Longitudinal analyses of early lesions by fluorescence: an observational study

Validity assessment of a third-generation light-induced fluorescence device in detecting proximal and occlusal caries lesions: A cross-sectional study

OBJECTIVES

The objective of this study was to evaluate the efficacy of a quantitative light-induced fluorescence (QLF) device (QrayCam Pro, AIOBIO, Seoul, Republic of Korea) in detecting and differentiating the severity of posterior proximal and occlusal primary caries.

MATERIALS AND METHODS

The study included a total of 120 teeth in 60 patients (of both genders, aged between 21 and 38 years) between January and March 2024, one carious tooth and one sound tooth were selected at random in each patient. All occlusal surfaces were evaluated in accordance with the International Caries Detection and Assessment System (ICDAS) Nyvad Criteria, using the visual tactile method. The ICDAS employs a scoring system ranging from 0 to 6, while the Nyvad Criteria employs a similar scoring system. Addionally, the depth of the proximal lesions was scored (0-6) using bite-wing radiography. The quantitative values representing the maximum loss of fluorescence (∆Fmax) and the maximum change in the ratio of red and green fluorescence (∆Rmax) were obtained using the Q-ray Clinical software v 1.45. To assess the validity, the sensitivity, specificity, and area under the receiver operating characteristics curve (AUROC) were calculated. Spearman correlation coefficient was used to investigate the correlation between the findings of the traditional and QLF examination methods.

RESULTS

The AUROC values for both ∆Fmax and ∆Rmax were found to be excellent. The sensitivity of QrayCam Pro was found to be 84-88.6%, while the specificity was 100%. The correlation analysis demonstrated a strong correlation between scores obtained from the traditional examination and the QLF values.

CONCLUSIONS

Based on the findings of this study, QrayCam Pro exhibits potential as a valuable additional tool for not only detecting caries but also for assessing their severity and activity.

CLINICAL RELEVANCE

This study revealed that QrayCam Pro might be suggested as a precise tool for enhancing caries detection and assessment compared to traditional methods. By providing quantitative data on caries severity and activity, it enables more informed treatment decisions, potentially optimizing outcomes for patients.

Diagnostic agreement between visual examination and an automated scanner system with fluorescence for detecting and classifying occlusal carious lesions in primary teeth

OBJECTIVES

To investigate the in vivo diagnostic agreement between visual examination (VE) using the International Caries Detection and Assessment System (ICDAS) and an automated scanner system for detecting and classifying carious lesions in primary teeth.

METHODS

5-year-old children (n = 216) underwent VE and intraoral scanning (TRIOS 4, 3Shape TRIOS A/S, Copenhagen, Denmark). Dental caries experience was recorded for each tooth surface using ICDAS. An automated, fluorescence-based caries scoring system was applied to eligible primary teeth occlusal surfaces on the 3D models using commercially available software. The automated system classified surfaces as sound, initial caries (ICDAS 01/02), or moderate-extensive caries (ICDAS ≥03). The diagnostic agreement was investigated using multi-level modelling and intraclass correlation coefficients. Analyses were repeated at both the initial threshold (ICDAS ≥01) and the moderate-extensive threshold (ICDAS ≥03).

RESULTS

213 participants were included in the study, and 1525 primary molar occlusal surfaces were included in the analysis. The odds of detecting caries using the automated system were 46 % lower at the initial disease threshold (OR 0.54, 95 % CI 0.39-0.74) and 70 % lower at the moderate-extensive disease threshold (OR 0.30, 95 % CI 0.16-0.58) compared to VE. The intraclass correlation estimates at the initial and moderate-extensive thresholds were 0.90 (95 % CI 0.70-0.96) and 0.76 (95 % CI 0.22-0.94) respectively.

CONCLUSION

The automated system is less likely to detect initial lesions and is more likely to underestimate lesion severity relative to visual examination using ICDAS.

CLINICAL SIGNIFICANCE

Clinically, using the automated tool to replace thorough visual inspection in primary teeth could result in missed opportunities to provide professional or self-care to arrest or reverse early disease. Additionally, it could misclassify moderate lesions as initial caries, potentially leading to complications associated with the delayed management of dental caries.

