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The effect of two clinical criteria in the assessment of caries lesions around restorations in children (CARDEC-03): study protocol for a diagnostic randomized clinical trial.

ABSTRACT: Introduction: The detection of caries lesions around restoration can be challenging. Therefore, the use of some criteria has been proposed in order to give more objectivity to the diagnosis process. Two of them are the International Dental Federation (FDI) and the Caries Associated with Restorations and Sealants (CARS) criteria. Both methods have a different approach to caries, and it is not possible to know which one of them is the best to use in clinical practice to assess restorations in children. Thus, the present protocol aims to evaluate the effect of the use of the FDI and CARS criteria in the assessment of caries lesions around restorations in primary teeth on outcomes related to oral health in children and costs resulting from the assessments. Methods and analysis: A total of 626 restorations of children from three to 10 years were randomly assessed and are being treated following the FDI criteria (FDI group) or CARS criteria (CARS group). Participants will be followed-up after six, 12, 18, and 24 months. The primary outcome will be the need for a new intervention in the evaluated restorations. This outcome consists of several components, and each of these events will be analyzed separately as secondary outcomes. The changes in children's oral health-related quality of life and the cost of the restoration dental treatments will also be analyzed as secondary outcomes. The methods will be compared using the Cox regression model with shared frailty. A significance level of 5% will be adopted for all statistical analyses. Discussion: This will be the first randomized clinical study carried out regarding the detection of caries lesions around restorations in primary teeth. Trial registration: The study underwent registration in Clinicaltrials.gov ( NCT03520309) on 9 May 2018.

SUBMITTER: Moro BLP

PROVIDER: S-EPMC7818095 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:AimThe present investigation aimed at assessing the diagnostic accuracy of DIAGNOdent compared to the International Caries Detection and Assessment System-II (ICDAS-II) in the detection of facial, smooth surface noncavitated carious lesions.Settings and designSixty patients were enrolled in the current study according to the eligibility criteria. There were 161 teeth with noncavitated, white spot carious lesions and 32 sound teeth.Materials and methodsBefore examination, teeth were cleaned and polished and all patients were assessed under standardized operating conditions: preset dental unit position, operating light, and prolonged air drying (approximately 5 s). All teeth were assessed by two calibrated examiners individually without any contact using ICDAS-II and DIAGNOdent.Statistical analysisThe diagnostic accuracy of DIAGNOdent device was determined, including sensitivity, specificity, overall accuracy, positive and negative predictive values, and receiver operating characteristic curve analysis. Chi-square test was conducted to compare the distribution of ICDAS-II and DIAGNOdent scores. Inter-observer agreement between assessors was evaluated using Cohen's kappa test.ResultsIn the current study, DIAGNOdent had an overall accuracy of 84.45% with sensitivity and specificity of 87.58% and 96.87%, respectively, and +PV and -PV of 97.7% and 83.9%, respectively, when score 0 represented sound tooth surface, while scores 1 and 2 were considered clinically noncavitated carious lesions. Moreover, when only ICDAS score 1 was considered representing first visual change in enamel, DIAGNOdent had an accuracy of 74.15% with sensitivity and specificity of 83.53% and 90.62%, respectively, and +PV and -PV of 93% and 78.6%, respectively. In the present study, when only ICDAS score 2 was considered representing distinct visual change in enamel, DIAGNOdent had an accuracy of 100% with sensitivity and specificity of 100% and 100%, respectively, and +PV and -PV of 100% and 100%, respectively.ConclusionsThe overall performance of DIAGNOdent was equivalent to the visual inspection using ICDAS-II. DIAGNOdent might be considered a useful adjunctive device for detection and monitoring development of noncavitated carious lesions on facial smooth surfaces.

Project description:PurposeTo establish the magnetic resonance imaging (MRI) and operative incidence of ramp lesions in a consecutive group of patients who had undergone anterior cruciate ligament reconstruction (ACLR) and to propose a graded radiologic classification that seeks to define key preoperative features that most strongly correlate with arthroscopically confirmed ramp lesions.MethodsAfter retrospective review, all consecutive patients who underwent ACLR with preoperative MRI over a 16-month period were included in the study. Diagnostic arthroscopy with direct visualization of the posteromedial compartment was used to establish the true incidence of ramp lesions. Three radiologists, blinded to the surgical findings, independently analyzed the MRI scans of all patients and classified the signal intensity at the posterior meniscocapsular junction using 4 criteria (type 1, diffuse increased signal equal to adjacent femoral cartilage; type 2, diffuse increased signal greater than cartilage; type 3, diffuse increased signal plus full-height linear fluid-signal cleft; and type 4, full-height fluid-signal meniscocapsular separation). Interobserver reliability, in addition to sensitivity, specificity, and positive and negative predictive values, was calculated.ResultsOf the 93 patients included (mean age, 26.7 years), 11 (11.8%) were confirmed to have ramp lesions on arthroscopy. Inter-rater reliability for the MRI diagnosis of the positive ramp lesions was good, at 0.75. Type 3 criteria were the most accurate, producing average sensitivity and specificity values of 85% and 82%, respectively.ConclusionsRamp lesions are not infrequently encountered in ACLR and, if not recognized at the time of surgery, may contribute to inferior outcomes. MRI is an effective method of preoperative assessment, and the presence of type 3 changes should be used as criteria for radiologically definitive ramp lesion diagnosis.Clinical relevanceThis study highlights the incidence of meniscal ramp lesions encountered in ACLR surgery and the effectiveness of MRI as a preoperative imaging modality.

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The effect of two clinical criteria in the assessment of caries lesions around restorations in children (CARDEC-03): study protocol for a diagnostic randomized clinical trial.

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