Fluorescence-aided Caries Excavation Research Articles

Visual Examination, Fluorescence-Aided Caries Excavation (FACE) Technology, Bitewing X-Ray Radiography in the Detection of Occlusal Caries in First Permanent Molars in Children.

To compare the effectiveness of visual examination, radiographic examination and fluorescence-aided caries excavation (FACE) in detecting occlusal caries in first permanent molars in 150 children aged 6-14 years with intact occlusal surface with caries lesions without cavitation, or with darkened or deep fissures that had no clear diagnosis. Two dentists independently performed a visual oral examination, FACE and bitewing radiography. The inter-rater reliability of each detection method was determined and their specificity and sensitivity. All caries detection methods showed high inter-rater reliability with absolute agreement between raters above 90%. Most caries lesions were detected by visual (75.8%) and FACE (79.1%), while only 28.8% of lesions were detected by radiography. Detection by visual examination was strongly correlated with detection by FACE (X2=37.9, Phi=0.498, p<0.001). A lower, yet statistically significant, correlation was found between visual examination and X-ray radiography (X2=5.53, Phi=0.190, p<0.001). FACE had higher sensitivity (87%) and specificity (65%) for detecting occlusal caries in comparison with radiography (60% specificity and 55% sensitivity). Although visual examination remains the best method to detect occlusal caries in young permanent molars in children, FACE is an effective and accurate diagnostic tool that may aid in detection and treatment decisions.

Does the heat generated by fluorescence-aided caries excavation system effect the pulp temperature of primary teeth irreversibly? An in-vitro evaluation of the temperature changes in the pulp chamber.

BackgroundThis study aimed to analyze the effect of the Fluorescence Aided Caries Excavation (FACE) and the remaining dentin thickness on the temperature changes of the pulp chamber. Material and MethodsFreshly extracted deciduous molars and a pulpal microcirculation model were used in the study. The sample size was calculated according to power analyses (power at 90%) based on previous studies. Thus, 40 samples were needed. Standard cavities (3x3 mm) were designed to obtain a 2 mm distance through to the pulp chamber, and in each tooth (n=10), these cavities were modified to obtain 1.5 mm, 1mm, and 0.5 mm final distance through to the pulp. Coronal parts of the teeth were placed on an acrylic plate with three gaps for feeding and extraction needles and the thermocouple. The temperature changes were recorded from the initial time to 15 s and 30 s,1 min, 1.5 min, 2 min, 2.5 min, 3 min intervals. ResultsThe results showed that hence the thickness between cavity floor and pulp chamber was decreased, and application time of FACE was increased, an increase in temperature changes was detected. However, the recorded values were not mean to cause irreversible damages to the pulp chamber. ConclusionsThe recent study showed that Face is an appropriate caries detecting system that does not affect the pulp chamber’s health, and it can be safely used in the primary teeth. Key words:Caries assessment, dental caries, dental pulp, pediatric dentistry.

Is Fluorescence Technology a Promising Tool for Detecting Infected Dentin in Deep Carious Lesions?

The purpose of this study was to determine if the degree of fluorescence detected by fluorescence-aided caries excavation (FACE) correlates with dentin bacterial microbiome diversity, as assessed by 16S rRNA gene amplicon sequencing, and with traditional tactile dentin caries assessment. Unidentified human teeth were obtained from a dental facility. The included teeth had a carious lesion two-thirds into the dentin, verified by radiography, and were red-fluorescing (RF) using FACE technology (SIROInspect; Sirona, Bensheim, Germany). Two independent examiners performed visual/tactile assessment of the lesions. RF sites were sampled with a sterile spoon excavator and dentin characteristics were evaluated. Once RF dentin was removed, a second sample of pink-fluorescing (PF) dentin was obtained. After excavation with a sterile round bur to nonfluorescing (NF) dentin, a third sample was collected with a slow-speed round bur. The samples were processed at the UNC (University of North Carolina at Chapel Hill) Microbiome Core Facility. Out of 134 extracted teeth collected, 21 fit the inclusion criteria, yielding 61 dentin samples. RF samples had the highest number of observed operational taxonomic units (n = 154), followed by PF (n = 109) and NF (n = 100). RF carious dentin was primarily “soft,” and NF dentin was assessed as “hard” 100% of the time by both examiners (rank correlation χ²: p < 0.001). However, approximately one-third of the tactile assessments of hard dentin still displayed some fluorescence, either pink or red. We concluded that the sampled fluorescing (RF and PF) and NF carious dentin layers displayed diverse bacterial taxa, and tactile assessments of soft, leathery, and hard corresponded with RF, PF, and NF.

