Digital Imaging Fiber-optic Transillumination Research Articles

Effect of resin composite shade on digital fiber-optic transillumination imaging in vitro.

Digital imaging fiber-optic transillumination (DIFOTI) devices have been used to detect caries, a technique without using X-rays. However, the effects of resin composites (RCs) shades on the images acquired with DIFOTI devices have not been investigated. Thus, this study aimed to elucidate the influence of RC shade on the images obtained with DIFOTI technique. Three shades (A1, A3, and Opaque) for each of four flowable RCs were filled on a cavity prepared in a left mandibular first premolar obtained from a donated body. Then, transmission images with a DIFOTI device (DIAGNOcam; KaVo, Biberach, Germany) were acquired, and the average lightness values of the images in the RC and enamel were used to calculate differences between those areas. To clarify the influence of the optical translucency and color on DIFOTI images, the color parameters (L*, a* and b*) of each RC were obtained with black and white backgrounds. The color differences between the backgrounds were calculated as transparency parameter (TP) values. The number of repetitions was set to 10. Differences in the lightness value of the shades varied in each RC. The difference in lightness was significantly associated with the TP value and color parameters of L* (p < 0.01), with negative (R = -0.81) and positive (R = 0.84) correlations, respectively. In conclusion, DIFOTI images of RCs with high optical translucency resembled those of the natural tooth structure.

Diagnostic reliability of the Digital Imaging Fiber Optic Transillumination: a review

Diagnostic reliability of the Digital Imaging Fiber Optic Transillumination: a review

Clinical Analysis of the Diagnostic Accuracy and Time of Execution of a Transillumination Caries Detection Method Compared to Bitewing Radiographs.

Purposes: this clinical study evaluated the accuracy and execution time of a digital imaging fiber-optic transillumination (DIFOTI) technique for the detection of approximal caries in posterior teeth compared to intra-oral examination associated with bitewing radiographs. Methods: one hundred patients were selected and submitted to clinical inspection and bitewing radiographs. The outcomes of this process were converted into scores, according to the International Caries Detection and Assessment System (ICDAS): 0—sound tooth; 1, 2, and 3—carious lesion confined within enamel; 4, 5, and 6—dentin carious lesion. Subsequently, an independent investigator acquired digital images of the same teeth using a DIFOTI device (DIAGNOcam, Kavo Dental), which were also converted into ICDAS scores. The time required for executing diagnostic procedures was measured. The clinical sensitivity and specificity of DIFOTI were analyzed by receiver operating characteristic (ROC) curves. The time necessary to perform the diagnostic methods was evaluated by Mann–Whitney U (alfa = 0.05). Results: the overall test accuracy for the DIFOTI-based device ranged from 0.717 to 0.815 (area under the ROC curve) with p < 0.0001 for all ICDAS scores. Bitewing radiographs took almost twice the time required by DIFOTI (p < 0.001). Conclusions: the DIFOTI-based device DIAGNOcam provided accurate detection of approximal caries in posterior teeth, even at early stages. The technique employed for transillumination caries diagnosis by the same device took less time than conventional bitewing radiographs. Clinical Relevance: transillumination devices, such as DIAGNOcam, can be accurately used for caries diagnosis in approximal surfaces of posterior teeth, demanding less clinical time and without radiation-related risks.

Diagonosis of dental caries: A conventional and current perspective

The diagnosis of dental caries is a basic skill a dentist must know but it remains difficult to master especiallyin early stages. Caries diagnosis may be done by visual method, tactile method, raidiography, cariesdetecting dyes, fiberoptic transillumination method, electronic caries monitor etc. dental caries diagnosisprimarily done by detection of white spot, discolouration frank cavitations and making use of explorersto feel the catch. Since a long time, Bitewings are most widely used for assessing caries radiographically.Fiber optic transillumination (FOTI) and digital imaging fiber optic transillumination (DIFOTI) makes useof visible light for caries detection. Quantitative Light-Induced Fluorescence (QLF) is based on property ofnatural fluorescence shown by tooth enamel. Electrical conductance technology makes use of the fact thatthere is a differential conductivity between sounds versus demineralized tooth enamel due to changes inporosity, as saliva soaks into the pores of the demineralized enamel and increases the electrical conductivityof the tooth. Alternating current impedance spectroscopy (Carie Scan) uses multiple electrical frequenciesto detect occlusal and smooth surface caries. CAD and PTR/LUM are newer trends being worked upon inthe field of dental caries diagnostics

Diagnostic Validity of Digital Imaging Fiber-Optic Transillumination (DIFOTI) and Near-Infrared Light Transillumination (NILT) for Caries in Dentine.

