Jonas Rodrigues - Academia.edu (original) (raw)

Papers by Jonas Rodrigues

Research paper thumbnail of Comparing the reliability of a new fluorescence camera with conventional laser fluorescence devices in detecting caries lesions in occlusal and smooth surfaces of primary teeth

Lasers in Medical Science, 2011

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

Research paper thumbnail of Reliability and discriminatory power of methods for dental plaque quantification

Journal of Applied Oral Science, 2010

OBJECTIVE: This in situ study evaluated the discriminatory power and reliability of methods of de... more OBJECTIVE: This in situ study evaluated the discriminatory power and reliability of methods of dental plaque quantification and the relationship between visual indices (VI) and fluorescence camera (FC) to detect plaque. MATERIAL AND METHODS: Six volunteers used palatal appliances with six bovine enamel blocks presenting different stages of plaque accumulation. The presence of plaque with and without disclosing was assessed using VI. Images were obtained with FC and digital camera in both conditions. The area covered by plaque was assessed. Examinations were done by two independent examiners. Data were analyzed by Kruskal-Wallis and Kappa tests to compare different conditions of samples and to assess the inter-examiner reproducibility. RESULTS: Some methods presented adequate reproducibility. The Turesky index and the assessment of area covered by disclosed plaque in the FC images presented the highest discriminatory powers. CONCLUSION: The Turesky index and images with FC with disclosing present good reliability and discriminatory power in quantifying dental plaque.

Research paper thumbnail of In vivo evaluation of laser fluorescence performance using different cut-off limits for occlusal caries detection

Lasers in Medical Science, 2009

The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparin... more The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparing different cut-off limits for occlusal caries detection. One hundred and thirty first permanent molars were selected. Visual examination and LF assessments were performed independently. The extent of caries was assessed after operative intervention. New cut-off limits were established and compared with those proposed by the manufacturer and by Lussi et al. (Eur J Oral Sci 109:14–19, 2001). Similar sensitivity and higher specificity was found at D2 (considering as disease only dentin caries) when the LF cut-off limits proposed by Lussi et al. and the new one were compared. At the D3 threshold (considering as disease only deep dentin caries), no statistically significant difference among the cut-off limits for sensitivity was found. However, the new cut-off limits showed higher specificity. The LF device provided good ability to detect dentin caries lesions. Furthermore, the new cut-off limits and the values proposed by Lussi et al. could be suggested for the in vivo detection of occlusal caries.

Research paper thumbnail of Light-emitting diode and laser fluorescence-based devices in detecting occlusal caries

Journal of Biomedical Optics, 2011

The aim of this study was to assess the performance of two light-emitting diode (LED)- and two la... more The aim of this study was to assess the performance of two light-emitting diode (LED)- and two laser fluorescence-based devices in detecting occlusal caries in vitro. Ninety-seven permanent molars were assessed twice by two examiners using two LED- (Midwest Caries - MID and VistaProof - VP) and two laser fluorescence-based (DIAGNOdent 2095 - LF and DIAGNOdent pen 2190 - LFpen) devices. After measuring, the teeth were histologically prepared and classified according to lesion extension. At D1 the specificities were 0.76 (LF and LFpen), 0.94 (MID), and 0.70 (VP); the sensitivities were 0.70 (LF), 0.62 (LFpen), 0.31 (MID), and 0.75 (VP). At D3 threshold the specificities were 0.88 (LF), 0.87 (LFpen), 0.90 (MID), and 0.70 (VP); the sensitivities were 0.63 (LF and LFpen), 0.70 (MID), and 0.96 (VP). Spearman's rank correlations with histology were 0.56 (LF), 0.51 (LFpen), 0.55 (MID), and 0.58 (VP). Inter- and intraexaminer ICC values were high and varied from 0.83 to 0.90. Both LF devices seemed to be useful auxiliary tools to the conventional methods, presenting good reproducibility and better accuracy at D3 threshold. MID was not able to differentiate sound surfaces from enamel caries and VP still needs improvement on the cut-off limits for its use.

Research paper thumbnail of In situ and in vitro comparison of laser fluorescence with visual inspection in detecting occlusal caries lesions

Lasers in Medical Science, 2011

The aim of this study was to compare the in situ and in vitro performances of a laser fluorescenc... more 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 D1 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 D1 and D2 (considering only dentinal caries as the disease) thresholds. For both methods, the results of sensitivity (at D1 and D2) and accuracy (at D1) showed significant differences between in vitro and in situ conditions. However, the sensitivity (at D1 and D2), specificity and accuracy (both at D1) 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.

