White spot lesions around brackets: in vitro detection by laser fluorescence

Evaluation of the effects of 2 different adhesive-coated bracket systems on white spot lesion formation

INTRODUCTION

This study evaluated the effects of 2 different adhesive-precoated (APC) bracket systems on white spot lesions (WSLs).

METHODS

The study had a split-mouth design, and 34 patients were included. The APC Flash-Free (FF) and APC II system brackets were used. At the end of the treatment, digital photographs of each tooth were taken, the WSLs were scored, and lesion areas were calculated. In the same session, the mineralization level of the teeth was measured by DIAGNOdent. The 2 bracket systems were compared in terms of bonding time.

RESULTS

There was no difference between the 2 groups regarding the number of WSLs or the size of the lesion areas. In the maxillary arch, 55.3% of the teeth in the FF group and 61.2% in the control group were healthy. In the mandibular arch, no lesions occurred in 61.2% of the teeth in the FF group and 64.7% of the control group. In the evaluation of DIAGNOdent measurements, WSL formation was detected in 3 teeth in the FF group and 4 in the control group. No statistically significant difference was found between the 2 groups. There was a significant difference between the 2 groups in the evaluation of bonding times.

CONCLUSIONS

The effects did not differ between FF and conventional brackets in patients undergoing fixed orthodontic treatment. The use of FF brackets significantly shortened the bonding time.

Comparison of therapies of white spot lesions: a systematic review and network meta-analysis

OBJECTIVE

White spot lesions (WSLs), the earliest evidence of enamel demineralization, are considered amenable to intervention to achieve a remineralized or arrested state of caries. The management of WSLs is quite challenging, and there is no definitive cure as yet. We performed a network meta-analysis to assess the efficacy of seven therapies for WSLs and gave a hierarchy of them.

MATERIALS AND METHODS

We systematically searched the PubMed, EMBASE, Cochrane, and Web of Science databases (last search: July 2022) to identify all relevant studies. We limited our search to studies published in English. Randomized controlled designed in vitro/clinical trials related to the efficacy of the seven therapies for WSLs were included. Data extraction was performed independently by two reviewers. The risk of bias (ROB) 2.0 tool from Cochrane and a previous in vitro methodological tool will be used for the quality assessment. Variations in quantitative light-induced fluorescence (QLF), laser fluorescence (LF), and lesions area were the primary outcome measures. Standard mean difference (SMD) was used as the effect size for the Network meta-analysis (NMA). Consistency and inconsistency tests were conducted. The hierarchy of 7 treatment effects was evaluated using surface probabilities under cumulative ranking (SUCRA). Publication bias was evaluated using a bias plot.

RESULTS

Forty-two articles were included in the systematic review. Thirty-one of them, with a total of 1906 participants, were included in the network meta-analysis. The studies owned a low and moderate risk of bias. This analysis does not suffer from significant inconsistency. The difference between 4 groups 'self-assembled peptide (SAP) P11-4', 'P11-4 + Fluoride Varnish (FV)', 'Resin Infiltration (RI)', 'casein phosphor peptides-amorphous calcium fluoride phosphate (CPP-ACFP)' and the 'Control' group was found to be statistically significant. Compared to the 'FV' and 'casein phosphor peptides-amorphous calcium phosphate (CPP-ACP)' groups, the 'P11-4 + FV" group and 'RI" group made a significant difference. The hierarchy was evident in the SUCRA values of 7 therapies. P11-4 + FV and RI were considered effective therapies compared to the control group or the FV group (gold standard group).

CONCLUSIONS

The available evidence suggests that resin infiltration and P11-4 in combination with fluoride varnish had advantages over gold standard (FV). The effect of tricalcium phosphate-based drugs and fluoride is not very noticeable. Overall, drugs based on P11-4 and resin infiltration will be better therapies. Using more than two drugs in combination also would increase efficacy.

