Validity and reliability of methods for the detection of secondary caries around amalgam restorations in primary teeth

Abstract

Secondary caries has been reported as the main reason for restoration replacement. The aim of this in vitro study was to evaluate the performance of different methods -visual inspection, laser fluorescence (DIAGNOdent), radiography and tactile examination -for secondary caries detection in primary molars restored with amalgam. Fifty-four primary molars were photographed and 73 suspect sites adjacent to amalgam restorations were selected. Two examiners evaluated independently these sites using all methods. Agreement between examiners was assessed by the Kappa test. To validate the methods, a caries-detector dye was used after restoration removal. The best cut-off points for the sample were found by a Receiver Operator Characteristic (ROC) analysis, and the area under the ROC curve (Az), and the sensitivity, specificity and accuracy of the methods were calculated for enamel (D2) and dentine (D3) thresholds. These parameters were found for each method and then compared by the McNemar test. The tactile examination and visual inspection presented the highest inter-examiner agreement for the D2 and D3 thresholds, respectively. The visual inspection also showed better performance than the other methods for both thresholds (Az = 0.861 and Az = 0.841, respectively). In conclusion, the visual inspection presented the best performance for detecting enamel and dentin secondary caries in primary teeth restored with amalgam.

Detection of proximal secondary caries at cervical class II-amalgam restoration margins in vitro

“…The LF method has been already tested for the detection of occlusal secondary caries around amalgam fillings in extracted permanent 7 and primary teeth. 23 It is not possible to directly compare our results with the study of Bamzahim et al, 7 because in that study the first LF device (DIAGNOdent 2095) was used and because only an overall accuracy was reported, independent of the histological lesion depth. For occlusal secondary caries in primary teeth, the accuracy at the D 3 -level was reported to be 0.69, 23 while in the present study slightly lower accuracies of 0.62 (TWDG) and 0.56 (WDG) for proximal surfaces were found.…”

“…23 It is not possible to directly compare our results with the study of Bamzahim et al, 7 because in that study the first LF device (DIAGNOdent 2095) was used and because only an overall accuracy was reported, independent of the histological lesion depth. For occlusal secondary caries in primary teeth, the accuracy at the D 3 -level was reported to be 0.69, 23 while in the present study slightly lower accuracies of 0.62 (TWDG) and 0.56 (WDG) for proximal surfaces were found. Compared to results that have been achieved for approximal primary caries in permanent teeth in vivo (Huth et al 17 : sensitivity 0.6, specificity 0.83 at dentine threshold), our results for the detection of secondary caries around amalgam restorations are considerably lower.…”

Detection of Caries Around Amalgam Restorations on Approximal Surfaces

“…However, different histological methods for validating secondary caries are described in the literature, including confocal laser scanning microscopy examination, 17 caries-detector dye application, 36 and histological specimen preparation associated with microhardness evaluation. 21,22 The LFpen cutoff limits used in this study were proposed by Lussi and others 31 for approximal primary lesions.…”

“…These differences could be due to the smaller number of approximal surfaces analyzed, the distribution pattern of caries lesions, with minimal areas of sound surfaces, the LF devices used and their different tips, the simulated contact point between two sound teeth, and the histological validation method used in their studies. Even though the LF method has been evaluated for secondary caries detection on occlusal surfaces around amalgam restorations, 18,36 these studies used a different device (DIAGNOdent 2095, KaVo), and the actual numbers may not be comparable.…”

Near-infrared imaging of secondary caries lesions around composite restorations at wavelengths from 1300–1700-nm

“…Generating radiographic images requires ionizing x-rays and a direct viewing angle of the interproximal regions to produce a diagnostic image [8]. When imaging restored teeth, amalgam and composite restorations are radiopaque and may mask the presence of caries either partially or completely which contributes to the difficulty of diagnosis, and therefore are poorly suited for detecting secondary caries [9–13]. …”