RESUMEN
BACKGROUND: The prophylactic removal of asymptomatic impacted wisdom teeth is defined as the (surgical) removal of wisdom teeth in the absence of local disease. Impacted wisdom teeth have been associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gums- and alveolar bone disease, damage of the adjacent teeth, the development of cysts and tumours. Several other reasons to justify prophylactic removal have also been given. Wisdom teeth do not always fulfil a functional role in the mouth. When surgical removal is carried out in older patients the risk of more postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries the prophylactic removal of trouble-free wisdom teeth, either impacted or fully erupted, has long been considered as 'appropriate care'. Prudent decision-making, with adherence to specified indicators for removal, may reduce the number of surgical procedures by 60% or more. It has been suggested that watchful monitoring of asymptomatic wisdom teeth may be an appropriate strategy. OBJECTIVES: To evaluate the effect of prophylactic removal of asymptomatic impacted wisdom teeth in adolescents and adults compared with the retention of these wisdom teeth. SEARCH STRATEGY: The following electronic databases were searched:The Cochrane Oral Health Group Trials Register (4 August 2004), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 4 August 2004), PubMed (1966 to 4 August 2004), EMBASE (1974 to 4 August 2004). There was no restriction on language. Key journals were handsearched. An attempt was made to identify ongoing and unpublished trials. SELECTION CRITERIA: All randomised or controlled clinical trials (RCTs/CCTs) comparing the effect of prophylactic removal of asymptomatic impacted wisdom teeth with no-treatment (retention). DATA COLLECTION AND ANALYSIS: Assessment of relevance, validity and data extraction were conducted in duplicate and independently by three reviewers. Where uncertainty existed, authors were contacted for additional information about randomisation and withdrawals. A quality assessment of the trials was carried out. MAIN RESULTS: Only three trials were identified that satisfied the review selection criteria. Two were completed RCTs and both assessed the influence of prophylactic removal on late incisor crowding in adolescents. One ongoing RCT was identified, but the researchers were unable to provide any data. They intend to publish in the near future and information received will be included in updates. Although both completed trials met the inclusion criteria of the review, regarding participants characteristics, interventions and outcomes assessed, different outcomes measures were assessed which prevented pooling of data. AUTHORS' CONCLUSIONS: No evidence was found to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults. There is some reliable evidence that suggests that the prophylactic removal of asymptomatic impacted wisdom teeth in adolescents neither reduces nor prevents late incisor crowding.
Asunto(s)
Tercer Molar/cirugía , Extracción Dental/métodos , Diente Impactado/cirugía , Adolescente , Adulto , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
In The Netherlands the routine oral examination (ROE) can be characterized as an important tool in dental care. As a result of the changing prevalence of oral diseases of the Dutch population the content of the routine oral examination has changed over time. A representative survey among general dental practitioners has been carried out to investigate the professional performance in the routine oral examination. Participants consisted of a random, stratified sample of 619 dentists, of whom 521 (85%) responded. The Dutch general dental practitioners use the routine oral examination mainly for detecting dental caries and to asses the status of the restorations. About 50% of the responders use a standard recall interval for all patients whereas the other half takes individual patient factors into consideration when determining the recall interval. Both groups differ significantly on the variables: 'time spend on the routine oral examination', 'the amount of diagnostic activities', 'the registration in patient dental records' and 'the frequency of using bitewing radiographs'. In the perspective of quality of dental care a national reconsideration of the routine oral examination by professionals and patients is advocated. The instrument of choice would be the use of evidence-based clinical practice guideline development procedures.
