Laser fluorescence assessment of dental caries arrest with two silver fluoride agents in patients with special needs- a preliminary report

PURPOSE

While silver diamine fluoride has been used extensively for caries arrest and desensitising, silver fluoride (AgF) at neutral pH may also have value as a minimally invasive dental caries treatment. This study explored the effectiveness of two AgF products (AgF/KI and AgF/SnF2) when used in adult patients with special needs (SN) who had high caries risk and salivary gland hypofunction.

METHODS

This split-mouth clinical study, over two appointments 3-months apart, compared the impact of a single application of AgF/KI (Riva Star Aqua, SDI) and AgF/SnF2 (Creighton Dental CSDS, Whiteley) on matched carious lesions in the same arch, by clinical visual-tactile (cVT) assessment of caries status and laser fluorescence (LF, DIAGNOdent) evaluation of bacterial load in the lesions, using repeated measures analysis.

RESULTS

Twelve participants were recruited in the study. A total of 56 teeth (28 pairs) were included. Both AgF products gave a significant decrease in caries activity as measured by cVT (P < 0.0001) and LF (P = 0.0027). There were no statistically significant differences between the two AgF treatments, with response rates for improvements in active lesions of 92% in the AgF/KI arm, and 96% in the AgF/SnF2 arm. There was no effect of tooth type, lesion type, arch type, plaque metabolism and plaque area at the site level on outcomes, nor was there a clustering effect of sites in a patient level analysis. Overall, LF was superior to cVT for detecting lesions that still progressed despite treatment (P = 0.0027).

CONCLUSION

A single application of AgF/KI or AgF/SnF2 has high predictability (over 90%) for achieving arrest in active caries lesions in adult patients with SN and high caries risk. Clinical assessment should use visual-tactile examination combined with LF readings to detect lesions that are still progressing and that require additional treatments. Future studies should compare these AgF modalities with SDF and explore factors such as time between applications and the need for repeated applications.

TRIAL REGISTRATION

The study was registered with the Australian Clinical Trials Registry (ACTRN12621001139864p) on 23/08/2021.

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

Aim

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

Settings and Design

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

Materials and Methods

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

Statistical Analysis

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

Results

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

Conclusions

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

Evaluation of the Demineralization Development around Different Types of Orthodontic Brackets

The aim of this study was to compare the demineralizations of the enamel surfaces around different types of orthodontic brackets in an artificial cariogenic environment. A total of 90 extracted human maxillary first premolar teeth were used in this in vitro study. The teeth were divided into 6 groups, 5 study and 1 control, each consisting of 15 samples. Victory metal, Gemini metal, Clarity self-ligating ceramic, APC Clarity Advanced ceramic and Clarity Advanced ceramic brackets (3M Unitek, Monrovia, Calif) used in the study groups were bonded to the teeth with the direct technique. The gingival, occlusal and proximal enamel surfaces adjacent to the brackets were measured with a DIAGNOdent pen (KaVo, Biberach, Germany) (T0). Then, the teeth were placed in a cariogenic suspension environment containing Streptococcus mutans, sucrose and artificial saliva. The teeth were removed from the cariogenic suspension at the end of 28 days. Enamel surfaces were remeasured with DIAGNOdent and the values were recorded (T1). Whether the obtained data were homogeneously distributed or not was determined by the Kolmogorov-Smirnov test, within-group comparisons were performed with the Wilcoxon test, and between-group comparisons were performed with Mann-Whitney U and Kruskal-Wallis tests. Significance level was accepted as p < 0.05. In all groups, the demineralization values of the enamel surfaces in the gingival, proximal and occlusal surfaces adjacent to the brackets were significantly higher in the T1 period than in the T0 period (p < 0.05). In the T1 period of Gemini metal, Clarity self-ligating ceramic and Clarity advanced ceramic bracket groups, the demineralization values of the proximal enamel surfaces were found to be significantly higher than the Victory metal and APC Clarity Advanced ceramic bracket groups (p < 0.05). In the T1 period, the demineralization values of the occlusal enamel surfaces of the Victory metal, APC Clarity Advanced ceramic bracket groups and control group were significantly lower than the Gemini metal, Clarity self-ligating ceramic and Clarity Advanced ceramic bracket groups (p < 0.05). Significant increases in enamel demineralization values were observed as a consequence of increased retention areas for microbial dental plaque on enamel surfaces adjacent to the bracket. Considering the importance of minimizing enamel demineralization in fixed orthodontic treatments, less enamel demineralization in Victory metal and APC Clarity Advanced ceramic bracket groups showed that these brackets can be preferred in patients with poor oral hygiene.

Evaluation of tooth demineralization using laser-fluorescence in dental school patients undergoing orthodontic treatment: A clinical study

BACKGROUND

Adverse effects can occur during orthodontic treatment.

OBJECTIVE

To evaluate the relationship between prevalence and severity of enamel demineralization using a laser-fluorescence device, with length of orthodontic treatment time.

