TY - JOUR

T1 - ICCMS™ root caries lesions stages and their underlying depth towards the pulp

T2 - an in vitro study with histologic evaluation

AU - Ekstrand, Kim R.

AU - Cordeschi, Thais

AU - Abreu-Placeres, Ninoska

N1 - Funding Information: We are thankful for the help received from Associate Professor Azam Bakhshandeh, University of Copenhagen, concerning the use of the microscope for assessing lesion depth,?for the help from?technical assistant?Camilla G?nd?z who to care of the material and?cut the teeth and for the statistical advice from Associate Professor Luis Garrido, Pontificia Universidad Catolica Madre y Maestra, Santo Domingo, Dominican Republic, and from Professor Fausto Mendes, University of Sao Paulo, Brazil. Funding Information: This research was conducted at the University of Copenhagen and only the participation of the second author (T.C.) was possible thanks to the funding of the Foundation for Research Support (FAPESP—Sao Paulo City) and the Research Internship Abroad (BEPE—process number 2018/ 08066–4). Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

PY - 2022/3

Y1 - 2022/3

N2 - Objective: To examine the relationship between the ICCMS™ (International Caries Classification and Managing System) features of root caries lesions and the underlying depth of the lesion towards the pulp. In order to control for bias, the study followed the tailored document for risk of bias assessment (RoB-tool) recently published. A pilot study showed that the outline of the pulp was much clearer on horizontal compared to vertical sections through the lesions (p = 0.03) and that the histological stereomicroscopical (SM) assessed lesion depth towards the pulp was not influenced by the cutting direction (p = 0.155). Material and methods: A sample of extracted permanent molar teeth (n = 100) were classified independently by two of the authors according to ICCMS™ as no sign of root caries lesion 0 = sound; 1 = initial lesion (non-cavitated); 2 = moderate lesion (cavity depth ≤ 2 mm) and 3 = extensive lesion (cavity depth > 2 mm). After horizontal sectioning (HS) through the lesion, the depth of the underlying lesion was SM assessed independently by two of the authors as 0 = no lesion; 1 = lesion in outer 1/3; 2 = middle 1/3; and 3 = inner 1/3 of the dentine towards the pulp. Results: Intra- and inter-reproducibility (weighted kappa values ≥ 0.83); the accuracy (Spearman’s rho-values) = 0.94 and 0.95; and specificity/sensitivities/AUC values (three different thresholds) were ≥ 0.91, ≥ 0.93, and ≥ 0.96, respectively. Conclusion: Under the umbrella of the RoB-tool, the validity in terms of the reproducibility and accuracy of the ICCMS™ root caries scoring system was high. Clinical relevance: By means of the ICCMS™ root caries scoring system, the underlying lesion depth can be estimated, which must be considered when managing the lesion.

AB - Objective: To examine the relationship between the ICCMS™ (International Caries Classification and Managing System) features of root caries lesions and the underlying depth of the lesion towards the pulp. In order to control for bias, the study followed the tailored document for risk of bias assessment (RoB-tool) recently published. A pilot study showed that the outline of the pulp was much clearer on horizontal compared to vertical sections through the lesions (p = 0.03) and that the histological stereomicroscopical (SM) assessed lesion depth towards the pulp was not influenced by the cutting direction (p = 0.155). Material and methods: A sample of extracted permanent molar teeth (n = 100) were classified independently by two of the authors according to ICCMS™ as no sign of root caries lesion 0 = sound; 1 = initial lesion (non-cavitated); 2 = moderate lesion (cavity depth ≤ 2 mm) and 3 = extensive lesion (cavity depth > 2 mm). After horizontal sectioning (HS) through the lesion, the depth of the underlying lesion was SM assessed independently by two of the authors as 0 = no lesion; 1 = lesion in outer 1/3; 2 = middle 1/3; and 3 = inner 1/3 of the dentine towards the pulp. Results: Intra- and inter-reproducibility (weighted kappa values ≥ 0.83); the accuracy (Spearman’s rho-values) = 0.94 and 0.95; and specificity/sensitivities/AUC values (three different thresholds) were ≥ 0.91, ≥ 0.93, and ≥ 0.96, respectively. Conclusion: Under the umbrella of the RoB-tool, the validity in terms of the reproducibility and accuracy of the ICCMS™ root caries scoring system was high. Clinical relevance: By means of the ICCMS™ root caries scoring system, the underlying lesion depth can be estimated, which must be considered when managing the lesion.

KW - Caries detection

KW - Demineralization

KW - Dental caries

KW - Root caries

U2 - 10.1007/s00784-021-04229-4

DO - 10.1007/s00784-021-04229-4

M3 - Journal article

C2 - 34671845

AN - SCOPUS:85117383903

VL - 26

SP - 2597

EP - 2605

JO - Clinical Oral Investigations

JF - Clinical Oral Investigations

SN - 1432-6981

IS - 3

ER -