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

Evaluation of DIAGNOdent pen for initial occlusal caries diagnosis in permanent teeth

BACKGROUND

To verify the validity of diagnosing initial caries on occlusal surface of permanent posterior teeth by laser fluorescence instrument DIAGNOdent pen.

METHODS

Patients from School of Stomatology in Wuhan University were selected and their posterior teeth were examined using DIAGNOdent pen and the International Caries Detection and Assessment System (ICDAS II) by an experienced dentist. After teeth extraction, histological criteria were used to determine the severity of the lesions. The sensitivity, specificity, accuracy, the area under the curve (AUC), and correlation of DIAGNOdent pen and ICDAS II were analyzed compared with histological criteria. Examiners' agreement was measured.

RESULTS

The sensitivity range was 0.440-1 while that of specificity was 0.750-0.994. The accuracy and AUC were above 80% and 0.7 respectively. Consistency of examiners' kappa values of ICDAS II, DIAGNOdent pen, and histological criteria were ranged from 0.629 to 0.840.

CONCLUSIONS

ICDAS II and DIAGNOdent pen can be effectively used in tandem or independently for the assessment of initial caries.

Occlusal Caries Detection with Intraoral Scanners in Pediatric Dentistry: A Comparative Clinical Study

Background: The aim of this clinical study was to compare the occlusal caries detection (OCD) performance of the intraoral scanners (IOSs) Trios 4 (TIO, 3Shape) and Emerald S (EME, Planmeca) and the Diagnocam (DIA, KaVo) with the established visual (WHO) examination (VIS, reference method). Methods: Between 08/2022 and 02/2023, 60 children (mean age 9.6 ± 2.5 years) were examined as part of their regular dental checkups. OCD was performed at the tooth level, separately for primary and permanent unrestored teeth. Furthermore, two thresholds were analyzed: sound versus overall caries (pooled data of enamel and dentin caries, TH1) and pooled data of sound and enamel caries versus dentin caries (TH2). Results: The best agreement with the reference method (reliability) in both dentitions was obtained for DIA (ĸ = 0.829/ĸ = 0.846; primary/permanent teeth), followed by EME (ĸ = 0.827/ĸ = 0.837) and TIO (ĸ = 0.714/ĸ = 0.680). Similar results were shown for the diagnostic quality (sensitivity, specificity and area under the curve of the receiver operating characteristic curve), with higher values for TH1 than for TH2. Both IOSs and the DIA showed worse results than the reference method VIS. Conclusions: Currently, IOS should be used as an additional caries detection tool, especially for visualization, and cannot be recommended as a basic tool for diagnosis or invasive/noninvasive therapy decisions in OCD.

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

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

Performance of near-infrared light transillumination in the detection of occlusal caries lesions in deciduous teeth

BACKGROUND

This study compared the performance of near-infrared light transillumination (NILT; DIAGNOcam [DC]) in detecting occlusal caries lesions in deciduous molars with the performance of the International Caries Detection and Assessment System (ICDAS), digital radiographic method (RX) and laser fluorescence (DIAGNOdent pen [LFpen]).

METHODS

Fifty-seven extracted deciduous molars with no frank cavitation caries lesions were selected. One site per tooth was evaluated twice each by two examiners using all methods. Then, a histological examination was performed using a stereomicroscope. The performance of the methods was assessed with respect to two thresholds: D1 (all visible caries lesions affecting enamel) and D3 (caries lesions extended into dentin).

RESULTS

A weighted kappa and intraclass correlation coefficients were calculated for intra- and inter-observer reproducibilities, varying from 0.31 (RX) to 0.89 (LFpen). The intra-observer reproducibility at D1 and D3 thresholds varied from 0.51 (ICDAS) to 0.85 (DC) and from 0.30 (ICDAS) to 1.00 (RX), respectively. The inter-observer reproducibility varied from 0.28 (RX) to 0.47 (DC) and from 0.22 (LFpen) to 0.75 (DC), respectively. At the D1 threshold, higher sensitivity and accuracy were found for LFpen (0.76/0.71) and ICDAS (0.65/0.66); and higher specificities were found for RX (0.94), DC (0.79), and ICDAS (0.71). At the D3 threshold, all methods exhibited lower sensitivities (0.13-0.35) and higher specificity, accuracy, and area under the ROC curve values (0.70-1.00). All methods showed a correlation with histological results, especially for ICDAS and DC.

