CARIES DIAGNOSIS-- Dr Thejokrishna P.ppt

caries diagnosos

2. Caries Diagnosis
Thejokrishna. P
Post-Graduate student
Dept of Pedodontics & Preventive Dentistry
Bapuji Dental College & Hospital.
Davangere 577 004

3. Objectives
Various methods available today.
To quantify the progress of caries .

4. Contents
Visual examination
Tactile examination
Conventional Radiographs
Digital radiography
Trans-illumination
DIFOTI
UV illumination
Near-IR light imaging
Quantitative light fluorescence
Diagnodent
Endoscope/ Video-scope
Ultra sound imaging
Electronic caries meter
Caries detection dyes
Conclusion & References

5. Terminology
Diagnosis: the art or act of distinguishing
one disease from another

6. Visual & Tactile examination
limited to, occlusal pits and fissures
variations -- tooth surface create reflections,
light spots, dark spots, and contain stains
create difficult conditions for visual decay
detection
Use of dental explorer and mirrors

7. White spot lesions

10. RADIOGRAPHY

11. Traditionally used :- Bitewing r/g – Caries active
ptn
Only 40% -- proximal lesion – in outer ½ of
dentin (R/G)-- actually cavitated
1-4 yrs -- progress through Enamel.
Identification of degree of mineralization in R/G
---does not justify surgical approach for lesion
removal.
Need for more accurate assessment of the speed of
caries progress.

12. DIGITAL RADIOGRAPHY

14. Digital subtraction radiography

15. 4 8
13 20
1

16. Fiber Optic trans-illumination, FOTI
Friedman & Marcus (1970)– detection of
approximal caries.
Basis : decayed matr- scatters light more
strongly – lower index of light transmission.
very Low sensitivity(0.13) & high
specificity(0.99).
Can detect En– crazing, cracks in tooth.

18. DIFOTI diagnostic imaging unit.
Non invasive
No radiation
detects early caries ,hidden caries
no film, film processing, mounting, and storage.

19. Disposable proximal surface mouthpiece.

20.  Clinical
examination.

21. Correct placement of proximal
mouthpiece.
 Position
the hand piece.
Image
review.

22. Patient database

23.  Caries
beneath old amalgam restoration.

24. Occlusal
decay around an amalgam restoration.

25.  Interproximal
caries.

26. Fluorescence in natural
diamonds
Fluorescence

28. Ultraviolet Illumination (UV I)
optical contrast b/n carious region(CR)& the
surrounding sound tissue.
mineral content – natural fluorescence under
UV
CR appears as dark spot against a fluorescent
background.
More sensitive than simple visual & tactile
methods( Alfano & Yao,1981)

29. Imaging of occlusal dental caries (decay)
with near-IR light at 1310-nm
Visible light Radiography
NIR image

31. Demineralization (decay) can be easily
differentiated from stains, pigmentation, and
hypomineralization (fluorosis).
the high transparency of the enamel -- imaging
at greater depth.
show high contrast between sound and
demineralized areas.
detection of subsurface decay hidden under the
enamel.

35. Laser auto-fluorescence (LAF)
Visible light within Blue-Green region
(488nm)– Argon ion laser.
Smooth-surface and fissure caries-early stage
( Bjelkhagen et al 1982)
.
Fluorescence in En –yellow range(540nm) –
yellow high pass filter

36. Demin
r
areas appear dark in this situation
Quantification of mineral loss - natural initial
smooth surface caries : <1mm dia with a lesion
depth <5- 10 microns
differential water content of early fissure caries &
sound occlusal enamel ---carbon dioxide laser to
reveal such lesions.

37. Quantitative light/ laser induced
fluorescence[QLF]
Diagnostic tool – in vivo/ invitro
quantitative assessment of dental caries,
plaque, calculus & staining.

