Download PDF
CC BY 4.0 · Eur J Dent 2023; 17(04): 1356-1362
DOI: 10.1055/s-0043-1764423
Case Report

Enhanced Clinical Decision-Making and Delivery of Minimally Invasive Care Using the ICCMS4D Integrated with Hands-Free Fluorescence-Based Loupes and a Chemomechanical Caries Removal Agent

Gal Hiltch
1   Department of Dentistry, Federal University of Rio Grande do Sul—UFRGS, Porto Alegre, Brazil
,
Liviu Steier 
2   Department of Preventive and Restorative Sciences, Dental School, University of Pennsylvania- UPENN, Philadelphia, Pennsylvania, United States
,
José Antonio Poli de Figueiredo 
3   Department of Morphological Sciences, Federal University of Rio Grande do Sul–UFRGS, Porto Allegre, Brazil
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

The purpose of this case report was to evaluate an approach for enhanced clinical decision-making while providing minimally invasive treatment, using the combined International Caries Classification and Management System (ICCMS 4D) with hands-free fluorescence-enhanced loupes (Reveal, Designs for Vision Inc., New York City, NY, United States) and a chemo-mechanical caries removal agent (Papacárie Duo Gel, Formula & Acao, Sao Paulo, Brazil). In recent decades, a shift towards a conservative approach to caries management has developed. The use of adequate operative techniques and correct decision-making are of paramount importance for early caries detection and tooth-preserving operative care. The use of noninvasive fluorescence-based adjuncts for enhanced diagnostic accuracy has gained popularity. Fluorescence describes the absorption of photons by a molecule, followed by its partial emission at a longer wavelength. Fluorescence detection of bacterial activity is largely based on the red/orange fluorescence emanating from bacterial metabolism, and has been shown to be found particularly in active caries and mature anaerobic plaque. The combined approach of using the standardized visual International Caries Detection and Assessment System (ICDAS) with fluorescence as an operative adjunct was shown to enhance the advantages of both systems. The approach may potentially increase detection sensitivity without compromising the specificity of the visual tactile method. A recent hands-free device is aimed to combine simultaneous diagnosis and therapy (theragnosis) using fluorescence, while overcoming possible obstacles to workflow continuity. The “Reveal” fluorescence-enhanced loupes are fitted with a dual white light/fluorescence light, and are said to allow the clinician to conduct any operational procedure with optional fluorescence guidance, from detection to caries removal, to treatment completion. Using the described method, a comprehensive pathway that emphasizes evidence-based information, correct clinical decision-making, and a minimally invasive therapeutic approach was proposed. The approach may represent a potential advancement in providing minimally invasive caries care.

