Performance of DIAGNOdent for detection and quantification of smooth-surface caries in primary teeth

Efficiency of Near-Infrared Technology in the Clinical Detection of Carious Lesions: A Systematic Review

The field of dentistry has seen various technological advances regarding caries detection, some lesions still prove to be difficult to detect. A reasonably new detection method, near-infrared (NIR), has shown good results in caries detection. This systematic review aims to compare NIR with conventional methods in terms of caries detection. Online databases (PubMed, Scopus, ScienceDirect, EBSCO, and ProQuest) were used for the literature search. The search was performed from January 2015 till December-2020. A total of 770 articles were selected, of that 17 articles qualified for the final analysis as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles were assessed according to a modified Critical Appraisal Skills Programme checklist, and then synthesis of the review started. The inclusion criteria were clinical trials done in vivo on teeth with active caries of vital or nonvital teeth. This review excluded nonpeer reviewed articles, case reports, case series, opinions, abstracts, non-English written articles, studies of subjects with arrested caries, or teeth with developmental defects of tooth structure and teeth having environmental defects of tooth structure, as well as in-vitro studies. The review compared near-infrared technology with radiography, visual inspection, and laser fluorescence in terms of caries detection, sensitivity, specificity, and accuracy. The sensitivity of NIR ranged from 99.1 to 29.1%. Studies showed that NIR exhibited higher sensitivity for occlusal enamel and dentin caries. The specificity of NIR ranged from 94.1 to 20.0%. In enamel and dentinal occlusal caries, NIR demonstrated lower specificity than that of radiograph. The specificity of NIR in early proximal caries was low. Accuracy was determined in 5 out of 17 studies where the values ranged from 97.1 to 29.1%. The accuracy of NIR was the highest for dentinal occlusal caries. NIR shows promising evidence as an adjunct in caries examination due to its high sensitivity and specificity; however, more studies are required to determine its full potential in different situations.

Assessment of White Spot Lesion and Enamel Demineralization in Orthodontic Patients With Fixed Brackets—A Clinical Appraisal Using Fluoride Mouth Rinse, Fluoride Varnish Containing CPP-ACP, and CPP-ACFP

Purpose:

Efficacy evaluation of casein phosphopeptide amorphous calcium phosphate complex (CPP-ACP), casein phosphopeptide amorphous calcium fluoride phosphate complex (CPP-ACFP), fluoride mouthrinse, and fluoride containing toothpaste as compared to control group for the remineralization of white spot lesions (WSLs) in orthodontic patients with fixed brackets in an in vivo study.

Methods:

Seventy-five subjects with WSL determined by DIAGNOdent were randomly divided into 5 groups. The WSLs DIAGNOdent values for 0, 3, 6, 9, and 12 months were tabulated and subjected to statistical analysis.

Results:

Among the groups, the remineralizing potential of fluoride mouth rinse, fluoride containing toothpaste, and CPP-ACP were similar; however, CPP-ACFP value was superior in comparison to all other groups.

Conclusion:

The CPP-ACFP technique is highly beneficial for the remineralization of WSL in an orthodontic patient when compared to fluoride mouth rinse, fluoride-containing toothpaste, and CPP-ACP paste.

Effect of Chlorhexidine Varnish and Fluoride Varnish on White Spot Lesions in Orthodontic Patients- a Systematic Review

Aim:

The aim of this study is to critically review the studies that studied the effect of Chlorhexidine varnish and fluoride varnish on White Spot Lesion (WSL) in patients undergoing orthodontic treatment.

Materials and Methods:

The electronic database PubMed, The Cochrane Library, Medline, Embase, Google Scholar, Web of Knowledge along with a complimentary manual search of all orthodontic journals till the first week of December 2019 was searched. English language study performed on humans, randomized or nonrandomized clinical trials, comparing the effect of fluoride and chlorhexidine varnish on WSL was included in the review. Quality assessment of included studies was performed.

Clinical Significance:

The need for an adjunct oral hygiene aid to reduce the incidence and prevalence of white spot lesions in orthodontic patients is necessary. The use of these varnishes will aid in the same and thus make the adverse effects of fixed orthodontic treatment negligible.

Review of Literature:

Enamel demineralization is a significant risk associated with orthodontic treatment when oral hygiene is poor. Prevention of demineralization during orthodontic treatment is one of the greatest challenges faced by clinicians despite modern advances in caries prevention. The development of White Spot Lesions (WSLs) is attributed to prolonged plaque accumulation around the brackets.

Results:

The search identified a total of 3 studies that were included in this review. One study had Low risk of bias and the remaining 2 studies had moderate overall risk. Results showed that there was a reduction in the incidence of white spot lesions in orthodontic patients after application of chlorhexidine and Fluoride varnish.

Conclusion:

Low level evidence is available to conclude that the use of chlorhexidine varnishes and fluoride varnishes reduces the prevalence of white spot lesions in patients undergoing fixed orthodontic treatment. Due to its limitations, the results of this systematic review should be handled with caution and further well-planned Randomized Clinical Trial (RCT) are needed to provide a discrete conclusion.

Light-based diagnostic methods for the in vivo assessment of initial caries lesions: Laser fluorescence, QLF and OCT

OBJECTIVES

To evaluate different light-based caries diagnostic methods for assessment of non-cavitated initial carious lesions on smooth surfaces.

METHODS

39 participants were included. For each participant, three regions of interest (ROI) with ICDAS codes 0, 1 or 2 were defined. All ROIs (n = 117) were investigated/imaged with laser fluorescence (LF, DIAGNOdent 2095; KaVo dental GmbH), quantitative light-induced fluorescence (QLF; Biluminator 2+, Inspektor Research Systems B.V.) and spectral-domain optical coherence tomography (SD-OCT; Telesto II, Thorlabs GmbH). The values of LF, ΔF of QLF, and the lesion extent assessed by OCT were categorized. Frequency distribution of LF-/QLF- and OCT-scores was determined for each ICDAS code included. Inter- and intra-examiner reproducibility of QLF and OCT measurements were assessed by unweighted kappa coefficient (ĸ) and Wilcoxon test (α = 0.05).

RESULTS

Compared with LF and QLF, OCT showed various manifestations of carious lesions for visually sound ROIs and a larger variation of caries extent in depth within the same ICDAS code groups. Intra-examiner reproducibility ranged between 0.49 and 1.00 for the QLF analysis and between 0.95 and 0.99 for the OCT analysis. Inter-examiner reproducibility ranged between 0.17 and 0.32 for the QLF analysis and between 0.65 and 0.79 for the OCT analysis.