Research paper thumbnail of Influence of examiner’s clinical experience on the reproducibility and accuracy of radiographic examination in detecting occlusal caries

Clinical Oral Investigations, 2010

The aim of this in vitro study was to assess the influence of varying examiner’s clinical experie... more The aim of this in vitro study was to assess the influence of varying examiner’s clinical experience on the reproducibility and accuracy of radiographic examination for occlusal caries detection. Standardized bitewing radiographs were obtained from 166 permanent molars. Radiographic examination was performed by final-year dental students from two universities (A, n = 5; B, n = 5) and by dentists with 5 to 7 years of experience who work in two different countries (C, n = 5; D, n = 5). All examinations were repeated after 1-week interval. The teeth were histologically prepared and assessed for caries extension. For intraexaminer reproducibility, the unweighted kappa values were: A (0.11–0.40), B (0.12–0.33), C (0.47–0.58), and D (0.42–0.71). Interexaminer reproducibility statistics were computed based on means ± SD of unweighted kappa values: A (0.07 ± 0.05), B (0.12 ± 0.09), C (0.24 ± 0.08), and D (0.33 ± 0.10). Sensitivity, specificity, and accuracy were calculated at D1 and D3 thresholds and compared by performing McNemar test (p = 0.05). D1 sensitivity ranged between 0.29 and 0.75 and specificity between 0.24 and 0.85. D3 specificity was moderate to high (between 0.62 and 0.95) for all groups, with statistically significant difference between the dentists groups (C and D). Sensitivity was low to moderate (between 0.21 and 0.57) with statistically significant difference for groups B and D. Accuracy was similar for all groups (0.55). Spearman’s correlations were: A (0.12), B (0.24), C (0.30), and D (0.38). In conclusion, the reproducibility of radiographic examination was influenced by the examiner’s clinical experience, training, and dental education as well as the accuracy in detecting occlusal caries.

Research paper thumbnail of Performance of Fluorescence Methods, Radiographic Examination and ICDAS II on Occlusal Surfaces in vitro

Caries Research, 2008

and 0.62 (intraexaminer). The Bland and Altman limits of agreement were 46.0 and 38.2 (LF), 55.6 ... more 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.

Research paper thumbnail of The Influence of Pit and Fissure Sealants on Infrared Fluorescence Measurements

Caries Research, 2008

The aim of this in vitro study was to evaluate the influence of pit and fissure sealants on fluor... more 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.

Research paper thumbnail of In vivo evaluation of laser fluorescence performance using different cut-off limits for occlusal caries detection

Lasers in Medical Science, 2009

The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparin... more The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparing different cut-off limits for occlusal caries detection. One hundred and thirty first permanent molars were selected. Visual examination and LF assessments were performed independently. The extent of caries was assessed after operative intervention. New cut-off limits were established and compared with those proposed by the manufacturer and by Lussi et al. (Eur J Oral Sci 109:14–19, 2001). Similar sensitivity and higher specificity was found at D2 (considering as disease only dentin caries) when the LF cut-off limits proposed by Lussi et al. and the new one were compared. At the D3 threshold (considering as disease only deep dentin caries), no statistically significant difference among the cut-off limits for sensitivity was found. However, the new cut-off limits showed higher specificity. The LF device provided good ability to detect dentin caries lesions. Furthermore, the new cut-off limits and the values proposed by Lussi et al. could be suggested for the in vivo detection of occlusal caries.

Research paper thumbnail of Reproducibility and accuracy of the ICDAS-II for occlusal caries detection

Community Dentistry and Oral Epidemiology, 2009

Abstract – Objectives: The aim of this in vitro study was to assess the inter- and intra-examin... more Abstract – Objectives: The aim of this in vitro study was to assess the inter- and intra-examiner reproducibility and the accuracy of the International Caries Detection and Assessment System-II (ICDAS-II) in detecting occlusal caries.Methods: One hundred and sixty-three molars were independently assessed twice by two experienced dentists using the 0- to 6-graded ICDAS-II. The teeth were histologically prepared and classified using two different histological systems [Ekstrand et al. (1997) Caries Research vol. 31, pp. 224–231; Lussi et al. (1999) Caries Research vol. 33, pp. 261–266] and assessed for caries extension. Sensitivity, specificity, accuracy and area under the ROC curve (Az) were obtained at D2 and D3 thresholds. Unweighted kappa coefficient was used to assess inter- and intra-examiner reproducibility.Results: For the Ekstrand et al. histological classification the sensitivity was 0.99 and 1.00, specificity 1.00 and 0.69 and accuracy 0.99 and 0.76 at D2 and D3, respectively. For the Lussi et al. histological classification the sensitivity was 0.91 and 0.75, specificity 0.47 and 0.62 and accuracy 0.86 and 0.68 at D2 and D3, respectively. The Az varied from 0.54 to 0.73. The inter- and intra-examiner kappa values were 0.51 and 0.58, respectively.Conclusions: ICDAS-II presented good reproducibility and accuracy in detecting occlusal caries, especially caries lesions in the outer half of the enamel.

