Reliability and validity issues of laser fluorescence measurements in occlusal caries diagnosis

In vivo validation of Diagnodent and Vista proof devices vs ICDAS clinical criteria on incipient carious lesions in adults

AIM

This study aimed to validate the in vivo performance of Diagnodent and Vista proof devices with ICDAS clinical criteria on incipient carious lesions in adults.

METHODS

A total of 44 adult patients with 230 incipient occlusal caries took part in the present study. These patients were assessed for caries with ICDAS clinical criteria, and then they were examined with Diagnodent pen™ (DP) and Vista proof™ (VP) fluorescence devices. Sensitivity, specificity accuracy, and ICC agreement between devices with ICDAS criteria, which served as a gold standard, were evaluated.

RESULTS

Regarding the caries diagnostic devices, sensitivity and specificity found 0,61 and 0,51 for DP, and 0,64 and 0,54 for VP, respectively. The different detection methods showed no differences in diagnostic capacity (Az values) each other, and ICC values with ICDAS criteria were calculated low.

CONCLUSIONS

DP and VP do not contribute to incipient occlusal carious lesions' better detective ability compared with visual ICDAS clinical criteria. The DP and VP devices presented no differences in diagnostic ability and measured lesion depth concerning the visual examination.

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.

Accurate Detection of Non-Cavitated Proximal Caries in Posterior Permanent Teeth: An in vivo Study

Purpose

This study aimed to compare the sensitivity and specificity of DIAGNOdent versus bitewing radiographs in detecting non-cavitated proximal caries.

Patients and Methods

This observational prospective study included 120 proximal surfaces, without obvious cavitation, on permanent mandibular and maxillary posterior teeth in patients over 16 years old. The DIAGNOdent test was performed, and digital bitewing radiographs were obtained; these were compared with a standard reference method, which comprised a clinical assessment of the proximal surfaces following the application of an orthodontic separator between the teeth for 7 days. Each test was performed by a different investigator blinded to the assessment results of the other examiners.

Results

The DIAGNOdent device exhibited a higher sensitivity in detecting enamel proximal caries (95%) than digital bitewing radiographs (64%), and the specificity of DIAGNOdent (89%) was greater than that of bitewing radiographs (77%). Regarding the detection of dentin caries, the sensitivities of DIAGNOdent and bitewing radiographs were similar (both 62%); however, the specificity of DIAGNOdent was higher (98% versus 88%). The results of the Kruskal–Wallis test revealed a significant difference in DIAGNOdent scores across the three diagnoses (sound tooth surfaces, enamel caries, dentin caries) (p-value <0.001).

Conclusion

The diagnostic accuracy of DIAGNOdent in detecting enamel caries is significantly higher than that of digital bitewing radiography. The routine use of DIAGNOdent can facilitate an accurate diagnosis of early carious lesions and inform the implementation of preventive treatment.

Clinical Evaluation of Ozone on Dentinal Lesions in Young Permanent Molars using the Stepwise Excavation

AIM

To evaluate the clinical changes in dentin of deep carious lesions in young permanent molars, following ozone application with and without the use of a remineralizing solution, using the stepwise excavation.

STUDY DESIGN

The sample included 162 first permanent immature molars, showing deep occlusal carious cavities that were indicated for indirect pulp capping. Teeth were divided into 2 main groups according to the method of ozone treatment. Each group was further subdivided equally into test and control subgroups. Following caries excavation, color, consistency and DIAGNOdent assessments of dentin were evaluated after 6 and 12 months.

RESULTS

Regarding dentin color and consistency, no significant differences were observed following ozone application, with and without a remineralizing solution. There were no significant differences between ozone treatment, and calcium hydroxide during the different evaluation periods, except in group I cases after 6 months, concerning the dentin color. The DIAGNOdent values were significantly reduced following ozone application, with or without a remineralizing solution, as well as between test and control cases in group I after 6 months.

CONCLUSIONS

Ozone application through the stepwise excavation had no significant effect on dentin color and consistency in young permanent molars. DIAGNOdent was unreliable in monitoring caries activity.

Detection of proximal caries using quantitative light-induced fluorescence-digital and laser fluorescence: a comparative study

PURPOSE

The purpose of this study was to evaluate the in vitro validity of quantitative light-induced fluorescence-digital (QLF-D) and laser fluorescence (DIAGNOdent) for assessing proximal caries in extracted premolars, using digital radiography as reference method.

MATERIALS AND METHODS

A total of 102 extracted premolars with similar lengths and shapes were used. A single operator conducted all the examinations using three different detection methods (bitewing radiography, QLF-D, and DIAGNOdent). The bitewing x-ray scale, QLF-D fluorescence loss (ΔF), and DIAGNOdent peak readings were compared and statistically analyzed.

RESULTS

Each method showed an excellent reliability. The correlation coefficient between bitewing radiography and QLF-D, DIAGNOdent were -0.644 and 0.448, respectively, while the value between QLF-D and DIAGNOdent was -0.382. The kappa statistics for bitewing radiography and QLF-D had a higher diagnosis consensus than those for bitewing radiography and DIAGNOdent. The QLF-D was moderately to highly accurate (AUC = 0.753 - 0.908), while DIAGNOdent was moderately to less accurate (AUC = 0.622 - 0.784). All detection methods showed statistically significant correlation and high correlation between the bitewing radiography and QLF-D.

CONCLUSION

QLF-D was found to be a valid and reliable alternative diagnostic method to digital bitewing radiography for in vitro detection of proximal caries.

Caries progression in non-cavitated fissures after infiltrant application: a 3-year follow-up of a randomized controlled clinical trial

Objectives

To evaluate the efficacy of a conservative treatment to prevent the progression of caries using an infiltrant on non-cavitated pit and fissures.