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Atención Odontológica/normas , Odontología/métodos , Odontólogos/psicología , Diagnóstico Bucal , Pautas de la Práctica en Odontología , Caries Dental/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Salud Bucal , Guías de Práctica Clínica como Asunto , Factores de TiempoRESUMEN
OBJECTIVES: To assess the opinions of general dental practitioners regarding the development and importance of clinical practice guidelines and their contribution to the quality of dental care. METHODS: A questionnaire was sent to a representative sample of 1656 dentists in the Netherlands. Factor analysis was conducted to identify scales of variables, and a reliability analysis was conducted to verify the reliability of the identified scales. The effect of the independent variables is expressed as odds ratio per scale part (standard deviation, SD). Regression analyses were conducted to study determinants of the opinions on clinical guidelines. RESULTS: The response rate was 73%; 54% of the respondents supported the development of clinical practice guidelines for dentists. Most respondents indicated that clinical practice guidelines could be used as a checklist, as a support in daily clinical decision making, and as a basis for continuing dental education. The factor analyses yielded four scale factors-contribution of guidelines to effectiveness of care (OR 1.95/SD), contribution of guidelines to professional autonomy (OR 1.70/SD), contribution of guidelines to quality of care (OR 2.52/SD), and contribution of guidelines to collaboration (OR 1.49/SD)-which complied with the criterion of Cronbach's alpha >0.60. Multiple regression analysis with the four scale factors as dependent variables yielded only extremely low correlations for practice and dentist characteristics (R(2)=0.01-0.04). CONCLUSIONS: Only about 50% of dentists support the development and implementation of clinical guidelines. Guidelines are seen as helpful in the provision of continuing dental education and as a support in daily clinical decision making. The most important barrier to successful implementation of clinical practice guidelines is the fear of dental practitioners that guidelines will reduce their professional autonomy. Practice and dentist characteristics are unrelated to dentists' opinions on clinical practice guidelines.
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Actitud del Personal de Salud , Odontología/normas , Odontólogos/psicología , Guías de Práctica Clínica como Asunto , Garantía de la Calidad de Atención de Salud , Adulto , Anciano , Análisis Factorial , Investigación sobre Servicios de Salud , Humanos , Persona de Mediana Edad , Países Bajos , Rol Profesional , Indicadores de Calidad de la Atención de Salud , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
In this paper two new visual scoring systems are described, aimed at estimating both depth and activity of occlusal lesions. Their validity is acceptable for lesion depth estimation. However, the validity of the activity estimate is to be questioned. Both for approximal enamel and dentine lesions as for deep dentinal occlusal lesions, bite-wing radiographs are still useful for evaluation of new lesions and lesion progression. Many quantitative caries diagnostic methods are being developed, but to this date none of them has been shown to be reliably applicable in lesion monitoring. The evaluation of caries risk factors is primarily useful for selecting preventive treatment options. Other caries prediction-tests than those based on the present caries lesions are of little value. The main disadvantage of such prediction models is that they are usually limited to application in children, where caries is a disease that affects all ages.
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Caries Dental/diagnóstico , Caries Dental/clasificación , Caries Dental/patología , Caries Dental/prevención & control , Humanos , Radiografía de Mordida Lateral , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
By conducting an oral examination, during radiographic examination and in treatment planning procedures dentists make numerous decisions. A dentist will be required to make his decisions explicit. Decision trees and decision analyses may play an important role. In a decision analysis, the probability of correct and incorrect decisions are multiplied by the utility of the decision outcomes. The treatment outcome with the highest expected utility should be selected. Complex decision tasks such as the estimation of an individual's caries risk or the diagnosis of bone disorders are currently available as computer applications. Also, a preliminary version of a computer programme which detects caries lesions from bitewing radiographs independent from the dentist has become available. It is expected that the applicability of decision analyses will increase when implemented in the dental practice software packages.
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Toma de Decisiones , Caries Dental/diagnóstico , Pautas de la Práctica en Odontología , Árboles de Decisión , Caries Dental/diagnóstico por imagen , Diagnóstico Bucal , Humanos , Valor Predictivo de las Pruebas , Radiografía de Mordida Lateral , Sensibilidad y EspecificidadRESUMEN
As a result of the caries prevalence of the Dutch population the character of the routine dental examination is changing. Caries screening remains relevant for high caries risk individuals but the interpretation of early caries lesions deserves more attention, especially the assessment of progression of caries lesions in time. Diagnosis of caries by dental practitioners in the Netherlands mainly consists of visual inspection in combination with bitewing radiography and both methods play an important role in the timing of bitewing radiographs and forthcoming recall visits for oral health examination. The content and frequency of the routine dental examination are discussed in relation to the individual risk prediction as relevant aspects of quality of dental care in the Netherlands.