DIAGNOdent versus International Caries Detection and Assessment System in detection of incipient carious lesions: A diagnostic accuracy study

Aim

The present investigation aimed at assessing the diagnostic accuracy of DIAGNOdent compared to the International Caries Detection and Assessment System-II (ICDAS-II) in the detection of facial, smooth surface noncavitated carious lesions.

Settings and Design

Sixty patients were enrolled in the current study according to the eligibility criteria. There were 161 teeth with noncavitated, white spot carious lesions and 32 sound teeth.

Materials and Methods

Before examination, teeth were cleaned and polished and all patients were assessed under standardized operating conditions: preset dental unit position, operating light, and prolonged air drying (approximately 5 s). All teeth were assessed by two calibrated examiners individually without any contact using ICDAS-II and DIAGNOdent.

Statistical Analysis

The diagnostic accuracy of DIAGNOdent device was determined, including sensitivity, specificity, overall accuracy, positive and negative predictive values, and receiver operating characteristic curve analysis. Chi-square test was conducted to compare the distribution of ICDAS-II and DIAGNOdent scores. Inter-observer agreement between assessors was evaluated using Cohen's kappa test.

Results

In the current study, DIAGNOdent had an overall accuracy of 84.45% with sensitivity and specificity of 87.58% and 96.87%, respectively, and +PV and -PV of 97.7% and 83.9%, respectively, when score 0 represented sound tooth surface, while scores 1 and 2 were considered clinically noncavitated carious lesions. Moreover, when only ICDAS score 1 was considered representing first visual change in enamel, DIAGNOdent had an accuracy of 74.15% with sensitivity and specificity of 83.53% and 90.62%, respectively, and +PV and -PV of 93% and 78.6%, respectively. In the present study, when only ICDAS score 2 was considered representing distinct visual change in enamel, DIAGNOdent had an accuracy of 100% with sensitivity and specificity of 100% and 100%, respectively, and +PV and -PV of 100% and 100%, respectively.

Conclusions

The overall performance of DIAGNOdent was equivalent to the visual inspection using ICDAS-II. DIAGNOdent might be considered a useful adjunctive device for detection and monitoring development of noncavitated carious lesions on facial smooth surfaces.

Fluoride varnish, ozone and octenidine reduce the incidence of white spot lesions and caries during orthodontic treatment: randomized controlled trial

This randomized, parallel, controlled trial assessed the effect of fluoride varnish, ozone and octenidine on white spot lesions (WSLs) and caries during orthodontic treatment. Patients were enrolled between 1st September 2017 and 31st August 2020 at initiation of orthodontic treatment in Department of Interdisciplinary Dentistry Pomeranian Medical University in Szczecin, Poland. All participants were randomly assigned to four study and one control groups using number random generator. However, investigators were not blinded due to the nature of the study. Groups I, II, III, IV had professional cleaning and varnishing (5% NaF) every 4 weeks. Groups II and IV had in-office ozone therapy before varnishing, groups III and IV received domestic octenidine mouthrinse. Group K had no professional hygienic or prophylactic procedures. WSLs were assessed at T0 and then every 4 weeks (T1-T4) and caries-at T0 and T4. The specific objective was to assess the influence of fluoride varnish, ozone and octenidine on the incidence of white spot lesions and caries during orthodontic treatment. The primary outcome of this report was the highest number of WSLs in group K and the lowest percentage of patients with WSLs in group IV. Each group comprised 30 randomized participants; they were all analyzed. No WSLs were found at T0, but they were stated in all groups at T4. The numbers of patients with WSLs significantly increased between T0-T4 in groups I and K. Group IV had the lowest percentage of patients with WSLs in T1-T4. WSLs in group IV were found no earlier than at T2. Group K had the highest percentage of WSLs at T4: 26%. At T0 all the groups had DMFs above 0 with a significant increase at T4. No side effects of the introduced prophylaxis were observed in any group. Caries is an important problem of fixed orthodontic treatment. Even an extremely intensive prophylaxis could not completely prevent WSLs and caries. Simultaneous application of fluoride varnish, ozone gas exposure and octenidine appears to have a beneficial effect in limiting the development of WSLs.Trial registration: NCT04992481.

