Diagnodent ® and the caveats of caries diagnosis by laser fluorescence (original) (raw)
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A COMPREHENSIVE REVIEW OF VARIOUS LASER-BASED SYSTEMS USED IN EARLY DETECTION OF DENTAL CARIES
Introduction: The aim was to comprehensively review the various laser-based systems used in early detection of dental caries. Methodology: PubMed/Medline and Google-scholar databases were searched from 1995 up to June 2015 using various combinations of the following keywords: “dental early caries”, “diagnosis”, “laser” and “light fluorescence” (LF). Literature reviews, letters to the Editor, and commentaries were excluded. Articles published only in English were included. The pattern of the present study was customized to primarily summarize the pertinent information. Results: Laser fluorescence at 655 nm (DIAGNOdent) is a promising tool for early detection of occlusal caries. Other systems based on the LF concept include VistaProof (VP) and DIAGNOdent Pen; however, no statistically significant difference in the caries detection efficacy has been reported between VP, DIAGNOdent Pen and DIAGNOdent devices. Although light emitting diode systems have also been tested for detecting caries, their diagnosing efficacy remains unclear due to a lack of studies. Conclusion: Lasers-based caries detection systems are useful tools in the early detection of caries in contrast to traditional visual and radiographic examination techniques; however, further studies are needed to assess the caries diagnostic efficacy of the various commercially available laser-based caries diagnostic systems. Keywords: dental early caries, diagnosis, laser and light fluorescence, light emitting diode
Caries diagnosis using light fluorescence devices: VistaProof and DIAGNOdent
Odontology, 2013
The modern concept of minimally invasive dentistry encompasses early detection of incipient carious lesions and their treatment. Due to the low sensitivity of visual inspection and radiography in the detection of occlusal hidden carious lesions under a macroscopically sound surface, several devices have been developed to increase detection accuracy. DIAGNOdent is one of the tools used for that purpose and VistaProof is a new device recently introduced into the market. They both use light fluorescence to detect incipient carious lesions. DIAG-NOdent is based on the fact that carious lesions show higher level of fluorescence than sound tissues when excited by light at specific wavelength. Vistaproof is based on the same principle, but it uses a different wavelength of excitation than DIAGNOdent and a video camera for the detection of fluorescence. The aim of this article was to compare these two devices and present their clinical use.
Caries Detection with Laser Fluorescence Devices. Limitations of Their Use
STOMATOLOGY EDU JOURNAL
Background: Dental caries is one of the most prevalent human diseases worldwide. The modern concept of minimal invasive dentistry includes early detection of incipient caries lesions and its treatment. Several optical and digital detection methods are available. Objective: This literature review presents the utility and limitations of laser fl uorescence caries detection devices DIAGNOdent (DD) and DIAGNOdent Pen (DDpen) (KaVo Dental GmbH, Biberach/ Riβ, Germany) for carious lesions on the occlusal surfaces of the permanent dentition. Data sources: All available in vitro and in vivo studies from Google Scholar, PubMed and Scopus machines corresponding to caries, DIAGNOdent, DIAGNOdent Pen and laser fl uorescence as key words, were reviewed. Data extraction: Certain limitations of the studies were the inadequate analysis of the experimental protocols, the widespread sample use of the third molar, mistakes in sample handling and the limited number of studies evaluating the detection capability of DD and DDPen for secondary caries. Data synthesis: DD and DDPen are useful devices for caries detection on the occlusal tooth surfaces. Their main advantages are the very high reproducibility of measurements (>0.90), the ease of handling and the quantifi cation and monitoring capacity. Their main limitations are the relatively low specifi city for enamel lesions, the necessity of unstained surfaces and absence of plaque and pastes during measurements and the absence of a universal, clinically functional calibration value (COV). Conclusion: Further studies are required for more reliable data analysis and clinical interpretation of the relevant results.
2004
This systematic review was conducted to assess the accuracy of laser fluorescence (DIAGNOdentTM) for diagnosis of occlusal caries in permanent teeth, using any sort of gold standard. The MEDLINE, LILACS, BBO and Cochrane library databases accessed by BIREME were searched for English, Spanish and Portuguese-language papers published between 1982 and 2003. Four works in English were selected. DIAGNOdentTM was found to be an accurate method for diagnosis of occlusal caries, mainly if employed simultaneously with visual inspection.Esta revisão sistemática foi realizada para avaliar a precisão da fluorescência a laser (DIAGNOdentTM) para o diagnóstico da cárie oclusal em dentes permanentes, utilizando qualquer tipo de gold standard. As bases de dados MEDLINE, LILACS, BBO e Cochrane Library, acessadas via BIREME, foram utilizadas para a busca de artigos em idioma inglês, espanhol e português, publicados de 1982 a 2003. Foram selecionados quatro trabalhos em inglês. Foi observado que o DIA...
