Does DIAGNOdent provide a reliable caries-removal endpoint?

Assessment of the correlation between fluorescence-featured intraoral scanner, laser fluorescence and spectrophotometric analyses in caries-affected dentin: an in-vitro diagnostic accuracy study

To investigate the relation between the caries scoring system of the fluorescence intraoral scanner (IOS) Trios 4 (3Shape, Denmark)a red laser light-induced fluorescence device DIAGNOdent Pen (Kavo, Germany), and the color parameters (L*a*b*) by a clinical contact type hybrid spectrophotometer Rayplicker (Borea, France) in the assessment of caries affected dentin tissue. Caries lesions were minimally invasively removal from 186 extracted molars. Teeth were scanned using Trios4, and the integrated software scored the cavity floor regarding the colors (yellow, initial caries; red, moderate-extensive caries) depending on the fluorescence features. Then the DIAGNOdent measurements were obtained from each cavity's deep and discolored surface points following the previously obtained Trios4 colors. Thus, the Trios4 reading could be quantitatively assessed. Cross-polarization photographs were using the Rayplickerand L*a*b color parameters, and 3D Master (VITA) color mapping was obtained by using the RayPlicker's software. Spearman's Rho Correlation, Kappa, Mann Whitney-U, One-way Analysis-of-Variance, and Kruskal Wallis tests were used for the statistical analyses (P < 0.05). Sensitivity, specificity and AUC were calculated. Trios4 and DIAGNOdent were positively correlated (r = 0.733;P < 0.001). The L*parameter by Rayplicker and Trios4 was negatively correlated(r=-0.742;P < 0,001). The a*parameter by Rayplicker and Trios4 scoring positively correlated(r = 0.552;P < 0.001). No significant correlation was observed between b*parameter by Rayplicker and Trios4 (r = 0.023; P = 0.760). DIAGNOdent readings according toTrios4 scorings were significant (P < 0.001). The teeth without caries scored by the Trios4 corresponded to the median value of 29 in DIAGNOdent readings, and 88 for the teeth with caries (by Trios4 / yellow-red). The agreement between the Trios4 and DIAGNOdent was 52.2% for the specimens with no residual caries. The presence of caries scores by the Trios 4 corresponded to the DIAGNOdent readings of %100 for all the teeth evaluated. Regarding the RayPlicker assessments, 33% of the sound cavities corresponded to 2M3 color, and 73% corresponded to 5M3 color. Trios4 scorings presented 0.782 AUC, 56.30% sensitivity, and 100% specificity in DIAGNOdent reference. Trios4 scoring was considered coherent with the DIAGNOdent Pen. DIAGNOdent readings and the Level of L* and a* parameters in the dentin tissue might be considered interrelated. Fluorescence-featured scanner devices can be useful clinical tools to evaluate remaining dentin tissue during the caries removal procedure.

Chemomechanical Caries Removal with Enzymatic Technology: A Comparative In Vitro Study

Purpose

This study aims to compare the efficiency of caries removal between the chemomechanical caries removal agent Brix 3000 and the conventional method using a laser fluorescent device (DIAGNOdent Pen), caries detection dye, microbial culture, and real-time polymerase chain reaction (PCR) methods.

Materials and methods

The study involved 64 primary molars with dentinal caries between March and June 2022. Standardization was achieved based on International Caries Detection and Assessment System (ICDAS-II) criteria (score 6) and DIAGNOdent Pen measurements (30 and above). Caries were removed using the conventional method (32) and Brix 3000 (32). Following this, dentin samples were collected, and measurements were made with the DIAGNOdent Pen to evaluate the presence of residual caries in both groups. After the measurements, the presence of residual caries was evaluated in both groups using caries detection dye. The decrease in values obtained by microbial culture and real-time PCR methods of dentin samples taken before and after caries removal was evaluated.

Results

When DIAGNOdent Pen and caries detection dye were evaluated, the caries removal efficiency of the conventional method was found to be higher (p < 0.05). As a result of the microbial culture evaluation for Streptococcus mutans and total bacteria, the caries removal efficiencies of both methods were found to be similar (p > 0.05). The caries removal efficiency of Brix 3000 was found to be higher as a result of the evaluation with real-time PCR for S. mutans (p < 0.05).

