Detection of Caries Around Resin-Modified Glass Ionomer and Compomer Restorations Using Four Different Modalities In Vitro

The aim of this study was to evaluate the ability of visual examination (International Caries Detection and Assessment System—ICDAS II), light-emitting diodes (LED) fluorescence (SPECTRA), laser fluorescence (DIAGNODent, DD), photothermal radiometry and modulated luminescence (PTR-LUM, The Canary System, CS) to detect natural decay beneath resin-modified glass ionomer (RMGIC) and compomer restorations in vitro. Twenty-seven extracted human molars and premolars, consisting of 2 control teeth, 10 visually healthy/sound and 15 teeth with natural cavitated lesions, were selected. For the carious teeth, caries was removed leaving some carious tissue on one wall of the preparation. For the sound teeth, 3 mm deep cavity preparations were made. All cavities were restored with RMGIC or compomer restorative materials. Sixty-eight sites (4 sites on sound unrestored teeth, 21 sound sites and 43 carious sites with restorations) were selected. CS and DD triplicate measurements were done at 2, 1.5, 0.5, and 0 mm away from the margin of the restoration (MOR). SPECTRA images were taken, and two dentists provided ICDAS II scoring for the restored surfaces. The SPECTRA data and images were inconclusive due to signal interference from the restorations. Visual examinations of the restored tooth surfaces were able to identify 5 of the 15 teeth with caries. In these situations, the teeth were ranked as having ICDAS II 1 or 2 rankings, but they could not identify the location of the caries or depth of the lesion. CS and DD were able to differentiate between sound and carious tissue at the MOR, but larger variation in measurement, and poorer accuracy, was observed for DD. It was concluded that the CS has the potential to detect secondary caries around RMGIC and compomer restorations more accurately than the other modalities used in this study.

In Vitro Detection of Caries Around Amalgam Restorations Using Four Different Modalities

Objective:

The aim of this study was to evaluate the ability of PTR-LUM (The Canary System, CS), laser fluorescence (DIAGNOdent, DD), LED fluorescence (Spectra), and visual inspection (ICDAS II) to detect natural decay around bonded amalgam restorations in vitro.

Methods:

Seventeen extracted human molars and premolars, consisting of visually healthy (n=5) and natural cavitated (n=12) teeth were selected. For the carious teeth, caries was removed leaving some decayed tissue on the floor and or wall of the preparation. For sound teeth, 3 mm. deep cavity preparations were made and teeth were restored with bonded-amalgam restorations. Thirty-six sites (13 sound sites; 23 carious sites) were selected. CS and DD scans were performed in triplicate at 2, 1.5, 0.5, and 0 mm away from the margin of the restoration (MOR). Spectra images were captured for the entire surface, and dentists blinded to the samples provided ICDAS II scoring.

Results:

Canary Numbers (Mean±SE) for healthy and carious sites at 2, 1.5, 0.5, and 0 mm from the MOR ranged from 12.9±0.9 to 15.4±0.9 and 56.1±4.0 to 56.3±2.0, respectively. DD peak values for healthy and carious sites ranged from 4.7±0.5 to 13.5±2.99, and 16.7±3.7 to 24.5±4.4, respectively. For CS and DD, sensitivity/specificity for sites at 2.0, 1.5, 0.5, 0 mm ranged from 0.95-1.0/0.85-1.0, and 0.45-0.74/0.54-1.0, respectively. For ICDAS II, sensitivity and specificity were 1.0 and 0.17, respectively. For Spectra, data and images were inconclusive due to signal intereference from the amalgam restoration.

Conclusions:

Using this in-vitro model, CS and DD were able to differentiate between sound and carious tissue at the MOR, but larger variation, less reliability, and poorer accuracy was observed for DD. Therefore, CS has the potential to detect secondary caries around amalgam restorations more accurately than the other investigated modalities.

Correlation with Caries Lesion Depth of The Canary System, DIAGNOdent and ICDAS II

Introduction:

The aim of this study was to correlate lesion depth of natural caries, measured with Polarized Light Microscopy (PLM), to Canary Numbers (CN) derived from The Canary System™ (CS), numerical readings from DIAGNOdent (DD), and lesion scores from ICDAS II.

Methods:

A total of 20 examination sites on extracted human molars and premolars were selected. The selected examination sites consisted of healthy and enamel caries on smooth and occlusal surfaces of each tooth. Two blinded dentists ranked each examination site using ICDAS II and the consensus score for each examined site was recorded. The same examination sites were scanned with CS and DD, and the CN and DD readings were recorded. After all the measurements were completed, the readings of the three caries detection methods were validated with a histological method, Polarized Light Microscopy (PLM). PLM performed by blinded examiners was used as the ‘gold standard’ to confirm the presence or absence of a caries lesion within each examined site and to determine caries lesion depth.