CONCLUSION

LF and QLF were insensitive to less pronounced smooth-surface lesions while OCT allowed differentiation based on the penetration depth of the carious lesions. This makes OCT a suitable method to complement conventional visual inspection in order to detect and assess (very) early lesions.

Fluorescence devices for the detection of dental caries

BACKGROUND

Caries is one of the most prevalent and preventable conditions worldwide. If identified early enough then non-invasive techniques can be applied, and therefore this review focusses on early caries involving the enamel surface of the tooth. The cornerstone of caries detection is a visual and tactile dental examination, however alternative methods of detection are available, and these include fluorescence-based devices. There are three categories of fluorescence-based device each primarily defined by the different wavelengths they exploit; we have labelled these groups as red, blue, and green fluorescence. These devices could support the visual examination for the detection and diagnosis of caries at an early stage of decay.

OBJECTIVES

Our primary objectives were to estimate the diagnostic test accuracy of fluorescence-based devices for the detection and diagnosis of enamel caries in children or adults. We planned to investigate the following potential sources of heterogeneity: tooth surface (occlusal, proximal, smooth surface or adjacent to a restoration); single point measurement devices versus imaging or surface assessment devices; and the prevalence of more severe disease in each study sample, at the level of caries into dentine.

SEARCH METHODS

Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 May 2019); Embase Ovid (1980 to 30 May 2019); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 May 2019); and the World Health Organization International Clinical Trials Registry Platform (to 30 May 2019). We studied reference lists as well as published systematic review articles.

SELECTION CRITERIA

We included diagnostic accuracy study designs that compared a fluorescence-based device with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded.

DATA COLLECTION AND ANALYSIS

Two review authors extracted data independently using a piloted study data extraction form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Sensitivity and specificity with 95% confidence intervals (CIs) were reported for each study. This information has been displayed as coupled forest plots and summary receiver operating characteristic (SROC) plots, displaying the sensitivity-specificity points for each study. We estimated diagnostic accuracy using hierarchical summary receiver operating characteristic (HSROC) methods. We reported sensitivities at fixed values of specificity (median 0.78, upper quartile 0.90).

MAIN RESULTS

We included a total of 133 studies, 55 did not report data in the 2 x 2 format and could not be included in the meta-analysis. 79 studies which provided 114 datasets and evaluated 21,283 tooth surfaces were included in the meta-analysis. There was a high risk of bias for the participant selection domain. The index test, reference standard, and flow and timing domains all showed a high proportion of studies to be at low risk of bias. Concerns regarding the applicability of the evidence were high or unclear for all domains, the highest proportion being seen in participant selection. Selective participant recruitment, poorly defined diagnostic thresholds, and in vitro studies being non-generalisable to the clinical scenario of a routine dental examination were the main reasons for these findings. The dominance of in vitro studies also means that the information on how the results of these devices are used to support diagnosis, as opposed to pure detection, was extremely limited. There was substantial variability in the results which could not be explained by the different devices or dentition or other sources of heterogeneity that we investigated. The diagnostic odds ratio (DOR) was 14.12 (95% CI 11.17 to 17.84). The estimated sensitivity, at a fixed median specificity of 0.78, was 0.70 (95% CI 0.64 to 0.75). In a hypothetical cohort of 1000 tooth sites or surfaces, with a prevalence of enamel caries of 57%, obtained from the included studies, the estimated sensitivity of 0.70 and specificity of 0.78 would result in 171 missed tooth sites or surfaces with enamel caries (false negatives) and 95 incorrectly classed as having early caries (false positives). We used meta-regression to compare the accuracy of the different devices for red fluorescence (84 datasets, 14,514 tooth sites), blue fluorescence (21 datasets, 3429 tooth sites), and green fluorescence (9 datasets, 3340 tooth sites) devices. Initially, we allowed threshold, shape, and accuracy to vary according to device type by including covariates in the model. Allowing consistency of shape, removal of the covariates for accuracy had only a negligible effect (Chi2 = 3.91, degrees of freedom (df) = 2, P = 0.14). Despite the relatively large volume of evidence we rated the certainty of the evidence as low, downgraded two levels in total, for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the high number of in vitro studies, and inconsistency due to the substantial variability of results.

AUTHORS' CONCLUSIONS

There is considerable variation in the performance of these fluorescence-based devices that could not be explained by the different wavelengths of the devices assessed, participant, or study characteristics. Blue and green fluorescence-based devices appeared to outperform red fluorescence-based devices but this difference was not supported by the results of a formal statistical comparison. The evidence base was considerable, but we were only able to include 79 studies out of 133 in the meta-analysis as estimates of sensitivity or specificity values or both could not be extracted or derived. In terms of applicability, any future studies should be carried out in a clinical setting, where difficulties of caries assessment within the oral cavity include plaque, staining, and restorations. Other considerations include the potential of fluorescence devices to be used in combination with other technologies and comparative diagnostic accuracy studies.

Fissure caries inhibition with a CO2 9.3-μm short-pulsed laser-a randomized, single-blind, split-mouth controlled, 1-year clinical trial

OBJECTIVES

The objective of this randomized, single-blind, split-mouth controlled, clinical trial was to evaluate whether the use of a short-pulsed 9.3-μm CO₂ laser increases the caries resistance of occlusal pit and fissures in addition to fluoride therapy over 12 months.

MATERIALS AND METHODS

A total of 60 participants, average age 13.1 years, were enrolled. At baseline, second molars were randomized into test and control, and assessed by ICDAS, SOPROLIFE, and DIAGNOdent. An independent investigator irradiated test molars with a CO₂ laser (wavelength 9.3 μm, pulse duration 4 μs, pulse repetition rate 43 Hz, beam diameter 250 μm, average fluence 3.9 J/cm², 20 laser pulses per spot). Test molars received laser and fluoride treatment, control teeth fluoride alone. Fluoride varnish was applied at baseline and at 6 months. After 6 and 12 months, teeth were again assessed.

RESULTS

A total of 57 participants completed the 6-month and 51 the 12-month recall. Laser-treated surfaces showed very slight ICDAS improvements over time with ICDAS change - 1 in 11% and 8%, no changes (ICDAS change 0) in 68% and 67%, and slightly worsened (ICDAS change 1) in 19% and 24% at 6- and 12-month recalls, respectively, and worsened by two scores in 2% at both recall time points. Control teeth showed significantly higher ICDAS increases, with 47% and 25% showing ICDAS change 0, ICDAS change 1 in 49% and 55%, and ICDAS change 2 in 4% and 20% at 6- and 12-month recalls, respectively. Differences in ICDAS changes between the groups were statistically significant (P = 0.0002 and P < 0.0001; Wilcoxon's signed-rank test, exact). A total of 22% of the participants developed ICDAS 3 scores on the control teeth.

