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.

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.

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.

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.

Molecular Fingerprint Imaging to Identify Dental Caries Using Raman Spectroscopy

Tooth loss impairs mastication, deglutition and esthetics and affects systemic health through nutritional deficiency, weight loss, muscle weakness, delayed wound healing, and bone fragility. Approximately 90% of tooth loss is due to dental caries and periodontal disease. Accordingly, early treatment of dental caries is essential to maintaining quality of life. To date, the clinical diagnosis of dental caries has been based on each dentist’s subjective assessment, but this visual method lacks objectivity. To improve diagnostic ability, highly sensitive quantitative methods have been developed for the diagnosis and prevention of dental caries and are gradually becoming a mandatory item in modern dentistry. High-resolution Raman spectroscopy is a suitable tool for recognizing the subtle structural changes that occur in dental enamel in already developed or, more importantly, incipient dental caries. Raman analysis could soon emerge as a breakthrough in dentistry because of its high diagnostic sensitivity. In this study, we build upon our previous findings in a new analysis of dental caries using Raman spectroscopy imaging and discuss the possibility of using Raman photonic imaging in support of objective diagnostics in dentistry. Our findings support the Raman method of caries detection in comparison with other conventional or new approaches.

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.

Comparative Evaluation of Resin Infiltration and Remineralisation of Noncavitated Smooth Surface Caries Lesions: 6-month Results

PURPOSE

To compare the therapeutic effects of the resin infiltration technique, self-assembling peptide (P11-4), and fluoride varnish application on white spot lesions (WSLs) on buccal surfaces based on LF pen measurements and LAA-ICDAS scores.

MATERIALS AND METHODS

The lesions of 113 patients from a total of 319 patients with at least four visible WSL on buccal surfaces were assessed by LAA-ICDAS and laser fluoresence (LF pen). To be included in the study, participants were required to have at least 4 buccal WLSs, each in different quadrants, with an LF pen score ≥ 8. Twenty-one patients were included in the study based on the laser fluoresence values. The lesions were randomly assigned into 4 groups (n = 21): IG (Icon), CRG (Curodont Repair), DG (Duraphat), and CG (control) groups. The treatment protocols were applied, but the control group received no treatment except regular brushing. Lesions were scored by LAA-ICDAS after 3 and 6 months and LF pen after 1 week, 3 and 6 months.

RESULTS

There was a statistically significant decrease in LF pen measurements of the control and the intervention groups after 6 months when compared to baseline. The greatest lesion regression was observed with IG (-23.25 ± 18.21), which differed statistically significantly from CRG (-8.15 ± 13.89), DG (-10.1 ± 10.31) and CG (-4.15 ± 9.72), followed by DG which differed statistically significantly from CG. Statistically significant differences were observed in the activity status of the lesions between baseline and 6 months, except for the control group.

CONCLUSION

In this study, the lesion regression rates shown by mean LF pen values in all groups after six months encourages the management of non-cavitated smooth surface caries lesions with non-operative treatment approaches. Regular brushing and professional tooth cleaning seem to be effective for the management of WSLs on buccal surfaces, and resin infiltration or fluoride varnish might enhance the improvement of these lesions in moderate- to high-caries-risk individuals.

Correlation between caries history and laser fluorescence of sound tooth enamel in restored and unrestored dentition

The aim of this study was to determine the correlation between laser fluorescence (LF) values of apparently sound tooth enamel and caries history. LF measurements were recorded from six sound enamel tooth surfaces in each of 346 subjects aged 8-25 years. Caries experience was evaluated using the decayed, missing, and filled tooth (DMFT) index and the International Caries Detection and Assessment System (ICDAS). To measure differences between the unrestored and restored tooth groups, an unpaired two-sample t-test was used. To assess the relationship between LF of sound enamel and caries experience based on the DMFT and ICDAS, Pearson's correlation coefficient and linear regression analyses were used. The LF values of sound dental enamel in subjects with no history of invasive dental treatment were highly correlated with caries experience, as measured by the DMFT index (R = 0.76) and ICDAS (R = 0.7). The LF values of sound enamel in subjects with a history of previous invasive dental treatment were weakly correlated with caries experience, as measured by the DMFT index (R = 0.33), and moderately correlated with the ICDAS values (R = 0.66). The LF value of clinically healthy tooth enamel correlates with caries status based on the DMFT or ICDAS.