Detection of pit and fissure sealant microleakage using quantitative light-induced fluorescence technology: an in vitro study

This in vitro study aimed to evaluate the feasibility of quantitative light-induced fluorescence (QLF) technology for detecting the presence and severity of microleakage of pit and fissure sealants. The areas of interest (AOIs) were 160 pits and fissures of 40 extracted permanent teeth. Fluorescent images were acquired using a QLF device, and the maximum fluorescence loss ΔFmax of each AOI was analyzed. After staining and cross-sectioning of the teeth, histological dye penetration was scored on a scale of 0 to 3. The relationship between ΔFmax and microleakage depth was analyzed, and the areas under the curve (AUCs) were calculated. The │ΔFmax│ increased as microleakage depth increased. The ΔFmax values of microleakage areas showed a strong significant correlation with the histological scores of dye penetration (r = - 0.72, P = 0.001). AUC analysis showed a high diagnostic accuracy for microleakage depth (AUC = 0.83-0.91). The highest AUC of 0.91 was found when differentiating the outer half microleakage of the sealant (histological score 0 vs. 1-3). QLF technology is effective in assessing the presence and severity of microleakage, suggesting its potential for noninvasive detection and monitoring of sealant microleakage in clinical settings.

Occlusal caries detection and monitoring using a 3D intraoral scanner system. An in vivo assessment

OBJECTIVE

To assess the agreement in detecting and monitoring occlusal caries over thirty months using conventional visual and radiographic assessment and an intraoral scanner system which supports automated caries scoring.

METHODS

Ninety-one young participants aged 12-19 years were included in the study. All occlusal surfaces were examined visually, radiographically (when indicated), and scanned with the TRIOS 4 intraoral scanner. TRIOS Patient Monitoring software (vers. 2.3, 3Shape TRIOS A/S, Denmark) was used for automated caries detection on the 3D digital models.

RESULTS

Fifty-five of the study participants were re-examined after 30-months. Significant differences regarding caries detection were found between the conventional methods and the automated caries scoring system (p < 0.01), with moderate positive percent agreement (49-61%) and high negative percent agreement (87-98%). All methods reported significant caries progression over the follow-up period (p < 0.01). However, the automated system showed significantly more caries progression than the other methods (p < 0.01).

CONCLUSIONS

The software for automated caries detection and classification showed moderate positive agreement and strong negative agreement with the conventional methods considering both the baseline and the follow-up assessments. The automated caries scoring system detected significantly fewer caries lesions and tended to underestimate the caries severity. All methods indicated significant caries progression over the follow-up period, while the automated system detected more caries progression.

CLINICAL SIGNIFICANCE

The TRIOS system supporting automated occlusal caries detection and classification can assist in detecting and monitoring occlusal caries on permanent teeth as a complementary tool to the conventional methods. However, the operator should be aware that the automated system shows a tendency to underestimate the caries presence and lesion severity.

Diagnostic Validity in Occlusal Caries Detection of ICDAS II, DIAGNOdent, Radiography and a Combination of the Three Methods: An In Vitro Study

In this study, we compare the efficacy and diagnostic concordance of the ICDAS, the radiographic criterion and the instrument known as the DIAGNOdent fluorescence laser pen on occlusal caries lesions using a histological section as the gold standard. Of 100 teeth that did not present cavitated occlusal lesions or occlusal fillings, 80 were chosen through a randomization program and examined by two previously trained and calibrated researchers. Subsequently, the teeth were sectioned with a diamond disk and observed under an optical microscope. The results were studied for caries with a limit established in enamel and caries with extension to dentin. The intra-examiner (0.821–0.933) and inter-examiner (0.817–0.924) reproducibility obtained for both ICDAS and DIAGNOdent for the diagnosis of borderline enamel caries was high. Similarly, intra-examiner (0.686–1.000) and inter-examiner (0.809–0.944) reproducibility for diagnosis of caries with dentin extension was also high for both methods. The sensitivity obtained was 0.76 (ICDAS), 0.87 (DIAGNOdent) and 0.58 (Rx), whereas the specificity obtained was 0.66 (ICDAS), 0.4 (DIAGNOdent) and 0.77 (Rx) for lesions limited to enamel. For lesions with extension to dentin, the sensitivity obtained was 0.73 (ICDAS), 0.82 (DIAGNOdent) and 0.09 (Rx), and the specificity obtained was 0.79 (ICDAS), 0.52 (DIAGNOdent) and 0.97 (Rx). Sensitivity increases in both cases by combining diagnostic methods. In conclusion, ICDAS and DIAGNOdent are better diagnostic methods than Rx for the detection of occlusal caries, and the combination of these methods helps to obtain a better diagnosis.

