DIAGNOdent

Laser Fluorescence System

The DIAGNOdent laser fluorescence system can give practitioners answers about hidden caries—painlessly, noninvasively, and reliably.

Is it caries or is it a healthy tooth? Hidden caries present a treatment dilemma for dentists: go ahead with exploratory excavation? What if there are no caries after opening? Alternatively, should the tooth only be observed—with the accompanying risk of giving caries more time to damage the tooth?

When it comes to hidden caries, traditional diagnostic methods often cannot provide definitive answers. While preventive dental programs and fluoridation have decreased the incidence and prevalence of dental caries in children and adolescents,^1-4 they have changed the pattern of caries distribution, with an increase in the proportion of occlusal caries.^5-10 With caries appearing later, occlusal surfaces that appear clinically healthy and apparently intact may hide lesions that penetrate the dentin.¹¹ Early detection and determination of caries lesion depth can mean the difference between preventive treatment and future surgical intervention. Studies have shown that the diagnosis of occlusal caries without cavities is difficult and frequently results in false-negative and false-positive findings.¹¹

A Problem Solver

That’s where DIAGNOdent comes in. Launched in Europe in 1998, this laser detection aid sees into occlusal pits and fissures, enabling dentists to confidently treat subsurface caries lesions. Years of research on the topic of laser fluorescence detection are behind DIAGNOdent. Many different wavelengths of light were tested for a variety of diagnostic modalities, but it was the patented 655 nm wavelength that proved to have the highest degree of sensitivity (ability to detect disease) and specificity (ability to detect true disease without falsepositives). DIAGNOdent’s accuracy and reliability make it a valuable adjunct to caries detection, allowing practitioners to provide a higher level of patient care. DIAGNOdent received ap proval from the Food and Drug Admin istration and was launched in the United States in February 2000. Since then, DIAGNOdent has won many pro fessional and industry awards for its ability to detect early-stage caries lesions so that teeth can be treated with minimal intervention.

Indications

DIAGNOdent is an aid to detecting caries that supplements the clinicians’ visual observations, knowledge of patient history, and information gathered from other diagnostic methods. DIAGNOdent, along with these clinical observations, assists dentists in making overall risk assessment and treatment determination. DIAGNOdent is designed for use as an aid in detecting caries and in monitoring or arresting the progression of caries by comparing a patient’s readings from visit to visit. However, DIAGNOdent should not be viewed as an indicator of the depth to which the clinician should excavate.

How DIAGNOdent Works

DIAGNOdent uses laser technology to detect and quantify hidden or subsurface caries by measuring laser fluorescence within the tooth structure. At a wavelength of 655 nm, clean, healthy tooth structures show little or no fluorescence, resulting in very low readings on the device’s display. Altered tooth surfaces and bacteria, including caries, will fluoresce. DIAGNOdent will show elevated scale readings on the display. In addition to the visual display, an audio tone will sound to indicate changes in the scale values.
Before using DIAGNOdent, the dentist should take a medical history and obtain information on the patient’s diet, oral hygiene, and past caries history. If available, radiographs should be examined and an initial dental exam should be performed, including a visual examination (if possible, using magnification and an intraoral camera). In addition, a risk assessment of the patient should be formed.
DIAGNOdent must be calibrated with the selected probe tip before use, and a patient-specific zero base line must be established. Before using DIAGNOdent, the patient’s teeth must be cleaned and dried. Suspicious tooth surfaces requiring further examination with DIAGNOdent can then be identified.

How Features

• DIAGNOdent is 90% accurate in detecting lesions not detectable with an explorer or bitewing x-rays. Its precise measurements allow objective monitoring of caries and prevent exploratory excavation or undertreatment.
• It is lightweight, compact, and port - able, and uses only light energy. The device poses no danger to staff or patients.
• Ideal for use during new patient exams and regular hygiene appointments.
• Encourages patient interaction and education; patients can hold the unit during scanning while operator and patient monitor the display.
• Can be battery operated for complete mobility.
• Storage/sterilization cassette has 4 occlusal tips.
• Detachable and sterilizable handpiece sheath and tips.
• Complete, easy-to-follow instructions are provided.

Continuing Innovation

DIAGNOdent is now available in a cordless Pen version, and recently the DIAGNOdent Perio Probe was introduced as an aid in the detection of subgingival calculus. The new Perio Probe detects calculus in periodontal pockets up to 9 mm deep and quantifies levels acoustically and visually, allowing for tracking over time. The Perio Probe detects 82% of subgingival calculus deposits. DIAGNOdent represents such a profound improvement over traditional caries detection tools that it has been integrated into the curriculum of leading dental schools. In addition, it is part of the standard examination protocol in more than 20,000 US dental practices. —Monica Roy Smith

References

1. Alwas-Danowska HM, Plasschaert AJ, Suliborski S, Verdonschot EH. Reliability and validity issues of laser fluorescence measurements in occlusal caries diagnosis. J Dent 2003;30:129-134.
2. Anttonen V, Seppa L, Hausen H. Clinical study of the use of the laser fluorescence device DIAGNOdent for detection of occlusal caries in children. Caries Res 2003;37:17-23.
3. Biesbrock AR, Chesters RK, Ellwood RP, Smith SR. The challenges of validating diagnostic methods relative to a conventional two-year caries clinical trial. J Dent Res 2004;83(special no. C):C53-C55.
4. Whelton H. Overview of the impact of changing global patterns of dental caries experience on caries clinical trials. J Dent Res 2004;83(special no. C):C29-C34.
5. Lussi A. Validity of diagnostic and treatment decisions of fissure caries. Caries Res 1991;25:296-303.
6. Kidd EA, Joyston-Bechal S, Beighton D. Microbiological validation of assessment of caries activity during cavity preparation. Caries Res 1993;27:402-408.
7. Pitts NB. Diagnostic tools and measurements: impact on appropriate care. Community Dent Oral Epidemiol 1997;25:24-35.
8. Shellis RP. Relationship between human enamel structure and the formation of carieslike lesions in vitro. Arch Oral Biol 1984;29:975-981.
9. Ashley P. Diagnosis of occlusal caries in primary teeth. Int J Paediatr Dent 2000;10:166-171.
10.Wenzel A. Bitewing and digital bitewing radiography for detection of caries lesions. J Dent Res 2004; 83(special no. C):C72-C75.
11. Barberia E, Maroto M, Arenas M, Cardoso Silva C. A clinical study of caries diagnosis with a laser fluorescence system. JADA 2008;139:572-579.