El diagnóstico de la caries ha cobrado especial relevancia durante estos últimos años. No tan sólo para poder comprobar cuando ella existe y actuar a tiempo, como también, cuando no la hay,no realizar tratamientos que no son necesarios.
Si bien, los métodos tradicionales, es decir, la inspección visual -detallada y valorada por Ricketts Op. Dent. 2002:27;231-237- el reconocimiento tactil, la radiografía y la anamnésis del paciente, nos pueden dar un porcentaje de asertividad en nuestro diagnóstico, es posible, desde hace algún tiempo, contar con nuevos métodos que pueden optimizar nuestra labor.
Existe solamente una marca comercial para este tipo de tecnología, el “Diagnodent” de KaVo. Este ha presentado un rendimiento satisfactorio, como queda evidenciado en la bibliografía que presentamos a continuación.
Dr. Jorge Garat.
Lasers Med Sci. 2009 Sep 26.
In situ and in vitro comparison of laser fluorescence with visual inspection in detecting occlusal caries lesions.
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.
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.
Caries Res. 2009;43(5):397-404. Epub 2009 Sep 16.
Validity and reliability of laser-induced fluorescence measurements on carious root surfaces in vitro.
Karlsson L, Johansson E, Tranaeus S.
Division of Cardiology and Endodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden. lena.karlsson@ki.se
The aim was to assess the validity of laser fluorescence (LF), visual inspection and surface texture on root caries lesions in vitro, related to histological lesion depths. Agreement on interdevice, interexaminer and intra-examiner levels as well as the influence of discolouration and surface texture on LF readings were investigated. Calibrated examiners assessed lesion colour and surface texture and performed measurements with 2 LF devices in 3 separate series at intervals of 1 week. Sections (300 mum thick) of 64 out of 93 teeth were obtained and examined under the microscope. Lesion depth was assessed with 2 references: from the delineated borderline of the original exposed root surface (ref. I), or if loss of surface continuity, the absolute lesion depth (ref. II). The correlation (Spearman rho) between LF readings and histological depth was low with values ranging from 0.22 (p > 0.05) to 0.31 (p < 0.05). LF 1 and LF 2 were significantly correlated with discolouration (rho = 0.52 and 0.46, respectively) and with surface texture denoted as hard (rho = 0.34 and 0.33, respectively). A significant correlation between colour and histological depth ref. I (rho = 0.51) and ref. II (rho = 0.56) was found. No significant correlation between surface texture and histological depth was found. The reliability, evaluated as intraclass correlation coefficient was for intra-examiner 0.99, interexaminer 0.97 and interdevice level 0.98. Large differences were found between 2 consecutive measurements, and high measurement errors indicated considerable deviation of individual measurements. Based on these findings, the LF device is not suitable as a diagnostic tool for root caries.
J Indian Soc Pedod Prev Dent. 2009 Apr-Jun;27(2):90-3.
An in-vitro comparison of visual inspection, bite-wing radiography, and laser fluorescence methods for the diagnosis of occlusal caries.
Pourhashemi SJ, Jafari A, Motahhari P, Panjnoosh M, Kharrazi Fard MJ, Sanati I, Sahadfar M, Pariab M.
Department of Pediatric Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. pourhash@sina.tum.ac.ir.
Purpose: The purpose of this study was to compare accuracy and reproducibility of visual inspection (VI), bitewing (BW) radiography, and laser fluorescence (LF, DIANOdent) methods in the diagnosis of occlusal caries. Materials and Methods: The study was done on 80 extracted permanent premolars that seem to be intact or with primary caries in fissures. Three trained dentist examined the teeth in four stages: VI, BW radiography, LF, and histologic examination. Sensitivity, specificity, positive and negative predictive values, and accuracy of all methods were calculated and compared. For the LF method, using ROC curve and counterpart points on it, we determined upper and lower limits and calculated the parameters. Results: The estimated accuracy was 58.9% for VI and 45.1% for BW radiography methods. Kappa coefficient for interexaminer reproducibility was 57% and 34.1% in VI and BW radiography, respectively. Inter- and intraexaminer reproducibility coefficients of LF methods were 78.4% and 83.6%, respectively. The mean intraexaminer reproducibility coefficient in the VI method was 61.2%. Conclusion: Although accuracy and reproducibility of the LF method were higher than those of the VI and BW radiography, it is better to use this method together with other methods to reduce diagnostic faults.
Relationship between DIAGNOdent values and sealant penetration depth on occlusal fissures.
Rodrigues JA, Diniz MB, Hug I, Cordeiro RC, Lussi A.
Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH 3010, Bern, Switzerland, jonas.rodrigues@zmk.unibe.ch.
The aim of this in vitro study was to evaluate the relationship between laser fluorescence values and sealant penetration depth on occlusal fissures. One hundred and sixty-six permanent molars were selected and divided into four groups, which were each treated using a different sealant (two clear and two opaque). The teeth were independently measured twice by two experienced dentists using two laser fluorescence devices-DIAGNOdent (LF and LFpen)-before and after sealing, and then thermoclycled. After measuring, the teeth were histologically prepared and assessed for caries extension. Digital photographs of the cut sealed sites were assessed, and the sealant penetration depth was measured. All 166 sites were measured by one of the examiners taking as limits the outer and inner surface of the sealant into the fissure. For each device (LF and LFpen) and each group, the difference between the values at baseline and after sealing was plotted against the sealant penetration depth and scatter plots were provided. It could be observed that most of the points were concentrated around the zero line, for both LF and LFpen in the four groups. In conclusion, there is no relation between changes in DIAGNOdent values and increasing of depth sealant penetration within the occlusal fissures.
J Dent. 2009 Jul;37(7):509-13. Epub 2009 Apr 29.
A comparison of root caries diagnosis based on visual-tactile criteria and DIAGNOdent in vivo.
Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
OBJECTIVES: This clinical study aimed to evaluate the validity of using DIAGNOdent in diagnosing root caries, and to assess the sensitivity and specificity of different cut-off DIAGNOdent values in assessing root caries with reference to visual-tactile criteria. METHODS: Exposed root surfaces were assessed by one examiner for root caries on 266 subjects using visual-tactile criteria and DIAGNOdent 2095 after dental scaling. Associations between DIAGNOdent values and visual-tactile diagnosis of root caries were determined. The cut-off level for statistical significance was 0.05. The sensitivity and specificity of DIAGNOdent with difference cut-off points were analysed compared to visual-tactile diagnosis of root caries. RESULTS: There was significant difference between DIAGNOdent values obtained from sound and carious root surfaces (p<0.001). On carious surfaces, active root caries obtained significantly higher DIAGNOdent values than inactive root caries (p<0.001). With increasing cut-off point DIAGNOdent values from 5 to 35, sensitivity decreased from 91.4% to 16.2% and specificity increased from 64.4% to 98.2%. A cut-off point of DIAGNOdent value between 5 and 10 produced the highest combined sensitivity and specificity. CONCLUSIONS: There was a significant difference in DIAGNOdent values between sound and carious root surfaces diagnosed by visual-tactile criteria supporting the validity of DIAGNOdent for assessing root caries. A DIAGNOdent value between 5 and 10 produced the highest combined sensitivity and specificity when visual-tactile assessment of root caries was regarded as the criterion. These findings have implications in using and explaining DIAGNOdent values in assessing root caries.
Oper Dent. 2009 Mar-Apr;34(2):136-41.
In vivo evaluation of DIAGNOdent for the quantification of occlusal dental caries.
Khalife MA, Boynton JR, Dennison JB, Yaman P, Hamilton JC.
Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
The accurate diagnosis of non-cavitated occlusal caries is generally considered problematic. Induced fluorescence quantified by the DIAGNOdent device (KaVo) gives a reading from 0-99, which may help in the caries diagnostic process. There is some controversy around the implication of increased severity of decay with increased DIAGNOdent readings. This in vivo study assessed the correlation of depth and volume of decay as it was removed by traditional rotary handpieces with DIAGNOdent readings and determined sensitivities/specificities of the device at different cut-off points. Included in the current study were 31 patients providing 60 permanent molar and premolar occlusal surfaces suspected of dentinal decay. DIAGNOdent readings were recorded, along with lesion depth (as measured by periodontal probe) and volume measurements (as calculated from measuring the mass of a polyvinyl siloxane impression of the cavity, divided by the material’s calculated density). Clinical detection of decay at the DEJ was used as the gold-standard to calculate an appropriate cut-off. Pearson correlation coefficients indicated that DIAGNOdent readings were weakly correlated with lesion depth (r = 0.47) and lesion volume (also r = 0.47). An appropriate cut-off point for the sample in the current study was calculated between 35 and 40; a more specific cut-off point could not be determined due to the sample size distribution. It was concluded that the DIAGNOdent device should be used as an adjunct in the caries diagnosis and treatment planning process.