Material and Methods

This controlled clinical trial selected 23 volunteers with clinically and radiographically non-cavitated occlusal caries among patients presenting a “rather low” to “very high” caries risk. Eighty-six teeth were randomly divided into two experimental groups: teeth receiving a commercial pit-and-fissure sealant (Alpha Seal-DFL) and contralateral teeth receiving Icon infiltrant (DMG). Caries progression was monitored by clinical (laser fluorescence caries detection) and radiographic examination at 12-month intervals over a period of 3 years of monitored caries progression. Probing the sealing materials to detect areas of retention was also used to evaluate marginal integrity.

Results

Statistical analysis showed no difference in caries progression using laser fluorescence caries detection when both materials were compared, regardless of the evaluation times (p>0.05). No significance was observed when the marginal sealant integrity of both materials was compared, regardless of the evaluation time (p<0.05). Marginal integrity significantly reduced after 1 year for both materials (p<0.05), but remained stable after 2 and 3 years of evaluation, compared with 1-year results (p>0.05). SEM analysis exhibited a more homogeneous sealing for the infiltrant than obtained by the sealant.

Conclusions

The infiltrant was effective to prevent the caries progression in non-cavitated pit-and-fissures after 3 years of clinical evaluation, comparable with the conventional sealant. The infiltrant also presented better results in terms of caries progression at the 3-year evaluation time using the radiographic analysis.

Clinical instruments and methods for assessing physical oral health: A systematic review

OBJECTIVE

This study aimed at exploring available clinical instruments and methods for assessing physical oral health, and at identifying those with sufficient diagnostic performance.

METHODS

A systematic literature search was conducted in Embase and MEDLINE. Identified instruments and methods were critically appraised, and quality of diagnostic performance was rated by two independent reviewers as A (sufficient diagnostic performance), B (either sufficient reliability or validity) or C (insufficient quality, or empirical results unsatisfactory and/or inconsistent). For all A-rated instruments and methods, an in-depth literature search was conducted to supplement and verify their effectiveness and accuracy.

RESULTS

A total of 141 instruments and methods were identified. Only 12 methods with sufficient diagnostic performance could be rated as A, 72 were rated as B, and 34 received a C-rating. Further 23 instruments and methods could not be rated due to lack of available information on diagnostic performance. Of all A-rated instruments, six were designed for tooth structure, two for periodontium, one for endodontium and three for temporomandibular joints and muscles.

CONCLUSION

Even though some instruments and methods exhibited good to excellent reliability and validity and can be recommended for research and clinical practice, they do not allow assessing all components of physical oral health. There is a need to identify and define standard instruments, and for components of physical oral health where methods with sufficient diagnostic performance are lacking, further research is required.

Diagnosis of occlusal caries lesions in deciduous molars by coherent light scattering pattern speckle

BACKGROUND

This study presents the correlation between laser speckle images and detection of incipient caries lesions from changs in the microstructure of the surface of tooth enamel.

METHODS

We used 30 healthy deciduous molar teeth collected from the Biobank Human Teeth, Faculty of Dentistry, University of São Paulo who had carious lesions induced by the pH cycling method. The samples were evaluated for the diagnosis of caries by two methods ICDAS and speckle pattern of coherent light scattering after 5, 10 and 15days and the results were statistically analyzed using α=0.05 significance level.

RESULTS

A significant difference was observed between the image of the speckle scattering of healthy and injured areas within the 3 study groups, but not when comparing the three groups, showing us that it is an innovative technique that needs further study, but can be used as a diagnostic method for the detection of early caries lesions.

CONCLUSION

It can be concluded that the analysis of scattering speckle pattern is a diagnostic technique that provides information on the microstructure of the surface of tooth enamel which has sensitivity for detection of incipient caries lesions.

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.

Caries diagnosis using light fluorescence devices in comparison with traditional visual and tactile evaluation: a prospective study in 152 patients

The objective of the study was to evaluate the in vivo effectiveness of two fluorescence techniques (DIAGNOdent and VistaProof) and of visual and tactile evaluation in the diagnosis of occlusal caries in permanent teeth. A total of 302 teeth (molars and premolars) from 152 patients were studied. The occlusal surfaces were cleaned using pumice mixed with water, followed by application of the diagnostic methods according to the instructions of the manufacturer, and of the visual and tactile methods according to the recommendations. The true extent of the lesions was determined by fissurotomy. The sensitivity and specificity of visual diagnosis were 79 and 72 %, respectively, versus 53 and 98 % in the case of tactile diagnosis. Teeth with caries lesions exhibited significantly higher DIAGNOdent and VistaProof scores than those without caries. Using the optimum cutoff point of 23.5 obtained in our study for DIAGNOdent, sensitivity and specificity were found to be 92.4 and 92.7 %, respectively, while values of 88.1 and 95.1 % were obtained with a cutoff point of 28.5. Sensitivity in the case of the VistaProof system varied between 92.9 % (cutoff point 1.05) and 85.3 % (cutoff point 1.3), with respective specificity values of 95.8 and 88.6 %. The areas under the curve were 0.756, 0.759, 0.954 and 0.965 for the visual and tactile methods and for DIAGNOdent and VistaProof, respectively. The fluorescence-based techniques showed greater internal and external validity than the visual and tactile methods in diagnosing occlusal caries in permanent teeth. VistaProof is the best method for diagnosing caries in its early stages.

In vivo study of different methods for diagnosing pit and fissure caries

Background

In recent years the early detection of such caries has gained importance, since it may avoid unnecessary dental tissue damage and allow minimally invasive dental treatment. A study is made of 5 systems for diagnosing caries: traditional visual and tactile methods, DIAGNOdent, VistaProof and CarieScan.

Material and Methods

A prospective study was made in the Department of Stomatology, Dental Pathology and Therapeutics Teaching unit of the University of Valencia (Valencia, Spain), involving the analysis of 32 teeth (molars or premolars of both arches scheduled for filling or for use as posts in dental bridges) in 28 patients. The following caries diagnostic methods were applied: visual, tactile, DIAGNOdent (KAvo, Biberach, Germany), VistaProof (Dürr Dental AG, Bietigheim-Bissingen, Germany) and CarieScan (IDMoS Dental Systems, Dundee, Scotland, United Kingdom). Fissurotomy was subsequently performed for histological validation.