The objective of the study is to analyse the available evidence for the validity of the transillumination method in the diagnosis of interproximal caries. Bibliographic searches were carried out in three data bases (PubMed, Embase, Scopus) with the key words “Transillumination AND caries”. A total of 11 studies were selected for the qualitative analysis and meta-analysis. In the qualitative analysis, both in vivo and in vitro studies were included. The gold standards were tomography, digital radiography, and clinical visual diagnosis. The meta-analysis determined the sensitivity, specificity, and area below the ROC curve relative to the transillumination method in the diagnosis of caries in dentine. Meta-analysis results obtained for transillumination gave a sensitivity value of 0.69 (confidence interval: 0.54–0.81), a specificity value of 0.89 (confidence interval: 0.61–0.98), while giving an AUC value of 0.79 (confidence interval: 0.67–0.87). Transillumination is a method offering moderate validity in the diagnosis of carious lesions in dentine, there is no strong evidence that may enable us to affirm that transillumination may fully substitute X-rays in the complementary diagnosis of carious lesions

Effect of resin composite filler on digital imaging fiber-optic transillumination.

Using a trans-illumination device that applies digital imaging fiber-optic transillumination (DIFOTI) technology, which involves the use of transmitted near-infrared laser light for inspection, the effect of composite resin (CR) restoration of a tooth on caries detection was evaluated. A cavity was formed in a tooth of the lower jaw cut from the specimen, experimental CRs with various filler rates were filled, and the influence of the filler on the obtained image was investigated. On the near-infrared images, the lightness differences between the CR-restored portion and the tooth portion were measured. The translucency parameter (TP) value and the correlation between the lightness differences and TP value of the CRs were investigated. The experimental results showed that the greater rate of macro-filler is, the lighter image and larger TP value. In other words, CR with hybrid filler to increase the TP value is less likely to affect caries detection by DIFOTI.

Assessment of the Depth of Clinically Detected Approximal Caries Lesions Using Digital Imaging Fiber-Optic Transillumination in Comparison to Periapical Radiographs.

ABSTRACTObjectivesThe aim of present prospective clinical trial was to assess the depth of clinically detected approximal caries lesions using digital imaging fiber-optic transillumination in comparison to periapical radiographs.Material and MethodsOne calibrated examiner diagnosed 31 approximal carious lesions in 10 patients with a mean age of 21.8 (SD 1.1) years. The lesions were assessed using digital imaging fiber-optic transillumination (DIFOTI) and digital periapical radiographs (PA). Depending on the depth of the lesions, scores for demineralisation in PA (R) and DIFOTI (F) images were given by two examiners: R0/F0 - no demineralisation, R1/F1 - demineralisation confined to the outer half of the enamel, R2/F2 - into the inner half of the enamel, 3/3 - along the amelodentinal junction, R3/F3 - into the outer half of dentine, R4/F4 - into the inner part of the dentine. Spearman’s rank correlation coefficient and kappa were calculated.ResultsSpearman’s rank correlation coefficient between DIFOTI and PA was 0.031 (P > 0.05), kappa was 0.077. In 26% of the cases, DIFOTI showed higher scores of demineralisation, relative to PA. In 36% of the cases, PA showed higher scores of demineralisation than DIFOTI. PA showed demineralisation into the outer and inner half of the dentine in 89% of the cases with underlying shadow and in 70% of the cases with opacities.ConclusionsDigital imaging fibre optic transillumination and periapical radiographs produce evaluations of the depth of approximal caries lesions that do not match.

In vitro visual and visible light transillumination methods for detection of natural non-cavitated approximal caries.