Conclusion

It is thought that Brix 3000 is an effective agent for caries removal and may be an alternative agent to the conventional method, especially considering its advantages in children.

How to cite this article

Aydogdu AB, Olmez A, Akca G. Chemomechanical Caries Removal with Enzymatic Technology: A Comparative In Vitro Study. Int J Clin Pediatr Dent 2025;18(3):245-250.

Accuracy of laser fluorescence in assessment of various caries removal techniques: an in vitro validation

BACKGROUND

This study aimed to evaluate the accuracy of laser fluorescence (LF) readings in detection of caries removal by various techniques (CRTs).

METHODS

A hundred and eighty extracted human molar teeth included in the study which were scored 3, 4, and 5 according to ICDAS. Each score group was randomly assigned to 4 subgroups according to CRT including ceramic bur (Group A), carbide bur (Group B), carbide bur with alumina abrasion (Group C), and carbide bur with bioactive glass (BAG) abrasion (Group D) (n = 15 for each group). A LF device (DIAGNOdent Pen, Kavo) was used to determine remaining caries. Histological sections of the teeth were examined under a dental operating microscope for validation. The data were analyzed using Fisher Freeman Halton, Fisher's Exact, Pearson Chi-Square, Bonferroni Adjusted Z tests, ROC analysis, Kappa statistic and Binary Logistic Regression(p < 0.05).

RESULTS

Histological examination revealed no significant differences among the CRTs and ICDAS scores (p > 0.05 for each). However, a significant difference was found between histological assessment and LF in ICDAS 5 score, specifically between Group B and Group D (p = 0.022), regarding caries presence. LF readings demonstrated over 0.9 area under curve (AUC) value regardless of CRT, except for ICDAS-4 score, and Group D in ICDAS-5 score. Overall, the AUC of LF was found to be 0.880 for the 38 cut-off point (p < 0.001), indicating a high level of accuracy. The univariate and multiple models showed the tested CRTs had no effect on the caries presence (p > 0.050).

CONCLUSIONS

The CRTs examined in this study demonstrated similar efficacy in terms of caries removal. However, the application of bioactive glass on caries-affected dentin may lead to overestimations in the LF readings. Additionally, LF on the cavity floor may not be clinically suitable for teeth with ICDAS 4 scores.

CLINICAL RELEVANCE

The clinical determination of caries removal endpoint is based on a multifactorial decision. However, when selective removal of soft dentin is performed, especially with bioactive glass abrasion in deep caries lesions, higher cut-off points might be determined in laser fluorescence readings to decide further operative intervention.

Antimicrobial photodynamic therapy as an adjunctive treatment to ultrasound for the dentin caries-like lesion removal

OBJECTIVE

To evaluate in vitro the efficacy of ultrasound device to remove caries-like dentin and the curcumin-mediated antimicrobial photodynamic therapy (aPDT) to decontaminate the affected dentin.

METHODS

Bovine dentin specimens (n = 173) of 4 × 4 × 2 mm were first submitted to Knoop surface microhardness to standardize the specimens (29 ± 3 KHN). Artificial caries lesion was induced by Streptococcus mutans strain by biological model for 7 days. Infected dentin was removed (1 min) with the following techniques: dentin excavator, bur at low-speed rotation and ultrasound device. After that, aPDT application was performed using blue LED under 460 nm. Polarized light microscopy (PLM), removal rate (n = 10), cross-sectional microhardness (n = 10), colony forming units per milliliter (CFU) (n = 9) and confocal laser microscopy (CM) (n = 2) were performed. ANOVA with Welch correction, post-hoc Games-Howell and two-way ANOVA followed by Tukey's post-hoc tests were used.

RESULTS

PLM confirmed the caries lesion formation with a depth of ∼147.9 µm. Groups treated with ultrasound showed lower removal rate (p = 0.001). Regardless of the treatment, the microhardness values increased as function of depth (p ≤ 0.05). Carbide bur showed the highest microhardness value, followed by ultrasound and excavator. CFU and CM showed a significant reduction in S. mutans after aPDT application.

