Caries Diagnostics

Dr. Sabine Geißler, München
Wissenschaft und Fortbildung BZB Juni 10 3, 6/1/2010

Größere Sicherheit bei der Kariesdiagnostik
Der folgende Beitrag stellt die Laserfluoreszenztechnik zur Kariesdiagnostik bei Kindern und Jugendlichen vor und zeigt deren Einsatzbereiche aber auch Anwendungsgrenzen auf.

© 2010 teamwork media GmbH

Dr. Sabine Geißler, München
Wissenschaft und Fortbildung BZB Juni 10 3, 6/1/2010

Größere Sicherheit bei der Kariesdiagnostik
Der folgende Beitrag stellt die Laserfluoreszenztechnik zur Kariesdiagnostik bei Kindern und Jugendlichen vor und zeigt deren Einsatzbereiche aber auch Anwendungsgrenzen auf.

© 2010 teamwork media GmbH

De Benedetto MS, Morais CC, Novaes TF, de Almeida Rodrigues J, Braga MM, Mendes FM
Department of Pediatric Dentistry, Faculdade de Odontologia da Universidade de São Paulo, São Paulo, Brazil
Lasers Med Sci. , 2/16/2010

The aims of this in vitro study were (1) to compare the reliability of a new fluorescence camera (FC; VistaProof) with that of two other laser fluorescence devices (DIAGNOdent and DIAGNOdent pen) in assessing smooth and occlusal caries lesions in primary teeth and (2) to determine the influence of the spacer, the protective cover and air drying on the FC readings. We selected 129 primary molars which were divided into two groups: smooth surfaces (n=68) and occlusal surfaces (n=61).

© Axel Springer Verlag; PMID: 20157753 [PubMed - as supplied by publisher]

De Benedetto MS, Morais CC, Novaes TF, de Almeida Rodrigues J, Braga MM, Mendes FM
Department of Pediatric Dentistry, Faculdade de Odontologia da Universidade de São Paulo, São Paulo, Brazil
Lasers Med Sci. , 2/16/2010

The aims of this in vitro study were (1) to compare the reliability of a new fluorescence camera (FC; VistaProof) with that of two other laser fluorescence devices (DIAGNOdent and DIAGNOdent pen) in assessing smooth and occlusal caries lesions in primary teeth and (2) to determine the influence of the spacer, the protective cover and air drying on the FC readings. We selected 129 primary molars which were divided into two groups: smooth surfaces (n=68) and occlusal surfaces (n=61). Two trained examiners performed the evaluations using the FC and the other laser fluorescence devices separately. One examiner repeated all assessments after 1 week. Inter- and intraexaminer reproducibility was calculated from the absolute values derived from the devices using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Pearson correlation was performed among the values obtained with the different devices. For aim 2, only teeth from the occlusal surface group were used. Another examiner performed measurements with the FC, varying the size of the spacer, the use of the plastic protective cover and the drying time (0, 3 and 15 s). Wilcoxon's test was used to compare these measurements. High values of interexaminer ICC were observed with the FC in both experiments. However, the highest intraexaminer ICC for smooth surfaces was found for the DIAGNOdent (ICC 0.918). A positive correlation between all methods was observed in both studies. Only drying for 15 s significantly increased the FC readings. In conclusion, the FC showed high reliability for occlusal and smooth surfaces, similar to the other fluorescence methods tested. Additionally, prolonged air drying increased the FC measurements.

© Axel Springer Verlag; PMID: 20157753 [PubMed - as supplied by publisher]

Astvaldsdóttir A, Tranæus S, Karlsson L, Peter Holbrook W
Department of Cariology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
Acta Odontol Scand. , 1/26/2010

Carious tissue fluoresces with a wavelength different from sound tissue when stimulated by light with a wavelength of 655 nm. This difference is thought to have a bacterial origin rather than indicating demineralization. This study aimed to measure fluorescence emitted by normal cultivable caries-associated bacterial flora and typical porphyrin-producing bacteria with DIAGNOdent, and to verify earlier findings that demineralization of the dental hard tissue does not affect DIAGNOdent readings.