Caries Res. 2009 May 12;43(4):302-307. [Epub ahead of print]
Evaluation of Laser Fluorescence in the Monitoring of the Initial Stage of the De-/Remineralization Process: An in vitro and in situ Study.
Spiguel MH, Tovo MF, Kramer PF, Franco KS, Alves KM, Delbem AC.
Pediatric Dentistry Department, School of Dentistry of Lutheran University of Brazil, Canoas, Brazil.
This study aimed to evaluate laser fluorescence (LF) for monitoring the initial stage of subsurface de- and remineralization (<150 mum depth). Ninety-six sound blocks of bovine enamel, selected according to surface hardness (SH) and LF were used in two experimental studies, in vitro and in situ. In vitro, blocks were exposed to a demineralizing solution, then remineralized by pH cycling for 6 days. In situ, 10 volunteers wore acrylic palatal appliances, each containing 4 dental enamel blocks that were demineralized for 14 days by exposure to 20% sucrose solution. Following this treatment, blocks were submitted to remineralization for 1 week with fluoride dentifrice (1,100 mug F/g). In both experiments, SH and LH were measured after demineralization and after remineralization. Further, enamel blocks were selected after the demineralization/remineralization steps for measurement of cross-sectional hardness and integrated loss of subsurface hardness (DeltaKHN). SH and DeltaKHN showed significant differences among the phases in each study. LF values for sound, demineralized and remineralized enamel were: 5.2 +/- 1.1, 8.1 +/- 1.2 and 5.6 +/- 0.8, respectively, in the in vitro study, and 5.3 +/- 0.3, 16.5 +/- 4.7 and 6.5 +/- 2.5, respectively, in the in situ study, values for demineralized enamel being significantly higher than for sound and remineralized enamel in both studies. However, LF was correlated with DeltaKHN only in situ. LF was capable of monitoring de- and remineralization in early lesions in situ, when bacteria are presumably present in the caries lesion body, but is not correlated with mineral changes in bacteria-free systems. Copyright © 2009 S. Karger AG, Basel.
Photomed Laser Surg. 2009 May 5. [Epub ahead of print]
The Influence of PVC Wrapping on the Performance of Two Laser Fluorescence Devices on Occlusal Surfaces In Vitro.
De Almeida Rodrigues J, Hug I, Lussi A.
Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern , Switzerland .
Abstract Objective: The aim of this study was to determine the influence of polyvinyl chloride (PVC) wrapping on the performance of two laser fluorescence devices (LF and LFpen) by assessing tooth occlusal surfaces. Background Data: Protection of their tips may influence LF measurements. To date there are no studies evaluating the influence of this protection on the performance of the LFpen on permanent teeth, or comparing it to the original LF device. Materials and Methods: One hundred nineteen permanent molars were assessed by two experienced dentists using the LF and the LFpen devices, both with and without PVC wrapping. The teeth were histologically prepared and assessed for caries extension. Results: The LF values with and without PVC wrapping were significantly different. For both LF devices, the sensitivity and accuracy were lower when the PVC wrapping was used. The specificity was statistically significantly higher for the LFpen with PVC. No difference was found between the areas under the ROC curves with and without PVC wrapping. The ICC showed excellent interexaminer agreement. The Bland and Altman method showed a range between the upper and the lower limits of agreement of 63.4 and 57.8 units for the LF device, and 49.4 and 74.2 for the LFpen device, with and without PVC wrapping, respectively. Conclusions: We found an influence of the PVC wrapping on the performance of the LF and LFpen devices. However, since its influence on detection of occlusal caries lesions is accounted for, the use of one PVC layer is suggested to avoid cross-contamination in clinical practice.
Caries Res. 2009 Mar 24;43(2):137-141.
Performance of Laser Fluorescence for Detection of Occlusal Dentinal Caries Lesions in Permanent Molars: An in vivo Study with Total Validation of the Sample.
Abalos C, Herrera M, Jiménez-Planas A, Llamas R.
Department of Dental Materials, University of Seville, Seville, Spain.
The objective of this in vivo study was to evaluate the performance of a laser fluorescence device in detecting dentinal caries in noncavitated occlusal surfaces. The sample included 102 first and second permanent molars, selected according to the criteria of Ekstrand et al. [Caries Res 1997;31:224-231]: 46 not suspected of having dentinal caries (score: 0-2) and 56 under suspicion (score: 3-4). Once measured by laser fluorescence, all were validated by fissurotomy (gold standard). To avoid ethical questions, the 46 teeth (score: 0-2) used were to serve as abutments for a fixed-fixed bridge. Visual inspection performed well, showing a sensitivity and specificity of 0.93 and 0.88, respectively. Laser fluorescence had an area under the receiver operating characteristic curve of A(z) = 0.85. The cutoff point with the highest sensitivity and specificity was 20, with a sensitivity and specificity of 0.89 and 0.75, respectively. Copyright © 2009 S. Karger AG, Basel.Photomed Laser Surg. 2009 Jan 30.
The Efficacy of Laser Fluorescence to Detect in Vitro Demineralization and Remineralization of Smooth Enamel Surfaces.
Diniz MB, Leme AF, Cardoso KD, Rodrigues JD, Cordeiro RD.
Department of Pediatric Dentistry, School of Dentistry of Araraquara, Säo Paulo State University (UNESP), Araraquara, SP, Brazil.
Abstract Objective: The purpose of this study was to evaluate the efficacy of the laser fluorescence (LF) device in detecting in vitro demineralization and remineralization of smooth surface caries-like lesions. Background Data: The early detection of smooth surface caries-like lesions is important to provide proper management of carious lesions, and allows monitoring of them over time. Also, some authors suggest that LF could be usefulin monitoring the caries pathological process. Materials and Methods: Seventy-eight blocks of bovine teeth were obtained, and then submitted to artificial caries lesion induction and to a pH-cycling process. Superficial microhardness (SMH) and laser fluorescence analysis were performed at baseline, after induction of caries-like lesions, and after the pH-cycling regimen to promote remineralization. Results: Friedman’s and multiple comparison tests were performed for all variables. SMH analysis showed significant differences (p < 0.05) between baseline (286.77 +/- 1.49 Vickers hardness number [VHN] units), before (38.48 +/- 0.85 VHN), and after remineralization (131.93 +/- 2.63 VHN). Baseline values for LF were extremely low (2.71 +/- 0.05), and a statistically significant difference was observed only after remineralization (3.61 +/- 0.08), as demonstrated by the increase in LF values. Conclusion: The LF device did not show efficacy for monitoring in vitro demineralization and remineralization of smooth enamel surfaces.
Caries Res. 2009 Jan 9;43(1):36-42.
Performance of a Pen-Type Laser Fluorescence Device and Conventional Methods in Detecting Approximal Caries Lesions in Primary Teeth – in vivo Study.
Novaes TF, Matos R, Braga MM, Imparato JC, Raggio DP, Mendes FM.
Department of Pediatric Dentistry, Faculdade de Odontologia da Universidade de São Paulo, São Paulo, Brazil.
This in vivo study aimed to compare the performance of different methods of approximal caries detection in primary molars. Fifty children (aged 5-12 years) were selected, and 2 examiners evaluated 621 approximal surfaces of primary molars using: (a) visual inspection, (b) the radiographic method and (c) a pen-type laser fluorescence device (LFpen). As reference standard method, the teeth were separated using orthodontic rubbers during 7 days, and the surfaces were evaluated by 2 examiners for the presence of white spots or cavitations. The area under the receiver-operating characteristics curve (A(z)) as well as sensitivity, specificity and accuracy (percentage of correct diagnosis) were calculated and compared with the McNemar test at both thresholds. The interexaminer reproducibility was calculated using the intraclass correlation coefficient (ICC-absolute values) and the kappa test (dichotomizing for both thresholds). The ICC value of the reference standard procedure was 0.94. At white-spot threshold, no methods tested presented good performance (sensitivity: visual 0.20-0.21; radiographic 0.16-0.23; LFpen 0.16; specificity: visual 0.95; radiographic 0.99-1.00; LFpen 0.94-0.96). At cavitation threshold, both LFpen and radiographic methods demonstrated higher sensitivity (0.55-0.65 and 0.65-0.70, respectively) and A(z) (0.92 and 0.88-0.89, respectively) than visual inspection sensitivity (0.30) and A(z) (0.69-0.76). All methods presented high specificities (around 0.99) and similar ICCs, but the kappa value for LFpen at white-spot threshold was lower (0.44). In conclusion, both LFpen and radiographic methods present similar performance in detecting the presence of cavitations on approximal surfaces of primary molars. Copyright © 2009 S. Karger AG, Basel.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Nov;106(5):729-35. Epub 2008 Jul 25.