METHOD

A cross-sectional study was conducted in 60 patients in a university orthodontic clinic. A clinical examination to establish demineralization at four sites on each tooth (premolar to premolar) was performed using the DIAGNOdent pen. The dependent variable was enamel demineralization, from which the prevalence (at least one affected site), extension (percentage of affected teeth) and adjusted average (average of the mean DIAGNOdent values per tooth) were calculated. The length of time for orthodontic treatment was determined in months. Various sociodemographic and clinical covariates were included.

RESULTS

Average number of months under orthodontic treatment was 26.37 ± 24.81 months. Prevalence of enamel demineralization was 80.0%, its extension was 21.9% ± 17.2 and adjusted average of DIAGNOdent values was 6.09 ± 1.75. By quadrant, the teeth most affected were 14 (34.4%), 24 (25.0%), 31 (30.2%) and 44 (33.3%). No significant relationship (p> 0.05) was observed between enamel demineralization and length of time under orthodontic treatment.

CONCLUSIONS

A high prevalence of dental demineralization was observed. In this sample, no relationship was observed between months under treatment and dental demineralization, or with other variables included in the study.

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.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Quantification of sugar intake and mineralization of teeth in 13-15-year-old subjects - A pilot study

BACKGROUND

Dental caries begins with the initiation of demineralization which is a reversible process. Diet, especially intake of sugar, is an important aetiological factor for demineralization of enamel which eventually leads to caries.

AIM

This study aims to understand the quantitative relationship between sugar consumption and mineralization by finding out the change in mineralization of teeth as a result of the change in the sugar score.

SETTINGS AND DESIGN

This interventional study was done among 119 teeth of 19 subjects who were between the ages of 13-15 years in Hubli city.

MATERIALS AND METHODS

Sugar score was calculated from a 5-day diet history of the subjects and a DIAGNOdent pen was used to indicate the mineralization value of the teeth before the intervention. Diet counseling was given as an intervention after which sugar score and DIAGNOdent scores were measured again after 14 days and compared with the baseline values.

STATISTICAL ANALYSIS

Descriptive statistics and a linear regression analysis was done to determine the relationship between the variables.

RESULTS

Sugar score and DIAGNOdent score after 14 days were found to have reduced significantly by 41.6% and 20.3% respectively from the baseline values. The Linear Regression indicated that a reduction of sugar score by 5 resulted in a decrease of DIAGNOdent score by 0.16.

CONCLUSION

The findings of the present study suggest that the modification of sugar consumption brought about a significant improvement in the mineralization of the demineralized teeth thus making diet counseling an effective preventive strategy for caries prevention.

Comparative Evaluation of Two Remineralizing Agents on Artificial Carious Lesion Using DIAGNOdent

Purpose

The current in vitro study was conducted to assess the remineralization potential of CPP-ACP and a customized dentifrice (tricalcium-phosphate) on artificial carious lesions using DIAGNOdent.

Materials and methods

Fifty-one extracted premolars that satisfied the inclusion criteria were painted using acid-resistant nail varnish. A window of 4 × 4 mm was exposed on the center of the buccal surface of each tooth. After 20 minutes of drying, the baseline reading of enamel specimens was assessed using DIAGNOdent. The teeth were then immersed in a bath of demineralizing solution. An incubation period of 96 hours at 37°C resulted in artificial caries-like lesions on the specimen. Readings of the specimen within the window after demineralization were recorded using DIAGNOdent for all the samples. The specimens were divided into three groups randomly [group I—casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), group II—customized dentifrice, group III—artificial saliva]. Samples were subjected to the daily treatment regimen for a period of 30 days. The samples were evaluated for remineralization by laser fluorescent device (DIAGNOdent) on the 15th and 30th day, respectively.

Results

The statistical analysis was done using the Friedman test, Kruskal–Wallis test, Wilcoxon sign rank test, and Mann–Whitney test. The results showed that both CPP-ACP and customized dentifrice showed almost similar remineralization potential but CPP-ACP showed significant remineralization (p < 0.001).

Conclusion

The DIAGNOdent observation conclusively proves that CPP-ACP and customized dentifrice remineralizes the demineralized tooth samples in vitro with CPP-ACP showing significant remineralization.

How to cite this article

Arjun DS, Bhat SS, Hegde SK, et al. Comparative Evaluation of Two Remineralizing Agents on Artificial Carious Lesion Using DIAGNOdent. Int J Clin Pediatr Dent 2021;14(2):192–195.

Effect of different remineralizing agents on the initial carious lesions - A comparative study

Objectives

This study aimed to assess and compare the effectiveness of three different remineralizing agents (Tricalcium phosphate paste, Fluoride varnish, and Nano-hydroxyapatite gel) using the DIAGNOdent device.

Material and Methods

The present clinical study was carried out on 90 initial carious lesions detected by ICDAS caries diagnostic criteria and then take the baseline record by DIAGNOdent device. The selected initial carious lesions were randomly classified into three groups according to treatment modalities (30 lesions in each group) according to remineralizing agents: group A (TCP), group B (fluoride varnish) and group C (nano-hydroxyapatite gel). The remineralizing agents were applied for four minutes once weekly for four weeks. At the fifth week, the DIAGNOdent scores of initial carious lesions were recorded to evaluate the effect of remineralizing agents. A paired t-test was used to compare between baseline date and follow up of DIAGNOdent scores. A one-way ANOVA test was used to compare DIAGNOdent scores among the three groups. Post- Hoc Tukey test was used to determine the significant difference between every two groups.