Keywords

caries detection - caries diagnostics - fluorescence - ICDAS


Publication History

Article published online:
27 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Schwendicke F, Frencken JE, Bjørndal L. et al. Managing carious lesions: consensus recommendations on carious tissue removal. Adv Dent Res 2016; 28 (02) 58-67
    CrossrefPubMedGoogle Scholar
  • 2 Banerjee A, Frencken JE, Schwendicke F, Innes NPT. Contemporary operative caries management: consensus recommendations on minimally invasive caries removal. Br Dent J 2017; 223 (03) 215-222
    CrossrefPubMedGoogle Scholar
  • 3 Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment: a systematic review. BMC Oral Health 2016; 16: 12
    CrossrefPubMedGoogle Scholar
  • 4 Slimani A, Sauro S, Gatón Hernández P. et al. Commercially available ion-releasing dental materials and cavitated carious lesions: clinical treatment options. Materials (Basel) 2021; 14 (21) 6272
    CrossrefPubMedGoogle Scholar
  • 5 Pitts N. “ICDAS”: an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Community Dent Health 2004; 21 (03) 193-198
    PubMedGoogle Scholar
  • 6 Pitts NB, Banerjee A, Mazevet ME, Goffin G, Martignon S. From “ICDAS” to “CariesCare International”: the 20-year journey building international consensus to take caries evidence into clinical practice. Br Dent J 2021; 231 (12) 769-774
    CrossrefPubMedGoogle Scholar
  • 7 Besegato JF, Melo PBG, Bernardi ACA, Bagnato VS, Rastelli ANS. Ultrasound device as a minimally invasive approach for caries dentin removal. Braz Dent J 2022; 33 (01) 57-67
    CrossrefPubMedGoogle Scholar
  • 8 Gomez J. Detection and diagnosis of the early caries lesion. BMC Oral Health 2015; 15 (Suppl. 01) S3
    CrossrefPubMedGoogle Scholar
  • 9 Slimani A, Terrer E, Manton DJ, Tassery H. Carious lesion detection technologies: factual clinical approaches. Br Dent J 2020; 229 (07) 432-442
    CrossrefPubMedGoogle Scholar
  • 10 Steier L, Figueiredo JAP, Blatz MB. Fluorescence-enhanced theragnosis: a novel approach to visualize, detect, and remove caries. Compend Contin Educ Dent 2021; 42 (08) 460-465
    PubMedGoogle Scholar
  • 11 van der Veen MH, de Josselin de Jong E. Application of quantitative light-induced fluorescence for assessing early caries lesions. Monogr Oral Sci 2000; 17: 144-162
    CrossrefPubMedGoogle Scholar
  • 12 König K, Flemming G, Hibst R. Laser-induced autofluorescence spectroscopy of dental caries. Cell Mol Biol 1998; 44 (08) 1293-1300
    PubMedGoogle Scholar
  • 13 Slimani A, Nouioua F, Panayotov I. et al. Porphyrin and pentosidine involvement. in the red fluorescence of enamel and dentin caries. Int J Experiment Dent Sci 2016; 5: 1-10
    CrossrefGoogle Scholar
  • 14 Felix Gomez G, Eckert GJ, Ferreira Zandona A. Orange/red fluorescence of active caries by retrospective quantitative light-induced fluorescence image analysis. Caries Res 2016; 50 (03) 295-302
    CrossrefPubMedGoogle Scholar
  • 15 Ko HY, Kang SM, Kim HE, Kwon HK, Kim BI. Validation of quantitative light-induced fluorescence-digital (QLF-D) for the detection of approximal caries in vitro. J Dent 2015; 43 (05) 568-575
    CrossrefPubMedGoogle Scholar
  • 16 Jablonski-Momeni A, Stucke J, Steinberg T, Heinzel-Gutenbrunner M. Use of ICDAS-II, fluorescence-based methods, and radiography in detection and treatment decision of occlusal caries lesions: an in vitro study. Int J Dent 2012; 2012: 371595
    CrossrefPubMedGoogle Scholar
  • 17 Ferreira Zandoná A, Santiago E, Eckert G, Fontana M, Ando M, Zero DT. Use of ICDAS combined with quantitative light-induced fluorescence as a caries detection method. Caries Res 2010; 44 (03) 317-322
    CrossrefPubMedGoogle Scholar
  • 18 Steier L, Sidhu P, Qasim SS, Mahdi SS, Daood U. Visualization of initial bacterial colonization on dentin using fluorescence activating headlight for fluorescence enhanced theragnosis. Photodiagn Photodyn Ther 2022; 38: 102732
    CrossrefPubMedGoogle Scholar
  • 19 Reddy MV, Shankar AJ, Pentakota VG, Kolli H, Ganta H, Katari PK. Efficacy of antimicrobial property of two commercially available chemomechanical caries removal agents (Carisolv and Papacarie): an ex vivo study. J Int Soc Prev Community Dent 2015; 5 (03) 183-189
    CrossrefPubMedGoogle Scholar
  • 20 Serban C, Lungeanu D, Bota SD. et al. Emerging technologies for dentin caries detection-a systematic review and meta-analysis. J Clin Med 2022; 11 (03) 674
    CrossrefPubMedGoogle Scholar
  • 21 Foros P, Oikonomou E, Koletsi D, Rahiotis C. Detection methods for early caries diagnosis: a systematic review and meta-analysis. Caries Res 2021; 55 (04) 247-259
    CrossrefPubMedGoogle Scholar
  • 22 Decup F, Lasfargues JJ. Minimal intervention dentistry II: part 4. Minimal intervention techniques of preparation and adhesive restorations. The contribution of the sono-abrasive techniques. Br Dent J 2014; 216 (07) 393-400
    CrossrefPubMedGoogle Scholar
  • 23 Trippe LH, Ribeiro AA, Azcarate-Peril MA, Preisser JS, Wang R, Zandona AF. Is fluorescence technology a promising tool for detecting infected dentin in deep carious lesions?. Caries Res 2020; 54 (03) 205-217
    CrossrefPubMedGoogle Scholar
  • 24 Leontiev W, Magni E, Dettwiler C, Meller C, Weiger R, Connert T. Accuracy of the fluorescence-aided identification technique (FIT) for detecting tooth-colored restorations utilizing different fluorescence-inducing devices: an ex vivo comparative study. Clin Oral Investig 2021; 25 (09) 5189-5196
    CrossrefPubMedGoogle Scholar