Caries detection with DIAGNOdent and ultrasound.
Tagtekin DA, Ozyoney G, Baseren M, Ando M, Hayran O, Alpar R, Gokalp S, Yanikoglu FC, Stookey GK.
Department of Operative Dentistry, Faculty of Dentistry, University of Marmara, Istanbul, Turkey. dtagtekin@hotmail.com
OBJECTIVE: The objective of this study was to evaluate the repeatability of 2 nondestructive caries detection methods, ultrasound (ULS) and DIAGNOdent, for the detection of approximal caries lesions, and to evaluate 2 tips provided for the DIAGNOdent. STUDY DESIGN: White/brown-spot lesions (n = 42) were captured by a digital camera, and measured by test methods and confocal laser scanning microscope (CLSM). Intra- and inter-observer reliability, accuracy, and Cohen’s kappa and Spearman’s rho statistics were used. RESULTS: At DIAGNOdent, intra-observer agreements were 78.5%, 66.7% for A tip and 59.5%, 47.6% for B for 2 examiners, respectively. Accuracy of both tips was 50% for the first examiner; 45.3% for A and 47.6% for the B tip for the second examiner. All ULS measurements were accurate, reliable, and positively and significantly correlated between examiners. CONCLUSION: The A tip of the DIAGNOdent was found to be better than the B tip for the detection of enamel caries. All DIAGNOdent and ULS measurements were positive and significantly correlated for both examiners. Both methods demonstrated high repeatability and accuracy.Gesundheitswesen. 2008 Nov;70(11):649-52.
[Occlusal caries - early detection in school-based dental screenings]
Goddon I, Berger S, Senkel H, Kühnisch J, Heinrich-Weltzien R.
Fachbereich Soziales & Gesundheitdes Ennepe-Ruhr-Kreises, Schwanenmarkt 5-7, 58452 Witten. I.Goddon@en-kreis.de
Concomitant to the general caries decline in children and adolescents, caries is mainly concentrated on occlusal surfaces of permanent molars. While occlusal cavities have been shifted to non-cavitated lesions, school-based visual tactile screenings on a cavity level based on the WHO standard (1997) are of limited value as evidence. To avoid cavities or extended restorations current dentistry targets at early prevention or minimal intervention. School-based visual screenings of non-cavitated lesions may support the preventive care strategies of dental practioners. A comparative diagnostic study in 8- to 12-year-olds in the Westfalian Ennepe-Ruhr district showed that occlusal surfaces scored as primarily sound under the WHO standard in fact revealed a high need for preventive (43%) and operative (30%) treatment after using additional visual and laser optical diagnostic measurements. Because of the limited information of the laser optical findings, laser fluorescence diagnostics should not be included in school-based dental screenings. Compromises are needed to introduce visual diagnostic examinations in school-based dental screenings.
Clinical evaluation of polypropylene glycol-based caries detecting dyes for primary and permanent carious dentin.
Hosoya Y, Taguchi T, Arita S, Tay FR.
Nagasaki University Graduate School of Biomedical Sciences, Medical and Dental Sciences, Unit of Translational Medicine, Department of Pediatric Dentistry, 1-7-1, Sakamoto, Nagasaki, 852-8588, Japan.
OBJECTIVE: The aim of this study was to compare the clinical efficacy of new caries detecting dye Caries Check Blue (CCB) with Caries Check (CC) and Caries Detector (CD) using a laser fluorescence device (DIAGNOdent). METHOD: Primary and permanent teeth with dentin caries were stained with polypropylene glycol (MW=300) based new caries detecting dyes CCB, CC, or propylene glycol (MW=76) based CD. In the CCB and CC groups, stained dentin was completely removed. In the CD groups, pink-stained dentin was retained according to the manufacturers’ instructions. Cavities before and after caries removal were measured with the DIAGNOdent. Data were analyzed using ANOVA and Fisher’s PLSD multiple comparison test at alpha=0.05. Regression analyses were performed between DIAGNOdent readings and scores obtained from the clinical parameters. RESULTS: The DIAGNOdent readings after caries removal were: primary-CCB (13.2+/-10.4), primary-CC (14.3+/-16.7), primary-CD (9.0+/-5.2), permanent-CCB (22.7+/-13.4), permanent-CC (10.6+/-6.8) and permanent-CD (9.7+/-9.0). Significant differences were identified between the permanent-CCB and all other groups. Correlation coefficients between DIAGNOdent readings and clinical parameters were low. CONCLUSIONS: When dentin stained with Caries Check Blue or Caries Check was completely removed, the DIAGNOdent readings were higher than those recorded when palely-stained pink dentin was retained with the Caries Detector, with significant difference observed for the permanent-CCB group. Caries Check Blue may be used clinically to avoid excessive removal of caries-affected or sound dentin in permanent teeth but not in primary teeth.
J Dent. 2008 Oct 17. [Epub ahead of print]
Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars.
Huth KC, Neuhaus KW, Gygax M, Bücher K, Crispin A, Paschos E, Hickel R, Lussi A.
Department of Restorative Dentistry, Periodontology and Paediatric Dentistry, Ludwig-Maximilians-University, Munich, Germany.
OBJECTIVES: To determine the clinical performance of a laser fluorescence device (DIAGNOdent pen, KaVo) to discriminate between different occlusal caries depths (D(0)-D(1-4); D(0-2)-D(3,4)) in permanent molars. METHODS: In this prospective, randomized two-centre-study 120 sound/uncavitated carious sites in 120 patients were measured after visual and radiographic caries assessment. In cases of operative intervention (n=86), the lesion depths after caries removal were recorded (reference). In cases of preventive intervention (n=34), the sites were reassessed visually/radiographically after 12 months to verify the status assessed before (reference). The discrimination performance was determined statistically (Mann-Whitney test, Spearman’s rho coefficient, and areas under the receiver operating characteristic curves (AUCs)). Sensitivities (SE) and specificities (SP) were plotted as a function of the measured values and cut-off values for the mentioned thresholds suggested. RESULTS: Sound sites (n=13) had significantly minor fluorescence values than carious sites (n=107) (P<0.0001) as had sites with no/enamel caries (n=63) compared to dentinal caries (n=57). The AUCs for the same discriminations were 0.92 and 0.78 (P<0.001). For the D(0)-D(1-4) threshold, a cut-off at a value of 12 (SE: 0.88, SP: 0.85) and for the D(0-2)-D(3,4) threshold at 25 (SE: 0.67, SP: 0.79) can be suggested. A moderate positive correlation between the measurements and the caries depths was calculated (rho=+0.57, P=0.01). CONCLUSION: Within this study, the device’s discrimination performance for different caries depths was moderate to very good and it may be recommended as adjunct tool in the diagnosis of occlusal caries.
J Dent. 2008 Sep 9.
Relationship between laser fluorescence and enamel hypomineralisation.
Farah RA, Drummond BK, Swain MV, Williams S.
Department of Oral Sciences, Faculty of Dentistry, University of Otago, New Zealand.
OBJECTIVES: To study the relation between the mechanical properties of hypomineralised enamel, and its laser fluorescence (LF). METHODS: Five extracted teeth with molar-incisor hypomineralisation (MIH) were sectioned longitudinally through the defects and polished to prepare the hypomineralised enamel for testing. Hardness (H) and elastic modulus (E) of enamel were measured using nanoindentation. Measurement recording started from the cervicoenamel junction and proceeded occlusally in increments of 200mum. Laser fluorescence readings were taken along the same line and at the same sites using a DIAGNOdent pen. RESULTS: H, E, and LF readings from cervical enamel were within the expected range for normal sound enamel. After log transformation of the H and E measurements to allow for linear correlation analysis, there was a significant and moderately strong inverse correlation between LF and H or E samples (r (between specimens)=0.59, r (between specimens)=0.39, respectively; p<0.001). CONCLUSIONS: This study shows that, in the absence of dental caries, increased DIAGNOdent readings can indicate enamel hypomineralisation. While the increased LF readings in carious enamel are thought to be related to the presence of caries bacterial metabolites, the increased readings in hypomineralised enamel may be related to proteins in the hypomineralised enamel and/or light scattering by the inhomogeneous enamel.
Caries Res. 2008;42(5):328-33.