The objective was to evaluate a visible-light-transillumination (using Digital Imaging Fiber-Optic Transillumination machine: DIFOTI) method using occlusal view (DIFOTI-occl), axial view (buccal and lingual: DIFOTI-axial), and combination of all views (DIFOTI-all) for detecting non-cavitated approximal caries and to compare its performance to visual examination (International Caries Detection and Assessment System: ICDAS). Thirty extracted human premolars were selected (sound to lesions into the outer one-third of the dentine) based on micro-computed tomography (μ-CT). Teeth were mounted in a custom-made device to simulate approximal contact. DIFOTI (Electro-Optical Sciences Inc., Irvington, NY, USA) images were obtained from the occlusal, buccal, and lingual views. DIFOTI image and ICDAS examinations were performed and repeated by three trained/calibrated examiners. Sensitivity, specificity, area under receiver operating characteristics curve (Az), inter- and intra-class correlation coefficients (ICCs), and correlation were determined. Sensitivity/specificity was for DIFOTI-occl: 0.42/0.75, DIFOTI-axial: 0.86/0.93, DIFOTI-all: 0.91/0.69, and for ICDAS: 0.89/0.83. Az for DIFOTI-occl was significantly lower than that of DIFOTI-axial (p < 0.001), DIFOTI-all (p = 0.002), and ICDAS (p = 0.005). Spearman correlation coefficients with μ-CT for DIFOTI-occl (r = 0.39) showed weak association, while DIFOTI-axial (r = 0.80), DIFOTI-all (r = 0.91), and ICDAS (r = 0.90) showed moderate association. ICCs for intra-examiner repeatability/inter-examiner agreement were for DIFOTI-occl (0.64/0.58), DIFOTI-axial (0.92/0.89), DIFOTI-all (0.85/0.83), and ICDAS (0.79/0.72). The results of the current in vitro study suggest that, for detection of non-cavitated approximal caries lesions, DIFOTI performs better using axial than occlusal view. Approximal non-cavitated caries detection is challenging. DIFOTI can observe images from occlusal-, buccal-, and lingual views. DIFOTI and visual (ICDAS) examinations of buccal- and lingual- and all-views are more suitable than those of occlusal view for a detection of non-cavitated approximal caries.

Validity of Digital Imaging of Fiber-Optic Transillumination in Caries Detection on Proximal Tooth Surfaces

Objective The aim of our study was to evaluate the validity of the digital imaging fiber-optic transillumination (DIFOTI) method in comparison with clinical visual examination (CV) and bitewing (BW) radiography on detecting caries lesions on proximal surfaces of teeth. Materials and Methods Proximal tooth surfaces of premolars and molars (n = 2,103) of 91 voluntary university students aged from 18 to 30 years were examined with CV, BW radiography, and the DIFOTI method. ResultsDIFOTI detected more initial and manifested caries lesions compared with CV and BW. Of the analyzed tooth surfaces, 69.8% were classified as sound by DIFOTI, 80.3% by BW, and 91.6% by CV. Initial caries lesions were found in 21.2% of the surfaces by DIFOTI, in 14.1% by BW, and in 6.2% by CV, whereas the proportions for manifested dental caries lesions were 9.0%, 5.6%, and 2.2%, respectively. The interexaminer agreement regarding the DIFOTI findings between an experienced clinician and a fifth-year dental student was high: κ = 0.67 for initial and κ = 0.91 for manifested caries lesions. ConclusionsThe noninvasive DIFOTI method seems to offer a potential tool for everyday clinical practice. In clinical use, DIFOTI finds well even initial caries lesions on proximal surfaces, thus providing an instrument for detecting lesions potential for arresting as well as for monitoring the outcome after preventive measures.

Alternative methods to visual and radiographic examinations for approximal caries detection.

A shift in caries prevalence from occlusal surfaces to approximal surfaces has been demonstrated by epidemiological studies. Two recent meta-analyses evaluated the performance of visual examination and radiography for carious lesion detection, and reported low sensitivity but high specificity for early approximal caries detection. This suggests that the conventional methods have a higher risk of failing to detect approximal lesions. Consequently, in caries susceptible populations, there is a risk of progression of non-cavitated lesions to irreversible tooth destruction before the lesions are detected. This paper aims to review the performance of unconventional and novel methods for approximal caries detection. In vitro and in vivo studies identified through a MEDLINE search using keywords such as caries detection, approximal caries detection, light fluorescence and dental caries, and transillumination and dental caries were reviewed. The unconventional methods known to be used for approximal caries detection and included in this review are: cone beam computed tomography, fiber-optic trans-illumination, digital imaging fiber optic trans-illumination, near-infrared digital imaging transillumination, optical coherence tomography, laser fluorescence, ultrasound, and LED reflection and refraction.

External and internal resin infiltration of natural proximal subsurface caries lesions: A valuable enhancement of the internal tunnel restoration.

