ALL RECENT DIGITAL

TECHNIQUES,
EQUIPMENTS USED IN
DIAGNOSIS, TREATMENT
PLAN
 Clinical examination of caries

◦ Visual method
Visual changes in tooth surface texture or color.
◦ Visual- tactile method
Tactile sensation when an explorer is used
◦ Radiograph
Panorama
Bite0wing
Periapical
◦ Dental floss
Proximal surface caries
◦ Trans-illumination
Proximal surface caries, if other than incipient, shows up as a
dark area along the marginal ridge when light is directed
through the tooth
Caries in the pits & fissures
◦ Caries occurring in the pits & fissures are detected with explorer that provides
catch or resistance to removal or tug-back, indicates a carious fissure or has
the probability of becoming carious.
◦ - It may be difficult to distinguish deep non-carious / stained groove from
carious fissure.
◦ When caries invades the proximal surface enamel and demineralized the dentin, a
white chalky appearance or a shadow under the marginal ridge may become
evident. Careful probing with a sharp explorer on the proximal surfaces may
detect catch or cavitation.
◦ - When the marginal ridge breaks, cavitation occurs.
Incipient Caires
◦ Incipient Caires occur mainly in gingival areas that are least accessible to
cleaning.
◦ - A white spot that is visually different from the adjacent translucent enamel &
will partially or totally disappear from vision by wetting, while drying again will
cause it to reappear.
◦ This disappearing-reappearing phenomenon distinguishes it from the white
spot resulting from developmental hypocalcification.
◦ - Both types of white spots are undetectable by tactile sensation because the
surface is intact, smooth and hard.
Arrested lesions
◦ Brown spots on intact, hard proximal surface enamel adjacent or gingival to the
contact area are often seen in older patients whose caries activity is low.
◦ - These discolored areas are evidence of former incipient carious enamel lesions
that have remineralized & stained with extrinsic staining & restorative
treatment is usually not indicated
Digital Diagnostic Aids
Intra-oral camera
Digital Radiographs
Cone Beam-Computed Tomography
Digital Transillumination
Light-Induced Fluorescence
Laser-Induced Fluorescence
Electric-Based Diagnostic Aids
intra-oral camera
◦ It is a camera placed inside the oral cavity to have an intra-oral image displayed on a screen. It improves
visual access to the oral cavity, improves lighting and magnification. It facilitates patient education about
his oral health.
Direct digital radiography
◦ digital radiographic methods for caries diagnosis was developed to increase reproducibility and accuracy
of radiographic caries inspite of its high cost.

◦ The advantages of digital radiography over conventional radiography:

