Klaus W. Neuhaus

Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars

OBJECTIVES To determine the clinical performance of a laser fluorescence device (DIAGNOdent pen, KaVo) to discriminate between different occlusal caries depths (D(0)-D(1-4); D(0-2)-D(3,4)) in permanent molars. METHODS In this prospective, randomized two-centre-study 120 sound/uncavitated carious sites in 120 patients were measured after visual and radiographic caries assessment. In cases of operative intervention (n=86), the lesion depths after caries removal were recorded (reference). In cases of preventive intervention (n=34), the sites were reassessed visually/radiographically after 12 months to verify the status assessed before (reference). The discrimination performance was determined statistically (Mann-Whitney test, Spearmans rho coefficient, and areas under the receiver operating characteristic curves (AUCs)). Sensitivities (SE) and specificities (SP) were plotted as a function of the measured values and cut-off values for the mentioned thresholds suggested. RESULTS Sound sites (n=13) had significantly minor fluorescence values than carious sites (n=107) (P<0.0001) as had sites with no/enamel caries (n=63) compared to dentinal caries (n=57). The AUCs for the same discriminations were 0.92 and 0.78 (P<0.001). For the D(0)-D(1-4) threshold, a cut-off at a value of 12 (SE: 0.88, SP: 0.85) and for the D(0-2)-D(3,4) threshold at 25 (SE: 0.67, SP: 0.79) can be suggested. A moderate positive correlation between the measurements and the caries depths was calculated (rho=+0.57, P=0.01). CONCLUSION Within this study, the devices discrimination performance for different caries depths was moderate to very good and it may be recommended as adjunct tool in the diagnosis of occlusal caries.

Preventing erosion with novel agents

OBJECTIVES This in vitro study aimed to investigate the protective effect of four commercial novel agents against erosion. METHODS Ninety human molars were distributed into 9 groups, and after incubation in human saliva for 2 h, a pellicle was formed. Subsequently, the specimens were submitted to demineralization (orange juice, pH 3.6, 3 min) and remineralization (paste slurry containing one of the tested novel agents, 3 min) cycles, two times per day, for 4 days. The tested agents were: (1) DenShield Tooth; active ingredient: 7.5% W/W NovaMin(®) (calcium sodium phosphosilicate); (2) Nanosensitive hca; active ingredient: 7.5% W/W NovaMin(®); (3) GC Tooth Mousse; active ingredient: 10% Recaldent™ (CPP-ACP); (4) GC MI Paste Plus; active ingredients: 10% Recaldent™, 900 ppm fluoride. Two experimental procedures were performed: in procedure 1, the tested agents were applied prior to the erosive attack, and in procedure 2 after the erosive attack. A control group receiving no prophylactic treatment was included. Surface nanohardness (SNH) of enamel specimens was measured after pellicle formation and after completion of daily cyclic treatment. RESULTS SNH significantly decreased at the end of the experiment for all groups (p<0.05). In both procedures, there was no statistically significant difference between the control group and those treated with paste slurries (p>0.05). In addition, the changes in SNH (ΔSNH=SNHbaseline-SNHfinal) did not show statistically significant difference between both procedures (p>0.05). CONCLUSION Tooth erosion cannot be prevented or repaired by these novel agents, regardless of fluoride content.

Performance of laser fluorescence devices, visual and radiographic examination for the detection of occlusal caries in primary molars