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Atención Odontológica/normas , Caries Dental/diagnóstico , Caries Dental/epidemiología , Caries Dental/patología , Diagnóstico Bucal , Humanos , Tamizaje Masivo , Países Bajos/epidemiología , Prevalencia , Radiografía de Mordida Lateral , Factores de Riesgo , Factores de TiempoRESUMEN
When enamel, dentine and substances in caries lesions are exposed to (laser) light of a specific colour, fluorescence may be induced. This principle is at the basis of two caries diagnostic methods, DIAGNOdent and Quantitative Laser (Light-induced) Fluorescence (QLF). Only the DIAGNOdent is commercially available. Bacterial porphyrins evoke fluorescence when illuminated with red light and the intensity of the emitted light is related to the size of the caries lesion. Published research indicates that the DIAGNOdent is particularly suitable for detecting small bacteria containing caries lesions, and to monitor such lesions. QLF is based on the fluorescence decrease in demineralised enamel upon exposure to blue-violet (laser) light. The intensity of the emitted light is related to the amount of mineral loss in the caries lesion. Using QLF the mineral loss in caries lesions can be measured quantitatively. Like the DIAGNOdent, QLF is particularly suitable to monitor caries lesions.
Asunto(s)
Caries Dental/diagnóstico , Diagnóstico Bucal/instrumentación , Rayos Láser , Diagnóstico Bucal/métodos , Fluorescencia , Humanos , Sensibilidad y EspecificidadRESUMEN
Recently, a device for detecting occlusal caries lesions (DIAGNOdent) has been introduced. The reproducibility and validity of this laser-fluorescence device were investigated. In the in vivo part of the study, 45 sites at the occlusal surfaces of permanent molar teeth in 13 patients were measured by 2 observers using 2 DIAGNOdent devices, one produced in 1998 and one in 1999. The interobserver reliability between both devices and both observers was established. In the in vitro part of the study, 49 permanent molars were measured by 2 observers using 2 DIAGNOdent devices. In addition, visual inspection was performed. The teeth were sectioned to measure the histological depth and area of the caries lesions. The reproducibility of both DIAGNOdent devices was high, and so was the interobserver reliability. The correlation between DIAGNOdent measurements and the actual depth of the caries lesions was lower than that of visual inspection. The correlation with the enamel part of the lesion exceeded that of the dentine part. It was concluded that the validity of the DIAGNOdent, expressed as the area under the Receiver Operating Characteristic (ROC) curve, was not statistically significantly different from that of visual inspection. Because of the high reproducibility, dental practitioners who wish to use the DIAGNOdent for monitoring caries lesions, this investigation indicates that an old device may be replaced by a new one, provided that the same tip will be used.
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Caries Dental/diagnóstico , Diagnóstico Bucal/instrumentación , Rayos Láser , Adolescente , Adulto , Diagnóstico Bucal/métodos , Femenino , Fluorescencia , Humanos , Masculino , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
During cavity excavation diagnostic test are used to prevent any unnecessary removal of sound dentine. In this study the validity of a newly introduced blue dye (Quadrant CariTest) was investigated. Twenty-five carious teeth were collected immediately after extraction. The caries lesions were stepwise excavated. From four excavation steps per lesion a digital and an ordinal blue measurement was obtained. From each excavation phase a little amount of excavated dentine was cultured on blood plates. The correlation coefficients between the ordinal and the digital blue measurements and the counts of micro-organisms, expressed in log(CFU)/ml, were respectively 0.56 and 0.45. The sensitivity and the specificity of the ordinal blue measurements were 0.69 and 0.83, those of the digital blue measurements 0.76 and 0.65. The area under ROC of the ordinal blue measurements was 0.77, and that of digital blue measurements 0.70. The areas under ROC were not significantly different (p = 0.14). It was concluded that the new caries indicator is well applicable during the cavity preparation to demonstrate infected dentine.
