In vivo assessment of clinical, radiographic and laser fluorescence examinations for the detection of secondary caries in Class I restorations

Agnieszka Witek, Jadwiga Buczkowska-Radlińska, Maja Bendyk-Szeffer, Alicja Nowicka, Katarzyna Barczak



Introduction: Contemporary conservative dentistry is mainly based on work using composite materials. This is connected not only with the possibility of their comprehensive applications, but also the aesthetic effects that can be achieved through a wide variety of materials. In cases where it is not possible to make a composite restoration properly, replacing it with an alternative material which will determine the more stable reconstruction of the tooth tissues should be considered. Improper composite restoration in a relatively short period of time can lead to marginal leakage, which contributes to the accumulation of dental plaque and the development of secondary caries.

The aim of the study was to assess the effectiveness of clinical, radiographic, and laser fluorescence examinations for the detection of secondary caries under Class I amalgam fillings and composite restorations.

Materials and methods: The study involved 94 patients, aged 17–67 years. We examined 200 restorations with marginal ditching, staining, or discoloration of the adjacent tooth tissues. Teeth with visible secondary caries were not included. Clinical, laser fluorescence and radiographic examinations were performed.

Results: Secondary caries was found in 137 of the 200 examined teeth. The laser fluorescence and radiographic examination methods showed low sensitivity for detecting secondary caries (0.31 and 0.39 respectively). Both methods showed higher specificity (0.86 and 0.98 respectively) and accuracy (0.49 and 0.58 respectively).

Conclusions: Clinical examination is the most effective method of diagnosing secondary caries in Class I restorations. Laser fluorescence and radiographic examinations should only be performed in addition to clinical examination.


DIAGNOdent; diagnosis; radiography; secondary caries

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Braga RR, Boaro LCC, Kuroe T, Azevedo CLN, Singer JM. Influence of cavity dimensions and their derivatives (volume and ‘C’ factor) on shrinkage stress development and microleakage of composite restorations. Dent Mater 2006;22:818-23.

Giachetti L, Russo DS, Bambi C, Grandini R. A review of polymerization shrinkage stress: current techniques for posterior direct resin restorations. J Contemp Dent Pract 2006;7:1-14.

Cenci MS, Pereira-Cenci T, Cury JA, Ten Cate JM. Relationship between gap size and dentine secondary caries formation assessed in a microcosm biofilm model. Caries Res 2009;43:97-102.

Kidd EAM, Joyston-Bechal S, Beighton D. Marginal ditching and staining as a predictor of secondary caries around amalgam restorations: a clinical and microbiological study. J Dent Res 1995;74:1206-11.

Ando M, González-Cabezas C, Isaacs RL, Eckert GJ, Stookey GK. Evaluation of several techniques for the detection of secondary caries adjacent to amalgam restorations. Caries Res 2004;38:350-6.

Shivakumar KM, Prasad S, Handu GN; International Caries Detection and Assessment System. A new paradigm in detection of dental caries. J Conserv Dent 2009;12:10-6.

Totiam P, González-Cabezas C, Fontana MR, Zero DT. A new in vitro model to study the relationship of gap size and secondary caries. Caries Res 2007;41:467-73.

Fabianelli A, Pollington S, Davidson CL, Cagidiaco MC, Goracci C. The relevance of micro-leakage studies. Int Dent South Afr 2007;9:64-74.

Lima FG, Romano AR, Correa MB, Demarco FF. Influence of microleakage, surface roughness and biofilm control on secondary caries formation around composite resin restorations: an in situ evaluation. J Appl Oral Sci 2009;17(1):61-5. doi: 10.1590/S1678-77572009000100012.

Sousa RP, Zanin IC, Lima JP, Vasconcelos SM, Melo MA, Beltrão HC, et al. In situ effects of restorative materials on dental biofilm and enamel demineralisation. J Dent 2009;37:44-51.