The aim of this in vitro study was to compare the performance of two laser fluorescence devices (LF, LFpen), conventional visual criteria (VE), ICDAS and radiographic examination on occlusal surfaces of primary teeth. Thirty-seven primary human molars were selected from a pool of extracted teeth, which were stored frozen at −20°C until use. Teeth were assessed twice by two experienced examiners using laser fluorescence devices (LF and LFpen), conventional visual criteria, ICDAS and bitewing radiographs, with a 2-week interval between measurements. After measurement, the teeth were histologically prepared and assessed for caries extension. The highest sensitivity was observed for ICDAS at D1 and D3 thresholds, with no statistically significant difference when compared to the LF devices, except at the D3 threshold. Bitewing radiographs presented the lowest values of sensitivity. Specificity at D1 was higher for LFpen (0.90) and for VE at D3 (0.94). When VE was combined with LFpen the post-test probabilities were the highest (94.0% and 89.2% at D1 and D3 thresholds, respectively). High values were observed for the combination of ICDAS and LFpen (92.0% and 80.0%, respectively). LF and LFpen showed the highest values of ICC for interexaminer reproducibility. However, regarding ICDAS, BW and VE, intraexaminer reproducibility was not the same for the two examiners. After primary visual inspection using ICDAS or not, the use of LFpen may aid in the detection of occlusal caries in primary teeth. Bitewing radiographs may be indicated only for approximal caries detection.

Prevention of crown and root caries in adults

Dental caries remains a significant challenge in oral health care. This review discusses current evidence regarding methods for the prevention of caries in adults, with particular emphasis on the control and reduction of dietary carbohydrates, the modification and reduction of cariogenic dental biofilm, the inhibition of de-mineralization and promotion of re-mineralization, and micro-invasive ⁄ minimally invasive technologies. In order to assess the efficacy of various caries preventive strategies, the caries increment, i.e. the number of new lesions per year, was the outcome parameter of choice when available. Relevant literature was identified by searching the Cochrane Library and PubMed using the MeSH terms dental caries or root caries in combination with one

In vivo performance of a laser fluorescence device for the approximal detection of caries in permanent molars.

OBJECTIVES The aim of this randomised clinical trial was to investigate if a laser fluorescence device is able to discriminate between sound and carious approximal sites and between enamel and dentinal lesions, as well as to find appropriate cut-off values. METHODS One hundred and seventeen sound or uncavitated carious sites in permanent molars were visually and radiographically examined, then either opened or not, after which their laser fluorescence was measured. Forty-three lesions were opened, the caries removed and the clinically identified caries depths were registered in addition to the radiographical scoring. Seventy-four sites were radiographically deemed sound or had enamel caries and were not opened. Here, the radiographical scorings were registered. RESULTS Taking the radiographic scoring as gold standard for all investigated approximal sites, sound sites (D(0), n=40) showed significantly lower laser fluorescence measurements than carious sites (D(1-4), n=77) (Mann-Whitney test, P<0.025) suggesting a cut-off at 7 (sensitivity=0.68, specificity=0.7). Comparing measurements of D(0-2) (n=74) and D(3,4) (n=43), the results were also different by a statistically significant amount (P<0.025) and the cut-off calculated to be 16 (sensitivity=0.6, specificity=0.84). A fair positive correlation between laser fluorescence values and radiographical scoring was found (rho=+0.47, P<0.01). Analysing the 43 opened lesions with their clinically found lesion depths as gold standard, there was a fair positive correlation to the laser fluorescence values (rho=+0.34, P=0.03) and a moderately strong correlation to the radiographic scoring (rho=+0.67, P<0.01). CONCLUSION The device may be an adjunct tool in the approximal detection of caries along with established procedures.

Light-emitting diode and laser fluorescence-based devices in detecting occlusal caries

The aim of this study was to assess the performance of two light-emitting diode (LED)- and two laser fluorescence-based devices in detecting occlusal caries in vitro. Ninety-seven permanent molars were assessed twice by two examiners using two LED- (Midwest Caries - MID and VistaProof - VP) and two laser fluorescence-based (DIAGNOdent 2095 - LF and DIAGNOdent pen 2190 - LFpen) devices. After measuring, the teeth were histologically prepared and classified according to lesion extension. At D1 the specificities were 0.76 (LF and LFpen), 0.94 (MID), and 0.70 (VP); the sensitivities were 0.70 (LF), 0.62 (LFpen), 0.31 (MID), and 0.75 (VP). At D(3) threshold the specificities were 0.88 (LF), 0.87 (LFpen), 0.90 (MID), and 0.70 (VP); the sensitivities were 0.63 (LF and LFpen), 0.70 (MID), and 0.96 (VP). Spearmans rank correlations with histology were 0.56 (LF), 0.51 (LFpen), 0.55 (MID), and 0.58 (VP). Inter- and intraexaminer ICC values were high and varied from 0.83 to 0.90. Both LF devices seemed to be useful auxiliary tools to the conventional methods, presenting good reproducibility and better accuracy at D(3) threshold. MID was not able to differentiate sound surfaces from enamel caries and VP still needs improvement on the cut-off limits for its use.

