Download Dental Caries Diagnostic Methods

Review Article
Dental Caries Diagnostic Methods
Zangooei booshehry, M. * Fasihinia, H. ** Khalesi, M. *** Gholami, L. ****
*Assistant Professor of Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Shahid Sadoughi
University of Medical Sciences , Yazd, Iran.
*General Physicion
**Student of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
***Post-graduate student of Prosthodontics, Faculty of Dentistry, Hamadan University of Medical Sciences.
**** Post-graduate student of Periodontics, Faculty of Dentistry, Hamadan University of Medical Sciences.
ABSTRACT
Dental caries, a progressive bacterial damage to teeth, is one of the most common diseases that
affects 95% of the population and is still a major cause of tooth loss. Unfortunately, there is
currently no highly sensitive and specific clinical means for its detection in its early stages. The
accurate detection of early caries in enamel would be of significant clinical value. Since, it is
possible to reverse the process of decay therapeutically at this stage, i.e. operative intervention might
be avoided. Caries diagnosis continues to be a challenging task for the dental practitioners.
Researchers are developing tools that are sensitive and specific enough for the current presentation
of caries. These tools are being tested both in vitro and in vivo; however, no single method will
allow detection of caries on all tooth surfaces. Therefore, the purpose of the present review was to
evaluate different caries diagnostic methods.
Keyword: Dental Caries, Diagnosis, Radiography
possibility of reversal. Rather, clinicians are
INTRODUCTION
A diagnostic method for dental caries
forced to measure a dynamic process as a
should allow the detection of the disease in
dichotomous variable of the presence or
its earliest stages and for all pathologic
absence of disease using clinical criteria (e.g.
changes attributable to the disease to be
color, softness, resistance to removal), which
determined from early demineralization to
are all rather subjective, and tools (e.g. sharp
cavitations. Unfortunately,
explorer and dental radiographs) which are
none of the
currently accepted clinical caries diagnostic
becoming less useful.
methodologies have the ability to account for
Although, no single method is currently
the dynamics of dental caries, including the
developed that will allow detection of caries
Corresponding Author: M. Khalesi, Address:
on all tooth surfaces, these technologies have
Department of Prosthodontics, Faculty of Dentistry,
the potential to offer higher specificity and
Hamadan University of Medical Sciences.
+989126778160
Fax:+98(351)6250344,
[email protected]
DJH 2010; Vol.2, No.1
Tel:
Email:
sensitivity with respect to caries detection
and quantification as well as to facilitate the
1
Khaleis et al.
Dental Caries…
development of more effective preventive
interventions.
some
(1)
dental
The technique of temporary elective tooth
This article aims to review
separation as an aid to diagnosis of caries in
caries
proximal smooth surfaces is now regaining
diagnostic
methods
available including:
popularity, albeit with less traumatic methods
CLINICAL VISUAL INSPECTION
that seem acceptable to most patients and
The coronal carious lesion starts as a
clinically
undetectable
subsurface
dentists. This method permits a more definite
assessment
of
whether
radiographically
demineralization. With further progression, it
detectable proximal enamel (D1, D2) and
will
dentin lesions (D3) are cavitated.
(eventually)
become
clinically
detectable, and can, then, be classified
Temporary
according to type, localization, size, depth,
complemented by a localized impression of
and shape.
the opened interproximal space, allows a
The visual method, a combination of light,
mirror,
and
the
probe
for
detailed
examination of every tooth surface, is by far
the most commonly applied method in
general
practice
worldwide.
Although
sensitivity is low and specificity is high, it
may be possible to detect noncavitated
enamel lesions (D1) on the free smooth
surfaces (buccal and lingual), most anterior
proximal surfaces, and the opening of some
fissures; clinically detected cavities limited to
the enamel (D1, D2); dentin lesions (D3)
with cavitations into the dentin on the buccal
and lingual surfaces, but there is limited
detection
of
posterior
approximal
and
occlusal lesions.