Research paper thumbnail of Light-emitting diode and laser fluorescence-based devices in detecting occlusal caries

Journal of Biomedical Optics, 2011

The aim of this study was to assess the performance of two light-emitting diode (LED)- and two la... more The aim of this study was to assess the performance of two light-emitting diode (LED)- and two laser fluorescence-based devices in detecting occlusal caries in vitro. Ninety-seven permanent molars were assessed twice by two examiners using two LED- (Midwest Caries - MID and VistaProof - VP) and two laser fluorescence-based (DIAGNOdent 2095 - LF and DIAGNOdent pen 2190 - LFpen) devices. After measuring, the teeth were histologically prepared and classified according to lesion extension. At D1 the specificities were 0.76 (LF and LFpen), 0.94 (MID), and 0.70 (VP); the sensitivities were 0.70 (LF), 0.62 (LFpen), 0.31 (MID), and 0.75 (VP). At D3 threshold the specificities were 0.88 (LF), 0.87 (LFpen), 0.90 (MID), and 0.70 (VP); the sensitivities were 0.63 (LF and LFpen), 0.70 (MID), and 0.96 (VP). Spearman's rank correlations with histology were 0.56 (LF), 0.51 (LFpen), 0.55 (MID), and 0.58 (VP). Inter- and intraexaminer ICC values were high and varied from 0.83 to 0.90. Both LF devices seemed to be useful auxiliary tools to the conventional methods, presenting good reproducibility and better accuracy at D3 threshold. MID was not able to differentiate sound surfaces from enamel caries and VP still needs improvement on the cut-off limits for its use.

Research paper thumbnail of In situ and in vitro comparison of laser fluorescence with visual inspection in detecting occlusal caries lesions

Lasers in Medical Science, 2011

The aim of this study was to compare the in situ and in vitro performances of a laser fluorescenc... more 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 D1 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 D1 and D2 (considering only dentinal caries as the disease) thresholds. For both methods, the results of sensitivity (at D1 and D2) and accuracy (at D1) showed significant differences between in vitro and in situ conditions. However, the sensitivity (at D1 and D2), specificity and accuracy (both at D1) 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.

Research paper thumbnail of The influence of zero value subtraction on the performance of a new laser fluorescence device for approximal caries detection

Lasers in Medical Science, 2009

The aim of this study was to assess the influence of the zero value subtraction on the performanc... more The aim of this study was to assess the influence of the zero value subtraction on the performance of laser fluorescence (LFpen) for approximal caries detection. Three areas (cuspal, middle and cervical) of both mesial and distal buccal surfaces of 78 permanent molars were assessed using both wedge-shaped (WDG) and tapered wedge-shaped (TWDG) tips. With the addition of the average, one cut-off value for each area was obtained and the performance was assessed. The areas under the receiver operating characteristics (ROC) curve, specificity, sensitivity and accuracy with and without the zero value subtraction were calculated. The McNemar test revealed a statistically significant difference for specificity at thresholds D1, D2 and D3 (WDG) and D1 and D2 (TWDG) when the zero value subtraction was not performed. Influence of the zero value subtraction on the LFpen performance was observed for approximal caries detection. However, when modified cut-off values were used, the zero value subtraction could be eliminated.

Research paper thumbnail of Influence of examiner’s clinical experience on the reproducibility and accuracy of radiographic examination in detecting occlusal caries

Clinical Oral Investigations, 2010

The aim of this in vitro study was to assess the influence of varying examiner’s clinical experie... more The aim of this in vitro study was to assess the influence of varying examiner’s clinical experience on the reproducibility and accuracy of radiographic examination for occlusal caries detection. Standardized bitewing radiographs were obtained from 166 permanent molars. Radiographic examination was performed by final-year dental students from two universities (A, n = 5; B, n = 5) and by dentists with 5 to 7 years of experience who work in two different countries (C, n = 5; D, n = 5). All examinations were repeated after 1-week interval. The teeth were histologically prepared and assessed for caries extension. For intraexaminer reproducibility, the unweighted kappa values were: A (0.11–0.40), B (0.12–0.33), C (0.47–0.58), and D (0.42–0.71). Interexaminer reproducibility statistics were computed based on means ± SD of unweighted kappa values: A (0.07 ± 0.05), B (0.12 ± 0.09), C (0.24 ± 0.08), and D (0.33 ± 0.10). Sensitivity, specificity, and accuracy were calculated at D1 and D3 thresholds and compared by performing McNemar test (p = 0.05). D1 sensitivity ranged between 0.29 and 0.75 and specificity between 0.24 and 0.85. D3 specificity was moderate to high (between 0.62 and 0.95) for all groups, with statistically significant difference between the dentists groups (C and D). Sensitivity was low to moderate (between 0.21 and 0.57) with statistically significant difference for groups B and D. Accuracy was similar for all groups (0.55). Spearman’s correlations were: A (0.12), B (0.24), C (0.30), and D (0.38). In conclusion, the reproducibility of radiographic examination was influenced by the examiner’s clinical experience, training, and dental education as well as the accuracy in detecting occlusal caries.