CONCLUSIONS

Microsecond short-pulsed 9.3-μm CO₂ laser irradiation markedly inhibits caries progression in pits and fissures in comparison with fluoride varnish alone.

CLINICAL RELEVANCE

The 9.3-μm CO₂ laser irradiation of pits and fissures enhances caries resistance.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02357979.

Clinical performance of clinical-visual examination, digital bitewing radiography, laser fluorescence, and near-infrared light transillumination for detection of non-cavitated proximal enamel and dentin caries

The aim of this study was to compare the clinical performance of clinical-visual examination using the International Caries Detection and Assessment System (ICDAS) II, digital bitewing radiography, near-infrared light transillumination (NIR-LT), and laser fluorescence (LF) for the detection of non-cavitated proximal enamel and dentin caries. The study included 335 patients, aged 12-18 years, with no cavities in the posterior teeth. Clinical-visual inspections of 335 non-cavitated proximal caries were performed by two examiners. For enamel caries, clinical validation included a combination of clinical-visual and digital bitewing radiography assessments. For dentin caries, the clinical validation was opening the cavity. The accuracy rate, sensitivity, specificity, predictive values, and areas under receiver operating characteristic curves were determined. The agreement between the examiners' measurements was calculated using the kappa coefficient. The sensitivity, specificity, and accuracy of the methods were compared using the McNemar test. The significance level was set at p < 0.05. Digital bitewing radiography had the highest sensitivity (0.96) and accuracy (0.96), and LF had the lowest sensitivity (0.38) and accuracy (0.39). After separation of the lesions into enamel and dentin caries, clinical-visual examination had the highest sensitivity (0.98) and accuracy (0.98) for enamel caries, while digital bitewing radiography had the highest sensitivity (0.97) and accuracy (0.97) for dentin caries. The NIR-LT method had a higher sensitivity for enamel caries (0.86). Each method also differed significantly from the others (p < 0.001). Digital bitewing radiography gave the best prediction of proximal enamel and dentin caries. NIR-LT showed good potential for detection of proximal caries.

Occlusal Caries Detection and Diagnosis Using Visual ICDAS Criteria, Laser Fluorescence Measurements, and Near-Infrared Light Transillumination Images

OBJECTIVE

Current diagnostic tools for non-cavitated occlusal caries are not very reliable. For this reason, newer systems need to be developed. The aim of this study was to compare the performance of visual inspection (ICDAS-II), laser fluorescence (DIAGNOdent pen), and the near-infrared transillumination technique (DIAGNOcam) in the detection of non-cavitated occlusal caries lesions under clinical and laboratory conditions in 90 third molar teeth planned for extraction.

MATERIALS AND METHODS

Ninety third molar teeth were firstly examined in clinical conditions, scored according to ICDAS-II criteria, and examined with DIAGNOdent pen and DIAGNOcam devices. After finishing the clinical examination, the teeth were re-evaluated shortly after the extractions with the same methods. Then, the teeth were sectioned for histological validation according to Downer's criteria. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic (ROC) curves were calculated based on the histological results.

RESULTS

For the D0-D1-4 threshold, the area under the ROC curve values ranged between 0.754 and 0.881 for all systems. Sensitivity values ranged between 80.5 and 96.1%, and specificity values ranged between 61.5 and 84.6% for the three caries detection methods. DIAGNOcam had the best correlation value (0.616) according to histological observations and demonstrated a sensitivity rate of 96.1%, a specificity rate of 61.5%, and an accuracy rate of 91.1%.

CONCLUSIONS

DIAGNOcam was found to be the most effective method for the diagnosis of occlusal caries without cavitation in permanent molar teeth.

Effect of Er,Cr:YSGG on Remineralization Using CPP - ACPF (MI - Paste Plus) after Enamel Erosion Caused by Carbonated Soft Drink in Primary Teeth: In-Vitro Study

BACKGROUND:

Erosion is a widespread phenomenon with higher predilection in primary dentition.

AIM:

The aim of the present study is to assess the remineralising effect of Er,Cr:YSGG laser application combined with CPP-ACPF after erosive demineralisation by Coca-Cola in primary teeth.

METHODS:

Fifty teeth (n = 10) were divided into; Group I: Artificial saliva, (Saliva natural, Medac, UK), Group II: CPP-ACPF (MI Paste Plus, GC Corp, USA), Group III: Er,Cr:YSGG (Waterlase iPlus, USA), Group IV: CPP-ACPF + Er,Cr:YSGG, Group V: Er,Cr:YSGG + CPP-ACPF. Teeth were immersed in Coca-Cola for 10 min, 5 times/day for 5 days. DIAGNOdent (DD) measurements were taken before and after the experiment.

RESULTS:

There was a significant increase in DD readings after erosive-treatment cycles in all test groups. The highest reading was in samples immersed in artificial saliva, and the lowest was in those subjected to combined CPP-ACPF and Er,Cr:YSGG laser application, regardless of the sequence used. There was no significant difference between samples immersed in artificial saliva, and after CPP-ACPF application. Similarly, there was no significant difference between samples treated by combined treatment of CPP-ACPF and Er,Cr:YSGG application. However, there was a significant difference between samples immersed in artificial saliva or treated with CPP-ACPF application and those subjected to combined treatment CPP-ACPF along with Er,Cr:YSGG.

CONCLUSION:

Combining Er,Cr:YSGG laser and CPP-ACPF paste significantly increased enamel remineralisation, regardless of the sequence implemented. Saliva naturally and CPP-ACPF application had a comparable effect on remineralisation.

Evaluation of laser fluorescence in combination with photosensitizers for detection of demineralized lesions

BACKGROUND AND OBJECTIVES

Early detection of caries plays an important role in its prognosis. This study sought to assess the efficacy of laser fluorescence alone and in combination with photosensitizers for detection of demineralized smooth-surface lesions of permanent teeth.

