Anzeige
Erschienen in:
05.05.2021 | Original Article
Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions
Erschienen in: Oral Radiology | Ausgabe 1/2022
Einloggen, um Zugang zu erhaltenAbstract
Background
During interventions for deep caries lesions without severe symptoms, preserving pulpal vitality is important to ensure treatment success, improve organ prognosis, and decrease cost-effectiveness. Current pre-operative radiographs allow visual estimation but not accurate measurement of lesion depth.
Purpose
Investigate the ability of ratio ‘remaining/total dentin thickness’ (RDT/TDT, as determined on pre-operative radiographs) to predict pulp exposure during excavation.
Methods
This retrospective study (January 2018–June 2020) analyzed data on 360 patients. Four independent raters examined standard pre-operative radiographs and their contrasted versions. Lines put at the dentino-enamel junction, the floor of the carious lesion, and the pulp chamber wall allowed deriving RDT/TDT. Inter-rater agreements and concordance were assessed. A logistic regression accounting for measurement errors provided odds ratios that estimated the ability of the RDT/TDT to predict pulp exposure.
Results
The median RDT/TDT ratio ranges were 16.8–26.5% on standard and 16.2–24.6% on contrasted radiographs. Inter-rater agreements on RDT/TDT were rather poor and inter-rater reliability was low and similar in standard and contrasted radiographs: the concordance correlation coefficients (95% CIs) were estimated at 0.46 (0.40; 0.51) and 0.46 (0.40; 0.52), respectively. The risk of pulp exposure increased by 2.5 times [odds ratio (95% CI) 2.57 (2.06; 3.20)] per 10-point decrease of the ratio on standard radiographs vs. 4.15 (3.15; 5.46) on contrasted radiographs.
Conclusion
RDT/TDT ratio is potentially helpful in predicting pulp exposure. However, the measurement errors on RDT and TDT being non-negligible and the interrater agreements poor, there is still place for advances through development of an automated process that will improve reliability and reproducibility of pulp exposure risk assessment.
Clinical trial
Trial registration number. ClinicalTrials.gov NCT04607395, October 29, 2020