Results

There were statistically significant differences among the three groups at follow up (p = 0.001). Within each group, there was a significant difference between baseline and follow up scores (p = 0.000 for the three groups). Multiple comparisons between every two groups showed a highly statistically significant difference at follow up records between nano-hydroxyapatite versus TCP and fluoride varnish on pit and fissure caries (p = 0.039 and p = 0.007 respectively) and the nano-hydroxyapatite was the best of them.

Conclusion

The present study concluded that the three remineralizing agents were effective in the treatment of initial carious lesion and the most effective remineralizing agent was nano-hydroxyapatite.

A Comparative Evaluation of Remineralizing Potential of Three Commercially Available Remineralizing Agents: An In Vitro Study

Aim

An in vitro study to evaluate and compare the remineralization potential of commercially available remineralizing agents containing silver diamine fluoride (SDF), casein sucrose phosphate (CSP), casein phospho peptide-amorphous calcium phosphate (CPP-ACP) using DIAGNOdent.

Materials and methods

Thirty freshly extracted premolars for orthodontic treatment were collected. Specimens were randomly divided into 3 groups of 10 each: group I: SDF, group II: CSP, group III: CPP-ACP. The samples were subjected to DIAGNOdent analysis for recording the baseline values. Specimens were placed in demineralizing solution incubated at 37°C for 72 hours. DIAGNOdent values were recorded after demineralization. Following this, remineralization procedure was carried out using 3 different remineralizing agents: group I samples with SDF, group II with CSP, and group III with CPP-ACP. The remineralization procedure was performed to group I once and repeated for 14 days for group II and group III and storage solution was changed every 24 hours. The samples were subjected to DIAGNOdent analysis after 72 hours, 7 days, and 14 days and values were recorded.

Results

The data were analysed using Statistical Package for the Social Sciences (SPSS) with analysis of variance (ANOVA) and post hoc test. Intragroup comparison of DIAGNOdent readings showed a highly significant difference between baseline, postdemineralization, and postremineralization values. Among intergroup comparison, SDF showed maximum remineralization values followed by CSP and CPP-ACP, respectively.

Conclusion

Silver diamine fluoride, CSP, and CPP-ACP are proven to possess remineralization potential.

Clinical significance

A comparative evaluation of these three remineralizing agents will aid in identifying most potent and effective agent in treating initial caries lesions in an effective noninvasive and child-friendly manner.

How to cite this article

Vinod D, Gopalakrishnan A, Subramani SM, et al. A Comparative Evaluation of Remineralizing Potential of Three Commercially Available Remineralizing Agents: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(1):61–65.

Spectral characteristics of caries autofluorescence obtained from different locations and caries severities

Dental caries usually occurs at interproximal and occlusal surfaces. The purpose of the present study was to determine if characteristic spectral factors extracted from autofluorescence (AF) spectra are informative regarding caries detection and the determination of caries stage as compared with DIAGNOdent results. AF spectra were obtained from caries lesions of different severities at two locations using a 405 nm laser. Three spectral factors, that is, spectral slope at 550 to 600 nm, spectral area under the curve at 500 to 590 nm and two-peak ratio between 625 and 667 nm, were extracted. The values of three spectral factors linearly decreased as caries progressed. According to micro-CT images, conventional visual and tactile inspections of lesions under or overestimated (25%-65%) caries states, and brown or thickly stained layer on interproximal or occlusal surfaces, respectively, caused misclassifications of caries stage. Of the spectral factors examined, spectral slope and area under curve for interproximal and occlusal surfaces, respectively, were found to be significantly related to caries stage and showed least data overlap. For interproximal and occlusal surfaces, DIAGNOdent readings of different stages overlapped considerably though their mean values were significantly different regardless of stage.

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

Objective: To analyse the published evidence of the validity of DIAGNDOdent and VistaProof in diagnosing carious depths in pre-cavitated lesions. Material and methods: A systematic review was carried out after identifying a total of 184 articles, including 27 concerning the qualitative review and a subsequent meta-analysis. The quality of the studies was evaluated by using the QUADAS-2 tool. Results: For DIAGNOdent, the sensitivity value was 0.77, the specificity value was 0.75 and AUC was 0.81 for the global meta-analyses. In relation to subgroups, the values estimated 0.85, 0.76 and 0.86, respectively, for the in vivo group and 0.71, 0.75 and 0.83 for the in vitro group. For VistaProof, sensitivity was 0.81, specificity 0.75 and AUC had a value of 0.80 in the global meta-analysis. For the subgroups, these were considered at 0.75, 0.81 and 0.89, respectively, for the in vivo group and 0.91, 0.74 and 0.76 for the in vitro group. Neither case presented publication bias when analysing the funnel plot, the classic fail-safe number and Egger’s intercept. Conclusion: Both VistaProof and DIAGNOdent are valid as they offer a moderate to high diagnostic effectiveness for dentine depth in pre-cavitated lesions.