Results

Visual inspection showed an area under the receiver operating characteristic curve (AUC-ROC) of 0.75, with a sensitivity and specificity of 0.75. Tactile diagnosis in turn showed AUC = 0.714, with maximum sensitivity (100%) and a specificity of 42.9%. DIAGNOdent (cutoff point 22.5) and VistaProof (cutoff point 1.1) showed AUC = 0.969, while CarieScan (cutoff point 21.5) presented AUC = 0.973. These latter three methods all had a sensitivity of over 92%. The specificity of DIAGNOdent was maximum, while that of CarieScan and VistaProof was 75%.

Conclusions

The emergent methods in the diagnosis of caries (DIAGNOdent, VistaProof and CarieScan) yielded similar results, and in all cases proved superior to the traditional visual and tactile methods. DIAGNOdent was seen to be the most effective technique, followed by CarieScan and VistaProof.

Key words:Caries diagnosis, emergent diagnostic methods, fluorescence, electrical impedance, minimally invasive dentistry.

Comparison of Proximal Caries Detection in Primary Teeth between Laser Fluorescence and Bitewing Radiography: An in vivo Study

Background and objective: Proximal caries detection is of great importance because of the rapid rate of caries progression and the difficulty in determining the absence or presence of a lesion in primary dentition. Although, various methods for caries diagnosis offer good diagnostic performances, they provide varying sensitivities for detecting proximal carious lesions. The objective of this study was to compare, in vivo, the accuracy of DIAGNOdent and bitewing radiography at detecting proximal caries in primary teeth.

Materials and methods: One Hundred and one primary maxillary and mandibular molars without obvious cavities of children between the age group of 3 and 10 years were included. The teeth were first subjected to DIAGNOdent examination followed by bitewing radiography. The specificity and sensitivity of the systems were calculated.

Results: At the dentin caries (D3) level, the sensitivity of DIAGNOdent and bitewing radiography was 78.5%; at the enamel caries (D1 and D2) level it was 39.12% and for the sound teeth (D0) it was found to be 76.52%. A strong association was observed between the DIAGNOdent and the bitewing radiograph (p < 0.001).

Conclusion: The DIAGNOdent can be used as an alternative diagnostic method in detection of proximal caries in primary teeth. But when seen at the each caries level, the DIAGNOdent is more accurate at the D0 and D3 threshold.

How to cite this article: Mepparambath R, Bhat SS, Hegde SK, Anjana G, Sunil M, Mathew S. Comparison of Proximal Caries Detection in Primary Teeth between Laser Fluorescence and Bitewing Radiography: An in vivo Study. Int J Clin Pediatr Dent 2014;7(3):163-167.

Can the individual calibration be modified when laser fluorescence method is used for caries detection?

BACKGROUND

Individual calibration (IC) for caries detection methods based on fluorescence is time-consuming, especially for paediatric dentists, if the calibration has to be performed tooth-by-tooth. However, it is not clear how this calibration actually interfere in laser fluorescence (LF) readings.

AIM

This in vivo study was to verify the influence of different modes of IC on laser fluorescence (LF) readings.

DESIGN

Ninety six occlusal and 95 buccal surfaces of 1st permanent molars were examined using LF device after IC performed on control (no IC), the examined teeth, a permanent incisor, a 1st primary molar or a 2nd primary molar. All modes of IC were performed in the same child. Wilcoxon test and Bland-Altman analysis were used to compare the readings. Intraclass correlation coefficients (ICC) were calculated.

RESULTS

Laser fluorescence readings without prior calibration were higher than readings performed after any mode of IC and resulted in different values of ICC. After other IC modes, the LF readings were statistically similar.

CONCLUSION

The absence of IC influences LF readings and LF reproducibility, but different IC methods can be considered in clinical practice.

The Effect of Pit and Fissure Sealants on the Detection of Occlusal Caries in vitro

AIMS

To compare, in vitro, the effect of placing opaque (OPS) and clear fluorescing (CFS) pit and fissure sealants (PFS) on the detection of occlusal caries (OCD).

STUDY DESIGN

Occlusal surfaces of 67 extracted molars were examined under standardised conditions by 6 final year undergraduate dental students, using visual, bitewing radiography, transillumination (FOTI), laser fluorescence (LF) and tactile methods of caries detection. The teeth were then assigned randomly to two groups for PFS placement: OPS and CFS; then the OCD methods were repeated. Caries presence/absence was determined histologically on serial sections examined under stereo-microscopy (10x).

RESULTS

Before PFS placement the sensitivity and specificity for the OCD methods were: visual: 68%, 71%; radiographic: 15%, 95%; FOTI: 36%, 93%; LF: 49%, 83% and tactile: 39%, 67%, respectively. After placement of OPS, the sensitivity of LF (20%) and visual (13%) methods decreased and specificity increased (93%, 98% respectively). Placement of CFS resulted in minor changes in sensitivity and specificity. Correlation (Spearman's Rho coefficients) between OCD methods and histological intra-dentinal caries for pre- PFS, OPS, and CFS were: visual: 0.38, 0.34, 0.33; FOTI: 0.42, 0.35, 0.43; and LF: 0.41, 0.30, and 0.45 respectively.

CONCLUSIONS

The sensitivity of all OCD methods was low, as well as their correlation to the histological gold standard. Placing OPS further decreased the sensitivity of LF and visual methods, whereas placing CFS had little effect on all OCD methods. It is recommended that tactile detection of occlusal caries should be discontinued, and the probe used only to clean the pits and fissures gently for more accurate visual detection, or prior to pit and fissure sealant placement. Further research into the development of an affordable, robust, accurate and easy to use method for OCD is required.

Comparison between a laser fluorescence device and visual examination in the detection of occlusal caries in children

Occlusal surfaces of molars are especially susceptible to the development of caries due to the features, such as pits and deep fissures, of their anatomical structure.

AIM

To evaluate the efficiency of DIAGNOdent laser fluorescence measurements in comparison with visual examination for occlusal caries detection for first permanent molars in children.