(1) Ease of manipulation of contrast and density.
(2) Lower exposure of radiation.
(3) Absence of dark room and processing solutions.
(4) It takes less time for imaging.
(5) Image storage and communication is easier.
 fiber-optic transillumination
◦ Fiber-optic transillumination (FOTI) has been introduced as a qualitative diagnostic method by which
teeth are transilluminated. The observation of shadows has been associated with the presence of caries
lesion. Digital imaging fiber optic transillumination (DIFOTI) was introduced to improve the sensitivity
of (FOTI) by replacing the human eye with a charge couple device (CCD). The image displayed on a
monitor screen in the form of different color values according to the degree of demineralization. The
transilluminated image is interpreted by the computer using mechanical rules. This quantitative method
has high sensitivity and specificity. It detects incipient and frank caries as well as fractures.
CariVu
◦ CariVu- Compact, Portable Caries Detection Device
● DEXIS CariVu is a compact, portable caries detection device that uses
transillumination technology to support the identification of occlusal, interproximal
and recurrent carious lesions and cracks.
•Uses transillumination technology that makes enamel appear transparent while
porous lesions trap and absorb light
•Allows the clinician to see through the tooth, exposing its structure and the
development of any carious lesions
•CariVu images read like familiar X-ray images
•Uses non-ionizing radiation which is ideal for children, pregnant women
and cancer patients who are X-ray averse
Light-Induced Fluorescence
• Detection of carious lesion & quantifying mineral loss
• determine if a lesion is active or not, and predict the likely progression of any given
lesion
• Caries lesions appear dark when viewed with QLF
• Other things can be detected and quantified also, like
dental plaque, calculus and staining.
Laser-Induced Fluorescence
• the fluorescence light irradiation use to discriminate between carious and sound
enamel.
• DIAGNODENT:
It is a portable diode laser device.
It operates- infra red light from a diode laser
light- transmitted - descendent optic fiber to a hand-held probe- surface of tooth
If the reading is 21-100 - definite area of decay require operative intervention.
5-25: initial lesions
25-35: early dentinal caries
> 35: advanced dentinal caries
Electrical caries monitor ECM
◦ This technique is based on the electrical conductivity differences between sound
and carious dental tissues.
◦ High measurements indicate well- mineralized tissue while low values indicate
demineralized tissue.
◦ The recording dial shows number from 0 to 10. When the value exceeds 5, this indicates that there is
sufficient demineralization
◦ A major advantage of the ECM is to present objective readings, which have the
potential for monitoring lesion progression, arrest, or remineralization.
MIDWEST CARIES I.D
MID is a small, battery-operated technology that emits a soft LED light for detecting
caries. A specific fiber optic signature captures the resulting reflection and refraction
of the light in the tooth and is converted to electrical signals that run through a
computer-based algorithm for analyzing the presence of caries
Ultrasonic caries detection
◦ In dentistry, ultrasound has been used to image the tooth and to find caries lesion on smooth surfaces. It
was concluded from this initial study that results showed great promise for ultrasound caries detection for
approximal surfaces.
◦ Diagnosis of carious lesion:
◦ Occlusal surface
◦ Proximal surface
◦ Facial and lingual surfaces
◦ Root surface.
 INTRODUCTION

• Conventional procedures of cavity preparation

with low and high-speed handpieces produce
noise, uncomfortable vibrations and stress for
patients.

• Lasers were introduced with a hope to

overcome the drawbacks posed by the
conventional dental procedures.
Carmen dm Todea. Laser applications in
conservative dentistry. TMJ; 20014:54:4:392-
 Dental Laser As An Alternative Treatment
Tool At Time Of Coronavirus Pandemic
• Dental lasers generate significantly reduced levels of aerosols and
droplets compared to high speed dental headpieces and ultrasonic
instruments.

• As well, with dental lasers will be no or reduced need for anesthesia

and minimal bleeding following surgical dental procedures.

• With the aforementioned qualities of dental lasers, the risk of

infection with COVID-19 and other viruses/bacteria will, potentially,
be reduced to great extent.
 Types of lasers based on energy emitted
Soft Tissue Hard tissue laser
Laser
Soft tissue lasers generally utilize Hard tissue lasers (surgical) can cut
diodes. both soft and hard tissues.

Clinical applications includes:

healing of localized osteitis,
healing of aphthous ulcers,
reduction of pain and
treatment of gingivitis.
 Caries detection

Caries Prevention
Clinical
Caries Removal & Cavity
Applications Of preparation
Laser Restoration removal
In Operative Etching of enamel & Dentin
Dentistry & Photopolymerization
Treatment of Dentinal
Hypersensitivity

Bleaching
Caries Detection by Lasers
Lasers used for caries detection:
 Quantitative Laser Fluorescence(QLF)

 Infrared Laser Fluorescence Technique using

DIAGNOdent.

 Optical Coherence tomography

Wadhawan R, Solanki G, Bhandari A, et al: Role of laser

therapy in dentistry: a review. Int J Biomed Res 2014; 5:
153–157.
 Quantitative Laser Fluorescence(QLF)
Used for detection of smooth surface and fissure caries at an
early stage.
In this method tooth is illuminated by a
beam of blue-green light(448nm) from
argon laser.

After exposure, enamel produces yellow

flouorescence.

