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Authors: Dr. Annil Dhingra

Traditionally, clinical examination with dental mirror and probe has been used for caries diagnosis. However, the validity of such probing has been criticized as the variations in fissure morphology, sharpness of the probe and pressure exerted by the operator may produce variable results. The use of an explorer when there is an area of white or opaque enamel may produce irreversible defects in occlusal fissures. Furthermore, it is stated that the explorer allows transmission of cariogenic flora from one infected site to anotherand it may be less accurate in diagnosis than visual inspection alone.

The use of bitewing radiographs for occlusal caries diagnosis has been questioned, due to the lack of accuracy in detecting enamel occlusal lesions. However, the value of this method has been reconsidered because of itsimportance in the diagnosis of hidden caries. A new method based on fluorescence measurements performed by a laser device has been growing in popularity during the past few years. When the laser irradiates the tooth, the light is absorbed by organic and inorganic substances present in the dental tissues, as well as by metabolites from oral bacteria. These metabolites could be porphyrins that are produced by several types of oral bacteria.

Studies using chromatography have found that porphyrins showed some fluorescence after excitation by red light. For this reason, the dental tissue emits fluorescent light after irradiation by red laser and, as the carious tissue increases the emitted fluorescent light compared to healthy tissue, this causes a significant difference between carious and sound structures. The performance of the laser device has been reported by several in vitro and few in vivo studies. However, the results varied substantially. While some studies have shown good performance, others have found low values of specificity.

Minimally invasive dentistry is the new trend in modern dentistry which allows optimal esthetic outcomes together with maximum conservation of sound tissues. In this perspective, the concept of diagnostic tools that accurately identify incipient carious lesions is extremely appealing. DIAGNOdent try to fulfill this need, even if some limitations are still present. DIAGNOdent has been widely described and studied in the literature.

Fig.1

DIAGNOdent pen Features
 
  • Portable, handheld, pen-like device – moves easily from room to room
  • Prospective usage:

- Ideal for dentists to confirm the precise location of the lesion prior to restorative treatment. The innovative technology of KaVo’sDIAGNOdent, a 655 nm diode laser, supports the detection of noncavitated, occlusal pit-and-fissure caries as well as smooth surface caries at the earliest possible stage. Clinical investigations have demonstrated high sensitivity (% correctly diagnosed cariously involved sites) and reproducibility in the diagnosis of pit-and-fissure caries. The measurements from DIAGNOdent, along with conventional diagnostic tools and the clinician’s professional judgment, aid dental professionals in determining whether to monitor suspect areas over time and treat with preventative therapy or restore the infected dentin with minimally invasive techniques.

Fig.2 The DIAGNOdent measures laser fluorescence within tooth structure. As the incident laser light is propagated into the site, two-way handpiece optics allows the unit to simultaneously quantify the reflected laser light energy. At the specific wavelength that the DIAGNOdent laser operates, clean healthy tooth structure exhibits little or no fluorescence, resulting in very low scale readings on the display. However, carious tooth structure will exhibit fluorescence, proportionate to the degree of caries, resulting in elevated scale readings on the display of the DIAGNOdent.

An audio signal allows the operator to hear changes in the scale values, enabling focus on the patient and not solely on the device. The innovative technology of KaVo’sDIAGNOdent, a 655 nm diode laser, supports the detection of noncavitated, occlusal pit-and-fissure caries as well as smooth surface caries at the earliest possible stage. Clinical investigations have demonstrated high sensitivity (% correctly diagnosed cariously involved sites) and reproducibility in the diagnosis of pit-and-fissure caries. The measurements from DIAGNOdent, along with conventional diagnostic tools and the clinician’s professional judgment, aid dental professionals in determining whether to monitor suspect areas over time and treat with preventative therapy or restore the infected dentin with minimally invasive techniques. The results of the several studies indicate that, although the laser method showed acceptable indexes of sensitivity and specificity, it is advisable to use this resource in association with visual inspection in order to reduce the possibility of false positive results.

Fig.1

DIAGNOdent Features
 
  • Integrated loudspeaker with intensity control emits audible tone
  • Battery operated for complete mobility
  • Highly resistant sapphire tips
  • Storage/sterilization cassette with 4 occlusal tips
  • Unit display shows maximum (peak) and current (moment) readings
  • Detachable / sterilizable grip sleeve and tips
DIAGNOdent Classic Features
  • Portable unit with fiber optic tubing and light, thin handpiece for easy access and comfort
  • Prospective usage:
- Ideal for use during new patient exams and regular appointments|
- Allows for patient interaction and education. During scanning, the patient can hold the unit while both the operator and patient can monitor the values on the unit display
 
Fig.1

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