RESUMO
AIMS: This study aimed to determine the kinds of sequelae resulting from intrusive luxation and subluxative injuries in primary anterior teeth as well as the timing of such sequelae. MATERIALS AND METHODS: In this longitudinal retrospective study, data were collected from dental records and radiographs of patients with traumatic dental injury (TDI) treated at the Centre for the Study and Treatment of Dental Trauma in Primary Dentition (Pelotas, RS, Brazil). Fifty-two children, with seventy intruded teeth, and 76 children, with 99 subluxated teeth, met the inclusion criteria. Sequelae, such as crown discoloration, fistula, pulp canal obliteration (PCO), inflammatory root resorption (IRR), and internal root resorption, were investigated. The data on the sequelae were distributed into eight follow-up periods: 0-30 days, 31-90 days, 91-180 days, 181-365 days, 1-2 years, 2-3 years, 3-4 years, and >4 years. RESULTS: The sample comprised 99 subluxation cases and 70 intruded teeth. Crown discoloration was the most prevalent sequelae. Among the subluxated teeth, <50% of IRR, fistula, crown discoloration, and PCO occurred within 180 days after TDI; however, the sequelae were also diagnosed after longer periods. Majority of sequelae of intrusion were diagnosed within the 181-365 days and 1-2 years periods but were also observed after more than 4 years of follow up. CONCLUSIONS: For both intrusion and subluxation, trauma sequelae were diagnosed even after the 3-4 years of follow-up.
Assuntos
Incisivo/lesões , Reabsorção da Raiz/diagnóstico por imagem , Avulsão Dentária/diagnóstico por imagem , Descoloração de Dente/diagnóstico por imagem , Brasil , Pré-Escolar , Feminino , Seguimentos , Humanos , Incisivo/diagnóstico por imagem , Estudos Longitudinais , Masculino , Maxila/diagnóstico por imagem , Maxila/lesões , Radiografia , Estudos Retrospectivos , Reabsorção da Raiz/etiologia , Avulsão Dentária/complicações , Descoloração de Dente/etiologiaRESUMO
BACKGROUND: The authors conducted an in vivo study to determine clinical cutoffs for a laser fluorescence (LF) device, an LF pen and a fluorescence camera (FC), as well as to evaluate the clinical performance of these methods and conventional methods in detecting occlusal caries in permanent teeth by using the histologic gold standard for total validation of the sample. METHODS: One trained examiner assessed 105 occlusal surfaces by using the LF device, LF pen, FC, International Caries Detection and Assessment System (ICDAS) criteria and bitewing (BW) radiographic methods. After tooth extraction, the authors assessed the teeth histologically. They determined the optimal clinical cutoffs by means of receiver operating characteristic curve analysis. RESULTS: The specificities and sensitivities for enamel and dentin caries detection versus only dentin caries detection thresholds were 0.60 and 0.93 and 0.77 and 0.52 (ICDAS), 1.00 and 0.29 and 0.97 and 0.44 (BW radiography), 1.00 and 0.85 and 0.77 and 0.81 (LF device), 0.80 and 0.89 and 0.71 and 0.85 (LF pen) and 0.80 and 0.74 and 0.49 and 0.85 (FC), respectively. The accuracy values were higher for ICDAS, the LF device and the LF pen than they were for BW radiography and the FC. CONCLUSIONS: The clinical cutoffs for sound teeth, enamel carious lesions and dentin carious lesions were, respectively, 0 through 4, 5 through 27 and 28 through 99 (LF device); 0 through 4, 5 through 32 and 33 through 99 (LF pen); and 0 through 1.2, 1.3 and 1.4 through 5.0 (FC). The ICDAS, the LF device and the LF pen demonstrated good performance in helping detect occlusal caries in vivo. The ICDAS did not seem to perform as well at the D(3) threshold (histologic scores 3 and 4) as at the D(1) threshold (histologic scores 1-4). BW radiography and the FC had the lowest performances in helping detect lesions at the D(1) and D(3) thresholds, respectively. CLINICAL IMPLICATIONS: Occlusal caries detection should be based primarily on visual inspection. Fluorescence-based methods may be used to provide a second opinion in clinical practice.
