Measurement Reliability of the Remaining Dentin Thickness below Deep Carious Lesions in Primary Molars
Roula Berbari, Alexandre Khairallah, Hussein F Kazan, Mohamad Ezzedine, Daniel Bandon
Affected dentin, Deep carious lesions, Digital radiography, Remaining dentin
Citation Information :
Berbari R, Khairallah A, Kazan HF, Ezzedine M, Bandon D. Measurement Reliability of the Remaining Dentin Thickness below Deep Carious Lesions in Primary Molars. Int J Clin Pediatr Dent 2018; 11 (1):23-28.
Aim: This study was carried out to assess the reliability of measurements of the remaining dentin thickness under deep carious lesions as estimated from digital radiographs. The goal is to allow clinicians to correlate the radiographic measurement to the exact value of the remaining dentin thickness. The results obtained will be tested further in a study that will evaluate the histopathologic pulpal state according to the caries’ lesion depth.
Materials and methods: The study was conducted in the Pediatric Dentistry Department at the Lebanese University, in collaboration with the research platform of the same university. Fifty deciduous molars with deep caries on proximal surfaces liable to extraction were collected. Before extraction, a digital in vivo periapical radiograph was taken, followed by manual excavation of the caries. After excavation, another radiograph was taken before the tooth was sectioned through the deepest site of the lesion. Another radiograph was then obtained for each tooth fragment. To evaluate the exact thickness of the remaining dentin, each fragment was measured on a histologic macrophotograph. The measurements were then compared statistically using a paired-samples t-test, and a correlation was sought.
Results: No significant difference was observed in the radiographs between the measurement of the remaining dentin thickness before and after the excavation of caries. In contrast, the radiographic measurements of remaining dentin thickness were underestimated by an average of 20% compared with those made with macrophotographs.
Limitations: Interpretation of radiographs varies from one practitioner to another and is a function of the operator\'s visual acuity.
Conclusion: Measuring the residual dentin thickness on a radiograph underestimates the actual thickness by about 20%. Further studies are needed to confirm these results.
Clinical significance: Our results indicate that remaining dentin thickness is greater in reality than is shown on a radiograph. This information can help clinicians to refine their diagnoses and treatment plans.
Ounsi HF, Debaybo D, Salameh Z, Chebaro A, Bassam H. Endodontic considerations in pediatric dentistry: a clinical perspective. Int Dent South Afr 2009;11(2):40-50.
AAPD. Guidelines on pulp therapy for primary and young permanent teeth: reference manual. Pediatr Dent 2014;37: 244-252.
Olatosi OO, Sote EO, Orenuga OO. Effect of mineral trioxide aggregate and formocresol pulpotomy on vital primary teeth: a clinical and radiographic study. Niger J Clin Pract 2015 Mar- Apr;18(2):292-296.
Murray PE, Smith AJ, Garcia-Godoy F, Lumley PJ. Comparison of operative procedure variables on pulpal viability in an ex vivo model. Int Endod J 2008 May;41(5):389-400.
Loiola ABA, Oliveira ALBM, Cordeiro RCL, Santos-Pinto LAM. Accuracy of radiographic examination in determining the depth of approximal carious lesions in primary molars. Rev Gaúcha Odontol 2012;60(4):461-466.
Wenzel A, Haiter-Neto F, Gotfredsen E. Influence of spatial resolution and bit depth on detection of small caries lesions with digital receptors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007 Mar;103(3):418-422.
Lancaster P, Craddock HL, Carmichael FA. Estimation of remaining dentin thickness below deep lesions of caries. Br Dent J 2011 Nov;211(10):E20.
Stanley HR. Pulp responses. In: Burns RC, Cohen S, editors. Pathways of the pulp. 3rd ed. St. Louis: Mosby; 1984, pp. 465-489.
Pameijer CH, Stanley HR, Ecker G. Biocompatibility of a glass ionomer luting agent. Part II. Crown cementation. Am J Dent 1991 Jun;4(3):134-141.
Smith AJ. Dentine formation and repair. In: Hargreaves KM, Goodies HE, editors. Seltzer and Bender's dental pulp. Quintessence Publications; 2002. p. 41-62.
Murray PE, Smith AJ, Windsor LJ, Mjör IA. Remaining dentine thickness and human pulp responses. Int Endod J 2003 Jan;36(1):33-43.
Bjørndal L. Indirect pulp therapy and stepwise excavation. Pediatr Dent 2008 May-Jun;30(3):225-229.
