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ePaper created 2016-04-05, 13:01:42 | version 1.38.0
laser 1 2016 | research 06 Fluorescence-guided caries excavation of decayed teeth An ex vivo study Authors: ZA Martin Augenstein & Prof. Dr Matthias Frentzen, Germany Introduction The goal of caries excavation is the elimination of bacterially infected dentin to give the maximal conservation of healthy dental hard tissue as well as to maintain the vitality of the dental pulp.1 Dentin layers near the pulp which can be remin- eralised—affected dentin—should be preserved in terms of an atraumatic therapy.2, 3 There are several techniques to determine the endpoint of the excavation clinically. One of these techniques is the examination of the hardness of the cavity floor using a dental probe. For this type of test, the dental probe must not infiltrate the material further; the “Crie dentaire“ must be audible. How- ever, this test is not objectifiable and does not correlate with bacterially infected dentin.2 Addi- tionally, Fusayama et al. observed that dentin areas close to the pulp show a significantly lower hardness than dentin of a chronical carious lesion.2 Studies with dye solutions, which are supposed to mark infected dentin, do not show unambigu- ous results either, since hypomineralised dentin areas and porosities are stained as well.4 This of- ten results in an overexcavation under clinical conditions, since even non-infected hypominer- alised areas such as the dentino-enamel junction or healthy areas near the pulp are stained.5, 6 A fluorescence-based optical method may be considered an alternative.7 Optical phenomena in the tooth structure damaged by caries or the spectroscopic detection of metabolic pro ducts of a microbial infection of the dentin are used.8, 9 Examples for this procedure are the DIAGNOdent®-system,10 intraoral camera sys- tems with blue light excitation11 as well as feed- back controlled Er:YAG laser systems.12 The previ- ously-mentioned systems are difficult to imple- ment in practice. The technology is very complex. Devices which stimulate the dentin with a blue-light diode (405 nm) present an alternative; the examiner gives an evaluation with the help of filter glasses, making the fluorescence visible during the treatment of caries excavation. This treatment technique is called the FACE® method (Fluorescence Aided Caries Excava- tion).7 The present study attempts to examine histologically under ex vivo conditions whether Fig. 1: SIROInspect® with filter glasses, accessory parts and charging station (Sirona Homepage, 2014). Fig. 1 12016