Comparison of Visual Examination and Magnification with DIAGNOdent for Detection of Smooth Surface Initial Carious Lesion-Dry and Wet Conditions

Objective

The aim of this study was to assess the effectiveness and reliability of magnification, DIAGNOdent in detection of smooth surface white spot lesions.

Study design

Three hundred children aged 5–10 years were examined by two examiners for presence of smooth surface white spot lesions using naked eye and magnifying loupes in wet and dry conditions followed by DIAGNOdent analysis. Data was analysed using Cohen's kappa coefficient, Friedman test and Paired t test. Accuracy was assessed by sensitivity and positive predicted values.

Results

Significant difference was found between naked eyes and magnifying loupes with and without air drying. While insignificant difference was found between DIAGNOdent and loupes.

Conclusion

Magnifying loupes with air drying is an effective method in detection of smooth surface white spot lesion.

Clinical significance

With the increased knowledge about the pathogenesis of dental caries and its ability to be remineralisable if detected early, makes it all the more important for the clinician to be vigilant in detection of early lesion to prevent the avoidable restorative approach for the same. Incorporation of magnification to routine dental examination by general dentist can help in early diagnosis and treatment of dental decay. This could prevent further progression of dental caries and reduces the incidence of tooth decay

How to cite this article

Gupta N, Sandhu M, et al. Comparison of Visual Examination and Magnification with DIAGNOdent for Detection of Smooth Surface Initial Carious Lesion—Dry and Wet Conditions. Int J Clin Pediatr Dent 2019;12(1):37–41.

Efficacy of different remineralization agents on treating incipient enamel lesions of primary and permanent teeth

Aims and Objectives:

The aim of this study was to compare the in vitro efficacy of different remineralization (RM) agents on RM of artificial caries by evaluating the density, light reflection, and the crystal size of the newly formed mineral in primary and permanent teeth.

Materials and Methods:

Caries-free primary and permanent molars were divided into seven groups (n = 20) and treated with: G1 – Deionized water, G2 – Colgate Cavity Protection, G3 – Sensodyne Rapid Relief, G4 – GC MI Paste Plus, G5 – Clinpro Tooth Creme, G6 – Clinpro 5000, and G7 – Sensodyne Repair and Protect. Lesion depths were evaluated using laser fluorescence (DIAGNOdent), and polarized light microscopy (PLM), and the minerals were evaluated using X-ray diffractometry (XRD).

Results:

The highest decrease in laser fluorescence readings was observed in G6 for both primary and permanent teeth. No significant difference was observed between G2, G4, G5, and G6 in permanent teeth and G4 and G6 in primary teeth (P > 0.05). In PLM analyses, lesions depths were found to be lower in G6 compared to the other groups. No significant difference was observed between G2, G4, and G6 (P < 0.05). XRD evaluation showed that the newly formed mineral in G6 was denser and highly crystallized compared to the other groups.

Conclusion:

This in vitro study demonstrated that Clinpro 5000 is more efficient in remineralizing incipient enamel lesions compared to the other agents tested.

Effect of Er,Cr:YSGG on Remineralization Using CPP - ACPF (MI - Paste Plus) after Enamel Erosion Caused by Carbonated Soft Drink in Primary Teeth: In-Vitro Study

BACKGROUND:

Erosion is a widespread phenomenon with higher predilection in primary dentition.

AIM:

The aim of the present study is to assess the remineralising effect of Er,Cr:YSGG laser application combined with CPP-ACPF after erosive demineralisation by Coca-Cola in primary teeth.

METHODS:

Fifty teeth (n = 10) were divided into; Group I: Artificial saliva, (Saliva natural, Medac, UK), Group II: CPP-ACPF (MI Paste Plus, GC Corp, USA), Group III: Er,Cr:YSGG (Waterlase iPlus, USA), Group IV: CPP-ACPF + Er,Cr:YSGG, Group V: Er,Cr:YSGG + CPP-ACPF. Teeth were immersed in Coca-Cola for 10 min, 5 times/day for 5 days. DIAGNOdent (DD) measurements were taken before and after the experiment.

RESULTS:

There was a significant increase in DD readings after erosive-treatment cycles in all test groups. The highest reading was in samples immersed in artificial saliva, and the lowest was in those subjected to combined CPP-ACPF and Er,Cr:YSGG laser application, regardless of the sequence used. There was no significant difference between samples immersed in artificial saliva, and after CPP-ACPF application. Similarly, there was no significant difference between samples treated by combined treatment of CPP-ACPF and Er,Cr:YSGG application. However, there was a significant difference between samples immersed in artificial saliva or treated with CPP-ACPF application and those subjected to combined treatment CPP-ACPF along with Er,Cr:YSGG.