MATERIALS AND METHODS

This in vitro experimental study was conducted on 60 extracted sound premolars. Four windows measuring 2 x 2 mm were created on each tooth. Forty out of 60 teeth were subjected to demineralization cycle. All teeth were then sectioned and subjected to DIAGNOdent Pen (Kavo, Biberach, Germany) alone and in combination with 0.2-mM tetrakis N-methylpyridyl porphyrin (TMPyP) fluorescent dye, 2% methylene blue and 2% new methylene blue photosensitizers. The results of histological analysis of sections served as the gold standard. The correlation of the results with the gold standard was assessed using the Pearson's correlation coefficient and receiver operating characteristic (ROC) curve. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the four techniques were evaluated as well.

RESULTS

The correlation between the results of DIAGNOdent laser with TMPyP dye and the gold standard was significant (P < 0.05). Also, this technique had the highest sensitivity while DIAGNOdent laser alone had the highest specificity.

CONCLUSION

Laser fluorescence with TMPyP fluorescent dye has suitable efficacy for early detection of initial enamel lesions.

Efficacy of fluorides and CPP-ACP vs fluorides monotherapy on early caries lesions: A systematic review and meta-analysis

The study aimed to evaluate the efficacy of the combination of CPP-ACP and fluorides compared with fluorides monotherapy on patients with early caries lesions. The Medline, Embase and Cochrane databases up to August 2017 were scanned, with no restrictions. Studies satisfied the guideline of randomised controlled trials (RCTs), the patients with early caries lesions and data considering the efficacy of fluorides and CPP-ACP versus fluorides alone were selected. There was no language restriction during the literature search process, however, only papers in English or Chinese were included during the selection process. Outcome variables include laser fluorescence, quantitative light-induced fluorescence, lesion area and visual inspection scores. Mean differences were calculated during the data extraction process. Ten studies including 559 patients were selected in the meta-analysis. Fluorides combined with CPP-ACP achieved the same efficacy for early caries lesions on smooth surfaces compared with fluorides monotherapy (mean difference: -13.90, 95% confidence interval: [-39.25, 11.46], P = 0.28), and the combination treatment showed significantly better efficacy than fluorides monotherapy for occlusal early caries lesions (mean difference: -21.02, 95% confidence interval: [-27.94, -14.10], P<0.01). However, further well-designed studies are still needed.

Evaluation of laser fluorescence in monitoring non-cavitated caries lesion progression on smooth surfaces in vitro

The aim of this study was to evaluate the performance of a pen-type laser fluorescence (LF) device (LFpen: DIAGNOdent pen) to detect and monitor the progression of caries-like lesions on smooth surfaces. Fifty-two bovine enamel blocks were submitted to three different demineralisation cycles for caries-like lesion induction using Streptococcus mutans, Lactobacillus casei and Actinomyces naeslundii. At baseline and after each cycle, the enamel blocks were analysed under Knoop surface micro-hardness (SMH) and an LFpen. One enamel block after each cycle was randomly chosen for Raman spectroscopy analysis. Cross-sectional micro-hardness (CSMH) was performed at different depths (20, 40, 60, 80 and 100 μm) in 26 enamel blocks after the second cycle and 26 enamel blocks after the third cycle. Average values of SMH (± standard deviation (SD)) were 319.3 (± 21.5), 80.5 (± 31.9), 39.8 (± 12.7), and 29.77 (± 10.34) at baseline and after the first, second and third cycles, respectively. Statistical significant difference was found among all periods (p < 0.01). The LFpen values were 4.3 (± 1.5), 7.5 (± 9.4), 7.1 (± 7.1) and 5.10 (± 3.58) at baseline and after the first, second, and third cycles, respectively, among all periods (p < 0.05). The CSMH values after the second and third cycles at 20, 40, 60, 80 and 100 μm were 182.8 (± 69.8), 226.1 (± 79.6), 247.20 (± 69.36), 262.35 (± 66.36) and 268.45 (± 65.49), and for the third cycle were 193.7 (± 73.4), 239.5 (± 81.5), 262.64 (± 82.46), 287.10 (± 78.44) and 284.79 (± 72.63) (n = 24 and 23), respectively. No correlation was observed between the LFpen and SMH values (p > 0.05). One sample of each cycle was characterised through Raman spectroscopy analysis. It can be concluded that LF was effective in detecting the first demineralisation on enamel; however, the method did not show any effect in monitoring lesion progression after three cycles of in vitro demineralisation.

The influence of the lining material on the repair of the infected dentin in young permanent molars after restoration: A randomized clinical trial

Aim:

This study evaluated the impact of liner material on the fluorescence, morphological and mineral characteristics of permanent carious dentin after cavity sealing.

Methods:

Thirty children (11.0 ± 2.7 years old) presenting at least one active deep carious lesion in permanent molars were selected. Fragments of carious dentin were removed from teeth before lining the cavity (baseline samples) with high-viscosity glass ionomer cement (G1) or an inert material (wax - G2). Cavities were restored with composite resin and reopened 60 days later, and other fragments were removed (60-day sample). The laser fluorescence (LF) readings and morphological and mineral changes of both groups were compared.

Results:

After 60 days, forty teeth were available for evaluation. Lower LF means were obtained (Wilcoxon signed-rank test; P < 0.05), and enhanced calcium and phosphorus levels were detected for both groups (t-test, P < 0.05). An uptake of fluorine was observed only in G1 (t-test; P < 0.05). Regardless of the group, baseline samples exhibited clear signs of bacterial invasion, and the collagen fibers were exposed; the 60-day samples showed a better-organized tissue with a more compact intertubular dentin.

Conclusion:

Caries arrestment with dentin reorganization occurs regardless of the lining material placed in contact with the infected dentin.

Pen-type laser fluorescence device versus bitewing radiographs for caries detection on approximal surfaces

Background

The accurate detection of approximal caries is generally difficult. The aim of this study was to assess the ability of the pen-type laser fluorescence device (LF pen) to detect approximal carious lesions in comparison to bitewing radiographs (BW).

Methods

Three hundred forty-one tooth surfaces were diagnosed in 20 patients with an average age of 26.70 (±2.82) years. Each test tooth was sequentially assessed by a single calibrated examiner using visual inspection, BW, and the LF pen. Radiographs were used as the gold standard to calculate an appropriate cut-off.

Results

Sensitivity, specificity and accuracy values for cut-off limits of 15, measured by the LF pen were compared using the chi² test (McNemar test). For approximal caries at D3 level, the highest values of specificity and sensitivity were observed for the LF pen at a cut-off value of 15 (96.8 and 83.0 %) and for visual inspection (99.3 and 4.3 %).

