Monday, July 1, 2019

Transillumination from Different Angles

 


Transillumination is a pretty cool and handy thing in dentistry.   In its most basic explanation, transillumination is passing photons through a substance (in this case tooth structure) and being able to examine the tooth from the other side.  The idea being that the light is reflected and refracted by variations in the structure.  For instance, shining a light from the buccal surface and observing from the lingual surface can reveal dark areas indicative of decay between the teeth.  

It can also show cracks, fractures, decay in pits and fissures, as well as other pathologies of teeth.  Personally I find the use of transillumination to be very helpful.  While it is NOT a replacement for routine radiographs (x-rays) it can aid in diagnosis for cases where radiographic images are not completely definitive or in situations such as a pregnant patient.  It can also be extremely helpful in situations of pain from cracked teeth or from injuries sustained from some type of traumatic impact.


There are a lot of transillumination devices that are readily available to purchase in dentistry.  All of them work well.  Probably the best known currently is the Kavo CariVu (called the DiagnoCam outside the US… no idea why).  The CariVu uses transillumination via near infrared energy and combines the transillumination with a camera lens that takes a picture of the tooth, allowing you to record what you see.  You can rotate the device around the tooth in "live" mode to get views from multiple angles and then freeze the image if you want to save it.  The near infrared energy is invisible to the human eye, but captured by the CCD in the device.  This wavelength of light is easily disrupted by changes in tooth structure (more so than visible light) which helps improve the accuracy.

However, what if you are working on a very tight budget?  Is there a way to utilize the advantages of this technology without having to make a major capital investment?  In some ways, yes it’s possible.  There are some curing lights on the market that have small “snap on” type attachments for the curing head that focus and create a small aperture for the light to shine through.  Usually these attachments are designed for “spot cure” situations such as bonding on veneers or other indirect restorative prosthetics.  A spot cure lens allows the user to cure just a small amount of the luting material, which holds the restoration firmly in place, while leaving the remaining material soft and easily removed from the margins.  Once the margins have been addressed, the spot cure lens is removed and the entire restoration is polymerized into place.

However, these spot cure attachments can also be used to focus a small amount of the curing light into the interproximal areas of teeth to transilluminate the area.  The only drawback to this method is that most curing lights are very intense, emitting photons in the range of 1000mw/cm2.  Lights of this intensity and in the 400-500 nm range can cause eye damage over the span of a career in dentistry.  To prevent that, the observer should wear orange eye protective glasses.


There is a company that offers a nice alternative to this.  The DentLight company has created the Fusion 5 curing light.  One of the genius parts of its design is the ability to swap the LED head.  There is a head for composite curing (blue), a head for oral cancer detection (violet), and a head for transillumination (white).  All the head sizes are the same, meaning that the spot cure attachment for the curing head will also snap onto the transillumination head.  Since the transillumination head is white LEDs there is no danger to the users eyes and the spot cure attachment focuses the light in a small spot size directly into the area needing evaluation.

The nice thing about this particular device is that it is multifaceted.  Rather than needing to purchase multiple devices for different uses/procedures, you can purchase one device with multiple uses.  This means less cash outlay and, perhaps even more importantly, fewer devices to keep track of, maintain, etc.  Swapping the different LED heads is simple and easy.  The curing light portion is also incredibly bright providing for good depth of cure, but that is a post for another day.


Finally I wanted to tell you about a little known device that can also help with transillumination.  As a tech nerd, I love American Science & Surplus.  The company has all kinds of interesting and affordable products and devices.  I love to browse the site just to see what wild and unusual things they have for sale.  It’s like a giant garage sale for gear heads at this site & most of the products are really easy on the wallet.

The other day I was browsing the site and lo and behold what did I find?  A device called a “Fiber Optic LED Bore Light”.  Basically the device is a small bright LED flashlight with an attachment that fits over the end which focuses the light into a small, clear acrylic fiber optic tip.  The device is sold as a way to look into hard to reach areas, but to me it looked like a nice little transilluminator.  Considering the price is $4.95 US I thought getting one was a no-brainer.  If it doesn’t work?  I’m out $5.

It turns out the little device works pretty darn well.  You can wrap it in a sheath used for your curing light so that there is no worry about cross contamination.  So if you are looking for a way to do transillumination and you are on a tight budget, this might be for you.  The best part is that for the price you can afford to have one in every treatment area too.  If you happen to get one, leave a comment below.  I’d love to hear what you think about it.  Actually I’d love to hear your thoughts on anything that I discuss here, so feel free to leave a comment.

Now also remember, all you can do with this is light up teeth.  There is no curing, no cancer screening, no ability take pictures, etc.  However for $4.95 it's not a bad little gadget.

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