Sealants on questionable for caries occlusal surfaces of permanent molars

Doctoral Dissertation uoadl:1325915 322 Read counter

Unit:
Τομέας Βασική Επιστήμη Οδοντιατρικών Βιοϋλικών
Deposit date:
2016-12-12
Year:
2016
Author:
Michalaki Maria
Dissertation committee:
Κωνσταντίνος Ουλής, Καθηγητής, Εργαστήριο Παιδοδοντιατρικής, Τμήμα Οδοντιατρικής, ΕΚΠΑ
Ευαγγελία Παπαγιαννούλη, Ομότιμη Καθηγήτρια,Τμήμα Οδοντιατρικής, ΕΚΠΑ
Γεώργιος Ηλιάδης, Καθηγητής, Εργαστήριο Βιοϋλικών,Τμήμα Οδοντιατρικής, ΕΚΠΑ
Παναγιώτης Λαγουβάρδος, Καθηγητής, Εργαστήριο Οδοντικής Χειρουργικής,Τμήμα Οδοντιατρικής, ΕΚΠΑ
Αικατερίνη Καββαδία, Αναπληρώτρια Καθηγήτρια, Εργαστήριο Παιδοδοντιατρικής,Τμήμα Οδοντιατρικής, ΕΚΠΑ
Σπυρίδωνας Ζηνέλης, Αναπληρωτής Καθηγητής, Εργαστήριο Βιοϋλικών,Τμήμα Οδοντιατρικής, ΕΚΠΑ
Γεώργιος Βαδιάκας, Επίκουρος Καθηγητής, Εργαστήριο Παιδοδοντιατρικής,Τμήμα Οδοντιατρικής, ΕΚΠΑ
Original Title:
Προληπτικές καλύψεις οπών και σχισμών (Sealants) σε αμφίβολες για τερηδόνα επιφάνειες μονίμων γομφίων
Languages:
Greek
Translated title:
Sealants on questionable for caries occlusal surfaces of permanent molars
Summary:
Pit and fissure sealants are proposed as one of the most acceptable methods of caries prevention on sound occlusal surfaces of permanent teeth as well as on high risk surfaces with incipient caries without cavities. Although, the results of studies on sealants effectiveness on questionable for caries occlusal surfaces and on high risk patients with incipient caries are contradictory.
The Purpose of this in vitro study is:
1. to categorize the occlusal surfaces in sound and questionable according to their visual clinical characteristics (ICDAS 1,2,3) and to correlate them with a) their radiographic picture, b) the DIAGNOdent measurements, and c) their histological characteristics after observation of the teeth sections under light microscope.
2. to analyze the enamel mineral composition of questionable for caries occlusal surfaces.
3. to test alternative means of etching materials and time of application on pits and fissures of questionable occlusal surfaces and evaluate the penetration and adaptation of sealant material on these surfaces.
Design: 84 human molars with questionable occlusal surfaces were used. In the first part of the study, 60 permanent molars were photographed via a polarized light microscope and classified according to the ICDAS (in codes 1, 2 and 3).
In addition to visual examination, teeth categorization was developed in conjunction with radiographs and fluorescence measurements. The depth and extent of enamel lesions were estimated by histological examination with polarized light microscopy.
In the second part the same sections used in the previous experiment studied by SEM as well as by SEM/EDX (scanning electron microscopy/energy dispersive X-ray microanalysis) employing area and line scan X-ray, to analyze and estimate enamel morphology and mineral composition of questionable surfaces and to compare them with the characteristics of sound enamel. Atomic number contrast backscattered electron images (BE) were obtained for phase identification and analysis performed by spot and area scan EDX.
In the third part 24 permanent molars (with codes 1, 2, 3) were etched with an inorganic (H3PO437%) with or without previous preparation with NaOCl before sealant application in different etching times (30 s vs 30 s+30 s). Sealant materials placement followed and teeth were sectioned at the direction of the characterized lesions. Surfaces were studied by polarized light microscope for estimation of sealant penetration and adaptation in fissure walls.

Results: The agreement between visual and histological examination was substantial (k=0,65), and between radiographic and histological examination, moderate (k=0,19).
The EDX analysis indicated changes in the Ca and P content that were more prominent in 2 and 3 ICDAS lesions. In these lesions Ca (Wt%) and P (Wt%) concentrations were statistically significant decreased (p=0,01) in comparison with sound areas implying the presence of regions with mineral depletion. In this study, alternative etching method and time of application were not significant predictors of sealant penetration and of sealant adaptation.
For ICDAS 3 compared to ICDAS 1, the odds of sealant penetration at level 3 vs sealant penetration at the combined levels 2 and 1 are 73% lower (p<0.001). For ICDAS 2 compared to ICDAS 1 and for ICDAS 3 compared to ICDAS 1, the odds of sealant adaptation at level 3 vs sealant adaptation at the combined levels 2 and 1 are statistically significant higher (p<0.01 and p<0.001) respectively.
Conclusions:
The agreement between visual and histological examination was substantial for ICDAS 1, 2 and 3 surfaces. ICDAS system has demonstrated reproducibility and accuracy for detection of caries on questionable occlusal surfaces.
Enamel composition of questionable occlusal surfaces is different from that of sound and the conventional etching methods possibly are not effective in preparing the enamel of these surfaces properly, before sealant placement.
Application of alternative sealant materials (H3PO4 and NaOCl) and different etching times did not improve sealant adaptation and penetration especially on surfaces with codes 2 and 3.
Main subject category:
Health Sciences
Keywords:
incipient lesions, questionable for caries occlusal surfaces, ICDAS codes 1 and 2, altered enamel composition
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
305
Number of pages:
168
File:
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