Conclusion

Within the limitations of this study, dentin caries on approximal surfaces could be detected equally well by the LF pen as by the bitewing radiographs. Therefore, the LF pen can be recommended as an alternative to radiographs for the detection of approximal caries in a regular dental practice setting.

Trial registration

DRKS00004817 on DRKS on 12^th March 2013.

Tooth demineralization and associated factors in patients on fixed orthodontic treatment

Dental demineralization was determined in patients at three time points during fixed orthodontic treatment. A multiple cross-sectional study included 108 patients divided into three different groups: (1) beginning of orthodontic treatment; (2) one year into treatment; and (3) two years into treatment. Demineralization was estimated using a DIAGNOdent pen. We obtained data from multiple tooth-by-tooth demineralization readings combined with salivary pH and patients' oral hygienic and dietary behaviors. A t-test for independent samples and Spearman´s correlation were performed. No demineralizations differences were found between the initial stage and one year into treatment. Between one and two years small differences were observed, but demineralization increased between the initial stage and second treatment year, predominating in upper right central incisors (p = 0.056), upper left lateral incisors (p = 0.040), both upper canines (p = 0.055 and p = 0.040, respectively) and first left premolars (p = 0.034 and p = 0.053, respectively). We did not find associations between oral hygiene and dietary behaviours or salivary pH. In conclusion, demineralization occurred in first year of treatment and increased during second year, predominating in the upper arch and the left side mainly in upper right central incisors, upper left lateral incisors, both upper canines, and first left premolars.

Laser fluorescence of caries detection in permanent teeth in vitro: a systematic review and meta-analysis

BACKGROUND/OBJECTIVES

The detection of dental caries in the early stages, particularly on the occlusal surfaces, has become a mainstay of contemporary clinical practice. The objective of the study was to verify the accuracy of laser fluorescence for caries detection.

METHODS

A comprehensive search of the MEDLINE (PubMed), EMBase, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS, Congress Abstracts, and Grey literature databases was undertaken from 1980 through January 2016. We included cross-sectional studies that evaluated laser fluorescence in caries diagnoses in vitro and compared them with histological analyses.

RESULTS

A total of 39 articles were included in the meta-analysis, which included 2082 caries sites. The pooled sensitivity was 0.71 (0.69, 0.73), and the specificity was 0.81 (0.73, 0.82). The diagnostic odds ratio was 14.93 (11.2, 19.9). A summary receiver operating characteristic curve was constructed. The area under the curve was 0.865.

CONCLUSION

This meta-analysis showed that laser fluorescence in vitro had the ability to diagnose occlusal caries lesions in permanent teeth and enamel and dentin caries.

Performance of fluorescence-based methods for detecting and quantifying smooth-surface caries lesions in primary teeth: an in vitro study

BACKGROUND

Although smooth-surface caries can be subjectively assessed by visual inspection, quantitative methods would improve the monitoring of these lesions.

AIM

To evaluate the in vitro performance of laser fluorescence devices, namely DIAGNOdent (LF) and DIAGNOdent pen (LFpen), and a fluorescence camera (VistaProof; FC) in the detection and quantification of smooth-surface caries in primary teeth.

DESIGN

Two examiners evaluated 99 smooth surfaces of 65 extracted primary molars using FC, LF, and LFpen. As a reference standard, the actual and relative lesion depths were determined using stereomicroscopy and polarized light microscopy. Reproducibilities were assessed, and correlation analyses were performed. The sensitivities, specificities, and accuracies of the methods were calculated and compared.

RESULTS

There was a significant correlation between the values obtained using the fluorescence-based devices and the actual and relative lesion depths, although the correlation coefficient values were not higher than 0.7 (LF, 0.673; LFpen, 0.646; FC, 0.663). The sensitivities of the devices were similar for the detection of enamel caries, although LFpen was superior in detecting dentin lesions. The reliabilities of all methods were moderate to low, with similar accuracies at all depths.

CONCLUSION

Although the fluorescence-based devices showed similar performance in the detection of enamel and dentin lesions, the reliability of these devices and the correlation of their findings with the actual and relative lesion depths were moderate with regard to smooth-surface caries in primary molars.

Effectiveness of Fluorescence-based Methods in Monitoring Progression of Noncavitated Caries-like Lesions on Smooth Surfaces

Although there has been a significant decrease in caries prevalence in developed countries, the slower progression of dental caries requires methods capable of detecting and quantifying lesions at an early stage. The aim of this study was to evaluate the effectiveness of fluorescence-based methods (DIAGNOdent 2095 laser fluorescence device [LF], DIAGNOdent 2190 pen [LFpen], and VistaProof fluorescence camera [FC]) in monitoring the progression of noncavitated caries-like lesions on smooth surfaces. Caries-like lesions were developed in 60 blocks of bovine enamel using a bacterial model of Streptococcus mutans and Lactobacillus acidophilus. Enamel blocks were evaluated by two independent examiners at baseline (phase I), after the first cariogenic challenge (eight days) (phase II), and after the second cariogenic challenge (a further eight days) (phase III) by two independent examiners using the LF, LFpen, and FC. Blocks were submitted to surface microhardness (SMH) and cross-sectional microhardness analyses. The intraclass correlation coefficient for intra- and interexaminer reproducibility ranged from 0.49 (FC) to 0.94 (LF/LFpen). SMH values decreased and fluorescence values increased significantly among the three phases. Higher values for sensitivity, specificity, and area under the receiver operating characteristic curve were observed for FC (phase II) and LFpen (phase III). A significant correlation was found between fluorescence values and SMH in all phases and integrated loss of surface hardness (ΔKHN) in phase III. In conclusion, fluorescence-based methods were effective in monitoring noncavitated caries-like lesions on smooth surfaces, with moderate correlation with SMH, allowing differentiation between sound and demineralized enamel.