CONCLUSION

Ultrasound was efficient, since it removed infected dentin, preserving the affected dentin and aPDT can be used as a complementary therapy to decontaminate the affected dentin.

CLINICAL SIGNIFICANCE

Ultrasound device may help the clinician to remove dentin caries-like lesions since it is a conservative technique and provided the removal of infected dentin, preserving the affected dentin. aPDT application may be used as a complimentary technique to promote antibacterial effect and possibly minimize the risk of secondary caries.

A Bibliometric Analysis (2010-2020) of the Dental Scientific Literature on Chemo-Mechanical Methods of Caries Removal Using Carisolv and BRIX3000

Reports in the literature have proposed and analyzed several minimally invasive techniques for caries removal in recent decades. In light of recent events surrounding the ongoing epidemiological context, concerns have been raised regarding the generation of aerosols during dental procedures. The aim of our research was to provide an overview of the scientific literature on the topic of chemo-mechanical caries removal (CMCR) methods, focusing on two products (Carisolv, BRIX3000), commercially available in Europe. A bibliometric analysis was used to investigate the scientific articles included in Web of Science (WoS) Core Collection database, published from January 2010 to December 2020. We analyzed the co-occurrence of all keywords (Author Keywords and the KeyWords Plus section), co-authorship and co-citation, using the free software VOSviewer. Our bibliometric analysis revealed a worldwide interest in the subject of chemo-mechanical methods of caries removal, which has transcended the area of pediatric dentistry. The analyzed studies have been conducted mainly in high-income countries that have developed sanitary policies regarding prevention and early treatment of carious lesions as a health priority.

Ultrasound device as a minimally invasive approach for caries dentin removal

Abstract The aim of this study was to evaluate the efficacy of an ultrasound device and the dentin surface morphology after removal of the caries dentin lesions by removal rate and scanning electron microscopy (SEM). The Knoop hardness test on the bovine dentin blocks (n = 20, 4x4x2mm) was performed to standardize the samples and only those with 38 ± 2 KHN were included. The dentin blocks were submitted to induction of artificial caries lesions, using the bacterial model. Strains of Streptococcus mutans and Lactobacillus acidophilus were used for 7 days. The caries dentin lesion was removed for 1 min, according to two methods: G1 - carbide bur under low-speed rotation (control group) and G2 - ultrasound device under refrigeration. For the removal rate, the samples were weighed 3 times: T0 (before induction), T1 (after induction) and T2 (after removal). Morphology evaluation of the residual dentin surface was performed by SEM. Data normality was verified by Shapiro-Wilk test (p ≥ 0.240). T-test for independent samples was applied to evaluate the removal rate. A significance level of 5% was adopted. G2 provided lower removal rate than G1 (G1: 3.68 mg and G2 = 2.26 mg). SEM images showed different morphological characteristics between the groups. G2 showed absent of smear layer, while G1 showed a visible smear layer over the surface. We concluded that ultrasound device provides minimally invasive removal with residual dentin exhibiting open dentin tubules and no smear layer formation and no bacteria, which infer the removal of the infected tissue.

X-ray microtomography assessment of Carisolv and Papacarie effect on dentin mineral density and amount of removed tissue

OBJECTIVE

The aim of the present study was to directly compare Carisolv and Papacarie regarding the volume of removed tissue (RT) and dentin mineral density (DMD) after excavation.

MATERIALS AND METHODS

Twenty permanent molars were randomized into two groups where caries was excavated using Carisolv or Papacarie followed by removal of softened tissue by a blunt instrument. X-ray microtomography was used to scan teeth before and after excavation generating two- and three-dimensional images that were used to calculate the percentage of RT relative to baseline tooth tissue volume and DMD that was categorized into sound dentin (>1.11 g/cm³) and residual caries (≤1.11 g/cm³). The two groups were compared using t-test Fisher exact test.

