Detection of Bacteria-Induced Early-Stage Dental Caries Using Three-Dimensional Mid-Infrared Thermophotonic Imaging.

Tooth decay, or dental caries, is a widespread and costly disease that is reversible when detected early in its formation. Current dental caries diagnostic methods including X-ray imaging and intraoral examination lack the sensitivity and specificity required to routinely detect caries early in its formation. Thermophotonic imaging presents itself as a highly sensitive and non-ionizing solution, making it suitable for the frequent monitoring of caries progression. Here, we utilized a treatment protocol to produce bacteria-induced caries lesions. The lesions were imaged using two related three-dimensional photothermal imaging modalities: truncated correlation photothermal coherence tomography (TC-PCT) and its enhanced modification eTC-PCT. In addition, micro-computed tomography (µ-CT) and visual inspection by a clinical dentist were used to validate and quantify the severities of the lesions. The observational findings demonstrate the high sensitivity and depth profiling capabilities of the thermophotonic modalities, showcasing their potential use as a non-ionizing clinical tool for the early detection of dental caries.

Building effective public dental care programs: The critical role of implementation evaluation.

There are significant income-related inequities in oral health and access to oral health care. Public dental programs generally aim to increase access to oral health care for individuals with financial barriers through government payments for appointments. Low engagement from both oral health care providers and intended patients are common challenges in delivery of public dental programs, and are impediments to program impact and outcomes. Still, these programs rarely address the systemic issues that affect the experiences of intended users. This accentuates the importance of monitoring of program delivery to refine or adapt programs to better meet needs of service providers and users. As such, specifying program goals and developing a related monitoring strategy are critical as Canada begins to implement a national public dental program. Drawing on an example of a pediatric public dental program for children from low-income families or with severe disabilities in Ontario, Canada, this article illustrates how an implementation and evaluation framework could be applied to measure implementation and impact of the national program. The RE-AIM framework measures performance across five domains: (1) Reach, (2) Effectiveness (patient level), (3) Adoption, (4) Implementation (provider, setting, and policy levels), and (5) Maintenance (all levels). Given the disparities in oral disease and access to oral health care, the results can be used most effectively to adapt programs if relevant stakeholders participate in reviewing data, investigating quality gaps, and developing improvement strategies.

Inadequacy of self-Implemented preventive measures to control caries increment due to poor dietary habits in 6 and 12 years old children in Riga, Latvia.

AIM: This study investigated whether the self-implemented preventive measures practiced among the 6 and 12 years olds in Riga, Latvia can control the caries increment due to poor dietary habits among this age groups. MATERIAL AND METHODS: Caries examination was performed on Thirty-eight 6 and thirty-nine 12 years olds by visual and bitewing radiographic examination at baseline and after 3 years. All participants and/or their parents completed dietary habits questionnaires. The data was analyzed using t-test, chi-square test, ANOVA and frequency tables, Wilcoxon and Fisher's tests (α=0.05). RESULTS: The mean (SD) values of caries experience at baseline/3-year period in 6- vs.12-year olds were as follows. DMFS: 0.72 (1.02)/3.13 (3.13) (p=0.0000) vs. 6.79 (5.14)/14.79 (9.86) (p=0.0000); dmfs: 11.26(8.71)/7.74 (4.86) (p=0.078) vs. 3.57 (2.03)/1.5 (0.71) (p=0.317). The statistical significance was reported only for the consumption of soft drinks (p=0.032) and sugared tea (p=0.018) for the 6 years olds, and for sugared tea (p=0.017) and number of teaspoons of sugar added to tea (p=0.0095) for the 12-years olds. There was positive caries increment in all the 6 and 12 years olds that reported significant increase in consumption of soft drinks and sugared tea, and increase daily number of teaspoons of sugar used in tea. CONCLUSIONS: The present study demonstrated high cariogenic diet among the children in Riga, which is associated with increased caries experience that the currently practiced self-implemented oral hygiene measures was not capable of controlling.

