-3) interproximal lesions (n = 54). RI treatments were performed in 2015-2017. Controls were initial lesions in the same bitewing radiographs without RI or other treatment (n = 24). For analyzes teeth were categorized as lower and upper premolars and molars. The change in lesions during the follow-up period was recorded surface wise as follows: deterioration / improvement from ICDAS score 3/improvement from ICDAS score 2/improvement per se/at follow-up, lesion was less diffuse/no change. The changes in each tooth surface were analyzed between RI intervention and control teeth by using Chi-square test. Proportions of successful and failed surfaces were given., Results: The mean length of follow-up period was 17.4 m (SD7.2). Arresting of caries lesions (ICDAS scores 2 and 3) was distinctly better in RI group (63.0%) compared with the controls (29.1%). The situation progressed among 29.2% of the controls whereas the respective proportion among the intervention group was 14.8%. Progression of lesions was more distinct in all tooth groups in the control group. Outcome was successful despite the lesion depth., Conclusions: Resin infiltration seems effective in arresting progression of initial caries lesions with monitoring period of 1.5 years., (© 2020 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Purpose: Conventional and Hall Technique (HT) Preformed Metal Crowns (PMCs) are used for treatment of carious primary molars. The aim was to evaluate the clinical and radiographic success of conventional and HT PMCs in a postgraduate dental setting., Methods: A retrospective study using patients' electronic case-notes and radiographic images of carious primary molars treated with either conventional or HT PMCs was conducted to assess clinical and radiographic success/failure. A Kaplan-Meier curve was used to assess PMC survival., Results: 187 PMCs (110 HT and 77 conventional) in 65 children (34 females and 31 males) at 6, 12, 18 and 24 months were assessed. At 24 months, the success rates of conventional and HT PMCs were 97.6% and 93.5%, respectively. Two HT (perforated/abscessed) and four conventional (abscessed) PMCs failures occurred. There was no significant difference in success/failure (p = 0.362) at 12 months, but the HT was more successful at 24 months (p = 0.002) with similar survival times for both methods., Conclusion: HT and conventionally placed PMCs, when placed in a postgraduate paediatric dentistry setting, were clinically and radiographically very successful at 6, 12, 18 and 24 months post operatively with a slightly higher success of the HT at 24 months.

Purpose: The purposes of this study were to determine the presence of interproximal carious lesions in the primary molars and assess the risk to adjacent and contralateral surfaces when caries is detected in one quadrant. Methods: Clinical records of high caries-risk children, including bitewing radiographs, were assessed for interproximal caries and the extent of marginal ridge breakdown. The carious lesions were scored radiographically by two calibrated examiners with excellent inter- and intraexaminer reliability. Correlations for the presence of adjacent surface caries and caries in another quadrant were determined by employing the strength of the associations, as quantified using chi-square analysis. Results: A total of 1,290 pairs of primary molars (A and B, I and J, K and L, S and T) were included. Only eight percent of interproximal surfaces were caries-free. Approximately 70 percent of the adjacent surfaces (A and B, I and J, K and L, and S and T) exhibited carious lesions in the enamel when there was enamel caries in one quadrant. Furthermore, 90 percent of the adjacent surfaces exhibited caries in the dentin if one adjacent interproximal surface exhibited dentinal caries. Conclusions: In high caries-risk children, only a small proportion of surfaces remain caries-free, and the adjacent surface caries prevalence remains high at 70 percent to 80 percent. The presence of interproximal caries in one quadrant is a good indicator of caries in the other quadrants, as is the marginal ridge breakdown which indicates the proximity to the pulp.