CONCLUSIONS

NILT technology (DC) and LFpen exhibited similar performance for the detection of occlusal caries lesions in deciduous molars when compared with ICDAS criteria.

Effect of resin composite shade on digital fiber-optic transillumination imaging in vitro

Digital imaging fiber-optic transillumination (DIFOTI) devices have been used to detect caries, a technique without using X-rays. However, the effects of resin composites (RCs) shades on the images acquired with DIFOTI devices have not been investigated. Thus, this study aimed to elucidate the influence of RC shade on the images obtained with DIFOTI technique. Three shades (A1, A3, and Opaque) for each of four flowable RCs were filled on a cavity prepared in a left mandibular first premolar obtained from a donated body. Then, transmission images with a DIFOTI device (DIAGNOcam; KaVo, Biberach, Germany) were acquired, and the average lightness values of the images in the RC and enamel were used to calculate differences between those areas. To clarify the influence of the optical translucency and color on DIFOTI images, the color parameters (L*, a* and b*) of each RC were obtained with black and white backgrounds. The color differences between the backgrounds were calculated as transparency parameter (TP) values. The number of repetitions was set to 10. Differences in the lightness value of the shades varied in each RC. The difference in lightness was significantly associated with the TP value and color parameters of L* (p < 0.01), with negative (R = - 0.81) and positive (R = 0.84) correlations, respectively. In conclusion, DIFOTI images of RCs with high optical translucency resembled those of the natural tooth structure.

Caries-preventing effect of a hydroxyapatite-toothpaste in adults: a 18-month double-blinded randomized clinical trial

Background

Dental caries is a worldwide challenge for public health. The aim of this 18-month double-blinded, randomized, clinical trial was to compare the caries-preventing effect of a fluoride-free, hydroxyapatite toothpaste (test) and a toothpaste with sodium fluoride (1450 ppm fluoride; positive control) in adults.

Methods

The primary endpoint was the percentage of subjects showing no increase in overall Decayed Missing Filled Surfaces (DMFS) index. The study was designed as non-inferiority trial. Non-inferiority was claimed if the upper limit of the exact one-sided 95% confidence interval for the difference of the primary endpoint DMFS between test and control toothpaste was less than the predefined margin of non-inferiority (Δ ≤ 20%).

Results

In total, 189 adults were included in the intention-to-treat (ITT) analysis; 171 subjects finished the study per protocol (PP). According to the PP analysis, no increase in DMFS index was observed in 89.3% of subjects of the hydroxyapatite group and 87.4% of the subjects of the fluoride group. The hydroxyapatite toothpaste was not statistically inferior to a fluoride toothpaste with regard to the primary endpoint.

Conclusion

Hydroxyapatite was proven to be a safe and efficient anticaries agent in oral care.

Clinical trial registration

NCT04756557.

LASER as a tool for surface modification of dental biomaterials: A review

In recent years, the application of lasers for modifying the surface topography of dental biomaterials has received increased attention. This review paper aims to provide an overview of the current status on the utilization of lasers as a potential tool for surface modification of dental biomaterials such as implants, ceramics, and other materials used for restorative purposes. A literature search was done for articles related to the use of lasers for surface modification of dental biomaterials in English language published between October 2000 and March 2023 in Scopus, Pubmed and web of science, and relevant articles were reviewed. Lasers have been mainly used for surface modification of implant materials (71%), especially titanium and its alloys, to promote osseointegration. In recent years, laser texturing has also emerged as a promising technique to reduce bacterial adhesion on titanium implant surfaces. Currently, lasers are being widely used for surface modifications to improve osseointegration and reduce peri-implant inflammation of ceramic implants and to enhance the retention of ceramic restorations to the tooth. The studies considered in this review seem to suggest laser texturing to be more proficient than the conventional methods of surface modification. Lasers can alter the surface characteristics of dental biomaterials by creating innovative surface patterns without significantly affecting their bulk properties. With advances in laser technology and availability of newer wavelengths and modes, laser as a tool for surface modification of dental biomaterials is a promising field, with excellent potential for future research.

