Class 2 Caries & Diagnostic Aids in Endodontics

This presentation dwells around the listed definitions of a class 2 caries lesion and also sheds light on the various available diagnostic modalities in the present world of Endodontics

1. CLASS II C RIES LESION & DIAGNOSTIC AIDS IN DENTAL C RIES Presented by – Dr. Ishaan Adhaulia College of Dental Sciences, Davangere

2. CARIES ? Dental caries is an irreversible microbial disease of the calcified tissues of the teeth, which results in demineralization of the inorganic portion & destruction of the organic substance of the tooth. ( Shafer, Hine & Levy ) Dental caries is an infectious microbiologic disease of the teeth that results in localized dissolution and destruction of calcified tissue. ( Sturdevant’s )

3. What is a Class II Cavity Lesion ? Based on the treatment and restoration design, Greene Vardiman Black defined class II caries lesion as, “ the caries lesions found on the proximal surfaces of molars and premolars ” (Operative Dentistry : Modern Theory & Practice, M.A. Marzouk , pg no. 10) & (Clinical Operative Dentistry : Principles & Practice, Ramya Raghu 2 nd Edition, pg no. 65)

4. According to Sturdevant , the proximal enamel surfaces immediately gingival to the contact area are the second most susceptible areas to dental caries lesions. These areas are protected physically and are relatively free from the effects of - Mastication - Tongue Movement - Salivary Flow ( Sturdevant’s Art & Science of Operative Dentistry 7 th Edition, pg no. 49, 50)

5. (Textbook of Operative Dentistry, Vimal K. Sikri , 4 th Edition, pg no. 19 & 63)

6. Diagnostic methods of caries detection Diagnosis is also defined as the art of distinguishing one disease from the other Diagnosis of caries implies deciding whether a lesion is active, progressing rapidly or slowly, or whether the lesion is already arrested . Without this information, a logical decision about treatment is impossible.

7. Traditional Methods Visual and tactile inspection Caries detector dyes Radiographic Methods Dental Floss Tooth Separation

8. Visual & Tactile Inspection The simplest clinical test is visual examination, this is to be done in regard to the patient’s chief complaint itself. A thorough visual & tactile examination of hard and soft tissue relies on checking the three C’s: colour , contour, and consistency

9. Normal Vital Tooth Non-Vital Tooth Discolouration due to old amalgam filling Crack developing on marginal ridge & extending into the pulp chamber

10. Normal Contour, Colour & Consistency of Gingiva Inflamed gingiva losing its contour, colour & consistency

11. Tactile Examination Use of a dental explorer may help in detection of dental caries. Softness at the base of a pit or fissure Binding or ‘catch’ of the explorer tip Tactile examination to be done carefully because it might lead to excessive cavitation & iatrogenic transfer of microbes into unaffected areas

12. Caries Detecting Dyes   Fusayama introduced a technique in 1972 that used a basic fuchsin red stain to aid in differentiating layers of carious dentin . Caries-detecting stains differentiate mineralized from demineralised dentin in both vital and non-vital teeth .

13. Caries Detecting Dyes Outer carious dentin is stainable because the irreversible breakdown of collagen cross-linking loosens the collagen fibres. Inner carious dentin and normal dentin are NOT stained because their collagen fibres are undisturbed and dense. Dyes do NOT stain bacteria but instead stain the organic matrix of poorly mineralized dentin .

14. Various Caries Detecting Dyes  Caries check (CC), containing 1% acid red in polypropylene glycol has been recently introduced. CD Dyes caries detector ( cad) Caries Marker ( cam) Seek ( see) Sable seek ( ses ) Carbolan green Coomassie blue Lissamine blue Snoop

15. Radiographic Methods Conventional intraoral peri -apical and bitewing radiographs are employed to diagnose dental caries Bitewing radiographs are useful in detecting occlusal & proximal caries Proximal caries in maxillary second premolar

16. Dental Floss Whenever dental floss is sawed through the contact areas between teeth, if it frays or shreds , then it is a sign of proximal caries .