A major shortcoming is this method was very
limited for detecting noncavitated lesions in
dentin or posterior proximal and occlusal
surfaces.
elective
tooth
separation,
more sensitive diagnosis of cavitations than
does the purely visual separation method. (2)
Ekstrand et al. evaluated the visual and tactile
assessment of arrested initial enamel carious
lesions and
showed that dentists were not
able to reliably and reproducibly determine
the subtle visual and tactile differences
between active and inactive enamel lesions.(3)
In another
study,
Sheehy performed
a
comparison between visual examination and
a laser fluorescence system for In vivo
diagnosis of occlusal caries and concluded
that since the laser fluorescence instrument
can not be expected to differentiate caries
from hypomineralizations, it should be used
as an adjunct to a clinical examination.
(4)
On
the other hand, there are some questions
about the use of dental explorer to probe
suspected carious lesions. Hamilton reported
that until to the time those facts emerge from
acceptable long-term clinical trials, dentist
2
DJH 2010; Vol.2, No.1
Khaleis et al.
Dental Caries…
should feel comfortable using the dental
explorer to probe suspected carious lesions.
(5)
allows instantaneous images to be made and
projected, and images taken during different
FIBER OPTIC TRANSILLUMINATION
examination can be compared for clinical
METHODS
changes among several images of the same
Fiber
optic
transillumination
(FOTI)
tooth over time. (1)
allows for the detection of carious lesion
However, Caution must be taken, when
because of the changes in the scattering and
interpreting a proximal DIFOTI image that is
absorption of light photons resulting from a
taken at a view similar to that of a
local decrease of transillumination due to the
conventional bitewing radiograph. Although,
(6)
the images may look similar, proximal
Enamel lesions appear as gray shadows and
lesions can be detected using DIFOTI only
dentin lesions appear as orange-brown or
by careful angulation, remembering that the
characteristics of the carious lesion.
bluish shadows.
(7)
In an in vitro study, FOTI,
resulting image is that of a surface or what is
performed along with visual examination,
near the surface. This also may explain why
had higher specificity both for enamel and
the DEJ is not always seen with conventional
dentinal lesions and had a better correlation
radiography, when the incident beam is
with histology.
(8)
Rousseau reported on the
transmitted through the entire tooth, often
development of a fiber-optics-based confocal
masking early changes in
imaging
and
However, this method is much better for
potential diagnosis of early dental caries. A
evaluating lesion depth at the proximal
novel
surface.
system
optical
for
the
detection
instrument,
capable
of
In
addition,
the surface.
another
possible
recording axial profiles through caries lesions
drawback of DIFOTI is the inability to
using single-mode optical fibers has been
quantify lesion progression, even though
developed which may provide additional
images can be compared over time.
diagnostic
in- vitro study indicated that the method has
practitioner.
Digital
information
for
a
general
(9)
Imaging
(10)
One
higher sensitivity than does a radiographic
Fiber
Optic
examination
for
detecting
occlusal
lesions
Transillumination (DIFOTI) is a relatively
interproximal,
and
new methodology that was developed in an
surfaces.(11)
attempt to reduce the perceived shortcomings
CARIES INDICATOR DYES
on
smooth
of FOTI by combining FOTI and a digital
In 1972, it was suggested that caries-
CCD camera. Images captured by the camera
detector dyes could help differentiate infected
are sent to a computer for analysis using
dentin from affected dentin. However, more
dedicated algorithms. The use of the CCD
recent studies have shown that these dyes are
DJH 2010; Vol.2, No.1
3
Khaleis et al.
Dental Caries…
non specific protein dyes that stain
with a depth of only 25 m have been
collagen in the organic matrix of less
measured in vitro. The restriction of light
mineralized dentin, whether it is infected or
scattering for caries diagnosis to smooth
not, rather than being specific for the
surfaces is a significant drawback to this
pathogenic bacteria.