Protocol for a Case Control Study to Evaluate Oral Health as a Biomarker of Child Exposure to Adverse Psychosocial Experiences.

BACKGROUND: The early identification of children who have experienced adversity is critical for the timely delivery of interventions to improve coping and reduce negative consequences. Self-report is the usual practice for identifying children with exposure to adversity. However, physiological characteristics that signal the presence of disease or other exposures may provide a more objective identification strategy. This protocol describes a case-control study that assesses whether exposure to adversity is more common in children with tooth enamel anomalies compared to children without such anomalies. METHODS: For 150 mother-child pairs from a pediatric dental clinic in Toronto, Canada, maternal interviews will assess the child's adverse and resilience-building experiences. Per child, one (exfoliated or extracted) tooth will be assessed for suspected enamel anomalies. If anomalies are present, the child is a case, and if absent, the child is a control. Tooth assessment modalities will include usual practice for dental exams (visual assessment) and modalities with greater sensitivity to identify anomalies. CONCLUSION: If structural changes in children's teeth are associated with exposure to adversity, routine dental exams could provide an opportunity to screen children for experiences of adversity. Affected children could be referred for follow-up.

Comparison of Long-Wave and Mid-Wave Infrared Imaging Modalities for Photothermal Coherence Tomography of Human Teeth.

The ability to detect dental caries at early stages lies at the heart of minimal intervention dentistry, enabling the curing or arresting of carious lesions before they advance to the cavity stage. Enhanced truncated-correlation photothermal coherence tomography (eTC-PCT) using mid-wave infrared (MWIR) cameras has recently been shown to offer tomographic visualization of early caries. The tomographic slicing ability of such systems, however, is believed to be limited by direct radiative thermal emission through the translucent dental enamel in the 3-5 µm MWIR spectral range. Such radiative emissions can dominate the delayed conductive thermal contributions needed for tomographic reconstruction of internal dental defects. It has been hypothesized that long-wave infrared (LWIR) eTC-PCT systems may offer better tomographic performance by taking advantage of the intrinsic attenuation of direct radiative emission by dental enamel in the LWIR spectral range, enabling more effective delayed conductive thermal contributions from subsurface caries. More than an order of magnitude lower cost of the system is another key attribute of LWIR eTC-PCT which can open the door for downstream translation of the technology to clinics. In this report, we offer a systematic comparison of the performance/effectiveness of caries detection with LWIR and MWIR eTC-PCT systems for detecting natural caries, bacterial caries, and artificially demineralized enamel surfaces. Our results suggest that the low-cost LWIR based eTC-PCT system provides 3D visualization and 2D slice-by-slice images of early caries and internal micro-cracks similar to those obtained from the more expensive MWIR-based eTC-PCT system, albeit with ∼1.3dB lower signal-to-noise ratio.

Detection and monitoring of early dental caries and erosion using three-dimensional enhanced truncated-correlation photothermal coherence tomography imaging.

SIGNIFICANCE: Dental caries is the most common oral disease, with significant effects on healthcare systems and quality of life. Developing diagnostic methods for early caries detection is key to reducing this burden and enabling non-invasive treatment as opposed to the drill-and-fill approach. AIM: The application of a thermophotonic-based 3D imaging modality [enhanced truncated-correlation photothermal coherence tomography (eTC-PCT)] to early dental caries is investigated. To this end, the detection threshold, sensitivity, and 3D lesion reconstruction capability of eTC-PCT in imaging artificially generated caries and surface erosion are evaluated. APPROACH: eTC-PCT employs a diode laser with pulsed excitation, a mid-IR camera, and an in-house developed image reconstruction algorithm to produce depth-resolved 2D images and 3D reconstructions. Starting with healthy teeth, dental caries and surface erosion are simulated in vitro through application of specific demineralizing/eroding acidic solutions. RESULTS: eTC-PCT can detect artificial caries as early as 2 days after onset of artificial demineralization and after 45 s of surface erosion, with a laser power equivalent to 64% of maximum permissible exposure. In both cases, the lesion is not visible to the eye and undetected by x-rays. eTC-PCT is capable of monitoring lesion progression in 2-day increments and generating 3D tomographic reconstructions of the advancing lesion. CONCLUSIONS: eTC-PCT shows great potential for further development as a dental imaging modality combining low detection threshold, high sensitivity to lesion progression, 3D reconstruction capability, and lack of ionizing radiation. These features enable early diagnosis and frequent monitoring, making eTC-PCT a promising technology for facilitating preventive dentistry.

