Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions
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 le...
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| Veröffentlicht in: | Oral radiology 2022, Vol.38 (1), p.89-98 |
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| creator | Gasqui, Marie-Agnès Pérard, Matthieu Decup, Franck Monsarrat, Paul Turpin, Yann-Loïg Villat, Cyril Gueyffier, François Maucort-Boulch, Delphine Roche, Laurent Grosgogeat, Brigitte |
| description | 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 |
| doi_str_mv | 10.1007/s11282-021-00530-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_03245178v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2617803402</sourcerecordid><originalsourceid>FETCH-LOGICAL-c433t-42c204651ae75c2eb0c23981128e2bc200fda10a5b695f5b0033f52ec89c1b073</originalsourceid><addsrcrecordid>eNp9kUFv1DAQhS0EotvCH-CALHGBQ2Bsx4l9rKpCkVaCA5wtx5ksXmXtYCfd8u_xkrZIHLh4pDffPM_oEfKKwXsG0H7IjHHFK-CsApACquMTsmENE5Vu2vop2YBmrGqAqzNynvMegOu6Vs_JmRBa1hrUhuy_jtYhjQO1NOCRJtv7OMadd3akPvR4V146Jey9m33Y0WkZJ4p3U8xLQtrhEEvxYcZ0i2H2MdCi0B5xos4mH5dMR8xFzy_Is8GOGV_e1wvy_eP1t6ubavvl0-ery23laiHmquaOQ91IZrGVjmMHjgutTrci70oPht4ysLJrtBxkByDEIDk6pR3roBUX5N3q-8OOZkr-YNMvE603N5dbc9JA8FqyVt2ywr5d2SnFnwvm2Rx8djiONmBZ3XDJecO0UqKgb_5B93FJoVxiCtIqEDXwQvGVcinmnHB43ICBOaVm1tRMSc38Sc0cy9Dre-ulO2D_OPIQUwHECuTSCjtMf__-j-1vmNah9A</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2617803402</pqid></control><display><type>article</type><title>Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Gasqui, Marie-Agnès ; Pérard, Matthieu ; Decup, Franck ; Monsarrat, Paul ; Turpin, Yann-Loïg ; Villat, Cyril ; Gueyffier, François ; Maucort-Boulch, Delphine ; Roche, Laurent ; Grosgogeat, Brigitte</creator><creatorcontrib>Gasqui, Marie-Agnès ; Pérard, Matthieu ; Decup, Franck ; Monsarrat, Paul ; Turpin, Yann-Loïg ; Villat, Cyril ; Gueyffier, François ; Maucort-Boulch, Delphine ; Roche, Laurent ; Grosgogeat, Brigitte</creatorcontrib><description>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</description><identifier>ISSN: 0911-6028</identifier><identifier>EISSN: 1613-9674</identifier><identifier>DOI: 10.1007/s11282-021-00530-w</identifier><identifier>PMID: 33954908</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Chemical Sciences ; Dental caries ; Dental Caries - diagnostic imaging ; Dental Caries - therapy ; Dental enamel ; Dentin ; Dentistry ; DNA nucleotidylexotransferase ; Humans ; Imaging ; Lesions ; Medicine ; NCT ; NCT04607395 ; Oral and Maxillofacial Surgery ; Original Article ; Radiography ; Radiology ; Reproducibility of Results ; Retrospective Studies ; Risk assessment</subject><ispartof>Oral radiology, 2022, Vol.38 (1), p.89-98</ispartof><rights>The Author(s), under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2021</rights><rights>2021. The Author(s), under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd.</rights><rights>The Author(s), under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2021.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c433t-42c204651ae75c2eb0c23981128e2bc200fda10a5b695f5b0033f52ec89c1b073</citedby><cites>FETCH-LOGICAL-c433t-42c204651ae75c2eb0c23981128e2bc200fda10a5b695f5b0033f52ec89c1b073</cites><orcidid>0000-0003-2194-7300 ; 0000-0002-9921-0977 ; 0000-0003-0042-7787</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11282-021-00530-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11282-021-00530-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33954908$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-03245178$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Gasqui, Marie-Agnès</creatorcontrib><creatorcontrib>Pérard, Matthieu</creatorcontrib><creatorcontrib>Decup, Franck</creatorcontrib><creatorcontrib>Monsarrat, Paul</creatorcontrib><creatorcontrib>Turpin, Yann-Loïg</creatorcontrib><creatorcontrib>Villat, Cyril</creatorcontrib><creatorcontrib>Gueyffier, François</creatorcontrib><creatorcontrib>Maucort-Boulch, Delphine</creatorcontrib><creatorcontrib>Roche, Laurent</creatorcontrib><creatorcontrib>Grosgogeat, Brigitte</creatorcontrib><title>Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions</title><title>Oral radiology</title><addtitle>Oral Radiol</addtitle><addtitle>Oral Radiol</addtitle><description>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</description><subject>Chemical Sciences</subject><subject>Dental caries</subject><subject>Dental Caries - diagnostic imaging</subject><subject>Dental Caries - therapy</subject><subject>Dental enamel</subject><subject>Dentin</subject><subject>Dentistry</subject><subject>DNA nucleotidylexotransferase</subject><subject>Humans</subject><subject>Imaging</subject><subject>Lesions</subject><subject>Medicine</subject><subject>NCT</subject><subject>NCT04607395</subject><subject>Oral