Effectiveness of fluorescence-based methods to detect in situ demineralization and remineralization on smooth surfaces

This study aimed to evaluate the effectiveness of fluorescence-based methods (DIAGNOdent, LF; DIAGNOdent pen, LFpen, and VistaProof fluorescence camera, FC) in detecting demineralization and remineralization on smooth surfaces in situ. Ten volunteers wore acrylic palatal appliances, each containing 6 enamel blocks that were demineralized for 14 days by exposure to a 20% sucrose solution and 3 of them were remineralized for 7 days with fluoride dentifrice. Sixty enamel blocks were evaluated at baseline, after demineralization and 30 blocks after remineralization by two examiners using LF, LFpen and FC. They were submitted to surface microhardness (SMH) and cross-sectional microhardness analysis. The integrated loss of surface hardness (ΔKHN) was calculated. The intraclass correlation coefficient for interexaminer reproducibility ranged from 0.21 (FC) to 0.86 (LFpen). SMH, LF and LFpen values presented significant differences among the three phases. However, FC fluorescence values showed no significant differences between the demineralization and remineralization phases. Fluorescence values for baseline, demineralized and remineralized enamel were, respectively, 5.4 ± 1.0, 9.2 ± 2.2 and 7.0 ± 1.5 for LF; 10.5 ± 2.0, 15.0 ± 3.2 and 12.5 ± 2.9 for LFpen, and 1.0 ± 0.0, 1.0 ± 0.1 and 1.0 ± 0.1 for FC. SMH and ΔKHN showed significant differences between demineralization and remineralization phases. There was a negative and significant correlation between SMH and LF and LFpen in the remineralization phase. In conclusion, LF and LFpen devices were effective in detecting demineralization and remineralization on smooth surfaces provoked in situ.

In vitro evaluation of the efficacy of laser fluorescence (DIAGNOdent) to detect demineralization and remineralization of smooth enamel lesions

Objective:

Early detection of smooth surface lesions is important for appropriate management and monitoring of dental caries. The purpose of this in vitro study was to evaluate the efficacy of laser fluorescence to detect demineralization and remineralization of smooth enamel surfaces.

Materials and Methods:

In this in vitro study, 132 enamel blocks of semi-impacted human third molars were obtained; artificial caries lesions were induced and they were submitted to the pH-cycling process to create remineralization. Superficial microhardness (SMH) and laser fluorescence (LF) analysis were performed at baseline, after demineralization, and remineralization processes. The data were analyzed by Statistical Package for Social Sciences (SPSS)-16 using analysis of variance (ANOVA), Paired samples t-test, and Pearson's correlation test.

Results:

There was a significant difference between SMH values at baseline, after demineralization and after remineralization. Also, a statistically significant difference was observed between LF values in these three stages. The LF values increased after demineralization and then decreased after remineralization, and the SMH values decreased after demineralization and increased after remineralization. There was an inverse relationship between SMH and LF only at baseline and after demineralization, but not after remineralization.

Conclusion:

The results showed that LF is an appropriate method for detection of demineralization in an in vitro condition in smooth enamel lesions, but it was not so efficient in the detection of remineralization.

In-vivo occlusal caries prevention by pulsed CO2 -laser and fluoride varnish treatment--a clinical pilot study

BACKGROUND AND OBJECTIVES

High caries prevalence in occlusal pits and fissures warrants novel prevention methods. An 86% reduction in dental enamel smooth surface demineralization in-vivo following short-pulsed 9.6 µm-CO(2) -laser irradiation was recently reported. The objective of this study was to conduct a blinded 12-month-pilot clinical trial of occlusal pit and fissure caries inhibition using the same CO(2) -laser irradiation conditions.

STUDY DESIGN/MATERIALS AND METHODS

Twenty subjects, average age 14 years, were recruited. At baseline, second molars were randomized into test and control groups, assessed by International Caries Detection & Assessment System (ICDAS-II), SOPROLIFE light-induced fluorescence evaluator in daylight and blue-fluorescence mode and DIAGNOdent. An independent investigator irradiated test molars with a CO(2) -laser, wavelength 9.6 µm, pulse-duration 20 µs, pulse-repetition-rate 20 Hz, beam diameter 800 µm, average fluence 4.5 ± 0.5 J/cm(2), 20 laser pulses per spot. At 3-, 6- and 12-month recall teeth were assessed by ICDAS, SOPROLIFE and DIAGNOdent. All subjects received fluoride varnish applications at baseline and 6-month recall.

RESULTS

All subjects completed the 3-month, 19 the 6-month and 16 the 12-month recall. At all recalls average ICDAS scores had decreased for the test and increased for the control fissures (laser vs. control, 3-month: -0.10 ± 0.14, 0.30 ± 0.18, P > 0.05; 6-month: -0.26 ± 0.13, 0.47 ± 0.16, P = 0.001; 12-month: -0.31 ± 0.15, 0.75 ± 0.17, P < 0.0001; mean ± SE, unpaired t-test) being statistically significantly different at 6- and 12-month recalls. SOPROLIFE daylight evaluation revealed at 6- and 12-months statistically significant differences in changes between baseline and recall for test and control molars, respectively (laser vs. control, 6-month: 0.22 ± 0.13, 0.17 ± 0.09, P = 0.02; 12-month: 0.28 ± 0.19, 0.25 ± 0.17, P = 0.03). For SOPROLIFE blue-fluorescence evaluation mean changes in comparison to baseline for the control and the laser treated teeth were also statistically significant for the 6- and 12-month recall.

CONCLUSION

Specific microsecond short-pulsed 9.6 µm CO(2) -laser irradiation markedly inhibits caries progression in pits and fissures in comparison to fluoride varnish alone over 12 months.

Fluorescence-based methods for detecting caries lesions: systematic review, meta-analysis and sources of heterogeneity

BACKGROUND

Fluorescence-based methods have been proposed to aid caries lesion detection. Summarizing and analysing findings of studies about fluorescence-based methods could clarify their real benefits.

OBJECTIVE

We aimed to perform a comprehensive systematic review and meta-analysis to evaluate the accuracy of fluorescence-based methods in detecting caries lesions.

DATA SOURCE

Two independent reviewers searched PubMed, Embase and Scopus through June 2012 to identify papers/articles published. Other sources were checked to identify non-published literature. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND DIAGNOSTIC METHODS: The eligibility criteria were studies that: (1) have assessed the accuracy of fluorescence-based methods of detecting caries lesions on occlusal, approximal or smooth surfaces, in both primary or permanent human teeth, in the laboratory or clinical setting; (2) have used a reference standard; and (3) have reported sufficient data relating to the sample size and the accuracy of methods.

STUDY APPRAISAL AND SYNTHESIS METHODS

A diagnostic 2×2 table was extracted from included studies to calculate the pooled sensitivity, specificity and overall accuracy parameters (Diagnostic Odds Ratio and Summary Receiver-Operating curve). The analyses were performed separately for each method and different characteristics of the studies. The quality of the studies and heterogeneity were also evaluated.