© PMID: 20100119 [PubMed - as supplied by publisher]

Astvaldsdóttir A, Tranæus S, Karlsson L, Peter Holbrook W
Department of Cariology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
Acta Odontol Scand. , 1/26/2010

Abstract Objective. Carious tissue fluoresces with a wavelength different from sound tissue when stimulated by light with a wavelength of 655 nm. This difference is thought to have a bacterial origin rather than indicating demineralization. This study aimed to measure fluorescence emitted by normal cultivable caries-associated bacterial flora and typical porphyrin-producing bacteria with DIAGNOdent, and to verify earlier findings that demineralization of the dental hard tissue does not affect DIAGNOdent readings. Material and methods. Bacterial samples were collected from five occlusal caries lesions in three subjects. From these, mixed anaerobic flora, Lactobacilli and mutans Streptococci were cultured in up to three different kinds of culture medium. Colonies of Lactobacilli and mutans Streptococci were also measured after transferring them to glass slides. Laboratory teaching strains of Prevotella spp., Porphyromonas gingivalis and Actinomyces odontolyticus were cultured anaerobically and fluorescence measured directly after an appropriate incubation period. Sound enamel surfaces of 15 extracted premolars were demineralized and changes in fluorescence measured. Results. DIAGNOdent readings > 20 were only obtained from young colonies of Prevotella and from colonies of mutans Streptococci cultured on mitis-salivarius-bacitracin agar. Higher measurements were obtained as the bacterial colonies aged. Lower measurements were obtained after transferring colonies to glass slides. Demineralization of enamel did not affect the DIAGNOdent measurements. Conclusions. The change in fluorescence measured with DIAGNOdent has a bacterial origin rather than occurring as a result of demineralization. The measurements are presumably dependent on bacterial metabolites rather than bacteria themselves, and probably record synergistic effects during the carious process rather than the quantity or species of bacteria involved.

© PMID: 20100119 [PubMed - as supplied by publisher]

Askaroglou E, Kavvadia K, Lagouvardos P, Papagiannoulis L
Department of Paediatric Dentistry, School of Dental Medicine, University of Athens, Athens, Greece.
Lasers Med Sci., 1/23/2010

The aim of this study was to investigate in vitro the effects of clear or opaque sealants, on the laser fluorescence readings for occlusal caries detection in primary molars. For this reason, 427 occlusal sites in 199 teeth were clinically examined by one dentist, and their laser fluorescence (LF) was measured locally with the DIAGNOdent device, both before and after the teeth had been sealed with Delton Clear LC or Delton Opaque LC.

© Axel Springer Verlag; PMID: 20099071 [PubMed - as supplied by publisher]

Askaroglou E, Kavvadia K, Lagouvardos P, Papagiannoulis L
Department of Paediatric Dentistry, School of Dental Medicine, University of Athens, Athens, Greece.
Lasers Med Sci., 1/23/2010

The aim of this study was to investigate in vitro the effects of clear or opaque sealants, on the laser fluorescence readings for occlusal caries detection in primary molars. For this reason, 427 occlusal sites in 199 teeth were clinically examined by one dentist, and their laser fluorescence (LF) was measured locally with the DIAGNOdent device, both before and after the teeth had been sealed with Delton Clear LC or Delton Opaque LC. For 29 of these teeth, we also measured the laser fluorescence by scanning the fissures before and after sealant application. We used Wilcoxon's signed ranks sum test and Spearman's rho correlation to compare and correlate the LF readings before and after sealing, while we used the Mann-Whitney U test to compare the two materials. Finally, we used the Kruskal-Wallis test to compare readings taken locally with those taken by the scanning technique. The results showed that there was an LF increase by a mean of 6 units after sealing with the clear material, while there was a 15 units decrease after sealing with the opaque one. LF readings before and after sealing correlated better for the clear material (rho = 0.826) than for the opaque one (rho = 0.507). LF readings were statistically significantly affected by both clear and opaque sealants (P < 0.001). However, this effect was statistically significantly less pronounced for the clear material (P < 0.001). There was also no difference between the LF readings taken by the fissure scanning technique or locally (P > 0.05). In conclusion, LF readings for occlusal caries detection in primary molars were significantly affected by both the clear and the opaque materials. However, the effect for the opaque material was more pronounced.

© Axel Springer Verlag; PMID: 20099071 [PubMed - as supplied by publisher]

Kimura Y, Tanabe M, Amano Y, Kinoshita J, Yamada Y, Masuda Y
Division of Endodontics, Department of Conservative Dentistry, Ohu University School of Dentistry, 31-1 Misumido, Tomita-machi, Koriyama-city, Fukushima, Japan
J Dent. , 12/1/2009

Many methods are used to detect vertical root fractures, but most are not adequate for identification of incomplete fractures or cracks. The purpose of this study was to evaluate the effects of three detergents on detection of vertical root fractures by DIAGNOdent with methylene blue (MB) solution.

