Impact of visual inspection and radiographs for caries detection in children through a 2-year randomized clinical trial

Pontes, Laura Regina Antunes; Novaes, Tatiane Fernandes; Lara, Juan Sebastián; Gimenez, Thaís; Moro, Bruna Lorena Pereira; Camargo, Lívia Arantes; Michel‐Crosato, Edgard; Pannuti, Cláudio Sérgio; Raggio, Daniela Prócida; Braga, Mariana Minatel; Mendes, Fausto Medeiros

doi:10.1016/j.adaj.2020.02.008

Cited by 22 publications

(36 citation statements)

References 17 publications

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“…One hundred and six children from the visual inspection group and 110 from the radiographic method group nished the study (p =0.108, by chi-square test) in the mail trial. Full data was published elsewhere, including the ow chart and participants' data at baseline [35].…”

Section: Resultsmentioning

confidence: 99%

“…In order to clarify this controversial issue, we designed a randomized clinical trial comparing two caries detection strategies: the combination of information obtained by visual inspection + radiographic assessment versus the information from visual inspection performed alone [34,35]. No statistically signi cant differences were observed in relation to the primary outcome (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…For the latter strategy, a positive result obtained with one of the methods would classify the surface as decayed. The primary endpoint was the number of new operative interventions performed on deciduous molars during the two-year follow-up and our ndings were recently published [35]. Data related to oral health-related quality of life and economic analysis will be further analyzed and published separately.…”

Section: Trial Designmentioning

confidence: 99%

“…The CARies DEtection in Children (CARDEC) trials initiative began with a randomized clinical trial testing two diagnostic strategies (and subsequent treatment) for caries detection in deciduous teeth of preschool children: visual inspection performed alone or simultaneously combined with a radiographic assessment. The main trial compared participants for the occurrence of new operative interventions during a two-year follow-up [34,35]. The present study, containing secondary analyses of data from the main trial, aimed to evaluate the placed interventions and clinical course on occlusal and proximal surfaces of deciduous molars of children diagnosed by both visual inspection and in combination with the radiographic method after 2 years.…”

Section: Introductionmentioning

confidence: 99%

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Negligible Therapeutic Impact, False-positives, Overdiagnosis and Lead-time Are the Reasons Why Radiographs Bring More Harm Than Benefits in the Caries Diagnosis of Preschool Children: Secondary Analysis of a Randomized Clinical Trial 

Pontes

Lara

Novaes

et al. 2020

Preprint

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Background: To evaluate the clinical course and interventions required during two years of follow-up of dental surfaces of deciduous molars diagnosed, and consequently treated, by two different strategies: diagnosis made by clinical examination alone or associated with radiographs.Methods: This is a secondary analysis of a two-arm randomized clinical trial with two parallel groups related to the diagnostic strategy for caries detection in preschool children. 216 children (3 to 6 years old) were followed-up for two years. All dental surfaces were diagnosed by visual inspection and later, through radiographic assessment. Baseline treatment was made in accordance with the results obtained by visual inspection performed alone or combined with radiographic method, considering the allocated group. Dental surfaces with no restoration needs, or those restored at the beginning of the study were followed-up for two years. The treatment decision was made according to the allocated group. The outcome was the occurrence of failure (a new caries lesion or a restoration replacement) during the follow-up. Results: 4,383 proximal and occlusal surfaces of deciduous molars in 216 preschool children were diagnosed and treated according to the abovementioned diagnostic strategies and followed-up for 24 months. The assessment of radiographs made change the initial decision reached by visual inspection in about 30% of the surfaces when all types of interventions were considered. However, most disagreements occurred for initial lesions, where radiographs tended to underestimate them. Discordances between methods occurred in less than 5% of all surfaces when considered lesions requiring operative treatment. For discrepancy cases, the placed interventions guided by following the radiographic results did not present less failures against those made following only visual inspection. As a matter of fact, the use of radiographs in the diagnostic strategy for caries detection in children brought more harms than benefits due to the occurrence of false-positives, overdiagnosis and lead-time bias.Conclusions: Simultaneous association of visual inspection and radiographic assessment for caries detection in preschool children causes more harms than benefits, and therefore, visual inspection should be conducted alone in the regular clinical practice.Trial registration: clinicaltrials.gov platform: NCT02078453, registered on 5th March 2014

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Trial Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Negligible Therapeutic Impact, False-positives, Overdiagnosis and Lead-time Are the Reasons Why Radiographs Bring More Harm Than Benefits in the Caries Diagnosis of Preschool Children: Secondary Analysis of a Randomized Clinical Trial 

Pontes

Lara

Novaes

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…The CARies DEtection in Children (CAR-DEC) trials initiative began with a randomized clinical trial testing two diagnostic strategies (and subsequent treatment) for caries detection in deciduous teeth of preschool children: visual inspection performed alone or simultaneously combined with a radiographic assessment. The main trial compared participants for the occurrence of new operative interventions during a twoyear follow-up [34,35].…”