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Colorantes , Caries Dental/diagnóstico , Preparación de la Cavidad Dental/métodos , Dentina/microbiología , Indicadores y Reactivos , Recuento de Colonia Microbiana , Caries Dental/microbiología , Humanos , Técnicas In Vitro , Curva ROC , Sensibilidad y Especificidad , Diente/microbiologíaAsunto(s)
Confidencialidad , Internet/tendencias , Radiografía Dental Digital/normas , Humanos , Países BajosRESUMEN
Recently, a new film for intraoral radiography was introduced, the Kodak Insight Dental film. The manufacturer claims that this film requires a reduced exposure time compared to Ektaspeed Plus-film, whereas other relevant film characteristics remained unchanged. These claims were investigated in this study. The exposure time of the Insight-film was on average 17% less than that of Ektaspeed Plus-film upon standard manual development, and 49% less than that of Kodak Ultraspeed-film. Compared to the E-speed film, the Insight-film has an identical gradient and spatial resolution (> 10 lp/mm). Compared to the D-speed film the gradient was larger, indicating a better contrast, whereas the resolution was the same. It was concluded that the Insight Dental film can be used in intraoral radiographic diagnosis.
Asunto(s)
Radiografía Dental/tendencias , Película para Rayos X/normas , HumanosRESUMEN
The decision to place sealants is a difficult one, and it has been suggested that in a low risk population it may be efficient to wait until caries is detected in the fissure. An invasive sealant technique with fissure preparation may then be indicated. The diagnostic method used in the indication of such a procedure should accurately detect both dentine caries and sound fissures: high sensitivity for dentine caries (at D3 threshold) with high specificity for enamel caries (at D1 threshold). The aims of this study were to assess the diagnostic performance of selected diagnostic methods at normal cut-offs for traditional dentine caries detection and at reduced cut-offs in relation to the desired performance mentioned above, and to assess whether fissure opening allows for accurate visual detection of dentinal caries. Data were obtained from 230 occlusal sites of 101 extracted human molar teeth. Diagnostic methods used on the entire sample were: visual inspection, electrical conductance measurements and laser fluorescence measurements. The sample was then divided into two groups. Group 1 was subjected to visual inspection after application of a dye. Group 2 was subjected to visual inspection after fissure opening only, and after subsequent dye application. Validation was performed by histological investigation. The results with cut-offs normally used in dentine caries detection were roughly in accordance with the literature, except for laser fluorescence. The sensitivity of visual inspection for dentinal caries (D3) was 17% before and 70% after fissure opening. Using reduced cut-offs, a 100% sensitivity (D3) was achieved with 2 methods, but this also resulted in 63 or 87% false positive diagnoses of sound surfaces. Visual inspection and electrical methods both showed a moderate to high sensitivity (D3) with a higher than 50% specificity (D1). It was concluded that visual inspection and electrical methods at reduced cut-offs may aid the indication of invasive sealant treatment. The visual detection of dentinal caries is substantially increased, but not perfect after fissure opening.