(10)
technique, although, there is continuing
Al-Sehaibany et al. evaluated the use of
research to develop a QLF system to detect
caries detector dye in the diagnosis of
occlusal caries.
occlusal carious lesions. The purpose of their
Kuhnisch et al. evaluated the in vivo
study was to compare the accuracy of
detection of non-cavitated caries lesions on
diagnosis of carious lesions in the occlusal
the occlusal surfaces by visual inspection and
pit, fissure, and groove system of lower
quantitative light-induced fluorescence. It
molars examined by two methods: the caries
was concluded that QLF detects more non-
detector
tactile
cavitated occlusal lesions and smaller lesions
explorer.
compared to visual inspection. However,
Histological cross sections confirmed a ratio
taking into consideration time-consuming
of 1:1 (100%) accuracy by caries detection
image capturing and
dye in diagnosing decay underlying the
understand that QLF is not really of practical
occlusal surface. Concurrent examination of
use in the dental office.
the same occlusal surface by traditional
Laser induced fluorescence
dye
examination
versus
using
traditional
a
dental
explorer examination was only reliable in a
(13)
analysis, we can
(14)
In 1998, Hibst and Gall described the
1:4 ratio (25%). (12)
successful use of red light (655nm) to
FLUORESCENT METHODS
differentiate between sound and carious
Quantitative light induced fluorescence
tissues and on this basis, the Diagnodent
(QLF)
system (DD) was developed. When using
QLF is based on the auto-fluorescence of
light with an excitation wavelength of
teeth. When teeth are illuminated with high
655nm, we can detect that more intense
intensity blue light, they will start to emit
fluorescence in the 700-800nm wavelength
light in the green part of the spectrum. The
region is observed from a carious lesion
fluorescence of the dental material has a
compared with a sound spot on enamel. DDS
direct relation with the mineral content of the
utilizes
enamel. No threshold for the detection of
excitation light source that is modulated to
white spot lesions using light scattering
differentiate it from ambient light. The light
a
655-nm
1-mW
laser
diode
techniques has been determined, but lesions
4
DJH 2010; Vol.2, No.1
Khaleis et al.
Dental Caries…
is transmitted though a descending optical
fiber to a hand-held probe. The probe is
placed close to the measured surface,
two instruments were developed and tested in
thereby illuminating it with the laser light.
the 1980. The Vanguard Electronic Caries
Carious tooth structures emit fluorescence
Detector
above 680 nm when encountering this light
Corp., InterLeuven laan, Cambridge, MA)
and
and
and the Caries Meter L (G-C International
quantified by the DD unit as a number
Corp., Leuven, Belgium). Both instruments
this
fluorescence
between 0-99.
(15)
is
detected
(Massachusetts
Manufacturing
The laser fluorescence
measure the electrical conductance between
device represents high reliability in the
the tip of a probe placed in the fissure and a
detection of occlusal caries in teeth and its
connector attached to an area of high
performance is similar to direct visual and
conductivity (e.g. gingiva or skin). The
radiographic
measured
examination.
So,
the
conductance,
which
was
a
DIAGNOdent may be a useful adjunct to
continuous variable, was ,then, converted to
conventional methods for occlusal caries
an ordinal scale: 0 to 9 for the vanguard
detection.
(16-18)
system and four colored lights for the caries
ELECTRICAL
CONDUCTANCE
Meter L (green = no Caries, yellow = enamel
caries, orange = dentine caries and red =
MEASUREMENTS (ECM)
The idea of an electrical method of caries
pulpal involvement). To prevent polarization,
detection dates back to 1878, while it is
both
believed to have first been proposed by
alternating
Magitot. The basis of the use of ECM is
respectively.
observations which show that sound surfaces
removed by a continuous stream of air in the
possess limited or no conductivity, whereas
vanguard
carious or demineralized enamel should have
conductance. Conversely, to assure a good
a measurable conductivity that will increase
electrical contact and minimize the effect of
with the increase of demineralization. By
saliva, the Caries Meter L requires that the
decreasing thickness and increased porosity,
pits and fissures be moistened with saline.
the performance of electrical resistance has
Electrical conductivity has been shown to
been reported to be as valid as or better than
have an overall satisfactory performance in
traditional
detecting occlusal caries in vitro and in vivo
means
of
diagnosing
fissure
caries. (19)
systems
used
a
voltage,
25Hz
Moisture
system
low-
to
and
frequency-
and
saliva
prevent
400Hz,
were
surface
and approximal caries in vitro. (13)
Based on the differences in the electrical
conductance of carious and sound enamel,
DJH 2010; Vol.2, No.1
5
Khaleis et al.