Introduction: The literature shows that selective carious tissue removal (SCTR) decreases the number and diversity of bacteria, stops the caries process and reduces the risk of pulp exposure. However, no consensus exists on which pulp liner would be suitable for teeth undergoing SCTR. So, this study will verify the in vivo response of dentine-pulp complex after SCTR in primary teeth with or without pulp liner material., Methods and Analysis: A randomised clinical trial, double-blinded, parallel-group and allocation concealment will be conducted with the enrolment of 384 patients from 5 to 9 years, with one maxillary/mandibular first/second primary molars with deep occlusal/occlusoproximal cavities. The remaining dentine will be lined with calcium hydroxide cement-group 1; mineral trioxide aggregate-group 2 and without liner-group 3. The primary outcome will be success of the of dentine-pulp complex evaluated clinically and radiographically at 6, 12 and 24 months, while the secondary outcomes will be the measurement of the dentine barrier on periapical radiographs. During all study, two trained and calibrated examiners will evaluate the treated teeth clinically and radiographically. Interexaminer and intraexaminer reliability will be verified by casual and systematic error. The Kolmogorov-Smirnov test will be adopted to test the normality of continuous variables. Comparisons among groups will be performed by using the χ 2 test and anaylsis of variance, followed by Tukey test (p<0.05). The logistic regression will be applied, and the degrees of this association will be measured using the OR and 95% CI., Ethics and Dissemination: The present protocol was submitted and approved by the Ethical Committee of the University of São Paulo, Bauru, São Paulo, Brazil (CAAE: 79123517.0.0000.5417). Consent for publication will be obtained from all parents or legal guardians. Results of this study will be reported in full through peer-reviewed journals., Trial Registration Number: RBR-9fsxnn., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: This systematic review aimed to evaluate the clinical and radiographic outcomes of coronal and partial pulpotomies in mature permanent molars with cariously exposed vital pulp. Method and materials: The protocol of the current review was registered in the PROSPERO database (CRD 42020190785). Articles published between January 1980 and June 2020 were searched in eight different online databases and six textbooks according to PRISMA guidelines. Eleven studies were included in the analysis of 1-year success rates, whereas five studies were included in the analyses of 2-year and > 2-year success rates for coronal pulpotomy. Two studies were included in the analyses of the 1-year and 2-year success rates for partial pulpotomy. The clinical and radiographic success rates were estimated using the DerSimonian-Laird random effect method. The risks of bias were evaluated using Cochrane RoB 2, ROBINS-I, and Newcastle-Ottawa scale assessment tools. Evidence levels were determined using the Oxford Centre for Evidence-Based Medicine (OCEBM) recommendation tool. The success rates using different pulp capping medicaments and restorative materials were analyzed using meta-regression analysis. Results: The clinical and radiographic success rates of coronal pulpotomy ranged between 92.2% and 99.4%, whilst for partial pulpotomy, the success rates ranged between 78.2% and 80.6%. Different pulp capping medicaments and restorative materials showed no significant effect on the success rates of coronal pulpotomy, but the former significantly (P &lt; .05) affected the success rates of partial pulpotomy. Conclusion: Coronal and partial pulpotomies demonstrated a high success rate in treating cariously exposed vital pulp of mature permanent molars. Further well-designed studies with longer follow-up periods are required to validate these findings.

Clinical Relevance: Radiographic lesion depth should not be used as the single determinant of the restorative threshold for clinically inaccessible approximal caries lesions. Temporary tooth separation is a feasible and effective diagnostic aid for assessment and appropriate management of approximal lesions., Summary: In the era of tooth-preserving dentistry, the decision to restore approximal caries lesions must be based on the accurate assessment of tooth cavitation, as the accumulation of oral biofilms in these areas encourages lesion progression. However, lesions radiographically into dentin remain the main threshold criterion for restoring approximal lesions even though most of these lesions may not be cavitated. A school-based clinical protocol for temporary tooth separation (TTS) was developed to improve visual-tactile assessment and management of clinically inaccessible approximal lesions. TTS data retrieved from electronic health records were used to correlate radiographic lesion depth and surface cavitation status with lesion location and the patient's caries risk and to evaluate the effectiveness of TTS as a diagnostic aid for approximal lesions. Of the 206 lesions assessed, 66.5% (n=137) were located in the maxillary arch, 56.6% (n=116) in distal surfaces, 61.3% (n=114) in premolars, and 21.5% (n=40) in molars. After tooth separation, 79.6% (n=164) of the lesions were diagnosed as noncavitated, including 90% (n=66) of the lesions radiographically at the inner half of enamel (E2) and 66% (n=49) of those at the outer-third of dentin (D1). Logistic regression analysis using E2 and D1 lesions showed no significant association between lesion depth or cavitation status with lesion location and caries risk. TTS is a feasible and effective diagnostic aid for the assessment and appropriate management of approximal caries lesions. There is a need to reevaluate the use of radiographic lesion depth as the single determinant of the restorative threshold for clinically inaccessible approximal lesions., (©Operative Dentistry, 2020.)

