This study has three main objectives: Study 1) test the reproducibility and accuracy of the ICDAS I and ICDAS II caries detection systems;Study 2) validate a new impression material (Clinpro, 3M ESPE), which is said to detect lactic acid in plaque fermenting sucrose; Study 3) devise and test a scoring system for the assessment of caries activity of coronal lesions. Study 1): 141 extracted teeth were examined by two examiners using the ICDAS I and ICDAS II caries detection systems and validated against a histological classification system. Study 2): The accuracy of the impression material in predicting plaque with pH lower/higher than 5.5 was determined in an in situ study of 45 root dentin specimens by comparing the color change in the impression with the actual pH of the plaque, determined with a pH meter. Study 3): A scoring system to assess lesion activity was devised based on the predictive power of the visual appearance of the lesion (ICDAS II system), location of the lesion in a plaque stagnation area and, finally, the tactile feeling, rough/soft or smooth/hard, when running a perio-probe over the lesion. The accuracy was tested in a clinical The results from this study indicate that it is possible to predict lesion depth and assess the activity of primary coronal caries lesions accurately by using the combined knowledge obtained from the visual appearance, location of the lesion and tactile sensation during probing. Study 1): Intra-and inter-examiner reproducibility was found to be excellent (Kappa-values >0.82) and the associations strong (Spearmans correlation coefficients >0.90). Study 2): The Clinpro impression material was found to be acceptable as compared to the results of a pH meter, the combined sensitivity and specificity was 1.63. Study 3): ROC analysis showed that the devised classification system for determining lesion activity had acceptable accuracy (area under curve = 0.84 and the highest combined sum of specificity and sensitivity was 1.67).Thus, it is possible to predict lesion depth and assess the activity of primary coronal caries lesions accurately by using the combined knowledge obtained from visual appearance, location of the lesion and tactile sensation during probing.

Managing carious lesionsInnesGeneral rights Copyright and moral rights for the publications made accessible in Discovery Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from Discovery Research Portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain.• You may freely distribute the URL identifying the publication in the public portal. Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Variation in the terminology used to describe clinical management of carious lesions has 57 contributed to a lack of clarity in the scientific literature and beyond. The International Caries 58 Consensus Collaboration (ICCC), present issues around terminology, a rapid review of current 59 words used in the literature for caries removal techniques and present agreed terms and 60 definitions, explaining how these were decided. 61 1 Managing carious lesions: Consensus recommendations on terminology

Aim: The aim of this study was to assess inter- and intra-examiner reproducibility and accuracy in the detection and assessment of occlusal caries in extracted human teeth using a newly developed visual method for caries diagnosis (International Caries Detection and Assessment System, ICDAS-II). Serial sectioning and microscopy were used as the ‘gold standard’. Methods: The occlusal surfaces of 100 teeth were examined by 4 dentists using the ICDAS-II graded scores 0–6. Thereafter the teeth were serially sectioned and assessed for depth of the lesion with two histological classification systems. Results: The weighted kappa values for inter- and intra-examiner reproducibility for the ICDAS-II examination were 0.62–0.83. There was a moderate relationship between the visual and both histological examinations (r_s = 0.43–0.72). At the D1 diagnostic threshold (enamel and dentine lesions) specificity was 0.74–0.91 and sensitivity was 0.59–0.73. At the D3 diagnostic threshold (dentine lesions) specificity was 0.82–0.94 and sensitivity was 0.48–0.83 for the 4 examiners. Conclusion: The ICDAS-II system has demonstrated reproducibility and diagnostic accuracy for the detection of occlusal caries at varying stages of the disease process which are comparable to previously reported data using similar visual classification systems.

Stepwise and partial excavation reduced the incidence of pulp exposure in symptomless, vital, carious primary as well as permanent teeth. Therefore these techniques show clinical advantage over complete caries removal in the management of dentinal caries. There was no evidence of a difference in signs or symptoms of pulpal disease between stepwise excavation, and complete caries removal, and insufficient evidence to determine whether or not there was a difference in signs and symptoms of pulp disease between partial caries removal and complete caries removal. When partial caries removal was carried out there was also insufficient evidence to determine whether or not there is a difference in risk of restoration failure. The no dentinal caries removal studies investigating permanent teeth had a similar result with no difference in restoration failure. The other no dentinal caries removal study, which investigated primary teeth, showed a statistically significant difference in restoration failure favouring the intervention.Due to the short term follow-up in most of the included studies and the high risk of bias, further high quality, long term clinical trials are still required to assess the most effective intervention. However, it should be noted that in studies of this nature, complete elimination of risk of bias may not necessarily be possible. Future research should also investigate patient centred outcomes.