Dental Caries…
X RAY- BASED IMAGING
DIAGNOdent is very high and its diagnostic
Intra Oral Radiography (INR)
validity is higher than that of bitewing
The history of dental radiography begins
radiography for proximal caries detection in
(21)
with the discovery of the x- ray. The x- ray
primary teeth.
revolutionized the methods of practicing
Now, for the purpose of carious lesion
medicine and dentistry by making it possible
detection, intra oral radiography is a standard
(17)
procedure and is essential for diagnosing
to visualize internal body structures.
(22, 23)
Radiography is useful for the detection of
inter proximal caries.
dental caries because the caries process
Extra Oral Radiography (EOR)
causes tooth demineralization. The lesion is
Extraoral radiographic techniques for
darker than the unaffected portion and may
proximal caries detection have been studied
be detected in radiographs. An early carious
and proven to be inferior to intraoral
lesion may not have yet caused sufficient
techniques. However, the main focus was on
demineralization
conventional panoramic radiography.
to
be
detected
in
radiographs. It is often useful to mount
Clifton
successive sets of bitewing radiographs in
tomography and panoramic radiography as
one film holder to facilitate comparison and
well as intra-oral D-speed film for combined
evaluation of evidence of progression.
assessment of proximal and occlusal caries. It
Intra oral radiography can reveal carious
was concluded that when proximal surfaces
lesions that otherwise might go under
were evaluated alone, D-speed film was
detection
significantly better. For occlusal caries, there
during
a
thorough
clinical
et
al.
used
multidirectional
examination.
was no statistically significant difference
On the other hand, early carious lesions are
between multi directional tomography and
difficult
D-speed film. (24)
to
detect
with
radiographs,
particularly, when they are small and limited
One study has demonstrated that scanogram
to the enamel. Therefore, clinical and x-ray
images have the potential to be the first
examinations are necessary in the detection
practical extraoral imaging modality for
of dental caries.
proximal caries detection. Influencing factors
Posterior bitewing radiographs are the most
to be discussed are the sample, exposure
useful x-ray projections for detecting caries
techniques,
in the distal third of a canine and the
enhancement. In this study, the performance
interproximal
of
and
premolar and molars.
occlusal
(20)
surfaces
of
However, Virajsilp
V et al. reported that the reliability of
6
resolution
screen-film
and
and
enhanced
contrast
digital
scanograms were not statistically different
from Insight
film for proximal
caries
DJH 2010; Vol.2, No.1
Khaleis et al.
Dental Caries…
detection. Unenhanced digital scanograms
exhibited a statistically significant lower
diagnostic accuracy than Insight film.
(25)
including image manipulation and a
reduction in radiation required to obtain a
diagnostic image.
(1)
Digital radiography
The use of digital radiography addresses
two
primary disadvantages of dental film,
periapical diseases as it was previously
thought.
In addition, Alkurt MT
Increasing the diagnostic yield for caries may
showed that the diagnostic performance of E-
be possible with three-dimensional (3D)
and F- speed films and direct digital
imaging methods. However, general dentists
radiography are similar for proximal caries
currently use two-dimensional (2D) images,
detection.