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Toma de Decisiones , Caries Dental/diagnóstico , Selladores de Fosas y Fisuras/uso terapéutico , Área Bajo la Curva , Colorantes , Esmalte Dental/patología , Dentina/patología , Conductividad Eléctrica , Electrodiagnóstico/instrumentación , Reacciones Falso Positivas , Fluorescencia , Humanos , Rayos Láser , Diente Molar/patología , Tercer Molar/patología , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Estadística como AsuntoRESUMEN
For both general practitioners and researchers in caries diagnostics, the true validity of available diagnostic techniques is of considerable interest. Yet, for both bitewing radiography and fiber-optic transillumination, this is still not accurately known, nor is it clear which of the two techniques performs best clinically. This study's purpose was to estimate the clinical performance of the two techniques in diagnosing approximal caries lesions in low-caries-prevalence populations. Clinical studies that compare the two techniques were selected from literature. We determined 2 x 2 contingency tables from these studies and calculated one overall contingency table. The cut-off for decay was at dentinal caries. Assuming that erroneous outcomes from both techniques are mutually independent, we expressed diagnostic sensitivity and specificity of the two techniques as functions of the contingency table cell contents, with caries prevalence as the parameter. Because the caries prevalence was unknown, every sensitivity and specificity value was possible. From the conditions that sensitivity, specificity, and caries prevalence are always between one and zero, a limited range of sensitivity and specificity values was obtained. Three situations were examined: Bitewing radiography specificity is 1, fiber-optic transillumination specificity is 1, and both specificities are equal. Under these conditions, the bitewing radiography sensitivity was between 1.00 and 0.71 +/- 0.01, and the fiber-optic transillumination sensitivity was between 0.70 +/- 0.01 and 0.50 +/- 0.02. Both specificities were between 1.00 and 0.99. We concluded that the two techniques have comparable specificities. but that the fiber-optic transillumination sensitivity is significantly lower than that for bitewing radiography.
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Caries Dental/diagnóstico , Radiografía de Mordida Lateral/estadística & datos numéricos , Transiluminación/estadística & datos numéricos , Dentina , Tecnología de Fibra Óptica , Humanos , Modelos Estadísticos , Fibras Ópticas , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Recently erupted teeth are more sensitive to dental caries than teeth that have remained free from caries lesions for a few years after eruption. It has been hypothesized that this may be ascribed to differences in enamel porosity. The objective of the present work was to assess the time-dependence of electrical conductance, as an indication of porosity, of occlusal enamel in recently erupted permanent molar teeth. Fifty children aged 5-15 years of age, receiving regular dental care at six-month intervals, participated in the study when their first molar teeth (in 5- to 6-year-olds) or their second molar teeth (in 11- to 15-year-olds) had not been exposed to the oral environment for more than six months. On the first semi-annual check-up after eruption of a first or second molar, baseline diagnostic measurements, i.e., visual inspection and electrical conductance measurements (ECMs), were made at three or four pre-defined sites in the fissures. Subsequently, data collection was repeated every six months for three years. Sites were excluded from ECMs when a caries lesion was observed at a site by visual inspection. After 36 months, there were 257 sites in teeth considered sound upon visual examination. The ECM values of these sound sites showed a clear decrease with time after the first examination. The conductance decreased on average from 0.13 (Momega)(-1) to 0.059 (Momega)(-1). Since the conductance is assumed to be proportional to the porosity of the enamel, the latter decreased by a factor of 2.2 over the 36-month period. The results furthermore indicated a higher conductance for maxillary than for mandibular enamel. Almost all sites in that sample appeared to be in teeth that were observed for the first time during the months September to December. Electrical conductance, and therefore enamel porosity, of the sites showed a periodic variation with season of observation: In the fall, the conductance was higher than in the spring. This implies that a dentist should be more prudent in the fall than in the spring when indicating restorative treatment of an incipient caries lesion.
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Permeabilidad del Esmalte Dental/fisiología , Esmalte Dental/fisiología , Fisuras Dentales/fisiopatología , Adolescente , Niño , Preescolar , Esmalte Dental/química , Conductividad Eléctrica , Humanos , Porosidad , Análisis de Regresión , Estaciones del Año , Factores de Tiempo , Erupción DentalRESUMEN
AIM: The aim of this study was to investigate the influence of a low intensity alternating current on the odontoblasts and odontoblast layer and compare this with the effects of a direct current. METHODOLOGY: Teeth extracted for orthodontic reasons were immersed in physiological saline stabilized with thymol crystals. Within 1 h of extraction, an alternating or direct current was applied on the crown in the direction of the apex of the tooth for 120-360 s. The current doses were 12, 30, 60, 600, 1800, 3600, 7200, 24,000 and 144,000 microC. The teeth were fixed in Bouin or Baker fluids, the pulps removed, dehydrated and immersed in paraffin, then sectioned, stained with haematoxylin and eosin, and studied under a light microscope. RESULTS: Neither direct nor alternating current, similar to that applied in electrical caries diagnosis caused histological changes in the odontoblasts. CONCLUSIONS: There was no difference between direct and low intensity alternating current in the response of the odontoblast.