The influence of pit and fissure sealants on infrared fluorescence measurements.
Diniz MB, Rodrigues JA, Hug I, Cordeiro RC, Lussi A.
Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland. mibdiniz@hotmail.com
The aim of this in vitro study was to evaluate the influence of pit and fissure sealants on fluorescence readings using lasers. We selected 166 permanent molars and randomly divided them into 4 groups which were each treated with a different sealant (a commercially available clear sealant, 2 opaque sealants and an experimental nanofilled clear sealant). The teeth were independently measured twice by 2 experienced dentists using conventional laser fluorescence (LF) and a laser fluorescence pen device (LFpen), before and after sealing, and again after thermocycling to simulate the thermal stressing between the tooth and the dental materials. Friedman test showed no statistically significant changes using LF and LFpen for the commercial clear sealant group, although values tended to increase after sealing. However, the values increased significantly after thermocycling. There was a statistically significant decrease in fluorescence after application of opaque sealants. After application of the experimental nanofilled clear sealant, LF values increased only after thermocycling, whereas the LFpen values increased after sealing and after thermocycling as well. The intraclass correlation coefficient ranged from 0.87 to 0.96 for interexaminer and 0.82 to 0.94 for intraexaminer reproducibility. It was shown that pit and fissure sealants influence LF and LFpen readings, with the values increasing or decreasing according to the material used. In conclusion, both laser fluorescence devices could be useful as an adjunct to detect occlusal caries under unfilled clear sealants. Nevertheless, surfaces sealed with clear nanofilled material could be assessed using only the LF device. Copyright 2008 S. Karger AG, Basel.
J Am Dent Assoc. 2008 Aug;139(8):1105-12.
The influence of zero-value subtraction on the performance of two laser fluorescence devices for detecting occlusal caries in vitro.
Rodrigues Jde A, Hug I, Diniz MB, Cordeiro RC, Lussi A.
Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, Bern, Switzerland. jorodriguez@hotmail.com
BACKGROUND: The aim of this study was to evaluate the influence of zero-value subtraction on the performance of two laser fluorescence (LF) devices developed to detect occlusal caries. METHODS: The authors selected 119 permanent molars. Two examiners assessed three areas (cuspal, middle and cervical) of both mesial and distal portions of the buccal surface and one occlusal site using an LF device and an LF pen. For each tooth, the authors subtracted the value measured in the cuspal, middle and cervical areas in the buccal surface from the value measured in the respective occlusal site. RESULTS: The authors observed differences among the readings for both devices in the cuspal, middle and cervical areas in the buccal surface as well as differences for both devices with and without the zero-value subtraction in the occlusal surface. When the authors did not perform the zero-value subtraction, they found statistically significant differences for sensitivity and accuracy for the LF device. When this was done with the LF pen, specificity increased and sensitivity decreased significantly. CONCLUSIONS: For the LF device, the zero-value subtraction decreased the sensitivity. For this reason, the authors concluded that clinicians can obtain measures with the LF device effectively without using zero-value subtraction. For the LF pen, however, the absence of the zero-value subtraction changed both the sensitivity and specificity, and so the authors concluded that clinicians should not eliminate this step from the procedure. CLINICAL IMPLICATIONS: When using the LF device, clinicians might not need to perform the zero-value subtraction; however, for the LF pen, clinicians should do so.
Caries Res. 2008;42(4):297-304.
Performance of fluorescence methods, radiographic examination and ICDAS II on occlusal surfaces in vitro.
Rodrigues JA, Hug I, Diniz MB, Lussi A.
Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland. jorodrigues@hotmail.com
This study compared the performance of fluorescence-based methods, radiographic examination, and International Caries Detection and Assessment System (ICDAS) II on occlusal surfaces. One hundred and nineteen permanent human molars were assessed twice by 2 experienced dentists using the laser fluorescence (LF and LFpen) and fluorescence camera (FC) devices, ICDAS II and bitewing radiographs (BW). After measuring, the teeth were histologically prepared and assessed for caries extension. The sensitivities for dentine caries detection were 0.86 (FC), 0.78 (LFpen), 0.73 (ICDAS II), 0.51 (LF) and 0.34 (BW). The specificities were 0.97 (BW), 0.89 (LF), 0.65 (ICDAS II), 0.63 (FC) and 0.56 (LFpen). BW presented the highest values of likelihood ratio (LR)+ (12.47) and LR- (0.68). Rank correlations with histology were 0.53 (LF), 0.52 (LFpen), 0.41 (FC), 0.59 (ICDAS II) and 0.57 (BW). The area under the ROC curve varied from 0.72 to 0.83. Inter- and intraexaminer intraclass correlation values were respectively 0.90 and 0.85 (LF), 0.93 and 0.87 (LFpen) and 0.85 and 0.76 (FC). The ICDAS II kappa values were 0.51 (interexaminer) and 0.61 (intraexaminer). The BW kappa values were 0.50 (interexaminer) and 0.62 (intraexaminer). The Bland and Altman limits of agreement were 46.0 and 38.2 (LF), 55.6 and 40.0 (LFpen) and 1.12 and 0.80 (FC), for intra- and interexaminer reproducibilities. The posttest probability for dentine caries detection was high for BW and LF. In conclusion, LFpen, FC and ICDAS II presented better sensitivity and LF and BW better specificity. ICDAS II combined with BW showed the best performance and is the best combination for detecting caries on occlusal surfaces. Copyright 2008 S. Karger AG, Basel.
Odontology. 2008 Jul;96(1):21-5.
Impact of Streptococcus mutans on the generation of fluorescence from artificially induced enamel and dentin carious lesions in vitro.
Shigetani Y, Takenaka S, Okamoto A, Abu-Bakr N, Iwaku M, Okiji T.
Division of Cariology, Operative Dentistry and Endodontics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, 5274 Gakkocho-dori 2-Bancho, Chuo-ku, Niigata, 951-8514, Japan. yoshimi@dent.niigata-u.ac.jp
The purpose of this study was to examine whether Streptococcus mutans is implicated in the generation of fluorescence detected in carious lesions. Enamel surfaces and dentin cavities of extracted human teeth were subjected to artificial caries generation by exposing them either to a culture medium containing S. mutans or to a lactic acid buffer for 2 weeks. Fluorescence from the lesions was detected with confocal laser scanning microscopy or fluorescence microscopy at various excitation wavelengths, and maximum fluorescence radiance was computed using imageanalyzing software. Culture media of S. mutans were also examined for fluorescence generation. The results demonstrated that S. mutans-induced enamel and dentin lesions exhibited increased fluorescence in the red and green spectral regions, with the signal stronger in the red region. In the blue region, however, fluorescence signals in the corresponding area were below the background level. Significantly weaker or virtually no fluorescence was detected in lactic acid-demineralized lesions at all excitation wavelengths. Neither bacterial cells nor culture media generated any fluorescence. These results indicate that, although the presence of S. mutans may be a prerequisite for the emission of fluorescence from carious lesions, some interaction of S. mutans with exposed tooth matrix elements may also be required for the generation or unmasking of fluorophores.
Oral Health Prev Dent. 2008;6(2):165-9.
Laser fluorescence device does not perform well in detection of early caries lesions in primary teeth: an in vitro study.
Braga M, Nicolau J, Rodrigues CR, Imparato JC, Mendes FM.
Department of Pediatric Dentistry, School of Dentistry, Universidade de São Paulo, São Paulo, Brazil.
PURPOSE: To evaluate if using the laser fluorescence (LF) device improves the detection of early or more advanced occlusal caries lesions in primary teeth. MATERIALS AND METHODS: A total of 181 occlusal sites in primary teeth were assessed by one examiner using DIAGNOdent. The same examiner and a second examiner evaluated 72 of the sites again to assess intra- and inter-examiner reproducibility. After histological validation, lesions were divided at three thresholds according to the lesion depth: outer half of the enamel (D1), inner half of the enamel (D2) and dentine (D3). The sensitivity, specificity, accuracy and area under ROC curve were calculated for cut-off points for the sample considering the aforementioned thresholds. The parameters were compared using chi-square test and by comparison between unpaired ROC curves. RESULTS: The overall LF performance was better at dentine threshold than at enamel threshold. The higher specificity was found at D3 and D2, and higher accuracy at D3 (P < 0.001). The intra- and inter-examiner agreements were classified as good or excellent for all thresholds. CONCLUSIONS: The LF device performs better at the dentine threshold than at the enamel threshold. This method does not perform well in detecting initial enamel caries lesions.
Int J Paediatr Dent. 2008 Jul;18(4):300-5.
