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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.

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OBJECTIVES: This study aimed to evaluate the diagnostic performance of near-infrared imaging (NIRI) and unaided visual examination (UVE) in detecting proximal caries in permanent dentition in comparison with cone-beam computed tomography (CBCT). METHODS: Patients who underwent NIRI, UVE, and CBCT imaging within 1 week were enrolled. Using CBCT as the reference test, the positive percent agreement (PPA), negative percent agreement (NPA), and overall percent agreement (OPA) of NIRI, UVE, and a combination of the two for detecting proximal caries at different depths and in different tooth locations were assessed. Additionally, the consistency of these diagnostic methods with CBCT was evaluated. RESULTS: We evaluated 6,084 proximal surfaces and identified 177 CBCT-positive sites. NIRI had a PPA, NPA, and OPA of 68.93 %, 99.09 %, and 98.21 %, respectively, with a substantial agreement with CBCT. When combined with UVE, the PPA increased by approximately 50 % compared with that of UVE alone. Regarding caries at different depths, NIRI outperformed UVE in detecting initial caries (ICDAS 1-2) over moderate-to-advanced caries (ICDAS 3-6). However, the combined use of NIRI and UVE improved the detection of moderate-to-advanced caries. In the anterior teeth region, NIRI exhibited excellent agreement with CBCT, surpassing its performance in the posterior region. CONCLUSIONS: Although NIRI cannot fully replace radiographic methods, the substantial agreement of NIRI with CBCT in detecting proximal caries highlights its potential as a complementary tool in routine caries screening, especially when combined with UVE. CLINICAL SIGNIFICANCE: This study highlights the potential of NIRI as a radiation-free method for detecting proximal caries in permanent teeth. Early detection through regular NIRI scanning can lead to timely intervention, improved patient outcomes, and reduced overall disease burden.

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BACKGROUND: Modern management of dental caries should be more conservative and include early detection of lesions and active surveillance, in order to apply preventive measures and carefully monitor for signs of arrest or progression. Proximal slicing was suggested for nonrestorative caries treatment for primary incisors. The aim of the study was to examine the success of proximal slicing in primary maxillary incisors in arresting caries progression. METHODS: A retrospective cohort study. Data were collected from medical records of patients who had undergone proximal slicing in primary maxillary incisors with a follow-up period of at least 6 months. Treatment was considered a success when no further invasive clinical intervention was required within the follow-up period of at least 6 months. Treatment was considered a failure when further invasive clinical intervention was needed during the follow-up period (restoration, crown, or extraction). Additional variables included were the patient's gender, treated tooth, treated surface, age during their first visit to the clinic, age during slicing treatment, follow-up period, number of follow-up visits, and number of fluoride applications and additional slicing during follow-up. RESULTS: Seventy-one patients were included in the study. Proximal slicing was successful in 76% of participants with a follow-up of at least 6 months. Success was associated with older age at the first dental visit (3.5yo vs. 2.5yo, p = 0.0011) and age when proximal slicing was performed (4yo vs. 3yo, p < 0.001). CONCLUSION: Proximal slicing may successfully arrest proximal caries in primary maxillary incisors.

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Integrating technological tools with clinical visual examination for caries detection and diagnosis can improve preventative measures in dentistry, resulting in decreased treatment expenses and reduced time and costs associated with testing potential anticaries agents. This article provides an overview of the conventional and new emerging modern technologies that can assist dental professionals in the early detection and diagnosis of dental caries. These technologies aid in assessing the progression of carious lesions and monitoring them quantitatively or qualitatively over time. Traditional techniques (visual, tactile, and radiographic) have limitations in diagnosing early proximal caries accurately. Novel methods like fluorescence and transillumination, as well as advanced tools like OCT (optical coherence tomography), laser fluorescence, and QLF (quantitative light-induced fluorescence), are effective for early caries detection. Optical methods like fluorescence and transillumination are particularly successful in identifying initial caries stages. Moreover, this review highlights the clinical relevance of these methods and discusses potential future technologies like terahertz imaging and artificial intelligence (AI)-based approaches.

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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.