Minimal Invasive Potential of Three Caries Excavation Methods in Children

Background: Recently, the concept of minimally invasive (MI) dentistry has emerged. MI calls for the selective removal of heavily infected and irreversibly denatured dentin caused by carious lesions while preserving dentin that is demineralized but not infected. Aim: To compare the minimal invasive potential (MIP) of conventional caries excavation (CCE), caries detection dye (CDD), and fluorescence aided caries excavation (FACE) methods in children. Subjects and Methods: A total of 105 carious primary molars in 43 children were included in this study. The teeth were randomly divided into three groups according to the caries excavation method. Preoperative evaluation of the carious teeth was performed using digital radiography after sealing the cavities with a radiopaque material. Caries excavation was performed using CCE, CDD, or FACE method. The teeth were restored using self-cured glass ionomer. Post-operative radiographic examination was then performed. Pre-operative and post-operative widths and depths for the cavities were assessed. MIP was determined by comparing the prepared-cavity width and depth relative to the initial width and depth of the caries lesion, respectively. Results: There was no statistically significant difference between the MIP of examined groups neither after comparing cavity widths at p=0.253 nor depths at p=0.06. FACE showed the highest mean values of MIP potential for cavity widths (1.41±0.36) and depths (2.04±0.74). Conclusions: CCE, CDD, and FACE showed comparable MIP in children.

Microhardness and shear bond-strength of carious dentin after fluorescence-aided or conventionally excavation: (An in-vitro comparison).

BackgroundTo compare the fluorescence-aided and conventionally excavated dentin with microhardness and shear bond strength(SBS) tests.Material and MethodsTwenty-four teeth with dentin caries were bisected through the center of the lesion into two halves. Forty-eight dentin specimens were embedded and mounted in an acrylic resin. All carious tissue was removed and classified as caries free using conventional visual tactile criteria. Then half of the specimens(n=24) were reinspected with fluorescence-aided caries excavation light(FACE) (FaceLight, W&H Dentalwerk, Bürmoos GmbH, Austria). Specimens were subjected to microhardness and shear bond strength testings. The fracture mode analysis was also performed. The data were compared with Student’s t test and Chi-square test.ResultsResidual caries was observed in 2 out of 24 conventionally excavated specimens with FACE inspection(p>0.05). Mean Vickers hardness of the dentin was 61.5±5 in the FACE group and 70.3±3 kg/mm2 in the conventionally excavated group(p>0.05). The mean SBS value of FACE group was 11.42±1.63 MPa and 18.27±1.43 MPa in conventionally excavated group. There was no statistically significant difference between conventional and FACE groups for microhardness and SBS tests(p>0.05). There were also no significant differences on the fracture mode distributions of the groups(p>0.05).ConclusionsFACE method could be considered as a promising technique for removing infected dentin. Key words:FACE, conventional excavation, residual caries detection, shear bond strength, microhardness.

Comparison of two different methods of detecting residual caries.

ObjectivesThe aim of this study was to investigate the ability of the fluorescence-aided caries excavation (FACE) device to detect residual caries by comparing conventional methods in vivo.Materials and MethodsA total of 301 females and 202 males with carious teeth participated in this study. The cavity preparations were done by grade 4 (Group 1, 154 teeth), grade 5 (Group 2, 176 teeth), and postgraduate (Group 3, 173 teeth) students. After caries excavation using a handpiece and hand instruments, the presence of residual caries was evaluated by 2 investigators who were previously calibrated for visual-tactile assessment with and without magnifying glasses and trained in the use of a FACE device. The tooth number, cavity type, and presence or absence of residual caries were recorded. The data were analyzed using the Chi-square test, the Fisher's Exact test, or the McNemar test as appropriate. Kappa statistics was used for calibration. In all tests, the level of significance was set at p = 0.05.ResultsAlmost half of the cavities prepared were Class II (Class I, 20.9%; Class II, 48.9%; Class III, 20.1%; Class IV, 3.4%; Class V, 6.8%). Higher numbers of cavities left with caries were observed in Groups 1 and 2 than in Group 3 for all examination methods. Significant differences were found between visual inspection with or without magnifying glasses and inspection with a FACE device for all groups (p < 0.001). More residual caries were detected through inspection with a FACE device (46.5%) than through either visual inspection (31.8%) or inspection with a magnifying glass (37.6%).ConclusionsWithin the limitations of this study, the FACE device may be an effective method for the detection of residual caries.

Comparative clinical evaluation of the efficacy of a new method for caries diagnosis and excavation.