White Spot Lesions: A Serious but Often Ignored Complication of Orthodontic Treatment

Objective:

The objective of this narrative review is to present an overview of the prevalence, clinical manifestation, diagnosis, and latest advances on white spot lesions.

Background:

White spot lesions have been defined as the earliest stage of demineralization on enamel surfaces that are easily discernible to the human eye.

Methods:

Relevant articles on white spot lesions were searched and reviewed from March 1975 till May 2021 in Pubmed, Scopus, Google Scholar, and ScienceDirect and were included in this review.

Results:

Even though the orthodontic field has seen several advances over the last few years, this is one complication that persists. White spot lesions are very commonly seen after completion of fixed orthodontic therapy when brackets are debonded. Previously conducted research has shown that there is a high prevalence rate of white spot lesions, which ranges from 50 to 90%. On intra-oral examination, a white spot can be seen as a matte-textured, opaque white lesion. Since the demineralization process takes place below the enamel surface, the outer layer only demonstrates pores that affect the natural light refractory properties of a tooth. This is what leads to the characteristic appearance of these lesions. One of the goals of modern dentistry is to treat non-cavitated lesions by promoting remineralization without the involvement of any invasive procedures.

Conclusion:

Fixed orthodontic therapy is usually a lengthy process and requires active cooperation between the orthodontist and the patient. However, it is the responsibility of the treating orthodontist to examine the tooth surfaces at each appointment to diagnose a developing white spot lesion as early as possible. With recent advances in diagnostic techniques, it has become much easier to identify these initial lesions and prevent their progression to cavitated lesions.

Validation of clinical photography and a laser fluorescence device for assessment of enamel demineralization during multi-bracketed fixed orthodontic treatment

AIM

To compare the validity of DIAGNOdent pen™ 2190 and clinical photographs in the diagnosis (presence or absence) and assessment of white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment.

METHODS

A total of 1607 readings from 99 patients were obtained using DIAGNOdent pen™ 2190, clinical photographs, and visual assessment criteria to assess WSLs at 6 -, 12- and 18 months after bonding of brackets. Receiver operating characteristic curves were constructed, and areas under the curve (AUC) were calculated to assess the presence or absence of WSLs and distinguish the severity of WSLs as slight or severe. Sensitivities, specificities, and AUC were calculated for outcomes at an alpha of 0.05 and 95% confidence intervals (CIs).

RESULTS

The values of sensitivity and specificity of DIAGNOdent pen™ 2190 were found to be 0.78 and 0.83, respectively, to distinguish presence/absence of WSLs with good accuracy (AUC= 0.855; 95% CI: 0.820-0.889) and for digital photographs, accuracy was excellent (AUC= 0.973, 95% CI: 0.956-0.991) with sensitivity and specificity of 0.96 and 0.99, respectively. However, the accuracy of DIAGNOdent pen™ 2190 was poor (AUC= 0.543, 95% CI: 0.418-0.668) in delineating slight and severe WSLs with a sensitivity of 0.31 and specificity of 0.83; while the values of sensitivity and specificity for distinguishing slight or severe lesions for clinical photographs were 0.96 and 0.99, respectively with excellent accuracy (AUC=0.978, 95% CI: 0.936-1.000).

CONCLUSIONS

Clinical photographs had better validity than DIAGNOdent pen™ 2190 in diagnosis and assessment of severity of demineralized lesions during multi-bracketed fixed orthodontic treatment.

Use of bioluminescence measurements for detection of artificial demineralization adjacent to orthodontic brackets

PURPOSE

Enamel demineralization can occur as a side effect during orthodontic treatment with fixed appliances and should be detected as early as possible. A new approach to assess demineralization is a system consisting of a photosensitive protein that binds to free calcium ions at the enamel surface. A camera is then used to visualize the bioluminescence spots. This in vitro study aimed to evaluate the ability of the bioluminescence technology to assess artificially demineralized enamel adjacent to various orthodontic brackets.