and Maxillofacial Surgery</subject><subject>Original Article</subject><subject>Radiography</subject><subject>Radiology</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Risk assessment</subject><issn>0911-6028</issn><issn>1613-9674</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFv1DAQhS0EotvCH-CALHGBQ2Bsx4l9rKpCkVaCA5wtx5ksXmXtYCfd8u_xkrZIHLh4pDffPM_oEfKKwXsG0H7IjHHFK-CsApACquMTsmENE5Vu2vop2YBmrGqAqzNynvMegOu6Vs_JmRBa1hrUhuy_jtYhjQO1NOCRJtv7OMadd3akPvR4V146Jey9m33Y0WkZJ4p3U8xLQtrhEEvxYcZ0i2H2MdCi0B5xos4mH5dMR8xFzy_Is8GOGV_e1wvy_eP1t6ubavvl0-ery23laiHmquaOQ91IZrGVjmMHjgutTrci70oPht4ysLJrtBxkByDEIDk6pR3roBUX5N3q-8OOZkr-YNMvE603N5dbc9JA8FqyVt2ywr5d2SnFnwvm2Rx8djiONmBZ3XDJecO0UqKgb_5B93FJoVxiCtIqEDXwQvGVcinmnHB43ICBOaVm1tRMSc38Sc0cy9Dre-ulO2D_OPIQUwHECuTSCjtMf__-j-1vmNah9A</recordid><startdate>2022</startdate><enddate>2022</enddate><creator>Gasqui, Marie-Agnès</creator><creator>Pérard, Matthieu</creator><creator>Decup, Franck</creator><creator>Monsarrat, Paul</creator><creator>Turpin, Yann-Loïg</creator><creator>Villat, Cyril</creator><creator>Gueyffier, François</creator><creator>Maucort-Boulch, Delphine</creator><creator>Roche, Laurent</creator><creator>Grosgogeat, Brigitte</creator><general>Springer Singapore</general><general>Springer Nature B.V</general><general>Springer Verlag</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0003-2194-7300</orcidid><orcidid>https://orcid.org/0000-0002-9921-0977</orcidid><orcidid>https://orcid.org/0000-0003-0042-7787</orcidid></search><sort><creationdate>2022</creationdate><title>Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions</title><author>Gasqui, Marie-Agnès ; Pérard, Matthieu ; Decup, Franck ; Monsarrat, Paul ; Turpin, Yann-Loïg ; Villat, Cyril ; Gueyffier, François ; Maucort-Boulch, Delphine ; Roche, Laurent ; Grosgogeat, Brigitte</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c433t-42c204651ae75c2eb0c23981128e2bc200fda10a5b695f5b0033f52ec89c1b073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Chemical Sciences</topic><topic>Dental caries</topic><topic>Dental Caries - diagnostic imaging</topic><topic>Dental Caries - therapy</topic><topic>Dental enamel</topic><topic>Dentin</topic><topic>Dentistry</topic><topic>DNA nucleotidylexotransferase</topic><topic>Humans</topic><topic>Imaging</topic><topic>Lesions</topic><topic>Medicine</topic><topic>NCT</topic><topic>NCT04607395</topic><topic>Oral and Maxillofacial Surgery</topic><topic>Original Article</topic><topic>Radiography</topic><topic>Radiology</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Risk assessment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gasqui, Marie-Agnès</creatorcontrib><creatorcontrib>Pérard, Matthieu</creatorcontrib><creatorcontrib>Decup, Franck</creatorcontrib><creatorcontrib>Monsarrat, Paul</creatorcontrib><creatorcontrib>Turpin, Yann-Loïg</creatorcontrib><creatorcontrib>Villat, Cyril</creatorcontrib><creatorcontrib>Gueyffier, François</creatorcontrib><creatorcontrib>Maucort-Boulch, Delphine</creatorcontrib><creatorcontrib>Roche, Laurent</creatorcontrib><creatorcontrib>Grosgogeat, Brigitte</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Oral radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gasqui, Marie-Agnès</au><au>Pérard, Matthieu</au><au>Decup, Franck</au><au>Monsarrat, Paul</au><au>Turpin, Yann-Loïg</au><au>Villat, Cyril</au><au>Gueyffier, François</au><au>Maucort-Boulch, Delphine</au><au>Roche, Laurent</au><au>Grosgogeat, Brigitte</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions</atitle><jtitle>Oral radiology</jtitle><stitle>Oral Radiol</stitle><addtitle>Oral Radiol</addtitle><date>2022</date><risdate>2022</risdate><volume>38</volume><issue>1</issue><spage>89</spage><epage>98</epage><pages>89-98</pages><issn>0911-6028</issn><eissn>1613-9674</eissn><abstract>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</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>33954908</pmid><doi>10.1007/s11282-021-00530-w</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-2194-7300</orcidid><orcidid>https://orcid.org/0000-0002-9921-0977</orcidid><orcidid>https://orcid.org/0000-0003-0042-7787</orcidid></addata></record> |
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| ispartof | Oral radiology, 2022, Vol.38 (1), p.89-98 |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Chemical Sciences Dental caries Dental Caries - diagnostic imaging Dental Caries - therapy Dental enamel Dentin Dentistry DNA nucleotidylexotransferase Humans Imaging Lesions Medicine NCT NCT04607395 Oral and Maxillofacial Surgery Original Article Radiography Radiology Reproducibility of Results Retrospective Studies Risk assessment |
| title | Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions |
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