METHODS

The study involved 156 permanent molar teeth in 40 children aged 7-12 years. A relatively new technology, the fluorescence laser DIAGNOdent pen, was used for detecting and diagnosing caries on the occlusal surfaces of molars. The visual examination of fissures was based on the Ekstrand classification system.

RESULTS

The results showed a strong relationship between examination with the DIAGNOdent and visual inspection. DIAGNOdent's sensitivity and specificity were 97% and 52%, respectively, indicating that the laser fluorescence DIAGNOdent pen is a reproducible and accurate diagnostic tool that may be very helpful in conjunction with visual examination in the detection of occlusal caries in permanent molars in children.

Histological validation of near-infrared reflectance multispectral imaging technique for caries detection and quantification

Near infrared (NIR) multispectral imaging is a novel noninvasive technique that maps and quantifies dental caries. The technique has the ability to reduce the confounding effect of stain present on teeth. The aim of this study was to develop and validate a quantitative NIR multispectral imaging system for caries detection and assessment against a histological reference standard. The proposed technique is based on spectral imaging at specific wavelengths in the range from 1000 to 1700 nm. A total of 112 extracted teeth (molars and premolars) were used and images of occlusal surfaces at different wavelengths were acquired. Three spectral reflectance images were combined to generate a quantitative lesion map of the tooth. The maximum value of the map at the corresponding histological section was used as the NIR caries score. The NIR caries score significantly correlated with the histological reference standard (Spearman's Coefficient=0.774, p<0.01). Caries detection sensitivities and specificities of 72% and 91% for sound areas, 36% and 79% for lesions on the enamel, and 82% and 69% for lesions in dentin were found. These results suggest that NIR spectral imaging is a novel and promising method for the detection, quantification, and mapping of dental caries.

Laser fluorescence of dentin caries covered with a novel nano-filled sealant

The aim of the present study was to assess the possibility to measure caries-induced laser fluorescence underneath a novel nano-filled fissure sealant. Sixty freshly extracted human teeth with occlusal dentine carious lesions were horizontally divided, exposing the respective lesion. Teeth were randomly assigned to three groups: (I) white fissure sealant with filler particles (Fissurit F, Voco), (II) clear fissure sealant without filler particles (Fissurit, Voco) and (III) novel experimental fissure sealant with nano-filler particles (Voco). Starting with a sealant thickness of 3 mm, laser fluorescence measurements (DIAGNOdent, KaVo) were performed after finishing the sealant surfaces with polishing papers, reducing the material at intervals of 0.5 mm until the sealant was removed completely. Evaluating a thickness of 0.5 mm, both the clear (83 % of the baseline fluorescence after fine grit polishing) and the white sealant (25 %) did not allow to measure baseline fluorescence (p < 0.05) with no fluorescence reduction in the experimental sealant group (p > 0.05). With increasing sealer thickness, fluorescence was influenced even by the experimental material (89 % of the baseline value at 1 mm). However, by using the experimental material, statistically significant higher fluorescence values than those for the other materials under study (p < 0.05) were obtained. Thicker sealant layers and coarse grit polishing caused a decrease of laser fluorescence in all groups (p < 0.05). Employing the experimental nano-filled sealant, laser fluorescence measurements for caries detection can be performed through thicker sealant layers compared to conventional sealant materials. Thus, it might be possible to use this material to assess a caries progression underneath the sealant and administer an appropriate therapy in due time.

Light-emitting diode and laser fluorescence-based devices in detecting occlusal caries

The aim of this study was to assess the performance of two light-emitting diode (LED)- and two laser fluorescence-based devices in detecting occlusal caries in vitro. Ninety-seven permanent molars were assessed twice by two examiners using two LED- (Midwest Caries - MID and VistaProof - VP) and two laser fluorescence-based (DIAGNOdent 2095 - LF and DIAGNOdent pen 2190 - LFpen) devices. After measuring, the teeth were histologically prepared and classified according to lesion extension. At D1 the specificities were 0.76 (LF and LFpen), 0.94 (MID), and 0.70 (VP); the sensitivities were 0.70 (LF), 0.62 (LFpen), 0.31 (MID), and 0.75 (VP). At D(3) threshold the specificities were 0.88 (LF), 0.87 (LFpen), 0.90 (MID), and 0.70 (VP); the sensitivities were 0.63 (LF and LFpen), 0.70 (MID), and 0.96 (VP). Spearman's rank correlations with histology were 0.56 (LF), 0.51 (LFpen), 0.55 (MID), and 0.58 (VP). Inter- and intraexaminer ICC values were high and varied from 0.83 to 0.90. Both LF devices seemed to be useful auxiliary tools to the conventional methods, presenting good reproducibility and better accuracy at D(3) threshold. MID was not able to differentiate sound surfaces from enamel caries and VP still needs improvement on the cut-off limits for its use.

Effect of drying on the reproducibility of DIAGNOdent to detect caries-like lesions

The aim of this study was to verify the drying effect on the reproducibility of DIAGNOdent (Dd) devices to detect caries-like lesions. Three areas were created in each of the 34 bovine incisors: sound (S), demineralized (DE) and remineralized (RE). One examiner measured each area with two Dd devices (denominated X and Y), twice under humid, and twice under dry condition. Intra-rater agreement according each device and inter-device agreement were estimated by kappa statistics (k). Intra-rater agreement for device Y was substantial under humid (κ (DE)=0.68 and κ (RE+S)=0.68) and dry condition (k DE=0.64 and k RE+S=0.67). For device X, it was substantial under humid condition (k DE=0.57 and k RE+S=0.49), and it was almost perfect after air drying (κ (DE)=1.0 and κ (RE+S)=1.0). Inter-device agreement was slight (k =0.17) under humid condition, and it was substantial under dry condition (k =0.62). As reproducibility increased under dry condition, drying is advised to detect caries-like lesions on free smooth surfaces when different devices are used.

Correlation between laser fluorescence readings and volume of tooth preparation in incipient occlusal caries in vitro

OBJECTIVE

This study evaluated the correlation between laser fluorescence readings and the extent of incipient occlusal caries as measured by the volume of tooth preparation in vitro.