The aim of this ex-vivo study was to evaluate both the external and the internal penetration ability of a resin infiltrant into natural proximal and macroscopically intact white spot lesions, and to merge this approach with the internal tunnel preparation concept. 20 premolars and 20 molars with proximal subsurface lesions (ICDAS, code 2) and respective radiographic lesion depths extending into the middle third of dentin (D2 lesions) were selected and divided into two groups. Treatment needs were confirmed using digital imaging fiber-optic transillumination and laser fluorescence. Deproteinization (NaOCl; 2%) followed, and lesions of Group 1 (control; n = 20) were etched (HCl; 15%) and externally infiltrated (Icon). Accordingly, the specimens of Group 2 (n = 20) were treated with the resin infiltrant from external; then, internal Class I tunnels were prepared, lesions were internally infiltrated (Icon), and the occlusal cavities were restored (G-ænial Flo X) after etching (H3PO4 gel; 40%). Teeth were cut perpendicular to the proximal lesion surfaces, and percentage infiltrations were analyzed using confocal laser microscopy and a dedicated image manipulation program (GIMP). Regarding the external infiltration, no differences between both groups were detected (P = .114; Mann-Whitney). Additional internal application of the resin infiltrant significantly increased the percentage amount of enamel lesion infiltration (P < .0001; Wilcoxon). External and internal infiltration seem to complement the internal tunnel approach, thus remediating the drawbacks of the latter by occluding and stabilizing the porous areas of the proximal caries lesion, and preserving both the marginal ridge and the proximal contact area.

Detecting Incipient Caries Using Front-illuminated Infrared Light Scattering Imaging

A new method for early caries diagnosis was proposed and tested through a home-made optical examination system that used quantitative light fluorescence (QLF) and digital imaging fiber optic transillumination (FOTI) (DIFOTI), with light sources across a wide spectral range, from 350 nm to 1,000 nm. The front-illuminated infrared light scattering image (FIR) showed similar diagnostic abilities to that of DIFOTI. The FIR method was invented based on the observation that caries lesions lose the high transmittance and low scattering properties of benign enamel tissue. There are various methods for the early diagnosis of caries, such as visual examination, exploration, X-ray radiography, QLF, FOTI, and infrared fluorescence (diagnodent). Among them, methods based on optical properties are regarded as having the most potential. A comparative study was performed between the FOTI, QLF, diagnodent, optical coherence tomography, and FIR scattering image methods, using 20 extracted teeth samples with early caries. A scale of lesion measurement based on optical image contrast was proposed. The statistical analysis showed a significant correlation between the DIFOTI and FIR methods (r

Approximal Caries Detection by DIFOTI:In VitroComparison of Diagnostic Accuracy/Efficacy with Film and Digital Radiography

The aim of the present study was to compare the diagnostic accuracy/efficacy of digital imaging fiber-optic transillumination (DIFOTI) with film and digital radiography, in detection of approximal caries lesions. One hundred and twelve approximal surfaces were scored for caries, using DIFOTI images film and digital radiographs. All three sets of images were examined twice by 8 observers, with a minimal interval of one week between examinations. Validation of histological sections served as a reference standard. Reproducibility, based on intra- and interobserver agreement, was similar for all three methods. At diagnostic threshold D1 (enamel and dentin caries), DIFOTI showed significantly higher sensitivity, but differences in specificity between methods were nonsignificant. Diagnostic accuracy in the form of area under the receiver operating characteristic curve (AUC) was significantly higher for DIFOTI. At diagnostic threshold D3 (dentin caries), the differences in sensitivity and AUC among methods were nonsignificant, but DIFOTI showed significantly lower specificity. Compared with the radiographs, DIFOTI showed closer agreement, expressed as weighted kappa values, with the reference standard. The results show that under in vitro conditions, the diagnostic accuracy of DIFOTI in detecting early approximal enamel lesions is greater than that of film and digital radiography, while the potential for detecting lesions in dentin is similar for all three methods.

The Correlation of DIFOTI to Clinical and Radiographic Images in Class II Carious Lesions