Background: The mesial surface of the first permanent molar is the most caries-susceptible proximal surface of the permanent dentition in children under the age of 12., Aim: The aim of this study was to determine the association between caries progression on the mesial surface of the first permanent molar (T6M) and caries on the distal surface of the primary second molar (t5D) and the occlusal surface of the first permanent molar (T6O)., Design: Children (between 5 and 13 years old; N = 565) that had participated in a 4-year longitudinal caries study that at baseline had at least one T6 fully erupted with a t5 in proximal contact, with no restoration or sealant on T6O and t5D, and adequate bitewing radiographs were included. Clinical data using the International Caries Detection and Assessment System (ICDAS) and radiographs were used to determine the caries status of T6M, T6O, and t5D., Results: Baseline caries presence on t5D and T6O were highly significantly associated with follow-up caries presence on T6M (P < .001). The adjusted odds ratios corresponding to t5D and T6O were 3.94 (95% CI: [1.78, 8.71]) and 3.26 (95% CI: [1.46, 7.31]), respectively., Conclusion: These findings highlight the need for prevention and management of caries on T6O and t5D., (© 2020 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: In continuation with the ultraconservative minimal intervention approach for carious lesions treatment, lesion sterilization and tissue repair (LSTR) is a novel concept of using antibacterial drugs to disinfect dentinal, pulpal, and periapical lesions., Aims: The purpose of this study is to evaluate the clinical, radiographic, and microbiologic success rate of indirect pulp treatment (IPT) using a new technique minimal excavation and LSTR with triple antibiotic paste (TAP), for primary molars., Settings and Design: This was randomized controlled trial design., Materials and Methods: Forty-two healthy cooperative children aged 5-10 years having deep carious lesion in primary molars were randomly assigned to receive either traditional IPT with calcium hydroxide or minimal excavation and LSTR with TAP. Follow-up was done at 6 weeks, 3, 6, and 15-18 months intervals, and treatment success or failure was determined by a combination of clinical, microbiological, and radiographic findings., Statistical Analysis Used: Qualitative data were analyzed using Pearson's Chi-square test. Mann-Whitney U nonparametric test was used for statistically significant differences between the bacterial counts (median values and percent reduction) between the two groups and the Wilcoxon sign rank test for the intragroup evaluation of bacterial counts., Results: LSTR with TAP was found to be as effective as traditional indirect pulp treatment (P < 0.05)., Conclusions: Minimal excavation and LSTR with TAP can be an effective treatment methodology for the management of deep carious lesions in primary molars., Competing Interests: None

This paper aims to update the reader on how minimally invasive (MI) techniques may be used to improve the longevity of carious or defective/compromised first permanent molars (cFPMs) in young children. Clinical and radiographic diagnosis and the prognostic factors will be discussed in view of recent studies showing that these teeth can be kept in function and have an improved prognosis as the child gets older. Clinical protocols for their care, based on the latest evidence and techniques for MI restorations, together with longevity information of possible restorative options, are described. This paper also explores the rationale behind enforced extractions and related morbidity, in order to help oral healthcare practitioners to determine the optimal management of these key elements in the dentition for the benefit of the patients.