In vivo validity of proximal caries detection in primary teeth, with histological validation

BACKGROUND

Detection and diagnosis of proximal caries in primary molars are challenging.

AIM

The aim of this in vivo study was to assess the validity and reproducibility of four methods of proximal caries detection in primary molar teeth.

DESIGN

Eighty-two children (5-10 years) were recruited. Initially, 1030 proximal surfaces were examined using meticulous visual examination (ICDAS) (VE1), bitewing radiographs (RE), and a laser fluorescence pen device (LF1). Temporary tooth separation (TTS) was achieved for 447 surfaces, and these were re-examined visually (VE2) and using the LF pen (LF2). Three hundred and fifty-six teeth (542 surfaces) were subsequently extracted and provided histological validation.

RESULTS

At D₁ (enamel and dentine caries) diagnostic threshold, the sensitivity of VE1, RE, VE2, LF1, and LF2 examination was 0.52, 0.14, 0.75, 0.58, and 0.60 and the specificity values were 0.89, 0.97, 0.88, 0.85, and 0.77, respectively. At D₃ (dentine caries) threshold, the sensitivity values were 0.42, 0.71, 0.49, 0.63, and 0.65, respectively, whereas specificity was 0.93 for VE1 and VE2, and 0.98, 0.87, and 0.88 for RE, LF1, and LF2 examinations, respectively. ROC analysis showed radiographic examination to be superior at D₃ .

CONCLUSION

Meticulous caries diagnosis (ICDAS) should be supported by radiographs for detection of dentinal proximal caries in primary molars.

Effect of Er:YAG and Fluoride Varnishes for Preventing Primary Enamel Demineralisation

PURPOSE

To measure the demineralisation changes on human deciduous enamel produced by pH cycling after preventive treatment with Er:YAG laser irradiation, fluoride varnish application and a combination of the two.

MATERIALS AND METHODS

Sixty extracted human anterior primary teeth were assigned to six groups (n = 10). Group C: untreated; group L: Er:YAG laser; group TCP-NaF: Clinpro White (5% sodium fluoride and modified tricalcium phosphate); group CPP-ACP-NaF: MI varnish (5% sodium fluoride with casein phosphopeptide-amorphous and calcium phosphate); group L+TCP-NaF: Er:YAG + 5% sodium fluoride + modified tricalcium phosphate; group L+ CPP-ACP-NaF: Er:YAG + 5% sodium fluoride with casein phosphopeptide-amorphous and calcium phosphate. The samples were subjected to a 10-day pH-cycling regimen to create caries-like lesions, with 8 h in demineralising solution and 16 h in remineralising solution at 37°C. Enamel demineralisation was evaluated by laser fluorescence (DIAGNOdent) before and after pH cycling. The Mann-Whitney U-test and Wilcoxon tests were performed with statistical significance set at p ≤ 0.05.

RESULTS

The Wilcoxon test revealed statistically significant differences at baseline and after pH cycling in groups C (p = 0.02), L (p = 0.034) and L+TCP-NaF (p = 0.025) and the lowest percentage of healthy tooth substance compared to the other groups.

CONCLUSIONS

The results suggest that the treatment protocols employed in groups TCP-NaF, CPP-ACP-NaF, and L+ CPP-ACP-NaF had similar effects in terms of preventing demineralisation, as reflected in a higher percentage of healthy dental structure maintained. Hence, these treatments are recommended for clinical use as an effective preventive measure.

Performance of Different Methods for Detection of Incipient Occlusal Caries Lesions: An In Vitro Study

OBJECTIVE

The aim of this in vitro study was to evaluate the diagnostic performance of visual inspection (VI), laser fluorescence (LF pen), fluorescence camera (FC), and alternating current impedance spectroscopy technique (ACIST) for detection of incipient occlusal caries lesions. Histology was used as the gold standard to determine the interexaminer reliability of the methods, among three examiners with different levels of experiences (Examiner 1: 5 years; examiner 2: 10 years; and examiner 3: 25 years).