Diffuse Reflectance Spectroscopy as a Novel Method of Caries Detection-An In Vitro Comparative Study in Permanent Teeth

This in vitro study aimed to compare outcomes of dental caries detection using visual inspection classified according to the International Caries Detection and Assessment System (ICDAS) with objective assessments using a well-established laser fluorescence system (Diagnodent pen) and a novel diffuse reflectance spectroscopy (DRS) device. One hundred extracted permanent premolars and molars were utilized, including sound teeth, teeth with non-cavitated caries, or teeth with small cavitated lesions. A total of 300 regions of interest (ROIs) were assessed using each detection method. Visual inspection, being a subjective method, was performed by two independent examiners. The presence and extent of caries were histologically verified according to Downer's criteria, serving as a reference for other detection methods. Histological results revealed 180 sound ROIs and 120 carious ROIs, categorized into three different extents of caries. Overall, there was no significant difference between the detection methods in sensitivity (0.90-0.93) and false negative rate (0.05-0.07). However, DRS exhibited superior performance in specificity (0.98), accuracy (0.95), and false positive rate (0.04) compared to other detection methods. Although the tested DRS prototype device exhibited limited penetration depth, it shows promise as a method, particularly for the detection of incipient caries.

Clinical Performance of Diagnostic Methods in Third Molar Teeth with Early Occlusal Caries

The aim of this study was to compare the diagnostic performance of clinical visual examination (ICDAS II), digital periapical radiography (PR), near infrared light transillumination (NIR-LT), and laser fluorescence (LF) to microcomputed tomography (Micro-CT) which is the reference standard for the detection of non-cavitated occlusal enamel and dentin caries in third molar teeth. Potential participants were consecutively recruited. In this prospective study, 101 third molars of 101 patients were examined; the molars had non-cavitated occlusal caries which required extraction. ICDAS II, PR, NIR-LT and LF examinations were carried out by two blinded examiners. Reference standard was determined by micro-CT imaging seven days after extraction. Accuracy rate, sensitivity, specificity, predictive values and areas under receiver operating characteristic (ROC) curves (Az) were statistically analyzed. Nonparametric variables were subjected to the Kruskal−Wallis Test. Significance level was set as p < 0.05. NIR-LT had the highest sensitivity (99.67−99.67%) and accuracy (78.22−77.23%) for the determination of occlusal enamel caries according to examiners 1 and 2, respectively. LF method had the highest sensitivity (70.83−54.17%) and accuracy (66.34−59.41%) for determining occlusal dentin caries according to examiners 1 and 2, respectively. The ROC curve (Az) value ranged between 0.524 and 0.726 for the different methods tested. Most effective methods for the diagnosis of occlusal enamel and dentin caries were determined to be NIR-LT and LF pen methods, respectively. The present prospective clinical study showed that NIR-LT and LF-Pen were a reliable modality for the detection of occlusal enamel and dentin caries without ionizing radiation.

Evaluation of different remineralization agents in the treatment of natural caries-affected dentin in permanent teeth

BACKGROUND

In the preventive treatment protocol, providing remineralization of the tissue in demineralized dentin caries is an important step.

OBJECTIVE

In this in vitro study, the effectiveness of remineralization agents in natural caries-affected dentin (NCAD) were investigated.

METHODS

Forty caries slices were prepared from permanent molar dentin with International Caries Detection and Assessment System (ICDAS 2) (Code 3). The interventions with 8 days pH cycling were as follows: Deionized water (DW); 5% Sodium Fluoride (5% NaF) Varnish; Casein Phosphopeptide-Amorphous Calcium Fluoride Phosphate (CPP-ACFP); Calcium Glyserophosphate (CaGP) + Magnesium (Mg) + Xylitol. DIAGNOdent (Laser Fluorescence, LF), Surface Microhardness (SMH), and X-ray Fluorescence (XRF) Spectroscopy measurements were calculated before and after pH cycling.