METHODS

In all, 108 human enamel samples were allocated randomly to groups with different orthodontic bracket material: stainless steel, titanium, ceramic. Initial lesions were created adjacent to the brackets. The samples were assessed by bioluminescence before and after demineralization. Images were assessed for presence of bioluminescence spots (yes/no). To quantify the bioluminescence measurements, the images' pixel values (P) were calculated within a defined area (F) adjacent to each bracket before and after demineralization. Quantitative light-induced fluorescence measurements (ΔF, ΔQ) were performed as the reference standard for demineralization.

RESULTS

After demineralization, bioluminescence spots were visible (yes/no decision) in 87% of the samples. The pixel analysis of the bioluminescence spots showed significantly higher pixel values after demineralization compared to baseline (p < 0.0001). The bracket material had no influence on the bioluminescence measurements. All samples showed fluorescence loss with a median ΔF of -9.52% (±3.15) and a median ΔQ of -1.01% × mm² (±3.34), respectively.

CONCLUSION

The bioluminescence technology is a promising tool to demonstrate demineralization adjacent to different orthodontic brackets in vitro.

Effect of self-assembling peptide P11-4 on orthodontic treatment-induced carious lesions

This study aimed to evaluate the effect of self-assembling peptide P11-4 (SAP) in the therapy of initial smooth surface caries (white spot lesions, WSL) following orthodontic multibracket treatment. Twenty-three patients (13f/10m; average age 15.4 years) with at least two teeth with WSL were recruited for the randomised controlled clinical trial with split-mouth design. In opposite to the control teeth, the test teeth were treated with SAP on Day 0. The primary endpoint was the impedance measurement of WSL using customised tray to ensure reproducibility of the measurement location. The secondary endpoint was the morphometric measurement of WSL using a semi-automated approach to determine the WSL size in mm2. Treatment effects were adjusted for site-specific baseline values using mixed models adapted from the cross-over design. Test WSL showed a mean baseline impedance value of 46.7, which decreased to 21.1, 18.4, and 19.7 after 45, 90, and 180 days, respectively. Control WSL showed a mean baseline value of 42.0, which decreased to 35.0, 29.5, and 33.7, respectively. The overall treatment contrast was -13.7 (95% CI: -19.6 - -7.7; p < 0.001). For the secondary endpoint, the test WSL size decreased from 8.8 at baseline to 6.5 after 180 days. The control WSL decreased from 6.8 to 5.7, respectively. The related treatment contrast was -1.0 in favour of test WSL (95% CI: -1.6 - -0.5; p = 0.004). The treatment of initial carious lesions with self-assembling peptide P11-4 leads to superior remineralisation of the subsurface lesions compared with the control teeth.

Do total or partial etching procedures effect the rate of white spot lesion formation? A single-center, randomized, controlled clinical trial

OBJECTIVE

To determine whether total or partial etching procedures influence the appearance of white spot lesions (WSLs).

MATERIALS AND METHODS

This split-mouth, double-blind, controlled, randomized study included 20 patients (mean age 16.75 years), who had class I malocclusion, mild crowding, and satisfactory oral hygiene. A total of 40 maxillary quadrants were randomly allocated to be treated using a total etching (TE) or partial etching (PE) protocol. Quantitative light fluorescence images were captured at the beginning and at 3 (T1) and 6 (T2) months after beginning orthodontic treatmen, as well as when the debonding phase of orthodontic treatment was complete (T3). The presence of pre- and posttreatment WSLs was assessed with quantitative light fluorescence software and analyzed with Student's t-test.

RESULTS

The analyses showed that, at T2, the total etching group had significantly higher ΔQ and A scores than the partial etching group ( P < .05). The ΔF scores increased significantly at all timepoints in the TE group, but only at T1 and T3 in the PE group. However, no differences were noted at T3 between the TE and PE groups ( P > .05). The inclusion of only right-handed people may have limited the generalizability of the findings. The absence of analyses of the plaque and gingivitis scores of patients was another limitation of this study.