38. Omnii InspektorPro QLF

39. QLF system
•Hard ware( hand p/c)
•Windows PC
•QLF software
QLF Real time
Fluorescent images
Optical quantitative
Analysis tool
(software)
1.Lesion area
2.Lesion depth
3.Lesion volume
Xenon-tech
n

arc lamp
H
igh precision
&
repeatability

40. DIAGNODENT

42. 10 – 20 :- Enamel softening, Potential problem
req
r
close monitoring
20-100:- definite area of decay req
r
restoration.

43. KaVo PROPHYflex

45. Ultra-Sound Imaging.Adv Dent Res 7(2):70-79, 1993
Introduced Ng et al (1988)
Detecting early caries of smooth surface.
Ultra sound pulse echo technique.
Enamel surface & relative DEJ echo difference
< 57% difference of sound En mineral content– body
of lesion.

46. Ultrasonic
probe
White spot lesion
No/ weak surface
echoes
Visible cavitation
High amplitude
echo
Tooth surface

47. Endoscope/Videoscope
Based on fluorescence—400-500nm
Viewed through a specific broad band
gelatine filter—caries lesion – dark spots.
White light endoscopy
Integrated camera --- Videoscope—expert
independent examiners opinion.

48. Electrical resistance (ER)
Pincus, 1951-- thr electrical impedance.
Electrical conductivity --- function of porosity
En demin
r
-- porosity + saliva = conductive pathways for electrical current.
> demin
r
-- conductivity
Vanguard electronic caries detector—probe in fissure + hand held earth
Rock & Kidd (1988) in vivo- compared with H/L section –sensitivity0.70 &
a specificity 0.85
Regarded as only diagnostic tool with acceptable performance.

49. Dye penetration method:
Used to visualize – subject from routine
background.
Dyes– minimal req
r
criteria :-
1.Absolutely safe for intra oral use.
2.Specific and stain tissues intended to stain.
3.Easily removable & not permanent staining.

50. Dyes used for detection of Carious
Enamel
1.Procion dyes
2.Calcein dyes
3.Brilliant blue

51. 1.Procion dyes:
•Stains enamel-
• sometimes irreversible– reacts with N
2 & OH
-
groups of
En & acts as fixative.
2.Calcein dyes
•Complex with Ca & remains bound to lesion
•Fluorescent dye ., Zyglo ZL 22 for invitro only
•Visible by UV illumination.
3.Brilliant blue.
•Used to enhance the diagnostic quality of fiber optic
transillumination.

52. Modified dye penetration method
I
2
penetration method – En porosity– Bharkos et
al
Pot. Iodide—applied for specific time– affected
enamel.
No of micro pores – estm & indicates–
permeability of En.

53. Dyes used for detection of Carious
dentin.
Histopathologically
•Infected & affected dentin.
•0.5% basic fuschin in propylene glycol
•Demin
r
dentin – denatured collagen – stains
•Acid red & Methylene blue.
Vista red, Vistadental

54. Conclusion

55. Reference
1.A review of modern non-invasive systems for caries detection. Derek J Moore &
Nairn, H F Wilson. CPD Dentistry 2001; 2(3):86-90
2.Diagnosis of Occlusal Caries: Part I. Conventional Methods. Dorothy McComb,.
Laura E. Tam. J Can Dent Assoc 2001; 67(8):454-7. Part II:- J Can Dent Assoc
2001; 67(8):459-63.
3.The current status of laser applications in dentistry.LJ Walsh*Australian Dental
Journal 2003;48:(3):146-155.
4.Occlusal caries: wherefore art thou? D. C. Attrill,and P. F. Ashley Br Dent J 2001;
190: 440-443
5.Caries-Detector Dyes —How Accurate and Useful Are They? Dorothy McComb.
Journal of the Canadian Dental Association. 2000, Vol. 66, No. 4
6.Kavo dental products. www.kavousa.com
7.Imaging of occlusal dental caries (decay) with near-IR light at 1310-nm Christopher
M. Bühler, Patara Ngaotheppitak and Daniel Fried. Vol. 13, No. 2 / OPTICS EXPRESS