Laser

Fluorescence
Detection of
Occlusal Caries
Laser
Fluorescence
Detection of
Occlusal Caries
Clinical utilization of the KaVo DIAGNOdent
Angel Sanchez-Figueras, Jr., DDS

Detecting Occlusal Caries
Conventional methods of diagnosing dental caries such
as manual probing and radiographic evaluation are
often ineffective in detecting enamel defects, as they
may be too small or inaccessible to the diagnostic tool.
Additionally, manual probing has the potential of stim-
ulating caries due to the iatrogenic damage caused by
the explorer. Radiographs (eg, bitewing x-rays),
although effective in revealing advanced stages of
decay, are unsuccessful in detecting early caries, espe-
cially in the complex anatomy of fissure areas.
Fortunately, with the advent of the DIAGNOdent as
well as the use of traditional protocols, dental
clinicians can now successfully detect the presence of
occlusal decay and properly treat the tooth structure as
necessary.
0 20 40 60 80 100
Brown or black discoloration of the fissures 40%
Visual inspection with the aid of magnification 56%
Visual inspection 57%
Visual inspection and probing 58%
Distinct demineralization of the fissures 65%
X-ray bitewing 67%
KaVo DIAGNOdent 90%
A
lthough significant advances (eg, improved
oral hygiene, fluoridated water supply) have
been made in caries prevention, occlusal pit-
and-fissure decay still remains a major concern.
Research indicates that, while 80% of caries lesions
occur in the occlusal anatomy, a significant percent-
age of these lesions go virtually undetected using
conventional protocols.
D
I
A
G
N
O
S
T
I
C

M
E
T
H
O
D
A
Percentage of Correct Diagnoses
In Seemingly Intact Occlusal Surfaces
*
*Lussi A. Die Fissurenkaries, Diagnostik und therapeutische Grundsaetze.
University of Berne-Swiss Monthly Journal for Dentistry, Berne 1995;9.

Laser Fluorescence for Caries Detection
The DIAGNOdent measures laser fluorescence with-
in 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 KaVos DIAGNOdent,
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 clinicians professional judgment, aid
dental professionals in determining whether to
monitor suspect areas over time and treat with pre-
ventative therapy or restore the infected dentin with
minimally invasive techniques.
Function of the DIAGNOdent
Occlusal surfaces deemed free of decay after clinical and
radiographic examination.
Upon sectioning, caries is found underneath otherwise
intact enamel.

Proven Clinical Results Proven Clinical Results
Step 1: Evaluate patient for risk factors
I Previous restorative experience
I Dietary habits
I Oral Hygiene Level
Step 2: Debride pits and fissures
I Air polishing devices are high-
ly efficient means (ie, KaVo
PROPHYflex) for efficient removal
of organic plugs present inside
the occlusal pits and fissures.
Step 3: Scan with DIAGNOdent and ob-
serve and record numeric values
I Numeric values correlate to extent
of decay.
I Lussi (2000) recommends:
Values between 1015 require
no active care or treatment.
Values between 1530 require
preventative or operative care,
depending on the patients
caries risk.
Values of 30+ require opera-
tive and preventative care.
I Apply findings to current treat-
ment recommendations for
management of occlusal caries.
Step 4: If indicated, proceed with restora-
tive phase
I Restore using appropriate mate-
rials and technique.
CASE 1
CASE 2
CASE 3
Figure 1. Tooth No. 15 shows no signs
of caries.
Figure 1. Occlusal view of posterior tooth
that appears to be free of caries.
Figure 1. Occlusal view shows no signs
of carious lesions.
Figure 2. The radiograph did not show
any radiolucency on tooth No. 15.
Figure 2. The preoperative radiograph also
shows no indication of caries.
Figure 2. A radiograph of tooth No. 14
shows no visible carious involvement.
Best Practices
for Implementing
the DIAGNOdent
Case Presentations

Figure 3. The DIAGNOdent demonstrated
an elevated reading of 28 in the intact
mesial fossa.
Figure 3. The DIAGNOdent is applied in
order to confirm the presence of caries
in the seemingly intact posterior tooth.
Figure 3. Subsequent examination with
the DIAGNOdent revealed a peak reading
of 31 in both the central and distal fossa.
Figure 4. The final prerestorative photo-
graph shows the extent of the operative
preparations.
Figure 4. Carious lesions are removed,
and care is taken to preserve sound tooth
structure.
Figure 5. Postoperative occlusal view
demonstrates the natural form and color
of the restored tooth.
Figure 4. The suspect area of tooth No. 15
was excavated with air abrasion (KaVo
RONDOflex). Caries was already into
dentin.
Figure 5. Definitive restoration shown from
occlusal view following conclusion of success-
ful diagnostic and direct resin procedures.
Figure 5. Postoperative view of the poste-
rior site demonstrates restored tooth.
Courtesy of Angel Sanchez-Figueras, Jr., DDS
DIAGNOdent:28 DIAGNOdent:28
DIAGNOdent:90 DIAGNOdent:90
DIAGNOdent:31 DIAGNOdent:31

Features and Benefits
KaVo America Corporation
340 East Main Street, Lake Zurich, IL 60047
1.888.KaVo USA (1.888.528.6872)
Fax 1.847.550.6825 www.kavousa.com
Additional Reading
Croll TP, Tyma MS. Caries detection using laser fluorescence.
Compend Curr Educ Dent 2001;22(10):838-844.
Samaras C. Laser caries detection provides a great ROI.
Dentists Money Digest 2002;3(5):22.
Sanchez-Figueras A. Occlusal pit-and-fissure caries diagnosis:
A problem no more. Compend Curr Educ Dent 2003:24(5):3-11.
Lussi A. Die Fissurenkaries, Diagnostik und therapeutische Grundsaetze.
University of Berne-Swiss Monthly Journal for Dentistry, Berne 1995;9.
Lussi A. Clinical performance of the laser fluorescence system DIAGNOdent
for detection of occlusal caries (in German). Acta Med Dent Helv 2000;
5:15-19.
With DIAGNOdent, everybody wins:
Patient wins
I Early caries detection-over 90% accurate
I Promotes minimally invasive treatment
I Provides objective data to increase confidence
in treatment decisions
I Interactivity engages patient in examination process
I Safe, no x-ray exposure
I Painless
Hygienist wins
I Empowers hygienist to educate patients
I Provides quantifiable data to objectively monitor
lesions over time
I Enables placement of sealants with confidence
I Identifies areas of high risk to ensure doctors
involvement during hygiene appointment
You need this device!
Dir. Dr. Gordon Christensen, DIAGNOdent-Scientific Diagnosis
of Caries; Practical Clinical Courses, May 2001
Dentist wins
I Over 90% accurate in detecting lesions not
detectable with x-rays or explorer
I High patient acceptance, great marketing tool
I Increases confidence in treatment decisions
I Prevents over or under treatment of suspect teeth
I Perfect adjunct for microdentistry such as air
abrasion with new KaVo RONDOflex handpiece
I Practice Management Consultants and thousands of
U.S. dentists agree that the DIAGNOdent provides
the best ROI (return on investment) in dentistry
today.
9
0
6
.
8
1
4
1
/
7
.
0
4