© PMID: 19665275 [PubMed - indexed for MEDLINE]

Kimura Y, Tanabe M, Amano Y, Kinoshita J, Yamada Y, Masuda Y
Division of Endodontics, Department of Conservative Dentistry, Ohu University School of Dentistry, 31-1 Misumido, Tomita-machi, Koriyama-city, Fukushima, Japan
J Dent. , 12/1/2009

OBJECTIVE: Many methods are used to detect vertical root fractures, but most are not adequate for identification of incomplete fractures or cracks. The purpose of this study was to evaluate the effects of three detergents on detection of vertical root fractures by DIAGNOdent with methylene blue (MB) solution. METHODS: Vertical incomplete fractures were artificially created on the roots of extracted human teeth, the DIAGNOdent values (D values) recorded in the presence or absence of MB solution, and the effects of detergents on D values examined. The effects of 20% ethanol on enhancing detergent action were also investigated. Statistical analysis was performed using the Mann-Whitney U-test; a value of p<0.01 was considered significant. RESULTS: D values increased significantly when MB solution was used with 0.1% or 1.0% polyoxyethylene (10) octylphenyl ether compared to MB solution only. CONCLUSION: These findings suggest that 0.1% or 1.0% polyoxyethylene (10) octylphenyl ether could be used as an enhancer for detection of vertical root fractures by DIAGNOdent using MB solution.

© PMID: 19665275 [PubMed - indexed for MEDLINE]

Goel A, Chawla HS, Gauba K, Goyal A.
Department of Pedodontics and Preventive Dentistry, D. J. College of Dental Sciences and Research, Modinagar, India. dr.amitagoel@gmail.com
J Indian Soc Pedod Prev Dent. , 12/1/2009

This study was conducted to compare the in vivo effectiveness of DIAGNOdent with other conventional methods (visual, tactile and bitewing radiographs) for the detection of occlusal caries in primary molars. Another objective of the study was to calculate new cut-off limits for the detection of caries by DIAGNOdent in primary teeth.

© PMID: 19915274 [PubMed - in process]

Goel A, Chawla HS, Gauba K, Goyal A.
Department of Pedodontics and Preventive Dentistry, D. J. College of Dental Sciences and Research, Modinagar, India. dr.amitagoel@gmail.com
J Indian Soc Pedod Prev Dent. , 12/1/2009

AIM: This study was conducted to compare the in vivo effectiveness of DIAGNOdent with other conventional methods (visual, tactile and bitewing radiographs) for the detection of occlusal caries in primary molars. Another objective of the study was to calculate new cut-off limits for the detection of caries by DIAGNOdent in primary teeth. MATERIALS AND METHODS: Eighty-four primary molars in 52 children (aged 8-12 years), which were indicated for extraction, were selected and evaluated for dental caries using DIAGNOdent, visual and tactile examination and bitewing radiographs. Histological examination of the sections, prepared subsequent to extraction of the teeth, served as the gold standard for comparison of the above-mentioned methods. RESULTS: When considering enamel caries, values obtained for sensitivity, specificity and accuracy were 48.15, 100 and 49.40% for visual examination, 48.15, 100.00 and 49.40% for tactile examination, 49.38, 50.00 and 49.40% for bitewing radiographs, 85.19, 50.00 and 84.34% for DIAGNOdent scores interpreted according to manufacturer's cut-off limits and 81.48, 100.00 and 81.93% for DIAGNOdent scores interpreted according to newly formulated cut-off limits, respectively. At dentin caries cut-off levels, the values of sensitivity, specificity and accuracy for visual examination were 52.78, 89.36 and 73.49%; 50.00, 91.49 and 73.49% for tactile examination; 30.56, 82.98 and 60.24% for bitewing radiographs; 72.22, 76.60 and 74.70% for DIAGNOdent scores when interpreted according to manufacturer's cut-off limits and 77.48, 74.47 and 75.90%, respectively, for the DIAGNOdent scores when interpreted according to the newly formulated cut-off limits. CONCLUSIONS: DIAGNOdent showed higher sensitivity and accuracy as compared with other conventional methods for detection of enamel caries, whereas for detection of dentinal caries, even though the sensitivity was high, accuracy of the DIAGNOdent device was similar to other conventional caries diagnostic methods.

