Radiopaque Tagging Masks Caries Lesions following Incomplete Excavation in vitro.
One-step incomplete excavation seals caries-affected dentin under a restoration and appears to be advantageous in the treatment of deep lesions. However, it is impossible to discriminate radiographically between intentionally left, arrested lesions and overlooked or active lesions. This diagnostic uncertainty decreases the acceptance of minimally invasive excavation and might lead to unnecessary re-treatment of incompletely excavated teeth. Radiopaque tagging of sealed lesions might mask arrested lesions and assist in discrimination from progressing lesions. Therefore, we microradiographically screened 4 substances (SnCl2, AgNO3, CsF, CsCH3COO) for their effect on artificial lesions. Since water-dissolved tin chloride (SnCl2×Aq) was found to stably mask artificial lesions, we then investigated its radiographic effects on progressing lesions. Natural lesions were incompletely excavated and radiopaque tagging performed. Grey-value differences (△GV) between sound and carious dentin were determined and radiographs assessed by 20 dentists. While radiographic effects of SnCl2×Aq were stable for non-progressing lesions, they significantly decreased during a second demineralization (p < .001, t test). For natural lesions, tagging with SnCl2×Aq significantly reduced △GV (p < .001, Wilcoxon). Tagged lesions were detected significantly less often than untagged lesions (p < .001). SnCl2×Aq was suitable to mask caries-affected dentin and discriminate between arrested and progressing lesions in vitro. Radiopaque tagging could resolve diagnostic uncertainties associated with incomplete excavation.
Department of Operative and Preventive Dentistry, Charité- Universitätsmedizin, Berlin, Germany falk.schwendicke@charite.de.
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Schwendicke
Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany.
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Meyer-Lueckel
Department for Conservative Dentistry and Periodontology, Christian-Albrechts-University, Kiel, Germany.
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Schulz
Department for Conservative Dentistry and Periodontology, Christian-Albrechts-University, Kiel, Germany.
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Dörfer
Department of Operative and Preventive Dentistry, Charité- Universitätsmedizin, Berlin, Germany.
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Paris
D019342:Acetic Acid / Q000737:chemistry; D000328:Adult; D000368:Aged; D002586:Cesium / Q000737:chemistry; D003287:Contrast Media / Q000737:chemistry*; D057087:Dental Atraumatic Restorative Treatment / Q000379:methods*; D003731:Dental Caries / Q000000981:diagnostic imaging*; D003804:Dentin / Q000000981:diagnostic imaging; D003815:Dentists / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D005459:Fluorides / Q000737:chemistry; D006801:Humans; D008297:Male; D008422:Materials Testing; D008852:Microradiography / Q000379:methods; D008875:Middle Aged; D015588:Observer Variation; D016622:Silver Staining; D013052:Spectrometry, X-Ray Emission; D017971:Tin Compounds / Q000737:chemistry*; D017001:Tooth Demineralization / Q000000981:diagnostic imaging
D003287:Contrast Media; D017971:Tin Compounds; C023599:stannous chloride; D002586:Cesium; D019342:Acetic Acid; D005459:Fluorides; C027754:cesium fluoride
carious dentin; dental caries; dental materials; dental radiography; diagnosis; permanent dental restorations