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IN VIVO EVALUATION OF DIAGNODENT FOR THE QUANTIFICATION OF OCCLUSAL DENTAL CARIES

Clinical relevance

T here is a weak correlation between DIAGNOdent readings and carious lesion depth and volume. Based on the current study, the appropriate DIAGNOdent cut-off point to detect carious lesions reaching the DEJ or beyond is between 35 and 40.

SUMMARY

The accurate diagnosis of non-cavitatedocclusal caries is generally considered problematic induced fluorescence quantified by the DIAGNOdent device (kavo) gives a readings from 0-99, which may help in the caries diagnostic.

Process. There is some controversy around the implication of increased severity of decay with increased DIAGNOdent readings. This in vivo study assessed the correlation of depth and volume of decay as it wasremoved by traditional rotary handpieces with DIAGNOdent readings and determined sensitivities/specificities of the device at different cut-off points. Included in the current study were 31 patients providing 60 permanent molar and premolar occlusal surfaces suspected of dentinal decay. DIAGNOdent readings were recorded, along with lesions depth (as measured by periodontal probe) and volumemeasurements (as calculated from measuring the mass of a polyvinyl siloxane impression of the cavity, divided by the materials calculated density). Clinical detection of decay at the DEJ was used as the gold-standard to calculate an appropriate cut-off. Pearson correlation coefficients indicated that DIAGNOdent readings were weakly correlated with lesion depth (r=0.47) and lesion volume (also r=0.47) anappropriate cut-off point for the sample in the current study was calculated between 35 and 40. A more specific cut-off point could not be determined due to the sample size distribution. It was concluded that the DIAGNOdent device should be used as an adjunct in the caries diagnosis and treatment planning process.

INTRODUCTION

Commonly used methods for diagnosing dentinal caries innon-cavitated pits and fissures exhibit higt specificity but low sensitivity. Specificity, the correct recognition of sound teeth, was recently found to be 97% using traditional visual/tactile examination methods; while sensitivity, the ability to correctly recognize non-cavitated occlusal surfaces with dentinal caries, hovers at a mean of 19% in a low caries-risk population, specificity of a diagnosticmethod is critical: teeth that can be kept unrestored should not be operatively treated . To complement traditional clinical assessment by the clinician, there is a role for an objective detection method to support whether invasive therapy or a more conservative non-invasive approach is indicated.

Spitzer and bosch suggested that carious lesions, when exposed to certain wavelengths of light, emitmore intense fluorescence than sound tissue, mostly due to organic components and proteinic chromophores found in affected tooth structure. Fluorescence induced by red light (655 nm) has been shown to effectively differentiate between sound and carious tooth structure. This work led to the development of a laser-based instrument for the detection and quantification of dental caries on occlusalsurfaces, the DIAGNOdent (DD) (KaVo, Biberanch, Germany). DD produces a singles digit reading (ranging from 0 to 99), which offers an objective measurement of the fluorescence recorded by the device.

Research on DD has centered on its validation. It is well documented that this method has a high sensitivity in detecting early carious lesions. A number of different “cut-off points” minimize DDreading, indicating operative intervention, have been proposed. At high cut-off points, the device has increased specificity, which generally occurs at the expense of sensitivity. Lower cut-off points show higher sensitivity but lower specificity. Some have suggested the devices utility in the longitudinal measurements of teeth to monitor the progression of decay over time.

Because DD offers a...