RESULTS

DMD was higher after Papacarie than Carisolv (mean = 1.70 and 1.14, p = .14) with higher percentage of cases with sound dentin (70 and 60%, p = 1.00). The percentage of RT was lower after Papacarie than Carisolv (7.40 and 8.95%, p = .31) with 22.95% less RT in cases that ended with sound dentin after excavation.

CONCLUSIONS

There was higher DMD, more sound dentin and less RT when Papacarie was used compared to Carisolv.

Evaluation of dental explorer and visual inspection for the detection of residual caries among Greek dentists

Objectives

The objective of this study was to assess the effect of the operator's degree of clinical experience on the residual caries diagnosis through visual inspection and tactile sensation.

Materials and Methods

The participants were asked about the years of their clinical practice, any further training concerning cariology, their familiarity with the minimal invasive philosophy, and the techniques that they use to remove dental caries and detect when to stop the removal of carious tissues. In addition, an in vitro diagnostic test was conducted. Carious teeth were excavated to a level selected in random. Teeth were examined by each participant individually. Initial examination was performed by visual inspection. Subsequently, a dental explorer was used concerning the potential need for further removal of dental tissues. A sample of 380 dentists and dental school students were selected for the purposes of this study.

Results

Dental students presented statistically significant better sensitivity, than dentists from both age groups, during both visual inspection and tactile sensation of residual caries. Participants' ability to diagnose residual caries during cavity preparation was independent of their years of experience.

Conclusions

During the removal of carious lesions, with the goal of limiting the sacrifice of healthy structures and the leftover of residual caries, clinicians should combine a selective removal technique and the attentive visual inspection, with at least one further diagnostic method, aside from the dental explorer. Tactile examination of residual caries solely with the dental explorer must be used with attention.

Comparison of micro-CT imaging and histology for approximal caries detection

Histological sectioning is a generally accepted in vitro validation method for caries detection techniques. However, it requires cumbersome sample preparation and induces irreversible sample destruction. Micro-Computer Tomography (micro-CT) allows non-destructive imaging of tooth structure. The aim of this study was to compare the performance of histological sectioning and micro-CT imaging in detecting approximal carious lesions. Unlike previous studies, evaluation is objectified by comparing visual appearance of exactly corresponding anatomical regions. Sixty extracted human teeth were scanned with a desktop micro CT system. Axial histological slices were prepared and photographed. Sample preparation, combined with dedicated image processing, ensured selection of identical anatomical regions on radiographic and histological images. Evaluation of the presence and extent of carious lesions was performed by four dentists using custom-designed software. Each section was scored independently (histo or micro CT). Scores of approximal surfaces were retained for further analysis. Spearman’s correlation coefficients (0.738 to 0.829, p < 0.0001) showed a good agreement between signs of carious lesions in the identical region obtained with both methods. Bland-Altman plots showed that 90.76% of the data points were within the limits of agreement. Micro-CT imaging was shown to provide an interesting alternative to histological sectioning as detection method for carious lesions.

Comparison of two different methods of detecting residual caries

Objectives

The aim of this study was to investigate the ability of the fluorescence-aided caries excavation (FACE) device to detect residual caries by comparing conventional methods in vivo.

Materials and Methods

A total of 301 females and 202 males with carious teeth participated in this study. The cavity preparations were done by grade 4 (Group 1, 154 teeth), grade 5 (Group 2, 176 teeth), and postgraduate (Group 3, 173 teeth) students. After caries excavation using a handpiece and hand instruments, the presence of residual caries was evaluated by 2 investigators who were previously calibrated for visual-tactile assessment with and without magnifying glasses and trained in the use of a FACE device. The tooth number, cavity type, and presence or absence of residual caries were recorded. The data were analyzed using the Chi-square test, the Fisher's Exact test, or the McNemar test as appropriate. Kappa statistics was used for calibration. In all tests, the level of significance was set at p = 0.05.

Results

Almost half of the cavities prepared were Class II (Class I, 20.9%; Class II, 48.9%; Class III, 20.1%; Class IV, 3.4%; Class V, 6.8%). Higher numbers of cavities left with caries were observed in Groups 1 and 2 than in Group 3 for all examination methods. Significant differences were found between visual inspection with or without magnifying glasses and inspection with a FACE device for all groups (p < 0.001). More residual caries were detected through inspection with a FACE device (46.5%) than through either visual inspection (31.8%) or inspection with a magnifying glass (37.6%).