Detection of Dental Caries and Cracks with Quantitative Light-Induced Fluorescence in Comparison to Radiographic and Visual Examination: A Retrospective Case Study

The aim of this study was to present an optimal diagnostic protocol by comparing and analyzing a conventional examination and the quantitative light-induced fluorescence (QLF) technique. Selected were 297 teeth of 153 patients to take QLF images and bitewing radiographs. Occlusal dental caries, proximal dental caries and cracks were evaluated and scored using QLF, X-ray and/or visual criteria. The sensitivity, specificity, and area under the curve (AUC) of a receiver operating characteristic analysis were calculated. Two fluorescence parameters (|ΔFmax| and ΔRmax) were utilized to evaluate the fluorescence pattern according to the severity of lesions based on QLF or X-ray criteria. QLF showed higher scores for detecting occlusal dental caries and cracks than the conventional method. ΔRmax increased more clearly than ΔFmax did with occlusal dental caries. The |ΔFmax| values of occlusal dental caries, proximal dental caries and cracks showed good AUC levels (0.84, 0.81 and 0.83, respectively). The ΔRmax of occlusal dental caries showed the highest AUC (0.91) and the ΔRmax of proximal dental caries showed a fail level (0.59) compared to bitewing radiographs. The QLF image could visualize and estimate the degree of occlusal dental caries or cracks. Consequently, the QLF technique may be an adjunct tool to conventional methods for the detection of occlusal caries and peripheral cracks.

Monitoring enamel caries on resin-treated occlusal surfaces using quantitative light-induced fluorescence: an in vitro study

The aim of this study is to evaluate the ability of quantitative light-induced fluorescence (QLF) to monitor enamel caries lesions of different severity stages located on the occlusal surfaces of permanent teeth before and after treatment with resin infiltrant. Sixty extracted permanent teeth had one occlusal site selected and were categorized according to the International Caries Detection and Assessment System (ICDAS) criteria. The teeth were divided into three groups (n = 20): ICDAS 1, ICDAS 2, and ICDAS 3. The teeth were assessed by a trained examiner using QLF in two phases: (A) before and (B) after treatment with resin infiltrant. The caries lesions were evaluated using the following QLF parameters: area (mm²); ΔF, fluorescence loss (%); and ΔQ, fluorescence loss integrated over the lesion area (%*mm²). The resin infiltrant (Icon™) was applied on the occlusal surface following the manufacturer's recommendations. The teeth were then sectioned and prepared for polarized light microscopy analysis. The penetration of resin infiltrant was measured with ImageJ. The groups showed a statistically significant difference in all QLF parameters before and after caries infiltration, with the reduction of fluorescence values posttreatment (p < 0.05). Infiltrant penetration was observed in all groups, with a statistical difference between all groups (p < 0.05). The reduction in QLF parameters after resin infiltration suggests that QLF is able to monitor enamel caries lesions of different severity stages located on the occlusal surfaces of permanent teeth before and after treatment with resin infiltrant.

Photoinhibition of Streptococcus mutans Biofilm-Induced Lesions in Human Dentin by Violet-Blue Light

This in vitro study determined the effectiveness of violet-blue light on Streptococcus mutans (UA159) biofilm induced dentinal lesions. Biofilm was formed on human dentin specimens in a 96-well microtiter plate and incubated for 13 h in the presence of tryptic soy broth (TSB) or TSB supplemented with 1% sucrose (TSBS). Violet-blue light (405 nm) from quantitative light-induced fluorescence (QLF^TM) was used to irradiate the biofilm. Supernatant liquid was removed, and the biofilm was irradiated continuously with QLF for 5 min twice daily with an interval of 6 h for 5 d, except with one treatment on the final day. Colony forming units (CFU) of the treated biofilm, changes in fluorescence (∆F; QLF-Digital Biluminator^TM), lesion depth (L), and integrated mineral loss (∆Z; both transverse microradiography) were quantified at the end of the fifth day. Statistical analysis used analysis of variance (ANOVA), testing at a 5% significance level. In the violet-blue light irradiated groups, there was a significant reduction (p < 0.05) of bacterial viability (CFU) of S. mutans with TSB and TSBS. Violet-blue light irradiation resulted in the reduction of ∆F and L of the dentinal surface with TSBS. These results indicate that violet-blue light has the capacity to reduce S. mutans cell numbers.

