Use of DIAGNOdent and VistaProof in diagnostic of Pre-Cavitated Caries Lesions-A Systematic Review and Meta-Analysis

Evaluation of the remineralization potential of self-assembling peptide P11-4 with fluoride compared to fluoride varnish in the management of incipient carious lesions: a randomized controlled clinical trial

OBJECTIVES

The present trial's aim was to compare the remineralization potential of self-assembling peptide P11-4 combined with fluoride to that of fluoride varnish.

MATERIALS AND METHODS

Twenty-eight participants with 58 incipient carious lesions were enrolled in the present trial. Participants were randomly divided into two groups with 14 participants and 29 incipient lesions in each group. Patients were assigned either to self-assembling peptide combined with fluoride (Curodont Repair Fluoride Plus™) or sodium fluoride varnish (NaF, Bifluorid 10) groups. Both agents were applied according to the manufacturer's instructions on non-cavitated incipient carious lesions. Lesions were assessed by two calibrated and blinded assessors at baseline, and after one-, three- and six-months using a laser fluorescence device (DIAGNOdent).

RESULTS

Although laser fluorescence scores significantly improved in both groups over time (p < 0.05), no notable differences were evident between both groups at one-month (p > 0.05). Yet, at three- and six-months statistically lower laser fluorescence readings were evident in the self-assembling peptide combined with fluoride group in comparison to the fluoride alone group (p < 0.05). There was 60% less risk for caries progression for Curodont Repair Fluoride Plus™ when compared to NaF varnish after six months. Self-assembling peptide combined with fluoride was able to change 65.5% of non-cavitated carious lesions from DIAGNOdent score 3 (11-20) to score 1 (0-4). Fluoride varnish was able to change 13.8% of the lesions from score 3 to score 1 after six months.

CONCLUSIONS

The self-assembling peptide combined with fluoride varnish showed higher remineralization potential than fluoride varnish alone for incipient carious lesions over a six-months follow up.

CLINICAL RELEVANCE

The combination of self-assembling peptide P11-4 and fluoride could offer a new tool in managing incipient carious lesions.

Use of Digital Diagnostic Aids for Initial Caries Detection: A Review

The advance in digital diagnostic technologies has significantly facilitated the detection of dental caries. Despite the increase in clinically available digital diagnostic aids for dental caries, there is yet to be a comprehensive summary of all available technology. This review aims to provide an overview of digital diagnostic aids for the clinical detection of dental caries, particularly those at an initial stage. Currently available digital diagnostic aids for caries detection can be classified into four categories according to the initial source of energy, including radiation-based aids, light-based aids, ultrasound-based aids, and electric-based aids. Radiation-based aids use ionizing radiation, normally X-ray, to produce images of dental structures. Radiation-based aids encompass digital bitewing radiography and cone beam computed tomography. Light-based aids employ light or laser to induce signals for the detection of the changes in the carious dental hard tissue. Common light-based aids include digital transillumination and light/laser-induced fluorescence. Ultrasound-based aids detect the signal of ultrasound waves to assess the acoustic impedance of the carious teeth. The ultrasound caries detector is an available ultrasound-based aid. Electric-based aids assess the changes in the electric current conductance or impedance of the teeth with caries. Available electric-based aids include electrical conductance measurement and alternating current impedance spectroscopy. Except for these clinically available digital diagnostic aids, many digital diagnostic aids for caries detection are still under development with promising results in laboratory settings.

Development of a Visualisation Approach for Analysing Incipient and Clinically Unrecorded Enamel Fissure Caries Using Laser-Induced Contrast Imaging, MicroRaman Spectroscopy and Biomimetic Composites: A Pilot Study

This pilot study presents a practical approach to detecting and visualising the initial forms of caries that are not clinically registered. The use of a laser-induced contrast visualisation (LICV) technique was shown to provide detection of the originating caries based on the separation of emissions from sound tissue, areas with destroyed tissue and regions of bacterial invasion. Adding microRaman spectroscopy to the measuring system enables reliable detection of the transformation of the organic–mineral component in the dental tissue and the spread of bacterial microflora in the affected region. Further laboratory and clinical studies of the comprehensive use of LICV and microRaman spectroscopy enable data extension on the application of this approach for accurate determination of the boundaries in the changed dental tissue as a result of initial caries. The obtained data has the potential to develop an effective preventive medical diagnostic approach and as a result, further personalised medical treatment can be specified.

A comprehensive review on LED-induced fluorescence in diagnostic pathology

Sensitivity, specificity, mobility, and affordability are important criteria to consider for developing diagnostic instruments in common use. Fluorescence spectroscopy has been demonstrating substantial potential in the clinical diagnosis of diseases and evaluating the underlying causes of pathogenesis. A higher degree of device integration with appropriate sensitivity and reasonable cost would further boost the value of the fluorescence techniques in clinical diagnosis and aid in the reduction of healthcare expenses, which is a key economic concern in emerging markets. Light-emitting diodes (LEDs), which are inexpensive and smaller are attractive alternatives to conventional excitation sources in fluorescence spectroscopy, are gaining a lot of momentum in the development of affordable, compact analytical instruments of clinical relevance. The commercial availability of a broad range of LED wavelengths (255-4600 nm) has opened up new avenues for targeting a wide range of clinically significant molecules (both endogenous and exogenous), thereby diagnosing a range of clinical illnesses. As a result, we have specifically examined the uses of LED-induced fluorescence (LED-IF) in preclinical and clinical evaluations of pathological conditions, considering the present advancements in the field.

