Top tools for advanced caries detection

Minimally invasive dentistry has become a hot topic over the last few years. New technology and techniques have focused on earlier diagnosis and detection as well as early intervention of disease.

For  years the dental explorer has been the “staple” in most practices for diagnosing caries. The explorer’s use and interpretation of its findings is filled with inaccuracies. Studies have shown other modalities are more accurate than the explorer, our standard of caries diagnosis in dentistry.¹ In this article I’ll review recent advances in caries diagnosis and treatment to offer a fresh perspective on minimally invasive operative dentistry.

Before we can seek improvement, we must first acknowledge that our traditional means of occlusal cavities diagnosis has faults. We all know it is far easier to stick an explorer into a tooth like we were shown years ago in school, than to seek another modality to diagnose dental disease. Studies show our explorer’s accuracy varies, with some studies reporting accuracy at 25%.² Keeping that number in mind, and extrapolating that data a bit further, we can assume we are leaving areas of decay untreated.

Caries detection dye

As an adjunct to the explorer, many practitioners use caries detection dye. Caries detection dye comes in a variety of colors depending on the manufacturer. Caries detection dye works on the surface of teeth identifying areas of collagen and calcium displacement.³ Studies concur that if teeth are cleaned and free of debris, caries detection dye is accurate.² Yet dye can be messy, interpretation can vary from practitioner to practitioner, and false positives are a major concern.^4,5

Laser fluorescence

Laser fluorescence, as an adjunctive or stand alone tool, shows promise in the field of caries detection.⁶ KaVo Corp.’s DIAGNOdent (kavo.com) is a 655 nm caries detection laser that uses the diffraction of light to measure the extent of decay within the tooth. An audible sound alerts the practitioner to the presence of decay and a numerical value corresponds to the depth of the decay. While this device improved dramatically on traditional modalities, interpretation of results, especially in regard to early lesions, varied from practitioner to practitioner.

The latest advancement

The newest modality, SOPROLIFE from ACTEON, seems to hold the most promise. It is highly accurate and solves many of the earlier problems with other techniques and modalities. SOPROLIFE uses blue LED light at a wavelength of 450 nm. This wavelength excites dentin and its reaction produces a light signal called fluorescence. This signal is very low intensity compared with the blue LED signal emitted by the SOPROLIFE device.

When dentin is healthy, the spectrum (color) of the fluorescence is green. When the dentin is infected the spectrum is red. SOPROLIFE can be used in a diagnostic mode (pre-treatment) or in treatment mode throughout the entire excavation process.

The idea of dentists using SOPROLIFE is well thought out. Initially white light visualization (camera mode) allows for clear visualization of the dentition on a computer or television screen. Images in macro mode display in great detail and can be recorded and saved within a patient’s digital record. After pressing a button, the white light changes to the blue LED light, and detection mode is initiated. This allows dentists to perform a comprehensive laser-like caries exam and to record these images in a patient’s digital record. Once treatment is initiated, another button can be pressed, switching to treatment mode, and the practitioner can use SOPROLIFE to ensure a complete excavation of the lesion is achieved.

As evidenced here in clinical case 1, normal staining of the Class V composite is differentiated from decay with the SOPROLIFE (Figs.1 & 2). Caries detection dye may not be useful here and it’s possible this stained composite may only be polished as opposed to replaced. Once the composite is removed, the SOPROLIFE’s diagnosis mode kicks in and we can easily verify if decay is present (Fig. 3). (Note also slight decay on the lateral incisor.) Without SOPROLIFE, our options are caries detection dye or feeling if the dentin is soft with a sharp spoon excavator. Most practitioners use the latter and sometimes they can be fooled. It is apparent here that the dentin is still infected (slight red hue) and must still be excavated regardless if it feels soft or not.

Many patients have erosions on the buccal surfaces for a variety of reasons. These lesions, called abfractions, are sometimes restored or not, depending on if they are sensitive or if they have decay. Sometimes they are just stain and minimal treatment, if any, is done. The SOPROLIFE can quickly and accurately help the practitioner determine whether to perform a restoration. The initial exam of this canine clearly reveals the need to excavate the lesion (Fig. 4). Upon confirming with CDD, we see the dye is not as accurate. The SOPROLIFE image clearly shows an area of decay but the dye shows little penetration with mostly marginal staining (Fig. 5). Again, even after excavation is apparently complete, a slight red hue is present and we must remove more dentin (Fig. 6).

Routine hygiene examinations also are enhanced with the SOPROLIFE. Most hygienists use the dental explorer to determine if there is decay in a tooth. Here, (Fig. 7) we see some staining on the occlusal surface of the molar but the explorer does not stick at all. This stain potentially could be left or “watched,” but the SOPROLIFE clearly shows a problem that must be treated (Fig. 8).

It’s worth the investment

For someone to invest in new technology, the piece of equipment should do a number of things. Most importantly it should be better than the current modality the practitioner is using. It also should be ergonomic and should either make treatment easier and/or allow dental professionals to be more productive in the office. SOPROLIFE not only meets some of these criteria, it meets all of them, therefore making it a must have in today’s progressive dental practice.

About the author

Dr. Ron Kaminer is a 1990 graduate of the State University of New York at Buffalo. He maintains two offices, one in Hewlett, N.Y. and one in Oceanside, N.Y. He lectures nationally and internationally on Minimally Invasive Dentistry and technology and is a clinical consultant for numerous dental companies. He can be reached for questions at whitertth@aol.com.