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The noninvasive proximal adhesive restoration (NIPAR) technique is a noninvasive approach that utilizes a one-component universal adhesive for infiltration and a filled flowable resin for impermeable sealing. This technique offers several benefits. The noninvasive treatment approach is particularly significant in restorative dentistry, as it entails identifying and managing caries in their initial phases. The efficacy of the noninvasive proximal adhesive restoration technique is limited to non-cavitated lesions. In this case report, a 24-year-old male patient with no relevant medical conditions with a history of dental extractions and restorations visited the University of Geneva Dental School for a complete dental check-up. Orthopantomogram (OPG) and bitewing radiographs revealed multiple initial proximal caries in teeth # 37 (mesial), # 36 (mesial & distal), and # 35 (distal). In addition, DIAGNOcam (KaVo) was used as a diagnostic tool to establish proximal caries' progression. After discussing treatment options with the patient, a decision was made to treat the lesions at the enamel level using NIPAR.

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OBJECTIVES: Treatment of carious primary molars is always indicated, especially on young children; however, there are no clear guidelines that precisely explain the best treatment approach for Class II carious molars with marginal breakdown (International Caries Detection and Assessment System [ICDAS] 5). The objective of this prospective observational clinical study was to assess the efficacy of three restorative techniques in treating ICDAS 5 Class II lesions in primary molars: compomer fillings (CF), preformed metal crowns (PMC), and pulpotomy and conventional preformed metal crowns (PMC+P). The secondary goal was to evaluate the impact of some cofactors on the course of treatment. METHOD AND MATERIALS: Overall, 92 children (female, n = 50, 54.3%; male, n = 42, 45.7%) aged 2 to 9 years old (mean age = 5.9 ± 1.9 years) with 166 treated teeth were included. The average number of decayed, missing, or filled teeth (d3mft) of the whole sample was 8.0 ± 3.4. The distribution of the sample according to type of treatment was CF = 53 (31.9%), PMC = 64 (38.6%), and PMC+P = 49 (29.5%). Paired t test, nonparametric Friedman ANOVA test, and decision tree analysis were used as the basis for the statistics. RESULTS: After 12 months, data from 75.8% (72/95) treated patients, corresponding to 62.0% (103/166) of the treated teeth (CF = 42/53, 79.2%; PMC = 38/64, 59.4%; PMC+P = 23/49, 46.9%) were available for analysis. The mean patients age was 6.8 ± 1.8 years; 32 (47.1%) boys and 36 (52.9%) girls. The mean d3mft of the remaining sample was 7.8 ± 3.35. PMC and PMC+P arms showed the highest success rates (> 91%) as compared to the CF arm, which showed the lowest success rates (61.9%), with 9/42 teeth of the CF group (21.4%) presenting with minor failures, and 7/42 teeth (16.7%) with major failures (P < .0001). CONCLUSION: According to the decision tree analysis, PMC and PMC+P had a success rate of 99%, whereas CF had a success rate of only 69%. Some cofactors (treatment decision, Approximal Plaque Index, and tooth number) had a higher impact on the decision tree analysis than others (age, dmfs, and dmft values), especially when the treatment selection was CF. In future studies it is necessary to examine the impact of other cofactors on the outcomes of conventional fillings using a larger sample size.

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Background/purpose: Horizontal bitewing radiographs are widely and frequently used in dentistry and are very reliable in diagnosing proximal caries and interproximal alveolar bone level. However, it is challengeable in detecting interproximal root caries, horizontal and/or vertical alveolar bone loss, and furcation involvements. The aim of this article was to assess the accuracy of vertical bitewing images in the diagnosis of caries and alveolar bone level compared to the horizontal bitewing technique. Materials and methods: Each one of the 20 patients had eight bitewing radiographs to get four horizontal bitewing (control) and four vertical bitewing (experimental) images for the same posterior area; a steel wire (3 mm) was used on the sensor plate to help measure the magnification later on. The radiographs were processed digitally and were evaluated for caries by two expert restorative specialists and for bone loss by two experienced periodontists. They were also compared to the "gold standard," which is using of both clinical and radiographic examination for diagnosis. They were blinded to each other during images evaluation. Results: Of the 20-patient sample size, 70% were male and 30% were female, with a mean age of 29.9. The average number of radiographs taken to achieve four standard bitewing radiographs was 5.9 ± 1.7 for vertical bitewings and 5.3 ± 1.3 for horizontal bitewing radiograph. The measurements from the cementoenamel junction (CEJ) to the level of crestal bone didn't show a significant difference between the horizontal and vertical bitewing radiographs. The detection of furcation area in the molar teeth was much higher in the vertical bitewing (100%) compared to the horizontal bitewing (57.5%) (P < 0.0001). Conclusion: The vertical bitewing radiograph has the upper hand over the horizontal bitewing radiograph in the detection of furcation involvement, caries detection, and alveolar bone loss. Therefore, it is highly recommended to use vertical bitewing in caries and patients with periodontal disease rather than the conventional horizontal bitewing.

