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Evaluation of two visual criteria on diagnosis and treatment decisions of caries lesions around restorations

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Bruna Lorena Pereira Moro
Total Authors: 1
Document type: Doctoral Thesis
Press: São Paulo.
Institution: Universidade de São Paulo (USP). Faculdade de Odontologia (FO/SDO)
Defense date:
Examining board members:
Fausto Medeiros Mendes; Jose Carlos Pettorossi Imparato; Rafael Ratto de Moraes; Daniela Prócida Raggio
Advisor: Fausto Medeiros Mendes; Maximiliano Sérgio Cenci

This research aims to evaluate the effect of using two visual criteria on diagnosis and treatment decisions of caries lesions around restorations, focusing on clinical studies in primary teeth. The selected criteria were the International Dental Federation (FDI) criteria and the Caries Associated with Restorations and Sealants (CARS) system. For the FDI criteria, the subcategories marginal staining, marginal adaptation, and recurrence of caries were used. For the CARS system, a proposed treatment decision was used in association with the criteria. This thesis presents a compilation of studies related to this subject, being (I) a study protocol of a randomized clinical trial (RCT) to evaluate restorations in children, (II) a cross-sectional study to compare treatment decisions, (III) a delayed type cross-sectional prospective accuracy study in primary teeth, and (IV) an in vitro study using the criteria in permanent teeth. The RCT (I) objective, which is the main study, was to evaluate the effect of two visual criteria in the assessment of 626 restorations in primary teeth in a sample of children from three to 10 years old. The primary outcome will be the need for a new intervention in the evaluated restorations after two years of follow-up. The changes in children\'s oral health-related quality of life and the restorative dental treatment cost will also be analyzed as secondary outcomes. The cross-sectional study (II) aimed to investigate the influence of the FDI and CARS system on the decision to replace 550 restorations in primary posterior teeth in the same sample of children of the study (I). Variables that might influence this decision were also considered. The delayed type cross-sectional prospective accuracy study evaluated the sensibility, specificity, and accuracy of the FDI and CARS system in detecting caries lesions around 651 restorations in primary teeth in the same sample of children of the study (I). The reference standard methods were the restoration removal and visual-tactile examination of dentin beneath the margin interface when the replacement was indicated or visual-tactile detection and assessment of the restoration after six and 12 months of follow-up. An in vitro study (IV) was also carried out in a sample of 116 composite restorations of permanent posterior teeth. This study aimed to evaluate the FDI, CARS, and three-dimensional (3D) intraoral scanner\'s performance in detecting secondary caries lesions and predicting their severity. The reference standard was the histological examination. It was observed that restorations evaluated according to the FDI criteria were more frequently indicated for replacement than those assessed with the CARS system. Besides that, children\'s caries experience and multisurface restorations influenced the decision to replace restorations. Regarding the accuracy of the methods, the CARS system was more accurate than the FDI criteria. However, the FDI criteria for evaluating recurrence of caries and marginal adaptation presented similar performance to the CARS system when the dentin threshold is considered. On the other hand, marginal staining was not an accurate parameter to evaluate caries around restorations in primary teeth. In a sample of permanent teeth, both visual criteria are moderately correlated with lesion depth. The 3D intraoral scanner does not add further information to gap size assessment than visual inspection. In conclusion, the CARS system seems to be the most accurate diagnostic visual method and suggests less invasive treatment decisions than FDI criteria. However, the FDI recurrence of caries is similar to the CARS system. The marginal staining definitely should not be used to evaluate caries lesion around restorations or to indicate restoration replacement. (AU)

FAPESP's process: 17/22897-3 - The impact of two different clinical criteria for the evaluation of caries lesions around restorations in primary teeth: randomized clinical trial
Grantee:Bruna Lorena Pereira Moro
Support Opportunities: Scholarships in Brazil - Doctorate