Results:

Pearson’s coefficients of correlation with caries lesion depth of CNs, DD readings and ICDAS scores were 0.84, 0.21 and 0.77, respectively. Mean ± SD CN for sound sites (n=3), caries lesion depths <800 µm (n=11), and caries lesion depths >800 µm (n=6) were 11±1, 55±15, and 75±22, respectively. Mean ± SD DD readings for sound sites, caries lesion depths <800 µm, and caries lesion depths >800 µm were 1±1, 7±11, and 8±9, respectively. Mean ± SD ICDAS II scores for sound sites, caries lesion depths <800 µm, and caries lesion depths >800 µm were 0±0, 2±1, and 2±1, respectively. The intra-operator repeatability for the Canary System was .953 (0.913, 0.978).

Conclusion:

This study demonstrated that the CS exhibits much higher correlation with caries lesion depth compared to ICDAS II and DD. CS may provide the clinician with more information about the size and position of the lesion which might help in monitoring or treating the lesion.

The present extracted tooth study found that The Canary System correlates with caries lesion depth more accurately that ICDAS II and DIAGNOdent.

Multi-Centre Clinical Evaluation of Photothermal Radiometry and Luminescence Correlated with International Benchmarks for Caries Detection

INTRODUCTION

A clinical study was initiated to investigate a caries detection device (The Canary System (CS)), based on photothermal radiometry and modulated luminescence (PTR-LUM). The primary objective of this study was to determine if PTR-LUM values (in the form of Canary Numbers; CN) correlate with International Caries Diagnostic and Assessment System (ICDAS II) scores and clinical situations. The secondary objectives of this study were to monitor the safety of PTR-LUM, and collect data to determine how CN values could be used to differentiate healthy from decayed tooth surfaces on a normalized scale.

METHODS

The trial was a four site, non-blinded study. Data was collected from 92 patients, resulting in 842 scanned tooth surfaces over multiple appointments. Surfaces were assessed according to ICDAS II, and further stratified into five clinical situation categories: 1) healthy surface, 2) non-cavitated white and/or brown spots; 3) caries lesions; 4) cavitation and 5) teeth undergoing remineralization therapy.CN data was analyzed separately for smooth and occlusal surfaces. Using a semi-logarithmic graph to plot raw CN (rCN) and normalized (CN) values, rCN data was normalized into a scale of 0-100.

RESULTS

Linear correlations (R2) between CN and ICDAS II groupings for smooth and occlusal surfaces were calculated as 0.9759 and 0.9267, respectively. The mean CN values derived from smooth (20.2±0.6) and occlusal (19±1.0) surfaces identified as healthy had significantly lower CN values (P<0.05) compared with the values from the other clinical situation categories. No adverse events were reported.

CONCLUSION

The present study demonstrated the safety of PTR-LUM for clinical application and its ability to distinguish sound from carious tooth surfaces. A clear shift from the baseline in both PTR and LUM in carious enamel was observed depending on the type and nature of the lesion, and correlated to ICDAS II classification codes, which enabled the preliminary development of a Canary Scale.

Evaluation of photosensitizer penetration into sound and decayed dentin: A photoacoustic spectroscopy study

BACKGROUND

Photodynamic therapy (PDT) may have topical indications. In those cases it is important for a topical photosensitizer to penetrate into the tissue to which it has been applied. This study aimed to compare the penetration of two different concentrations of erythrosine into intact and in vitro decayed dentin samples.

METHODS

This in vitro study evaluated erythrosine (0.3 and 5%) penetration into sound (intact) and decayed dentin. A total of 11 dentin discs were prepared and divided into two equal halves, in order to keep one half sound while the other half was submitted to sterilization and an in vitro demineralization model for 5 days. Before erythrosine application, the organic and inorganic composition of all samples was evaluated by Fourier Transform Raman spectroscopy, and after erythrosine application for 30 min, the penetration depth was determined by Photoacoustic spectroscopy technique.

RESULTS

The results indicated that 0.3% erythrosine showed a higher penetration depth into sound dentin (p = 0.002); and 5% erythrosine higher penetration into decayed dentin (p < 0.001). However considering clinical parameters, no statistically significant difference was found between any of the conditions tested.

CONCLUSIONS

Erythrosine demonstrated ability to penetrate into dentin, irrespective of sound or decayed condition. Photoacoustic spectroscopy can be considered a method for estimating the penetration into hard tissues, and in conjunction with Raman spectroscopy, these are effective methods for evaluating the spectral response of dentin. Considering that erythrosine is capable of penetrating into decayed dentin, clinical trials are needed to test the effectiveness of this photosensitizer in Photodynamic therapy and Antimicrobial Photodynamic therapy.