MATERIALS AND METHODS

One hundred two molar teeth were selected. The occlusal surfaces of teeth were evaluated with VI, LF pen, FC, and ACIST devices independently by three examiners. Diagnostic performances of methods were evaluated with binormal receiver-operating characteristics analysis. Interexaminer agreement of detection methods was assessed using Cohen's kappa coefficient values (p < 0.001).

RESULTS

Incipient enamel lesions were determined more successfully with VI by all examiners. All detection methods were presented with statistically acceptable interexaminer agreement (p < 0.001). For D₂ and D₃ thresholds, FC for examiner 1, VI for examiner 2, and both VI and FC for examiner 3 demonstrated statistically high sensitivity and specificity (p < 0.05).

CONCLUSIONS

It can be concluded that diagnostic performance of the methods was insufficient for detecting incipient occlusal caries lesions by itself. Performance can be improved by using them with VI as a traditional caries detection method.

Alternative methods to visual and radiographic examinations for approximal caries detection

A shift in caries prevalence from occlusal surfaces to approximal surfaces has been demonstrated by epidemiological studies. Two recent meta-analyses evaluated the performance of visual examination and radiography for carious lesion detection, and reported low sensitivity but high specificity for early approximal caries detection. This suggests that the conventional methods have a higher risk of failing to detect approximal lesions. Consequently, in caries susceptible populations, there is a risk of progression of non-cavitated lesions to irreversible tooth destruction before the lesions are detected. This paper aims to review the performance of unconventional and novel methods for approximal caries detection. In vitro and in vivo studies identified through a MEDLINE search using keywords such as caries detection, approximal caries detection, light fluorescence and dental caries, and transillumination and dental caries were reviewed. The unconventional methods known to be used for approximal caries detection and included in this review are: cone beam computed tomography, fiber-optic trans-illumination, digital imaging fiber optic trans-illumination, near-infrared digital imaging transillumination, optical coherence tomography, laser fluorescence, ultrasound, and LED reflection and refraction.

Laser fluorescence of caries detection in permanent teeth in vitro: a systematic review and meta-analysis

BACKGROUND/OBJECTIVES

The detection of dental caries in the early stages, particularly on the occlusal surfaces, has become a mainstay of contemporary clinical practice. The objective of the study was to verify the accuracy of laser fluorescence for caries detection.

METHODS

A comprehensive search of the MEDLINE (PubMed), EMBase, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS, Congress Abstracts, and Grey literature databases was undertaken from 1980 through January 2016. We included cross-sectional studies that evaluated laser fluorescence in caries diagnoses in vitro and compared them with histological analyses.

RESULTS

A total of 39 articles were included in the meta-analysis, which included 2082 caries sites. The pooled sensitivity was 0.71 (0.69, 0.73), and the specificity was 0.81 (0.73, 0.82). The diagnostic odds ratio was 14.93 (11.2, 19.9). A summary receiver operating characteristic curve was constructed. The area under the curve was 0.865.

CONCLUSION

This meta-analysis showed that laser fluorescence in vitro had the ability to diagnose occlusal caries lesions in permanent teeth and enamel and dentin caries.

Optimal power settings of aluminum gallium arsenide lasers in caries inhibition - An in vitro study

Context:

Incipient carious lesions are characterized by subsurface dissolution due to more fluoride ions in the 50-100 microns of the tooth's outer surface.

Aims:

To determine an optimal power setting for 810 nm aluminum gallium arsenide laser for caries inhibition.

Materials and Methods:

Fifty-four caries-free extracted teeth were sectioned mesiodistally. The samples were divided into 18 groups for each power setting being evaluated. Each group had six samples. The laser used is 810 nm aluminum gallium arsenide laser with power setting from 0.1 watts to 5 watts. Laser fluorescence based device was used to evaluate the effect of irradiation.

Statistical Analysis Used:

Paired “t” test, one-way analysis of variance (ANOVA), Tukey's post hoc test, and the Pearson's correlation test.

