TY - JOUR

T1 - A macroscopic and histologic analysis of radiographically well-defined deep and extremely deep carious lesions

T2 - carious lesion characteristics as indicators of the level of bacterial penetration and pulp response

AU - Demant, S.

AU - Dabelsteen, S.

AU - Bjørndal, L.

N1 - This article is protected by copyright. All rights reserved.

PY - 2021

Y1 - 2021

N2 - AIM: To investigate the relationship between radiographically and macroscopically well-defined carious lesions and the dentine-pulp complex with regard to: a) level of bacterial penetration, b) inflammatory status including the presence of hyperplastic pulp stroma; and c) formation of hard and/or ectopic connective tissue.METHODOLOGY: The material comprised 68 untreated cavitated permanent teeth divided into well-defined radiographic categories based on the lesion-penetration depth: a) Deep lesions ( ≥¾ of the dentine thickness with a radio-dense zone separating the lesion from the pulp) and b) extremely deep lesions (the carious lesion penetrated the entire thickness of the dentine, without a radio-dense zone). After extraction, the teeth were processed for histology. The material was scored with regard to coronal break-down, macroscopic variables describing caries activity, and histological variables describing the dentine-pulp complex (bacteria, inflammatory infiltrate, partial pulp necrosis, hyperplastic changes, hard tissue/ectopic presence of connective tissue). Interrater agreement was assessed using Cohen´s kappa. Associations between variables were assessed using Pearson's χ2 or Fisher's Exact test. The effect size was reported by odds ratio (OR) and associated 95% confidence interval (CI). Level of significance was set to 5%.RESULTS: There were significant associations between a closed environment (1-2 surfaces involved) and the presence of biofilm, retrograde demineralization and light-coloured demineralized dentine. Whereas radiographically defined deep lesions tended to have bacteria only in the primary dentine (P = 0.000, OR = 20.55, 95% CI [4.44, 107.89 ]), extremely deep carious lesions tended to have bacteria in contact with the pulpal tissue (P = 0.007, OR =6.84, 95% CI [2.00, 62.83]), presence of an inflammatory infiltrate (Fisher's Exact; P = 0.000); and partial pulp necrosis. Hyperplastic pulps were seen only in extremely deep lesions.CONCLUSIONS: Unlike deep lesions, extremely deep carious lesions were often associated with severe pulp inflammation and infection. A radiographic threshold between deep and extremely deep lesions is suggested as indicator of the bacterial penetration level and the severity of the pulpal response prior to intervention.

AB - AIM: To investigate the relationship between radiographically and macroscopically well-defined carious lesions and the dentine-pulp complex with regard to: a) level of bacterial penetration, b) inflammatory status including the presence of hyperplastic pulp stroma; and c) formation of hard and/or ectopic connective tissue.METHODOLOGY: The material comprised 68 untreated cavitated permanent teeth divided into well-defined radiographic categories based on the lesion-penetration depth: a) Deep lesions ( ≥¾ of the dentine thickness with a radio-dense zone separating the lesion from the pulp) and b) extremely deep lesions (the carious lesion penetrated the entire thickness of the dentine, without a radio-dense zone). After extraction, the teeth were processed for histology. The material was scored with regard to coronal break-down, macroscopic variables describing caries activity, and histological variables describing the dentine-pulp complex (bacteria, inflammatory infiltrate, partial pulp necrosis, hyperplastic changes, hard tissue/ectopic presence of connective tissue). Interrater agreement was assessed using Cohen´s kappa. Associations between variables were assessed using Pearson's χ2 or Fisher's Exact test. The effect size was reported by odds ratio (OR) and associated 95% confidence interval (CI). Level of significance was set to 5%.RESULTS: There were significant associations between a closed environment (1-2 surfaces involved) and the presence of biofilm, retrograde demineralization and light-coloured demineralized dentine. Whereas radiographically defined deep lesions tended to have bacteria only in the primary dentine (P = 0.000, OR = 20.55, 95% CI [4.44, 107.89 ]), extremely deep carious lesions tended to have bacteria in contact with the pulpal tissue (P = 0.007, OR =6.84, 95% CI [2.00, 62.83]), presence of an inflammatory infiltrate (Fisher's Exact; P = 0.000); and partial pulp necrosis. Hyperplastic pulps were seen only in extremely deep lesions.CONCLUSIONS: Unlike deep lesions, extremely deep carious lesions were often associated with severe pulp inflammation and infection. A radiographic threshold between deep and extremely deep lesions is suggested as indicator of the bacterial penetration level and the severity of the pulpal response prior to intervention.

U2 - 10.1111/iej.13424

DO - 10.1111/iej.13424

M3 - Journal article

C2 - 33012046

VL - 54

SP - 319

EP - 330

JO - International Endodontic Journal

JF - International Endodontic Journal

SN - 0143-2885

IS - 3

ER -