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ePaper created 2016-04-05, 13:01:42 | version 1.38.0
| research laser 1 2016 08 and was photographed through a high-pass filter which had the same properties as the filter glasses of the goggles (Figs. 2a, d, g and 3a, d, g). This filter system only lets waves with a wavelength larger than 500 nm pass. Subsequently, an access cavity was prepared with a diamond bur and the carious changed tissues were excavated with a carbide bur with 1,600 rpm using the laser system accord ing to the manufacturer information until no more red fluorescent dentin was visible. The ex- aminer used magnifying glasses to control the treatment. An X-ray and photographic documen- tation as well as a fluorescence image of the tooth were made according to the initial photographs (Figs. 2c, f, h and 3). The teeth were stored in iso- tonic saline solution during all steps of the exam- ination. Before histological thin-section prepara- tions were made, the teeth were stored in forma- lin solution (4 %) and stained with rhodamine fuchsine fast green. Overview pictures were made of all dental probes with a magnification of six times (Figs. 2i and 3i). The identification of histo- logical caries zones (Fig. 4), until which an exca- vation was performed under the control of the laser system, was carried out at a magnification of 12 times and 18 times respectively. Untreated teeth with cavitated decayed lesions served as histological reference. Results In 93 % of the teeth with cavitated caries lesions, red fluorescence were detected in the area of the lesion. Two samples did not show red fluorescent features, but only fluoresced in the brownish spectral range. These two teeth were also excavated until there was no more brownish fluorescence. The sections of these teeth did not show any abnormalities of structure in the pe- riphery of the carious lesions. The X-rays revealed a complete excavation for all teeth. 96 % of the teeth were identified histo- logically free from bacteria (Figs. 2 and 3). In 37 % of the samples, parts of sclerotic dentin were preserved. After the excavation using the laser system, carious dentin (microbiological contami- nation) was identified histologically only in one sample. Discussion In2002,Lennonetal.alreadyexaminedwhether red fluorescence corresponds to bacterially in- fected dental hard tissue.7 In his study, the FACE® method was compared to other methods of exca- vation. DNA labeling of the samples was assessed by means of CLSM (Confocal Laser Scanning Mi- croscopy)asobjectiveevidence.Thestudyshowed a sensitivity of 94 % and a specificity of 83 % for the FACE® method. The results of a conventional excavation method were distinctly below those values and the excavation method using carious detector dye were rated the worst with 65 % for sensitivity and a were only 17 % for specificity.7 Another significant finding is that if there was a Fig. 3 a–i: Case example II— Documentation of a tooth sample in process of the examination; before excavation a daylight shot and a fluorescene shot (through a high-pass filter > 500 nm) of the cavitated decayed lesion were taken; intermediate steps (b), (e) as well as the complete excavation (c), (f) using the SIROInspect® were documented; additionally X-rays were taken after extraction and after the complete treatment (g), (h); the histological examination of the thin sections was evaluated microscopically (i). Fig. 3d Fig. 3f Fig. 3h Fig. 3g Fig. 3i Fig. 3b Fig. 3a Fig. 3c Fig. 3e 12016