MATERIALS AND METHODS

One hundred and three permanent molars and premolars containing incipient occlusal pit-and-fissure caries and sound occlusal surfaces (1/4 of the sample, control) were selected. DIAGNOdent (KaVo Dental Corporation, Lake Zurich, IL, USA) readings were obtained according to manufacturer instructions. Caries was removed with 1/4 round burs in high speed. The volume of tooth preparation was measured using a surrogate measure based on the amount of composite needed to fill the preparations. Sensitivity and specificity using different cutoff values were calculated for lesions/preparations extending into dentin. The results were analyzed statistically.

RESULTS

The Pearson correlation for preparation volume and DIAGNOdent reading measurements was low (r = 0.285). Sensitivity and specificity of DIAGNOdent for detection of dentinal lesions were 0.83 and 0.60, and 0.66 and 0.73 for the cutoff values of 20 and 30, respectively.

CONCLUSIONS

Within the limitations of this study, laser fluorescence measured with DIAGNOdent does not correlate well with extent of carious tooth structure in incipient occlusal caries.

CLINICAL SIGNIFICANCE

Clinicians should not rely only on DIAGNOdent readings to determine the extension of incipient occlusal caries.

The influence of PVC wrapping on the performance of two laser fluorescence devices on occlusal surfaces in vitro

OBJECTIVE

The aim of this study was to determine the influence of polyvinyl chloride (PVC) wrapping on the performance of two laser fluorescence devices (LF and LFpen) by assessing tooth occlusal surfaces.

BACKGROUND DATA

Protection of their tips may influence LF measurements. To date there are no studies evaluating the influence of this protection on the performance of the LFpen on permanent teeth, or comparing it to the original LF device.

MATERIALS AND METHODS

One hundred nineteen permanent molars were assessed by two experienced dentists using the LF and the LFpen devices, both with and without PVC wrapping. The teeth were histologically prepared and assessed for caries extension.

RESULTS

The LF values with and without PVC wrapping were significantly different. For both LF devices, the sensitivity and accuracy were lower when the PVC wrapping was used. The specificity was statistically significantly higher for the LFpen with PVC. No difference was found between the areas under the ROC curves with and without PVC wrapping. The ICC showed excellent interexaminer agreement. The Bland and Altman method showed a range between the upper and the lower limits of agreement of 63.4 and 57.8 units for the LF device, and 49.4 and 74.2 for the LFpen device, with and without PVC wrapping, respectively.

CONCLUSIONS

We found an influence of the PVC wrapping on the performance of the LF and LFpen devices. However, since its influence on detection of occlusal caries lesions is considered for, the use of one PVC layer is suggested to avoid cross-contamination in clinical practice.

In situ and in vitro comparison of laser fluorescence with visual inspection in detecting occlusal caries lesions

The aim of this study was to compare the in situ and in vitro performances of a laser fluorescence (LF) device (DIAGNOdent 2095) with visual inspection for the detection of occlusal caries in permanent teeth. Sixty-four sites were selected, and visual inspection and LF assessments were carried out, in vitro, three times by two independent examiners, with a 1-week interval between evaluations. Afterwards, the occlusal surfaces were mounted on the palatal portion of removable acrylic orthodontic appliances and placed in six volunteers. Assessments were repeated and validated by histological analysis of the tooth sections under a stereomicroscope. For both examiners, the highest intra-examiner values were observed for the visual inspection when in vitro and in situ evaluations were compared. The inter-examiner reproducibility varied from 0.61 to 0.64, except for the in vitro assessment using LF, which presented a lower value (0.43). The methods showed high specificity at the D(1) threshold (considering enamel and dentin caries as disease). In vitro evaluations showed the highest values of sensitivity for both methods when compared to the in situ evaluations at D(1) and D(2) (considering only dentinal caries as the disease) thresholds. For both methods, the results of sensitivity (at D(1) and D(2)) and accuracy (at D(1)) showed significant differences between in vitro and in situ conditions. However, the sensitivity (at D(1) and D(2)), specificity and accuracy (both at D(1)) of the methods were not significantly different when the same condition was considered. It can be concluded that visual inspection and LF showed better performance in vitro than in situ.

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.

The efficiency of operating microscope compared with unaided visual examination, conventional and digital intraoral radiography for proximal caries detection

Objective. The purpose of this study was to evaluate the efficiency of operating microscope compared with unaided visual examination, conventional and digital intraoral radiography for proximal caries detection. Materialsand Methods. The study was based on 48 extracted human posterior permanent teeth. The teeth were examined with unaided visual examination, operating microscope, conventional bitewing and digital intraoral radiographs. Then, true caries depth was determined by histological examination. The extent of the carious lesions was assessed by three examiners independently. One way variance of analysis (ANOVA) and Scheffe test were performed for comparison of observers, and the diagnostic accuracies of all systems were assessed from the area under the ROC curve (A_z). Results. Statistically significant difference was found between observers (P < .01). There was a statistically significant difference between operating microscope-film radiography, operating microscope-RVG, unaided visual examination-film radiography, and unaided visual examination-RVG according to pairwise comparison (P < .05). Conclusion. The efficiency of operating microscope was found statistically equal with unaided visual examination and lower than radiographic systems for proximal caries detection.

In vitro detection and quantification of enamel and root caries using infrared photothermal radiometry and modulated luminescence

Artificially created demineralized and remineralized carious lesions on the root and enamel of human teeth were examined by photothermal radiometry (PTR) and modulated luminescence (LUM). Fourteen extracted human teeth were used and a lesion was created on a 1 mmx4 mm rectangular window, spanning root to enamel, using a lactic acid-based acidified gel to demineralize the tooth surface. The lesion was then exposed to a remineralization solution. Each sample was examined with PTR/LUM on the root and enamel before and after treatment at times from 1 to 10 (5 on root) days of demineralization and 2 to 10 days of remineralization. Ten-day (5 on root) demineralized samples were remineralized. After completing all the experiments, transverse microradiography (TMR) analysis was performed to compare and correlate the PTR/LUM signals to the depth of lesions and mineral losses. The PTR and LUM amplitudes and phases showed gradual and consistent changes with treatment time. In this study, TMR showed good correlation coefficients with PTR and LUM. It was also found that the length of the treatment time did not correlate very well to any technique, PTR/LUM or TMR, which implies a significant degree of inhomogeneity of the demireralization and remineralization rates in each and every tooth.