The authors conducted a study to evaluate the correlation between digital imaging fiber-optic transillumination (DIFOTI) (KaVo Dental, Lake Zurich, Ill.) and clinical and radiographic images in estimating the true clinical axial extension of Class II carious lesions. The authors examined 51 Class II carious lesions visually, imaged them by means of DIFOTI and radiographed them with D-speed film and a complementary metal oxide silicon (CMOS)-based digital radiographic sensor. They validated axial extension of the lesions clinically. They compared the clinical and radiographic depths of the carious lesion with the size of the lesion on the DIFOTI images. The authors detected 84 percent of the lesions with DIFOTI, and 82 percent showed a visible dark shadow under the marginal ridge when examined clinically. DIFOTI correlated significantly with the clinical depth of decay (Pearson r = 0.43189). The combination of a CMOS digital sensor and DIFOTI (R2 = 0.7210) provided readings closer to the clinical measures than did the combination of D-speed film and DIFOTI (R2 = 0.6215). DIFOTI images correlated with clinical depth, especially in smaller lesions, and improved the estimation of lesion size when used in conjunction with the CMOS digital sensor and D-speed images. Using radiographs in combination with DIFOTI images could help clinicians determine the presence and, to some extent, the size of proximal caries, especially in smaller lesions.

Digital Imaging Fiber-Optic Trans-Illumination, F-speed radiographic film and depth of approximal lesions

Detection of early carious lesions is a prerequisite to an optimal preventive and minimal surgical intervention strategy. The authors conducted this study to determine whether Digital Imaging Fiber-Optic Trans-Illumination (DIFOTI) (Electro-Optical Sciences, Irvington, N.Y.) could be useful in evaluating early approximal lesions and to compare radiographs produced with F-speed film with both histologic lesion depth and cavitation. The authors created artificial approximal lesions in vitro in extracted teeth over 14 weeks and imaged them using a "bitewing-like" view every two weeks with DIFOTI and F-speed radiographic film. At the end of the 14 weeks, the authors examined the lesions for surface cavitation using visual and tactile methods. They then thin-sectioned the lesions and subjected them to histologic analysis using polarized light microscopy (PLM). DIFOTI was not able to measure the depth of a lesion in any of the samples. It was, however, able to show surface changes associated with early demineralization as early as two weeks. The depth of a lesion measured using F-speed radiographic film was not statistically different from the depth of a lesion measured with PLM histologic analysis (P > .05). None of the lesions showed any signs of surface cavitation after 14 weeks of demineralization. DIFOTI technology should not be used to decide between surgical or chemical treatment strategies based on lesion depth. We found that F-speed radiographic film was accurate in the approximating the depth of the lesion histologically. Ideally, the clinical decision whether to cut the tooth should be made based on cavitation rather than histologic lesion depth.

A resource guide for practice development through technology

A resource guide for practice development through technology

Emerging Methods of Caries Diagnosis

Current diagnostic tools used in dental caries detection are not sensitive enough to diagnose the disease process in its early stages and, frequently, once a diagnosis is made, restoration is the only effective means of treatment. The purpose of this review was to systematically assess the available literature for evidence to determine if emerging diagnostic methods for dental caries are more efficient than traditional methods for detecting and monitoring the progress of caries in permanent and primary teeth. Inclusion and exclusion criteria were established preceding the literature search. Included articles were grouped by type of emerging technology and study design. The types of emerging technologies included laser fluorescence, light fluorescence, digital imaging fiber optic transillumination, and ultrasound. Primarily on the basis of in vitro and preclinical data, some of the reviewed methodologies showed promising results for the detection and monitoring of early caries lesions. However, very little clinical data are available to validate these emerging technologies. It was concluded that, although significant promise is apparent with these technologies, there is not enough evidence available at this time for any of the reviewed diagnostic techniques to be recommended as a substitute for traditional diagnostic techniques.

Wavelet representations for monitoring changes in teeth imaged with digital imaging fiber-optic transillumination.

Digital imaging fiber-optic transillumination (DI-FOTI) is a novel method to detect and monitor dental caries, using light, a charge-coupled device (CCD) camera, and computer-controlled image acquisition. The advantages of DIFOTI over radiography include: no ionizing radiation, no film, real-time diagnosis, and higher sensitivity in detection of early lesions not apparent to X-ray, as demonstrated in vitro. Here, we present a method of processing DIFOTI images, acquired at different times, for monitoring changes. Of central importance to this application is pattern matching of image frames that is invariant to translation and rotation of a tooth, relative to the field of view of the imaging camera, and that is robust to changes in illumination source intensity. Our method employs: 1) wavelet modulus maxima representations for segmentation of teeth images; 2) first and second moments of gray level representations of DIFOTI images in the spatial domain, to estimate tooth location and orientation; and 3) multiresolution wavelet magnitude representations for quantitative monitoring. Even with illumination source intensity variation, it is demonstrated in vitro that such wavelet representations can facilitate detection of simulated clinical changes in light transmission that cannot be detected in the spatial domain.