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Pulpa Dental/efectos de la radiación , Electricidad/efectos adversos , Odontoblastos/efectos de la radiación , Adolescente , Adulto , Pulpa Dental/citología , Prueba de la Pulpa Dental/efectos adversos , Prueba de la Pulpa Dental/métodos , HumanosRESUMEN
Aim of the study was to evaluate a method for selecting topics suitable for developing dental clinical practice guidelines in the Netherlands, based on an analysis of Dutch dental journals. A search for dental clinical topics was conducted by analysing Dutch dental journals, magazines and series over the period 1992-1997. The numbers of publications per topic were plotted against the publication years. The number of publications as well as the value of the slope of the linear regression were considered to be indicators of the importance of a topic. 'Dental implants (indication)' had the highest number of publications, followed by 'orthodontic treatment planning' and 'periodontology (indication)'. The topic 'practice hygiene' showed the highest value of the slope of the linear regression, followed by 'TMJ dysfunction' and 'dental implants (indication)'. With this method, it is feasible to detect changes and tendencies in the Dutch dental literature. It permits a selection of clinically relevant topics over a time span. It was concluded that this method may be very useful in the selection of a topic, but should probably be combined with other methods.
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Odontología/normas , Odontología/tendencias , Publicaciones Periódicas como Asunto/tendencias , Implantes Dentales/tendencias , Humanos , Metaanálisis como Asunto , Países Bajos , Ortodoncia/tendencias , Guías de Práctica Clínica como Asunto , Análisis de RegresiónRESUMEN
This symposium report evaluates the achievements made in caries diagnostic research since the previous symposium held in 1992. The symposium aimed at presenting the state of the art of caries diagnostic methods, on presenting the links between caries diagnosis and subsequent treatment decisions and their effect on the treatment outcomes, particularly the quality of dental care. The variation among dentists in diagnosing (small) caries lesions and in treatment decision making is considerable. This has been explained by the imperfection of caries decision making tests, but also by making incorrect treatment decisions due to incorrect or partial understanding of diagnostic test parameters. Meta-analyses into the performance of caries diagnostic tests revealed that the available quantitative methods are very promising. It was concluded that these methods had high correlations with lesion depth. They were considered suitable to monitor small changes in lesions. Many obstacles have been experienced in attempting to transfer the outcomes of diagnostic research into clinical practice and it was concluded that caries diagnosis researchers should co-operate with manufacturers to introducing valid new diagnostic tools to the market. Main research priorities for the coming 10 years are to conduct cost-effectiveness and cost-utility studies of caries diagnostic tools, to continue to review the performances of diagnostic tests, to transfer diagnostic knowledge and experience to the general practitioners particularly by constructing evidence-based clinical guide-lines, to study the relationship between diagnosis and treatment decision, and to assess the effect of diagnostic and treatment decisions on the outcome of care.