(26)
and although CT/MRI modalities exist for
Three dimensional x-ray imaging
hospitals, there are no systems for general
Since the discovery of the x-ray in 1895
practitioner caries diagnosis. The choices for
and its application to dentistry, radiographic
3D imaging of dentoalveolar diagnostic tasks
imaging of oral anatomy has consisted
are currently limited to different forms of
primarily of viewing 3-D structures collapsed
local CT including x-ray microtomography
onto a two-dimensional (2-D) plan. This form
(XMT),
of
tomography (TACT) and super-ortho-cubic
imaging,
known
as
transmission
tuned
aperture
radiography, is characterized by a point
CT. (27)
source of radiation producing a beam which
X-ray microtomography
computed
passes through the patient and strikes a
X-ray microtomography is a miniaturized
relatively flat image receptor (usually a film).
version of computerized axial tomography
This produces essentially an attenuation map
with a resolution of the order of micrometres.
of the structures through which the beam has
In the biomedical field, it is particularly
been transmitted. While the dental profession
useful in the study of hard tissue because of
has relied on this method for obtaining
its ability to accurately measure the linear
information about the hard tissues of the oral
attenuation coefficient. From this, the mineral
cavity, it inevitably superimposes anatomy
concentration can be computed, which is one
and metallic restorations which confound the
measure
problem of identifying and/or localizing
microtomography
diseases or objects in three dimensions.
dimensional images of bone from which
Moreover, studies have shown that intra-oral
structural parameters can be derived which
films produced in this way are not sensitive
could not be measured using conventional
for the detection of caries, periodontal, and
histomorphometry.
DJH 2010; Vol.2, No.1
of
bone
we
quality.
can
form
Using
three-
(28)
7
Khaleis et al.
Dental Caries…
Daatselaar et al. described the development
mineral content in the lesion area (Delta Z/
of a bench top local CT device which is able
Lesd in Vol %), the mineral Vol % and
of producing spatial and contrast resolutions
position of the subsurface layer and lesion
necessary
of
body.The accuracy of TMR for enamel and
other
dentine in lesion depth is about 200 Vol %.
authors
m in deltea Z. With mineral details of
concluded that ‘local CT reconstruction are
approximately 2-3 µm can be detected. The
feasible’ and ‘the resolution of the local CT
time required for making 5 scans plus
images produced from basis projections that
evaluation is 3-4 minutes (which is less than
were acquired using standard dental CCD
1 minute for a scan). The time required for
sensor was diagnostically suitable. This
acquiring step wedge data is one minute or
makes local CT a potential technique for the
less depending on the number of step wedge
for
interproximal
improved
caries
dentoalveolar
as
conditions.
detection
well
as
The
diagnosis of interproximal caries.
(29)
Transverse microadiography(TMR)
steps. Statistical analysis of many scans is
supported.
(30)
TMR or contact- microradiography is the
Longitudinal Micro Radiography (LMR)
most practical and widely accepted method
LMR is a method to determine mineral
used to assess de- and re- mineralization of
loss in tooth slice samples in vitro. In this
dental hard tissues in studies. It is a highly
method, a microradiogram of a slice of a
sensitive method to measure the change in
tooth is prepared. Mineral content is then
mineral content of enamel and dentine
computed by performing measurements of
samples. In TMR, the tooth sample to be
the optical density of the microradiogram and
investigated is cut into thin slices (about 80
by comparing these values with that of an
m and 200 m for dentine samples). A
aluminum step wedge. LMR is based on the
microradiographic image is made on high
same principle as TMR. In contrast to TMR,
resolution
X-ray exposure of the
where a transversal slice of the tooth is
sections together with a calibration step
created, LMR is based on longitudinal slices.
wedge. The microradiogram is digitized by a
The LMR system is highly automated.
video camera or photomultiplier. The mineral
Scanning the sample is performed using a
can be automatically calculated from the gray
XY scanning table and all calculations are
levels of the images of section and step
performed automatically.
wedge. Parameters of interest are mineral
Tuned Aperture Computed Tomography
loss (Delta Z in Vol %. m ), lesion depth
(TACT)
film
(29)
(Lesd in m ), ratio or average loss of
8
DJH 2010; Vol.2, No.1
Khaleis et al.
