Influence of the condition of the adjacent tooth surface on fluorescence measurements for the detection of approximal caries

Evaluation of dental explorer and visual inspection for the detection of residual caries among Greek dentists

Objectives

The objective of this study was to assess the effect of the operator's degree of clinical experience on the residual caries diagnosis through visual inspection and tactile sensation.

Materials and Methods

The participants were asked about the years of their clinical practice, any further training concerning cariology, their familiarity with the minimal invasive philosophy, and the techniques that they use to remove dental caries and detect when to stop the removal of carious tissues. In addition, an in vitro diagnostic test was conducted. Carious teeth were excavated to a level selected in random. Teeth were examined by each participant individually. Initial examination was performed by visual inspection. Subsequently, a dental explorer was used concerning the potential need for further removal of dental tissues. A sample of 380 dentists and dental school students were selected for the purposes of this study.

Results

Dental students presented statistically significant better sensitivity, than dentists from both age groups, during both visual inspection and tactile sensation of residual caries. Participants' ability to diagnose residual caries during cavity preparation was independent of their years of experience.

Conclusions

During the removal of carious lesions, with the goal of limiting the sacrifice of healthy structures and the leftover of residual caries, clinicians should combine a selective removal technique and the attentive visual inspection, with at least one further diagnostic method, aside from the dental explorer. Tactile examination of residual caries solely with the dental explorer must be used with attention.

Effect of Different Contact Materials on Approximal Caries Detection by Laser Fluorescence and Light-Emitting Diode Devices

OBJECTIVE

The aim of this in vitro study was to investigate the influence of the adjacent tooth surface on pen type laser fluorescence (LFpen) and light-emitting diode (LED) device readings in detecting approximal caries lesions in permanent teeth.

BACKGROUND DATA

Early detection of noncavitated dental caries is important, because disease progression can be easily halted at this stage with certain applications, such as fluoride therapy, antibacterial therapy, dietary changes, or low-intensity laser irradiation.

MATERIALS AND METHODS

A total of 87 permanent molars with 156 approximal surfaces were assessed with LED- and LF-based devices in contact with sound tooth surfaces (the control group) as well as approximal amalgam, composite, zirconia, and full ceramic restorations. All teeth were assessed once by one trained examiner. After the LF and LED assessments, the teeth were histologically evaluated using stereomicroscopy as the gold standard. The sensitivity, specificity, accuracy, and area under the receiver operating characteristics (ROC) curve were calculated according to the appropriate thresholds (T1, sound surface or enamel caries; T2, dentin caries).

RESULTS

For the LFpen device, higher sensitivity and accuracy was found when the adjacent surface was sound at the T1 threshold and no significant differences were found among accuracy at the T2 threshold. For the LED-based device, no significant differences were found among sensitivities at the T1 threshold. At the T2 threshold, specificity was higher when the adjacent tooth had a zirconia restoration.

CONCLUSIONS

It was found that both devices could be used effectively for evaluating approximal surfaces with adjacent restored teeth, regardless of the different kinds of restorative materials.

Detection of Caries Around Amalgam Restorations on Approximal Surfaces

To evaluate the in vitro performance of the International Caries Detection and Assessment System (ICDAS) visual examination, bitewing radiography (BW), and the DIAGNOdent 2190, a pen-type laser fluorescence device (LFpen), in detecting caries around amalgam restorations on approximal surfaces. Approximal surfaces (N=136) of permanent posterior teeth (N=110) with Class II amalgam restorations were assessed twice by two experienced examiners using ICDAS, BW, and LFpen. The occurrence of proximal overhangs was also evaluated. The teeth were histologically prepared and assessed for caries extension. Different cutoff limits for the LFpen were used. Intraexaminer and interexaminer reproducibility showed moderate to good agreement for all the methods (weighted κ/intraclass correlation coefficient=0.40 to 0.87). The specificities at D1 (all visible lesions affecting enamel) and D3 (lesions extended into dentin) were, respectively, 0.41 and 0.82 for ICDAS, 0.70 and 0.82 for BW, and 0.77-0.89 and 0.88-0.94 for LFpen. The sensitivities were 0.80 and 0.52 for ICDAS, 0.56 and 0.51 for BW, and 0.04-0.23 and 0.01-0.02 for LFpen at D1 and D3, respectively. At the D1/D3 thresholds, the accuracy and the area under the receiver operating characteristic curve (Az) values were similar and statistically higher for ICDAS (0.65/0.68 and 0.633/0.688) and BW (0.64/0.68 and 0.655/0.719), respectively; whereas, LFpen presented lower accuracy (0.37-0.44/0.49-0.52) and Az (0.390-0.454/0.345-0.395) values. The occurrence of overhangs (26.8%) was shown to be irrelevant in determining the presence of secondary caries. The ICDAS and BW methods presented the best performance in detecting caries lesions affecting enamel and dentin on approximal surfaces of amalgam restorations.

