1. Methods of Caries Well-Timed Diagnostics X-ray Diagnostics in Dentistry
Operative Dentistry 1
ST1/ZAA35
Stomatolog Julia Morozova

2. Caries well-timed diagnostics
Diagnostics of initial stages of dental caries
Primary prevention- without preparation
Secondary prevention- minimal invasive meausures

3. Caries incipiens: clinical symptoms
Focus of enamel demineralization
White spot
Surface layer of enamel is maintained

4. Methods of caries well-timed diagnostics
Common:
Visual-tactile
Transillumination using dental mirror and source of light
Detection using dyes
With special equipment
Radiographic diagnostics
Laser Fluorescence
Quantitative Light-Induced Fluorescence
Fiber Optic Trasillumination
Digital Image Fiber Optic Transillumination
Electronic Caries Monitor
Ultrasonic detection

5. 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)

6. Visual-tactile assessment
Clean and dry tooth surface
Dental mirror
Dental probe
Perfect illumination
Magnification

7. Transillumination using dental mirror and light from unit
For approximal surfaces of frontal teeth

8. 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

9. Radiographic examination
Intraoral radiograms
Bite-wing (interproximal) projection
Ortopantomogram
Cone beam volumetric tomography

10. Parallel technique of radiogram making
The radiogram is the most close to the real situation in the mouth (isometric orthoradial)
It requares the use of special holders

11. Carious lesion Clearing with different size
Approximal, fissural, root, secondary (reccurent) carious lesions
It is not deciding examination method for vestibular, oral or occlusal lesions
The most suitable is the bite-wing technique (premolar, molar)

12. 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

13. 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

14. 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

15. 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

16. 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)

17. 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)

18. 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)

19. 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

20. DIFOTI: contraindications, limits of using
Large fillings
Crowns
Subgingival localization of tooth decay
Calculus or tooth discoloration can lead to light scattering and can be shown like shade

21. DIFOTI: possibilities
Primary carious lesions (occlusal and approximal) esp. on distal teeth
Caries reccurent (upto definite depth)
Cracks or imperfections in supragingival regio

22. 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

23. 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)

24. 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)

25. Thank you for attention