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.

Effect of dietary habits on laser fluorescence values of visually sound occlusal surfaces among Finnish schoolchildren

AIM

This study was designed to ascertain whether schoolchildren with unfavourable dietary habits have higher values for laser fluorescence on clinically sound occlusal tooth surfaces than do those who have favourable dietary habits.

DESIGN

The study was conducted in two phases. In the first phase, 462 children aged 13-14 years answered a questionnaire on dietary habits. The children were ranked according to a total score based on the presumed harmfulness of their dietary habits. One hundred children with the lowest and highest dietary scores were invited to the second phase of the study consisting of a visual examination, laser fluorescence scanning of premolars and molars, and an oral self-care questionnaire.

RESULTS

Seventy-four and 76 children with favourable and unfavourable habits, respectively, were examined. A total of 1221 sound occlusal surfaces were scanned. Children with unfavourable dietary habits had higher median laser fluorescence values than did those with favourable habits (P < 0.0246). The effect of dietary habits was strongest in molars.

CONCLUSION

High laser fluorescence values on several clinically sound occlusal surfaces of a child may indicate unfavourable dietary habits.

The application of ozone in dentistry: a systematic review of literature

OBJECTIVES

(1) To systematically review the clinical application and remineralization potentials of ozone in dentistry; (2) To summarize the available in vitro applications of ozone in dentistry.

SOURCES

Ovid MEDLINE, CINAHL, etc. (up to April 2007).

STUDY SELECTION

In vitro or in vivo English language publications, original studies, and reviews were included. Conference papers, abstracts, and posters were excluded.

RESULTS

In vitro: Good evidence of ozone biocompatibility with human oral epithelial cells, gingival fibroblast, and periodontal cells; Conflicting evidence of antimicrobial efficacy of ozone but some evidence that ozone is effective in removing the microorganisms from dental unit water lines, the oral cavity, and dentures; Conflicting evidence for the application of ozone in endodontics; Insufficient evidence for the application of ozone in oral surgery and implantology; Good evidence of the prophylactic application of ozone in restorative dentistry prior to etching and the placement of dental sealants and restorations. In vivo: Despite the promising in vitro evidence, the clinical application of ozone in dentistry (so far in management of dental and root caries) has not achieved a strong level of efficacy and cost-effectiveness.

CONCLUSIONS

While laboratory studies suggest a promising potential of ozone in dentistry, this has not been fully realised in clinical studies to date. More well designed and conducted double-blind randomised clinical trials with adequate sample size, limited or no loss to follow up, and carefully standardised methods of measurement and analyses are needed to evaluate the possible use of ozone as a treatment modality in dentistry.

In vivo comparison of laser fluorescence measurements with conventional methods for occlusal caries detection

The purpose of this study was to evaluate the efficiency of the laser fluorescence (LF) (DIAGNOdent) measurements comparing with visual examination and conventional bitewing radiography for occlusal caries detection. The study comprised 44 occlusal surfaces. Three examiners independently evaluated the teeth by visual examination, LF measurements, and bitewing radiographs. After the evaluations, the teeth were opened, and the clinical lesion depth was determined. One-way variance analysis (ANOVA) was performed for comparison of observers. The diagnostic performance of three methods was assessed by using non-parametric tests (Kruskal-Wallis, Mann-Whitney U, and Spearman rank correlation). No statistically significant difference was found between observers (p > 0.05), and statistically significant difference was found between diagnostic systems (p < 0.01). The correlation of LF measurements with the clinical lesion depth was better than visual examination and bitewing radiography. This result concluded that LF may be a useful adjunct to visual examination, and the diagnostic performance of this device seems to be good for occlusal caries detection.

Validity of diode laser to monitor carious lesions in pits and fissures

OBJECTIVE

To analyse the DIAGNOdent's performance to longitudinally monitor the arrestment of non-cavitated carious lesions in occlusal surfaces.

METHODS

The sample consisted of 15 children (12-13 years old) with 40 active non-cavitated lesions. The protocol for the examinations was: prophylaxis, drying teeth for 30s; clinical examination, examination with DIAGNOdent. Lesions were classified as active or arrested according to this criteria--active lesion: opaque and whitened enamel, and arrested lesion: enamel with shiny, white or dark spot. The cut offs used for DIAGNOdent measurements were: between 0 and 14--sound tissue (stage 1), between 15 and 20--enamel lesion (stage 2) and above 20--dentine lesion (stage 3). The patients were treated with professional plaque removal, topical application of 1.23% of fluoride in gel and oral hygiene instructions. Thirty days after the first session, the lesions were examined (clinical and DIAGNOdent examinations). The lesions that were not arrested after this period were resubmitted to the previous treatment measurements at 14-day intervals until total clinical arrestment.

RESULTS

The Kappa index was 0.75 for the clinical examination and 0.71 for the DIAGNOdent examination. After 60 days, all the 40 initial lesions were arrested. The mean, +/-standard deviation, median and range of values with DIAGNOdent of active lesions were respectively 22.34, +/-21.41, 15.00 and 0-81.00; after clinical arrestment these values were 20.25, +/-18.01, 15.00 and 0-71.00. No significant difference was observed between the two periods.

CONCLUSION

DIAGNOdent was not capable to monitor changes occurring during the clinical arrestment of lesions.

The intra/inter-examiner reproducibility of the new DIAGNOdent Pen on occlusal sites

OBJECTIVE

This in vitro study on occlusal sites aimed to assess the intra/inter-examiner reproducibility of the new DIAGNOdent Pen (KaVo, Biberach, Germany) and to prove the assumption that its handling is easy to learn by dental students.

