06 - Real Life Cases

international caries detection and assessment system (ICDAS)

developed classification system that correlates clinical appearance with known histology

• also takes into account radiographic appearance

• large clinical visual caries usually equals large radiographic decay, but not always

• teeth are classified according to visual appearance, radiographic form, size, and activity of lesion

American dental association caries classification system

classifies lesion by location, extent, and activity

caries risk assessment

individual assessment of each patient as to his or her disease, risk factors, and protective factors to determine current and future caries disease

caries management by risk assessment

applies evidence-based approach to preventing or treating dental caries at earliest stages

• clinically proven program to manage oral health through science-based assessment

• goal to impede underlying bacteria that causes cavities, enhance natural remineralization process, and combine it with minimally invasive restorative dentistry

disease indicators

• white spots

• restorations <3 years

• enamel lesions

• cavities

risk factors

• bad bacteria

• absence of saliva

• dietary habits

protective factors

• saliva and sealants

• antibacterials

• fluoride

• effective diet

use of explorers to detect carious lesions

• pros:

  • dentists are well-trained in using explorer as aid. in diagnosing carious lesions

  • explorer is time efficient

  • research supports use of explorer

  • explorer is well accepted by patients

• cons:

  • explorer can damage outer enamel layer and inhibit remineralization

  • explorer is unable to accurately probe fissures and contacts

  • research supports use of caries detection devices

  • explorers transfer cariogenic bacteria from site to site

caries detection dyes

when applied to the tooth, organic matrix of mineralized dentin absorbs the stain

• healthy dentin is unaffected and retains a natural color, while carious dentin will be discolored

• circumpulpal dentin and near dentinal-enamel junction is less mineralized, so it will also stain

• used in endodontics to locate canal orifices

• non-specific in regard to affected and infected dentin

DIAGNOdent

uses laser fluorescence to aid in detection of caries within tooth structure

• carious tooth structure will exhibit fluorescence, proportionate to degree of caries, resulting in elevated sale readings on display

• clean healthy tooth structure exhibits little or no fluorescence and will result in low scale readings on display

canary system

when placed on tooth, a low-powered pulsating laser light is shone on tooth during a three second scan to generate photothermal (PTR) and luminescence (LUM) responses

• laser causes tooth to heat up, where defective tooth structure retains heat instead of releasing it

• canary number → output generated about probable health status of a given tooth, converting PTR/LUM signatures into a number on a scale of 0 to 100

  • lower numbers suggest healthy enamel

  • higher numbers suggest presence of cracks and caries

CamX Spectra caries detection aid

uses fluorescence to detect caries in fissures and smooth surfaces

• four violent LEDs stimulate metabolic products found in cariogenic bacteria, causing them to glow red while healthy enamel glows green

• detects decay hidden between margins of existing composite and amalgam rsetorations

Dexis CariVu

uses transillumination technology that makes enamel appear transparent while porous lesions trap and absorb light

• allows clinician to see through the tooth, exposing its structure and development of any carious lesions

• images read like familiar x-ray images

• uses non-ionizing radiation that is ideal for children, pregnant women, and patients who are x-ray adverse

radiographic AI

use of AI to detect carious lesions in radiograph

• not accurate and can have false positives

Icon

revolutionary new approach ot treat incipient caries, a caries infiltrant

• fills and reinforces demineralized enamel without drilling or anesthesia, up to the first third of dentin, approximately 30 microns

glass ionomers

exhibit excellent bond strength to tooth structure and are moisture tolerant

• releases calcium and phosphate ions which combine into the surface layer of the glass ionomer and forms immediate layer called the inter-diffusion zone

• bond layer is very strong and reduces microleakage

• addition of resin improves strength, handling, and wear of material

predicta bioactive

made of pH-sensitive hydroxyapatite mineral fillers that respond to acidic environment by releasing calcium, phosphate, and fluoride ions into saliva around tooth

activa

moisture friendly ionic-resin that exhibits exceptional marginal integrity, sealing ability against microleakage, and intimate adaptation to tooth structure

• releases phosphate and recharges with fluoride while bonding to calcium in tooth structure

giomer

surface pre-reacted glass (S-PRG) filler particles

• uniquely releases fluoride, sodium, strontium, aluminum, and borate 

• inhibits plaque formation and possesses remarkable acid neutralization capabilities

re-gen

incorporates bioactive materials into adhesive layer, depositing biologically charged ions directly onto the tooth to promote regeneration of tooth structure

• normally → adhesive needed to place composite restoration to bond composite to tooth and seal tooth from external environment but will seal out ions released from adjacent restorative materials