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BACKGROUND: Few studies report on managing initial proximal caries with sealants, and no reports focus on fluoride-releasing sealants. AIM: To compare the effectiveness between applications of a fluoride-releasing sealant and fluoride varnish on proximal enamel caries to control caries progression in permanent teeth. DESIGN: This was a split-mouth randomized controlled trial in forty-four 11- to 16-year-old children with radiographic caries in at least one contralateral pair of teeth with proximal enamel caries. The lesions were evaluated using DIAGNOdent and were also assessed visually after tooth separation. The lesions in each subject were randomly sealed with a fluoride-releasing sealant (Helioseal® F) or applied with fluoride varnish (Duraphat®). The fluoride varnish-treated lesion was reapplied at 3 and 6 months. Clinical examination, bitewing radiograph evaluation, and DIAGNOdent assessment were performed at 6 and 12 months. The caries progression outcome variables were regression, no change, and progression. The data were analyzed with the McNemar-Bowker test. RESULTS: Radiographic examination and DIAGNOdent assessment demonstrated no significant differences in the percentages of regression, no change, or progression at the 12-month follow-up (p > .05). CONCLUSION: Applications of a fluoride-releasing sealant and of fluoride varnish three times resulted in a nonsignificant difference in caries progression of initial proximal caries at the 12-month follow-up.

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OBJECTIVES: The objective was to evaluate the diagnostic accuracy of radiographic evaluation (XR), visual-tactile assessment (VT), laser-fluorescence (LF) (DIAGNOdent Pen/KaVo), and near-infrared-light transillumination (NILT) (DIAGNOcam/KaVo) on proximal root caries lesions in vitro. METHODS: Two-hundred extracted permanent premolars and molars with and without proximal root caries lesions were allocated to 50 diagnostic models simulating the proximal contacts between teeth and mounted in a phantom dummy head. Two independent examiners used the diagnostic approaches to detect any or advanced root caries lesions, with histologic evaluation of the lesions serving as reference. Receiver operating characteristic (ROC) curves were employed, and sensitivity, specificity, and the area under the ROC curve (AUC) are calculated. Significant differences in mean AUCs between approaches were assumed if p < 0.05 (two-sample t-test). RESULTS: NILT was not applicable for proximal root caries detection. The sensitivity/specificity to detect any lesions was 0.81/0.63 for XR, 0.76/0.88 for VT and 0.81/0.95 for LF, and the sensitivity/specificity to detect advanced lesions was 0.43/0.94 for XR, 0.66/0.99 for VT, and 0.83/0.78 for LF, respectively. For both, any and advanced root caries lesions, mean AUCs for LF and VT were significantly higher compared to XR (p < 0.05). For any root caries lesions, LF was significantly more accurate than VT (p = 0.01), but not for advanced root caries lesions (p = 0.59). CONCLUSIONS: Under the in vitro conditions chosen, LF and VT were more accurate than XR to detect proximal root caries lesions, with LF being particularly useful for initial lesion stages. CLINICAL RELEVANCE: LF might be a useful diagnostic aid for proximal root caries diagnosis. Clinical studies are necessary to corroborate the findings.

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Introduction The dental students are trained to identify the proximal carious lesion using clinical tools and radiography over three years of academic curriculum. During these years the students are expected to learn detection of incipient carious lesions and take appropriate preventive/restorative measure. Method This study aimed at evaluating the ability of the students and interns to detect only-enamel proximal caries on the five digital bitewing radiographs. The digital bitewing radiographs were having incipient carious lesions involving enamel on proximal surface of mandibular first molars. Results A total of 101 participants (M = 29, F = 72) from fifth (D5) and sixth (D6) years of dentistry evaluated the radiographs and the KR20 values for D5, D6, and total sample were 0.79, 0.64, and 0.41 respectively. Conclusion Overall students' assessment of detection of incipient carious lesion was low. There is need to enhance clinical and radiological cognitive skills among students with emphasis on interdisciplinary learning objectives.