© PMID: 19915274 [PubMed - in process]

Apostolopoulou D, Lagouvardos P, Kavvadia K, Papagiannoulis L
Dept. Paediatric Dentistry, School of Dentistry, University of Athens, Greece.
Eur Arch Peadiatr Dent;10Suppl 1:11-5, 11/10/2009

This was to validate in vitro a laser fluorescence device, DIAGNOdent 2095 - DD, on the detection of occlusal caries in primary molars using the histological examination as the gold standard and to compare the laser fluorescence findings to the results of the conventionally used diagnostic methods.

© Axel Springer Verlag; PMID: 19863893 [PubMed - in process]

Apostolopoulou D, Lagouvardos P, Kavvadia K, Papagiannoulis L
Dept. Paediatric Dentistry, School of Dentistry, University of Athens, Greece.
Eur Arch Peadiatr Dent;10Suppl 1:11-5, 11/10/2009

AIM: This was to validate in vitro a laser fluorescence device, DIAGNOdent 2095 - DD, on the detection of occlusal caries in primary molars using the histological examination as the gold standard and to compare the laser fluorescence findings to the results of the conventionally used diagnostic methods. STUDY DESIGN AND METHODS: 111 occlusal pits in 24 extracted primary molars were examined for caries by one trained operator (Intra-examiner Reliability K>0.83), using direct visual (DV), indirect visual (IDV), radiographic (XR) and fluorescence (DD) examinations and then the extent of caries was determined histologically. Sensitivity, specificity, accuracy and the area under the ROC curve - AUC were calculated for all methods, using the histological evaluation as the gold standard. STATISTICS: Differences between examination methods were estimated by pair-wise comparison of their respective AUC. RESULTS: DD's sensitivity for enamel and for dentine lesions respectively was 0.90 and 0.36, its specificity 0.36 and 0.91 and its accuracy 0.61 and 0.65. The DD device exhibited better sensitivity than specificity for enamel lesions and better specificity than sensitivity for lesions into dentine. The DD device was found to have the highest sensitivity for lesions into enamel, specificity and accuracy and as well as the largest AUC compared with all other methods. For lesions into dentine however, according to AUC values the DD was not statistically significant different from the other methods. CONCLUSION: Compared with the other methods, the DD had the highest validity for enamel caries while its validity for caries into dentine was not statistical different from the other methods.

© Axel Springer Verlag; PMID: 19863893 [PubMed - in process]

Sainsbury AL, Bird PS, Walsh LJ.
University of Queensland School of Dentistry, Brisbane, Australia
J Endod. 35(10):1404-7, 10/1/2009

Real-time assessment of the microbial status of the root canal system would be useful in clinical endodontic practice for determining endpoints of biomechanical treatment. This laboratory study used an existing laser fluorescence device, the DIAGNOdent (KaVo, Biberach, Germany), in a proof-of-concept study.

© Elsevier Verlag; PMID: 19801240 [PubMed - indexed for MEDLINE]

Sainsbury AL, Bird PS, Walsh LJ.
University of Queensland School of Dentistry, Brisbane, Australia
J Endod. 35(10):1404-7, 10/1/2009

INTRODUCTION: Real-time assessment of the microbial status of the root canal system would be useful in clinical endodontic practice for determining endpoints of biomechanical treatment. This laboratory study used an existing laser fluorescence device, the DIAGNOdent (KaVo, Biberach, Germany), in a proof-of-concept study. METHODS: Visible laser red light (wavelength 655 nm) was used to elicit fluorescence emissions in the near-infrared range from infected and uninfected root canals. A prototype sapphire tip designed for periodontal assessment was used to analyze the pulp chamber and coronal third of the root canal system in extracted teeth. The fluorescence properties of bacterial cultures, monospecies biofilms in root canals, pulpal soft tissues, and sound dentin were also evaluated, together with 50 extracted teeth with known endodontic pathology. RESULTS: Sound dentin and healthy pulpal soft tissue gave an average fluorescence reading of 5 (on a scale of 100), whereas biofilms of Enterococcus faecalis and Streptococcus mutans established in root canals showed a progressive increase in fluorescence over time. Fluorescence readings reduced to the "healthy" threshold reading of 5 when root canals were endodontically treated, and the experimentally created bacterial biofilms were removed completely. High fluorescence readings were recorded in the root canals and pulp chambers of extracted teeth with radiographic evidence of periapical pathology and scanning electron microscopy evidence of bacterial infection. CONCLUSIONS: The use of the DIAGNOdent fluorescence approach for the assessment of the status of the pulp chamber and root canal system holds promise for clinical application; once more, flexible tips can be developed for gaining greater penetration into middle and apical thirds of the root canal.

