LASER FLUORESCENCE IN DETECTION OF

OCCLUSAL CARIES

ARTICLE
Performance of laser fluorescence for the
detection of occlusal dentinal caries lesions in
permanent molars: an in vivo study with total
validation of the sample
Aim of the Study
To evaluate the performance of laser fluorescence in
detecting non-cavitated occlusal caries in molars under
clinical conditions ( in vivo).

Clinical Significance
To calculate realistic values for sensitivity and specificity.
Terms to define
in vivo- in the living organism
in vitro- in the laboratory or clinic
sensitivity-
specificity-
Introduction
 Laser fluorescence found to be accurate in
both in vivo and in vitro studies.
 In vitro studies is better than in vivo due to
absence of
 bacterial plaque
 acquired pellicle
 saliva
 or soft tissues
 Results from in vitro studies were
questionable because disinfection fluids were
suspected to affect LF measurements

 Groove-fossa system – 1st and 2nd molars

more pronounced thus more vulnerable to
caries
Materials and Method
a) Sample Selection

 46 healthy subjects ( ages 19-29)

 1st or 2nd molars : abutments and not suspected of having
hidden lesions
 Other 1st and 2nd molars : suspected of having hidden lesion
 Ekstrand Criteria
 0 = no or slight change in enamel translucency after prolonged
air drying (>5s)
 1 = opacity or discolouration hardly visible on wet surface but
distinctly after air drying
 2 = opacity or discolouration distinctly visible without air drying
 3 = localized enamel breakdown
 4 = cavitation exposing dentin
 b)LF Calibration and Examination
 20 1st and 2nd permanent molars with macroscopically
intact surfaces were measured under clinical conditions.

 Before LF examination, teeth were cleaned with a

rotating brush and water.

 Standard value :
 measuring fluorescence on a sound region located on the buccal
surface
 cone shaped tip positioned on target site, rotated around long
axis and max. LF reading recorded
 mean value of these 2 measurements was calculated
Validation by Biopsy
 Fissures were opened to detect dentinal caries
using a sharp explorer
 Hard surfaces were said to be caries free while
surfaces that were soft were carious
 The extent of caries after complete removal of
softened dentine was then determined
according to the scale :
 (D 0+1+2) – no dentinal caries
 (D3+4) – dentinal caries
Statistical Analysis
 Data analyzed with SSPS 14.0 statistical software package.
 LF readings were categorized:
 Different groups
 Median
 Interquartile range
 Sensitivity and specificity were calculated at D3 level for all of
the cut off points
 Cut off point that showed max performance (sum of sensitivity
and specificity) were selected and the best cut off point at that
level was chosen
 Cut off with the greatest specificity and without a substantial
loss in total performance was used as the decisive factor to
diminish negative cost
Results
 Of the 46 teeth chosen without suspicion of dentinal caries according to Ekstrand Criteria,
42 showed to be caries free once the fissurotomy was completed with a score of 0-2

 Of the 56 teeth with suspicion of dentinal caries, 50 showed to be carious once the with a
score of 3-4

 Therefore the validation through fissurotomy revealed that in the sample,

48 (47%) were sound or had enamel caries lesions (D 0+1+2)
54 (53%) had dentinal caries (D 3+4)

 The diagnostic perfomance of the visual inspection was

0 .93 sensitivity
0 .88 specificity
 Fissurotomy Sensitivity Specificity

No dental With
caries dental
caries
Visual inspection ≤2 42 4
Visual inspection 3 or 4 6 50 0.93 0.88

LF<20 36 6
LF≥20 12 48 0.89 0.75

Table 1. Diagnostic perfomance of the LF and of visual inspection for dentinal caries: sensitivity
and specificity
 The Lf values for the group D 0+1+2 showed a median of 16.0 and an
Interquartile range of 14.25
 For the D 3+4 group the median was 32.5 and the Interquartile range was
21.25
 The difference between the two groups were statistically significant
(α < 0.001)
 The optimal cut off for dentinal caries was 20 where the maximum
performance was 1.64 : sensitivity = 0.89 and specificity = 0.75