Robust multiparameter method of evaluating the optical and thermal properties of a layered tissue structure using photothermal radiometry.

The thermal and optical properties of multilayered dental tissue structure, the result of the surface-grown prismless layer on enamel, were evaluated simultaneously using multiparameter fits of photothermal radiometry frequency responses. The photothermal field generated in a tooth sample with near-infrared laser excitation was described using a coupled diffuse-photon-density and thermal wave model. The optical (absorption and scattering) coefficients and thermal parameters (spectrally averaged infrared emissivity, thermal diffusivity and conductivity) of each layer, as well as the thickness of the upper prismless enamel layer, were fitted using a multiparameter simplex downhill minimization algorithm. The results show that the proposed fitting approach can increase robustness of the multiparameter estimation of tissue properties in the case of ill-defined multiparameter fits, which are unavoidable in in vivo tissue evaluation. The described method can readily be used for noninvasive in vitro or in vivo characterization of a wide range of layered biological tissues.

3D Dental Subsurface Imaging Using Enhanced Truncated Correlation-Photothermal Coherence Tomography.

Development of accurate and sensitive dental imaging technologies is a top priority in the pursuit of high-quality dental care. However, while early dental caries detection and routine monitoring of treatment progress are crucial for effective long-term results, current radiographic technologies fall short of this objective due to low sensitivity for small lesions and use of ionizing radiation which is unsuitable for frequent monitoring. Here we demonstrate the first application of enhanced Truncated Correlation-Photothermal Coherence Tomography (eTC-PCT) to dental imaging. eTC-PCT is non-invasive and non-ionizing, operates well below the maximum permissible exposure (MPE) limit, and features 3D subsurface imaging capability with operator controlled axial resolution. We explore the potential of this method for dental applications and demonstrate its capability for depth-resolved tomographic 3D reconstructions of the details and subsurface extent of a variety of dental defects. To this end, in this proof-of-concept study, dental eTC-PCT imaging results, and its sensitivity to dental caries, are discussed in comparison with visual examination, x-rays and micro-CT imaging.

Caries Increment and Oral Hygiene Changes in 6- and 12-Year-Old Children in Riga, Latvia: A 3-Year Follow-Up Report Using ICDAS II and RADKE Criteria.