Introduction: Dental operating microscopes (DOM) enable dentists to examine, with the aid of magnification and photodocumentation in clinical conditions, the occlusal anatomy of newly erupted permanent molars and to detect any early carious lesions more precisely., Aim: To determine the advantages of magnifying technology in detecting early occlusal carious lesions in newly erupted permanent first molars., Materials and Methods: We examined 176 first molars of 44 children divided into two age groups: 7-8 and 9-10 years. The surfaces of each of the teeth were examined after they were cleaned with a brush without paste. The diagnoses were first made using only illumination and a clinical examination. These were followed by a visual examination of the occlusal surface using a DOM at ×8 magnification. A photo of the occlusal surface was then taken with a camera at the respective magnification for the purposes of photodocumentation., Results: This study demonstrated that dental operating microscopes increased by 7% the rate of successful detection of early caries lesions on the occlusal surfaces. There was also a significant increase of the number of diagnosed cavitated caries in the dentine in comparison with those detected with naked eye. Using DOMs in pediatric dentistry facilitates the more detailed and precise diagnosing of early stage carious lesions and/or cavitations in the fissures., Conclusion: The use of a DOM facilitates differential diagnosing between deep fissures and early carious lesions, which is a key point in the assessment of occlusal surfaces of newly erupted permanent molars, necessary for their preventative sealing and micro-invasive treatment., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Optical coherence tomography (OCT) can create cross-sectional images of tooth without X-ray exposure. This study aimed to investigate the diagnostic accuracy of 3D imaging of OCT for proximal caries in posterior teeth. Thirty-six human molar teeth with 51 proximal surfaces visibly 6 intact, 16 slightly demineralized, and 29 distinct carious changes were mounted to take digital radiographs and 3D OCT images. The sensitivity, specificity and area under the receiver operating characteristic curve (AUC) for the diagnosis of enamel caries and dentin caries were calculated to quantify the diagnostic ability of 3D OCT in comparison with digital radiography. Diagnostic accuracy was evaluated by the agreement with histology using weighted Kappa. OCT showed significantly higher sensitivity, AUC and Kappa values than radiography. OCT can be a safer option for the diagnosis of proximal caries in posterior teeth that can be applied to the patients without X-ray exposure.

Purpose: Impacted third molars (M3s) may lead to external root resorption (ERR) and dental caries (DC) in the adjacent second molars (M2s). The aim of this study was to identify the risk factors for ERR and DC in M2s associated with impacted M3s., Materials and Methods: We implemented a cross-sectional study and enrolled a sample composed of patients with M3s and M2s present and cone-beam computed tomography (CBCT) scans available for review. If there was contact between the M2 and the adjacent M3 and the border of radiolucency was more distinct, the case was considered ERR. Apart from that, the case was considered DC. Potential predictor variables were defined as age, gender, tooth location, M2-M3 contact, root development in M3, M3 inclination, M3 impaction type, and M3 follicular diameter. Outcomes of the study were DC and ERR in M2s. CBCT was used to detect the presence of DC and ERR in M2s., Results: A total of 250 eligible images of M3s in the upper and lower jaws of 167 patients were included. The mean age of the patients with CBCT images available was 26.08 ± 4 years (range, 18 to 40), and 43.6% of the patients were men. Factors associated with a significantly increased frequency of ERR in M2s included maxillary location, presence of M2-M3 contact, and mesioangular inclination (P < .005). DC in M2s was significantly more likely to occur in those with absence of contact between M2 and M3 (P < .005)., Conclusions: The results of this study showed an increased risk of ERR to be associated with maxillary molars, mesioangular inclination, and presence of M2-M3 contact. The variable associated with an increased risk of DC was the absence of M2-M3 contact., (Copyright © 2020 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: This in vitro study evaluated the caries status of the smooth surfaces of primary molars using the DIAGNOdent pen, Vistacam iX, and Bitewing radiography as compared to histologic assessment., Methods: 68 primary molars were selected, and their mesial or distal caries status were determined using DIAGNOdent pen, Bitewing radiography, and Vistacam iX. To achieve reference standards, the teeth were sectioned and directly assessed by a stereomicroscope. The Mc Nemar test was used to compare the sensitivity, specificity, and accuracy of the methods. The spearman rank correlation coefficient (r) was also determined to compare the extent of caries with histology. The statistical significance level was set at α = 0.05., Results: Regarding D1 as a cut-off point for histological assessments, sensitivity, specificity, and accuracy of DIAGNOdent pen were 82 %, 75 %, and 80 % while the values were 63 %, 100 % and 62 % for bitewing radiography and 56 %, 100 % and 59 % for Vistacam iX. Regarding D3 as a cut-off point for histological analysis; Sensitivity, specificity, and accuracy rates of DIAGNOdent pen were 71 %, 86 % and 80 % while these values were 71 %, 73 % and 72 % for bitewing radiography and 50 %, 78 % and 67 % for Vistacam iX., Conclusion: In conclusion, the DIAGNOdent pen shows the highest performance and accuracy to detect smooth surface caries both at D1 and D3 among the three methods. Although VistaCam iX and bitewing radiography showed better performance at D3 compared to D1, their performances were lower than the DIAGNOdent pen., (Copyright © 2020 Elsevier B.V. All rights reserved.)