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Methods of Caries Well-Timed DiagnosticsX-ray Diagnostics in Dentistry

Stomatolog Julia Morozova

Operative Dentistry 1 ST1/ZAA35

Caries well-timed diagnostics

• Diagnostics of initial stages of dental caries

• Primary prevention- without preparation

• Secondary prevention- minimal invasive meausures

Caries incipiens: clinical symptoms

• Focus of enamel demineralization• White spot• Surface layer of enamel is maintained

Methods of caries well-timed diagnostics

• Common: • Visual-tactile• Transillumination using dental mirror and source of

light• Detection using dyes

• With special equipment• Radiographic diagnostics• Laser Fluorescence• Quantitative Light-Induced Fluorescence• Fiber Optic Trasillumination• Digital Image Fiber Optic Transillumination• Electronic Caries Monitor• Ultrasonic detection

Methods of caries well-timed diagnostics (requiring special equipment)

Physical effect Application in caries diagnostics

X-rays RTG, RVG, CBCT, CBVT

Laser fluorescence Laser detection of caries (DIAGNOdent)

Electricity Electronic Caries Monitor (ECM)

Ultrasound Ultrasonic detection of caries

Light with different wavelength Quantitative Light-induced Fluorescence (QLF)Fiber Optic Transillumination (FOTI) (Dia Lux)Digital Image Fiber Optic Transillumination (DIFOTI) (DIAGNOcam)

Visual-tactile assessment

• Clean and dry tooth surface• Dental mirror • Dental probe• Perfect illumination• Magnification

Transillumination using dental mirrorand light from unit

• For approximal surfaces of frontal teeth

Detection using dyes

Use:• Caries detection• Detection of necrotic tissues during preparation (dye is

connected with irreversibly destructured collagen fibers)• Finding of root canal entrances in endodontics• Detection of tooth cracks

Radiographic examination

• Intraoral radiograms• Bite-wing (interproximal) projection• Ortopantomogram• Cone beam volumetric tomography

Parallel technique of radiogram making

• The radiogram is the most close to the real situation in the mouth (isometric orthoradial)

• It requares the use of special holders

Carious lesion• Clearing with different size

• Approximal, fissural, root, secondary (reccurent) carious lesions

• It is not deciding examination method for vestibular, oral or occlusal lesions

• The most suitable is the bite-wing technique (premolar, molar)

Bite-wing radiograms evaluation

• D1 -clearing is in the outer half of the enamel

• D2 -clearing is in the inner half of the enamel

• D3 -clearing goes upto enamel-dentin junction

• D4 –clearing is in dentin

Laser Fluorescence (DIAGNOdent)

• Red light at a wavelength of 655 nm• Sound hard dental tissues do not react to this wavelength• Metabolites from cariogennic bacteria create an infrared fluorescence • In special device (DIAGNOdent, KaVo, Germany; Hibst, Gall,

late 1990s) the emitted light is channelled through the handpiece and presented as a number on a display

DIAGNOdent- working procedure

• Careful cleaning of tooth surface• Drying by air stream• Calibration of the device by

application onto sound enamel• Measuring • Allows to detect carious lesions on

the smooth, occlusal as well as approximal surfaces

DIAGNOdent- criteria for evaluation

0 – 4 Sound enamel or caries incipiens (D1)

4 – 10 Decay of inner layer of enamel without damage of enamel-dentin junction (D2)

10 – 18 Decay of external layer of dentin (D3)

>18 Extensive decay of inner layer of dentin (D4)

*A.Lussi, S. Imwinkelried, N.B. Pitts, C. Longbottom, E. Reich. Performance and Reproducibility of a Laser Fluorescence System for Detection of Occlusal Caries in vitro. Caries Res. 1999;33(4):261–266

Quantitative Light-induced Fluorescence (QLF)

• Uses the phenomenon of tooth auto fluorescence • Primary diagnostics as well as check up of necrotic tissues

removing• Soprolife (ActeonGroup, France); InspektorTM Pro (Inspektor

Dental Care, Amsterdam, The Netherlands)

Fiber Optic Transillumination (FOTI)• Uses light transmission through the tooth• Demineralized dental hard tissues scatter and absorb light

more than sound tissue• For enamel and dentin caries detection on occlusal,

approximal and smooth surfaces of anterior and posterior teeth (carious lesions appear darker compared to sound tissue)

• Dia Lux (KaVo, Germany)

Digital Imaging of Fiber Optic Transillumination (DIFOTI)

• Uses the same principles like FOTI• White light is delivered through an optical fiber via handpiece

channelling the image back to a digital camera and visualizing the image on a monitor via computer system

• DIAGNOcam (KaVo, Germany)

DIFOTI (DIAGNOcam): principle of working

• Light with wave length 780 nm• Tooth is light conductor• Digital camera makes black-and-white record on the

computer display• Tooth decay looks like dark shade

DIFOTI: contraindications, limits of using

• Large fillings• Crowns• Subgingival localization of tooth decay• Calculus or tooth discoloration can lead to light

scattering and can be shown like shade

DIFOTI: possibilities

• Primary carious lesions (occlusal and approximal) esp. on distal teeth

• Caries reccurent (upto definite depth)• Cracks or imperfections in supragingival regio

Electronic Caries Measurement (ECM)

• Sound dental hard tissue shows very high electrical resistance or impedance

• Demineralized enamel has lower resistance • Ground-unit • Handpiece • The result is presented on a display as

a number between 1 and 13

Alternating Current Impedance Spectroscopy (ACIST)

• It is based on the same principle of electrical proud as the ECM

• It measures resistance, continuous conduction as well as transverse conductance

• CarieScanTM (IDMoS PLC, Dundee, UK)

Ultrasound diagnostics (Ultrasonic Caries Detector- UCD)

• Sound waves can pass through gases, liquids and solids and boundaries between them

• Images of tissues can be acquired by collecting of the reflected sound waves

• Ultrasonic probe allows to examine inaccessible places• UCD (Novadent Ltd., Lod, Israel)

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