RESULTS

LF values decreased between 5% NaF, CCP-ACFP and CaGP. NCAD treated with 5% NaF, CaGP and CCP-ACFP exhibited statistically higher hardness compared to the control group. After 5% NaF application, SMH values were significantly higher than the others. There was no statistically significant difference between baseline and after pH cycling hardness of the control group. After cycling, XRF showed that Ca and P concentrations were increased in all groups.

CONCLUSION

The application of agents used in the study could be recommended and promoted as a treatment option of caries dentin for conventional management of caries.

Near-Infrared Transillumination for Occlusal Carious Lesion Detection: A Retrospective Reliability Study

The aim of this study was to assess the reliability of three diagnostic methods (near-infrared transillumination (NIRT), bitewing radiographs (BW), and clinical images (CI)) to detect occlusal carious lesions in a low caries risk population. This retrospective analysis included one hundred and eighty-eight occlusal surfaces, scored as sound surface, early lesion, or distinct lesion. We evaluated the agreement between and within the methods over time. Kappa statistics tested the correlation between the methods. Examiners detected occlusal early lesions more frequently with visual examination and NIRT and the same lesions were confirmed on the 2-year follow-up. Within the limitations of this study, we were able to establish that early occlusal lesions can be detected and monitored over time using NIRT and visual exam, while BW scores showed mostly sound surfaces at both examinations. NIRT combined with clinical examination can be considered appropriate to detect and monitor early enamel caries on the occlusal surface in low caries-risk populations.

The Therapeutic Effectiveness Using Fluorescence-Guided Surgery for MRONJ

Background. Long-term application of antiresorptive and/or antiangiogenic agents may cause oral disorders, including medication-related osteonecrosis of the jaw (MRONJ), which remains an incurable disease. Surgical treatment can help alleviate infection of the jaw and block the progress of the disease, but postoperative recurrence is often caused by incomplete resection of necrotic bone during surgery. The traditional method for determining the boundary of necrotic bone resection is primarily based on the color, geology, and microcirculation-based bleeding state according to the bone tissue, which is easily affected by the surgeon’s clinical experience and can cause insufficient resection of osteonecrosis bone. Recent studies have proposed using fluorescence technology-assisted necrotic bone resection. Objective. Systematic literature review was conducted to evaluate the therapeutic effectiveness of fluorescence-guided MRONJ surgery. Design. PubMed/MedLine, Scopus, and Web of Science databases were searched from inception to February 7, 2022. Randomized controlled trial (RCT) studies were evaluated according to the Cochrane risk of bias tool ROB 2, and non-RCT (N-RCT) studies were evaluated according to the ROBINS-I tool. Results. A total of 6 articles were included in the systematic review, including 4 N-RCT studies (1 retrospective study and 3 prospective studies) and 2 RCT studies, with 240 patients and 280 MRONJ lesions. The vast majority of studies were with moderate risk of bias, and the quality of the evidence was moderate. Conclusion. Evidence of moderate strength suggests that fluorescence-assisted techniques effectively determine the bone resection boundaries in MRONJ surgery. However, whether the prognosis of patients treated with fluorescence-guided surgery is significantly better than that of traditional surgery must be proved by randomized controlled studies with larger sample sizes and higher quality.

Near-infrared light transillumination for occlusal caries detection in dog teeth: A comparative study

The aim of this study is to compare the effectiveness of visual, radiologic, and near-infrared light transillumination caries detection methods on caries of dog teeth in-vitro. A total of 237 dog molar teeth were evaluated with three different methods; visio-tactile examination with a probe, radiographic assessment, and NIR-LT. Each tooth was evaluated with all of the methods; the absence or presence of occlusal caries was scored either 0, caries not present, or 1, caries present. All caries detection methods yielded the same outcomes for each tooth. Among all caries detection methods positive Spearman’s rho value (ϱ=1) indicated that there was a strong positive correlation between the caries detection methods. Since NIR-LT is such a comfortable and easy caries diagnosis method, it can be used without sedation, especially in calm dogs.