Results:

The paired t-test showed that there is minimum divergence from the control for 3.5 watts. Tukey's post hoc test also showed statistically significantly results for 3.5 watts. The Pearson's correlation test showed that there was negative correlation between the watts and irradiation.

Conclusions:

The power setting that gave statistically significant results was 3.5 watts.

Comparison of caries diagnostic modalities: A clinical study in 40 subjects

BACKGROUND AND OBJECTIVES

Few studies have been published that evaluate the usefulness of different caries- diagnostic modalities in general dental practice. The goal of this study was to compare the results of screening for coronal dental caries in a general dental practice using clinical observations, radiographs, laser fluorescence (DIAGNOdent™) (LF), and optical coherence tomography (OCT). Diagnostic agreement between OCT and LF versus standard clinical techniques for detecting caries was determined in 40 subjects.

STUDY DESIGNS/MATERIALS AND METHODS

Forty patients with >1 coronal carious lesion as determined by prescreening using clinical examination and radiographs were enrolled in this study. Subjects with gross caries were excluded. Subsequently each patient underwent a full detailed dental examination by an experienced clinician, using visual examination and radiographs according to standard clinical practice. The coronal surfaces of a total of 932 teeth were examined and charted. Teeth were then photographed, rediagnosed using the LF system, and imaged using OCT. Two blinded pre-standardized examiners reviewed radiographic and OCT images and assigned caries status.

RESULTS

Based on manufacturer's cutoff values, sensitivity and specificity for coronal caries using LF technique (i) on unaltered tooth surfaces were 73.7% and 94.1%, respectively and (ii) in previously restored or sealed teeth, they were 19.2% and 95.8%, respectively. LF technique was unable to assess tissue health underneath sealants and restorations. Clinician agreement (kappa [k]) regarding caries diagnosis using OCT imaging was overall 0.834 (SE = 0.034). Sensitivity and specificity for caries using OCT technique (i) on unaltered tooth surfaces approximated 74.1% and 95.7%, respectively and, (ii) in previously restored or sealed teeth, they approximated 76.0% and 95.6%, respectively. Although OCT was able to detect lesions beneath many resin restorations and sealants, results varied considerably between materials. OCT imaging was unable to detect caries when caries was >2 mm below the tooth surface.

CONCLUSION

These findings support the usefulness of LF for primary caries detection, and the clinical utility of OCT for early caries detection and monitoring under dental resin restorations and sealants. Lasers Surg. Med. 48:924-928, 2016. © 2016 Wiley Periodicals, Inc.

Laser fluorescence in monitoring the influence of targeted tooth brushing on remineralization of initial caries lesions on newly erupted molar teeth - RCT

OBJECTIVE

This study aimed to monitor mineralization changes in initial caries lesions on newly erupted second molars using laser fluorescence (LF) scanning after a 1-month targeted tooth brushing intervention.

METHODS

Altogether, 124 13- to 14-year-old school children were invited to participate. Of those who fulfilled the clinical criteria (at least one initial lesion with LF value >10 in second molars), 51 gave their written consent to participate. Laser fluorescence values were registered at baseline and after 1-month follow-up period. All participants were individually taught targeted tooth brushing of their second molars and randomly provided tooth paste with 0 or 1500 ppm fluoride. Brushing frequency was investigated at baseline and after the follow-up. Change in LF values was compared considering the tooth, content of fluoride in the paste and brushing frequency.

RESULTS

In lesions with LF values ≤30 at baseline, change in LF values demonstrated improvement. Improvement was detected especially in upper molars. In lesions with LF values >30 at baseline, improvement was least detected. Brushing frequency increased slightly during the intervention.

CONCLUSIONS

Laser fluorescence is a simple method and useful in monitoring remineralization of incipient lesions even in weeks. Targeted tooth brushing seems to induce remineralization even in weeks. Laser fluorescence could be a valuable motivating tool in promoting patients' self-care.

