COMPARISON OF DIFFERENT METHODS OF EXCAVATION CONTROL FOR MINIMALLY INVASIVE CARIES TREATMENT
Table 1 . Distribution of the extracted teeth included in the experiment
Control method Up to affected dentine
Mechanical excavation
Up to healthy dentine
Visual / tactile ( Bjørndal ) Group 1 Group 2
Fluorescence with Facelight Group 3 Group 4
Table 2 . Criteria for evaluating dentine Visual criteria - color of dentine black
dark brown light brown yellow light yellow
Tactile criteria [ with dental probe ] - dentine texture
very soft dentine - the probe penetrates easily and flakes off pieces of it ; soft dentine - the probe penetrates and leaves the dentine without resistance ; medium-hard dentine - slight resistance when probing ; hard dentine - when driving on dentine light resistance and a white trail remains ; hard non carious dentine - when probing slightly creaking and resistance . properties ( relatively preserved three-dimensional collagen structure , preserved intrafibrillar mineral ). In practice the most often method applied to control the excavation is the classical - visual and tactile , assessing the color and texture of carious dentine . The method is highly subjective , and requires the development of other methods to control the excavation by staining with dyes , by stimulating of the dental structures ’ fluorescence etc . 1 , 8 , 9 In recent years FACE ( Fluorescence Aided Caries Excavation ) technology was established as an innovative method for the detection of infected dentine . It uses the principle of fluorescence , wherein a substance by light of a certain wavelength ( most often in the blue or ultraviolet range , it can be also laser light ) irradiated is and it absorbs the photons , which secondarily emits to a longer wavelength light . Control of excavation is based on different fluorescence of various dental tissues and on red fluorescence of bacterial products . 10 Such a device is Facelight light probe ( W & H Dentalwerk Bürmoos GmbH , Bürmoos , Austria ), where the tooth is illuminated with violet light ( 405 nm ). Infected dentine can be seen in red and healthy structures in green color . 7 SOPROLIFE ( SOPRO ACTEON Imaging , La Ciotat cedex , France ) is a similar device consisting of an intraoral camera with the capability of high magnification device for detecting caries by black green fluorescence due to the loss of mineral and control excavation in dentine . 11 , 12 There are studies that use a diode laser fluorescence ( DIAGNOdent pen , KaVo Dental GmbH , Biberach , Germany ) to control the excavation of carious dentine not with standing that the apparatus itself is designed primarily for the diagnosis of initial carious lesions . 9 , 13 Comparative studies with regard to accuracy , sensitivity and specificity of various methods for assessment of the residual dentine have been conducted . Usually these are in vitro experiments on extracted teeth , where as a standard a histological findings , visualized by confocal microscopy , scanning electron microscopy or confocal laser scanning microscopy , etc . are evaluated . 14 , 15 The results give priority to the modern fluorescent techniques that objectify in best way the infected dentine and give the possibility of minimally invasive excavation in
11 , 16 , 17
the deep dentinal caries treatment . The purpose of this study is to investigate changes in the in-depth dentine color at mechanical caries excavation using two in vitro control methods , the visual and tactil and the fluorescence with Facelight .
2 . Material and methods
The subject of our experiment were 32 extracted teeth with similar sized dentinal occlusal or proximal carious lesions ( D3 ), divided into 4 groups oof 8 teeth each ( Table 1 ). During the excavation , the samples were evaluated clinically by two methods : A visual tactile method 18 and the fluorescence method with a caries detector - Facelight ( W & H Dentalwerk Bürmoos GmbH , Bürmoos , Austria ) - an innovative method for detection of infected dentine , in which the tooth is illuminated with violet light up to 405 nm . Glasses with filter up to 500 nm of the optical spectrum are used . Infected dentine can be seen in red and healthy structures in green-like color . The criteria used for dentin evaluation are presented in Table 2 . We used the following criteria for healthy and affected dentine specified in our previous study . 19 Criteria for excavation up to healthy dentine ( Table 2 ):
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