Impedance Spectroscopy as a Tool for the Detection of Occlusal Noncavitated Carious Lesions

A total 302 teeth (148 molars and 154 premolars) corresponding to 152 patients aged ≥18 years were evaluated for caries using the ICDAS (International Caries Detection and Assessment System), fluorescence (DD, DIAGNOdent) and electrical impedance (IMS, CarieScan PRO) systems. Fissurotomy and intraoral radiographs were used as the gold standard. Accordingly, 27.5% (n=84) of the teeth were classified as sound, while 26.9% (n=81) had enamel involvement and 45.6% (n=138) presented carious lesions reaching the dentin. Sensitivity (Se), specificity (Sp), and the area under the curve (AUC) were, respectively, 90.7%, 87.8%, and 0.954 (IMS); 92.4%, 92.7%, and 0.954 (DD); and 79.0%, 72.3%, and 0.756 (ICDAS). With regard to Se and Sp, there were significant differences between ICDAS and DD (p<0.001) and between ICDAS and IMS (p=0.01), but not between IMS and DD (p=0.07). In relation to AUC, there were significant differences between ICDAS and DD (p<0.001), and between ICDAS and IMS (p<0.001), but not between IMS and DD (p>0.05). The correlations between fissurotomy and each method were 88.7% (IMS), 89.7% (DD), and 77.1% (ICDAS). Within the limitations of this study, clinically, the electrical system is not useful for differentiating between sound teeth and truly incipient caries lesions by itself. The fluorescence or electrical systems are recommended with the ICDAS to detect carious lesions in their early stages.

Emerging Technologies for Dentin Caries Detection-A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed at assessing the diagnostic accuracy of emerging technologies, such as laser fluorescence (LF), transillumination, light-emitting diode devices, optical coherence tomography (OCT), alternating current impedance spectroscopy, fluorescence cameras (FC), photo-thermal radiometry, and modulated luminescence technology. In vivo and in vitro results of such non-ionizing, non-invasive, and non-destructive methods' effectiveness in non-cavitated dentin caries detection are sometimes ambiguous. Following the PRISMA guidelines, 34 relevant research articles published between 2011-2021 were selected. The risk of bias was assessed with a tool tailored for caries diagnostic studies, and subsequent quantitative uni- and bi-variate meta-analysis was carried out in separate sub-groups according to the investigated surface (occlusal/proximal) and study setting (in vivo/in vitro). In spite of the high heterogeneity across the review groups, in vitro studies on LF and FC proved a good diagnostic ability for the occlusal surface, with area under the curve (AUC) of 0.803 (11 studies) and 0.845 (five studies), respectively. OCT studies reported an outstanding performance with an overall AUC = 0.945 (four studies). Promising technologies, such as OCT or FC VistaProof, still need well-designed and well-powered studies to accrue experimental and clinical data for conclusive medical evidence, especially for the proximal surface. Registration: INPLASY202210097.

In vivo effectiveness of visual inspection and laser fluorescence in the diagnosis of early pit-and-fissure carious lesions: A cross-sectional study in a group of Romanian children

General practitioners are still facing great challenges in the management of occlusal caries. Therefore, the development of better diagnostic protocols and assessment of caries activity might improve the results of nonoperative treatment. This study aimed to evaluate the effectiveness of visual inspection based on ICDAS-II (International Caries Detection and Assessment System) and DiagnoDent pen in the detection of pit-and-fissure early lesions in young permanent molars. The evaluation of 237 occlusal surfaces and caries risk assessment were performed in 96 children aged 7 to 15 years. The presence of pit-and-fissure noncavitated lesions was recorded using ICDAS-II scoring system and laser fluorescence. Statistical analysis was performed using McNemar test, with a level of significance of P < .05. The caries risk was measured for all participants. In 109 occlusal surfaces both methods identified enamel changes (46%) and in 62 cases both methods excluded the carious lesion (26.2%). The statistical analysis showed a significant moderate agreement between ICDAS-II code and DiagnoDent pen measurements (McNemar chi-squared statistic 9.5, P = .002 and Cohen kappa coefficient = 0.427). The majority of children (69.8%) had moderate caries risk and the most frequent risk factors recorded were sugar intake between meals, lack of regular dental control and poor oral hygiene. We concluded that ICDAS-II is a valuable and reliable diagnostic tool for early pit-and-fissure lesions and could be used alone during dental examination in children. The evaluation of caries risk should become clinical routine, as parameters belonging to high risk were frequently recorded in our study group.