These florescent images are captured

using a color video camera & analysed
in software
Demineralized area appears- darker
images against the florescent
background of sound enamel.
Demineralized tissues absorb dyes like fluorol TGA, Sodium
Fluorescence.

Also referred to as dye enhanced laser

fluorescence.
Wadhawan R, Solanki G, Bhandari A, et al: Role of laser
therapy in dentistry: a review. Int J Biomed Res 2014; 5:
153–157.
 s
Advantage
1) Convenient & 1) Only discerns enamel
Relatively Fast Method. demineralization

Disadvantag
2) Natural Lesions with 2) Potential for operator
diameter of less than bias as it relies upon a
1.0mm & depth of 5- subjective analysis of a
10mm have been stored tooth image.
detected.
3) Inability to detect
3) Suitable for interproximal lesions.

es
quantifying mineral
loss around different
restoration. 4) Limited to measurement
of enamel lesions.
Wadhawan R, Solanki G, Bhandari A, et al: Role of laser
therapy in dentistry: a review. Int J Biomed Res 2014; 5:
153–157.
 Diagnodent, a 655 nm diode laser, aids in the◦
detection of incipient caries is called laser-
.induced fluorescence

When the laser irradiates the tooth, the light is ◦

absorbed by organic and inorganic substances
present in the dental tissues, as well as by
.metabolites such as bacterial porphyrins

These porphyrins showed some fluorescence◦

.after excitation by red light

Wadhawan R, Solanki G, Bhandari A, et al: Role of laser

therapy in dentistry: a review. Int J Biomed Res 2014; 5:
153–157.
 Since bacteria are present in the carious lesions, carious tissue ◦
exhibits more fluorescence as compared to the healthy tissue
.which distinguish between the carious and sound tooth structure

28
Wadhawan R, Solanki G, Bhandari A, et al: Role of laser
 ADVANTAGES

1. 90% success to diagnose pit and fissure caries.

2. High Reproducibility & Reliability.
3. Readily Transportable
4. Non invasive and painless
5. Safe, no X RAY Exposure
6. Promotes Minimally invasive treatment.
Wadhawan R, Solanki G, Bhandari A, et al: Role of laser
therapy in dentistry: a review. Int J Biomed Res 2014; 5:
153–157.
 Disadvantages
• False result with presence of plaque and calculus

• Cant distinguish between hypo mineralized and carious

structure.

• Readings do not relate to amount of dentinal decay.

• Limited accessibility to the embrasure prevents

Wadhawan R, Solanki G, Bhandari A, et al: Role of laser
accurate reading
therapy of interproximal
in dentistry: a review. Intsurfaces
J Biomed Res 2014; 5:
153–157.
• Composite resins can fluoresce, prompting elevated readings; hence
the DIAGNOdent should not be used on these materials.

• Caries underneath amalgam restorations is measured accurately

only if there is caries at the margin, however if the caries is under
the floor of the amalgam the reading will not be accurate.

• If used in deep preparations, in close proximity to the pulp; elevated

values may be obtained, possibly resulting from fluorescence of
underlying pulp and not necessarily as a result of caries
Barcellos DC, Santos VMM, Niu L, et al: Repair of composites: effect of
laser and different surface treatments. Int J Adhes Adhes 2015; 59: 1–6.
• Chaza Kouchaji, 2013 Results showed a strong relationship between
examination with the diagnodent and visual inspection.
• Diagnodent’s sensitivity and specificity were 97% and 52%,
respectively, indicating that the laser fluorescence diagnodent pen is a
reproducible and accurate diagnostic tool that may be very helpful in
conjunction with visual examination in the detection of occlusal caries
Caries Prevention
• Laboratory studies have indicated that enamel surfaces exposed to laser
irradiation are more acid resistant than non-laser treated surfaces
(Watanabe et al., 2001; Arimoto et al., 2001).

