Courseware
Methods of Caries Well-Timed Diagnostics
X-ray Diagnostics in Dentistry
Předmět:
Operative Dentistry 1
Autor:
Stomatolog Julia Morozova
Poznámky:
ST1/ZAA35
Caries well-timed diagnostics
• Diagnostics of initial stages of dental caries
• Primary prevention- without preparation
• Secondary prevention- minimal invasive meausures
Caries incipiens: clinical symptoms
• Focus of enamel demineralization
• White spot
• Surface layer of enamel is maintained
Methods of caries well-timed diagnostics
• Common:
• Visual-tactile
• Transillumination using dental mirror and source of
light
• Detection using dyes
• With special equipment
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Radiographic diagnostics
Laser Fluorescence
Quantitative Light-Induced Fluorescence
Fiber Optic Trasillumination
Digital Image Fiber Optic Transillumination
Electronic Caries Monitor
Ultrasonic detection
Methods of caries well-timed diagnostics
(requiring special equipment)
Physical effect
Application in caries diagnostics
X-rays
RTG, RVG, CBCT, CBVT
Laser fluorescence
Laser detection of caries (DIAGNOdent)
Electricity
Electronic Caries Monitor (ECM)
Ultrasound
Ultrasonic detection of caries
Light with different wavelength
Quantitative Light-induced Fluorescence
(QLF)
Fiber Optic Transillumination (FOTI) (Dia
Lux)
Digital Image Fiber Optic
Transillumination (DIFOTI) (DIAGNOcam)
Visual-tactile assessment
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Clean and dry tooth surface
Dental mirror
Dental probe
Perfect illumination
Magnification
Transillumination using dental mirror
and light from unit
• For approximal surfaces of frontal teeth
Detection using dyes
Use:
• Caries detection
• Detection of necrotic tissues during preparation (dye is
connected with irreversibly destructured collagen
fibers)
• Finding of root canal entrances in endodontics
• Detection of tooth cracks
Radiographic examination
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Intraoral radiograms
Bite-wing (interproximal) projection
Ortopantomogram
Cone beam volumetric tomography
Parallel technique of radiogram making
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The radiogram is the most close to the real situation in
the mouth (isometric orthoradial)
It requares the use of special holders
Carious lesion
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Clearing with different size
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Approximal, fissural, root, secondary (reccurent) carious
lesions
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It is not deciding examination method for vestibular, oral or
occlusal lesions
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The most suitable is the bite-wing technique (premolar,
molar)
Bite-wing radiograms evaluation
• D1 -clearing is in the outer
half of the enamel
• D2 -clearing is in the inner
half of the enamel
• D3 -clearing goes upto
enamel-dentin junction
• D4 –clearing is in dentin
Laser Fluorescence (DIAGNOdent)
• Red light at a wavelength of 655 nm
• Sound hard dental tissues do not react
to this wavelength
• Metabolites from cariogennic bacteria
create an infrared fluorescence
• In special device (DIAGNOdent, KaVo, Germany; Hibst, Gall,
late 1990s) the emitted light is channelled through the
handpiece and presented as a number on a display
DIAGNOdent- working procedure
• Careful cleaning of tooth surface
• Drying by air stream
• Calibration of the device by
application onto sound enamel
• Measuring
• Allows to detect carious lesions on
the smooth, occlusal as well as
approximal surfaces
DIAGNOdent- criteria for evaluation
0–4
Sound enamel or caries incipiens (D1)
4 – 10
Decay of inner layer of enamel without damage of
enamel-dentin junction (D2)
10 – 18
Decay of external layer of dentin (D3)
>18
Extensive decay of inner layer of dentin (D4)
*A.Lussi, S. Imwinkelried, N.B. Pitts, C. Longbottom, E. Reich. Performance and Reproducibility of a Laser Fluorescence System for
Detection of Occlusal Caries in vitro. Caries Res. 1999;33(4):261–266
Quantitative Light-induced Fluorescence (QLF)
• Uses the phenomenon of tooth auto fluorescence
• Primary diagnostics as well as check up of necrotic tissues
removing
• Soprolife (ActeonGroup, France); InspektorTM Pro (Inspektor
Dental Care, Amsterdam, The Netherlands)
Fiber Optic Transillumination (FOTI)
• Uses light transmission through the tooth
• Demineralized dental hard tissues scatter and absorb light
more than sound tissue
• For enamel and dentin caries detection on occlusal,
approximal and smooth surfaces of anterior and posterior
teeth (carious lesions appear darker compared to sound
tissue)
• Dia Lux (KaVo, Germany)
Digital Imaging of Fiber Optic Transillumination (DIFOTI)
• Uses the same principles like FOTI
• White light is delivered through an optical fiber via handpiece
channelling the image back to a digital camera and visualizing
the image on a monitor via computer system
• DIAGNOcam (KaVo, Germany)
DIFOTI (DIAGNOcam): principle of working
• Light with wave length 780 nm
• Tooth is light conductor
• Digital camera makes black-and-white record on the
computer display
• Tooth decay looks like dark shade
DIFOTI: contraindications, limits of using
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Large fillings
Crowns
Subgingival localization of tooth decay
Calculus or tooth discoloration can lead to light
scattering and can be shown like shade
DIFOTI: possibilities
• Primary carious lesions (occlusal and approximal)
esp. on distal teeth
• Caries reccurent (upto definite depth)
• Cracks or imperfections in supragingival regio
Electronic Caries Measurement (ECM)
• Sound dental hard tissue shows very high electrical resistance
or impedance
• Demineralized enamel has lower resistance
• Ground-unit
• Handpiece
• The result is presented on a display as
a number between 1 and 13
Alternating Current Impedance Spectroscopy (ACIST)
• It is based on the same principle of electrical proud as the
ECM
• It measures resistance, continuous conduction as well as
transverse conductance
• CarieScanTM (IDMoS PLC, Dundee, UK)
Ultrasound diagnostics
(Ultrasonic Caries Detector- UCD)
• Sound waves can pass through gases, liquids and solids and
boundaries between them
• Images of tissues can be acquired by collecting of the
reflected sound waves
• Ultrasonic probe allows to examine inaccessible places
• UCD (Novadent Ltd., Lod, Israel)
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