CONCLUSION:

Combining Er,Cr:YSGG laser and CPP-ACPF paste significantly increased enamel remineralisation, regardless of the sequence implemented. Saliva naturally and CPP-ACPF application had a comparable effect on remineralisation.

Effectiveness of Desensitizing Dentifrice and Mouthwash on Dentin Hypersensitivity and Tooth Remineralization

Background:

Over many years, numerous products have been suggested for the relief of dentin hypersensitivity (DH). Calcium sodium phosphosilicate is one desensitizing agent that has remineralizing potential. Available in toothpaste and mouthwash delivery vehicle, this study was carried out to compare the effectiveness on dentinal hypersensitivity (using the Airblast test and Cold test) and on tooth remineralization (using DIAGNOdent pen) in a 4-week period.

Materials and Methods:

Out of the 45 patients screened, 28 patients who fulfilled the inclusion criteria and who willingly signed the consent form were selected and were randomly allocated into two groups – toothpaste and mouthwash. The tooth numbers and specific site of dentinal hypersensitivity for every patient were noted and the air blast test, cold test, and DIAGNOdent scores were recorded at baseline visit. The patients were instructed about the use of the product and were asked to come on the 30^th day for re-evaluation.

Results:

Within-group comparison showed a significant reduction (P < 0.05) in the air blast score (toothpaste – 68.53% and mouth rinse – 48.52%), cold test score (toothpaste – 56.38% and mouth rinse – 38.87%), and DIAGNOdent score (toothpaste – 20.35% and mouth rinse – 9.49%). In-between group comparison showed no statistically significant difference (P > 0.05).

Conclusion:

Desensitizing mouthwash is as effective as toothpaste in reducing DH with a fair remineralization potential comparable with that of the toothpaste.

Difference assessment of composite resins and sound tooth applicable in the resin-imbedded tooth for resin repair using fluorescence, microhardness, DIAGNOdent, and X-ray image

OBJECTIVE

Visual differentiation of resin and tooth in a tooth cavity is not simple due to their highly similar shade. The purpose of the present study was to find any noninvasive method which can effectively differentiate resin from sound tooth in a resin-imbedded tooth for resin repair.

MATERIALS AND METHODS

For the study, various resin products were imbedded into the cavity of sound tooth. By applying laser of different wavelengths, autofluorescence (AF) of sound tooth and resin products were obtained. Microhardness, X-ray radiograph, and DIAGNOdent were tested for each tooth, resin product, and resin-imbedded tooth.

RESULTS

For the AF spectra obtained using the 405-nm wavelength, sound tooth has emission peak at 440-470 nm and near 490 nm. Sound tooth has several times higher microhardness than resin products regardless of position in tooth subsurface. Due to the difference of radiopaque fillers' composition and concentration, resin products have different brightness in the X-ray radiograph. DIAGNOdent readings for tooth and resin products were inconsistently different, and the difference of obtained values was slightly not to be applicable for the differentiation.

CONCLUSION

Among the tested methods, with noninvasive treatment, AF spectrum by the 405-nm wavelength showed the apparent difference between resin and tooth.

CLINICAL SIGNIFICANCE

For the resin repair in a resin-imbedded tooth cavity, AF spectrum produced by 405-nm wavelength could be a useful method in tracing the resin-tooth boundary if combined with conventional X-ray radiography.

Evaluation of the Effect of Different Laser Activated Bleaching Methods on Enamel Susceptibility to Caries; An In Vitro Mode

Introduction: Today, bleaching is a routine noninvasive alternative for treatment of discolored teeth. The aim of this study was to determine whether conventional or laser activated bleaching predispose teeth to develop caries or not. Methods: Sixty human molars were mounted on acrylic cylinders and their Knoop microhardness (KHN) as well as DIAGNOdent (DD) values were recorded. They were divided into 4 experimental groups; G1) conventional bleaching with 40% hydrogen peroxide gel, G2) Diode laser assisted bleaching with same gel, G3) Nd:YAG laser assisted bleaching with the same gel, G4) control group. After bleaching, all samples were subjected to a three day pH cycling regimen and then, KHN and DD values were measured. Results: All groups had significant reduction in KHN values. It seems that there is no statistically meaningful difference between changes in enamel microhardness of the sample groups and all groups have changed in a similar amount. Reduction of DD scores were significant in Diode laser and conventional groups, however changes in Nd:YAG laser and control groups were not significant. Changes in DD values have followed a similar pattern among groups, except in G1- G4 and G2-G4 couples. Conventional and diode laser groups had a meaningful difference in reduction of DD values in comparison with the control group. Conclusion: It can be concluded that bleaching whether conventional or laser activated, does not make teeth vulnerable to develop carious lesions.