Fuks AB, Guelmann M, Kupietzky A. Current developments in pulp therapy for primary teeth. Endod Topics 2010 Sep;23(1):50-72.
Lennon AM, Attin T, Martens S, Buchalla W. Fluorescenceaided caries excavation (FACE), caries detector, and conventional caries excavation in primary teeth. Pediatr Dent 2009 Jul-Aug;31(4):316-319.
Boston DW, Graver HT. Histological study of an acid red caries-disclosing dye. Oper Dent 1989 Autumn;14(4):186-192.
Aboujaoude S, Noueiri B, Berbari R, Khairalla A, Sfeir E. Evaluation of a modified Pulpotec endodontic approach on necrotic primary molars: a one-year follow-up. Eur J Paediatr Dent 2015 Jun;16(2):111-114.
Miles DA. Imaging using solid-state detectors. Dent Clin North Am 1993 Oct;37(4):531-540.
De La Dure-Molla M, Artaud C, Naulin-Ifi C. Approches diagnostiques des lésions carieuses. EMC Médecine Buccale 2016;11(1):1-9.
Daudibertieres L, Etienne G, Barthe M, Cattoen M. Imagerie de la lésion carieuse: traitement et analyse. Rev Odontostomatol 1993;22(1):9-21.
Hausmann E, Allen K, Carpio L, Christersson LA, Clerehugh V. Computerized methodology for detection of alveolar crestal bone loss from serial intraoral radiographs. J Periodontol 1992 Aug;63(8):657-662.
Neena IE, Ananthraj A, Praveen P, Karthik V, Rani P. Comparison of digital radiography and apex locator with the conventional method in root length determination of primary teeth. J Indian Soc Pedod Prev Dent 2011 Oct-Dec;29(4): 300-304.
Li G, Qu XM, Chen Y, Zhang ZY, Ma XC. Diagnostic accuracy of proximal caries by digital radiographs: an in vivo and in vitro comparative study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010 Mar;109(3):463-467.
Everett FG, Fixott HC. The incorporated millimeter grid in oral roentgenography. Quintessence Int Dent Dig 1975 May;6(5):53-58.
Krithika AC, Kandaswamy D, Velmurugan N, Krishna VG. Non-metallic grid for radiographic measurement. Aust Endod J 2008 Apr;34(1):36-38.
Russel M, Pitts B. Radiovisiographic diagnosis of dental caries: initial comparison of basic mode videoprints with bitewing radiography. Caries Res 1993;27(1):65-70.
Valizadeh S, Goodini M, Ehsani S, Mohseni H, Azimi F, Bakhshandeh H. Designing of a computer software for detection of approximal caries in posterior teeth. Iran J Radiol 2015 Aug;12(4):e16242.
White SC, Hollender L, Gratt BM. Comparison of xeroradiographs and film for detection of proximal surface caries. J Am Dent Assoc 1984 May;108(5):755-759.
Jesse SA, Makins SR, Bretz WA. Accuracy of proximal caries depth determination using two intraoral film speeds. Gen Dent 1999 Jan-Feb;47(1):88-93.
Kooistra S, Dennison JB, Yaman P, Burt BA, Taylor GW. Radiographic versus clinical extension of class II carious lesions using an F-speed film. Oper Dent 2005 Nov-Dec;30(6):719-726.
Mejàre I, Kidd EAM. Radiography for caries diagnosis. In: Fejerskov O, Kidd E, editors. Dental caries: the disease and its clinical management. 2nd ed. Oxford: Blackwell Munksgaard;2008. pp. 69-88.
Kamburoğlu K, Kurt H, Kolsuz E, Öztaş B, Tatar I, Çelik HH. Occlusal caries depth measurements obtained by five different imaging modalities. J Digit Imaging 2011 Oct;24(5):804-813.
Fusayama T. Two layers of carious dentin. Diagnosis and treatment. Oper Dent 1979 Spring;4(2):63-70.
Zheng L, Hilton JF, Habelitz S, Marshall SJ, Marshall GW. Dentin caries activity status related to hardness and elasticity. Eur J Oral Sci 2003 Jun;111(3):243-252.
Maltz M, Garcia R, Jardim JJ, de Paula LM, Yamaguti PM, Moura MS, Garcia F, Nascimento C, Oliveira A, Mestrinho HD. Randomized trial of partial vs. stepwise caries removal. J Dent Res 2012 Nov;91(11):1026-1031.