Methods dentists use to diagnose primary caries lesions prior to restorative treatment: Findings from The Dental PBRN

Abstract

Objective To (1) quantify the diagnostic techniques used by Dental Practice-Based Research Network (DPBRN) dentists before they decide to treat primary caries lesions surgically and (2) examine whether certain dentist, practice, and patient characteristics are associated with their use. Methods A total of 228 DPBRN dentists recorded information on 5,676 consecutive restorations inserted due to primary caries lesions on 3,751 patients. Practitioner-investigators placed a mean of 24.9 (SD=12.4) restorations. Lesions were categorized as posterior proximal, anterior proximal, posterior occlusal, posterior smooth, or anterior smooth. Techniques used to diagnose the lesion were categorized as clinical assessment, radiographs, and/or optical. Statistical analysis utilized generalized mixed-model ANOVA to account for the hierarchical structure of the data. Results By lesion category, the diagnostic technique combinations used most frequently were clinical assessment plus radiographs for posterior proximal (47%), clinical assessment for anterior proximal (51%), clinical assessment for posterior occlusal (46%), clinical assessment for posterior smooth (77%), and clinical assessment for anterior smooth (80%). Diagnostic technique was significantly associated with lesion category after adjusting for clustering in dentists (p<0.0001). Conclusion These results — obtained during actual clinical procedures rather than from questionnaire-based hypothetical scenarios — quantified the diagnostic techniques most commonly used during the actual delivery of routine restorative care. Diagnostic technique varied by lesion category and with certain practice and patient characteristics.

Practice-Based Research Networks, Part II: A Descriptive Analysis of the Athletic Training Practice-Based Research Network in the Secondary School Setting

“…This study is an important first step for the AT-PBRN before the initiation of more complex studies of practice characteristics or comparative effectiveness. As with other PBRNs, [19][20][21] identifying basic information regarding the clinicians, patients, and practice characteristics of providers within the PBRN is a critical first step in developing the research agenda for the network. This study provides the first estimates of the types of conditions seen and treatments performed by secondary school clinicians participating in the AT-PBRN.…”

Morphological analysis of proximal contacts in class II direct restorations with 3D image reconstruction

“…Coupled with this, class II restorations exhibit a higher failure rate compared to other composite restorations. 18,19 Since the consistency of resin composites differs from that of amalgam, it is difficult to condense composite restorations against the contact areas. The procedures required to achieve a physiological contact in class II composite restorations include a pre-wedging process to increase tooth separation, proper selection of the matrix system, and a pull-against-contact motion during filling and light-curing.…”

Effect of Clinical Experience on Accuracy and Reliability of Radiographic Caries Detection

“…In addition, caries lesions can extend into the dentin without causing a visible cavitation (Akpata et al, 1996). Therefore, an accepted method for proximal caries detection involves a combination of visual-tactile examination and radiographic examination, with bitewing radiographs for assessment of proximal lesions (Pitts, 1996;Rindal et al, 2010).…”