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ePaper created 2018-10-24, 06:07:02 | version 1.58.2
28 Dental Tribune Middle East & Africa Edition | January - February 2014industry X-ray-free caries diagnostics in the everyday dental practice routine By KAVO A lternative, X-ray-free caries diagnostics in- struments, such as DIAGNOdent, Vista- Cam iX, Soprolife – to name but a few - have been finding their way into dental prac- tices for some years now. Up to now, however, I have not been personally convinced by any of these instruments. One reason was that integration in our existing practice systems seemed to be time consum- ing and expensive. However, the restricted diagnostic spec- trum (simultaneous detection of occlusal and proximal le- sions) also gave rise to doubts. With the desire to re-equip my practice for a more extensive prophylactic care copncept in caries diagnostics, I had an op- portunity to test a new diagnos- tic procedure (DIAGNOcam, KaVo, Biberach/Riss) more ex- tensively. The following article briefly examines the underlying tech- nology and, on the basis of spe- cific cases, shows the diagnos- tic potential of DIAGNOcam, including possible applications in relation to prophylaxis. Technologically advanced The DIAGNOcam basically re- lies on a tried & tested technol- ogy that is used today in many practices: transillumination. In contrast to conventional technology with an interden- tal light source, DIAGNOcam practically uses the entire tooth as a light propagation medium. At places where there is a cari- ous lesion which blocks light propagation, a shadow is pro- duced. This is captured by an integrated video camera that relays the images in real-time to the computer screen. The light is introduced via the gin- giva and bones at root level. According to information from the manufacturer this enables the reliable presentation of proximal and occlusal lesions. Cracks and secondary caries under fillings also show up, provided that the fillings do not exceed a certain size. The de- tachable DIAGNOcam tip can be removed and sterilized. Dif- ferent tips are available for the milk and adult teeth. Fig. 1: DIAGNOcam with USB port. Besides transmitting data to a standard computer, power is also supplied via the USB ca- ble. (picture: KaVo Dental, Bib- erach/Riss) With the DIAGNOcam soft- ware live images and stills can be viewed on a monitor and a connection established to the network and the practice man- agement software (via VDDS interface). Of course, it is also possible to use a separate (standard) laptop. Stills can be taken at any position by press- ing the switch (ring switch). There are extensive editing options available for the auto- matically saved images. First step toward X-ray-free caries diagnostics The computer and KaVo’s KiD program are started and the rubber arms of the DIAGNO- cam slide over the proximal zone of the teeth. After adjust- ment of the camera position, above all in the vertical axis and in its inclination to the tooth axis, a crisp image is ob- tained. It should be noted that a learning phase is required for proper handling of the PC screen. Especially in the proxi- mal zone, caries lesions are revealed by the DIAGNOcam, which probably would not have been possible to identify clear- ly by sight or which would not have showed up at all. By the same token, this means that I can offer my caries patients earlier and hence more effec- tive treatment. It should be noted, however, that the DIAG- NOcam cannot distinguish be- tween active and inactive car- ies. Consequently, active caries can only be differentiated from inactive caries by means of a time progression (screening) and corresponding progres- sion. With a little practice, it soon becomes a genuine pleasure to work with DIAGNOcam, which offers an additional di- agnostic tool for use in dental examinations. The enclosed guide makes it easy to learn how to interpret the images. At present, however, KaVo ad- vises against basing diagnoses solely on the DIAGNOcam, in- stead recommending that the camera be used as an auxiliary diagnostic instrument. Not- withstanding this, I have not during the test phase identified any incorrect diagnoses com- pared with X-ray diagnostics. Especially in the diagnosis of proximal caries, an improved correlation of the DIAGNOcam image with the clinical extent is apparent. Another major ad- vantage is that proximal over- laps which frequently hinder diagnosis with X-ray images, do not not occur with the DI- AGNOcam due to the nature of the system. In a workflow in accordance with manufacturer recommen- dations (visual inspection, DI- AGNOcam, X-ray image), a di- agnosis of suspected caries can be verified by the DiagnoCam, avoiding an unnecessary X-ray session. Integration in dental prophy- laxis As mentioned above, our prac- tice is undergoing expansion and reorientation