Dental Caries…
It has been shown in controlled in vitro
Computer- aided radiographic method
studies that it can enhance the clinician’s
exploits
ability to
computers in assessing and recording lesion
detect
anatomically
and
localize
significant
disease,
structures
and
the
measurement
potential
of
size. In the new Trophy 97 system, artificial
abnormalities. TACT promises to overcome
intelligence
some
of
detector) is integrated: approximal carious
and
lesions are diagnosed and evaluated with the
increases the 3-D information
currently
aid of unique histologic database, allowing
available
influence
graphic
of
the
conventional
current
dental
in
ways
limitations
technologies
that
can
software
visualization
(Logicon
of
the
size
caries
and
significantly the diagnosis and management
progression of the lesion.
of dentoalveolar diseases and abnormalities.
At both D1 and D3 thresholds, computer-
With TACT, the patient has to remain
aided methods offer high levels of sensitivity
motionless
individual
for approximal lesions. Earlier soft wares
exposure. The time between exposures is
paid some trade off high with specificity, but
determined by convenience, diagnostic task,
newer methods also have high values for this
economics or other factors, because delays
measure.
have no impact on the accuracy of the
that the major advantages may be the
reconstruction. This approach also permits
significant dose reductions and the ability for
the
image quality manipulation.
only during
signal-to-noise
interactively
examination.
to
ratio
the
each
to
needs
be
tuned
of
the
(31)
(33)
Furthermore, Wenzel reported
(34)
Terahertz Pulse Imaging (TPI)
Terahertz pulse imaging (TPI) is s
Harse et al. performed a study to compare the
relatively new imaging technique that has
difference in the accuracy of proximal caries
been demonstrated in both non-biological
detection
by
tuned
aperture
applications. Although, the TPI system is a
computed tomography (TACT),
intraoral
new technique for imaging caries using non
TACT,
It
was
ionizing impulses of terahertz radiation, (an
concluded that extraoral TACT was not
electromagnetic radiation) and its ability to
statistically different from intraoral TACT or
detect early stages of caries lesions in various
film radigraphs for proximal caries detection.
sections of teeth and a hope in future when
This suggested that extraoral TACT may
this technique could indicate caries in all
and
extraoral
film
radiography.
have some clinical utilities.
(32)
areas
of
teeth.
Terahertz
systems
are
Computer- Aided Radiographic Method
relatively expensive and do not offer the
(CARM)
resolving power of radiographic examination.
This system also needs more researches to
DJH 2010; Vol.2, No.1
9
Khaleis et al.
Dental Caries…
make it possible to be inserted into the mouth
the TPI system uses only micro-watts of
for in vivo studies, while it is expected that
radiation of a type that is non-ionizing.
technological developments will improve the
Because the exposure levels from this system
systems to bring them within easy reach of
are
dentists. The coherent detection scheme of
exposure levels that occur naturally, this
system will be safer than those employing X-
of TMR depth plus an intercept of micron,
rays. Unlike radiography TPI also delivers a
whereas further calculations allowed the
spectrum of different frequencies for each
TMR depths to be determined to within 5%
pixel measured. This offers the possibility of
using TPI. (36)
using that spectrum for diagnosis that goes
These are some caries diagnosis methods
beyond
used today. In this era of evidence based
levels.
simply
measuring
mineralization
(35)
orders
of
magnitude
smaller
than
dentistry, systematic reviews and validation
Pickwell et al. compared terahertz pulsed
studies of caries detection methods have been
imaging
transmission
addressed in some studies but there is still
for
depth
need for more studies in the future to clearly
measurement of enamel demineralizations. It
determine the best and most accurate ways of
was
caries diagnosis.
(TPI)
microradiography
concluded
with
(TMR)
that
TPI
measured
demineralization in the range of 47% of that
REFERENCES
5. Hamilton JC. Should a dental explorer be used
1. Stooky GK, Jackson RD, Ferreira G, Analoui
to probe suspected carious lesions? Yes--an
M. Dental caries diagnosis. Dent Clin of North
explorer is a time-tested tool for caries detection.