A Clinical Study of Caries Diagnosis With a Laser Fluorescence System
The Journal of the American Dental Association, 2008
Background. The authors conducted an in vivo study to compare a laser fluorescence system with a visual system for occlusal caries diagnosis in children's primary and permanent molars. Methods. The authors selected for evaluation 320 untreated, cavityfree primary and permanent molars in healthy children aged 6 through 14 years. Two of the authors conducted the laser fluorescence evaluation. Another of the authors completed the clinical evaluation. The κ value was 0.68. The authors compared sensitivity, specificity, predictive values, odds ratio and receiver operating characteristic (ROC) curves for the laser fluorescence system. Results. For the whole sample, the sensitivity and specificity of the laser fluorescence system were 0.79 and 0.87, respectively. The positive and negative odds ratios for the whole sample were 6.33 and 0.23. The positive and negative predictive values for the whole sample were 33.9 percent and 98.1 percent. The value of the area beneath the ROC curve (AUC) was 0.92 for the whole sample. Conclusions. The laser fluorescence system was more precise than visual evaluation in identifying lesions without cavities and healthy surfaces in primary and permanent molars. Clinical Implications. In daily practice, dentists can consider the laser fluorescence system a complementary tool in the visual exploration of occlusal surfaces of primary molars and permanent first molars.
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 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.
Alexandria Dental Journal, 2019
INTRODUCTION: The importance of early detection before the development of irreversible damage is now generally accepted. Most studies do not report the presence of non cavitated lesions, though they have been shown to have predictive value. OBJECTIVES: Validate LASER diode near-infrared transillumination (DIAGNOcam) as a diagnostic instrument in the early detection of noncavitated carious lesions. MATERIALS AND METHODS: Thirty three extracted sound premolars were examined on both approximal surfaces by (D1) EDX to determine Ca/P ions ratio (1.8≤), (D2) Periapical Digital Radiography, and (D3) LASER diode near-infrared transilluminated using DIAGNOcam. Any defect that indicated cavities by any of the mentioned methods discarded the tooth. To confirm that the selected sound teeth were intact, three teeth were randomly selected and invasively imaged by Scanning Electron Microscopy. The remaining thirty teeth were covered with acid resistant varnish except in 3x3mm in approximal areas and were immersed in a demineralizing solution for 72H Then, the teeth were then reexamined using D1, D2 & D3. To confirm that the results obtained, three teeth were randomly selected and invasively imaged by Scanning Electron Microscopy. RESULTS: D1 detected (100%) Ca/P ions ratio less than 1.8 (demineralized), D2 detected (6.67%) with enamel radiolucency and (93.33%) without any radiolucency, while D3 detected (100%) demineralized enamel. Pearson's Chi square test as well as validity tests showed that there is a statistically significant difference between D2 and the other diagnostic means (D1 and D3). SEM showed evidence of enamel demineralization in the three randomly selected teeth. CONCLUSIONS: LASER diode near-infrared transillumination (DIAGNOcam) is a reliable and valid method in detecting early enamel caries demineralization.
Evaluation of visual, explorer, and a laser device for detection of early occlusal caries
Reliable early diagnosis represents the keystone in modern dental care. This study aimed at disclosing a correlation between length of experience by the dentist and accuracy of caries diagnosis, by traditional clinical technique, that included visual and explorer examination, and evaluating the accuracy of the DIAGNOdent laser device. Histological sections confirmed clinical data obtained. Results showed that a reverse relationship between length of experience and accuracy of caries diagnosis i.e. younger dentist could achieve more accurate diagnosis. Laser diagnosis was superior to clinical diagnosis, whether by vision or explorer. It is concluded that DIAGNOdent laser is a promising instrument that can represent a valuable contribution to the dental practice.
Romanian Journal of Morphology and Embryology, 2013
The aims of this study were to determine the diagnostic accuracy and reproducibility of the laser fluorescence device (LF), and the relationship between laser fluorescence readings taken at the entrance of the fissure, ICDAS visual examination caries detection system and the histological depth of the lesion. Two hundred and forty teeth (122 human third molars and 118 bicuspids) were selected from 62 patients enrolled in the study. Visual and LF examinations (Diagnodent, Kavo, Biberach, Germany) of the occlusal surfaces were performed in vivo. After tooth extraction, histological sections were evaluated by stereomicroscopy in vitro. Statistical analysis was performed using multiple statistical methods (SPSS ver. 17). Intra-examiner reproducibility for the LF measurements was excellent: intraclass-correlation coefficient (ICC) for LF was 0.957. Kappa values for each examiner's reproducibility were 0.74-0.82. The diagnostic performance of the LF device gave a good overall diagnostic accuracy according to ICDAS II codes and histological values as indicated by the area under the ROC curve of 0.707 and 0.709 respectively. The results of the study showed acceptable diagnostic accuracy for the laser fluorescence device. This supports the view that dentists can be site specific in applying fluorescence-based devices to multiple discrete sites within the same surface. In conclusion, these diagnostic methods have different characteristics, indications and limitations for use. In order to detect caries on occlusal surfaces thoroughly, a combination of methods would be the best practice moderated by clinical knowledge and experience.