OBJECTIVES: The purpose of this study was to investigate the caries increment and oral hygiene changes over a 3-year period and also compare the sensitivity and specificity of Radke's caries assessment method to ICDAS II among 6- and 12-year-old children in Riga, Latvia. MATERIALS AND METHODS: Thirty-eight 6 and thirty-nine 12-year-old children were examined visually and with bitewing (BW) radiographs for dental caries at baseline and after a 3-year period. Decayed, missing, and filled surfaces (dmfs/DMFS) in all teeth were scored by one calibrated examiner using the Radke's caries scoring criteria. Oral hygiene level was determined using Green-Vermillion index (G-V ind.) at baseline and after 3 years. ICDAS II was used to assess all children only at the 3rd-year time point. The parents of the 6- and 12-year-old children responded to a questionnaire on oral hygiene at baseline and at the 3-year mark. STATISTICAL ANALYSIS: The data were analyzed using t-test, Chi-square test, Wilcoxon test (α= 0.05), and sensitivity and specificity tests. RESULTS: The mean (SD) values of G-V ind. and caries experience at baseline/3-year period in 6- versus 12-year-old children were as follows. G-V ind.: 1.14(0.80) /1.48(0.89) [p = 0.4768] versus 0.99(0.45)/1.45(1.22) [p = 0.0337]. DMFS: 0.72(1.02)/ 3.13(3.13) [p = 0.0000] versus 6.79(5.14)/14.79(9.86)[p = 0.0000]; dmfs: 11.26(8.71)/7.74 (4.86) [p = 0.0780] versus 3.57 (2.03)/1.5(0.71)[p = 0.3173].The sensitivity and specificity of Radke to ICDAS II of caries-affected surfaces was: in proximal surfaces-0.57 and 0.98, on occlusal surfaces-0.83 and 0.98, on buccal/lingual surfaces-0.43 and 0.99. CONCLUSIONS: The result of the present study suggests that the increased caries experience over a 3-year period among the 6- and 12-year-old children in Riga may be due to the concurrent decreased level of oral hygiene, suggesting that ICDAS II instead of Radke's criteria should be used to detect and monitor dental caries.

In vitro detection and quantification of enamel and root caries using infrared photothermal radiometry and modulated luminescence.

Artificially created demineralized and remineralized carious lesions on the root and enamel of human teeth were examined by photothermal radiometry (PTR) and modulated luminescence (LUM). Fourteen extracted human teeth were used and a lesion was created on a 1 mmx4 mm rectangular window, spanning root to enamel, using a lactic acid-based acidified gel to demineralize the tooth surface. The lesion was then exposed to a remineralization solution. Each sample was examined with PTR/LUM on the root and enamel before and after treatment at times from 1 to 10 (5 on root) days of demineralization and 2 to 10 days of remineralization. Ten-day (5 on root) demineralized samples were remineralized. After completing all the experiments, transverse microradiography (TMR) analysis was performed to compare and correlate the PTR/LUM signals to the depth of lesions and mineral losses. The PTR and LUM amplitudes and phases showed gradual and consistent changes with treatment time. In this study, TMR showed good correlation coefficients with PTR and LUM. It was also found that the length of the treatment time did not correlate very well to any technique, PTR/LUM or TMR, which implies a significant degree of inhomogeneity of the demireralization and remineralization rates in each and every tooth.

Detection of Caries Around Resin-Modified Glass Ionomer and Compomer Restorations Using Four Different Modalities In Vitro.

The aim of this study was to evaluate the ability of visual examination (International Caries Detection and Assessment System-ICDAS II), light-emitting diodes (LED) fluorescence (SPECTRA), laser fluorescence (DIAGNODent, DD), photothermal radiometry and modulated luminescence (PTR-LUM, The Canary System, CS) to detect natural decay beneath resin-modified glass ionomer (RMGIC) and compomer restorations in vitro. Twenty-seven extracted human molars and premolars, consisting of 2 control teeth, 10 visually healthy/sound and 15 teeth with natural cavitated lesions, were selected. For the carious teeth, caries was removed leaving some carious tissue on one wall of the preparation. For the sound teeth, 3 mm deep cavity preparations were made. All cavities were restored with RMGIC or compomer restorative materials. Sixty-eight sites (4 sites on sound unrestored teeth, 21 sound sites and 43 carious sites with restorations) were selected. CS and DD triplicate measurements were done at 2, 1.5, 0.5, and 0 mm away from the margin of the restoration (MOR). SPECTRA images were taken, and two dentists provided ICDAS II scoring for the restored surfaces. The SPECTRA data and images were inconclusive due to signal interference from the restorations. Visual examinations of the restored tooth surfaces were able to identify 5 of the 15 teeth with caries. In these situations, the teeth were ranked as having ICDAS II 1 or 2 rankings, but they could not identify the location of the caries or depth of the lesion. CS and DD were able to differentiate between sound and carious tissue at the MOR, but larger variation in measurement, and poorer accuracy, was observed for DD. It was concluded that the CS has the potential to detect secondary caries around RMGIC and compomer restorations more accurately than the other modalities used in this study.