Research paper thumbnail of In vivo evaluation of laser fluorescence performance using different cut-off limits for occlusal caries detection

Lasers in Medical Science, 2009

The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparin... more The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparing different cut-off limits for occlusal caries detection. One hundred and thirty first permanent molars were selected. Visual examination and LF assessments were performed independently. The extent of caries was assessed after operative intervention. New cut-off limits were established and compared with those proposed by the manufacturer and by Lussi et al. (Eur J Oral Sci 109:14-19, 2001). Similar sensitivity and higher specificity was found at D 2 (considering as disease only dentin caries) when the LF cut-off limits proposed by Lussi et al. and the new one were compared. At the D 3 threshold (considering as disease only deep dentin caries), no statistically significant difference among the cut-off limits for sensitivity was found. However, the new cut-off limits showed higher specificity. The LF device provided good ability to detect dentin caries lesions. Furthermore, the new cut-off limits and the values proposed by Lussi et al. could be suggested for the in vivo detection of occlusal caries.

Research paper thumbnail of Performance of Fluorescence Methods, Radiographic Examination and ICDAS II on Occlusal Surfaces in vitro

Caries Research, 2008

and 0.62 (intraexaminer). The Bland and Altman limits of agreement were 46.0 and 38.2 (LF), 55.6 ... more 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.

Research paper thumbnail of Influence of Different Professional Prophylactic Methods on Fluorescence Measurements for Detection of Occlusal Caries

Caries Research, 2011

This study aimed to evaluate the influence of professional prophylactic methods on the DIAGNOdent... more This study aimed to evaluate the influence of professional prophylactic methods on the DIAGNOdent 2095, DIAGNOdent 2190 and VistaProof performance in detecting occlusal caries. Assessments were performed in 110 permanent teeth at baseline and after bicarbonate jet or prophylactic paste and rinsing. Performance in terms of sensitivity improved after rinsing of the occlusal surfaces when the prophylactic paste was used. However, the sodium bicarbonate jet did not significantly influence the performance of the fluorescence-based methods. It can be concluded that different professional prophylactic methods can significantly influence the performance of fluorescence-based methods for occlusal caries detection.

Research paper thumbnail of The Influence of Pit and Fissure Sealants on Infrared Fluorescence Measurements

Caries Research, 2008

The aim of this in vitro study was to evaluate the influence of pit and fissure sealants on fluor... more 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.

Research paper thumbnail of In vitro comparison of laser fluorescence performance with visual examination for detection of occlusal caries in permanent and primary molars

Lasers in Medical Science, 2009

The aim of this study was to compare the performance of the DIAGNOdent 2095 with visual examinati... more The aim of this study was to compare the performance of the DIAGNOdent 2095 with visual examination for occlusal caries detection in permanent and primary molars. The sample comprised 148 permanent human molars and 179 primary human molars. The samples were measured and visually examined three times by two examiners. After measurement, the teeth were histologically prepared and assessed for caries extension. Sensitivity, specificity, accuracy and area under the receiver operating characteristics (ROC) curve were calculated. Intra-class correlation (ICC), unweighted kappa and the Bland and Altman method were used to assess inter- and intra-examiner reproducibility. DIAGNOdent showed higher specificity and lower sensitivity than did visual examination. The ICC values indicated an excellent agreement between the examinations. Kappa values varied from good to excellent for DIAGNOdent but from poor to good for visual examination. In conclusion, the DIAGNOdent may be a useful adjunct to conventional methods for occlusal caries detection.

Research paper thumbnail of The Efficacy of Laser Fluorescence to Detect in Vitro Demineralization and Remineralization of Smooth Enamel Surfaces

Photomedicine and Laser Surgery, 2009

The purpose of this study was to evaluate the efficacy of the laser fluorescence (LF) device in d... more 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. 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 useful in monitoring the caries pathological process. 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. 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. The LF device did not show efficacy for monitoring in vitro demineralization and remineralization of smooth enamel surfaces.