Conclusions

Within the limitations of this study, the FACE device may be an effective method for the detection of residual caries.

Desempenho de métodos baseados em indução de fluorescência na avaliação da remoção de dentina cariada

Resumo Introdução Critérios clínicos vêm sendo utilizados para determinação da presença de tecido cariado remanescente, mas geram dúvidas, tornando-se relevante a utilização de métodos que auxiliem na determinação da presença de cárie dentária remanescente. Objetivo Avaliar in vitro a eficácia de métodos de indução de fluorescência no diagnóstico da remoção de tecido cariado artificial dentinário. Material e método O esmalte oclusal de 94 terceiros molares humanos hígidos foi removido, expondo a dentina subjacente, para indução microbiológica de lesão de cárie artificial. Após a remoção do tecido cariado induzido, o remanescente dentinário foi avaliado por dois examinadores com DIAGNOdent, DIAGNOdent pen e Quantitative Light-Induced Fluorescence (QLF). Após todas as avaliações, secções dos dentes foram observadas e fotografadas em lupa estereoscópica com 30× de aumento por um examinador independente. As imagens foram analisadas no software Image J, permitindo a quantificação de tecido remanescente em milímetros quadrados. Foi calculada a reprodutibilidade interexaminador através de coeficiente intraclasse, sensibilidade, especificidade e área sob a curva ROC, e o teste de McNemar (p<0,05) foi aplicado para comparação dos diferentes métodos. Resultado Dos 94 dentes, 51 (54,2%) apresentaram remanescente de tecido cariado. Os valores de sensibilidade, especificidade e área sobre a curva ROC foram semelhantes para os três grupos (p>0,05). Os valores de reprodutibilidade variaram entre 0,952 e 0,978. Conclusão Dentre os métodos utilizados, o DIAGNOdent e o DIAGNOdent pen apresentaram melhor desempenho na avaliação da presença de cárie artificial remanescente quando comparados ao QLF.

Caries-removal effectiveness of a papain-based chemo-mechanical agent: A quantitative micro-CT study

The aim of this study was to access the effectiveness and specificity of a papain-based chemo-mechanical caries-removal agent in providing minimum residual caries after cavity preparation. In order to do it, extracted carious molars were selected and scanned in a micro-CT before and after caries-removal procedures with the papain-based gel. Similar parameters for acquisition and reconstruction of the image stacks were used between the scans. After classification of the dentin substrate based on mineral density intervals and establishment of a carious tissue threshold, volumetric parameters related to effectiveness (mineral density of removed dentin volume and residual dentin tissue) and specificity (relation between carious dentin in removed volume and initial caries) of this caries-removal agent were obtained. In general, removed dentin volume was similar or higher than the initial carious volume, indicating that the method was able to effectively remove dentin tissue. Samples with an almost perfect accuracy in carious dentin removal also showed an increased removal of caries-affected tissue. On the contrary, less or no affected dentin was removed in samples where some carious tissue was left in residual dentin. Mineral density values in residual dentin were always higher or similar to the threshold for mineral density values in carious dentin. In conclusion, the papain-based gel was effective in removing carious dentin up to a conservative in vitro threshold. Lesion characteristics, such as activity and morphology of enamel lesion, may also influence caries-removal properties of the method.

Effectiveness of Different Mechanical Methods on Dentin Caries Removal: Micro-CT and Digital Image Evaluation

PURPOSE

To determine the caries removal effectiveness (CRE) and minimal invasive potential (MIP) of caries excavation methods using digital imaging and microtomography analyses.

METHODS

Twelve human molars with occlusal caries lesions in dentin were randomly divided into three groups (carbide bur, exacavator, and polymer bur). They were sectioned mesiodistally, and standardized digital and computed microtomography x-ray (micro-CT) images were taken from each section before and after caries excavation. On each image, initial carious dentin (IC), prepared cavity (PC), and residual caries (RC) were defined according to visual criteria using ImageJ software. CRE was determined based on the RC/IC ratio, whereas MIP was determined by the PC/IC ratio. Data were analyzed using one-way analysis of variance and Student t-test or with Kruskal-Wallis and Student-Newman-Keuls test. The level of significance was set at 0.05.