Diagnosis and Management Approaches for Non-cavitated Carious Dental Lesions- A Narrative Review

Background:

Dental caries is one of the most prevalent diseases. Its detection and management should start with a comprehensive treatment plan, with the goals of the elimination of cariogenic bacteria, the reduction of plaque acidogenicity, the encouragement of tooth remineralization, and the repair of damaged teeth.

Objectives:

The aim of this paper was to review the literature regarding the latest updates on the diagnosis and management approaches of non-cavitated carious dental lesions.

Methods:

Studies regarding the diagnosis and management of non-cavitated carious dental lesions were included.

Results:

The subclinical non-cavitated carious lesion might progress to an early enamel lesion, develop into an established dentin lesion, or sometimes end up with a lesion reaching the pulp. The detection and management of caries should be patient-centered, risk-based, and evidence-supported, and should consider the dentists’ expertise and the patients’ needs and preferences. The visual-tactile and radiographic detection of non-cavitated carious lesions are greatly helped by the advances of non-invasive detection tools such as DIAGNOdent, fiber-optic transillumination, quantitative light-induced fluorescence, and DIAGNOcam.

Conclusion:

Accordingly, non-cavitated carious lesions can be arrested by several non-invasive techniques, which are preferred over the invasive options. The clinicians can use sealants plus fluoride varnish on occlusal surfaces, fluoride varnish or resin infiltration on proximal surfaces, and resin infiltration,fluoride gel, or varnish alone on facial or lingual surfaces to manage non-cavitated carious lesions.

Detection Methods for Early Caries Diagnosis: A Systematic Review and Meta-Analysis

The aim was to appraise the evidence on the performance of various means for the detection of incipient caries in vivo. Five databases of published and unpublished research were searched for studies from January 2000 to October 2019. Search terms included "early caries" and "caries detection." Inclusion criteria involved diagnostic test accuracy studies for early caries detection in permanent and primary teeth. A risk-of-bias assessment was performed using the QUADAS-2 tool. We performed the study selection, data extraction, and risk-of-bias assessment in duplicate. The review protocol was a priori registered in the Open Science Framework. Of the initially 22,964 search results, 51 articles were included. For permanent teeth, when histologic examination was considered as the reference for occlusal surfaces, the sensitivity (Se) range appeared high for the DIAGNOdent Pen (DD Pen) at 0.81-0.89, followed by ICDAS-II at 0.62-1, DIAGNOdent (DD) at 0.48-1, and bitewing radiography (BW) at 0-0.29. The corresponding specificity (Sp) range was: DD Pen 0.71-0.8, ICDAS-II 0.5-0.84, DD 0.54-1, and BW 0.96-1. When operative intervention served as the reference for occlusal surfaces, again, the DD means valued the most promising results on Se: DD 0.7-0.96 and DD Pen 0.55-0.90, followed by ICDAS-II 0.25-0.93, and BW 0-0.83. The Sp range was: DD 0.54-1, DD Pen 0.71-1, ICDAS-II 0.44-1, and BW 0.6-1. For approximal surfaces, the Se was: BW 0.75-0.83, DD Pen 0.6, and ICDAS-II 0.54; the Sp was: BW 0.6-0.9, DD Pen 0.2, and ICDAS-II 1. For primary teeth, under the reference of histologic assessment, the Se range for occlusal surfaces was: DD 0.55-1, DD Pen 0.63-1, ICDAS-II 0.42-1, and BW 0.31-0.96; the respective Sp was: DD 0.5-1, DD Pen 0.44-1, ICDAS-II 0.61-1, and BW 0.79-0.98. For approximal surfaces, the Se range was: DD Pen 0.58-0.63, ICDAS-II 0.42-0.55, and BW 0.14-0.71. The corresponding Sp range was: DD Pen 0.85-0.87, ICDAS-II 0.73-0.93, and BW 0.79-0.98. Se and Sp values varied, due to the heterogeneity regarding the setting of individual studies. Evidently, robust conclusions cannot be drawn, and different diagnostic means should be used as adjuncts to clinical examination. In permanent teeth, visual examination may be enhanced by DD on occlusal surfaces and BW on approximal surfaces. In primary teeth, DD Pen may serve as a supplementary tool across all surfaces.