Research paper thumbnail of Comparing the reliability of a new fluorescence camera with conventional laser fluorescence devices in detecting caries lesions in occlusal and smooth surfaces of primary teeth

Lasers in Medical Science, 2011

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

Research paper thumbnail of Reliability and discriminatory power of methods for dental plaque quantification

Journal of Applied Oral Science, 2010

OBJECTIVE: This in situ study evaluated the discriminatory power and reliability of methods of de... more OBJECTIVE: This in situ study evaluated the discriminatory power and reliability of methods of dental plaque quantification and the relationship between visual indices (VI) and fluorescence camera (FC) to detect plaque. MATERIAL AND METHODS: Six volunteers used palatal appliances with six bovine enamel blocks presenting different stages of plaque accumulation. The presence of plaque with and without disclosing was assessed using VI. Images were obtained with FC and digital camera in both conditions. The area covered by plaque was assessed. Examinations were done by two independent examiners. Data were analyzed by Kruskal-Wallis and Kappa tests to compare different conditions of samples and to assess the inter-examiner reproducibility. RESULTS: Some methods presented adequate reproducibility. The Turesky index and the assessment of area covered by disclosed plaque in the FC images presented the highest discriminatory powers. CONCLUSION: The Turesky index and images with FC with disclosing present good reliability and discriminatory power in quantifying dental plaque.

Research paper thumbnail of In vivo evaluation of laser fluorescence performance using different cut-off limits for occlusal caries detection

Lasers in Medical Science, 2009

The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparin... more The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparing different cut-off limits for occlusal caries detection. One hundred and thirty first permanent molars were selected. Visual examination and LF assessments were performed independently. The extent of caries was assessed after operative intervention. New cut-off limits were established and compared with those proposed by the manufacturer and by Lussi et al. (Eur J Oral Sci 109:14–19, 2001). Similar sensitivity and higher specificity was found at D2 (considering as disease only dentin caries) when the LF cut-off limits proposed by Lussi et al. and the new one were compared. At the D3 threshold (considering as disease only deep dentin caries), no statistically significant difference among the cut-off limits for sensitivity was found. However, the new cut-off limits showed higher specificity. The LF device provided good ability to detect dentin caries lesions. Furthermore, the new cut-off limits and the values proposed by Lussi et al. could be suggested for the in vivo detection of occlusal caries.

Research paper thumbnail of Light-emitting diode and laser fluorescence-based devices in detecting occlusal caries

Journal of Biomedical Optics, 2011

The aim of this study was to assess the performance of two light-emitting diode (LED)- and two la... more The aim of this study was to assess the performance of two light-emitting diode (LED)- and two laser fluorescence-based devices in detecting occlusal caries in vitro. Ninety-seven permanent molars were assessed twice by two examiners using two LED- (Midwest Caries - MID and VistaProof - VP) and two laser fluorescence-based (DIAGNOdent 2095 - LF and DIAGNOdent pen 2190 - LFpen) devices. After measuring, the teeth were histologically prepared and classified according to lesion extension. At D1 the specificities were 0.76 (LF and LFpen), 0.94 (MID), and 0.70 (VP); the sensitivities were 0.70 (LF), 0.62 (LFpen), 0.31 (MID), and 0.75 (VP). At D3 threshold the specificities were 0.88 (LF), 0.87 (LFpen), 0.90 (MID), and 0.70 (VP); the sensitivities were 0.63 (LF and LFpen), 0.70 (MID), and 0.96 (VP). Spearman's rank correlations with histology were 0.56 (LF), 0.51 (LFpen), 0.55 (MID), and 0.58 (VP). Inter- and intraexaminer ICC values were high and varied from 0.83 to 0.90. Both LF devices seemed to be useful auxiliary tools to the conventional methods, presenting good reproducibility and better accuracy at D3 threshold. MID was not able to differentiate sound surfaces from enamel caries and VP still needs improvement on the cut-off limits for its use.

Research paper thumbnail of In situ and in vitro comparison of laser fluorescence with visual inspection in detecting occlusal caries lesions

Lasers in Medical Science, 2011

The aim of this study was to compare the in situ and in vitro performances of a laser fluorescenc... more 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 D1 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 D1 and D2 (considering only dentinal caries as the disease) thresholds. For both methods, the results of sensitivity (at D1 and D2) and accuracy (at D1) showed significant differences between in vitro and in situ conditions. However, the sensitivity (at D1 and D2), specificity and accuracy (both at D1) 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.