A Changeable Lab-on-a-Chip Detector for Marine Nonindigenous Microorganisms in Ship's Ballast Water

The spread and invasion of many nonindigenous species in the ship's ballast water around the world has been a hazard and threat to ecology, economy, and human health. The rapid and accurate detection of marine invasive species in ship's ballast water is essential. This article is aimed at analysing ballast water quality by means of a changeable microfluidic chip detector thus comply with the D-2 standard of ship's ballast water management and sediment convention. The detection system was designed through the integration of microfluidic chip technology, the impedance pulse sensing and LED light induced chlorophyll fluorescence (LED-LICF) detection. This system can measure the number, size, shape, and volume of targeted microorganisms, and it can also determine the chlorophyll fluorescence intensity, which is an important factor in analysing the activity of phytoplankton. The targeted samples were Chlorella volutis, Dunaliella salina, Platymonas subcordiformis, Chrysophytes, Escherichia coli, and Enterococci. The whole detection or operation can be accomplished through online detection in a few minutes with using micron volume of the sample solution. The valid data outputs are simultaneously displayed in terms of both impedance pulse amplitudes and fluorescent intensity signals. The detection system is designed for multi-sizes real time detection through changing the microchannel sizes on the microfluidic chip. Because it can successfully detect the label-free microorganisms, the system can be applicable to in-situ detections with some modifications to the system.

Pilot clinical study to assess caries lesion activity using quantitative light-induced fluorescence during dehydration

This study aimed to evaluate the ability of quantitative light-induced fluorescence (QLF) to assess caries lesion activity using visual examination (VE) as the gold standard. Twenty-four visible white spot lesions on buccal surfaces were examined from 23 children, ages 9 to 14 years. At baseline, the surface was hydrated with water, and thereafter, it was dehydrated with continuous compressed air during image acquisition. QLF images were acquired at 0 (baseline), 5, and 15 s. QLF variables [ QLF V : fluorescence loss ( ? F ), lesion size (S), ? Q : ? F × S ] was recorded. Changes-in- QLF V per second ( ? QLF V ) were determined: ? QLF V = ( QLF VN ? QLF V Baseline ) / N , where N indicates dehydration time. One experienced dentist conducted VE independently using a dental unit’s light, compressed air, and explorer.

The Oral Microbiome of Children: Development, Disease, and Implications Beyond Oral Health

In the era of applied meta-omics and personalized medicine, the oral microbiome is a valuable asset. From biomarker discovery to being a powerful source of therapeutic targets and to presenting an opportunity for developing non-invasive approaches to health care, it has become clear that oral microbes may hold the answer for understanding disease, even beyond the oral cavity. Although our understanding of oral microbiome diversity has come a long way in the past 50 years, there are still many areas that need to be fine-tuned for better risk assessment and diagnosis, especially in early developmental stages of human life. Here, we discuss the factors that impact development of the oral microbiome and explore oral markers of disease, with a focus on the early oral cavity. Our ultimate goal is to put different experimental and methodological views into perspective for better assessment of early oral and systemic disease at an early age and discuss how oral microbiomes-at the community level-could provide improved assessment in individuals and populations at risk.

Use of a fluorescence-based camera for monitoring occlusal surfaces of primary and permanent teeth

BACKGROUND

Sound teeth and incipient lesions require regular monitoring to detect possible progression of caries early on.

AIM

To evaluate the ability of the VistaProof (VP) fluorescence-based camera for monitoring occlusal surfaces.

DESIGN

A total of 419 posterior teeth (205 primary molars, 145 permanent molars, and 69 premolars) of 35 patients were examined (average age: 9.1 years). The occlusal surfaces were classified visually according to the criteria of the International Caries Detection and Assessment System (ICDAS). VP measurements were performed at baseline (t1), and the examinations were repeated after six (t2) and twelve month (t3). Correlation between methods was calculated using Spearman's rank correlation coefficient (r_s ). Wilcoxon test was used to monitor whether VP identified changes as well as ICDAS (α = 0.05).

RESULTS

Correlations between ICDAS and VP were significantly positive (r_s : 0.66-0.73, P < 0.001). No significant differences were found between all times for the ICDAS findings. Significant differences for the VP were ascertained for t1/t2 (P = 0.03). Results based on cluster randomization showed significant differences between ICDAS and VistaProof concerning the absence/presence of changes in the finding (P < 0.0005).