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OBJECTIVES: To assess the cytotoxicity of an experimental hybrid-glass-based infiltrant and its effect on biofilm attachment, growth and metabolic activity, and to compare it to the resin-based infiltrant Icon. METHODS: Cytotoxicity of hybrid-glass-based material (EXP) and resin-based infiltrant Icon (Icon) was tested in direct contact tests on freshly cured (direct_mat) and on materials kept for 24 h in cell culture medium (direct_exmat), and extract test with materials 24-h extracts (extract). Cell viability of L929 mouse fibroblast cell line was measured with MTT assay, according to ISO10993-5:2009. Biofilm attachment (5 h), growth (24 h and 48 h) and lactic-acid production (24 h and 48 h) on glass-disk specimens coated with EXP or Icon, or uncoated (control), were assessed using a microcosm biofilm model and Amsterdam Active Attachment system. At indicated time points, biofilms were harvested, plated, and CFU counts were determined, while lactic-acid production was measured colorimetrically. RESULTS: Cell viability reduction by EXP was below 30%-threshold in direct contact tests, while in extract test an increased cell viability was observed. Icon reduced cell viability substantially in all three tests. Significantly less bacteria attached to the surface of EXP after 5 h compared to Icon and control. Biofilm growth was significantly lower on EXP than on Icon and control after 24 h, but this difference was smaller and statistically insignificant after 48 h. There was no difference in lactic-acid production among groups. SIGNIFICANCE: Novel hybrid-glass-based infiltrant seems to have a better biocompatibility and accumulates on its surface less bacteria than resin-based infiltrant, which makes it an attractive resin-free alternative.

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This study aimed to evaluate the validity of a deep learning-based convolutional neural network (CNN) for detecting proximal caries lesions on bitewing radiographs. A total of 978 bitewing radiographs, 10,899 proximal surfaces, were evaluated by two endodontists and a radiologist, of which 2,719 surfaces were diagnosed and annotated with proximal caries and 8,180 surfaces were sound. The data were randomly divided into two datasets, with 818 bitewings in the training and validation dataset and 160 bitewings in the test dataset. Each annotation in the test set was then classified into 5 stages according to the extent of the lesion (E1, E2, D1, D2, D3). Faster R-CNN, a deep learning-based object detection method, was trained to detect proximal caries in the training and validation dataset and then was assessed on the test dataset. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic curve were calculated. The performance of the network in the overall and different stages of lesions was compared with that of postgraduate students on the test dataset. A total of 388 carious lesions and 1,435 sound surfaces were correctly identified by the neural network; hence, the accuracy was 0.87. Furthermore, 27.6% of lesions went undetected, and 7% of sound surfaces were misdiagnosed by the neural network. The sensitivity, specificity, PPV, and NPV of the neural network were 0.72, 0.93, 0.77, and 0.91, respectively. In contrast with the network, 52.8% of lesions went undetected by the students, yielding a sensitivity of only 0.47. The F1-score of the students was 0.57, while the F1-score of the network was 0.74 despite the accuracy of 0.82. A significant difference in the sensitivity was found between the model and the postgraduate students when detecting different stages of lesions (p < 0.05). For early lesions which limited in enamel and the outer third of dentin, the neural network had sensitivities all above or at 0.65, while students showed sensitivities below 0.40. From our results, we conclude that the CNN may be an assistant in detecting proximal caries on bitewings.

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Understanding the root and canal anatomy is pivotal before initiating endodontic surgical procedures. Any missed canal will cause treatment failure and ultimately lead to tooth extraction in this era of tooth conservation. Mandibular second premolars have attracted researchers and clinicians for having aberrant anatomy. Variations in the number of roots or canals may not be discerned on 2D radiographs and may become apparent during treatment procedures. The occurrence of two roots in the lower second premolar has been reported in the current case. Here, in this case, the authors have described the clinical course of the patient along with the management of these two rooted mandibular second premolars.