Evaluation of different methods for monitoring incipient carious lesions in smooth surfaces under fluoride varnish therapy.
Ferreira JM, Silva MF, Oliveira AF, Sampaio FC.
Postgraduation Program in Dentistry, Master Program in Preventive and Pedodontic Dentistry, Federal University of Paraiba, João Pessoa, Brazil. jainara.s@ig.com.br
BACKGROUND: There are only a few studies relating visual inspection methods and laser fluorescence when monitoring regression of incipient carious lesions. AIM: The purpose of this study was to monitor incipient carious lesions in smooth surfaces under varnish fluoride therapy using visual inspection methods and laser fluorescence (LF). DESIGN: Active white spot lesions (n = 111) in upper front teeth of 36 children were selected. The children were subjected to four or eight applications of fluoride varnish in weekly intervals. The visual systems were activity (A) and maximum dimension in millimetres (D). They were applied together with LF readings (L) in the beginning of the study (W1), in the 5th week (W5), and in the 9th (W9) week. RESULTS: The mean (SD) of L values in W5 and W9 were 5.6 (3.8) and 4.5 (3.3), respectively; both were significantly different from the initial score of 7.4 (5.1) in W1. There was a positive correlation between D and L in W5 (r = 0.25) and W9 (r = 0.36; P < 0.05). The mean (SD) values of L were lower following the activity criteria. CONCLUSIONS: Our findings support the finding that incipient carious lesions in smooth surfaces under fluoride therapy can be monitored by laser fluorescence and visual inspection methods.
Lasers Med Sci. 2008 Jun 7.
Dye-enhanced laser fluorescence detection of caries lesions around brackets.
Alencar CJ, Braga MM, de Oliveira E, Nicolau J, Mendes FM.
Department of Pediatric Dentistry, Faculdade de Odontologia da Universidade de São Paulo, Av. Lineu Prestes, 2227, São Paulo, SP, 05508-000, Brazil.
The aim was to evaluate the performance of DIAGNOdent [laser fluorescence(LF) and LFpen] devices enhanced by fluorescent dye in detecting mineral loss around brackets and comparing the inhibitory effect of bonding material on artificial demineralization, and to verify whether LF methods show the same trends of mineral loss. Brackets were bonded to premolar halves with Fuji Ortho LC, Transbond XT, and Ortho Glass LC cements (n = 15). The teeth were soaked in demineralizing solution (pH = 4.8) for 16 days. Mineral loss was calculated by atomic emission spectrometry, and lesions were measured with LF devices with dye [tetrakis N-methylpyridyl porphyrin (TMPyP)]. Groups were compared with regard to LF readings and mineral loss, and performance of caries detection was calculated. Higher mineral loss and LF-TMPyP values occurred in the resin group. LFpen-TMPyP readings were significantly higher in the demineralized groups. Correlation was observed between mineral loss and LF measurements. LF methods are capable of identifying lower demineralization around brackets bonded with resin-modified glass ionomer cements.
J Am Dent Assoc. 2008 May;139(5):572-9.
A clinical study of caries diagnosis with a laser fluorescence system.
Barbería E, Maroto M, Arenas M, Silva CC.
Dental Care Program for Children, Department of Prevention, Pediatric Dentistry and Orthodontics, Complutense University of Madrid, Madrid, Spain. barberia@odon.ucm.es
BACKGROUND: The authors conducted an in vivo study to compare a laser fluorescence system with a visual system for occlusal caries diagnosis in children’s primary and permanent molars. METHODS: The authors selected for evaluation 320 untreated, cavity-free primary and permanent molars in healthy children aged 6 through 14 years. Two of the authors conducted the laser fluorescence evaluation. Another of the authors completed the clinical evaluation. The kappa value was 0.68. The authors compared sensitivity, specificity, predictive values, odds ratio and receiver operating characteristic (ROC) curves for the laser fluorescence system. RESULTS: For the whole sample, the sensitivity and specificity of the laser fluorescence system were 0.79 and 0.87, respectively. The positive and negative odds ratios for the whole sample were 6.33 and 0.23. The positive and negative predictive values for the whole sample were 33.9 percent and 98.1 percent. The value of the area beneath the ROC curve (AUC) was 0.92 for the whole sample. CONCLUSIONS: The laser fluorescence system was more precise than visual evaluation in identifying lesions without cavities and healthy surfaces in primary and permanent molars. CLINICAL IMPLICATIONS: In daily practice, dentists can consider the laser fluorescence system a complementary tool in the visual exploration of occlusal surfaces of primary molars and permanent first molars.
Comparison of visual inspection, radiographic examination, laser fluorescence and their combinations on treatment decisions for occlusal surfaces.
Valera FB, Pessan JP, Valera RC, Mondelli J, Percinoto C.
Bauru Dental School, University of São Paulo, Brazil.
PURPOSE: To compare visual inspection (VI), radiographic examination (RX) and the laser fluorescence device DIAGNOdent (L), as well as their combinations in vitro regarding treatment decisions for occlusal surfaces. METHODS: 72 extracted human permanent teeth (molars and premolars) were used. Treatment decisions were recorded by three calibrated examiners, and the options available were fissure sealant and conservative restoration. For validation of treatment decisions, the teeth were sectioned and examined in a stereomicroscope. Thereafter, dental slices were scanned and the images were edited to facilitate classification of existing carious lesions. Intra and inter-examiner reproducibility for the determination of treatment plans were calculated using Cohen’s kappa test (95%-CI). Sensitivity, specificity, positive and negative predictive values, and the area under the ROC curve were also calculated. RESULTS: VI and L provided on average the greatest intra- and inter-examiner reproducibility, respectively. Although the combination of diagnostic methods may decrease both intra- and inter examiners reproducibility, combination of VI, L and RX resulted in the greatest sensitivity, being statistically superior to RX and L. There was more inter-examiner agreement for the option of restorative treatment, while the use of sealants as a treatment option yielded the lowest values. Negative predictive values were numerically inferior to positive predictive values, indicating that the examiners preferred not to restore a carious tooth than to proceed operatively in an intact tooth. The combination of the three methods studied showed the best results in determining treatment plans for occlusal surfaces, when compared to the other types of exams. On the other hand, radiographic examination and laser fluorescence were less efficient when used alone.
Acta Odontol Scand. 2008 Feb;66(1):13-7.Links
Effect of dental material fluorescence on DIAGNOdent readings.
Hitij T, Fidler A.
Dental School, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
OBJECTIVE: Diagnosis of secondary caries with the DIAGNOdent device has been found to be comparable to visual and radiographic diagnostic methods, but the fluorescence of restorative materials might affect DIAGNOdent values and result in false-positive diagnosis. The aims of this study were: (1) to measure baseline fluorescence of restorative materials and fluorescence changes induced by aging, bleaching, staining, and polishing; (2) to assess intra-examiner reproducibility of these measurements; and (3) to compare the values obtained with the DIAGNOdent against the threshold values for enamel and dentinal caries. MATERIAL AND METHODS: 270 disk-shaped specimens fabricated from 15 different restorative materials were divided into 3 groups, which were aged in water, bleached with 10% carbamide peroxide, and stained with red wine. Specimen fluorescence was measured with the DIAGNOdent before and after these treatments. The red-wine-stained specimens were also polished and measured again. RESULTS: Intra-examiner reproducibility of the measurements was excellent. For all materials, baseline DIAGNOdent values, as well as the values of aged and bleached samples, were considerably lower than the dentinal caries threshold. The values of one stained filled resin fissure sealant, one stained resin composite, and one stained resin-modified glass ionomer exceeded the dentinal caries threshold. Polishing reduced these DIAGNOdent values to below the dentinal caries threshold, except for the filled resin fissure sealant specimen. CONCLUSIONS: Stained dental materials might affect DIAGNOdent readings and consequently result in false-positive diagnoses of secondary caries. Dental fillings should be polished prior to DIAGNOdent measurement.
Quintessence Int. 2005 Mar;36(3):183-9.
Use of laser fluorescence in monitoring the durability and cariostatic effects of fluoride and chlorhexidine varnishes on occlusal caries: a clinical study.
Gokalp S, Ba?eren M.
Hacettepe University, Faculty of Dentistry, Department of Conservative Dentistry, Ankara, Turkey.
