Wednesday, July 25, 2012

Air Techniques Spectra - Digital Caries Detection in Action and Restoration with the Lightwalker Er:YAG Laser

The diagnostic armamentarium of dentistry is changing. Several dental schools are no longer teaching the "sharp explorer diagnosis" and are using other more advanced diagnostic protocols. I've been fortunate enough to have studied and used digital caries detection devices for several years now. I've found them to be reliable, accurate, and of great benefit to my patients.

In the last 4 years or so, we've seen the evolution of caries detection to what I now am referring to as "visual diagnostics". The devcies use CCD's (digital camera chips, also called Charged Couple Devices) to take photos of teeth using certain colors of light that help reveal decay at stages where it is much more difficult to find using conventional methods.

The real advantage of visual diagnostic devcies is that, by finding problem areas in the early stages, the doctor can decide whether to attempt to remineralize the areas using a combination of techniques & products or if the tooth requires a restoration. By taking and saving these images, areas can be monitored and compared to see if areas are improving, worsening, or staying the same. The more data the doctor has, the more accurate the treatment can be.

What follows is an example of monitoring a tooth over time with the Air Techniqes Spectra device. The Spectra takes a photo of the tooth and applies a special algorithm to the data it detects. This algorithm allows the areas of concern to be clearly shown on the tooth surface. The "overlay" has the appearance of Doppler weather radar.

 
 
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18 months ago, this tooth shows an area in blue that indicates very early breakdown of the enamel matrix. Many of these areas can be remineralized, however others continue to progress. The area is not detectable using standard visual inspection or the traditional sharp explorer. The colors along the side are due to the soft tissue and are not indicative of any type of breakdown of the tooth.
 
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8 months ago, this image shows that the initial breakdown of the enamel has continued to progress. The area now has progressed to a small area of red that is indicative of actual decay in the enamel. Based on data such as the patients DMF rate and other factors this area might be slated for a restoration or remineralization therapy and monitored further. It now begins to appear suspicious when viewed under 4.8x magnification, but does not provide any type of tactile indication of breakdown with a sharp explorer.
 
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One month ago, the area of red has expanded and now has a center of orange which indicates the decay has now passed the DEJ. At this point it was decided to intervene surgically. The area of decay was removed using the Lightwalker laser, an Er:YAG hard tissue laser, which means we could remove the decay without using anesthetic. It was restored conservatively using a flowable composite. The area appears extremely suspicious when viewed under 4.8x magnification and now began to exhibit a very "slight" stick with a sharp explorer. When excavation was complete, this area was 6-7mm deep yet provided such slight tactile feedback from the explorer that it might have been considered a "watch" area even though the DEJ had been exceeded and the lesion had shown continual growth over an 18 month period of monitoring. Even though the lesion had progressed to this point, it was still removed painlessly by using the Lightwalker laser.
 
This is just one example of how visual diagnostic devices are helping to provide more and better data that allow us to make better decisions. In this case a small restoration was placed with no anesthetic which allowed more of the patient's natural tooth structure to be preserved.

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