• It is believed that laser irradiation of dental hard tissues modifies the

calcium to phosphate ratio, reduces the carbonate to phosphorous ratio
and leads to the formation of more stable and less acid soluble compounds
Barcellos DC, Santos VMM, Niu L, et al: Repair of composites: effect of
laser and different surface treatments. Int J Adhes Adhes 2015; 59: 1–6.
further reducing susceptibility to acid attack and caries.
• The degree of protection against caries progression provided by
the one-time initial laser treatment was reported to be
comparable to daily fluoride treatment by a fluoride dentifrice
(Featherstone, 2000).

• The threshold pH for enamel dissolution was reportedly lowered

from 5.5 to 4.8 and the hard tooth structure was four times more
resistance to acid dissolution.

Barcellos DC, Santos VMM, Niu L, et al: Repair of composites: effect of

laser and different surface treatments. Int J Adhes Adhes 2015; 59: 1–6.
 Caries
• Cavity preparation byRemoval
using lasers has been an
area of major research interest ever since
lasers were initially developed in the early
1960s.

• At present, several laser types with similar

wavelengths in the middle infrared region of
the electromagnetic spectrum are being used
Buchalla W, Attin T: External bleaching therapy with
commonly forby
activation cavity
heat, preparation
light or laser –and caries review. Dent
a systematic
Mater 2007; 23: 586– 596.
removal.
Laser assisted cavity Conventional cavity
preparation preparation
Burs produce abrasive cutting from
Lasers cut at a point of their tip their sides and are also cut at the
end
To be used with up and down Side brushing action is also used
motion along with end cutting
Rough edges that need hand
instruments such as excavators to Produces smooth edges
carry away the ablation products

Removes smear layer Produces a smear layer

Considered safe in cases of Considered unsafe in cases of

unexpected patient movement unexpected patient movement

Buchalla W, Attin T: External bleaching therapy with activation

by heat, light or laser – a systematic review. Dent Mater 2007;
23: 586– 596.
 ADVANTAGES

• Laser Induced Analgesia (No Need For Local Anesthesia)

• Less Post-operative sensitivity because dentin may be fused.

• Access to subgingival caries is greatly improved since lasers

vaporize gingival tissues.

• Due to alterations of surface structure, the lased tooth becomes

resistant to decay. In case of root caries, placement of restorative

material may not be necessary after laser application.

Drawbacks:-

1) Patient feels slightly warm sensation.

2) Usually Lasers produce too much heat, melt the enamel

and damage the pulp.

3) It has been observed that uncooled laser ablation of

enamel can lead to a temperature rise as high as 300–
800 ° C that may lead to permanent damage to the
Buchalla W, Attin T: External bleaching therapy with activation
dental pulp
by heat, light or laser – a systematic review. Dent Mater 2007;
23: 586– 596.
• A systematic review by Jacobsen et al evaluated randomized
clinical trials that studied the efficacy of erbium lasers. It was
suggested that lasers are as effective as conventional rotatory
instruments in removing dental caries.

• However, thermal injury to the dental pulp and the longevity of the
restorations could not be assessed due to a lack of follow-up.
Patients preferred laser ablation over conventional dental burs for
Cavity Preparation Using Ultra-Short Pulsed Lasers

• Precisely cut hard materials including tooth enamel and

dentin with less temperature rise than conventional lasers.

• Lasers have also been used to increase the adhesion of

bonding agents with dentin by increasing the wettability.

Lasers in Conservative Dentistry: An Overview, GauranGi KaKodKar, ida de noronha de

ataide, rajdeep pavasKar Journal of Clinical and Diagnostic Research. 2012 May (Suppl-1), Vol-
 Restoration removal

The Er: YAG laser is capable of removing cement, composite resin ◦

.and glass ionomer (Dostalova et al., 1998; Gimbel, 2000)

.Lasers should not be used to ablate amalgam restorations◦

The Er: YAG laser is incapable of removing gold crowns, cast ◦

.restorations and ceramic materials (Keller et al., 1998)

Lasers in Conservative Dentistry: An Overview, GauranGi KaKodKar, ida de noronha de

ataide, rajdeep pavasKar Journal of Clinical and Diagnostic Research. 2012 May (Suppl-1), Vol-
6(3):533-536
 Etching of Enamel & Dentin With
Lasers
• Laser etching has been evaluated as an alternative to the acid
etching of enamel and dentine.
• The Er:YAG laser produces micro-explosions during hard tissue
ablation that result in microscopic and macroscopic irregularities.