Gupta KV, Verma P, Trivedi A. Evaluation of microleakage of various restorative materials: an in vitro study. J Life Sci 2011;3:29-33.

Nedeljkovic I, Teughels W, De Munck J, Van Meerbeek B, Van Landuyt KL. Is secondary caries with composites a material-based problem? Dent Mater 2015;31(11):e247-77. doi: 10.1016/

Krupiński J, Krupińska A, Lejman L, Modelska D, Roterman I, Sciegienny­‍-Malec J, et al. Clinical pattern of secondary dental caries in relation to tissue defect class and type of filling material. Czas Stomatol 1990;43:595-9.

Bernardo M, Luis H, Martin MD, Leroux BG, Rue T, Leitão J, et al. Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. J Am Dent Assoc 2007;138:775-8.

Diniz MB, Eckert GJ, González-Cabezas C, Cássia Loiola Cordeiro R, Gonçalves Ferreira-Zandona A. Caries detection around restorations using ICDAS and optical devices. J Esthet Restor Dent 2016;28:110-21.

Pitts NB. Clinical diagnosis of dental caries: a European perspective. J Dent Educ 2001;65:972-8.

Gordan VV, Riley JL, Carvalho RM, Snyder J, Sanderson JL, Anderson M, et al. Methods used by dental practice-based research network (DPBRN) dentists to diagnose dental caries. Oper Dent 2011;36:2-11.

Braga MM, Chiarotti APS, Imparato JCP, Mendes FM. Validity and reliability of methods for the detection of secondary caries around amalgam restorations in primary teeth. Braz Oral Res 2010;24:102-7.

Moreira PL, Messora MR, Pereira SM, de Almeida SSM, da Cruz AD. Diagnosis of secondary caries in esthetic restorations: influence of the incidence vertical angle of the x-ray beam. Braz Dent J 2011;22:129-33.

Brouwer F, Askar H, Paris S, Schwendicke F. Detecting secondary caries lesions. A systematic review and meta-analysis. J Dent Res 2016;95:143-51.

Pedrosa RF, Brasileiro IV, dos Anjos Pontual ML, dos Anjos Pontual A, da Silveira MM. Influence of materials radiopacity in the radiographic diagnosis of secondary caries: evaluation in film and two digital systems. Dentomaxillofac Radiol 2011;40:344-50.

Hewlett ER, Atchison KA, White SC, Flack V. Radiographic secondary caries prevalence in teeth with clinically defective restorations. J Dent Res 1993;72:1604-9.

Pretty IA, Smith PW, Edgar WM, Highama SM. Detection of in vitro demineralization adjacent to restorations using quantitative light induced fluorescence (QLF). Dent Mater 2003;19:368-74.

Kulczyk T, Dyszkiewicz-Konwińska M, Owecka M, Krzyżostaniak J, Surdacka A. The influence of amalgam fillings on the detection of approximal caries by cone beam CT: in vitro study. Dentomaxillofac Radiol 2014;43(7):20130342. doi: 10.1259/dmfr.20130342.

Hitij T, Fidler A. Effect of dental material fluorescence on DIAGNOdent readings. Acta Odontol Scand 2008;66(1):13-7.

Bamzahim M, Aljehani A, Shi XQ. Clinical performance of DIAGNOdent in the detection of secondary caries lesions. Acta Odontol Scand 2005;63:26-30.

Hall AF, Deschepper E, Stookey GK. In vitro studies of laser fluorescence for detection and quantification of mineral loss from dental caries. Adv Dent Res 1997;11:507-14.

Diniz MB, Cordeilo RCL, Ferreira-Zandona AG. Detection of caries around amalgam restorations on approximal surfaces. Oper Dent 2016;41:34-43.

Boston DW. Initial in vitro evaluation of DIAGNOdent for detecting secondary carious lesions associated with resin composite restorations. Quintessence Int 2003;34:109-16.


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