© Elsevier Verlag; PMID: 19801240 [PubMed - indexed for MEDLINE]

Braga MM, Morais CC, Nakama RC, Leamari VM, Siqueira WL, Mendes FM
Department of Pediatric Dentistry, Faculdade de Odontologia da Universidade de São Paulo, São Paulo, Brazil
Oral Surg Med Oral Pathol Oral radio Endod.; 108(4):e35-41, 10/1/2009

The aim was to compare the performance of different methods in detecting approximal caries lesions primary molars ex vivo.

© Elsevier Verlag; PMID: 19778733 [PubMed - indexed for MEDLINE]

Braga MM, Morais CC, Nakama RC, Leamari VM, Siqueira WL, Mendes FM
Department of Pediatric Dentistry, Faculdade de Odontologia da Universidade de São Paulo, São Paulo, Brazil
Oral Surg Med Oral Pathol Oral radio Endod.; 108(4):e35-41, 10/1/2009

OBJECTIVE: The aim was to compare the performance of different methods in detecting approximal caries lesions primary molars ex vivo. STUDY DESIGN: One hundred thirty-one approximal surfaces were examined by 2 observers with visual inspection (VI) using the International Caries Detection and Assessment System, radiographic interpretation, and clinically using the Diagnodent pen (LFpen). To achieve a reference standard, surfaces were directly examined for the presence of white spots or cavitations, and lesion depth was determined after sectioning. The area under the receiver operating characteristic curve (A(z)), sensitivity, specificity, and accuracy were calculated, as well as the interexaminer reproducibility. RESULTS: Using the cavitation threshold, all methods presented similar sensitivities. Higher A(z) values were achieved with VI at white spot threshold, and VI and LFpen had higher A(z) values at cavitation threshold. VI presented higher accuracy and A(z) than radiographic and LFpen at both enamel and dentin depth thresholds. Higher reliability values were achieved with VI. CONCLUSIONS: VI performs better, but both radiographic and LFpen methods also show good performance in detecting more advanced approximal caries lesions.

© Elsevier Verlag; PMID: 19778733 [PubMed - indexed for MEDLINE]

de Paula AB, Campos JA, Diniz MB, Hebling J, Rodrigues JA.
Department of Dental Materials, Piracicaba School of Dentistry, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil.
Lasers Med Sci. , 9/26/2009

The aim of this study was to compare the in situ and in vitro performances of a laser fluorescence (LF) device (DIAGNOdent 2095) with visual inspection for the detection of occlusal caries in permanent teeth. Sixty-four sites were selected, and visual inspection and LF assessments were carried out, in vitro, three times by two independent examiners, with a 1-week interval between evaluations. Afterwards, the occlusal surfaces were mounted on the palatal portion of removable acrylic orthodontic appliances and placed in six volunteers.

© Axel Springer Verlag; PMID: 19784712 [PubMed - as supplied by publisher]

de Paula AB, Campos JA, Diniz MB, Hebling J, Rodrigues JA.
Department of Dental Materials, Piracicaba School of Dentistry, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil.
Lasers Med Sci. , 9/26/2009

The aim of this study was to compare the in situ and in vitro performances of a laser fluorescence (LF) device (DIAGNOdent 2095) with visual inspection for the detection of occlusal caries in permanent teeth. Sixty-four sites were selected, and visual inspection and LF assessments were carried out, in vitro, three times by two independent examiners, with a 1-week interval between evaluations. Afterwards, the occlusal surfaces were mounted on the palatal portion of removable acrylic orthodontic appliances and placed in six volunteers. Assessments were repeated and validated by histological analysis of the tooth sections under a stereomicroscope. For both examiners, the highest intra-examiner values were observed for the visual inspection when in vitro and in situ evaluations were compared. The inter-examiner reproducibility varied from 0.61 to 0.64, except for the in vitro assessment using LF, which presented a lower value (0.43). The methods showed high specificity at the D(1) threshold (considering enamel and dentin caries as disease). In vitro evaluations showed the highest values of sensitivity for both methods when compared to the in situ evaluations at D(1) and D(2) (considering only dentinal caries as the disease) thresholds. For both methods, the results of sensitivity (at D(1) and D(2)) and accuracy (at D(1)) showed significant differences between in vitro and in situ conditions. However, the sensitivity (at D(1) and D(2)), specificity and accuracy (both at D(1)) of the methods were not significantly different when the same condition was considered. It can be concluded that visual inspection and LF showed better performance in vitro than in situ.

© Axel Springer Verlag; PMID: 19784712 [PubMed - as supplied by publisher]