Evaluation of the DIAGNOdent method for detection and quantification of carious lesions - in vitro and in vivo studies

.........................................................................................................................6 List of Papers.................................................................................................................8 Introduction...................................................................................................................9 Primary occlusal caries and conventional detection methods .................................................11 Secondary caries and conventional detection methods............................................................13 Requirements of an ideal diagnostic method ............................................................................14 New methods for caries detection ..............................................................................................15 Aims .............................................................................................................................22 General aim .................................................................................................................................22 Specific aims ................................................................................................................................22 Material and Methods.................................................................................................23 Teeth.............................................................................................................................................23 Equipment ...................................................................................................................................25 Measurement with DIAGNOdent (Papers I, II, III, IV)..........................................................25 Measurement with ECM (Paper I) ............................................................................................27 Radiographic examination (Papers II, III) ...............................................................................27 Visual examination (Papers II, III, IV) .....................................................................................28 Validation ....................................................................................................................................29 Statistical analyses ......................................................................................................................30 Results..........................................................................................................................33 Reliability and Agreement..........................................................................................................33 Validity.........................................................................................................................................34 Discussion....................................................................................................................36 Reliability and Agreement..........................................................................................................37 Validity.........................................................................................................................................38 Future applications .....................................................................................................................45 Conclusions .................................................................................................................46 Acknowledgements......................................................................................................47 References ...................................................................................................................49 Evaluation of the DIAGNOdent method for detection and quantification of carious lesions in vitro and in vivo studies 6 Abstract The sites most susceptible to dental caries are the occlusal surfaces and the margins of existing restorations. These are also the sites at which lesion detection by conventional methods is most unsatisfactory. There is a need in general dental practice for simple efficient methods of detecting and recording quantitative data about the presence and severity of caries at the most susceptible sites and monitoring lesion response to intervention. Aim The aim of the present thesis was to evaluate a new laser fluorescence-based device, DIAGNOdent, for detection and quantification of carious lesions on occlusal surfaces and around the margins of restorations under both in vitro and in vivo conditions. Methods Part I: DIAGNOdent and occlusal caries (papers I and IV) The performance of the DIAGNOdent instrument was compared with the Electronic Caries Monitor (ECM), a method based on electrical conductance measurement, for in vitro detection and quantification of occlusal caries. In paper IV, DIAGNOdent readings on teeth scheduled for extraction were recorded before and after extraction, and during storage of the extracted teeth for three months. Lesion depth was determined by histopathological analysis in both papers. Part II: DIAGNOdent and secondary caries (papers II and III) Restored teeth were measured with DIAGNOdent along the margin of the restoration, under laboratory and clinical conditions. The restorations were then removed and visual-tactile examination was conducted by two observers. For the in vitro study, the teeth were hemisectioned and examined under a microscope.