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1. Laser fluorescence
Quantitative light induced fluorescence: (QLF)
Laser fluorescence and dye-enhanced laser fluorescence
are alternative techniques for caries detection( Fig:1). The
DIAGNOdent (KaVo) is a laser fluorescence
device( Fig:2).7 The device contains a diode laser (such
as those used in computer disc readers) that emits a
pulsed light of one specific wavelength directed onto a
tooth, the light wavelength is consistent until it
encounters a change in tooth structure.
Changes in structure attributable to decay cause the light
to refract (break up) and change color (owing to a loss of
energy, which results in a longer wavelength) (Fig:2b).
This changes the pulse of fluorescent light reflected back
to a sensor. The device translates these changes into a
qualitative reading that is subsequently displayed by the
control unit and interpreted as a numeric value from 1 to
99. When the unit shows a value of less than 30, the
tooth is usually sound. A sound signal can be correlated
to the digital readout. The device is easy to use and is
calibrated to a standard, which allows comparison of
current readings to those of previous or subsequent
patient visits.
Studies showed:
1.Accuracy of DIAGNOdent was significantly better than
that of radiography for occlusal lesions.
2.The device could diagnose pit and fissure lesions with
92% accuracy.
3.DIAGNOdent has higher diagnostic validity than the
ECM for occlusal caries and good in vitro reproducibility of
findings.
2. Electronic Caries Monitor
The electronic caries monitor (ECM) (Lode Diagnostics,
Germany),(Fig:3), measures a tooth's electric resistance
during controlled air drying to determine its mineral
content.
The electric resistance value of any given area of a tooth
depends on the local porosity, the amount of liquid
present, the temperature, the mobility of the liquid, and
the ion concentration of the liquid. To avoid the influence
of surface liquid (saliva), the ECM technique involves
drying the tooth surface using a standardized airflow
procedure. Interpreting the measurements is relatively
complex since there is no standard representing different
levels of caries. Studies suggest that ECM can be an
accurate diagnostic tool for the diagnosis of early,
noncavitated occlusal lesions on posterior teeth.
Detection with chemical dyes
Dyes are a diagnostic aid for detecting caries in
questionable areas (ie, for locating soft dentin that is
presumably infected)9. Fusayama introduced a technique
in 1972 that used a basic fuchsin red stain to aid in
differentiating layers of carious dentin.10,11 Because of
potential carcinogenicity, basic fuchsin was replaced by
10 seconds
3.The tooth is rinsed with water and suctioned and then
excess water is removed. After rinsing with water for 10
seconds, some tooth structure shows Discoloration
4.Stained decay is removed with a spoon excavator and
evaluated by tactile sensation.
When removing stained caries, it is important to be
conservative near the pulp. Any questionable stained
dentin should be left in place; remineralization will occur
in this area, and the bacterial activity will be arrested
once the tooth is restored.
Detection with transillumination2
Transillumination works best with longer wavelengths of
light in the yellow and orange range, because they have
higher penetration properties. Blue light used for curing is
the least effective, owing to decreased penetration and
increased scattering. Blue light should be avoided, since
it is harmful to the eyes. A major advantage of
transillumination is that the patient can easily see the
problems that the practitioner is addressing. It can be
used as a screening device to determine if a radiograph is
necessary.
Transillumination works best when a small light source is
used in a dark field. The optimal approach is to turn the
operatory light away and use an incandescent yellow-towhite light source about 1-mm wide. The most contrast is
achieved when the light source is placed against the side
of the tooth that has the most enamel and then viewed
from the side of the tooth with the largest mass of
algorithms.
The DIFOTI device has been tested by imaging teeth in
vitro. The results suggest it can sensitively detect
proximal, occlusal, and smooth-surface caries.
Detection with digital radiographs
Digital intraoral radiographs have become available to
the profession over the past decade. Several studies have
shown that, theoretically, direct digital radiography
provides a number of advantages when compared with
conventional film. These include contrast and edge
enhancement, image enlargement, lower radiation dose,
image compression, and automated image analysis.
Digital radiology encompasses all the techniques that
produce digital (or computerized) images, as opposed to
conventional radiology that uses x-ray film. Note that
dental radiology is currently limited to radiography, in
other terms to one-shot images. Some technologies
would indeed allow the acquisition of a sequence of
images, or even live x-ray video such as radioscopy or
fluoroscopy used in other medical fields. But dental
applications, which require the practitioner's hands be in
the field of the acquired subject, preclude the use of a
continuous x-ray stream for obvious reasons.
Techniques:
There are three main techniques that are used in intraoral
digital radiology: film scanners, intraoral phosphor plates,
Advantages:
The RVG uses at the mean time the most standard
principle of the conventional radiology and the most
advanced digital and electronic tools that allow:
1. The total suppression of the film, which is replaced by
the intraoral sensor. Consequently that eliminates :
1.1 the film processing drawbacks (chemical liquids to be
changed from time to time, loss of time while waiting the
radio to be ready) that cause breaks during the operating
act.
1.2 image distortions due to film bending.
1.3 the dark room and bulky processing machine.
2. Getting an instant X-ray image that provides to the
doctor accurate clinical information for his diagnostic
3. Up to 90% X-ray doses reduction compared to standard
film. Only a few tenth of seconds are necessary to take an
x-ray image.
4. Unparalleled diagnostic capabilities thanks to: 4.1 the
high resolution of the image (over 20 line pairs per mm)
which is the only condition for the image to contain
accurate clinical details.
4.2 the display of the image in scale one to the monitor.
savings.
Digital Subtraction Radiography
For years dentistry has dealt with the problem of no
quantitative measures to determine the success of a
particular treatment. When evaluating bone height,
changes can be masked by disparities in projection
geometry. Digital subtraction radiography is a technique
that allows us to determine quantitative changes in
radiographs. The premise is quite simple. A radiographic
image is generated before a particular treatment is
performed. At some time after the treatment, another
image is generated. The two images are digitized and
compared on a pixel-by-pixel basis. The resultant image
shows only the changes that have occurred and
subtracts those components of the image that are
unchanged.
DICOM Standard
Medical imaging has dealt with many of the issues that
confront digital dental imaging. Medical radiologists found
that many of their imaging systems could not
communicate with each other. Most manufacturers had
their own proprietary software and file types that were
not compatible with those of other manufacturers. This
led to the development of the DICOM Standard. DICOM
stands for Digital Imaging and Communications in
Medicine. The current version is 3.0. The DICOM 3.0
standard addresses the need for standardized formats so
digital information can be transferred to remote sites as
Cost of devices.
Cost of converting previous records to digital
Thickness of the sensor
Rigidity of the sensor
Loss or breakage of sensors.
Lack of universal use of digital radiography.