CONCLUSION

Correlation between ICDAS and VP was strong. The VP supported the findings of visual examination for monitoring occlusal surfaces, although not all changes could be detected with respect to the visual findings.

Orange/Red Fluorescence of Active Caries by Retrospective Quantitative Light-Induced Fluorescence Image Analysis

This retrospective clinical study determined the association of caries activity and orange/red fluorescence on quantitative light-induced fluorescence (QLF) images of surfaces that progressed to cavitation, as determined by clinical visual examination. A random sample of QLF images from 565 children (5-13 years) previously enrolled in a longitudinal study was selected. Buccal, lingual and occlusal surface images obtained after professional brushing at baseline and every 4 months over a 4-year period were analyzed for red fluorescence. Surfaces that progressed (n = 224) to cavitation according to the International Caries Detection and Assessment System (ICDAS 0/1/2/3/4 to 5/6 or filling), and surfaces that did not progress (n = 486) were included. QA2 image analysis software outputs the percentage increase of the red/green components as x0394;R and area of x0394;R (areax0394;R) at different thresholds. Mixed-model ANOVA was used to compare progressive and nonprogressive surfaces to account for correlations of red fluorescence (x0394;R and areax0394;R) between surfaces within a subject. The first analysis used the first observation for each surface or the first available visit if the surface was unerupted (baseline), while the second analysis used the last observation prior to cavitation for surfaces that progressed and the last observation for surfaces that did not progress (final). There was a significant (p < 0.05) association between red fluorescence and progression to cavitation at thresholds x0394;R0, x0394;R10, x0394;R20, x0394;R60, x0394;R70, x0394;R80, x0394;R90 and x0394;Rmax at baseline and for x0394;R0 and x0394;R10 at the final observation. Quantification of orange/red fluorescence may help to identify lesions that progress to cavitation. Future studies identifying microbiological factors causing orange/ red fluorescence and its caries activity are indicated.

Predicting Dental Caries Outcomes in Children: A "Risky" Concept

In recent years, unprecedented gains in the understanding of the biology and mechanisms underlying human health and disease have been made. In the domain of oral health, although much remains to be learned, the complex interactions between different systems in play have begun to unravel: host genome, oral microbiome with its transcriptome, proteome and metabolome, and more distal influences, including relevant behaviors and environmental exposures. A reasonable expectation is that this emerging body of knowledge can help improve the oral health and optimize care for individuals and populations. These goals are articulated by the National Institutes of Health as "precision medicine" and the elimination of health disparities. Key processes in these efforts are the discovery of causal factors or mechanistic pathways and the identification of individuals or population segments that are most likely to develop (any or severe forms of) oral disease. This article critically reviews the fundamental concepts of risk assessment and outcome prediction, as they relate to early childhood caries (ECC)-a common complex disease with significant negative impacts on children, their families, and the health system. The article highlights recent work and advances in methods available to estimate caries risk and derive person-level caries propensities. It further discusses the reasons for their limited utility in predicting individual ECC outcomes and informing clinical decision making. Critical issues identified include the misconception of defining dental caries as a tooth or surface-level condition versus a person-level disease; the fallacy of applying population-level parameters to individuals, termed privatization of risk; and the inadequacy of using frequentist versus Bayesian modeling approaches to derive individual disease propensity estimates. The article concludes with the notion that accurate caries risk assessment at the population level and "precision dentistry" at the person level are both desirable and achievable but must be based on high-quality longitudinal data and rigorous methodology.

Detecting Short-Term Changes in the Activity of Caries Lesions with the Aid of New Technologies

This paper discusses the use of new technologies for the assessment of caries and more in particular changes in caries activity. Over the past decades, we have seen a shift from restorative treatment caries to a prevention-driven approach. Also there is a need for shorter and less expensive caries clinical trials. These demand earlier detection of lesions and the monitoring of lesion changes longitudinally in time, which has led to the development of new technologies to aid clinical visual examination. Also clinical visual inspection indices have been refined to fit this purpose. There is a constant flow of technologies emerging and disappearing. This review discusses the merits of recent developments regarding their respective uses for research purposes in testing new caries prevention strategies as well as in clinical caries management in dental private practice. Which technique to choose highly depends on the needed resolution of information.