An Experimental and Clinically Controlled Study of the Prevention of Dental Caries Using 1.23% Fluoride Gel in Elderly Patients

AIM

To describe the enamel and dentin fluoride mineralization process in practical application and assess the fluoride gel (NaF 1.23%) effectiveness in dental caries prevention for elderly patients.

MATERIALS AND METHODS

Two different types of study were applied: (a) experimental study of fluoride mineralization of enamel and dentin in vitro; (b) clinical controlled interventional studies of the effectiveness in dental caries prevention using 1.23% fluoride gel. Experimental research was performed in laboratory conditions. Teeth of the elderly extracted due to dental diseases served as research objects. Enamel surface and dental root surface were examined under a scanning electron microscope (SEM) before and after demineralization with 37% phosphoric acid within 15 s, as well as after remineralization with toothpaste and 1.23% fluoride gel. Controlled clinical research included 218 older people divided into two groups (intervention group, n = 106; control group, n = 112). In the intervention group, the application of the gel lasts 4 min in the morning for 18 months. The control group received adult P/S toothpaste and a P/S toothbrush. The DIAGNOdent device was used to assess damage both before and after demineralization. For the clinical evaluation of dental caries, international caries detection and assessment system (ICDAS) has been used. Decay missing-filled index (DMFT), effective index (Ef-I), and intervention index (In-I) were determined. Statistical data were analyzed using Mann-Whitney U test and χ2 test. Differences were considered significant at P < 0.05.

RESULTS

An SEM image of the enamel surface and dental root surface after teeth remineralization with fluoride gel shows a hard enamel surface without cracks, even in color and structure. After brushing with toothpaste, numerous cracks remain on the surface of the enamel, and the surface layer of the enamel with a depth of 9.64 microns remains damaged without remineralization. After 18 months of intervention, the rate of dental caries in the control group increased from 42.1% to 68.8%, and in the intervention group it increased from 30.8% to 17.0%. A comparison of the 1.23% fluoride gel with toothpaste shows that the former exhibits performance in protecting teeth from decay and it is 108.2% more effective than the latter.

CONCLUSIONS

Practical experiments proved the function of remineralizing the enamel and dentin of 1.23% fluoride gel on the teeth of the elderly. Intervention research has proven the performance of preventing dental decay from 1.23% fluoride gel for the elderly in question.

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.

Use of optical fluorescence for the diagnosis of dental biofilm in young permanent molars - A case series

BACKGROUND

Fluorescence appears clearly in oral biofilm in red tones, showing the presence of microorganisms in regions where there is biofilm accumulation. This study aims to evaluate the applicability and effectiveness of the diagnosis of oral biofilm with the optical fluorescence technique using the EVINCE (Evidenciador Clínico - MMOptics, São Carlos, SP, Brazil) equipment. Furthermore, to compare the efficacy of the optical fluorescence diagnostic method with the traditional method of clinical disclosure of Fuchsin-based dye biofilm and to observe their combined use.

METHODS

Sixteen children, aged between 7 and 12, were included in this case series, following the Oral Hygiene Index - Simplificated (OHI-S) evaluation. They were evaluated by 3 different professionals. The 1 st evaluator checked the OHI-S observing only with EVINCE. In the second stage, a 2nd evaluator performed the traditional disclosure technique with Fucsina, and finally a 3rd evaluator who observed with EVINCE the teeth previously stained in stage 2, combining the two methods. Descriptive analysis of the variables was performed and comparative tests of repeated measures to evaluate differences between the results of the three evaluation methodologies.

RESULTS

There is no significant difference between the observation made only with EVINCE and with the traditional methodology of plaque disclosure. However, there is a difference when the two techniques are used in the third evaluation moment, showing that the combination could provide better results.

CONCLUSIONS

The association of both the conventional method and the use of EVINCE showed a very satisfactory result for the diagnosis of the presence of biofilm.

Use of the ozonation method in treating dentin caries in children’s permanent teeth

Relevance. Permanent teeth carious involvement starts from their eruption in children aged 5-6 years. Hard tissues mineralization in permanent teeth lasts long. Nowadays, efficacy of combined applying calcium containing drugs and the ozonation method while treating permanent teeth caries in children with incompleted processes of dental hard tissues mineralization has not been revealed.

Purpose. Increasing effectiveness of dentin caries treatment of children's permanent teeth with incompleted mineralization processes in dental hard tissues.

Materials and methods. There were carried out clinical and laboratory examinations and treatment of 41 children (aged 6-14). They had dentin caries in permanent teeth with incompleted mineralization processes in hard tissues .In 2 groups studied carious cavities were treated mechanically and medically and afterwards the dentin density measurement was made by the method of fluorecent analysis using DIAGNOdent apparatus. The mineralization degree of clinically intact dentin having been determined, in Group 1 Dycal paste and a hermetic temporary filling of glass ionomer cement were placed onto the floor of carious cavities. In Group 2 carious cavities were treated mechanically and medically and then ozonized during 30 seconds with Kavo - HealOzone apparatus followed by application of Dycal paste onto the floor of carious cavities and temporary filling with glass ionomer cement. Three months later, the temporary filling material and Dycal paste were removed out of the children's teeth in both groups and measuring mineralization degree of the clinically intact dentin was made again.

Results. Dentin mineralization increase in Group 1 showed 33,9% following delayed filling technique. In Group 2 the ozonation method promoted the increase by 54,9%.

Conclusions. Carious cavitiies ozonation before applying calcium containing material favours higher mineralization degree (by 21%).