Amer 1999; 43(4):665-677.
J Am Dent Assoc. 2005; 136(11):1526
2. Axelsson Per. Diagnosis and risk prediction of
6. Zandoná AF, Zero DT. Diagnostic tools for
dental caries. Chicago, Quintessence 2000; p:
early caries detection. J Am Dent Assoc 2006;
181-182, 198-199, 204, 206, 208-218.
137(12):1675-84
3. Ekstrand KR, Ricketts DN, Longbottom C,
7. Pine CM. Fibre-optic transillumination (FOTI)
Pitts NB. Visual and tactile assessment of arrested
in caries diagnosis. In: Stookey GK, ed. Early
initial enamel carious lesions: an in vivo pilot
detection of dental caries I: Proceedings of the 4th
study. Caries Res. 2005; 39(3):173-7.
Annual Indiana Conference. Indianapolis: Indiana
4. Sheehy EC, Brailsford SR, Kidd EA, Beighton
University; 1996:51–65.
D, Zoitopoulos L. Comparison between visual
8. Côrtes DF, Ellwood RP, Ekstrand KR. An in
examination and a laser fluorescence system for
vitro comparison of a combined FOTI/visual
in vivo diagnosis of occlusal caries. Caries Res.
examination of occlusal caries with other caries
2001; 35(6):421-6.
diagnostic methods and the effect of stain on their
10
DJH 2010; Vol.2, No.1
Khaleis et al.
diagnostic
Dental Caries…
performance.
Caries
Res
2003;
37(1):8–16.
for the detection of occlusal caries in primary
teeth. Int J Paediatr Dent 2008; 18(3):197-204.
9. Rousseau C, Poland S, Girkin JM, Hall AF,
Whitters CJ. Development of fibre-optic confocal
17. Rodrigues JA, Diniz MB, Josgrilberg EB,
microscopy for detection and diagnosis of dental
Cordeiro RC. In vitro comparison of laser
caries. Caries Res 2007; 41(4):245-51.
fluorescence
10. Young DA. New caries detection technologies
performance
with
visual
examination for detection of occlusal caries in
and modern caries management: Merging the
strategies. Gen Dent 2002; 50(4):320-31.
permanent and primary molars. Lasers Med Sci
11. Schneiderman A, Elbaum M, Shultz T, Keem
2009; 24(4):501-6.
S, Greenebaum M, Driller J. Assessment of dental
18. Huth KC, Lussi A, Gygax M, Thum M,
caries
with
Digital
Imaging
Fiber-Optic
Crispin A, Paschos E, Hickel R, Neuhaus KW. In
Transillumination (DIFOTI): in vitro study.
vivo performance of a laser fluorescence device
Caries Res 1997; 31(2): 103–10.
12. al-Sehaibany F, White G, Rainey JT. The use
for the approximal detection of caries in
of caries detector dye in diagnosis of occlusal
permanent molars. J Dent 2010; 38(12):1019-26.
carious lesions. J Clin Pediatr Dent 1996;
19-Stookey G.K., Jackson R.D., Zandona A.G.,
20(4):293-8.
13. Pretty I.A., Smith PW, Edgar WM, Higham
Analoui
M.:
Dental
Caries
Diagnosis.
SM. Detection of in- vitro demineralization
Dent Clin North Am. 1999 ; 43(4):665-77.
adjacent to restorations using quantative light
20. Bahrami G, Hagstrom C, wenzel A. Bitewing
induced fluorescence. Dent Mater 2003; 19: 368-
examination
with
four
digital
receptors.
374.
14. Kühnisch J, Ifland S, Tranaeus S, Hickel R,
Dentomaxillo facial Radiol 2003; 32: 317-321.