Detection of interproximal demineralized lesions on human teeth in vitro using frequency-domain infrared photothermal radiometry and modulated luminescence.

Frequency-domain photothermal radiometry (FD-PTR or PTR) is used to detect mechanical holes and demineralized enamel in the interproximal contact area of extracted human teeth. Thirty-four teeth are used in a series of experiments. Preliminary tests to detect mechanical holes created by dental burs and 37% phosphoric acid etching for 20 s on the interproximal contact points show distinct differences in the signal. Interproximal contact areas are demineralized by using a partially saturated acidic buffer system. Each sample pair is examined with PTR before and after micromachining or treating at sequential treatment periods spanning 6 h to 30 days. Dental bitewing radiographs showed no sign of demineralized lesion even for samples treated for 30 days. Microcomputer tomography (micro-CT), transverse microradiography (TMR), and scanning electron microscopy (SEM) analyses are performed. Although micro-CT and TMR measured mineral losses and lesion depths, only SEM surface images showed visible signs of treatment because of the minimal extent of the demineralization. However, the PTR amplitude increased by more than 300% after 80 h of treatment. Therefore, PTR is shown to have sufficient contrast for the detection of very early interproximal demineralized lesions. The technique further exhibits excellent signal reproducibility and consistent signal changes in the presence of interproximal demineralized lesions, attributes that could lead to PTR as a reliable probe to detect early interproximal demineralization lesions. Modulated luminescence is also measured simultaneously, but it shows a lower ability than PTR to detect these interproximal demineralized lesions.

Remineralization of natural early caries lesions in vitro by P11 -4 monitored with photothermal radiometry and luminescence.

AIM: The efficacy of self-assembling peptide P11 -4 to regenerate enamel in natural early caries lesions was evaluated over 50 days by photothermal radiometry and luminescence using The Canary System (CS) and The Canary Lab (CL). METHODS: Baseline readings for sound and carious sites on smooth surfaces of extracted teeth were obtained by scanning with CS and CL. Teeth were then randomly assigned to a treatment group (TG, treated with P11 -4), a placebo group (PG, same vehicle as treatment group without P11 -4), or a control group (CG, no treatment). All the teeth were then placed in artificial saliva to facilitate natural remineralization, and the sites were rescanned with CS and CL at 7, 14, 30, and 50 days. RESULTS: For carious sites in TG, mean canary numbers (CN) derived from CS decreased significantly (P<.01) from 44±3.8 at baseline to 24±4.9 at day 50; the mean CN for the TG derived from CL also decreased significantly (P<.05), from 65 at baseline to 45 at day 50. In contrast, no significant changes in CN were observed for carious sites in the CG or PG using either CS or CL. CONCLUSIONS: P11 -4 promoted the regeneration of early caries.

Comparison of The Canary System and DIAGNOdent for the in vitro detection of caries under opaque dental sealants.

AIM: The aim of the present study was to investigate the ability of operators using The Canary System and DIAGNOdent to detect natural pit and fissure caries under four commonly-used opaque dental sealants. METHODS: Mixed sound and carious pits/fissures (N = 105) selected from 40 human teeth were randomly assigned (10 teeth/group) to one of four opaque sealant groups (Delton, Embrace WetBond, Helioseal F, UltraSeal XT Plus). Selected pits/fissures sites on occlusal surfaces were scanned with The Canary System and DIAGNOdent, sealed, re-scanned, and subjected to polarized light microscopy to confirm whether the scanned regions were sound or carious. Sensitivities and specificities for each detection method before and after sealant placement were calculated. RESULTS: The Canary System and DIAGNOdent were able to distinguish between sound and carious tissue beneath opaque sealants with an accuracy of 76% and 59%, respectively. CONCLUSIONS: The Canary System can serve as a clinical tool to aid dental professionals to detect and monitor the status of caries lesions and tooth structure underneath sealant. The increased likelihood of false-positive diagnoses with DIAGNOdent due to intrinsic auto-fluorescence of sealant filler and opacifying agents might limit its usefulness as an aid to detect caries underneath opaque sealants.

