Elastomeric impression as a diagnostic method of cavitation in proximal dentin caries in primary molars

Abstract

The purpose of this study was to validate the elastomeric impression after temporary tooth separation as a method of cavitation detection in proximal caries lesions in primary molars with outer half dentin radiolucency. Fifty-one children (4-10 years old), presenting radiolucency in the outer half of the dentin at the proximal surfaces of primary molars and proximal anatomic contact with the adjacent tooth (without restoration/cavitated caries lesion) were enrolled in the study. Temporary tooth separation was performed with an orthodontic rubber ring placed around the contact point during 2-3 days. Thereafter, impression of the proximal surfaces was made. The elastomeric impressions were classified as "non-cavitated" or "cavitated" surfaces. Visual inspection after tooth separation was considered as the gold standard. Examiner reliability of visual inspection after tooth separation was determined (kappa 0.92). Impression examination was repeated every 5 participants to evaluate the reproducibility of the method. The frequency of cavitated lesions was 65%, and 67% of those were inactive. Sensitivity, specificity, positive and negative predictive values were 0.88% (95%CI 0.73-0.95), 0.89% (95%CI 0.67-0.97), 0.94% (95%CI 0.79-0.98) and 0.80% (95%CI 0.58-0.92), respectively. Impression examination showed total agreement regarding cavitation. The evaluation of elastomeric impression after tooth separation is a useful clinical resource in cavitation detection for clinicians and researchers when visual inspection is doubtful.

Methods Used by Dental Practice-based Research Network (DPBRN) Dentists to Diagnose Dental Caries

“…This study did not investigate all diagnostic methods available for detection of proximal lesions in posterior teeth and, therefore, it is unclear whether respondents make use of other diagnostic methods in those cases. Improved methods for the diagnosis of proximal lesions have been reported with the use of tooth separation and impression techniques 38,39. These methods accurately identify the presence of cavitation on the surface and thus allow for a more accurate decision regarding treatment.…”

Case Report: a 5-Year Follow-up of Proximal Caries Lesion Diagnosis

“…There is no single early caries detection method that is specific and sensitive 8 . Thus, fiber-optical transillumination (FOTI) 15 , laser fluorescence 7 , temporary separation [16][17][18] , and elastomeric impression after temporary tooth separation 17 may be used as additional auxiliary means of caries detection.…”

“…Temporary separation is also recommended as an alternative diagnostic method to overcome the difficulty of visually examining proximal surfaces and thus to visually detect the presence or absence of cavitation 16,17 . This method promotes spacing from 0.2 to 1 mm between teeth 16,22 and it is more effective in the maxillary arch, due to the different characteristics of the alveolar bone between maxillary and mandibular arches 10 .…”

“…Additionally, taking an elastomeric impression after temporary tooth separation has been proposed as a method of cavitation detection in proximal caries lesions 17 . This diagnostic method can be advantageous both for clinical follow-up of proximal caries lesions and for clinical studies that investigate the progression of these lesions 17 .…”

Effect of Different Contact Materials on Approximal Caries Detection by Laser Fluorescence and Light-Emitting Diode Devices

“…2,[7][8][9] Another method is separating the teeth temporarily with elastomeric separators, which allows for direct inspection of proximal sites. 10,11 This method is nondestructive, reversible, and inexpensive, and it may be a useful aid in the diagnosis and management of some lesions. However, occasional discomfort provoked by the placement of the rubber rings and the need for two appointments are disadvantages of the method.…”