RESULTS

Seventy five studies met the inclusion criteria from the 434 articles initially identified. The search of the grey or non-published literature did not identify any further studies. In general, the analysis demonstrated that the fluorescence-based method tend to have similar accuracy for all types of teeth, dental surfaces or settings. There was a trend of better performance of fluorescence methods in detecting more advanced caries lesions. We also observed moderate to high heterogeneity and evidenced publication bias.

CONCLUSIONS

Fluorescence-based devices have similar overall performance; however, better accuracy in detecting more advanced caries lesions has been observed.

Performance of laser fluorescence devices and visual examination for the detection of occlusal caries in permanent molars

The aim of this study was to evaluate the diagnostic capabilities of a laser fluorescence tool DIAGNOdent (KaVo, Biberach, Germany) and two light-emitting diode fluorescence tools-Spectra Caries Detection Aid (AIR TECHNIQUES, Melville, NY), and SOPROLIFE light-induced fluorescence evaluator in daylight and blue florescence mode (SOPRO, ACTEON Group, La Ciotat, France)-in comparison to the caries detection and assessment system (ICDAS-II) in detection of caries lesions. In 100 subjects (age 23.4±10.6 years), 433 posterior permanent unrestored teeth were examined. On the occlusal surfaces, up to 1066 data points for each assessment method were available for statistical evaluation, including 1034 ICDAS scores (intra-examiner kappa=0.884). For the SOPROLIFE tool, a new caries-scoring system was developed. Per assessment tool each average score for one given ICDAS code was significantly different from the one for another ICDAS code. Normalized data linear regression revealed that both SOPROLIFE assessment tools allowed for best caries score discrimination followed by DIAGNOdent and Spectra Caries Detection Aid. The area under the receiver operating characteristics curve calculations showed the same grading sequence when cutoff point ICDAS codes 0-1-2 were grouped together. Sensitivity and specificity values at the same cutoff were calculated (DIAGNOdent 87/66, Spectra Caries Detection Aid 93/37, SOPROLIFE 93/63, SOPROLIFE blue fluorescence 95/55.).

Diagnostic Aids in Pediatric Dentistry

Diagnosis involves development of a comprehensive and concise database of pertinent information, sufficient to understand the patient’s problem as well as answer questions arising in the treating clinicians’ mind. It is an accomplished art to develop a communication with the child and elicit relevant information from him. Thus, the signs and symptoms elicited on the basis of patient’s experiences and clinician’s knowledge forms the elementary framework of a good prognosis. This article aims to unveil the “must know” fundamentals of a sound diagnosis for a sound treatment plan.

The efficacy of laser fluorescence to detect in vitro demineralization and remineralization of smooth enamel surfaces

OBJECTIVE

The purpose of this study was to evaluate the efficacy of the laser fluorescence (LF) device in detecting in vitro demineralization and remineralization of smooth surface caries-like lesions.

BACKGROUND DATA

The early detection of smooth surface caries-like lesions is important to provide proper management of carious lesions, and allows monitoring of them over time. Also, some authors suggest that LF could be useful in monitoring the caries pathological process.

MATERIALS AND METHODS

Seventy-eight blocks of bovine teeth were obtained, and then submitted to artificial caries lesion induction and to a pH-cycling process. Superficial microhardness (SMH) and laser fluorescence analysis were performed at baseline, after induction of caries-like lesions, and after the pH-cycling regimen to promote remineralization.

RESULTS

Friedman's and multiple comparison tests were performed for all variables. SMH analysis showed significant differences (p +/- 0.05) between baseline (286.77 +/- 1.49 Vickers hardness number [VHN] units), before (38.48 +/- 0.85 VHN), and after remineralization (131.93 +/- 2.63 VHN). Baseline values for LF were extremely low (2.71 +/- 0.05), and a statistically significant difference was observed only after remineralization (3.61 +/- 0.08), as demonstrated by the increase in LF values.

CONCLUSION

The LF device did not show efficacy for monitoring in vitro demineralization and remineralization of smooth enamel surfaces.

In vitro ability of a laser fluorescence device in quantifying approximal caries lesions in primary molars

OBJECTIVES

This in vitro study aimed at evaluating the ability of Laser Fluorescence device (LFpen) in quantifying approximal caries lesions in primary molars.

METHODS

Two examiners assessed 123 approximal surfaces of primary molars using the DIAGNOdent pen (LFpen). Surfaces were determined to be either sound with white-spot lesions or have small cavitations. After sectioning, lesion depth was determined through polarized light microscopy. The intra-/inter-examiner agreement was calculated using intraclass correlation coefficient (ICC) and Bland-Altman analyses. Furthermore, Spearman correlation coefficients (Rs) were calculated between LFpen readings and lesion depth.

RESULTS

Correlation between LFpen values and lesion depth was low for both examiners (Rs=0.36 and 0.51), especially when cavitated lesions were excluded from the analysis (Rs=0.22 and 0.40). For all surfaces, ICC revealed intra- and inter-examiner reproducibility values of 0.75 and 0.63, respectively, but when only non-cavitated surfaces were analyzed, these values decreased (0.41 and 0.33, respectively).

CONCLUSIONS

LFpen readings present low correlation with approximal caries lesion depth and low reproducibility, especially in white-spot lesions. Therefore, the device could not be a suitable method for monitoring non-cavitated approximal caries lesion in primary molars.

Clinical trial for detection of dental caries using laser-induced fluorescence ratio reference standard

We present the clinical applicability of fluorescence ratio reference standard (FRRS) to discriminate different stages of dental caries. Toward this, laser-induced autofluorescence emission spectra are recorded in vivo in the 400- to 800-nm spectral range on a miniature fiber optic spectrometer from 65 patients, with a 404-nm diode laser as the excitation source. Autofluorescence spectra of sound teeth consist of a broad emission at 500 nm that is typical of natural enamel, whereas in caries teeth additional peaks are seen at 635 and 680 nm due to emission from porphyrin compounds in oral bacteria. Scatter plots are developed to differentiate sound teeth from enamel caries, sound teeth from dentinal caries, and enamel caries from dentinal caries using the mean fluorescence intensity (FI) and ratios F500F635 and F500F680 measured from 25 sites of sound teeth and 65 sites of carious teeth. The sensitivity and specificity of both the FI and FRRS are determined. It is observed that a diagnostic algorithm based on FRRS scatter plots is able to discriminate enamel caries from sound teeth, dentinal caries from sound teeth, and enamel from dentinal caries with overall sensitivities of 85, 100, and 88% and specificities of 90, 100, and 77%, respectively.

