Caries diagnosis by laser

Basic and clinical investigationsMed.

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Laser Applvol. Reich-eThe influence of toothpastes and prophylaxis pastes on fluorescence measurements for caries detection in vitroEur.

Oral Scivol. Paulus-rCaries detection by red excited florescence: investigations on fluorophoresCaries Resvol. Shugars-dA systematic review of the performance of a laser fluorescence device for detecting cariesJ.

Angmar-mansson-bFluorescence methods. Donly-z and.

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Gupta-m, and. Gugnani-sLight induced fluorescence evaluation: A novel concept for caries diagnosis and excavationJ. Feuerstein-o and M. Calderon-sDetection of cavitated carious lesions in approximal tooth surfaces by ultrasonic caries detector. Ozturk-f, A. Hayran-o, and. Stookey-gDetection of natural white spot caries lesions by an ultrasonic systemCaries Resvol.

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Hume, and W. Shellis-r, P. Cross-k, and. Reynolds-eEnamel subsurface lesion remineralisation with casein phosphopeptide stabilised solutions of calcium, phosphate and fluorideCaries Resvol. Cai-f, V. Nowicki-a, and. Reynolds-eRemineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphateJ. Resvol. Derache-fImpact du xylitol sur le risque carieux -implications militairesMédecine Arméesvol.

Makinen-kTurku sugar studies. Final report on the effect of sucrose, fructose and xylitol diets on the caries incidence in manActa Odontol. Scandvol. De and. SchrezenmeirProbiotics, prebiotics, and synbioticsAdv. Stecksen-blicks-cProbiotics and oral health effects in childrenInt. Paedodontic Soc. Childvol. Grenier-dLes probiotiques en santé buccale: mythe ou réalité? Bichatpp. Attal-jInfiltration, a new therapy for masking white spots on enamel: a case series with month follow-upEur J Esthet Dentvol.

Meyer-lueckel and C. Kielbassa-aResin infiltration of artificial enamel caries lesions with experimental light curing resinsDent. Jvol. Paris-sProgression of artificial enamel caries lesions after infiltration with experimental light curing resinsCaries Resvol. Lasfargues-jPréparations et restaurations adhésives à minima Apport des techniques sono-abrasivesRéalités Clinvol.

Dos, S. Primo-l, and. Maia-lPreparation time and sealing effect of cavities prepared by an ultrasonic device and a high-speed diamond rotary cutting systemJ. The use of air-polishing to remove plaque improved diagnosis by QLF.

QLF was not designed to discriminate between lesions restricted to the enamel and those extending into the dentin. Furthermore, Banerjee and Boyde 17 showed that the fluorescence from dentin was not related to dentin demineralization, so this method is not suitable for measuring dentin demineralization. The unit emits light at nm wavelength from a fibre optic bundle directed onto the occlusal surface of a tooth.

A second fibre optic bundle receives the reflected fluorescent light beam, and changes caused by demineralization are assigned a numeric value, which is displayed on the monitor.

The system is calibrated to a provided standard and to reference sound enamel. The instructions for the DIAGNOdent system specify that the occlusal area to be diagnosed be clean, because plaque, tartar and discolouration may give false values. A laser probe is used to scan over the fissure area in a sweeping motion. The instructions suggest that, in general, numeric data between 5 and 25 indicate initial lesions in the enamel and that values greater than this range indicate early dentinal caries.

Advanced dentin caries is said to yield values greater than Surprisingly, the device showed higher diagnostic accuracy in the detection of dentinal caries than enamel caries. The authors suggested that the DIAGNOdent values were dependent on the volume of the caries rather than on the depth of the lesion.

With a cut-off of 18 to 22, the sensitivity for diagnosis of dentinal caries in wet teeth was 0.

The investigators concluded that overall correlation between DIAGNOdent and microradiography results was moderate but that the device appeared superior to conventional radiography. They reported that the instrument was very sensitive to the presence of stains, deposits and calculus, all of which led to erroneous readings.

Similarly, any changes in the physical structure of the enamel, including disturbed tooth development or mineralization, produced erroneous readings. Second repeated sets of DIAGNOdent measurements showed better cor relation with the microradiography standard, which was construed as revealing operator learning and skill development.

Reproducibility for the DIAGNOdent device was high in this study, but there was also evidence of different degrees of learning for individual dentists, and for 2 of the clinicians reproducibility was poor.

The investigators used low cut-off values 10 to 18 for diagnosis and recommended caution in extrapolating their results to the clinical situation. In the end, Lussi and others 4 concluded that, because of its rapidity and very high specificity, visual diagnosis remains the method of first choice and they suggested that this type of examination be carried out before any other technique.

The DIAGNOdent device could then be used for sites of clinical uncertainty, as a second opinion or diagnostic adjunct. The results of Shi and others 6 and Lussi and others, 4 who evaluated the DIAGNOdent device in vitro for the detection of occlusal decay, cannot be directly generalized to clinical practice. The prevalence of caries in those studies was higher than in the typical clinical situation.

Air-dried occlusal surfaces of molars and premolars were examined visually along with bite-wing radiographs if available and with the DIAGNOdent device. The extent of decay was determined by means of an explorer during operative intervention. A high sensitivity 0. However, the calculated sensitivity was based on a population of teeth with a very high prevalence of caries, since only teeth that appeared clinically to require operative intervention were assessed for the presence of decay. There was a wide range of readings for enamel caries approximately 7 tosuperficial dentinal caries approximately 7 to and deep dentinal caries approximately 12 toand the ranges for each overlapped considerably.

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The DIAGNOdent device was not able to distinguish clearly between deep dentinal caries and more superficial dentinal caries.

However, the available documentation for its use is limited and involves primarily in vitro studies. Whereas the basic research behind the typical QLF technique, which uses lower wavelength light, is relatively plentiful, little documentation exists for the measurement of enamel fluorescence with the red nm diode laser light source used in the DIAGNOdent system.

For example, there is no basic research to show the correlation between DIAGNOdent measurements and the degree of tooth demineralization. The typical QLF methods use a nm high-pass filter to receive the nm autofluorescent light from enamel and to exclude the lower-wavelength light scattered by the teeth.

In contrast, the DIAGNOdent system uses a nm filter and detects caries by measuring changes in fluorescence intensity rather than by analyzing spectral differences. It is of considerable concern that scientific evidence showing a direct correlation between the numeric DIAGNOdent reading and the severity of disease is lacking. Also of concern is how the DIAGNOdent readings relate to the presence of dentinal decay and the need for operative intervention.

As stated previously, typical QLF results show a strong correlation with the degree of enamel demineralization only but no correlation with the degree of dentinal decay. Furthermore, correlation with the degree of enamel demineralization is limited in depth. At this time, in light of the unanswered questions and given the overall reduction in the prevalence of caries in the population, the clinical value of the device requires further investigation.

Conclusions The development of reliable, accurate quantitative methods to diagnose and monitor early carious lesions is critical.