Research paper thumbnail of Influence of examiner’s clinical experience on the reproducibility and accuracy of radiographic examination in detecting occlusal caries

Clinical Oral Investigations, 2010

The aim of this in vitro study was to assess the influence of varying examiner’s clinical experie... more The aim of this in vitro study was to assess the influence of varying examiner’s clinical experience on the reproducibility and accuracy of radiographic examination for occlusal caries detection. Standardized bitewing radiographs were obtained from 166 permanent molars. Radiographic examination was performed by final-year dental students from two universities (A, n = 5; B, n = 5) and by dentists with 5 to 7 years of experience who work in two different countries (C, n = 5; D, n = 5). All examinations were repeated after 1-week interval. The teeth were histologically prepared and assessed for caries extension. For intraexaminer reproducibility, the unweighted kappa values were: A (0.11–0.40), B (0.12–0.33), C (0.47–0.58), and D (0.42–0.71). Interexaminer reproducibility statistics were computed based on means ± SD of unweighted kappa values: A (0.07 ± 0.05), B (0.12 ± 0.09), C (0.24 ± 0.08), and D (0.33 ± 0.10). Sensitivity, specificity, and accuracy were calculated at D1 and D3 thresholds and compared by performing McNemar test (p = 0.05). D1 sensitivity ranged between 0.29 and 0.75 and specificity between 0.24 and 0.85. D3 specificity was moderate to high (between 0.62 and 0.95) for all groups, with statistically significant difference between the dentists groups (C and D). Sensitivity was low to moderate (between 0.21 and 0.57) with statistically significant difference for groups B and D. Accuracy was similar for all groups (0.55). Spearman’s correlations were: A (0.12), B (0.24), C (0.30), and D (0.38). In conclusion, the reproducibility of radiographic examination was influenced by the examiner’s clinical experience, training, and dental education as well as the accuracy in detecting occlusal caries.

Research paper thumbnail of Performance of Fluorescence Methods, Radiographic Examination and ICDAS II on Occlusal Surfaces in vitro

Caries Research, 2008

and 0.62 (intraexaminer). The Bland and Altman limits of agreement were 46.0 and 38.2 (LF), 55.6 ... more 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.

Research paper thumbnail of The Influence of Pit and Fissure Sealants on Infrared Fluorescence Measurements

Caries Research, 2008

The aim of this in vitro study was to evaluate the influence of pit and fissure sealants on fluor... more 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.

Research paper thumbnail of In vivo evaluation of laser fluorescence performance using different cut-off limits for occlusal caries detection

Lasers in Medical Science, 2009

The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparin... more The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparing different cut-off limits for occlusal caries detection. One hundred and thirty first permanent molars were selected. Visual examination and LF assessments were performed independently. The extent of caries was assessed after operative intervention. New cut-off limits were established and compared with those proposed by the manufacturer and by Lussi et al. (Eur J Oral Sci 109:14–19, 2001). Similar sensitivity and higher specificity was found at D2 (considering as disease only dentin caries) when the LF cut-off limits proposed by Lussi et al. and the new one were compared. At the D3 threshold (considering as disease only deep dentin caries), no statistically significant difference among the cut-off limits for sensitivity was found. However, the new cut-off limits showed higher specificity. The LF device provided good ability to detect dentin caries lesions. Furthermore, the new cut-off limits and the values proposed by Lussi et al. could be suggested for the in vivo detection of occlusal caries.

Research paper thumbnail of Reproducibility and accuracy of the ICDAS-II for occlusal caries detection

Community Dentistry and Oral Epidemiology, 2009

Abstract – Objectives: The aim of this in vitro study was to assess the inter- and intra-examin... more Abstract – Objectives: The aim of this in vitro study was to assess the inter- and intra-examiner reproducibility and the accuracy of the International Caries Detection and Assessment System-II (ICDAS-II) in detecting occlusal caries.Methods: One hundred and sixty-three molars were independently assessed twice by two experienced dentists using the 0- to 6-graded ICDAS-II. The teeth were histologically prepared and classified using two different histological systems [Ekstrand et al. (1997) Caries Research vol. 31, pp. 224–231; Lussi et al. (1999) Caries Research vol. 33, pp. 261–266] and assessed for caries extension. Sensitivity, specificity, accuracy and area under the ROC curve (Az) were obtained at D2 and D3 thresholds. Unweighted kappa coefficient was used to assess inter- and intra-examiner reproducibility.Results: For the Ekstrand et al. histological classification the sensitivity was 0.99 and 1.00, specificity 1.00 and 0.69 and accuracy 0.99 and 0.76 at D2 and D3, respectively. For the Lussi et al. histological classification the sensitivity was 0.91 and 0.75, specificity 0.47 and 0.62 and accuracy 0.86 and 0.68 at D2 and D3, respectively. The Az varied from 0.54 to 0.73. The inter- and intra-examiner kappa values were 0.51 and 0.58, respectively.Conclusions: ICDAS-II presented good reproducibility and accuracy in detecting occlusal caries, especially caries lesions in the outer half of the enamel.