CONCLUSIONS

WSL formation was observed mostly in maxillary lateral incisor teeth irrespective of the etching technique. Although PE seems to be more successful in the first 6 months, no difference was observed between PE and TE in the long term for WSL formation.

Resin infiltrant for non-cavitated caries lesions: evaluation of color stability

BACKGROUND

The objective of this in vitro study was to evaluate the over time color stability of one resin infiltrant (Icon) upon exposure to staining solutions (coffee and wine) compared with one nano-hybrid sealant (Grandio Seal), one transparent fissure sealant with fluoride (Control Seal) and one nanofilled composite (Filtek Supreme XTE).

MATERIAL AND METHODS

All materials were polymerized according to manufacturers' instructions into silicon rings (height 1 mm; internal diameter 6 mm; external diameter 8 mm) to obtain specimens identical in size. The specimens were immersed in staining solutions at room temperature over a 28-day test period. The control samples have not been subjected to the staining process. A colorimetric evaluation according to the CIE L*a*b* system was performed by a blind trained operator at 7, 14, 21, 28 days of the staining process. Shapiro Wilk test and Kruskal Wallis ANOVA were applied to assess significant differences among different materials. Means were compared with Scheffe's multiple-comparison test at the 0.05 level of significance.

RESULTS

In the case of all materials, immersion in solutions resulted in clinically perceivable color changes after 1 week (∆E < 3.3). Lowest CIE L* variation was registered for Control Seal and Grandio Seal both after 1 week and after 1 month, while Icon showed significantly higher variation (P < 0.05). Color coordinate CIE a* varied significantly more for Icon samples (P > 0.05). Color coordinate CIE b* varied similarly for all materials tested (P > 0.05).

CONCLUSIONS

Immersion in coffee or red wine resulted in clinically perceivable color changes for all materials tested. Icon showed the highest color variations both after 1 week and 1 month. Icon can fix the initial esthetic problem associated with white spot lesions, but the resin may become more discolored than other materials over time. Key words:CIE Lab, color stability, resin infiltrant.

Effect of resin infiltration on enamel surface properties and Streptococcus mutans adhesion to artificial enamel lesions

The aim of this study was to evaluate and compare the effects of resin infiltration and sealant type on enamel surface properties and Streptococcus mutans adhesion to artificial enamel lesions. Artificial enamel lesions were produced on the surfaces of 120 enamel specimens, which were divided into two groups: Group A and Group B (n=60 per group). Each group was further divided into four subgroups (n=15 per subgroup) according to sealant type: Group I-Demineralized enamel (control); Group II-Enamel Pro Varnish; Group III-ExciTE F; and Group IV-Icon. In Group A, hardness and surface roughness were evaluated; in Group B, bacterial adhesion was evaluated. Icon application resulted in significantly lower surface roughness and higher hardness than the other subgroups in Group A. In Group B, Enamel Pro Varnish resulted in lowest bacterial adhesion, followed by Icon. This study showed that resin infiltration of enamel lesions could arrest lesion progress.

In vitro effects of two topical varnish materials and Er:YAG laser irradiation on enamel demineralization around orthodontic brackets

The aim of this in vitro was to evaluate the effects of tricalcium phosphate (TCP) and amorphous calcium phosphate (ACP) containing varnish materials and Er:YAG laser irradiation on enamel demineralization around orthodontic brackets. Forty extracted human premolar teeth were randomly divided into four treatment groups (i.e., 10 in each group): (1) 5% NaF-ACP varnish, (2) 5% NaF-TCP varnish, (3) Er:YAG laser, and (4) control (no treatment). Er:YAG laser was operated at a wavelength of 2.94 μm and the energy output was 80 mJ per pulse; a pulse duration of 200 μsec and and a frequency of 2 Hz were used with water cooling. All samples were then put into pH cycles. Surface microhardness values and representative SEM images were assessed. Surface microhardness values were evaluated using Kruskal-Wallis and Mann-Whitney U tests. The results revealed that demineralization was significantly lower in the TCP and ACP varnish groups, whereas mean surface microhardness values of the TCP varnish were found higher than the ACP (P < 0.05). TCP and ACP varnish materials were found effective for reducing enamel demineralization around orthodontic brackets. Use of Er:YAG laser irradiation as described in this study for inhibition of demineralization was found not satisfactory.