RESULTS

For both digital image and micro-CT analysis, the carbide bur showed higher CRE values than the excavator (p=0.0063 and p=0.0263, respectively) and the polymer bur (p=0.0028 and p=0.0005, respectively). The latter two presented similar results (p>0.05). Regarding MIP, for the digital image analysis, the polymer bur was different from the carbide bur (p=0.0030) but was not different from that of the excavator (p=0.1240). For micro-CT analysis, the MIP values of all the groups were significantly different, and the polymer bur was the most conservative method (p<0.05).

CONCLUSIONS

The carbide bur was the most effective method for caries removal but was not completely conservative. The polymer bur and excavator presented low invasive potential but were not able to remove all of the carious dentin.

Current update of chemomechanical caries removal methods

Chemomechanical caries removal is an excellent method for minimally invasive caries excavation, and the removal agents are either sodium hypochlorite (NaOCl)- or enzyme-based. The NaOCl-based agents include GK-101, GK-101E (Caridex) and Carisolv, and the enzyme-based agents include Papacarie and the experimental material, Biosolv. This review outlines the changes in chemomechanical caries removal methods and focuses on recently published laboratory and clinical studies. The historical development, mechanism of action, excavation time and biological effects on pulp and dental hard tissues are described. Based on existing evidence, the currently available chemomechanical caries removal methods are viable alternatives to conventional rotary instrument methods. Chemomechanical methods could be extremely useful in very anxious, disabled and paediatric patients. It does seem some of these agents would still benefit from quicker excavation times in order to achieve more universal acceptance. However, as a means of conserving the caries-affected dentine, chemomechanical caries removal is possibly much more successful than conventional rotary instrumentation.

Micro-computerized tomography assessment of fluorescence aided caries excavation (FACE) technology: comparison with three other caries removal techniques

BACKGROUND

The aim of this study was to determine the caries removal effectiveness (CRE) and minimal invasiveness potential (MIP) of four dentine caries removal methods.

METHODS

After carious molars were scanned using micro-computerized tomography (micro-CT), dentine caries were removed by fluorescence aided caries excavation (FACE) technology, laser induced fluorescence (LIF), chemomechanical excavation (CME), and conventional excavation (CE). Micro-CT was then repeated. CRE was determined based on the volume of residual caries/initial caries (RC/IC) and the mean mineral density (MD) at the cavity floor. MIP was determined by measuring the volume of the prepared cavity/initial cavity (PC/IC).

RESULTS

Among the four groups, the LIF group had the smallest RC/IC (0.08), the highest mean MD at the cavity floor (1.32 g/cm(3) ) and the highest MIP (4.47). The CME group had the highest RC/IC (0.24), the lowest mean MD (1.01 g/cm(3) ) and the lowest MIP (2.23). The CE group exhibited a more acceptable CRE (RC/IC = 0.13, mean MD = 1.21 g/cm(3) ) but had a higher MIP (3.95). Both the CRE and MIP parameters of FACE technology were the second most acceptable (RC/IC = 0.12, mean MD = 1.13 g/cm(3) , MIP = 3.20) and did not differ significantly from the most acceptable.

CONCLUSIONS

FACE is an effective caries removal technology for removing infected dentine without significantly increasing cavity size.