Types of Lasers and Their Applications in Pediatric Dentistry

Laser technology has been recently introduced into the dental field with the idea to replace drilling. Having a less painful first dental experience by the use of modern instruments like laser can be an efficient preventive and therapeutic strategy in pediatric dentistry. Pedodontists need to learn the new less invasive technologies and adopt them in their routine practice. This study aimed to review the available types of lasers and their applications in pediatric dentistry. An electronic search was carried out in IranMedex, InterScience, Scopus, Science Direct, PubMed, ProQuest, Medline and Google Scholar databases to find relevant articles published from 2000 to 2014. Relevant textbooks were reviewed as well. Laser can be used as a suitable alternative to many conventional diagnostic and therapeutic dental procedures. It is especially efficient for caries detection and removal, pulp therapy, lowering the risk of infection, inflammation and swelling and reducing bleeding. On the other hand, due to minimal invasion, laser treatment is well tolerated by children. Improved patient cooperation leads to higher satisfaction of the parents, dentists and the children themselves.

Technological advances in caries diagnosis

Understanding the nature of the caries lesion, disease activity, and the patient's caries risk are all used in determining the nature of dental care to be delivered. An examination should include a health and social history and clinical examination using appropriate technologies. This allows proper assessment and suggests a logical management intervention. Minimally invasive dentistry is a concept based on an assessment of a patient's caries risk and the application of the current therapies to prevent, control, and treat the disease. The history of the dental examination and the variety of current technologies are discussed.

An in vitro comparison of different diagnostic methods in detection of residual dentinal caries

The aim of this study was to investigate the efficiency of different diagnostic methods in detection of residual dentinal caries in excavated cavities. Fifty extracted molar with deep dentinal carious lesions were excavated using a slow-speed handpiece. All cavities were assessed by laser fluorescence(LF) device, electronic caries monitor(ECM), and caries detector dye(CDD) by three independent observers blindly. The measurements were repeated after two weeks. Specimens containing dentin slices 150 μm in thickness were prepared for histological analyses. The existence and absence of carious dentin was determined using a lightmicroscope. The average intraobserver accuracy was 1.00 (perfect agreement) for CDD, 0.86 (excellent agreement) for ECM, and 0.50 (good agreement) for LF. The average interobserver accuracy values were 0.92 (excellent agreement), (0.36 marginal agreement) and 0.48 (good agreement), for CDD, ECM, and LF, respectively. The average specificity was 0.60 for CDD, 73% for ECM, and 0.50 for LF. The average sensitivity was 0.55 for CDD, 0.85 for LF, and 0.47 for ECM. The average accuracy values were 0.53, 0.51, and 0.81 for CDD, ECM, and LF, respectively. LF had the greatest sensitivity and accuracy values of any of the methods tested. As a conclusion, LF device is appeared to most reliable method in detection of remain caries in cavity. However, because of its technical sensitivity it may susceptible to variations in measurements. To pay attention to the rule of usage and repeated measurements can minimize such variations in clinical practice. It was concluded that LF is an improvement on the currently available aids for residual caries detection.

Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars

OBJECTIVES

To determine the clinical performance of a laser fluorescence device (DIAGNOdent pen, KaVo) to discriminate between different occlusal caries depths (D(0)-D(1-4); D(0-2)-D(3,4)) in permanent molars.