Assessing near infrared optical properties of ceramic orthodontic brackets using cross-polarization optical coherence tomography

Secondary decay (caries) under ceramic orthodontic brackets remains a significant dental problem and near infrared cross-polarization optical coherence tomography (CP-OCT) has the potential to detect underlying demineralization. The purpose of this study was to determine the effect of crystalline structure and chemical composition of ceramic brackets on CP-OCT imaging. Four ceramic brackets types, which were divided into monocrystalline and polycrystalline, were examined using CP-OCT. The results of this study demonstrated that the crystallinity of the ceramic brackets affected the 1310 nm CP-OCT imaging with the greatest attenuation seen in polycrystalline alumina brackets. The alumina polycrystalline bracket materials had significantly higher attenuation and scattering than alumina monocrystalline brackets (p < 0.05, ANOVA, Bonferroni). Additionally, bracket base morphology and composition affected NIR light attenuation. There was considerable attenuation in bracket bases that contained additive zirconium spheres (∼30 µm) and this alteration was significantly greater than the jagged alumina crystallographic alterations found in the other bracket systems (p < 0.05, ANOVA, Bonferroni). Noninvasive, near infrared (NIR) cross-polarization optical coherence tomography (CP-OCT) has potential to effectively image through portions of ceramic brackets; however, further investigation into the optical effects of resin integration in the base portion of the brackets is warranted.

Effect of different concentrations of papain gel on orthodontic bracket bonding

Background

The objective of this study was to verify the hypothesis that enamel deproteinization with papain gel at concentrations of 2%, 4%, 6%, 8%, and 10% increases shear bond strength as concentration increases.

Methods

A total of 180 bovine mandibular permanent incisors were used, divided into six groups (n = 30), and denominated as follows: group 1 is the control group (CG) in which brackets are bonded with resin-modified glass ionomer cement (RMGIC) according to the manufacturer's recommendations and groups 2, 3, 4, 5, and 6 have brackets bonded with RMGIC after enamel deproteinization with papain gel at concentrations of 2%, 4%, 6%, 8%, and 10%, respectively. After bonding, teeth were immersed in artificial saliva and kept at a temperature of 37°C for 24 h. Mechanical tests were then performed in a universal mechanical test machine EMIC DL 5000 (Sao Jose dos Pinhais, Brazil). Values obtained were submitted to analysis of variance and then to Tukey's test (p < 0.05).

Results

The results demonstrated that groups 5 and 6 showed the highest shear bond strength, differing statistically from the other groups (p < 0.05). CG with no papain gel used showed the lowest value and in turn showed no differences for groups 2, 3, and 4. As regards adhesive remnant index, CG showed statistical differences from the others. Groups 2, 3, 4, 5, and 6, in which papain gel was used, presented no statistical differences among them (p > 0.05).

Conclusions

It was concluded that enamel deproteinization with 8% and 10% papain gel increases shear bond strength of orthodontic brackets bonded with RMGIC.

Novel treatment of white spot lesions: A report of two cases

This case report describes a technique used to treat smooth surface white spot lesions microinvasively. It is based on the infiltration of an initial enamel caries lesion with low-viscosity light-curing resins called infiltrants. The surface layer is eroded and desiccated, followed by resin infiltrant application. The resin penetrates into the lesion microporosities driven by capillary force and is hardened by light curing. Infiltrated lesions lose their whitish appearance and look similar to sound enamel. Additionally, the treatment prevents lesion progression. This technique might be an alternative to microabrasion and restorative treatment in treating of white spot lesions of esthetically relevant teeth.