In Vivo Evaluation of DIAGNOdent for the Quantification of Occlusal Dental Caries

There is a weak correlation between DIAGNOdent readings and carious lesion depth and volume. Based on the current study, the appropriate DIAGNOdent cut-off point to detect carious lesions reaching the DEJ or beyond is between 35 and 40.

Evaluation of different methods for monitoring incipient carious lesions in smooth surfaces under fluoride varnish therapy

BACKGROUND

There are only a few studies relating visual inspection methods and laser fluorescence when monitoring regression of incipient carious lesions.

AIM

The purpose of this study was to monitor incipient carious lesions in smooth surfaces under varnish fluoride therapy using visual inspection methods and laser fluorescence (LF).

DESIGN

Active white spot lesions (n = 111) in upper front teeth of 36 children were selected. The children were subjected to four or eight applications of fluoride varnish in weekly intervals. The visual systems were activity (A) and maximum dimension in millimetres (D). They were applied together with LF readings (L) in the beginning of the study (W1), in the 5th week (W5), and in the 9th (W9) week.

RESULTS

The mean (SD) of L values in W5 and W9 were 5.6 (3.8) and 4.5 (3.3), respectively; both were significantly different from the initial score of 7.4 (5.1) in W1. There was a positive correlation between D and L in W5 (r = 0.25) and W9 (r = 0.36; P < 0.05). The mean (SD) values of L were lower following the activity criteria.

CONCLUSIONS

Our findings support the finding that incipient carious lesions in smooth surfaces under fluoride therapy can be monitored by laser fluorescence and visual inspection methods.

Autoclaving and battery capacity influence on laser fluorescence measurements

AIM

To evaluate the influence of probe tip autoclaving and depleted alkaline batteries on laser fluorescence (LF-DIAGNOdent) device performance.

MATERIAL AND METHODS

One-hundred-and-twenty occlusal sites were analyzed with an LF device in nine conditions: No autoclaved probe and probe after 5, 10, 15, 20, 25, 30, 40, and 50 autoclaving cycles. Subsequently, the performance of the device was analyzed with: New batteries, batteries with 1.49/1.39 V, 1.38/1.37 V, 1.36/1.34 V, 1.33/1.32 V, and lower than 1.32 V. LF values, sensitivity, specificity, accuracy, and area under the ROC curve were compared.

RESULTS

In the probe study, sensitivity was lower after 50 sterilizing cycles, though specificity was higher than the assessment performed using a new tip. In the batteries study, specificity was higher for depleted batteries, but LF performance did not differ significantly among the groups.

CONCLUSION

Batteries do not significantly influence device performance, but consecutive sterilization of probes in autoclave alters readings, downgrading its performance.

Fiber optic backscatter spectroscopic sensor to monitor enamel demineralization and remineralization in vitro

In this study, a Fiber Optic Backscatter Spectroscopic Sensor (FOBSS) is used to monitor demineralization and remineralization induced changes in the enamel. A bifurcated fiber optic backscatter probe connected to a visible light source and a high resolution spectrophotometer was used to acquire the backscatter light spectrum from the tooth surface. The experiments were conducted in two parts. In Part 1, experiments were carried out using fiber optic backscatter spectroscopy on (1) sound enamel and dentine sections and (2) sound tooth specimens subjected to demineralization and remineralization. In Part 2, polarization microscopy was conducted to examine the depth of demineralization in tooth specimens. The enamel and dentine specimens from the Part-1 experiments showed distinct backscatter spectra. The spectrum obtained from the enamel-dentine combination and the spectrum generated from the average of the enamel and dentine spectral values were closely similar and showed characteristics of dentine. The experiments in Part 2 showed that demineralization and remineralization processes induced a linear decrease and linear increase in the backscatter light intensity respectively. A negative correlation between the decrease in the backscatter light intensity during demineralization and the depth of demineralization determined using the polarization microscopy was calculated to be p = -0.994. This in vitro experiment highlights the potential benefit of using FOBSS to detect demineralization and remineralization of enamel.

Ability of laser fluorescence device associated with fluorescent dyes in detecting and quantifying early smooth surface caries lesions

A laser fluorescence (LF) device is a portable tool, but it does not measure minor mineral changes. Our in vitro study aim is to propose the association of an LF with two fluorescent dyes and to evaluate the performance in detecting and quantifying early demineralization. Artificial caries lesions are created in 40 primary canine teeth using a demineralizing solution (pH=4.8) for 12, 24, 48, and 96 h. LF measurements are performed with DIAGNOdent after demineralization in these samples and in 20 sound primary teeth. Measurements with LF with 0.2-mM tetrakis(N-methylpyridyl)porphyrin (LF TMPyP) and with 4-mM protoporphyrin IX (LF PPIX) are made. The amount of calcium loss is determined by atomic emission spectrometry. A correlation between LF and LF with dyes and mineral loss and receiver operating characteristics analysis are performed, as well as comparisons of sensitivity, specificity, and accuracy values. Significant correlation is obtained with LF TMPyP and mineral loss of lesions demineralized for 24, 48, and 96 h. Better performance is achieved with LF TMPyP for all parameters than with LF alone. LF PPIX does not present good results. In conclusion, LF TMPyP provides good performance in detecting and quantifying very early enamel caries lesions.

Performance of methods of occlusal caries detection in permanent teeth under clinical and laboratory conditions

OBJECTIVES

To compare performance of visual inspection and Laser fluorescence methods to detect occlusal caries lesions under clinical and laboratory conditions in permanent teeth.

METHODS

One hundred and ten sites in 57 third molars scheduled for extraction were examined with visual inspection and laser fluorescence (DIAGNOdent) device by two trained examiners. After the extraction, teeth were re-examined. Then, teeth were sectioned to perform histological validation. Best cut-off points were calculated with ROC analysis, and sensitivity, specificity and accuracy were calculated at D2 and D3 thresholds. Comparisons between the methods and conditions of examination were performed using McNemar test. Inter-examiner agreement in the same conditions and agreement between the methods performed in vivo and in vitro conditions were assessed by Kappa test. Laser fluorescence values obtained in two conditions were compared with Wilcoxon test.

RESULTS

No difference was observed with visual inspection in both conditions. Laser fluorescence performed in vitro presented higher specificity and accuracy at D3 threshold. Visual inspection showed higher reproducibility. After adjustment of cut-off points for laser fluorescence method, there was no difference between the evaluated parameters.

CONCLUSION

Only slightly differences were observed between the examinations performed under clinical and laboratory conditions in the detection of occlusal caries lesions in permanent teeth.