Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Preventive and Community Dentistry, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Clin Oral Investig. 2019 Jul;23(7):2907-2912. doi: 10.1007/s00784-018-02794-9. Epub 2019 Jan 5.
Discriminating non-cavitated from cavitated proximal lesions without tooth separation is only limitedly possible using visual-radiographic assessment alone. We evaluated how additional tactile assessment might increase the accuracy of this discrimination in vitro.
Surface integrity of 46 primary molars with proximal lesions extending radiographically into outer third of dentin (ICDAS-codes: 2 n = 34, 3 n = 8 and 5 n = 4) were mounted in groups of two in manikin heads and independently assessed by three examiners using visual-radiographic and additional tactile assessment using a cow-horn-ended explorer with or without gingival displacement. After examination, lesion surfaces were evaluated for possible damage using scanning-electronic microscopy. Analysis of variance (ANOVA) was performed for evaluating if tactile assessment and gingival displacement significantly affected accuracy.
Tactile assessment significantly increased sensitivity of detecting cavities (p < 0.001, ANOVA), but decreased specificity (p < 0.05). Sensitivities/specificities varied between 33 (8)%/96 (1)% and 86 (6)%/84 (5)%. Gingival displacement had no significant impact on accuracy (p > 0.05). Scanning-electron microscopy revealed no cavitation.
In vitro, tactile assessment of proximal surfaces was useful and safe.
Analysis of the cavitation level by using a cow-horn-ended probe might be leading to useful information in addition to bitewing assessment under clinical circumstances.
仅通过目视-射线评估，很难区分未发生龋坏的非窝洞型和已发生龋坏的窝洞型近中面龋损。本研究评估了在体外情况下，额外的触觉评估是否能提高这种区分的准确性。
46 颗近中面龋损延伸至牙本质外三分之一的乳磨牙（ICDAS 编码：2 型 n=34，3 型 n=8，5 型 n=4）被分组安装在头模中，由 3 名检查者独立进行目视-射线评估和使用牛角探针的额外触觉评估，探针检查时是否伴有牙龈移位。检查后，使用扫描电子显微镜评估病变表面是否有损伤。方差分析（ANOVA）用于评估触觉评估和牙龈移位是否显著影响准确性。
触觉评估显著提高了检测龋洞的敏感性（p<0.001，ANOVA），但降低了特异性（p<0.05）。敏感性/特异性在 33（8）%/96（1）%和 86（6）%/84（5）%之间变化。牙龈移位对准确性无显著影响（p>0.05）。扫描电子显微镜显示无龋坏。
在体外，近中面的触觉评估是有用且安全的。
在临床情况下，使用牛角探针分析龋坏程度可能除了咬合翼片评估外，还能提供有用的信息。