A comparison of near-infrared imaging with other diagnostic tools for dental caries

Dental caries is one of the most common diseases in the world, and global incidence rates are increasing. The early detection of dental lesions enables a conservative approach to be employed and represents a priority in modern dentistry. Recent studies have suggested that conventional diagnostic methods, such as visual tactile inspection and X-ray examination, exhibit low sensitivity and are not very effective in early diagnoses. Consequently, late detection of decay is associated with an increased loss of tooth structure. New diagnostic systems based on optical properties have been developed to facilitate early detection. Several studies have evaluated the performance of near-infrared imaging (NIRI) as an early diagnostic tool. NIRI using light ranging from 700 to 1700 nm has demonstrated better optical properties compared to conventional optical systems using light in the visible spectra. NIRI enables deeper penetration of the light in the tooth tissue, weak scattering with lower background noise and strong photon absorption with detailed images. Several in vivo studies have demonstrated that NIRI technology has the potential to improve performance compared with current diagnostic methods. NIRI exhibits increased sensitivity compared to radiographs and is more suitable to identify approximal enamel lesions. This paper aims to review these recent advances and their potential applications in daily clinical practice.

Comparison of novel and established caries diagnostic methods: a clinical study on occlusal surfaces

Background

The purpose of this prospective clinical diagnostic study with validation was to compare the diagnostic accuracy of near-infrared transillumination (NIRT), laser fluorescence measurement (LF), alternating current impedance spectroscopy (ACIS) and their combinations as adjunct methods to visual examination (VE) for occlusal caries detection using a hybrid reference standard.

Methods

Ninety-six first and second non-cavitated permanent molars from 76 individuals (mean age 24.2) were investigated using (VE) (ICDAS) and bitewing radiography (BWR), as well as NIRT, LF and ACIS. The findings of BWR and NIRT were evaluated by two examiners while the other examinations were conducted by one calibrated dentist. The hybrid reference standard consisted of non-operative validation based on the results of VE and BWR and operative validation. Statistical analysis included cross-tabulations, calculation of sensitivity, specificity and area under the receiver operating characteristic curve at three diagnostic thresholds: caries in general, enamel caries and dentin caries.

Results

NIRT, LF and ACIS exhibited high sensitivity for caries in general [1.00 (1.00–1.00), 0.77 (0.65–0.88), 0.75 (0.63–0.87)) and for dentin caries (0.97 (0.91–1.03), 0.76 (0.76–0.90), 0.64 (0.47–0.80)]. Sensitivity values for enamel caries were weak (0.21, 0.11, 0.37). Specificity values did not fall below 0.65 (NIRT) for all categories and methods, except for NIRT at the caries detection threshold (0.27). A combination of LF and ACIS with VE improved the diagnostic performance at the overall and the enamel caries threshold. The other methods showed fair to excellent discrimination at the overall caries threshold (NIRT 0.64, LF 0.89 and ACIS 0.86) and acceptable discrimination at the dentin caries threshold (NIRT 0.82, LF 0.81 and ACIS 0.79). AUROC for enamel caries exhibited the weakest discrimination. Accuracy was 65.6% for VE, 69.8% for BWR, 50.0% for NIRT, 53.1% for LF and 74.0% for ACIS. Reliability assessment for BWR and NIRT showed at least substantial agreements for all analyses.

Conclusions

The methods, NIRT, LF and ACIS, revealed different potential but no impeccable performance for occlusal caries detection. All are suitable instruments to detect hidden carious lesion in dentin. As auxiliaries to VE, LF and ACIS showed an increase in diagnostic performance.