In vivo assessment of caries excavation with a fluorescence camera compared to direct bacteriological sampling and quantitative analysis using flow cytometry

The aim of this study was to assess the performance of the fluorescence camera device VistaCam iX (VC) for the control of caries excavation compared to visual assessment and bacteriological evaluation. Twenty-three patients with 32 dentinal carious lesions were included in the study. The lesions were classified using the International Caries Detection and Assessment System. Fluorescence images were taken at the surface of each lesion using the VC before excavation (stage 1), during (stage 2) and after excavation (stage 3). At each stage, dentine samples were collected. All cavities were closed after excavation using permanent fillings. Bacteria were counted within each dentine sample using flow cytometry. Significant moderate correlation between the fluorescence readings and the bacteria count was found at stage 3 (Spearman correlation coefficient rs = 0.40, p = 0.027). Area under the ROC curve (AUC) was calculated for fluorescence readings and bacteria count using the clinical status at stage 3 as a reference. AUC was 0.954 for the VC readings and 0.797 for bacteria count. Using the median bacteria count at stage 3 as a reference, the AUC for the fluorescence readings was 0.753. The results indicate that the fluorescence camera appears to be a useful supplementary tool in assessing the endpoint of caries excavation with the advantage of enabling data to be digitally visualized and stored. When an experienced dental clinician determined the excavation endpoint, the performance with respect to remaining bacteria count was good.

The use of computer-assisted FACE for minimal-invasive caries excavation

OBJECTIVES

Caries excavation is still a demanding procedure today. In the past years, methods using light-induced fluorescence have proven their ability to detect bacteria remaining in the tooth's hard tissues. However, methods to control the complete removal of infected dentine have not yet been validated. The aim of the present study was to evaluate the degree of dentine removal during caries excavation using a camera- and software-based device as a guide for fluorescence-aided caries excavation (FACE) in comparison to visual-tactile inspection and a dye-staining method.

MATERIALS AND METHODS

One hundred teeth with carious lesions (C3) were randomly allocated to four groups and excavated with the respective method as primary excavation control method. When the first method indicated complete caries excavation, a second method was used to affirm this. Subsequently, dentine samples were taken to determine residual contamination using PCR. After embedding and sectioning the teeth dentine, microhardness was measured perpendicular to the cavity floor.

RESULTS

By using the camera- and software-based device, 94 % of the cavities tested were free of bacterial contamination. All cavities excavated with the dye-staining or visual-tactile control method were free of bacterial contamination but resulted in a significantly higher dentine removal.

CONCLUSION

The camera- and software-assisted caries excavation seems to be an adequate method to remove contaminated dentine without removing affected dentine.

CLINICAL RELEVANCE

Beside its original application to monitor carious, the device is safe, effective, and easy to use for guided caries excavation and is of worth for both everyday practice and undergraduate education.

Evaluating the efficiency of caries removal using an Er:YAG laser driven by fluorescence feedback control

INTRODUCTION

Caries lesions in dental hard tissues autofluoresce when exposed to light of certain wavelengths, whereas sound tissues do not, and this can be used as an in vitro histological marker for dental caries. Detection of autofluorescence is the basis of KaVo DIAGNOdent™ technology, and provides objective feedback control of laser-stimulated ablation of dental caries for the KaVo Key Laser 3™. This Er:YAG laser operates at 2940nm wavelength, and is effective at removal of infected dental hard tissues. Micro-computed tomography (micro-CT) allows the non-invasive investigation of three-dimensional structures and analysis of mineral density profiles of dentine following laser ablation.

OBJECTIVE

To evaluate removal of infected, demineralised dentine by Er:YAG irradiation with a laser feedback mechanism, using micro-CT.

DESIGN

27 carious teeth (1 control) and 1 sound tooth, treated with the KaVo Key Laser 3™ using a KaVo™ non-contact 2060 handpiece at specific feedback settings, were examined using a Skyscan 1172 Micro-CT, to observe the efficiency of demineralised dentine removal. Grey scale images obtained were colour rendered to assist detection of demineralised tissue if present.

RESULTS

Complete removal of demineralised tissue occurred with laser-stimulated ablation under feedback control at values of 7 and 8 when measured by micro-CT. At greater values, removal of demineralised dentine was incomplete.

CONCLUSION

Examination of dental tissues by micro-CT allowed determination of the efficiency of Er:YAG laser-stimulated ablation. Feedback control of the KaVo Key Laser 3™ appeared to operate like a cut-off switch when infected dentine was eliminated, at a threshold of between 6 and 7.