In Vitro Comparison of Diagnostic Accuracy of DIAGNOdent and Digital Radiography for Detection of Secondary Proximal Caries Adjacent to Composite Restorations

Introduction: Early detection of secondary proximal caries is critical for the preservation of tooth vitality. This study sought to assess and compare the diagnostic accuracy of DIAGNOdent and digital radiography for detection of secondary proximal caries adjacent to composite restorations. Methods: Sixty extracted molars including 30 teeth with carious lesions and 30 sound teeth were randomly selected. Class II cavities were prepared in all teeth and carious dentin was intentionally left in the gingival floor of cavities in 30 carious teeth. All cavities were restored with composite resin. The teeth were mounted in wax blocks (three teeth per block) and examined for caries using (DIAGNOdent kaVo Dental, Biberach, Germany). Digital radiographs using DIGORA photostimulable phosphor (PSP) plates (Soredex Corporation, Helsinki, Finland) were obtained from all teeth using the parallel technique and were evaluated by 4 observers. Repeated measure analysis of variance (ANOVA) was applied to calculate sensitivity and specificity values of the two diagnostic techniques. Receiver operating characteristic (ROC) curve was plotted for DIAGNOdent results and based on that, the cutoff points were determined. Results: The sensitivity and specificity values at the cut-off point of 10.5 were 0.622±0.038 and 0.822±0.077 for DIAGNOdent and 0.591±0.093 and 0.891±0.083 for digital radiography, respectively. The area under the ROC curve was 0.7 for DIAGNOdent. Weighted kappa revealed moderate to almost perfect intra-observer agreement (0.46-0.99). Intraclass correlation coefficient (ICC) for DIAGNOdent was calculated to be 0.88. Conclusion: No statistically significant difference was noted in diagnostic accuracy of DIAGNOdent and digital radiography for detection of secondary proximal caries adjacent to composite restorations. Thus, DIAGNOdent may be used as an adjunct diagnostic tool for detection of secondary proximal caries beneath composite restorations.

Diagnosis and staging of caries using spectral factors derived from the blue laser-induced autofluorescence spectrum

OBJECTIVE

The aim of this study was to identify the factors derived from the 405nm laser-induced autofluorescence (AF) spectra that could be used to diagnose and stage caries.

MATERIALS AND METHODS

Teeth (20 teeth per stage) were classified as sound, stage II, III, and IV based on a visual and tactile inspection. The specimens were re-examined and reclassified based on micro-CT analysis. From the teeth, the AF was obtained using a 405nm laser. Three spectral factors (spectral slope at 550-600nm, area under the curve at 500-590nm, and two-peak ratio between 625 and 667nm) were derived from the AF spectra. Using these factors, the diagnosis and staging of caries were tested, and the results were compared with those of DIAGNOdent.

RESULTS

After micro-CT analysis, only 13, 11, and 13 teeth were reclassified as stages II, III, and IV, respectively. The reclassified groups showed less data overlap between the stages, and the spectral slope was 40.1-74.6, 27.5-39.6, 11.1-27.4, and 1.0-9.7 for sound, stage II, III, and IV, respectively. The differentiation of stages III and IV using DIAGNOdent appeared to be difficult due to the considerable data overlap.

CONCLUSION

Among the factors tested, the spectral slope at 550-600nm showed the best match with the caries specimens, in which their stage had been identified precisely.

CLINICAL SIGNIFICANCE

The 405nm laser-induced AF spectra can be applied to the diagnosis and staging of caries alone or in conjunction with conventional methods, such as visual, tactile, and X-ray inspection.

Effect of Silver Nanoparticle-Added Pit and Fissure Sealant in the Prevention of Dental Caries in Children

OBJECTIVE

The objective of this study was to evaluate the effects of pit and fissure sealant mixed with silver nanoparticles on dental caries, by means of monthly measurement of fluorescence with DIAGNOdent over six months.

STUDY DESIGN

This study was divided in two phases: experimental and clinical. In the experimental phase, the adhesion and microleakage of the pit and fissure sealant experiment were evaluated. Two groups of 10 teeth, without serious carious lesions, were included. Conventional (group A) and silver nanoparticles (group B) were added to the pit and fissure sealant. For the clinical phase, a split-mouth study was performed on 40 children aged 6-10 years old with healthy, erupted permanent first molars. A conventional pit and fissure sealant or a silver nanoparticle-mixed sealant was randomly placed. Repeated measures analysis was performed.

RESULTS

Conventional sealant presented an average microleakage of 30.6%, and the silver nanoparticle-mixed sealant showed 33.6% (P=NS). A three times greater reduction in fluorescence was found in the silver nanoparticles group compared to the conventional group (P<0.05). No sex- or age-based associations were found.

CONCLUSIONS

The silver nanoparticle-mixed sealant reduced tooth demineralization significantly and likely increased remineralization, compared to the conventional sealant.

Evaluation of different Diagnostic Modalities for Diagnosis of Dental Caries: An in vivo Study

Aim

The aim of this study was to compare and evaluate the efficacy of different diagnostic aids for diagnosis of dental caries and to compare the validity in terms of sensitivity and specificity of all four diagnostic modalities for diagnosis of caries.

Materials and methods

Occlusal surfaces of 100 primary and permanent molars were examined using the four diagnostic systems (visual, intraoral camera, DIAGNOdent, and DIAGNOdent with dye). These results were compared with operative intervention gold standard. Sensitivity and specificity were calculated for each diagnostic system for both enamel and dentin caries. Interrater agreement was calculated for each diagnostic system using kappa statistics.

