Clinical Accuracy of Two Different Criteria for the Detection of Caries Lesions around Restorations in Primary Teeth

Abstract

This is a delayed-type cross-sectional prospective accuracy study nested in a randomized clinical trial. The aim was to investigate the diagnostic accuracy of two visual criteria for caries lesions detection around restorations in primary teeth: the International Dental Federation (FDI) criteria, considering adaptation, staining and presence of caries, and the Caries Associated with Restorations and Sealants (CARS) system. For this, one examiner made the diagnosis and subsequent treatment decision using visual assessment in 163 children (3 to 10 years old) with both FDI and CARS criteria. The order of criteria used was defined by randomization. The reference standard was composed of two approaches: (i) presence of carious tissue after restoration removal or (ii) presence of caries lesions after six and 12 months of follow-up. Sensitivity, specificity, and accuracy parameters were calculated at the dentin threshold. Poisson multilevel regression analyses were performed to evaluate the association of the diagnostic methods and other explanatory variables with the outcomes. Of the 651 restorations included, 480 were evaluated by the reference standard methods and were analyzed. The CARS system presented higher accuracy (0.721) than those obtained with FDI recurrence of caries (0.702), FDI marginal adaptation (0.700) and FDI marginal staining criteria (0.681). The FDI marginal staining showed the study’s lowest sensitivity (0.280) and accuracy (0.681) values. The specificity values of FDI recurrence of caries and FDI marginal adaptation were lower than the CARS system. Restorations assessed after the follow-up period resulted in lower sensitivity but higher specificity than those replaced after initial evaluation. In conclusion, the CARS system is more accurate in detecting caries around restorations in primary teeth than the FDI system, in general. However, the FDI recurrence of caries and FDI marginal adaptation present similar performance to the CARS system when the dentin threshold is considered. On the other hand, marginal staining is not an accurate parameter to evaluate caries around restorations.

Diagnostic Strategies for Restorations Management: A 70-Month RCT

“…As outlined, marginal staining, typically noted for anterior restorations in the esthetic domain, was integrated here to examine its potential as a caries predictor. The latest FDI version cautions against equating marginal staining with secondary caries, aligning with the existing literature (Mjör and Toffenetti 2000;Moro et al 2022;Uehara et al 2023). The updated criteria highlight the importance of considering marginal adaptation scores in conjunction with lesion location and the patient's caries history, risk, and activity when determining the treatment decision.…”

“…If so, primary caries diagnostic criteria should apply, focusing on lesion extension and activity for treatment (Dennison and Sarrett 2012). Results derived from this trial indicated that overemphasis on marginal defects might lead to false positives and overtreatment (Uehara et al 2023), a trend also seen in primary teeth (Moro et al 2022).…”

Secondary Caries Detection and Treatment Decision according to Two Criteria and the Impact of a Three-Dimensional Intraoral Scanner on Gap Evaluation

“…On the other hand, the CARS system evaluates only the same stages as coronal primary caries and does not present any treatment decision linked to the evaluation method. However, the authors of the present study adapted the decisions based on the recommendations for the treatment of primary caries lesions and has been using on studies to investigate secondary caries in primary teeth [Moro et al, 2020a;Moro et al, 2020b;Moro et al, 2022]. Nevertheless, there is a lack of evidence about the accuracy and impact of both criteria on caries around restoration assessment in permanent teeth.…”