Aim:The purpose of this study is to compare the efficiency of fluorescence-aided caries excavation (FACE) to remove carious dentin primary teeth with that of conventional methods.Methods and Materials:After caries excavation was carried out, dentin surfaces were conventionally inspected using visual tactile criteria and 415 cavities which were classified as caries-free, re-inspected with Face-Light and caries detector dye (CDD) methods. Orange-red fluorescing areas classified as carious dentin, as well as stained carious dentin. All the data were recorded according to localization of the caries and determination efficiency of the methods. X2 test was used to compare the mean values of both Face-Light and dye applications, while Wilcoxon test performed to evaluate the effectiveness for each diagnostic method.Results:A total of 273 patients with 415 Class II (OM/OD) cavities (1.65 ± 0.52 teeth per patient) with carious lesions in molar and premolar teeth, were examined. Out of 415 teeth, in 149 teeth (35.9%) no caries findings had been illustrated. While FACE detected remaining carious or partially removed areas in 237 teeth (57.2%), CDD stained only 29 teeth by itself (P < 0.05).Conclusion:In conclusion, FACE has a higher detectability compared to visual inspection and caries detector dye in diagnosis and removal of carious dentin.

Micro-computerized tomography assessment of fluorescence aided caries excavation (FACE) technology: comparison with three other caries removal techniques

The aim of this study was to determine the caries removal effectiveness (CRE) and minimal invasiveness potential (MIP) of four dentine caries removal methods. After carious molars were scanned using micro-computerized tomography (micro-CT), dentine caries were removed by fluorescence aided caries excavation (FACE) technology, laser induced fluorescence (LIF), chemomechanical excavation (CME), and conventional excavation (CE). Micro-CT was then repeated. CRE was determined based on the volume of residual caries/initial caries (RC/IC) and the mean mineral density (MD) at the cavity floor. MIP was determined by measuring the volume of the prepared cavity/initial cavity (PC/IC). Among the four groups, the LIF group had the smallest RC/IC (0.08), the highest mean MD at the cavity floor (1.32 g/cm(3) ) and the highest MIP (4.47). The CME group had the highest RC/IC (0.24), the lowest mean MD (1.01 g/cm(3) ) and the lowest MIP (2.23). The CE group exhibited a more acceptable CRE (RC/IC = 0.13, mean MD = 1.21 g/cm(3) ) but had a higher MIP (3.95). Both the CRE and MIP parameters of FACE technology were the second most acceptable (RC/IC = 0.12, mean MD = 1.13 g/cm(3) , MIP = 3.20) and did not differ significantly from the most acceptable. FACE is an effective caries removal technology for removing infected dentine without significantly increasing cavity size.

The use of computer-assisted FACE for minimal-invasive caries excavation

Caries excavation is still a demanding procedure today. In the past years, methods using light-induced fluorescence have proven their ability to detect bacteria remaining in the tooth's hard tissues. However, methods to control the complete removal of infected dentine have not yet been validated. The aim of the present study was to evaluate the degree of dentine removal during caries excavation using a camera- and software-based device as a guide for fluorescence-aided caries excavation (FACE) in comparison to visual-tactile inspection and a dye-staining method. One hundred teeth with carious lesions (C3) were randomly allocated to four groups and excavated with the respective method as primary excavation control method. When the first method indicated complete caries excavation, a second method was used to affirm this. Subsequently, dentine samples were taken to determine residual contamination using PCR. After embedding and sectioning the teeth dentine, microhardness was measured perpendicular to the cavity floor. By using the camera- and software-based device, 94 % of the cavities tested were free of bacterial contamination. All cavities excavated with the dye-staining or visual-tactile control method were free of bacterial contamination but resulted in a significantly higher dentine removal. The camera- and software-assisted caries excavation seems to be an adequate method to remove contaminated dentine without removing affected dentine. Beside its original application to monitor carious, the device is safe, effective, and easy to use for guided caries excavation and is of worth for both everyday practice and undergraduate education.

An in vitro comparison of fluorescence-aided caries excavation and conventional excavation by microhardness testing

The aim of this in vitro study was to compare fluorescence-aided caries excavation with conventional excavation based on the Martens and Vickers hardness of dentin at the cavity floor after caries removal. In total, 20 extracted human teeth with dentin caries were bisected through the lesion center into two halves, which were assigned to either the fluorescence-aided caries excavation group or the conventional excavation group. After the treatment, embedding, mounting, and polishing, a line of indentations from the dental pulp across the sound dentin to the cavity floor was made on each sample. The data were compared with Student's t and Mann-Whitney U tests. The calculated Vickers hardness of the sound dentin was 57 ± 10 kg/mm(2) in the fluorescence-aided caries excavation group and 59 ± 8 kg/mm(2) in the conventional excavation group, which is consistent with the previous studies. The absolute and relative Martens hardness measurements of the cavity floor were 224 ± 93 N/mm(2) and 46 ± 17%, respectively, in the fluorescence-aided caries excavation group and 412 ± 75 N/mm(2) and 81 ± 14%, respectively, in the conventional excavation group. Based on either the Martens or Vickers hardness, both the absolute and relative microhardness measurements of the cavity floor after fluorescence-aided caries excavation were significantly lower than the values obtained by conventional excavation. Fluorescence-aided caries excavation showed the tissue-preserving property and was more conservative than the conventional excavation in this in vitro study.