Results

For both enamel and dentin caries, the highest sensitivity values were provided by DIAGNOdent (0.91 and 0.72) and lowest for visual examination on wet surface (0.60 and 0.50). For both enamel and dentin caries, the specificity was found to be highest for intraoral camera on dry surface and lowest for visual examination. The DIAGNOdent gave the highest value of interrater agreement (kappa), i.e., 0.816 as compared with 0.03 for visual examination.

Conclusion

The study clearly demonstrated that DIAGNO-dent was the most accurate and valid system tested for the detection of occlusal caries. It has the advantage of quantifying the mineral content, helping to improve the diagnostic efficacy and treatment and accurate assessment of fissures where the visual examination alone is not adequate, thus complementing the traditional dental examination.

How to cite this article

Zaidi I, Somani R, Jaidka S, Nishad M, Singh S, Tomar D. Evaluation of different Diagnostic Modalities for Diagnosis of Dental Caries: An in vivo Study. Int J Clin Pediatr Dent 2016;9(4):320-325.

Comparison of Proximal Caries Detection in Primary Teeth between Laser Fluorescence and Bitewing Radiography: An in vivo Study

Background and objective: Proximal caries detection is of great importance because of the rapid rate of caries progression and the difficulty in determining the absence or presence of a lesion in primary dentition. Although, various methods for caries diagnosis offer good diagnostic performances, they provide varying sensitivities for detecting proximal carious lesions. The objective of this study was to compare, in vivo, the accuracy of DIAGNOdent and bitewing radiography at detecting proximal caries in primary teeth.

Materials and methods: One Hundred and one primary maxillary and mandibular molars without obvious cavities of children between the age group of 3 and 10 years were included. The teeth were first subjected to DIAGNOdent examination followed by bitewing radiography. The specificity and sensitivity of the systems were calculated.

Results: At the dentin caries (D3) level, the sensitivity of DIAGNOdent and bitewing radiography was 78.5%; at the enamel caries (D1 and D2) level it was 39.12% and for the sound teeth (D0) it was found to be 76.52%. A strong association was observed between the DIAGNOdent and the bitewing radiograph (p < 0.001).

Conclusion: The DIAGNOdent can be used as an alternative diagnostic method in detection of proximal caries in primary teeth. But when seen at the each caries level, the DIAGNOdent is more accurate at the D0 and D3 threshold.

How to cite this article: Mepparambath R, Bhat SS, Hegde SK, Anjana G, Sunil M, Mathew S. Comparison of Proximal Caries Detection in Primary Teeth between Laser Fluorescence and Bitewing Radiography: An in vivo Study. Int J Clin Pediatr Dent 2014;7(3):163-167.

Monitoring of sound and carious surfaces under sealants over 44 months

Although there is strong evidence for the effectiveness of sealants, one major barrier in sealant utilization is the concern of sealing over active caries lesions. This study evaluated detection and monitoring of caries lesions through a clear sealant over 44 mo. Sixty-four 7- to 10-year-old children with at least 2 permanent molars with International Caries Detection and Assessment System (ICDAS) scores 0-4 (and caries less than halfway through the dentin, radiographically) were examined with ICDAS, DIAGNOdent, and quantitative light-induced fluorescence (QLF) before sealant placement and 1, 12, 24, and 44 mo (except QLF) after. Bitewing radiographs were taken yearly. DIAGNOdent and QLF were able to distinguish between baseline ICDAS before and after sealant placement. There was no significant evidence of ICDAS progression at 12 mo, but there was small evidence of minor increases at 24 and 44 mo (14% and 14%, respectively) with only 2% ICDAS ≥ 5. Additionally, there was little evidence of radiographic progression (at 12 mo = 1%, 24 mo = 3%, and 44 mo = 9%). Sealant retention rates were excellent at 12 mo = 89%, 24 mo = 78%, and 44 mo = 70%. The small risk of sealant repair increased significantly as baseline ICDAS, DIAGNOdent, and QLF values increased. However, regardless of lesion severity, sealants were 100% effective at 12 mo and 98% effective over 44 mo in managing occlusal surfaces at ICDAS 0-4 (i.e., only 4 of 228 teeth progressed to ICDAS ≥ 5 associated with sealants in need of repair and none to halfway or more through the dentin, radiographically). This study suggests that occlusal surfaces without frank cavitation (ICDAS 0-4) that are sealed with a clear sealant can be monitored with ICDAS, QLF, or DIAGNOdent, which may aid in predicting the need for sealant repair.

Cut off values of laser fluorescence for different storage methods at different time intervals in comparison to frozen condition: A 1 year in vitro study

Aims:

The aim of the following study is to evaluate the change in laser fluorescence (LF) values for extracted teeth stored in different solutions over 1 year period, to give cut-off values for different storage media at different time intervals to get them at par with the in vivo conditions and to see which medium gives best results with the least change in LF values and while enhancing the validity of DIAGNOdent in research.