OBJECTIVE: The aim of this study was to compare the effectiveness and caries-preventive effects of a fluoride varnish (Fluor Protector; 0.1% fluoride) and a chlorhexidine varnish (Cervitec; 1% chlorhexidine and 1% thymol) on initial caries of occlusal fissures and to monitor the durability of the varnishes by the use of a fluorescence system, DIAGNOdent (Dd). METHOD AND MATERIALS: Nineteen subjects underwent professional tooth cleaning at the beginning of the study. Afterward, fluorescence measurements (baseline) were obtained from 56 test sites and 28 control sites on the central fossae of molars. Each subject had Fluor Protector and Cervitec application on randomly assigned experimental teeth, and applications were followed by Dd measurements. Measurements were repeated after 1 and 6 months. RESULTS: There was an increase in fluorescence values immediately after application of varnish in the two test groups. One month after varnish application, Dd scores for group Fluor Protector were not significantly different from Dd scores obtained immediately after application (P = .108), whereas Dd scores for group Cervitec decreased significantly (P = .007). For both test groups, there was a significant decrease between the values obtained immediately after application and those acquired after 6 months. There was also a significant decrease between 1 month and 6 months for test groups and a slight but significant increase for the control group (P = .011). No significant difference was found between the Fluor Protector and Cervitec groups after 6 months. CONCLUSION: It was concluded that the Dd system may be used to monitor the existence of these two varnishes.
Lasers in dentistry 2. Diagnosis of dental caries with lasers
Verdonschot EH – Ned Tijdschr Tandheelkd – 01-Apr-2002; 109(4): 122-6
Afdeling Cariologie en Endodontologie, Universitair Medisch Centrum Sint Radboud, Huispost 117, Postbus 9101 6500 HB Nijmegen. e.verdonschot@dent.kun.nl
Verdonschot EH; van der Veen MH
When enamel, dentine and substances in caries lesions are exposed to (laser) light of a specific colour, fluorescence may be induced. This principle is at the basis of two caries diagnostic methods, DIAGNOdent and Quantitative Laser (Light-induced) Fluorescence (QLF). Only the DIAGNOdent is commercially available. Bacterial porphyrins evoke fluorescence when illuminated with red light and the intensity of the emitted light is related to the size of the caries lesion. Published research indicates that the DIAGNOdent is particularly suitable for detecting small bacteria containing caries lesions, and to monitor such lesions. QLF is based on the fluorescence decrease in demineralised enamel upon exposure to blue-violet (laser) light. The intensity of the emitted light is related to the amount of mineral loss in the caries lesion. Using QLF the mineral loss in caries lesions can be measured quantitatively. Like the DIAGNOdent, QLF is particularly suitable to monitor caries lesions.
Light-induced fluorescence studies on dehydration of incipient enamel lesions.
Al-Khateeb S – Caries Res – 2002 Jan-Feb; 36(1): 25-30
Department of Orthodontics, Jordan University of Science and Technology, Amman, Jordan.
Al-Khateeb S; Exterkate RA; de Josselin de Jong E; Angmar-Månsson B; ten Cate JM
Changes in the hydration state of enamel affect its optical qualities, such as light scattering and fluorescence. In this study, the rate of fluorescence loss was measured when incipient enamel lesions with different de-remineralization history were left to dehydrate. Four groups of lesions were studied. In groups A, B and C, the lesions were prepared in vitro in an acid-gel system. Group A was kept as control, and groups B and C were remineralized (4 weeks) without and with 1 ppm F in solution, respectively. Group D consisted of natural incipient lesions. Enamel fluorescence was measured for all lesions immediately after removal from water and subsequently at short intervals for 30 min. The change in fluorescence with dehydration varied between the groups. In lesions from groups A and B, it followed a double exponential decrease, while in lesions from groups C and D, it followed a mono-exponential decrease. In all groups, the fluorescence of sound surfaces declined mono-exponentially. The ‘fractional fluorescence difference’, defined as (L(sound) – L(carious) )/L(sound), became constant after periods of dehydration of about 5, 5, 20 and 5 min for groups A to D, respectively. The observation of the change of fluorescence with dehydration should be taken into consideration when planning studies that use fluorescence as an assessment method. However, it might also be used to gain insight into the properties for fluid transport inside the various lesions, relevant to de-remineralization or fluoride treatments.
Pinelli C – Caries Res – 2002 Jan-Feb; 36(1): 19-24
Validity and reproducibility of a laser fluorescence system for detecting the activity of white-spot lesions on free smooth surfaces in vivo.
Department of Restorative Dentistry, Piracicaba School of Dentistry, University of Campinas, Piracicaba, Brazil. camilapinelli@yahoo.com
Pinelli C; Campos Serra M; de Castro Monteiro Loffredo L
The aim of the study was to determine the reproducibility and validity of DIAGNOdent in detecting active and arrested caries lesions on free smooth surfaces. Volunteers were selected from state schools of Piracicaba, São Paulo, Brazil. Overall, 220 lesions were clinically examined. Two specially trained (‘calibrated’) examiners performed both clinical and laser evaluations independently, and after a 1-week interval, the examinations were repeated. The intra-examiner agreement for the laser evaluation was substantial (kappa(ex1) = 0.79, kappa(ex2) = 0.71). There was almost perfect agreement between the two examiners for the clinical examination (kappa(ex1) = 0.95, kappa(ex2) = 0.85). The inter-examiner agreement showed substantial reproducibility (kappa = 0.77) for the laser examination and almost perfect agreement (kappa = 0.85) for the clinical evaluation. The validation criterion was the clinical examination of white spots, recorded as active or arrested. The sensitivity was 0.72 and the specificity was 0.73, which indicates that the DIAGNOdent was a good auxiliary method for detecting incipient caries lesions on free smooth surfaces. The utilization of both methods can improve the efficacy of caries diagnosis.
Ando M – Caries Res – 2001 Nov-Dec; 35(6): 464-70
Comparative study to quantify demineralized enamel in deciduous and permanent teeth using laser- and light-induced fluorescence techniques.
Department of Preventive and Community Dentistry, Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis, IN 46202-2876, USA. mando@iupui.edu
Ando M; van Der Veen MH; Schemehorn BR; Stookey GK
Caries is a disease that affects both deciduous and permanent dentitions. Caries progresses more rapidly in deciduous enamel than in permanent enamel. Therefore, new caries diagnostic methods need to be tested on the deciduous teeth as well. Quantitative laser-induced fluorescence (QLF I) as well as the quantitative light-induced fluorescence (QLF II) seem promising for the quantification of mineral loss from dental caries but have only been tested on the permanent dentition. The objective of this study was to determine and compare the ability of QLF I and QLF II to quantify mineral loss from carious lesions in both deciduous and permanent teeth. Thirty sound deciduous and 30 sound permanent teeth were cleaned and divided into three groups each containing 10 deciduous and 10 permanent teeth. Windows on the buccal or labial enamel surfaces were demineralized for 48, 72, or 96 h. Images of demineralized enamel were captured using QLF I and QLF II. The images were analyzed to determine the mean change in fluorescence radiance (Delta F, %). The teeth were then sectioned for assessment of lesion depth (microm) and integrated mineral loss (IML, vol% x microm) using transverse microradiography (TMR), as the ‘gold standard’ for lesion analysis. The results indicated a good correlation for Delta F between QLF I and QLF II in both deciduous (r = 0.96) and permanent teeth (r = 0.98). There was a good correlation between Delta F and TMR (lesion depth and IML) in deciduous teeth (r = 0.76 and 0.84 with QLF I, r = 0.81 and 0.88 with QLF II). In permanent teeth, the correlation between Delta F and TMR (lesion depth and IML) was lower than in deciduous teeth (r = 0.07 and 0.53 with QLF I, r = 0.15 and 0.62 with QLF II). From these results it can be concluded that either QLF method is capable of quantifying mineral loss in early carious lesions in deciduous teeth. Moreover, under the conditions of this study, the use of either QLF method to quantify mineral loss in early carious lesions in deciduous teeth is slightly more accurate than in permanent teeth.
Sheehy EC – Caries Res – 2001 Nov-Dec; 35(6): 421-6
Comparison between visual examination and a laser fluorescence system for in vivo diagnosis of occlusal caries.
Dental Caries Research Group, Guy’s King’s and St. Thomas’ Dental Institute, London, United Kingdom.
Sheehy EC; Brailsford SR; Kidd EA; Beighton D; Zoitopoulos L
This study compared a laser fluorescence (LF) system (DIAGNOdent) with a visual caries scoring system for in vivo detection and diagnosis of occlusal caries under the conditions of an epidemiological study, in 132 mandibular and 38 maxillary first permanent molars in 170 children (mean age: 6.85 +/- 0.58 years). The teeth were cleaned and occlusal caries status in a selected investigation site recorded using both visual and LF systems. The LF readings were interpreted both according to the cut-off points recommended by the manufacturers and those based on laboratory research with histological validation. The percentage agreement of the LF and visual scoring system was better using the cut-off limits recommended by the manufacturer. Histological validation was not possible in this clinical study, but it appeared that either the LF method was overscoring some lesions or the visual method was underscoring them. Since the LF instrument cannot be expected to differentiate caries from hypomineralisation, it should probably be used as an adjunct to a clinical examination.