METHODS

Two hundred and forty-one sites of 90 occlusal non-cavitated molar surfaces were investigated twice by 2 dentists and 2 undergraduate students with the DIAGNOdent Pen according to manufacturer's instructions. Intra/inter-examiner reproducibility was assessed calculating intra-class correlation coefficients (ICCs) and the range of the 95% limits of agreement by Bland and Altman.

RESULTS

Intra-examiner reproducibility revealed excellent ICCs (0.84-0.92); but the range amounted to 41.2-59.1, which indicate a wide measuring range. The inter-examiner reproducibility using all measurements had to be proved as excellent (ICC 0.84); the range was found in the same order of magnitude as mentioned above (53.2). When measurements were categorised according to treatment related cut-offs a good inter-examiner reproducibility was detected in the interval of <30 (ICC 0.70); an excellent ICC were registered for the interval >30 (ICC 0.51). For both intervals the range values (<30: range 32.3 and >30: range 67.7) exceeded a deviation limit of +/-20%. Both students tended to measure slightly more precise compared to the dentists.

CONCLUSIONS

This study revealed a wide measuring range of DIAGNOdent Pen readings. Since there were no differences between dentists and students it can be used as adjunct tool by undergraduates as well. Nevertheless, based on the registered reproducibility the DIAGNOdent Pen should be used additionally to visual inspection and dental radiographs.

Reproducibility of DIAGNOdent 2095 and DIAGNOdent Pen measurements: results from an in vitro study on occlusal sites

The aim of this in vitro study was to investigate the intra- and interdevice reproducibility of the DIAGNOdent 2095 (DD2095) and the new DIAGNOdent Pen (DDPen) on non-cavitated occlusal caries sites. Altogether, 241 sites on 90 molars were inspected twice with both devices and by four examiners. The intra/interdevice reproducibilities were assessed by means of the intraclass correlation coefficient (ICC) as well as by the range of the 95% limits of agreement of Bland & Altman. Additionally, a linear mixed-effects model was fitted with fixed effects for the visual scores and the devices used and random effects for occlusal sites and examiners within each measurement site. In result, the following values were determined for the intradevice reproducibility: DD2095: ICC 0.89, range 42.3; and DDPen: ICC 0.88, range 49.3. The interdevice reproducibility was found to be in the same order of magnitude (ICC 0.82, range 53.7). The comparison between both devices indicated significantly lower mean values for the DDPen. The estimates of the linear model show that there is a high variation between the sites that cannot be explained by the fixed effects. In conclusion, both devices showed an imperfect reproducibility, which indicate the usage as adjunct tool only in clinical practice.

Detection of interproximal demineralized lesions on human teeth in vitro using frequency-domain infrared photothermal radiometry and modulated luminescence

Frequency-domain photothermal radiometry (FD-PTR or PTR) is used to detect mechanical holes and demineralized enamel in the interproximal contact area of extracted human teeth. Thirty-four teeth are used in a series of experiments. Preliminary tests to detect mechanical holes created by dental burs and 37% phosphoric acid etching for 20 s on the interproximal contact points show distinct differences in the signal. Interproximal contact areas are demineralized by using a partially saturated acidic buffer system. Each sample pair is examined with PTR before and after micromachining or treating at sequential treatment periods spanning 6 h to 30 days. Dental bitewing radiographs showed no sign of demineralized lesion even for samples treated for 30 days. Microcomputer tomography (micro-CT), transverse microradiography (TMR), and scanning electron microscopy (SEM) analyses are performed. Although micro-CT and TMR measured mineral losses and lesion depths, only SEM surface images showed visible signs of treatment because of the minimal extent of the demineralization. However, the PTR amplitude increased by more than 300% after 80 h of treatment. Therefore, PTR is shown to have sufficient contrast for the detection of very early interproximal demineralized lesions. The technique further exhibits excellent signal reproducibility and consistent signal changes in the presence of interproximal demineralized lesions, attributes that could lead to PTR as a reliable probe to detect early interproximal demineralization lesions. Modulated luminescence is also measured simultaneously, but it shows a lower ability than PTR to detect these interproximal demineralized lesions.

In vitro quantification of smooth surface caries with DIAGNOdent and the DIAGNOdent pen

OBJECTIVE

A new generation of the laser fluorescence device, DIAGNOdent, for caries detection and quantification has been introduced recently. It is the DIAGNOdent pen. The aim of this study was to compare the validity and reliability of both laser-based devices, DIAGNOdent and the DIAGNOdent pen, in quantifying smooth surface caries.

MATERIAL AND METHODS

The material comprised a sample of 52 premolar teeth extracted on orthodontic indication. The teeth were visually sound or had various stages of non-cavitated carious lesions on smooth surfaces. All teeth were photographed and measured with both DIAGNOdent and the DIAGNOdent pen by two examiners independently. The teeth were then sectioned into 300-microm slices and analysed under a microscope for verification of lesion depth. Histopathological analyses were performed by two observers to assess lesion depth, which was classified into five categories ranging from sound to dentinal caries. Reliability and validity of the two devices were evaluated in terms of intra-class coefficients and Spearman rank correlation coefficient, respectively. The relation between measurements performed by DIAGNOdent and the DIAGNOdent pen was analyzed using Pearson's correlation coefficient.

RESULTS

Both DIAGNOdent and the DIAGNOdent pen had excellent intra-observer agreement and acceptable inter-observer agreement. The correlation with histology for DIAGNOdent and the DIAGNOdent pen ranged between 0.47 and 0.57, although the correlation between DIAGNOdent and the DIAGNOdent pen was high.

CONCLUSIONS

In this in vitro study, the new laser fluorescence device, the DIAGNOdent pen, showed similar reliability and validity at quantification of smooth surface caries compared to the conventional DIAGNOdent device. Agreement between DIAGNOdent and the DIAGNOdent pen was excellent.