METHODS

In this prospective, randomized two-centre-study 120 sound/uncavitated carious sites in 120 patients were measured after visual and radiographic caries assessment. In cases of operative intervention (n=86), the lesion depths after caries removal were recorded (reference). In cases of preventive intervention (n=34), the sites were reassessed visually/radiographically after 12 months to verify the status assessed before (reference). The discrimination performance was determined statistically (Mann-Whitney test, Spearman's rho coefficient, and areas under the receiver operating characteristic curves (AUCs)). Sensitivities (SE) and specificities (SP) were plotted as a function of the measured values and cut-off values for the mentioned thresholds suggested.

RESULTS

Sound sites (n=13) had significantly minor fluorescence values than carious sites (n=107) (P<0.0001) as had sites with no/enamel caries (n=63) compared to dentinal caries (n=57). The AUCs for the same discriminations were 0.92 and 0.78 (P<0.001). For the D(0)-D(1-4) threshold, a cut-off at a value of 12 (SE: 0.88, SP: 0.85) and for the D(0-2)-D(3,4) threshold at 25 (SE: 0.67, SP: 0.79) can be suggested. A moderate positive correlation between the measurements and the caries depths was calculated (rho=+0.57, P=0.01).

CONCLUSION

Within this study, the device's discrimination performance for different caries depths was moderate to very good and it may be recommended as adjunct tool in the diagnosis of occlusal caries.

Effect of dental material fluorescence on DIAGNOdent readings

OBJECTIVE

Diagnosis of secondary caries with the DIAGNOdent device has been found to be comparable to visual and radiographic diagnostic methods, but the fluorescence of restorative materials might affect DIAGNOdent values and result in false-positive diagnosis. The aims of this study were: (1) to measure baseline fluorescence of restorative materials and fluorescence changes induced by aging, bleaching, staining, and polishing; (2) to assess intra-examiner reproducibility of these measurements; and (3) to compare the values obtained with the DIAGNOdent against the threshold values for enamel and dentinal caries.

MATERIAL AND METHODS

270 disk-shaped specimens fabricated from 15 different restorative materials were divided into 3 groups, which were aged in water, bleached with 10% carbamide peroxide, and stained with red wine. Specimen fluorescence was measured with the DIAGNOdent before and after these treatments. The red-wine-stained specimens were also polished and measured again.

RESULTS

Intra-examiner reproducibility of the measurements was excellent. For all materials, baseline DIAGNOdent values, as well as the values of aged and bleached samples, were considerably lower than the dentinal caries threshold. The values of one stained filled resin fissure sealant, one stained resin composite, and one stained resin-modified glass ionomer exceeded the dentinal caries threshold. Polishing reduced these DIAGNOdent values to below the dentinal caries threshold, except for the filled resin fissure sealant specimen.

CONCLUSIONS

Stained dental materials might affect DIAGNOdent readings and consequently result in false-positive diagnoses of secondary caries. Dental fillings should be polished prior to DIAGNOdent measurement.

Comparison of two laser fluorescence devices for the detection of occlusal caries in vivo

Laser fluorescence measurements have been shown to be well suited for caries diagnosis. The aim of this study was to compare two laser fluorescence devices and to correlate the respective values with the visual and radiographic assessment and with the extent of the carious lesion. Ninety-four clinically non-cavitated occlusal carious lesions in the premolars and molars of 82 patients were examined. Laser fluorescence values on the surface were measured with a conventional laser fluorescence system and a novel laser fluorescence pen device. When operative intervention at a site was indicated, the extent of caries was determined after its removal. Readings obtained with both systems were significantly different with an interdevice factor of 0.64. Sensitivity and specificity for operative care were 92.6% and 53.7%, respectively, for the conventional, and 88.9% and 53.7%, respectively, for the pen device. For both devices, a correlation between laser fluorescence values and the visual and radiographic assessment and with the extent of the lesion was shown. The study indicates that the novel laser fluorescence device seems to be suitable for occlusal caries diagnosis. However, proposed guidelines for the clinical use of laser fluorescence readings of the conventional device cannot be transferred to the novel pen system.