Takamori K – J Clin Laser Med Surg – 01-Oct-2001; 19(5): 267-71
Detection of occlusal caries under sealants by use of a laser fluorescence system.
Department of Pediatric Dentistry, Meikai University, Saitama, Japan. takamori@dent.meikai.ac.jp
Takamori K; Hokari N; Okumura Y; Watanabe S
OBJECTIVE: In recent years, various dental caries diagnosis systems, including digital radiography, light fluorescence, and lasers, have been developed. The aim of this study was to evaluate the new laser fluorescence system known as DIAGNOdent for its ability to detect occlusal caries under sealants. BACKGROUND DATA: Fluorescence induced by laser light for early diagnosis of enamel caries was introduced by Bjelkhagen et al. in 1982, but these systems were difficult to use in the oral cavity. Recently, DIAGNOdent has been shown to have a higher diagnostic validity for the detection and quantification of caries lesions than the electronic caries monitor and to have a higher reproducibility for measurements, according to work by Lussi et al. in 1999. The laser diagnosis system is able to indicate the value of reflected fluorescence on a digital display. This value is associated with the carious progression. METHODS: Thirty-two extracted permanent premolars and molars that had occlusal dental caries were used in this study. The reflected fluorescence was measured by use of DIAGNOdent at the occlusal surface of the tooth before and after chemical irrigation, acid etching, and application of a light-cured fluoride releasing sealant. The measurements were two or three points per experimental tooth. A total of 53 points on the experimental teeth was evaluated. RESULTS: The mean reflected fluorescence value was significantly decreased by chemical irrigation; however, no difference was noted between the value before and the salve after acid etching. These teeth were divided into three groups: clear, red, and white as tooth color sealants of the tooth. The reflected fluorescence value before and after sealants was tested for statistical significance. The diagnosis of caries under sealants was up to 10 of reflected fluorescence value in the study. Clear and red sealants were used to reveal caries under sealants using visual inspection, and all sealants groups achieved 90% of reflected fluorescence value after sealants application. However, the white sealants did not reveal caries through visual inspection. The detection ability of caries under white sealants was 53.5% (n = 23/42). CONCLUSIONS: This laser diagnosis system makes it easy to detect the existence of caries under a pit and fissure sealant during a routine check-up.
Pereira AC – Caries Res – 2001 Mar-Apr; 35(2): 83-9
Caries detection methods: can they aid decision making for invasive sealant treatment?
Department of Community Dentistry, University of Campinas, São Paulo, Brasil. apereira@fop.unicamp.br
Pereira AC; Verdonschot EH; Huysmans MC
The decision to place sealants is a difficult one, and it has been suggested that in a low risk population it may be efficient to wait until caries is detected in the fissure. An invasive sealant technique with fissure preparation may then be indicated. The diagnostic method used in the indication of such a procedure should accurately detect both dentine caries and sound fissures: high sensitivity for dentine caries (at D3 threshold) with high specificity for enamel caries (at D1 threshold). The aims of this study were to assess the diagnostic performance of selected diagnostic methods at normal cut-offs for traditional dentine caries detection and at reduced cut-offs in relation to the desired performance mentioned above, and to assess whether fissure opening allows for accurate visual detection of dentinal caries. Data were obtained from 230 occlusal sites of 101 extracted human molar teeth. Diagnostic methods used on the entire sample were: visual inspection, electrical conductance measurements and laser fluorescence measurements. The sample was then divided into two groups. Group 1 was subjected to visual inspection after application of a dye. Group 2 was subjected to visual inspection after fissure opening only, and after subsequent dye application. Validation was performed by histological investigation. The results with cut-offs normally used in dentine caries detection were roughly in accordance with the literature, except for laser fluorescence. The sensitivity of visual inspection for dentinal caries (D3) was 17% before and 70% after fissure opening. Using reduced cut-offs, a 100% sensitivity (D3) was achieved with 2 methods, but this also resulted in 63 or 87% false positive diagnoses of sound surfaces. Visual inspection and electrical methods both showed a moderate to high sensitivity (D3) with a higher than 50% specificity (D1). It was concluded that visual inspection and electrical methods at reduced cut-offs may aid the indication of invasive sealant treatment. The visual detection of dentinal caries is substantially increased, but not perfect after fissure opening.
Shi XQ – Caries Res – 2001 Jan-Feb; 35(1): 21-6
Comparison of QLF and DIAGNOdent for quantification of smooth surface caries.
Department of Cariology and Endodontology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden.
Shi XQ; Tranaeus S; Angmar-Månsson B
The aim was to compare the detection and quantification of smooth surface caries by KaVo DIAGNOdent and quantitative laser/light-induced fluorescence (QLF) using a laser and a lamp as two different light sources. On 40 premolar teeth extracted from adolescents, 71 non-cavitated approximal surfaces were assessed. For QLF, both mean and maximum fluorescence losses were registered. To provide a gold standard for verification, the teeth were then sectioned and lesion depth, stratified on a five-point scale, was determined by histopathology and microradiography. The correlation between the gold standard and the two methods was assessed by Spearman’s rank correlation coefficient. The sensitivity and specificity of the methods for detection of smooth surface caries at D(3) level were also assessed. For lesion depth, correlation with the gold standard was similar for QLF and DIAGNOdent: about 0.85. With respect to dentinal caries detection, sensitivity for DIAGNOdent was 0.75 and specificity 0.96, with a cut-off point of 9. The corresponding values for QLF were 0.94 and 1, with a cut-off value of 20% of fluorescence loss. Spearman’s rank correlation coefficients for enamel mineral loss and QLF and DIAGNOdent, respectively, were 0.76 and 0.67. It was concluded that for quantification of smooth surface caries, the methods are of equal merit, but for scientific purposes, QLF offers the advantage of closer correlation with changes in mineral content.
Shi XQ – Acta Odontol Scand – 01-Apr-2001; 59(2): 74-8
Validation of DIAGNOdent for quantification of smooth-surface caries: an in vitro study.
Department of Cariology and Endodontology, Karolinska Institutet, Huddinge, Sweden.
Shi XQ; Tranaeus S; Angmar-Månsson B
The aims were 1) to validate a laser-based device, KaVo DIAGNOdent, for quantification of caries lesions on smooth surfaces, using histopathologic and microradiographic analyses as the gold standard, and 2) to test inter- and intra-observer agreements. We also investigated the influence on DIAGNOdent readings of the storage medium used for extracted teeth. Two observers measured independently the tooth surfaces of 40 extracted premolars that had been stored in thymol-saturated saline. After subsequent storage in neutral-buffered formalin for 14 days they were re-measured. The teeth were then sectioned for histopathologic and microradiographic analysis. The Spearman rank correlation coefficients between lesion depth and DIAGNOdent readings were 0.78-0.83 and 0.85 for teeth stored in thymol-saturated saline and formalin, respectively. Inter- and intra-observer agreements were 0.94 and 0.95 when the teeth were stored in thymol-saturated saline. The DIAGNOdent reading was almost 1.5 times higher for teeth stored in formalin than for those stored in thymol saline. The Spearman rank correlation coefficient between mineral loss in enamel (deltaZ) and DIAGNOdent readings ranged from 0.64 to 0.68. It was concluded that DIAGNOdent may be helpful for assessing smooth-surface caries, but the cut-off points need to be assessed under clinical conditions. The increase in fluorescence associated with storage of teeth in formalin warrants further investigation.
Attrill DC – Br Dent J – 28-Apr-2001; 190(8): 440-3
Occlusal caries detection in primary teeth: a comparison of DIAGNOdent with conventional methods.