Assuntos
Cárie Dentária/diagnóstico , Lasers , Adolescente , Adulto , Dente Pré-Molar/diagnóstico por imagem , Dente Pré-Molar/patologia , Cárie Dentária/diagnóstico por imagem , Cárie Dentária/patologia , Esmalte Dentário/diagnóstico por imagem , Esmalte Dentário/patologia , Fissuras Dentárias/diagnóstico , Fissuras Dentárias/diagnóstico por imagem , Fissuras Dentárias/patologia , Dentina/diagnóstico por imagem , Dentina/patologia , Fluorescência , Humanos , Processamento de Imagem Assistida por Computador/métodos , Funções Verossimilhança , Dente Molar/diagnóstico por imagem , Dente Molar/patologia , Fibras Ópticas , Fotografia Dentária/instrumentação , Exame Físico , Curva ROC , Radiografia Interproximal/métodos , Sensibilidade e Especificidade , Software , Coroa do Dente/diagnóstico por imagem , Coroa do Dente/patologia , Descoloração de Dente/diagnóstico , Descoloração de Dente/diagnóstico por imagem , Descoloração de Dente/patologia , Adulto JovemRESUMO
The purpose of this study was to evaluate the use of a laser fluorescence device for detection of occlusal caries in permanent teeth. One hundred and ninety-nine non-cavitated teeth from 26 patients aged 10 to 13 years were selected. After dental prophylaxis, two previously calibrated dentists examined the teeth. Visual inspection, radiographic examination and laser measurements were performed under standardized conditions. The validation method was cavity preparation with a small cone-shaped diamond bur, when the two examiners agreed about the presence of dentin caries. It was found that the laser detection method produced high values of sensitivity (0.93) and specificity (0.75) and a moderate positive predictive value (0.63). The laser device showed the lowest value of likelihood ratio (3.68). Kappa coefficient showed good repeatability for all methods. Although the laser device had an acceptable performance, this equipment should be used as an adjunct method to visual inspection to avoid false positive results.
Assuntos
Cárie Dentária/diagnóstico , Dentina/patologia , Lasers , Adolescente , Criança , Cárie Dentária/diagnóstico por imagem , Cárie Dentária/patologia , Preparo da Cavidade Dentária/instrumentação , Preparo da Cavidade Dentária/métodos , Esmalte Dentário/patologia , Fissuras Dentárias/diagnóstico , Fissuras Dentárias/diagnóstico por imagem , Fissuras Dentárias/patologia , Dentina/diagnóstico por imagem , Fluorescência , Humanos , Valor Preditivo dos Testes , Radiografia Interproximal , Sensibilidade e Especificidade , Descoloração de Dente/diagnóstico , Descoloração de Dente/diagnóstico por imagem , Descoloração de Dente/patologiaRESUMO
The aim of this ex vivo study was to compare visual clinical and radiographic examinations to the histological analysis for proximal caries diagnosis in extracted permanent molars and premolars. The relationship between clinical aspects and carious lesions was also evaluated. Eighty-eight proximal surfaces (44 freshly extracted teeth) were longitudinally sectioned with a 370-microm diamond disk, thinned with wet silicon carbide paper and observed with a stereomicroscope at x40 magnification. Sensitivity and specificity were 65.6% and 83.3% for clinical examination and 29.7% and 95.8% for radiographic examination, respectively. Kappa values ranged from 0.64 to 0.91. The white spots corresponded to lesions restricted to enamel, while the dark spots corresponded to lesions that reached the dentinoenamel junction. In most cases, cavitation corresponded to dentin lesions. It may be concluded that interproximal radiographic examination is not a reliable method for detection of incipient proximal carious lesions.