Fluorescence-guided surgical management of medication-related osteonecrosis of the jaws

Medication-related osteonecrosis of the jaw (MRONJ) results in progressive destruction of the jawbones, and advanced cases demand surgical intervention. The total removal of necrotic bone is required to prevent recurrence and infection. However, determining the limits between necrotic and healthy bone is a challenge. The use of fluorescence to detect tissue alterations and determine necrosis extension is a promising method to avoid inadequate bone debridement. In the literature, there are several studies and reported cases that successfully use fluorescence-guided surgery (FGS) of MRONJ. The objective of this study was to present a critical review of the literature regarding the intraoperative use of optic fluorescence to differentiate healthy and necrotic bone in MRONJ. Studies that evaluated the intraoperative use of optic fluorescence to determine the surgical margins of MRONJ were searched in Pubmed/Medline and Scopus databases using the following terms: "medication-related osteonecrosis of the jaws" and "fluorescence". Eighteen papers describing the intraoperative use of FGS in ONJ management were selected, totalizing 218 patients. Of those 18 papers, only 5 were prospective studies, and the other 13 were isolated case reports, case series, and technical notes. The use of FGS to delimitate the resection margin of MRONJ is a promising method. There is no need for the application of exogenous fluorophore to perform FGS and the most often used light device was the VELScope® system. Further prospective studies with larger samples are still required to ascertain the fluorescence validity as a supporting method in MRONJ surgical treatment and to establish clinical protocols.

Near-infrared transillumination with high dynamic range imaging for occlusal caries detection in vitro

The aim of this study was to assess near-infrared transillumination with high dynamic range imaging (NIRT-HDRI) for occlusal caries detection in vitro and to compare it with visual inspection using the International Caries Detection and Assessment System II (ICDAS) and digital bitewing radiography (BWR). Sixty-one extracted permanent molars with sound or occlusal carious surfaces without severe cavitation were visually assembled. Two examiners assessed twice these surfaces independently using ICDAS, BWR and NIRT-HDRI. The latter was performed with a prototype consisting of two laser sources (780 nm), a CCD sensor and subsequent processing with image analysis software. Thresholds for carious surfaces, enamel and dentin lesions were defined for all methods. Micro-computed tomography served as the reference standard. Linear weighted Kappa analysis of the methods versus the reference at the threshold carious surface, enamel and dentin lesion revealed 0.59/0.08/0.12 for ICDAS, 0.37/- 0.06/0.58 for BWR and 0.33/- 0.01/0.51 for NIRT-HDRI. Sensitivity values at the three thresholds were 0.85/0.78/0.13 for ICDAS, 0.59/0.00/0.69 for BWR and 0.98/0.33/0.78 for NIRT. Specificity values at the three thresholds were 0.70/0.40/1.00 for ICDAS, 0.9./0.96/0.90 for BWR and 0.30/0.65/0.72 for NIRT-HDRI. Reliability analysis revealed substantial agreement for BWR and NIRT and almost perfect agreement for ICDAS. NIRT exhibited a strong ability to identify occlusal dental decay in general; however, it revealed a tendency towards overestimation. Its strength was the detection of dentin caries lesions compared with ICDAS and BWR. NIRT-HDRI seems to be a suitable method to detect hidden dentin caries as a supplement to visual examination.

Recent Advances and the Potential for Clinical Use of Autofluorescence Detection of Extra-Ophthalmic Tissues

The autofluorescence (AF) characteristics of endogenous fluorophores allow the label-free assessment and visualization of cells and tissues of the human body. While AF imaging (AFI) is well-established in ophthalmology, its clinical applications are steadily expanding to other disciplines. This review summarizes clinical advances of AF techniques published during the past decade. A systematic search of the MEDLINE database and Cochrane Library databases was performed to identify clinical AF studies in extra-ophthalmic tissues. In total, 1097 articles were identified, of which 113 from internal medicine, surgery, oral medicine, and dermatology were reviewed. While comparable technological standards exist in diabetology and cardiology, in all other disciplines, comparability between studies is limited due to the number of differing AF techniques and non-standardized imaging and data analysis. Clear evidence was found for skin AF as a surrogate for blood glucose homeostasis or cardiovascular risk grading. In thyroid surgery, foremost, less experienced surgeons may benefit from the AF-guided intraoperative separation of parathyroid from thyroid tissue. There is a growing interest in AF techniques in clinical disciplines, and promising advances have been made during the past decade. However, further research and development are mandatory to overcome the existing limitations and to maximize the clinical benefits.