Dentin Optical Density in Molars Subjected to Partial Carious Dentin Removal

This study aimed to evaluate changes in the optical density of dentin in primary molars with deep caries three to six months after they were subjected to partial carious dentin removal. Study design: This was a blind controlled, clinical therapy study. Standardized digitalized bitewing radiographs of 42 teeth were analyzed using Adobe Photoshop® to quantitatively determine the gray scale of the affected dentin beneath the restoration, in comparison with healthy dentin. A mixed-effects model was used for statistical analysis. The gray tone level was considered a dependent variable; the tooth region and the time, in addition to the interaction between them, were the independent variables. Values of p < 0.05 were significant. Results: During the interval between time zero and three months, the gray tone levels of affected dentin varied from 80.99 ± 3.17 to 98.57 ± 3.17; i.e., an estimated increase of 18 (p < 0.0001). The values for healthy dentin ranged from 118.22 ± 3.17 to 122.02 ± 3.17; i.e., a mean increase of four in the gray tone levels (p = 0.0003). During the interval between three and six months, both healthy and affected dentin showed similar behavior (98.57 ± 3.17 to 103.32 ± 3.20 and 122.02 ± 3.7 to 126.56 ± 3.20, respectively) (p = 0.0001). Conclusions: Significant increments were observed in the optical density of the affected dentin after three months compared to that of healthy dentin in primary molars treated using the partial carious dentin removal technique.

primary teeth, dental caries, optical density

1. Kidd EA, Fejerskov O. What constitutes dental caries? Histopathology of caries enameland dentin related to the action of cariogenic biofilms. J. Dent Res. 83 (spec no. C): C35-C38. 2004.

2. Maltz M, de Oliveira EF, Fontanella V, Bianchi R . A clinical, microbiologic, and radiographic study of deep caries lesions after incomplete caries removal. Quint Int; 33(2):151-159. 2002.

3. Maltz M, Garcia R, Jardim JJ, de Paula LM, Yamaguti PM, Moura MS, et al. Randomized trial of partial vs. stepwise caries removal. J Dent Res.; 91:1026-1031. 2012.

4. Schwendicke S, Doerfer CE, Paris S. Incomplete caries removal: A systematic review and Meta-analysis. J Dent Res; 92(4):306-314. 2013.

5. Thompson V, Craig RG, Curro FA, Green WS, Ship JA. Treatment of deep carious lesions by complete excavation or partial removal: a critical review. J Amer Dent Assoc; 139(6):705-712. 2008.

6. Massara ML, Alves JB, Brandao PR. Atraumatic restorative treatment: clinical, ultrastructural and chemical analysis. Caries Res; 36(6):430-436. 2002.

7. Smales RJ, Ngo HC, Yip KH, Yu C. Clinical effects of glass ionomer restorations on residual carious dentin in primary molars. Amer J Dent; 18(3):188-193. 2005.

8. Mandari GJ, Matee MI. Atraumatic Restorative Treatment (ART): the Tanzanian experience. Int Dent J; 56(2):71-76. 2006.

9. Santiago BM, Ventin DA, Primo LG, Barcelos R. Microhardness of dentine underlying ART restorations in primary molars: an in vivo pilot study. Brit Dent J; 199(2):103-106. 2005.

10. American Academy of Pediatric Dentistry. Police on Interim Therapeutic Restoration (ITR) - Oral Health Policies; 35(6):48-49. 2013.

11. Mickenautsch S, Grossman E. Atraumatic Restorative Treatment (ART): factors affecting success. J App Oral Sc; 14 Suppl: 34-36. 2006.

12. Bezerra AC, Novaes RC, Faber J, Frencken JE, Leal SC. Ion concentration adjacent to glass-ionomer restorations in primary molars. Dent Mat; 28(11):259-263. 2012.

13. Bresciani E. Clinical trials with Atraumatic Restorative Treatment (ART) in deciduos and permanent teeth. J Appl Oral Sc; 14 Suppl:14-19. 2006.

14. Faccin ES, Ferreira SH, Kramer PF, Ardenghi TM, Feldens CA. Clinical performance of ART restorations in primary teeth: a survival analysis. J Clin Pediatr Dent; 33(4):295-298. 2009.

15. Frencken JE, Taifour D, van ‘t Hof MA. Survival of ART and amalgam restorations in permanent teeth of children after 6.3 years. J Dent Res; 85(7):622-626. 2006.

16. Honkala E, Behbehani J, Ibricevic H, Kerosuo E, Al-Jame G. The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic. Int J Paediatr Dent; 13(3):172-179. 2003.

17. Lo EC, Holmgren CJ, Hu D, van Palenstein Helderman W. Six-year follow up of atraumatic restorative treatment restorations placed in Chinese school children. Commun Dent Oral Epidemiol; 35(5):387-392. 2007.

18. Alves LS, Fontanella V, Damo AC, Ferreira de Oliveira E, Maltz M . Qualitative and quantitative radiographic assessment of sealed carious dentin: a 10-year prospective study. Oral Surg. Oral Med. Oral Pathol Oral Radiol Endod; 109(1):135-141. 2010

19. Pretty IE. Caries detection and diagnosis: Novel and technologies. J Dent; 34:727-739. 2006.

20. Mariath AA, Casagrande L, de Araujo FB. Grey levels and radiolucent lesion depth as cavity predictors for approximal dentin caries lesions in primary teeth. Dent. Maxill. Facial. Radiol; 36(7):377-381. 2007.

21. Oliveira EF, Carminatti G, Fontanella V, Maltz M . The monitoring of deep caries lesions after incomplete dentine caries removal: results after 14-18 months. Clin. Oral Invest; 10(2):134-139. 2006.

22. Ricketts DN, Ekstrand KR, Martignon S, Ellwood R, Alatsaris M, Nugent Z. Accuracy and reproducibility of conventional radiographic assessment and subtraction radiography in detecting demineralization in occlusal surfaces. Caries Res ; 41(2):121-128. 2007.

23. Wenzel A, Anthonisen PN, Juul MB . Reproducibility in the assessment of caries lesion behaviour: a comparison between conventional film and subtraction radiography. Caries Res; 34(3):214-218. 2000.

24. American Academy of Pediatric Dentistry. Guideline on behavior guidance for the pediatric dental patient. Manual of reference; 35(6):175-187. 2011.

25. Pitts NB, Rimmer PA. An in vivo comparison of radiographic and directly assessed clinical caries status of posterior approximal surfaces in primary and permanent teeth. Caries Res; 26(2):146-152. 1992.

26. McLean, Robert A.; Sanders, William L.; Stroup, Walter W. “A Unified Approach to Mixed Linear Models”. The American Statistician (American Statistical Association).; 45 (1): 54-64. 1991.

27. Toi CS, Bonecker M, Cleaton-Jones PE . Mutans streptococci strains prevalence before and after cavity preparation during Atraumatic Restorative Treatment. Oral Microbiol Immunol; 18(3):160-164. 2003.

28. Yegonpal V, Harneker SY, Patel N, Siegfried N. Dental fillings for the treatment of caries in the primary dentition. Cochrane Database Syst. Rev; 15(2) 4483. 2009.

29. Pereira MG. Epidemiologia: teoria e prática / Epidemiology: theory and practice. Rio de Janeiro: Guanabara koogan; 1995.

30. Aponte AJ, Hartsook JT, Crowley MC. Indirect pulp capping success verified. J Dent Child; 33(3):164-166. 1966. 31. Jordan RE, Suzuki M. Conservative treatment of deep carious lesions. J Can Dent Assoc; 37(9):337-342. 1971.