DIAGNOdent Pen versus tactile sense for detection of subgingival calculus: an in vitro study

The objective of this study is to compare the performance of the DIAGNOdent laser fluorescence (LF) Pen to conventional periodontal probing for detection of subgingival calculus under defined laboratory conditions. Extracted teeth with various levels of subgingival deposits of calculus were mounted anatomically in stone casts, and an impression material was used to replicate periodontal soft tissues. The casts were examined for the presence of subgingival calculus at eight surfaces per tooth (240 sites) using LF and a periodontal probe. Sites were rescored after 1 and 3 weeks. Direct imaging of the root surfaces under magnification was the gold standard. As a result, for an experienced operator, LF was more accurate than tactile assessment (across all sites, 84.0% vs. 59.8%). The performance difference was greater for multi-rooted teeth (85.8% vs. 56.9%) than single-rooted teeth (77.2% vs. 66.7%). The performance of LF in this laboratory trial was influenced strongly by clinician skill and experience. When used by an experienced operator, LF was more sensitive (75.1% vs. 69.2%), specific (92.6% vs. 86.3%), and accurate (84% vs. 77.9%) than for an inexperienced operator. In conclusion, under the defined laboratory conditions used, LF had better performance than tactile examination, particularly for multi-rooted teeth. This method may have value clinically as an adjunct for detecting subgingival deposits of calculus in clinical practice. The usefulness of the method improves with operator experience.

Effect of tablets containing probiotic bacteria (Lactobacillus reuteri) on early caries lesions in adolescents: a pilot study

The objective of the study was to investigate the effect of tablets containing probiotic lactobacilli on early caries lesions in adolescents with quantitative light-induced fluorescence (QLF). 36 healthy adolescents of both sexes (12-17 years of age) were enrolled and randomly allocated to a placebo-controlled trial with two parallel groups. The test group received two tablets daily containing two strains of Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) for a period of three months, while the control group got identical placebo tablets without live bacteria. The primary outcome was QLF-readings (change in fluorescence, ΔF and lesion area, mm2) at baseline and after 3 months, conducted at two buccal sites of each individual, pre-selected with clearly visible clinical signs of enamel demineralisation (white spots). Significantly more premolars were allocated to the placebo group, while the test group had more incisors (P<0.05). There were no statistically significant differences in fluorescence values between the groups, neither at baseline, nor at the follow-up. There was however a significant decrease in fluorescence over time in the test group, but not in the placebo group (P<0.05). No alterations of the lesion area (ΔA) were found in any group. The inter-examiner intra-class correlation coefficient-value for QLF-readings was excellent. No side- or adverse effects were reported during the intervention period. This pilot study found a significant decrease over time in the test group. However, no statistically significant differences in fluorescence values between the groups were found. Hence, the null hypothesis could not be rejected.

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.

Detection of non-cavitated occlusal caries with impedance spectroscopy and laser fluorescence: an in vitro study

Objective:

To evaluate the performance of an impedance spectroscopy technology for detecting non-cavitated occlusal caries lesions in permanent teeth in vitro. The method was compared with a commonly used laser fluorescence device and validated against histology.

Material and Methodology:

A non-cavitated sample of 100 extracted posterior teeth was randomly selected and assessed for caries on enamel and dentin level with aid of CarioScan PRO (ACIS) and DIAGNOdent pen (LF pen) by three examiners. After the measurements, the extension of the lesion was histologically determined as gold standard. Sensitivity, specificity, accuracy and receiver-operating curves were calculated. Intra- and inter-examiner reproducibility was expressed by intra class correlation coefficients.

Results:

The histological caries prevalence was 99% and 41% exhibited dentin caries. The ACIS technique displayed high specificities but almost negligible sensitivities at readings >50. A similar pattern was noted for the LF pen at readings >30. The intra- and inter-examiner reproducibility varied between 0.47 and 0.98 and the values were generally lower for the ACIS technique than for the LF pen. The inter-examiner agreement reached excellent levels with both methods.

Conclusions:

In vitro,the ACIS technique showed a low ability to disclose occlusal caries lesions in the enamel and/or dentin of non-cavitated permanent molars. However, further in vivo studies of permanent occlusal surfaces are needed to mirror the clinical situation.

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.