RESUMEN
The presence of initial caries accounts for the majority of approximal carious lesions in many countries. The aim of this clustered, split-mouth, randomised, controlled clinical trial was to use a metal separator to widen the approximal space in a one-visit session before sealing and to evaluate patient acceptance, together with the efficacy of the proximal sealing in arresting incipient carious lesions after 2 years. A total of 48 patients with a mean age of 41.9 years were selected. They had at least one pair of proximal initial carious lesions, including the distal surface of the canines to the mesial surface of the third molars (bite-wing score D1-D3). The patient's caries risk at baseline was analyzed using a Cariogram. All surfaces were examined for mutans streptococci (ms) counts. The separator technique made it possible to diagnose whether or not a microcavity was present. After 2 years, 212 surfaces in 45 subjects were examined using the same as baseline standardized digital follow-up radiographs. Two analyses were performed, one sensitive, where a progression or a regression was assessed if one of the examiners made one of those diagnoses, and one conservative, where unchanged. For both analyses, the sealed test surfaces showed a significantly higher regression (67 and 29%) compared to the control group (13 and 2%) p < 0.0001. It did not appear that the baseline variables, such as the caries risk, surface diagnoses, or ms counts, influenced the caries outcome. In the test group, there was no difference in caries progression if there was a microcavity or not. The separation treatment was well accepted by the patients. The method of separation for diagnosis and sealing treatment in a single session appears to be a clinically applicable method for the control of proximal carious lesions.
Asunto(s)
Caries Dental , Selladores de Fosas y Fisuras , Adulto , Caries Dental/diagnóstico por imagen , Caries Dental/terapia , HumanosRESUMEN
AIMS: To evaluate the diagnostic abilities of near-infrared light transillumination (using the DIAGNOcam) and bitewing radiographs in detecting cavitated proximal carious lesions in primary molars. SUBJECTS AND METHODS: The study was a cross-sectional analytical, clinical study. The proximal surfaces of primary molars of healthy 5- to 8-year-old children were radiographically screened for the presence of carious lesions in the enamel or outer third of dentin (D1). Two trained and calibrated examiners evaluated the depth of caries in bitewing radiographs and DIAGNOcam images and then verified the presence of cavitation by direct visual examination using the "International Caries Detection and Assessment System" after temporary tooth separation. RESULTS: A total of 236 proximal lesions were included in the study. Most of the clinically cavitated lesions (51.9%) were D1 radiographically and in outer dentin lesions (scores 3 and 4) by the DIAGNOcam (37% and 48.1%, respectively). Although DIAGNOcam showed higher sensitivity (0.852) compared to the radiographs (0.519), it showed slightly less specificity (0.569) compared to the radiographs (0.579). However, DIAGNOcam showed higher value of the area under the curve (AUC = 0.722; P < 0.001) compared to the radiographic method (AUC = 0.561; P = 0.308). CONCLUSIONS: The DIAGNOcam showed higher sensitivity and better accuracy than bitewing radiographs in diagnosing cavitated proximal lesions in primary molars and can be generally considered as an alternative to radiographs to detect cavitation without the hazards of ionizing radiation in children.