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Background: Radiography plays an important role in detection of interproximal caries. The aim of study is to compare diagnostic ability of conventional film and photostimulable phosphor (PSP) with direct measurement using stereomicroscope in detecting proximal caries. Methodology: In this descriptive study - diagnostic test evaluation, 200 proximal surfaces of 100 extracted human posterior teeth were radiographed with dental X-ray unit. Evaluation of conventional and digital radiographs was performed twice by three observers. Carious lesions were classified based on a four-point scale (R0-R3) suggested by Abesi et al. Weighted kappa coefficients were calculated to assess intra- and interobserver agreement for each image set. Indices of diagnostic ability calculation were based on the first readings of the three observers. The scores were compared with the histological gold standard using receiver operating characteristic (ROC) analysis to evaluate diagnostic ability. Results: Intraobserver kappa coefficients calculated for each observer for each method of detecting caries ranged from 0.914 to 0.956. Interobserver kappa coefficients for each image set ranged from 0.8788 to 0.9583. The sensitivity and specificity of film for the first observer were 77.5% and 78.3% and for PSP were 77.5% and 80%, respectively. ROC analysis revealed that there were no statistically significant results (P > 0.05) between Az values for the two detection methods. Conclusion: PSP plate should be preferred over conventional films in detecting cavitated proximal caries. Further studies with more noncavitated proximal surfaces are required to conclusively establish the diagnostic ability of PSP over conventional film.

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With advances in technology, dentists nowadays manage dental caries with the philosophy of minimally invasive dentistry. Dental restoration is now performed most conservatively with minimal destruction of tooth structure when operative dentistry is indicated. Some operative dentists suggested using tunnel restoration for treating proximal caries as a conservative alternative to the conventional box preparation. The main advantage of tunnel restoration over the conventional box or slot preparation includes being more conservative and increasing tooth integrity and strength by preserving the marginal ridge. However, tunnel restoration is technique sensitive and requires advanced operative skills. Tunnel restoration can be an option to restore proximal caries if the dentist selects the proper case and pays attention to the details of the restorative procedures. With the dentist's advanced training, advanced light-emitting diode handpieces, magnifying loupes, precise digital imaging and new generation restorative materials, good results can be obtained in selected cases. This study reviews the literature on tunnel restoration and provides updated techniques and clinical data that can be used in tunnel restoration to oversee its limitations and the perspective on restorative treatment.

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Detection of proximal carious lesions involves the combination of clinical and radiographic methods, both with inherent difficulties. The present cross-sectional study is aimed at estimating the prevalence of cavitation in proximal carious lesions, based on a direct clinical assessment of previously detected radiographic lesions, in permanent molars and premolars. Proximal dental surfaces were radiographically evaluated using the ADA coding system and cavitation was determined through clinical visual examination of the surfaces after separation with elastomeric bands. One-hundred and twenty-six patients attending the dental clinics at the University of Talca were examined, comprising 508 proximal surfaces with radiographic codes ranging from E1 to D3. Two examiners were trained and calibrated for radiographic and clinical detection of proximal lesions. Most participants were females (61.9%). The age mean of participants was 28.7 (0.8) years old. A total of 22.2% of the examined surfaces were cavitated. Only few lesions coded as E1 (n = 4; 2.1%) and E2 (n = 9; 9.8%) were cavitated. Fifty D1 (35.5%) and 22 D2 (41.5%) lesions were cavitated after separation. Most lesions coded as D3 (n = 28; 84.8%) were cavitated. The multilevel binary regression model (p = 0.003) demonstrated that sex, age, jaw, tooth type, surface, and side were not associated with the likelihood of having proximal cavitation. Challenging conventional wisdom, most D1 and D2 lesions were not cavitated. Combining detection methods seems desirable to increase the accuracy in assessing approximal posterior lesions. The low proportion of cavitated lesions reinforces the idea of cautiously indicating invasive approaches for managing proximal carious lesions.