Stösser L, Heinrich-Weltzien R. In vivo detection
21. Virajsilp V, Thearmontree A, Aryatawong S,
of non-cavitated caries lesions on occlusal
Paiboonwarachat D. Comparison of proximal
surfaces by visual inspection and quantitative
caries detection in primary teeth between laser
light-induced fluorescence. Acta Odontol Scand
fluorescence and bitewing radiography. Pediatr
2007;65(3):183-8.
15. Boston DW. Initial in vitro evaluation of
Dent 2005; 27(6):493-9.
Diagnodent for detecting secondary carious
22.Forner L, Lleno MC, Almrich JM, Garcia-
lesions
associated
with
resin
composite
Godoy F. Digital radiology and image analysis for
restorations. Quintessence Int. 2003; 34(2):109approximal caries diagnosis. Oper Dent 1999;
16.
16. Kavvadia K,
Lagouvardos
P. Clinical
performance of a diode laser fluorescence device
24:312-315.
23.Haak R, Wicht MJ, Nowak G, Hellmich.
Influence of displayed imgae size on radiographic
DJH 2010; Vol.2, No.1
11
Khaleis et al.
Dental Caries…
detection of approximal caries. Dentomaxillofac
(TACT). Theory and application for three-
Radiol 2003; 32:242-246.
dimensional
24.Clifton TL, Tyndall DA, Ludlow JB. Extraoral
Dentomaxillofacial Radiology 1997; 26: 53-62.
radiographic
32. Harase Y, Araki K, Okano T. Accuracy of
imaging
of
primary
caries.
dento
–
alveolar
imaging.
Dentomaxillofac Radiol 1998; 27(4):193-8.
extraoral tuned aperture computed tomography
25.Khan EA, Tyndall DA, Caplan D. Extraoral
(TACT) for proximal caries detection. Oral Surg
imaging for proximal caries detection: Bitewing
Oral Med Oral Pathol Oral Radiol Endod 2006;
vs scanogram. Oral Surg Oral Med Oral Pathol
101(6):791-6.
Oral Radiol Endod 2004; 98(6): 730-7.
33. Albrektsson TO, Bratthall D, Glantz JP,
26.Alkurt MT, Peker I, Bala O, Altunkaynak B. In
Lindhe
vitro comparison of four different dental X-ray
treatment. London, Quintessence 2001; p: 19.
films and direct digital radiography for proximal
34.
caries detection. Oper Dent 2007; 32(5):504-9.
manipulation of intraoral radiographs to enhance
27.Daataselaar AN, Tyndall DA, Stelt PF.
diagnosis in dental practice: a review. Int Dent J
Detection
1993; 43(2):99-108.
of
caries
with
local
CT.
JT.
Wenzel
Tissue
A.
preservation
in
Computer-aided
caries
image
Dentomaxillofacial Radiol 2003; 32: 235-241.
35.
28.Daatselaar AN, Dunn SM Spoelder HJW,
Bryan E, Ciesla Craig M, Arnone D, Wallace V,
Germans DM, Renambot L, Bal HE et al.
et al. Terahertz pulse imaging: A pilot study of
Feasibility of local CT of dental tissues.
potential applications in dentistry. Caries Res
Dentomaxillofacial radiol 2003; 32:173-180.
2003; 37:352-359.
29. Daatselarr AN Van, Tyndall DA, Stelt PF
36. Pickwell E, Wallace VP, Cole BE, Ali S,
Vander. Detection of caries with local CT.
Longbottom C, Lynch RJ, Pepper M. A
Dentomaxillfac Radiol 2003;32:235-241.
comparison of terahertz pulsed imaging with
30. Http://www.inspeaktor. nl/ dental/ tmrmain.
transmission
Htm. Accessed October 26, 2010
measurement of enamel demineralisation in vitro.
31. webber RL, Horton RA, Tyndall DA, Ludlow
Caries Res 2007; 41(1):49-55.
JB.
12
Tuned
aperture
computed
Crawley David A, Longbottom C, Cole
microradiography
for
depth
tomography
DJH 2010; Vol.2, No.1