Effectiveness of a calcium sodium phosphosilicate containing prophylaxis paste in reducing dentine hypersensitivity immediately and 4 weeks after a single application: a double‐blind randomized controlled trial

Aims The aim of this single-site, randomized, controlled, double-blind, 3-arm parallel study was to determine the effectiveness of a prophylaxis paste containing 15% calcium sodium phosphosilicate (CSPS; NovaMin®) with and without fluoride in reducing dentine hypersensitivity immediately after a single application and 28 days following dental scaling and root planing. Materials & Methods Overall, 151 subjects were enrolled in this study. All subjects received a scaling and root planing procedure followed by a final prophylaxis step using one of three different prophylaxis pastes: Test-A (15% NovaMin® and NaF), Test-B (15% NovaMin®) and a control. Dentine hypersensitivity was assessed by tactile stimulus (Yeaple Probe®) and by air blast (Schiff scale) at baseline, immediately after and 28 days after a prophylaxis procedure. One hundred and forty-nine subjects completed the study. Results Subjects having received the test prophylaxis pastes showed statistically lower (anova, p < 0.05) dentine hypersensitivity compared with the control group immediately after the prophylaxis procedure (Yeaple Probe®: Test-A = 20.9 ± 12.6, Test-B = 22.7 ± 12.9, Control=11.2 ± 3.1; Schiff score: Test-A = 1.1 ± 0.6, Test-B = 1.1 ± 0.6, Control = 2.0 ± 0.7) and after 28 days (Yeaple probe: Test-A = 21.5 ± 11.9, Test-B = 20.6 ± 11.3, Control = 11.8 ± 6.0; Schiff score: Test-A = 1.0 ± 0.6, Test-B = 1.0 ± 0.6, Control = 2.0 ± 0.7). Conclusions In conclusion, the single application of both fluoridated and non-fluoridated prophylaxis pastes containing 15% CSPS (NovaMin®) provided a significant reduction of dentine hypersensitivity up to at least 28 days.

Infiltration of natural caries lesions in relation to their activity status and acid pretreatment in vitro.

This study aimed at testing how active and inactive enamel caries lesions differ by their degree of resin infiltration, and whether the choice of acid pretreatment plays a crucial role. Four examiners assessed 104 human molars and premolars with noncavitated enamel lesions and classified them as ‘active’ or ‘inactive’ using the Nyvad criteria. Forty-five teeth were included in this study after independent unanimous lesion activity assessment. Lesions were cut perpendicularly into 2 halves. Each half lesion was pretreated with either 15% hydrochloric acid or 35% phosphoric acid. The lesions were infiltrated after staining with rhodamine isothiocyanate. Thin sections of 100 µm were prepared and the specimens were bleached with 30% hydrogen peroxide. The specimens were then counterstained with sodium fluorescein, subjected to confocal laser scanning microscopy and analyzed quantitatively. Outcome parameters were maximum and average infiltration depths as well as relative penetration depths and areas. In active lesions no significant difference of percentage maximum penetration depth and percentage average penetration depth between lesions pretreated with hydrochloric or phosphoric acid could be observed. In inactive lesions, however, phosphoric acid pretreatment resulted in significantly lower penetration compared to hydrochloric acid pretreatment. Surface conditioning with hydrochloric acid led to similar infiltration results in active and inactive lesions. Moreover, inactive lesions showed greater variability in all assessed infiltration parameters than did active lesions. In conclusion, caries lesion activity and acid pretreatment both influenced the infiltration. The use of phosphoric acid to increase permeability of the surface layer of active lesions should be further explored.