Research paper thumbnail of Light-emitting diode and laser fluorescence-based devices in detecting occlusal caries

Journal of Biomedical Optics, 2011

The aim of this study was to assess the performance of two light-emitting diode (LED)- and two la... more The aim of this study was to assess the performance of two light-emitting diode (LED)- and two laser fluorescence-based devices in detecting occlusal caries in vitro. Ninety-seven permanent molars were assessed twice by two examiners using two LED- (Midwest Caries - MID and VistaProof - VP) and two laser fluorescence-based (DIAGNOdent 2095 - LF and DIAGNOdent pen 2190 - LFpen) devices. After measuring, the teeth were histologically prepared and classified according to lesion extension. At D1 the specificities were 0.76 (LF and LFpen), 0.94 (MID), and 0.70 (VP); the sensitivities were 0.70 (LF), 0.62 (LFpen), 0.31 (MID), and 0.75 (VP). At D3 threshold the specificities were 0.88 (LF), 0.87 (LFpen), 0.90 (MID), and 0.70 (VP); the sensitivities were 0.63 (LF and LFpen), 0.70 (MID), and 0.96 (VP). Spearman's rank correlations with histology were 0.56 (LF), 0.51 (LFpen), 0.55 (MID), and 0.58 (VP). Inter- and intraexaminer ICC values were high and varied from 0.83 to 0.90. Both LF devices seemed to be useful auxiliary tools to the conventional methods, presenting good reproducibility and better accuracy at D3 threshold. MID was not able to differentiate sound surfaces from enamel caries and VP still needs improvement on the cut-off limits for its use.

Research paper thumbnail of In situ and in vitro comparison of laser fluorescence with visual inspection in detecting occlusal caries lesions

Lasers in Medical Science, 2011

The aim of this study was to compare the in situ and in vitro performances of a laser fluorescenc... more 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 D1 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 D1 and D2 (considering only dentinal caries as the disease) thresholds. For both methods, the results of sensitivity (at D1 and D2) and accuracy (at D1) showed significant differences between in vitro and in situ conditions. However, the sensitivity (at D1 and D2), specificity and accuracy (both at D1) 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.

Research paper thumbnail of The influence of zero value subtraction on the performance of a new laser fluorescence device for approximal caries detection

Lasers in Medical Science, 2009

The aim of this study was to assess the influence of the zero value subtraction on the performanc... more The aim of this study was to assess the influence of the zero value subtraction on the performance of laser fluorescence (LFpen) for approximal caries detection. Three areas (cuspal, middle and cervical) of both mesial and distal buccal surfaces of 78 permanent molars were assessed using both wedge-shaped (WDG) and tapered wedge-shaped (TWDG) tips. With the addition of the average, one cut-off value for each area was obtained and the performance was assessed. The areas under the receiver operating characteristics (ROC) curve, specificity, sensitivity and accuracy with and without the zero value subtraction were calculated. The McNemar test revealed a statistically significant difference for specificity at thresholds D1, D2 and D3 (WDG) and D1 and D2 (TWDG) when the zero value subtraction was not performed. Influence of the zero value subtraction on the LFpen performance was observed for approximal caries detection. However, when modified cut-off values were used, the zero value subtraction could be eliminated.

Research paper thumbnail of Influence of examiner’s clinical experience on the reproducibility and accuracy of radiographic examination in detecting occlusal caries

Clinical Oral Investigations, 2010

The aim of this in vitro study was to assess the influence of varying examiner’s clinical experie... more The aim of this in vitro study was to assess the influence of varying examiner’s clinical experience on the reproducibility and accuracy of radiographic examination for occlusal caries detection. Standardized bitewing radiographs were obtained from 166 permanent molars. Radiographic examination was performed by final-year dental students from two universities (A, n = 5; B, n = 5) and by dentists with 5 to 7 years of experience who work in two different countries (C, n = 5; D, n = 5). All examinations were repeated after 1-week interval. The teeth were histologically prepared and assessed for caries extension. For intraexaminer reproducibility, the unweighted kappa values were: A (0.11–0.40), B (0.12–0.33), C (0.47–0.58), and D (0.42–0.71). Interexaminer reproducibility statistics were computed based on means ± SD of unweighted kappa values: A (0.07 ± 0.05), B (0.12 ± 0.09), C (0.24 ± 0.08), and D (0.33 ± 0.10). Sensitivity, specificity, and accuracy were calculated at D1 and D3 thresholds and compared by performing McNemar test (p = 0.05). D1 sensitivity ranged between 0.29 and 0.75 and specificity between 0.24 and 0.85. D3 specificity was moderate to high (between 0.62 and 0.95) for all groups, with statistically significant difference between the dentists groups (C and D). Sensitivity was low to moderate (between 0.21 and 0.57) with statistically significant difference for groups B and D. Accuracy was similar for all groups (0.55). Spearman’s correlations were: A (0.12), B (0.24), C (0.30), and D (0.38). In conclusion, the reproducibility of radiographic examination was influenced by the examiner’s clinical experience, training, and dental education as well as the accuracy in detecting occlusal caries.