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Toma de Decisiones , Caries Dental/diagnóstico , Restauración Dental Permanente , Calidad de la Atención de Salud , Análisis Costo-Beneficio , Caries Dental/terapia , Investigación Dental , Europa (Continente) , Medicina Basada en la Evidencia , Humanos , Metaanálisis como Asunto , Guías de Práctica Clínica como Asunto , Transferencia de Tecnología , Resultado del TratamientoRESUMEN
INTRODUCTION: Problems that may arise in resin composite Class 2 restorations include microleakage and postoperative sensitivity. However, limited in-vivo research is conducted to evaluate these processes. AIM: The aim of this study was to assess postoperative sensitivity, microleakage and the pooling of adhesives in relation to Class 2 box-type composite restorations placed in vivo using various adhesive systems and application techniques. MATERIALS AND METHODS: One hundred and forty-four Class 2 box restorations were placed in the mesial and distal surfaces of 72 premolar teeth in-vivo using one of three combinations of adhesive systems and three filling techniques. After 6 weeks of clinical service postoperative sensitivity was recorded. The teeth were then extracted, immersed in a dye solution and sectioned. Microleakage and pooling of the adhesive was recorded. Statistical analysis involved logistic regression and chi2 tests to identify differences between groups at p < 0.05. RESULTS: Of the 144 restorations, 65 showed minimal cervical leakage in enamel, 5 suffered leakage into dentin and 74 were free of microleakage. No statistically significant differences were found in cervical microleakage between the adhesive systems or between filling procedures. Occlusal microleakage in the enamel was present in 16 of the 160 restorations. Liner Bond 2 restorations leaked significantly more at the occlusal surface (p < 0.05). Pooling of the adhesive was significantly less when PhotoBond was used. No spontaneous postoperative sensitivity was reported. Twenty-eight restorations were sensitive to loading. Postoperative sensitivity was significantly less in patients with Liner Bond 2 restorations. CONCLUSIONS: The adhesive systems used in this study showed minimal leakage into dentin in vivo. Using Liner Bond 2, restorations exhibited more occlusal leakage but were significantly less sensitive to loading.
Asunto(s)
Resinas Compuestas/química , Filtración Dental/etiología , Adaptación Marginal Dental , Restauración Dental Permanente/efectos adversos , Sensibilidad de la Dentina/etiología , Adhesivos/química , Adolescente , Diente Premolar , Distribución de Chi-Cuadrado , Colorantes , Resinas Compuestas/efectos adversos , Preparación de la Cavidad Dental , Esmalte Dental/ultraestructura , Filtración Dental/diagnóstico , Restauración Dental Permanente/clasificación , Restauración Dental Permanente/métodos , Dentina/ultraestructura , Recubrimientos Dentinarios/efectos adversos , Recubrimientos Dentinarios/química , Estudios de Seguimiento , Humanos , Modelos Logísticos , Metacrilatos/efectos adversos , Metacrilatos/química , Cementos de Resina/efectos adversos , Cementos de Resina/química , Estrés Mecánico , Cuello del Diente/ultraestructuraRESUMEN
Electrical conductance measurements are being used experimentally for occlusal caries detection. Recently, it was suggested to cover the fissure system with a conducting medium, resulting in a surface-specific measurement. It was the aim of this study to determine in vitro the reproducibility of this modified technique for occlusal caries in posterior teeth, to determine for a large study sample the correlation between the electrical measurements and histological lesion depth, and to evaluate the difference between results for premolars and molars. For the reproducibility determination, surface-specific electrical resistance measurements were made using a sample of 68 posterior teeth. Eight operators performed measurements on all teeth, and repeated measurements on 24 teeth. The validity study included the previous sample and the collected samples from two more studies, resulting in a total sample of 325 posterior teeth. One operator had performed electrical resistance measurements on all teeth in the sample. Reproducibility was good: mean Pearson's correlation coefficient 0.89 (+/-0.05) for interexaminer correlation, and 0.86 (+/-0.12) for intra-examiner correlation, using log (resistance) as the result parameter. The correlation coefficient between log(resistance) and histological lesion depth for the large sample was -0.78 for all teeth, -0.64 for premolars, and -0.73 for molars. The regression line for molars was located below the regression line for premolars: at a hypothetical histology score of 2.5 (a dentine caries threshold) the estimated resistance threshold would be 507 kOmega for premolars, and 233 kOmega for molars. Converted to Electronic Caries Monitor (ECM) readings, the difference is about 1.4 on the ECM scale. It was concluded that the in vitro reproducibility of the described surface-specific method for electrical resistance measurement is very good, even for inexperienced operators. The correlation between measurements and histological lesion depth is moderate to good. The method is sensitive to electrode area differences, which will result in different clinical cut-offs for caries diagnosis in premolar and molar teeth.