Late Infiltration of Post-orthodontic White Spot Lesions

AbstractWhite spot lesion (WSL) infiltration has been recommended immediately after debonding of orthodontic brackets. It is however not clear if established inactive WSLs can also be masked through infiltrationOrthodontic treatment of a 19-year-old patient had to be terminated prematurely due to development of multiple WSLs of varying severity. Three months after debonding, the patient presented for lesion infiltration. After etching with 15% HCl gel and re-wetting of the dried surfaces it seemed that a good outcome could be expected. Lesion infiltration led to complete masking of less severe WSLs. The visual appearance of moderate and severe WSLs was improved but they were still visible after treatment.Inactive WSLs may not represent an increased caries risk, but patients are often bothered esthetically. Infiltration by repeated etching might be a viable approach even for inactive WSLs. Controlled clinical trials are needed to investigate the long-term performance of this technique.ZusammenfassungDie Infiltration initialer kariöser Läsionen (Kreideflecke, White- Spot-Läsionen) wird unmittelbar nach der Entfernung kieferorthopädischer Brackets empfohlen. Es ist jedoch unklar, ob auch etablierte Kreideflecken durch Infiltration maskiert werden können.Bei einem 19-jährigen Patienten musste die festsitzende orthodontische Phase wegen Auftretens multipler initial kariöser Läsionen vorzeitig beendet werden. Drei Monate nach der Entfernung der Brackets wurde der Patient zur Infiltration vorstellig. Nach dem Ätzen mit 15%igem HCl-Gel konnte durch gezieltes Wiederbefeuchten der getrockneten Zahnoberflächen das zu erwartende Ergebnis antizipiert werden. Die Infiltrationstechnik führte zur vollständigen Maskierung weniger stark ausgeprägter Kreideflecke. Stärker demineralisierte Läsionen wurden optisch verbessert, waren aber nach der Behandlung noch immer sichtbar.Inaktive Kreideflecke sprechen nicht unbedingt für ein erhöhtes Kariesrisiko, aber Patienten stören sich häufig an der kosmetischen Einbuße. Die Infiltration dieser Läsionen mit multiplen Ätzschritten könnte auch für inaktive Kreideflecke sinnvoll sein. Es fehlen jedoch Langzeitdaten aus klinischen Untersuchungen zur Validierung dieser Methode.

Prosthetic rehabilitation and treatment outcome of partially edentulous patients with severe tooth wear: 3-years results

OBJECTIVES The purpose of this study was to report on the management and treatment outcomes of partially edentulous elderly patients with severe tooth wear. METHODS Partially edentulous patients with severe tooth wear who underwent the same protocols for full prosthodontic rehabilitation were eligible for this observational study. Their clinical diagnoses were based on a complete oral examination, photos, functional and cast analysis, general health conditions and behavioural aspects, such as acidic diets and bruxism. A 6-month preliminary phase with splints and provisional prostheses was maintained prior to the final fabrication of fixed and removable prostheses. All patients completed a follow-up period of ≥3years. The outcomes were technical and biological complications with the prosthesis (wear or fracture of anchorage, abutment, prosthesis core or veneering, and implants, plaque index, caries, endodontic and periodontal lesions, tooth fractures and periimplantitis) and oral health-related quality of life (using the oral health impact profile questionnaire, German version of OHIP G-14). RESULTS Data from 42 patients (33 men, 9 women) with a mean age of 62±8years were available. The probability that a first, second or third technical complication occurred was 49%, 38% and 21%, respectively. About 50% of the patients remained without any complication. The average OHIP-value was 5±7, which represents high oral health-related quality of life. No statistically significant correlations between the OHIP values and the type of prostheses or the occurrence of complications were observed. CONCLUSIONS From multiple perspectives, the rehabilitation of partially edentulous patients with severe tooth wear is a complex task, and more information regarding treatment protocols, prosthetic indications and treatment outcome is needed.