Occlusal caries diagnosis in permanent teeth: an in vitro study

The reduction in caries prevalence has not occurred uniformly for all dental surfaces. As the occlusal surfaces are still the most likely sites for the development of lesions, new methods of diagnosis are still being evaluated. This study compared a laser fluorescence (LF) system (DIAGNOdent) with the Ekstrands visual system for in vitro detection of occlusal caries. A total of 57 extracted molars with macroscopically intact occlusal surfaces were selected. Two-examiners assessed 110 sites by visual inspection (VI) and LF. After ten days from the first measurement, all teeth were re-evaluated through the same methods by each examiner. Caries extension was histologically assessed (X 40). The methods were compared by means of sensitivity, specificity, intra- and inter-examiner reproducibility and area under the ROC curve. The kappas test showed good intra- and inter-examiner reproducibility for both methods. VI and LF showed similar sensitivities for both examiners, however, VI showed higher specificities than LF. The overall analysis, as demonstrated by the area under the ROC curve, showed that VI had a better performance than the LF device. It was concluded that the Ekstrands visual system is more reliable than the LF device. LF should be considered only as an adjuvant for occlusal caries diagnosis.

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.

Relationship between Colors of Carious Dentin and Laser Fluorescence Evaluations in Caries Diagnosis

This in vitro study investigated the relationship between assessments of dentin caries using a laser fluorescence device (DIAGNOdent) and a caries detector dye during caries removal. The dentin of eight extracted carious molars was removed at 300-microm interval points from the dentin surface toward the pulp chamber. Before and after each removal, images of the carious surfaces were taken in association with color-matching stickers (for color correction) and the surfaces were evaluated by DIAGNOdent based on fluorescence emission from the tooth surface. For the L* values (CIE 1976 L*a*b* color system), there was a strong negative correlation between DIAGNOdent results and the corrected L* values of the carious surfaces (Pearson's correlation coefficient: -0.853); additionally, there was a significant correlation between them (p<0.05). However, there were no significant correlations between the DIAGNOdent results and the corrected a* and b* values of the carious surfaces (Pearson's correlation coefficients: 0.108 and 0.018 respectively). In conclusion, DIAGNOdent was shown to be applicable for caries diagnosis during caries removal.

Clinical effectiveness of laser fluorescence, visual inspection and radiography in the detection of occlusal caries

The aim of this in vivo study was to compare a laser fluorescence (LF) device with Ekstrand's visual scoring system and radiographic assessment for detection of occlusal caries. Thirty-eight adults aged 19-35 years participated in the study; a total of 57 third molars with macroscopically intact occlusal surfaces were selected. Two examiners assessed 110 sites by visual inspection (VI), bitewing radiography (BW) and LF. Teeth were then extracted and caries extent assessed by histology. The detection methods were compared by means of sensitivity, specificity, inter-examiner reproducibility (kappa statistics) and area under the ROC curve. VI and LF had similar (p > 0.05) and superior sensitivities than BW (p < 0.05). VI and BW showed similar specificities, which was superior to LF. The inter-examiner reproducibility was good for VI and BW and moderate for LF. The area under ROC curves showed that VI was better than LF. It was concluded that Ekstrand's visual scoring system is the most valid method for caries diagnosis. LF should be considered an adjunct to caries diagnosis.

Nonsurgical treatment of incipient and hidden caries

Traditionally, dentists have been trained in the surgical model for caries management whereby detection is akin to diagnosis. This model unfortunately has been translated to patient expectations. Nevertheless, a growing body of clinical evidence suggests that noncavitated lesions, even those extending into dentin, can be managed by nonsurgical means with an expectation for remineralization.

Clinical Study on the Effect of Professional Cleaning of Occlusal Tooth Surfaces on Laser Fluorescence Measurements

Manufacturer's advice is to professionally clean teeth before using a laser fluorescence (LF) device in order to avoid false-positive diagnoses. Professional cleaning is not included in routine dental check-ups in children in Finland because it is time-consuming. The aim of our present study was to evaluate the effect of professional cleaning of teeth on LF in children. A total of 642 occlusal surfaces in permanent molars and premolars in 9- to 16-year-olds (n = 46) were first examined visually. After that the first measurements with LF were made without cleaning the teeth. At the same appointment the second measurements were carried out after professional cleaning using a soft rubber cup and either polishing paste or plain water spray. The differences in LF of uncleaned and cleaned teeth were determined separately for teeth with a visual score of 0 (sound) and > 0. In premolars cleaning had no significant effect on LF. In molars, the values increased when the teeth were cleaned, the difference of the measurements being statistically significant in molars with visual score > 0 cleaned with plain water spray. For molars that were cleaned with paste, the differences were not statistically significant. Sealants did not modify the effect of cleaning. As a conclusion cleaning with a rotating instrument and water spray before LF measurements is recommended in teeth with visible plaque. Also in clean teeth, cleaning is advisable in cases where LF readings approach threshold level for operative intervention. The finding that uncleaned teeth gave lower values than cleaned teeth is opposite to what has been suggested.

Diagnosis of pit and fissure caries using frequency-domain infrared photothermal radiometry and modulated laser luminescence

Non-intrusive, non-contacting frequency-domain photothermal radiometry (FD-PTR or PTR) and frequency-domain luminescence (FD-LUM or LUM) have been used with 659- and 830-nm laser sources to assess the pits and fissures on the occlusal surfaces of human teeth. Fifty-two human teeth were examined with simultaneous measurements of PTR and LUM and were compared to conventional diagnostic methods including continuous (dc) luminescence (DIAGNOdent), visual inspection and radiographs. To compare each method to the others, sensitivities and specificities were calculated by using histological observations as the gold standard. With the combined criteria of four PTR and LUM signals (two amplitudes and two phases), it was found that the sensitivity of this method was much higher than any of the other methods used in this study, whereas the specificity was comparable to that of dc luminescence diagnostics. Therefore, PTR and LUM, as a combined technique, has the potential to be a reliable tool to diagnose early pit and fissure caries and could provide detailed information about deep lesions. Using the longer wavelength (830-nm) laser source, it has been shown that detection of deeper subsurface lesions than the 659-nm probe provides is possible.