Unit of Prosthodontics, University of Manchester. david.attrill@man.ac.uk
Attrill DC; Ashley PF
OBJECTIVE: To compare the accuracy and repeatability of three diagnostic systems (DIAGNOdent, visual and radiographic) for occlusal caries diagnosis in primary molars. DESIGN: Two examiner, in vitro, blinded study. Histological gold standard. MATERIALS AND METHODS: 58 occlusal surfaces of primary molars examined in turn by two examiners using each of three diagnostic systems (DIAGNOdent, visual and radiographic). These results were compared with a histological gold standard. Sensitivity and specificity were calculated for each diagnostic system at a range of thresholds. Inter- and intra- examiner repeatability were calculated for each diagnostic system using the kappa statistic. MAIN OUTCOME MEASURES: Sensitivity, specificity, inter and intra examiner repeatability for each diagnostic system. RESULTS: The highest sensitivity values were provided by DIAGNOdent (0.77 and 0.80, examiners 1 and 2 respectively) however this was offset by a lower specificity (0.82 and 0.85) than all other systems with the exception of examiner 1 at V1 visual threshold. The DIAGNOdent gave the highest values of kappa for intra- and inter-examiner repeatability with the exception of intra-examiner repeatability for examiner 2 where visual diagnosis had the highest value of kappa. CONCLUSION: The DIAGNOdent was the most accurate system tested for the detection of occlusal dentine caries in primary molars. The performance of the DIAGNOdent systems was not statistically significantly better than that achieved using visual examination for non-cavitated teeth (V1 and V2 threshold). DIAGNOdent may prove useful as a predictive clinical tool, however with appropriate training visual examination may offer similar results without the need for additional equipment.
Lussi A – Eur J Oral Sci – 01-Feb-2001; 109(1): 14-9
Clinical performance of a laser fluorescence device for detection of occlusal caries lesions.
Department of Operative, Preventive and Paediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland. adrian.lussi@zmk.unibe.ch
Lussi A; Megert B; Longbottom C; Reich E; Francescut P
Children and adolescents must be examined often for occlusal caries. Diagnosis of fissure caries is difficult especially when the tooth surface appears seemingly intact. It has been shown that using traditional clinical methods, as little as 20% of teeth with fissure caries under intact surfaces were correctly recognised as such. Therefore, new methods for increasing the accuracy of diagnosis have been sought for years. Recently, a new device, based on fluorescence measurements, was introduced. The purpose of this study was to test the device under in vivo conditions in order to provide recommendations for its use in the dental office. Seven general dental practitioners examined a total of 332 occlusal surfaces in 240 patients. Caries extent was determined for each site after operative intervention (=’gold standard’). Clinical inspection and analysis of bitewing radiographs exhibited statistically significant lower sensitivities (31-63%) than did the DIAGNOdent device (sensitivity > or = 92%). It is recommended that the laser device is used in the decision-making process in relation to the diagnosis of occlusal caries as a second opinion in cases of doubt after visual inspection.
Tranaeus S – Caries Res – 2002 Jan-Feb; 36(1): 3-9
In vivo repeatability and reproducibility of the quantitative light-induced fluorescence method.
Department of Cariology and Endodontology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden. sofia.tranaeus@ofa.ki.se
Tranaeus S; Shi XQ; Lindgren LE; Trollsås K; Angmar-Månsson B
In vivo repeatability and reproducibility of the quantitative light-induced fluorescence (QLF) method were tested with respect to three variables: lesion area, and average and maximum changes in lesion fluorescence. To test the image-capturing stages, three analysts each captured images of 15 incipient smooth surface lesions in vivo, and the images were analysed by one of the analysts. To test the analytical stage of the method, three analysts analysed the images of 15 in vivo incipient smooth surface lesions. For the image-capturing stage, inter-examiner reliability showed an intra-class correlation coefficient (r) between 0.95 and 0.98. For the analytical stage, intra-examiner reliability for all three analysts showed a value of r between 0.93 and 0.99. Inter-examiner reliability showed a value of r between 0.95 and 0.99. It was concluded that the in vivo repeatability and reproducibility of the QLF method are excellent.
7-Apr-2000; 65(68): 18234-6
Medical devices; laser fluorescence caries detection device. Food and Drug Administration, HHS. Final rule.
The Food and Drug Administration (FDA) is classifying the laser fluorescence caries detection device into class II (special controls). The special controls that will apply to this device are set forth below. The agency is taking this action in response to a petition submitted under the Federal Food, Drug, and Cosmetic Act (the act) as amended by the Medical Device Amendments of 1976 (the amendments), the Safe Medical Devices Act of 1990, and the Food and Drug Administration Modernization Act of 1997. The agency is classifying this device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.
Dent Clin North Am – 01-Oct-2000; 44(4): 955-69, ix
Caries detection and prevention with laser energy.
Department of Preventive and Restorative Dental Sciences, University of California San Francisco, USA. jdbf@itsa.ucsf.edu
Featherstone JD
Laser light can be used in the visible region (blue or red) as a tool for the detection of carious lesions. Techniques developed to date for early caries detection by laser light rely on fluorescence naturally from the tooth material or from bacterial by-products. Fluorescence techniques have been introduced clinically in Europe and show great promise for improved management of dental caries. Laboratory studies have shown that specific laser irradiation that is absorbed strongly by the carbonated hydroxyapatite mineral of the teeth can heat a thin layer at the surface briefly, altering its composition and making it strongly resistant to subsequent acid attack in the caries process. This resistance leads to major inhibition of subsequent subsurface caries progression and shows great promise for the treatment of susceptible sites on the tooth. This technology, if used in conjunction with ablation of carious lesions by specific laser irradiation, could prevent secondary progression around restorations
Shi XQ – Caries Res – 2000 Mar-Apr; 34(2): 151-8
Occlusal caries detection with KaVo DIAGNOdent and radiography: an in vitro comparison.
Department of Cariology and Endodontology, Karolinska Institutet, Huddinge, Sweden.
Shi XQ; Welander U; Angmar-Månsson B
A new laser fluorescence method, KaVo DIAGNOdent, was tested with respect to reproducibility and validity and compared with radiography regarding accuracy in the detection of occlusal caries. Seventy-six extracted premolar and molar teeth were measured twice with DIAGNOdent under both wet and dry conditions, at an interval of 2 weeks. Conventional film radiographs were exposed. Microradiographic analysis of sections of the teeth served as the gold standard. Intra-class correlation coefficient and Pearson’s correlation coefficient were used to assess the reproducibility and the validity of the method, respectively. The influence of time and varying humidities on DIAGNOdent readings were analysed by two-way repeated measure ANOVA. ROC curves were plotted for DIAGNOdent readings and radiographic registration of caries by 6 observers, and the areas under the curves were compared using Student’s t test. Under both wet and dry conditions, the reproducibility of the DIAGNOdent method was excellent: R = 0.97 and 0.96, respectively. The diagnostic accuracy of DIAGNOdent was significantly better than that of radiography (p< or =0.001). In this in vitro study of detection of occlusal caries, the diagnostic performance of the DIAGNOdent method was superior to that of radiography.
Caries Res – 1999 Jul-Aug; 33(4): 261-6
Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro.
Department of Operative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland.
Lussi A; Imwinkelried S; Pitts N; Longbottom C; Reich E
The diagnosis of occlusal caries at non-cavitated sites remains problematic, especially since clinical visual detection has limited sensitivity. Electrical methods of detection show considerable promise, but specificity is reduced. The aims of this in vitro study were: (1) to assess the validity of a new laser fluorescence device–the DIAGNOdent–(and compare the values with those of a fixed-frequency electrical device); (2) to determine the optimum cut-off points of the new device for different stages of the caries process, and (3) to assess the reproducibility of the new laser device. For validity and determination of optimum cut-off points, 105 extracted teeth with macroscopically intact occlusal surfaces were measured by a single examiner, using both the laser fluorescence device (on both moist and dried teeth) and an Electronic Caries Monitor. The teeth were subsequently examined histologically to determine the specificity, sensitivity and likelihood ratio at the D2 (caries extending through more than half of the enamel thickness) and D3 (caries involving dentin) levels. The values obtained for the laser device ranged from 0.72 to 0.87 (specificity), 0.76 to 0.87 (sensitivity) and 3.0 to 5.6 (likelihood ratio). Those for the ECM ranged from 0.64 to 0.78 (specificity), 0. 87 to 0.92 (sensitivity) and 2.4 to 4.1 (likelihood ratio). To determine intra- and interexaminer reproducibility of the DIAGNOdent, 11 dentists recorded two different measurements at the same site on a separate set of 83 extracted molar teeth, and these were compared using Cohen’s kappa (at D2 and D3 levels) and Spearman’s correlation coefficient. The average intra-examiner kappa scores were 0.88 (D2) and 0.90 (D3), with a Spearman correlation of 0.97. For interexaminer reproducibility, the average kappa values were 0.65 (D2) and 0.73 (D3), with a Spearman correlation of 0.84. It is concluded that for occlusal caries (1) the new laser device has a higher diagnostic validity than the ECM, and (2) in vitro, measurements using the device are highly reproducible. Thus, the laser device could be a valuable tool for the longitudinal monitoring of caries and for assessing the outcome of preventive interventions.Avda.
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