Our hypothesis was that a method of caries activity evaluation based on the clinical features of the lesions would be less time consuming but more influenced by the examiner's experience than the scoring system used in association with the International Caries Detection and Assessment System (ICDAS). Thus, the aim of this study was to evaluate the performance of three groups of examiners with different levels of experience using two different methods to assess the activity status of caries lesions by visual inspection. A cross-sectional study in a dental office setting was performed selecting 18 children, aged three to eight years, who had sought dental treatment at a dental school. Examinations to detect caries lesions were performed using visual inspection by six examiners with different levels of experience: two undergraduate dental students, two specialists in pediatric dentistry, and two graduate students. The examiners used ICDAS and two different methods to assess caries activity: using an additional score system or considering the examination of clinical features. Two benchmark examiners examined the children in a joint session, and their consensus was considered to be the reference standard. The sensitivity, specificity, and reproducibility were calculated for different thresholds: all, cavitated, and active caries lesions. Multilevel analyses were performed to compare the different methods and examiners. No differences were observed among the examiners, either in detecting all lesions and cavitated lesions or regarding the activity assessment. The methods of assessing activity status performed similarly, but the time spent on examinations was shorter for the method evaluating clinical features. In conclusion, the experience of examiners does not significantly influence the performance of visual inspection, and both methods of assessing activity status result in similar diagnostic accuracy.

Clinical guidelines advise that dentists take radiographs in children to detect caries lesions missed by visual inspection; however, due to the current low caries prevalence in most countries, we hypothesized that the adjunct methods of caries detection would not significantly improve the detection of primary molar lesions in comparison to visual inspection alone. We evaluated the performance of visual inspection, alone or in combination with radiographic and laser fluorescence pen (LFpen) methods, in detecting occlusal and approximal caries lesions in primary molars. Two examiners evaluated children who had sought dental treatment with these diagnostic strategies. The reference standard involved the temporary separation of approximal and operative interventions for occlusal surfaces. The sensitivity, specificity, accuracy and utility of diagnostic strategies were calculated. Simultaneous combined strategies increased sensitivities but decreased specificities. Furthermore, no differences were observed in accuracy and utility, parameters more influenced by caries prevalence. In conclusion, adjunct radiographic and laser fluorescence methods offer no benefits to the detection of caries in primary teeth in comparison to visual inspection alone; hence, present clinical guidelines should be re-evaluated.

268 59th ORCA Congress June 27–30, 2012, Cabo Frio, Brazil (available online only) No. 4

AIM:This in vitro study aimed to compare the time required for removal, the presence of residues of restorative material, tooth structure loss and dental surface morphology after removal of composite resin and amalgam restorations from occlusal cavities in primary molars using conventional high-speed bur and CVDentus® ultrasonic diamond tips.MATERIALS AND METHODS:A total of 37 primary molars were allocated into four groups: Group 1 (n=9)-amalgam restorations removed using high-speed bur; Group 2 (n=10)-amalgam restorations removed using ultrasonic tip; Group 3 (n=8)- composite resin restorations removed using high-speed bur; Group 4 (n=10)-composite resin restorations removed using ultrasonic tip. After being restored, teeth were sectioned and analyzed through stereoscopic microscope images before and after restoration removal. The structural loss was analyzed by software of image analysis, and an examiner assessed for the presence of residues. Scanning electron microscopy was used to evaluate the morphology. Time and structural loss values were compared using ANOVA, and the percentages of samples with residues using Fisher test.RESULTS:There was no statistically significant difference in the tooth structure loss among different methods and restorative materials, as well as in the presence of residues of restorative material. However, diamond burs were faster than the ultrasonic method for both materials. Differences in dental morphology were observed between the methods of restoration removal, but not related to the restorative material.CONCLUSION:Both conventional high-speed bur and ultrasonic diamond tip methods remove similar amounts of tooth structure, but the removal performed with diamond tips in ultrasonic devices is slower.CLINICAL SIGNIFICANCE:This study shows that both ultrasonic and conventional high-speed bur methods for removing restorations generate similar loss of sound dental tissue, but the former is slower.

Focal dermal hypoplasia (FDH), also known as Goltz-Gorlin syndrome, is an autosomal dominant disease affecting tissues derived from the ectoderm and mesoderm. Knowledge and early diagnosis of the craniofacial alterations commonly found in patients with FDH provide oral health care professionals with effective preventive and therapeutic tools. This article aims to review the craniofacial characteristics present in FDH and the main systemic manifestations that have implications for dental management, while presenting a new case of the syndrome with novel oral findings.