The New Gold Standard for Diagnostics
KaVo Kerr Connections
The New Gold Standard for Diagnostics
Many patients still think that a dental explorer is one of our primary diagnostic tools for finding decay. As dental practitioners, we know that at best, the dental explorer is only good for evaluating the hardness of dentin, evaluating the margins of dental restorations and we could we could add the explorer is useful for evaluating root surfaces in patients with periodontal issues. However, studies show that the accuracy of the dental explorer to find tooth decay is about 14%1. Hence, the dental explorer would not be considered a very good tool for diagnosing carious legions.
The typical standard of care for caries diagnostics has been the intraoral radiograph. This technology was invented in 1895, and first introduced to the United States in April 1896 by Dr C. Edmond Kells’ dental office in New Orleans2. It is hard to believe that our profession relies so heavily on protecting and managing tooth decay and bone pathology with technology introduced over a 100 years ago. Various research articles have been published over the years talking about the accuracies or lack thereof with the dental radiograph in finding tooth decay. One of the concerns is that decay must be larger than 2-3 mm deep or 1/3 the bucco-lingual distance in order to be detected on a radiograph. 3 Research has also shown that radiographic analysis can detect only about 50% of carious lesions.4 Additionally, when opening a cavity found using intraoral diagnostics techniques, we often find that the size on the radiographic image appears smaller than what we see inside the tooth. The reason for this is the surrounding area is damaged but not demineralized enough to see on a radiograph. So anytime we find a lesion/cavity on a radiographic, we know it is in fact, larger in reality. Yet many times we tell a patient we will watch the lesion. Watch it what…grow? They typically never get better.
So what could we use to possibly detect cavities earlier and save precious tooth structure? Transillumination offers one possible solution. CariVu, a DEXIS product from KaVo Kerr, uses transillumination technology to support the identification of occlusal, interproximal and recurrent carious lesions and cracks.
It also helps identify caries lesions earlier than with a traditional radiograph and does so in a manner that does not utilize ionizing radiation. It’s a wonderful piece of technology for the dental practitioner. The CariVu looks like an intraoral video camera with two rubber tips at the end which house the two light sources that illuminate the tooth. The tooth appears somewhat translucent allowing the video camera to capture images of lesions (these include cracks and caries) which appear darker because they are trapping and absorbing the light. CariVu detects occlusal, recurrent, and proximal caries at a high rate of accuracy, in fact, at 99% for proximal caries5. So the CariVu is a live video that you can capture anything you see and store the image in your DEXIS software that comes with the CariVu. These images are really powerful in patient consultations. The patient can see the cavity with their own eyes and are more likely to move forward with treatment. Here is an example.
Take a look at the radiograph (Fig 1) and treat this like one of your patients. Do you see any cavities you would address? If you do, would you watch it over time or recommend treatment?
Now look at the CariVu image (Fig 2). Isn’t it more obvious that this patient does need treatment? Perhaps some dentists might not have diagnosed the lesion at all. Think of how many times we as dentists may have under diagnosed or misdiagnosed patients. It happens much more than you think. It is amazing to me, how much more accurately we can diagnosis caries and other issues since having implemented this technology in my practice. We still need radiographs for evaluating bone and roots, but with our new protocol, we are taking less radiographs and using CariVu for most of our caries diagnosis as we believe this technology is the new gold standard for diagnostics.
1. Lussi A. Validity of diagnostic and treatment decisions of fissure caries. Caries Res. 1991;25(4):296-303.
2. Kracher CM. C. Edmund Kells (1856-1928). J Hist Dent. 2000;48(2):65-69.
3. Rock WP, Kidd EAM. The electronic detection of demineralization in occlusal fissures. Br Dent J. 1988;164(8):243‐247.
4. Senel, B., K Kamburoglu, K., Ücok, Ö., Yüksel S. P., Özen, T., Avsever, H. Diagnostic accuracy of different imaging modalities in detection of proximal caries. Dentomaxillofac Radiol. 2010;39(8):501–511.
5. Kühnisch J. Benefits of the DIAGNOcam Procedure for the Detection and Diagnosis of Caries [study project]. Munich: Ludwig Maximilian 21 University of Munich; 2013.