• These micro-irregularities make the enamel surface microretentive

and they may offer a mechanism of adhesion without acid-etching.

• Dye penetration done for laser treated cavities showed irregular

cavity surface with the use of Er:YAG thus enhancing the adhesion
and sealing.

Thukral S. Laser Etching..Solaze. J Las dent 2007;1(1)14-16.

• Etching with dentin, results in carbonization or charging
due to its high organic content.

• Moreover, the dentin structure is changed. It shows

presence of fungi form projections and there is localized
melting on dentinal surface causing sealing of dentinal
tubules thereby reducing micro-leakage and enhancing
the bond of final composite restoration.
Upendra et al 2014,evaluated the shear bond strength of
composite resin bonded to enamel which is pretreated using
acid etchant and Er,Cr:Ysgg and he concluded that for enamel
surface, mean shear bond strength of bonded composite
obtained after laser etching were significantly lower than those
obtained after acid etching.
Photopolymerization Of Composite Resins
• The argon laser is one promising source, as the wavelength of the
light which is emitted by this laser is optimal for the initiation of
polymerization of the composite resins.

• The argon laser at 488nm (blue) is used.

• The argon wavelength activates camphorquinone , a photoinitiator

that causes polymerisation of the resin composites.

• The argon laser radiation also alter the
surface chemistry of both the enamel and the
root surface dentine, which reduces the
probability of the recurrent caries.

• It is used at 250+_ 50 mw/ cm2 for 5-8

seconds
 Advantages For
Using Laser For
Photopolymerizati
on
Reduced
Better polymerizatio
Increase Polymerizatio
depth of n n shrinkage.
Better
physical cure
properti
Shorte es.
r
Curing
Time
Lasers in Conservative Dentistry: An Overview, GauranGi KaKodKar, ida de noronha de
ataide, rajdeep pavasKar Journal of Clinical and Diagnostic Research. 2012 May (Suppl-1), Vol-
6(3):533-536
 Mode of action
• He-Ne lasers alter electrical activity in the pulpal nerve cells to make
them less sensitive to pain .

• Also, it has been speculated that GaAIAs lasers depress the C-fiber
conductivity to reduce pain sensation.

• The Nd:YAG and CO 2 lasers have been thought to occlude the dentinal
tubules, thereby reduced dentin sensitivity.

• The Nd:YAG lasers can be combined with fluoride varnish to produce an

effective protocol for treating dentin hypersensitivity
 Treatment Of Tooth Erosion

• Dental erosion is caused by a series of extrinsic and intrinsic factors.

• Carbondioxide lasers have been mostly used in the prevention of

erosion, due to its
efficient interaction with hydroxyapatite crystals.
 Advantages &
Disadvantages Of Lasers
Advantages of lasers

• It is painless, bloodless that results in clean surgical field

and fine incision with precision.

• The risk of infection is reduced as a more sterilized

environment is created, as laser kills microorganisms.

• No post-operative discomfort, minimal pain and swelling,

generally doesn't require medication.

• Superior and faster healing, offers better patient compliance
• Reduced operator chair time.

• Minimal invasive cavity preparation • Bactericidal effect

• Haemostatic effect

• Increase in the success of direct and indirect pulp capping

procedures

• Increased depth of penetration; makes it possible to cure

thicker increments of composite resin.
 Disadvantages of laser

.Relatively high cost◦

. Requires specialized training for the clinician ◦

.Modification of clinical technique is required ◦

Harmful to eyes and skin of both clinician and patients if ◦

.exposed adversely

No single wavelength of laser will optimally treat all dental ◦

diseases

.Lasers don't completely eliminate the need for anesthesia ◦