to a pro- phylactic concept Even if this process is not yet complete, I would like to discuss my expe- rience to date. Fig. 2: Use of the DI- AGNOcam by den- tal hygienist After performing dental cleaning, my dental hygien- ist often reported torn floss or unclear bop’s. This usually resulted in further X- ray investigations with waiting times, at the expense of my time spent treating the patient. This situation has now changed: the problem is discussed before- hand with the patient with the dental hygienist and visually presented with the DIAGNO- cam. This significantly raises the hygienist’s status in the pa- tient’s eyes. At the same time, I can see a trust-building effect from the patient’s perspective, so that not only the dentist, but the entire treatment team con- tributes to the patient’s dental health with state-of-the-art di- agnostic procedures. I am in- volved in the next phase of the workflow and I decide on the basis of the initial images re- corded by the assistant, wheth- er I can clinically confirm the situation or take another look with the DIAGNOcam or get an X-ray taken. All my patients benefit from X- ray-radiation-free diagnostics. Especially children, pregnant women and patients who are fearful of X-rays. Especially with regard to child prophylax- is, simple screening makes an enormous and very welcome contribution to keep the teeth of young children healthy. Cost-effectiveness presenta- tion of this diagnostic method With the introduction of the DI- AGNOcam as an integral part of the treatment, I have raised the original price for professional dental hygiene treatment by €12 (comparable rö2 BEMA). A short, conservative calculation makes it clear that the invest- ment in the device pays off in a very short time. The additional time expenditure in prophy- laxis is low and acceptable. A flat-rate allowance for running costs for the DIAGNOcam of €1,000/year is integrated in the below calculation. Calculation of DIAGNOcam in prophylaxis The procurement costs of the DIAGNOcam are around €4,800€ plus sales tax. Ac- cording to the above estimate, the investment pays off in the course of the first year, without taking into account deprecia- tion. The acceptance for an ad- ditional charge of €12 for the use DIAGNOcam (especially when included in the dental hygiene session) is very high. In addition, it can be seen that the the proportion of cases de- manding treatment in adhesive filling therapy (with average time outlay) increases. This is least costly for patients that a later treatment, usually with more extensive and expen- sive treatments. At the same the profitability for the dentist remains the same or may, de- pending on the practice struc- ture, even be increased, as few- er laboratory made prosthetics are needed, for example, and the turnover generated thus remains in the practice. I have not been able to determine in the test period to what extent this positively influences the calculation. General conclusion We Swabians have a reputa- tion for being a rather under- stated lot. It is therefore it does not easily to me to say what an enormous gain this has been for my practice. No more than I can claim the opposite. First and foremost, the increase in the quality of caries diagnostics should be mentioned. I identify more and can therefore treat my patients at an early stage. This not only gives me, as a practitioner, a good feeling but also the patient who feels well taken care of. X-ray images are certainly (still) considered to be the gold standard. However, now and again it is difficult to convince especially critical pa- tients (such as the parents of very young patients)about X- rays. Our dental hygienists are very happy to be able to inte- grate the DIAGNOcam in their treatment. Summing up, in my opinion the introduction of the DIAGNOcam has significantly enhanced our practice, both financially and in terms of in- tangible values. Clinical case study Case 1: proximal caries in an upper molar Fig. 3: initial situation Fig. 4: DIAGNOcam Fig. 5: X-ray image Fig. 6: cavity prepared Fig. 7: filling with SONICfill The clinical investigation of an upper molar does not provide any evidence of the presence of carious processes in the me- sial contact zone (Fig. 3). In contrast, in the DIAGNOcam image (Fig. 4) a broad shadow zone can be seen which has al- ready extended to the enamel- dentine boundary. The bitewing image (Fig. 5) only reveals a extremely faint lightness of this area. After opening a carious process was revealed (Fig. 6), which was treated after excavation and preparation with the SONICfill system (Fig. 7). Figure 1 Figure 3 Figure 5 Figure 7 Figure 2 Figure 4 Figure 6 KaVo Dental GmbH Alexia Valera 9th Floor Rotana Arjaan Tower Dubai Media City, UAE Tel. +971 4 4332186 Mob. +971 56 1757141 E-Mail: alexia.valera@kavo.com www.kavo.com/MEA Contact Information