Materials and Methods:

Ninety extracted teeth selected, from a pool of frozen teeth, were divided into nine groups of 10 each. Specimens in Groups 1-8 were stored in 1% chloramine, 10% formalin, 10% buffered formalin, 0.02% thymol, 0.12% chlorhexidine, 3% sodium hypochlorite, a commercially available saliva substitute-Wet Mouth (ICPA Pharmaceuticals) and normal saline respectively at 4°C. The last group was stored under frozen condition at −20°C without contact with any storage solution. DIAGNOdent was used to measure the change the LF values at day 30, 45, 60, 160 and 365.

Statistical Analysis Used:

The mean change in LF values in different storage mediums at different time intervals were compared using two-way ANOVA.

Results:

At the end of 1 year, significant decrease in fluorescence (P < 0.05) was observed in Groups 1-8. Maximum drop in LF values occurred between day 1 and 30. Group 9 (frozen specimens) did not significantly change their fluorescence response.

Conclusions:

An inevitable change in LF takes place due to various storage media commonly used in dental research at different time intervals. The values obtained from our study can remove the bias caused by the storage media and the values of LF thus obtained can hence be conveniently extrapolated to the in vivo condition.

An in vivo comparison of two diagnostic methods in secondary caries detection

OBJECTIVE

The aim of this study was to compare the level of agreement between four operators with different levels of experience for two methods of detecting secondary enamel and dentin carious lesions in composite restored teeth.

MATERIALS AND METHODS

Sixty teeth of 40 patients with with secondary carious lesions in the composite resin were selected. The teeth were examined by two methods; visual inspection and a laser fluorescence device (DIAGNO dent pen 2190) by four operators including an undergraduate student, a dentist with 5 years of clinical experience, a general dentist with 12 years of clinical experience and an oral and maxillofacial radiologist. Cohen's kappa statistic was applied in order to assess the agreement between the diagnoses performed by the four operators with each diagnostic method.

RESULTS

The diagnosis performed by different operators achieved an excellent agreement with high ICC.

CONCLUSION

DIAGNOdent can be a useful device for secondary caries detection in posterior teeth as an adjunct to visual examination.

Micro-computerized tomography assessment of fluorescence aided caries excavation (FACE) technology: comparison with three other caries removal techniques

BACKGROUND

The aim of this study was to determine the caries removal effectiveness (CRE) and minimal invasiveness potential (MIP) of four dentine caries removal methods.

METHODS

After carious molars were scanned using micro-computerized tomography (micro-CT), dentine caries were removed by fluorescence aided caries excavation (FACE) technology, laser induced fluorescence (LIF), chemomechanical excavation (CME), and conventional excavation (CE). Micro-CT was then repeated. CRE was determined based on the volume of residual caries/initial caries (RC/IC) and the mean mineral density (MD) at the cavity floor. MIP was determined by measuring the volume of the prepared cavity/initial cavity (PC/IC).

RESULTS

Among the four groups, the LIF group had the smallest RC/IC (0.08), the highest mean MD at the cavity floor (1.32 g/cm(3) ) and the highest MIP (4.47). The CME group had the highest RC/IC (0.24), the lowest mean MD (1.01 g/cm(3) ) and the lowest MIP (2.23). The CE group exhibited a more acceptable CRE (RC/IC = 0.13, mean MD = 1.21 g/cm(3) ) but had a higher MIP (3.95). Both the CRE and MIP parameters of FACE technology were the second most acceptable (RC/IC = 0.12, mean MD = 1.13 g/cm(3) , MIP = 3.20) and did not differ significantly from the most acceptable.

CONCLUSIONS

FACE is an effective caries removal technology for removing infected dentine without significantly increasing cavity size.

In vitro evaluation of the efficacy of laser fluorescence (DIAGNOdent) to detect demineralization and remineralization of smooth enamel lesions

Objective:

Early detection of smooth surface lesions is important for appropriate management and monitoring of dental caries. The purpose of this in vitro study was to evaluate the efficacy of laser fluorescence to detect demineralization and remineralization of smooth enamel surfaces.

Materials and Methods:

In this in vitro study, 132 enamel blocks of semi-impacted human third molars were obtained; artificial caries lesions were induced and they were submitted to the pH-cycling process to create remineralization. Superficial microhardness (SMH) and laser fluorescence (LF) analysis were performed at baseline, after demineralization, and remineralization processes. The data were analyzed by Statistical Package for Social Sciences (SPSS)-16 using analysis of variance (ANOVA), Paired samples t-test, and Pearson's correlation test.

Results:

There was a significant difference between SMH values at baseline, after demineralization and after remineralization. Also, a statistically significant difference was observed between LF values in these three stages. The LF values increased after demineralization and then decreased after remineralization, and the SMH values decreased after demineralization and increased after remineralization. There was an inverse relationship between SMH and LF only at baseline and after demineralization, but not after remineralization.

Conclusion:

The results showed that LF is an appropriate method for detection of demineralization in an in vitro condition in smooth enamel lesions, but it was not so efficient in the detection of remineralization.