Research paper thumbnail of In vivo evaluation of laser fluorescence performance using different cut-off limits for occlusal caries detection

Lasers in Medical Science, 2009

The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparin... more The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparing different cut-off limits for occlusal caries detection. One hundred and thirty first permanent molars were selected. Visual examination and LF assessments were performed independently. The extent of caries was assessed after operative intervention. New cut-off limits were established and compared with those proposed by the manufacturer and by Lussi et al. (Eur J Oral Sci 109:14-19, 2001). Similar sensitivity and higher specificity was found at D 2 (considering as disease only dentin caries) when the LF cut-off limits proposed by Lussi et al. and the new one were compared. At the D 3 threshold (considering as disease only deep dentin caries), no statistically significant difference among the cut-off limits for sensitivity was found. However, the new cut-off limits showed higher specificity. The LF device provided good ability to detect dentin caries lesions. Furthermore, the new cut-off limits and the values proposed by Lussi et al. could be suggested for the in vivo detection of occlusal caries.

Research paper thumbnail of Performance of Fluorescence Methods, Radiographic Examination and ICDAS II on Occlusal Surfaces in vitro

Caries Research, 2008

and 0.62 (intraexaminer). The Bland and Altman limits of agreement were 46.0 and 38.2 (LF), 55.6 ... more 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.

Research paper thumbnail of Influence of Different Professional Prophylactic Methods on Fluorescence Measurements for Detection of Occlusal Caries

Caries Research, 2011

This study aimed to evaluate the influence of professional prophylactic methods on the DIAGNOdent... more This study aimed to evaluate the influence of professional prophylactic methods on the DIAGNOdent 2095, DIAGNOdent 2190 and VistaProof performance in detecting occlusal caries. Assessments were performed in 110 permanent teeth at baseline and after bicarbonate jet or prophylactic paste and rinsing. Performance in terms of sensitivity improved after rinsing of the occlusal surfaces when the prophylactic paste was used. However, the sodium bicarbonate jet did not significantly influence the performance of the fluorescence-based methods. It can be concluded that different professional prophylactic methods can significantly influence the performance of fluorescence-based methods for occlusal caries detection.

Research paper thumbnail of The Influence of Pit and Fissure Sealants on Infrared Fluorescence Measurements

Caries Research, 2008

The aim of this in vitro study was to evaluate the influence of pit and fissure sealants on fluor... more 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.

Research paper thumbnail of In vitro comparison of laser fluorescence performance with visual examination for detection of occlusal caries in permanent and primary molars

Lasers in Medical Science, 2009

The aim of this study was to compare the performance of the DIAGNOdent 2095 with visual examinati... more The aim of this study was to compare the performance of the DIAGNOdent 2095 with visual examination for occlusal caries detection in permanent and primary molars. The sample comprised 148 permanent human molars and 179 primary human molars. The samples were measured and visually examined three times by two examiners. After measurement, the teeth were histologically prepared and assessed for caries extension. Sensitivity, specificity, accuracy and area under the receiver operating characteristics (ROC) curve were calculated. Intra-class correlation (ICC), unweighted kappa and the Bland and Altman method were used to assess inter- and intra-examiner reproducibility. DIAGNOdent showed higher specificity and lower sensitivity than did visual examination. The ICC values indicated an excellent agreement between the examinations. Kappa values varied from good to excellent for DIAGNOdent but from poor to good for visual examination. In conclusion, the DIAGNOdent may be a useful adjunct to conventional methods for occlusal caries detection.

Research paper thumbnail of The Efficacy of Laser Fluorescence to Detect in Vitro Demineralization and Remineralization of Smooth Enamel Surfaces

Photomedicine and Laser Surgery, 2009

The purpose of this study was to evaluate the efficacy of the laser fluorescence (LF) device in d... more 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. 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 useful in monitoring the caries pathological process. 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. 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. The LF device did not show efficacy for monitoring in vitro demineralization and remineralization of smooth enamel surfaces.