Section: Introductionmentioning

confidence: 99%

Negligible therapeutic impact, false-positives, overdiagnosis and lead-time are the reasons why radiographs bring more harm than benefits in the caries diagnosis of preschool children

et al. 2021

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Background To evaluate the clinical course and interventions required during two years of follow-up of dental surfaces of deciduous molars diagnosed, and consequently treated, by two different strategies: diagnosis made by clinical examination alone or associated with radiographs. Methods This is a secondary analysis of a two-arm randomized clinical trial with parallel groups related to the diagnostic strategy for caries detection in preschool children. 216 children (3–6 years old) were followed-up for two years. All dental surfaces were diagnosed by visual inspection and later, through radiographic assessment. Baseline treatment was made in accordance with the results obtained by visual inspection performed alone or combined with radiographic method, considering the allocated group. Dental surfaces with no restoration needs, or those restored at the beginning of the study were followed-up for two years. The treatment decision was made according to the allocated group. The outcome was the occurrence of failure (a new caries lesion or a restoration replacement) during the follow-up. Results 4383 proximal and occlusal surfaces of deciduous molars in 216 preschool children were diagnosed and treated according to the abovementioned diagnostic strategies and followed-up for 24 months. The assessment of radiographs made change the initial decision reached by visual inspection in about 30% of the surfaces when all types of interventions were considered. However, most disagreements occurred for initial lesions, where radiographs tended to underestimate them. Discordances between methods occurred in less than 5% of all surfaces when considered lesions requiring operative treatment. For discrepancy cases, the placed interventions guided by following the radiographic results did not present less failures against those made following only visual inspection. As a matter of fact, the use of radiographs in the diagnostic strategy for caries detection in children brought more harms than benefits due to the occurrence of false-positives, overdiagnosis and lead-time bias. Conclusions Simultaneous association of visual inspection and radiographic assessment for caries detection in preschool children causes more harms than benefits, and therefore, visual inspection should be conducted alone in the regular clinical practice. Trial registration Clinicaltrials.gov platform: NCT02078453, registered on 5th March 2014.

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The Caries Lesion: Diagnosis, Decision-Making, and Recommendations for Lesion Management

Araujo

Maltz

Cavalheiro

et al. 2023

Contemporary Endodontics for Children and Adolescents

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Impact of visual inspection and radiographs for caries detection in children through a 2-year randomized clinical trial

Cited by 22 publications

References 17 publications

Negligible Therapeutic Impact, False-positives, Overdiagnosis and Lead-time Are the Reasons Why Radiographs Bring More Harm Than Benefits in the Caries Diagnosis of Preschool Children: Secondary Analysis of a Randomized Clinical Trial

Negligible Therapeutic Impact, False-positives, Overdiagnosis and Lead-time Are the Reasons Why Radiographs Bring More Harm Than Benefits in the Caries Diagnosis of Preschool Children: Secondary Analysis of a Randomized Clinical Trial

Negligible therapeutic impact, false-positives, overdiagnosis and lead-time are the reasons why radiographs bring more harm than benefits in the caries diagnosis of preschool children

The Caries Lesion: Diagnosis, Decision-Making, and Recommendations for Lesion Management

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Impact of visual inspection and radiographs for caries detection in children through a 2-year randomized clinical trial

Cited by 22 publications

References 17 publications

Negligible Therapeutic Impact, False-positives, Overdiagnosis and Lead-time Are the Reasons Why Radiographs Bring More Harm Than Benefits in the Caries Diagnosis of Preschool Children: Secondary Analysis of a Randomized Clinical Trial&nbsp;

Negligible Therapeutic Impact, False-positives, Overdiagnosis and Lead-time Are the Reasons Why Radiographs Bring More Harm Than Benefits in the Caries Diagnosis of Preschool Children: Secondary Analysis of a Randomized Clinical Trial&nbsp;

Negligible therapeutic impact, false-positives, overdiagnosis and lead-time are the reasons why radiographs bring more harm than benefits in the caries diagnosis of preschool children

The Caries Lesion: Diagnosis, Decision-Making, and Recommendations for Lesion Management

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Negligible Therapeutic Impact, False-positives, Overdiagnosis and Lead-time Are the Reasons Why Radiographs Bring More Harm Than Benefits in the Caries Diagnosis of Preschool Children: Secondary Analysis of a Randomized Clinical Trial

Negligible Therapeutic Impact, False-positives, Overdiagnosis and Lead-time Are the Reasons Why Radiographs Bring More Harm Than Benefits in the Caries Diagnosis of Preschool Children: Secondary Analysis of a Randomized Clinical Trial