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OBJECTIVES: The aim of this study was to evaluate the use of digital bitewing radiographs using photostimulable phosphor (PSP) plates in the estimation of the true extension of proximal carious lesions. METHODS: The sample size was calculated to be 70 teeth. Adult patients with a minimum of one posterior tooth with primary proximal caries lesions were included. A preoperative bitewing radiograph was taken and the extension of the carious lesion was measured from the most prominent point on the adjacent sound tooth to the deepest axial point of the lesion. An experienced general dentist provided the restorative treatment and made a polyvinyl siloxane impression of the cavity preparation. Clinical caries extension was measured from the most prominent point of the adjacent tooth until the deepest boundary of the axial wall of the preparation on the impression. Postoperative radiographs were taken at the completion of restorative care. The bitewing radiographs were done using PSP plates and caries extension measurements were performed using measuring tools of the digital radiography software. Pairwise comparisons were made between preoperative and postoperative radiographs, and the true clinical depth measurements using paired t-tests. RESULTS: In total, 73 teeth from 44 subjects were included. A significant difference of 0.82 mm was found between preoperative radiographs and clinical measurements (p<0.001). Similarly, comparisons between preoperative and postoperative radiographic measurements showed significant differences of 0.99 mm (p<0.001). CONCLUSIONS: The study found that the true clinical extension of proximal caries after non-selective caries removal was significantly deeper than the preoperative radiographic extension assessment. This was not influenced by the tooth type, the location of the tooth, or the affected tooth surfaces. CLINICAL SIGNIFICANCE: When a non-selective caries removal strategy is adopted, clinicians should be aware that PSP bitewing radiographs underestimate the true clinical extension of proximal caries lesions. This will have an impact on clinicians' practice and restorative treatment decisions.

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The present study aimed to evaluate the performance of convolutional neural networks (CNNs) that were trained with small datasets using different strategies in the detection of proximal caries at different levels of severity on periapical radiographs. Small datasets containing 800 periapical radiographs were randomly categorized into a training and validation dataset (n = 600) and a test dataset (n = 200). A pretrained Cifar-10Net CNN was used in the present study. Different training strategies were used to train the CNN model independently; these strategies were defined as image recognition (IR), edge extraction (EE), and image segmentation (IS). Different metrics, such as sensitivity and area under the receiver operating characteristic curve (AUC), for the trained CNN and human observers were analysed to evaluate the performance in detecting proximal caries. IR, EE, and IS recognition modes and human eyes achieved AUCs of 0.805, 0.860, 0.549, and 0.767, respectively, with the EE recognition mode having the highest values (p all < 0.05). The EE recognition mode was significantly more sensitive in detecting both enamel and dentin caries than human eyes (p all < 0.05). The CNN trained with the EE strategy, the best performer in the present study, showed potential utility in detecting proximal caries on periapical radiographs when using small datasets.

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OBJECTIVES: To assess the effectiveness of two experimental, hybrid-glass-based infiltrants in arresting artificial white spot lesions (WSLs) in vitro, and to compare it with resin-based infiltrant Icon. METHODS: Artificial WSLs were formed on bovine enamel specimens (n = 68). Specimens were divided into four groups according to WSLs treatment: 1) no-treatment control (NTC), 2) infiltration with Icon (Icon), 3) infiltration with experimental hybrid-glass material (EXP), and 4) infiltration with experimental hybrid-glass material containing hydroxyapatite (HAp) nanoparticles (1%) (EXP-HAp). Half of the specimens from each group were subjected to cariogenic challenge using pH-cycling, consisting of a 7-day alternate incubation (37°C) in demineralization (4 h/day, pH=4.6) and remineralization solutions (20 h/day, pH=7.2). Another half of the specimens was incubated in distilled water (control). Caries progression was assessed by measuring surface micro-hardness (SMH), roughness (Ra) and average surface level, and by analyzing WSLs morphology. Non-cycled and pH-cycled specimens were compared with Man-Whitney U test, while different treatment groups were compared with Kruskal-Wallis test with pairwise comparisons (p < 0.05). RESULTS: In all groups (NTC, Icon and EXP-HAp) except EXP, SMH decreased significantly after pH cycling. In addition, SMH increased in EXP upon pH cycling and was significantly higher than in other pH-cycled groups (<0.001). Ra increased considerably, while surface level decreased after pH cycling in all groups except in EXP. Signs of demineralization and roughness increase in NTC, Icon and EXP-HAp were also observed with the SEM. SIGNIFICANCE: Experimental hybrid-glass-based material without HAp-nanoparticles could completely arrest the progression of WSLs, unlike its version with HAp-nanoparticles and resin-based infiltrant Icon.

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