Minimal intervention dentistry for managing dental caries - a review: report of a FDI task group

This publication describes the history of minimal intervention dentistry (MID) for managing dental caries and presents evidence for various carious lesion detection devices, for preventive measures, for restorative and non-restorative therapies as well as for repairing rather than replacing defective restorations. It is a follow-up to the FDI World Dental Federation publication on MID, of 2000. The dental profession currently is faced with an enormous task of how to manage the high burden of consequences of the caries process amongst the world population. If it is to manage carious lesion development and its progression, it should move away from the 'surgical' care approach and fully embrace the MID approach. The chance for MID to be successful is thought to be increased tremendously if dental caries is not considered an infectious but instead a behavioural disease with a bacterial component. Controlling the two main carious lesion development related behaviours, i.e. intake and frequency of fermentable sugars, to not more than five times daily and removing/disturbing dental plaque from all tooth surfaces using an effective fluoridated toothpaste twice daily, are the ingredients for reducing the burden of dental caries in many communities in the world. FDI's policy of reducing the need for restorative therapy by placing an even greater emphasis on caries prevention than is currently done, is therefore, worth pursuing.

Differences between reported and actual restored caries lesion depths: results from The Dental PBRN

OBJECTIVE

The objectives of this research were to (1) quantify the discordance between the caries lesion depth at which dentists restored initial lesions during a clinical study ("actual depth") and the lesion depth that they reported during a hypothetical clinical scenario ("reported depth"); (2) test the hypothesis that certain practitioner, practice, patient, and caries lesion characteristics are significantly associated with this discordance.

METHODS

Practitioner-investigators who perform restorative dentistry in their practices completed an enrollment questionnaire and participated in two consecutive studies on caries diagnosis and treatment. The first study was a survey asking about caries treatment. The second study collected data on restorations placed in routine clinical practice due to caries in patients over 19 years of age on occlusal surfaces only or proximal surfaces only. We report results on 2691 restorations placed by 205 dentists in 1930 patients with complete data.

RESULTS

Discordance between actual depth and reported depth occurred in only about 2% of the restorations done due to proximal caries, but about 49% of the restorations done due to occlusal caries. Practice type, restorative material used and the diagnostic methods used were significantly associated with discordance.

CONCLUSION

Dentists frequently restored occlusal caries at a shallower depth as compared to their reported depth, but the discordance was very small for proximal lesions. Discordance for occlusal caries was more common when radiographs were not taken or if a resin restoration was placed.

Intraoral pH measurement of carious lesions with qPCR of cariogenic bacteria to differentiate caries activity

OBJECTIVES

A low pH environment is created by cariogenic bacteria. This study was aimed to measure pH of carious lesions intraorally using a micro-pH sensor, and assess predominant acid-producing cariogens by qPCR to differentiate caries activities.

METHODS

103 dentine lesions classified as active or arrested caries based on the clinical and radiological examinations were collected from patients after intraoral measurement of the lesion surface pH using a micro-pH sensor. Quantitative detection of genomic DNA copies of target cariogenic bacteria (mutans streptococci and Lactobacillus spp.) in each lesion was performed using real-time PCR. Correlation between the pH ranges and the number of bacterial species was examined by Spearman test.

RESULTS

50 samples were diagnosed as active and 53 as arrested lesions. Statistically significant difference was observed on average surface pH value between active and arrested lesions (p<0.05). Prevalence of Lactobacillus spp. was higher in active lesions than in arrested lesions (76% vs. 58% of samples, respectively). When the carious lesions were categorised into four different pH ranges (up to 5.5, from 5.6 to 5.8, from 5.9 to 6.1 and 6.2 or above), increased prevalence of Lactobacillus spp. was observed with decrease of pH levels. A significant negative relationship was found between pH value and number of Lactobacillus spp. (r=-0.209, p<0.05) but no such correlation was found for mutans streptococci.

CONCLUSIONS

Intraoral pH measurement might be clinically useful to determine acidity of the local environment of carious lesions as one aspect of the caries activity assessment.

CLINICAL SIGNIFICANCE

The population of certain bacteria may indicate activity of carious lesions. Intraoral pH measurement of the carious lesions using a micro-pH sensor may be a clinically feasible method for assessment of lesion acidity.