Preventive Effect of Ozone on the Development of White Spot Lesions during Multibracket Appliance Therapy

Objective: To test the null hypotheses: (1) there is no difference in the caries protective effect of ozone and Cervitec/Fluor Protector during multibracket (MB) appliance therapy, and (2) DIAGNOdent and quantitative light-induced fluorescence (QLF) are not superior to a visual evaluation of initial caries lesions.

Materials and Methods: Twenty right-handed patients with a very poor oral hygiene who required full MB appliance therapy were analyzed during 26 months. In a split-mouth-design, the four quadrants of each patient were either treated with ozone, a combination of Cervitec and Fluor Protector, or served as untreated controls. The visible plaque index (VPI) and white spot formation were analyzed clinically. DIAGNOdent and QLF were used for a quantitative assessment of white spot formation.

Results: The average VPI in all four dental arch quadrants amounted to 55.6% and was independent of the preventive measure undertaken. In the quadrants treated with Cervitec/Fluor Protector, only 0.7% of the areas developed new, clinically visible white spots. This was significantly (P &lt; .05) less than in the quadrants treated with ozone (3.2%). The lesions detected with QLF only partially corresponded to the clinically detected white spots, while DIAGNOdent proved to be unable to detect any changes at all.

Conclusions: The caries protective effect of Cervitec/Fluor Protector during MB therapy was superior to ozone, and a visual evaluation of initial caries lesions was superior to both DIAGNOdent and QLF.

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.

Longitudinal quantification of incipient carious lesions in postorthodontic patients using a fluorescence method

The aims of this study were to evaluate the effect of two caries-preventive programs, and to apply the laser fluorescence method, DIAGNOdent, for longitudinal quantification of changes in incipient carious lesions. Twelve subjects with 127 test teeth exhibiting white spot lesions on the buccal surfaces after completed orthodontic therapy were enrolled in the study. Visual examination was performed at baseline and after 12 months. The subjects were divided into two groups: one group received repeated professional tooth cleaning combined with oral hygiene instruction; and the control group received repeated oral hygiene instruction only. The white spot lesions were measured by DIAGNOdent at baseline, and at 3, 6, 9, and 12 months thereafter. There was a significant difference in the DIAGNOdent readings between the first and the final evaluations. However, there was no statistically significant difference between the two treatment groups regarding changes of DIAGNOdent values over time. In conclusion, it may be possible to use DIAGNOdent for longitudinal quantification of carious lesions on smooth surfaces over a period of 1 yr under in vivo conditions. The combination of professional tooth cleaning and oral hygiene instruction had a similar efficacy to professional tooth cleaning only for promoting the remineralization of white spot lesions.

A systematic review of the performance of a laser fluorescence device for detecting caries

BACKGROUND

The DIAGNOdent, or DD (KaVo America, Lake Zurich, Ill.), a device for detecting caries using laser fluorescence, has been growing in popularity during the past three years. Although several evaluations of its diagnostic performance have appeared in the literature, the range of reported performances is extensive.

TYPES OF STUDIES REVIEWED

The authors conducted a systematic review of the literature to assess the diagnostic performance of the DD. Of 115 articles identified in the search, 25 studies were included in the review according to criteria requiring histologic validation and outcomes expressed as sensitivity and specificity values.

RESULTS

For detection of dentinal caries, sensitivity values ranged widely (0.19 to 1.0), although most tended to be high. Specificity values exhibited a similar pattern, ranging from 0.52 to 1.0. In comparison with visual assessment methods, the DD exhibited a sensitivity value that was almost always higher and a specificity value that was almost always lower. The body of evidence is characterized largely by in vitro studies, so that generalization to the clinical setting is uncertain. Because caries thresholds varied substantially across the studies, synthesized estimates of performance were not possible.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The DD clearly is more sensitive than traditional diagnostic methods; however, the increased likelihood of false-positive diagnoses compared with that with visual methods limits its usefulness as a principal diagnostic tool.