Combined Near-Infrarred Light Transillumination and Direct Digital Radiography Increases Diagnostic In Approximal Caries

Abstract

The objective of this study was to evaluate the clinical ability of Near-Infrared Light-Transillumination (NILT) for approximal dentinal caries detection and to compare with direct digital-radiography (DDR), as well as to determine whether the combination of both techniques improves the diagnostic capacity of the lesions. From 88 patients (over 18 years), 138 posterior teeth (76 molars and 62 premolars), that had approximal caries reached into dentine determined by DDR, were included. Lesion extension and DDR images were scored as follows: D0 = sound surface, D1/D2 = caries restricted to the outer/inner-half of the enamel, and D3/4 = caries restricted to the outer/inner-half of the dentin. Opening of the approximal surface using 0.5 mm-in-diameter diamond-bar was used as gold-standard. The lesion extension was then determined by the following criteria: no dentinal caries (D0/1/2) or dentinal caries (D3/4). Seventy-one lesions were D3 and 67 lesions were D4. Sensitivities of overall/D3/D4 were 98.0/95.7/100.0 (NILT) and 100/100/100 (DDR), respectively. Correlations with gold-standard were 0.92 (NILT) and 0.42 (DDR), respectively. The correlation increased to 0.97 (p = 0.045) on combining NILT and DDR. There was no difference in sensitivity between the methods (p > 0.05); but was differences in the correlation (p < 0.01). It can be concluded that NILT showed sensitivity similar to that of DDR and higher correlation than DDR for approximal dentinal caries detection. Accordingly, it may be used to monitor the progression of caries without exposing the patient to ionizing radiation, this being of particular interest in growing patients and in pregnant women. In this respect, NILT can be an effective diagnostic tool adjunctive to bitewing radiographs in detecting approximal dentinal caries. The combination of NILT and DDR represents an increase in the diagnosis of approximal lesions The proposed diagnostic protocol comprises visual examination, followed by NILT and DDR only if the former technique detects approximal caries.

Ex vivo investigation on internal tunnel approach/internal resin infiltration and external nanosilver-modified resin infiltration of proximal caries exceeding into dentin

“…Along with the radiologic diagnosis, we used the DIAGNOcam (KaVo) readings for the final tooth selection, since near-infrared transillumination clearly enables differentiation of lesions limited to enamel from those reaching the dentin. It should be kept in mind that bitewing radiographs tend to underestimate lesion depths [55,96], even if combined with visual inspection [56]; instead, the use of near-infrared transillumination does disclose the true lesions extent more accurately [73], and, although not considered our primary aim, this has been corroborated by the current study.…”

“…This mainly is owed to the fact of increasing cavitation probabilities of the outer enamel surface [33,34,69], and these breakdowns, in turn, correspond to impaired biofilm removal and decreasing remineralization capabilities (even with patients showing normal salivary function [70]); moreover, it is well-known that lesions extending clearly beyond the enamel-dentin border (> 0.5 mm) are most likely to progress within a period of 3 years [71], and comparable deteriorations have been reported with increasing ICDAS severities [36]. Therefore, in accordance with the current study set-up, temporary separation of teeth to inspect the proximal surface integrity [72] and DIAGNOcam readings to scrutinize lesion severities [56,73] would seem advisable prior to any treatment decision. With proximal caries extending into dentin, modified partial [74] or internal [30] tunnel restoration techniques (both actually representing a Class I cavities), allowing for an internal and external resin infiltration have been suggested recently [32]; it should be emphasized that this concept of double-sided resin infiltration would seem consistent with the prevailing recommendations on treatment decisions related to surgical intervention.…”

Diagnostic Accuracy of Digital Radiography and Novel Diagnostic Tools versus Visual ICDAS Criteria: A Systematic Review

“…Digital dental radiography proved to be a reliable tool in detecting initial carious lesions/ especially proximal lesions [7], also using filters as negative images allowed easier and more efficient detection of occlusal lesions [6]. The digital bitewing radiography was proposed to be high value and reliability in detecting proximal caries [8].…”

Photoacoustic imaging of occlusal incipient caries in the visible and near-infrared range

“… 4 5 Due to these limitations, the last few years have seen an increased interest in the development of new methods of caries diagnosis with highly accurate and non-invasive methods, such as transillumination, fluorescence-based imaging, optical coherence tomography (OCT), and photoacoustic (PA) imaging. 6 7 8 9 10 11 12 13 …”