17. Tooth Separation To detect initial proximal caries , separation of the contacting teeth can be achieved using wedges or a mechanical separator. Once the proximal surface is accessible, visual examination and gentle probing may help in diagnosis of the carious lesion

18. Recent Methods Of Caries Detection Fiber -optic Trans-illumination Method Digital Fiber -optic Trans-illumination CariVu Computer Aided Radiographic Method Digital Subtraction Radiography Electric Conductance Measurements - Electronic Caries Monitor Endoscopic Filtered Fluorescence Quantitative Laser Fluorescence Kavo-DIAGNOdent Vistaproof SOPROLIFE The Canary System

19. Fiberoptic Transillumination Caries lesions have a lowered index of light transmission. When teeth are examined with a fiberoptic light source, caries appears as a dark shadow After drying the tooth a fiber -optic probe can be placed in the buccal or lingual embrasure between two adjacent teeth . Caries appears evident as a dark shadow beneath the marginal ridge

20. Digital Fiberoptic Transillumination Combination of FOTI and a digital CCD camera Images captured are sent to a computer for analysis, digital images of the same can be viewed Can detect incipient caries and recurrent caries very early It does NOT measure the depth of the lesion

21. CariVu ™ DEXIS CariVu ™ is a compact, portable caries detection device that uses transillumination technology to support the identification of occlusal , interproximal and recurrent carious lesions and cracks.

22. CariVu ™ Uses non-ionizing radiation , safe for children and pregnant women & patients who are X-Ray averse. Enamel appears transparent , while the porous lesions trap and absorb light

23. Computer Aided Radiographic Method This method uses the measurement potential of computers in assessing and recording the size of the carious lesion Provides graphic visualization of the size and progression of carious lesions, specially proximal lesions . Software's examples like ‘ Logicon Caries Detector System and Ramsoft ’ Logicon ™

24. Digital Subtraction Radiography Images of low diagnostic value are reduced Changes in radiograph can be precisely detected Picture of radiograph taken using high quality video camera , then fed into a computer called ‘digitizer’ Two radiographs with identical exposure are used, one called ‘ reference image ’, other taken for comparision . Both images are superimposed , differences between the two can be seen as dark areas.

25. Digital Subtraction Radiography

26. Electrical Conductance Measurements Proposed by MAGITOT Principle lies behind the insulation property of sound enamel due to high inorganic content . Sound enamel has limited conductivity whereas carious enamel acts as conductive pathway.

27. Based on the difference in the electrical conductance of sound and carious enamel , two devices were made : Vanguard Electronic Caries Detector Caries Meter Measured electrical conductivity indicates the degree of demineralization.

28. ECM (Electric Caries Monitor) It measures the resistance of tooth to mild electrical stimulus & is related to porosity of the lesion Used in combination with 5 second compressed air The system relates the time taken to stabilize , with larger, wetter lesions taking longer to stabilize than smaller dryer one’s .

29. Endoscopic Filtered Fluorescence When a tooth is illuminated with blue light in the wavelength of 400-500nm, sound enamel and carious enamel demonstrates different fluorescence When viewed through a filter , white spot lesions appear darker than sound enamel.

30. Quantitative Laser Fluorescence Related to endoscopic filtered fluorescence Bacterial metabolites within caries produce fluorescence that can be enhanced by laser . Tooth is illuminated with broad beam of blue light (488nm) from an argon ion laser . Enamel fluorescence observed in 540nm range , it is observed through a yellow high-pass filter (520nm) Demineralised enamel appears dark Cannot differentiate between caries, hypo- plasia , stains, calculus or between active and inactive lesions

31. Kavo-DIAGNOdent ™ Introduced by KaVo , Biberach , Germany in 1998 It emits a red light (655nm) which is absorbed by bacterial by-products such as porphyrins This light is partially re-emitted as near infrared florescence This device captures this fluorescence and translates it on a numerical scale from 0-99 , higher the number, the deeper the caries lesions . Does NOT detect proximal lesions

32. Interpretation of the numerical values of Kavo-DIAGNOdent ™

33. VistaProof ™ It is a fluorescence based camera and software system introduced in Bietigheim , Germany It emits special high energy LED violet light at 405nm and captures images of occlusal surfaces This light stimulates Porphyrins (special metabolites of cariogenic bacteria) to emit a red light , while sound enamel emits green light

34. SOPROLIFE ™ SOPROLIFE ™ is a more recently released device using a light induced fluorescence evaluator for diagnostic and treatment purposes. It’s camera selectively amplifies fluorescence signals to detect any carious lesion or diseased tissue based on the variation of its auto-fluorescence compared with the healthy area of the same tooth

35. The Canary System™ Named after the ‘ canary in a coal mine ’ Detects caries under sealants and around the margins of restorations . Detects caries on all tooth surfaces, as small as 50 microns up to 5 mm below the surface . NOT affected by stain or calculus . Does NOT require isolation or dry field .

36. The Canary System™ It uses low powered pulsating laser light , which is absorbed by tooth Laser light is converted into luminescence & there is release of heat This system also has an intra-oral camera which detects the presence of cracks and caries .

37. The Canary System

38. Bibliography

39. Thanks for your patience