Detection of Incipient Interproximal Lesions Using Dye Enhanced Fluorescence

Abstract:

Detecting early interproximal lesions still pose a challenge. X-ray bitewings show lesions that have caused significant demineralization, and often should be treated restoratively. Thus, developing a sensitive methods for detecting early interproximal lesions is highly desirable.

Objectives:

The aim of this study was to develop and evaluate a method of dye enhanced fluorescence microscopy for detecting incipient interproximal caries.

Methods:

114 extracted teeth were mounted in multiple blocks, and 168 interproximal surfaces were simulated. 3 examiners evaluated interproximal surfaces of teeth by three method of direct visual (DV), bitewing X-ray (XR) and fluorescence (F) examination. The examiners assessment of lesions for each method was recorded as “Lesion” or “No Lesion” for each interproximal surface on each tooth.

Following DV and XR examination by 3 examiners, a 1mg/1ml water solution of Chlorophyll-a was applied to the interproximal areas. These areas were then washed with distilled water and wiped. Light in wavelength of 650 nm excited the area of interest, while a detector with a filter range of 790 nm detected the emission fluorescence. Images were then transferred digitally and visualized on monitor, while the same examiners recorded their assessment of visualizing lesions independently. Later, teeth were sliced for histological analysis (gold standard) to confirm existence of lesions; thus, DV, XR and F examinations were compared against gold standard to determine sensitivity and specificity of each method.

Results:

Lesions were present in 111 out of 170 interproximal surfaces. Sensitivity ranges for DV, XR and F were 0.44-0.49, 0-0.11 and 0.85-0.93 respectively. Specificity however ranged 0.75-0.84, 0.95-0.98 and 0.82-0.89 for DV, XR and F respectively.

Conclusions:

Results show that Chlorophyll-a fluorescence is far more sensitive than DV or XR in detecting early lesions. However, XR still has the lead in specificity followed by F and DV.