In Vitro Detection of Caries Around Amalgam Restorations Using Four Different Modalities.

OBJECTIVE: The aim of this study was to evaluate the ability of PTR-LUM (The Canary System, CS), laser fluorescence (DIAGNOdent, DD), LED fluorescence (Spectra), and visual inspection (ICDAS II) to detect natural decay around bonded amalgam restorations in vitro. METHODS: Seventeen extracted human molars and premolars, consisting of visually healthy (n=5) and natural cavitated (n=12) teeth were selected. For the carious teeth, caries was removed leaving some decayed tissue on the floor and or wall of the preparation. For sound teeth, 3 mm. deep cavity preparations were made and teeth were restored with bonded-amalgam restorations. Thirty-six sites (13 sound sites; 23 carious sites) were selected. CS and DD scans were performed in triplicate at 2, 1.5, 0.5, and 0 mm away from the margin of the restoration (MOR). Spectra images were captured for the entire surface, and dentists blinded to the samples provided ICDAS II scoring. RESULTS: Canary Numbers (Mean±SE) for healthy and carious sites at 2, 1.5, 0.5, and 0 mm from the MOR ranged from 12.9±0.9 to 15.4±0.9 and 56.1±4.0 to 56.3±2.0, respectively. DD peak values for healthy and carious sites ranged from 4.7±0.5 to 13.5±2.99, and 16.7±3.7 to 24.5±4.4, respectively. For CS and DD, sensitivity/specificity for sites at 2.0, 1.5, 0.5, 0 mm ranged from 0.95-1.0/0.85-1.0, and 0.45-0.74/0.54-1.0, respectively. For ICDAS II, sensitivity and specificity were 1.0 and 0.17, respectively. For Spectra, data and images were inconclusive due to signal intereference from the amalgam restoration. CONCLUSIONS: Using this in-vitro model, CS and DD were able to differentiate between sound and carious tissue at the MOR, but larger variation, less reliability, and poorer accuracy was observed for DD. Therefore, CS has the potential to detect secondary caries around amalgam restorations more accurately than the other investigated modalities.

Multi-Centre Clinical Evaluation of Photothermal Radiometry and Luminescence Correlated with International Benchmarks for Caries Detection.

INTRODUCTION: A clinical study was initiated to investigate a caries detection device (The Canary System (CS)), based on photothermal radiometry and modulated luminescence (PTR-LUM). The primary objective of this study was to determine if PTR-LUM values (in the form of Canary Numbers; CN) correlate with International Caries Diagnostic and Assessment System (ICDAS II) scores and clinical situations. The secondary objectives of this study were to monitor the safety of PTR-LUM, and collect data to determine how CN values could be used to differentiate healthy from decayed tooth surfaces on a normalized scale. METHODS: The trial was a four site, non-blinded study. Data was collected from 92 patients, resulting in 842 scanned tooth surfaces over multiple appointments. Surfaces were assessed according to ICDAS II, and further stratified into five clinical situation categories: 1) healthy surface, 2) non-cavitated white and/or brown spots; 3) caries lesions; 4) cavitation and 5) teeth undergoing remineralization therapy.CN data was analyzed separately for smooth and occlusal surfaces. Using a semi-logarithmic graph to plot raw CN (rCN) and normalized (CN) values, rCN data was normalized into a scale of 0-100. RESULTS: Linear correlations (R2) between CN and ICDAS II groupings for smooth and occlusal surfaces were calculated as 0.9759 and 0.9267, respectively. The mean CN values derived from smooth (20.2±0.6) and occlusal (19±1.0) surfaces identified as healthy had significantly lower CN values (P<0.05) compared with the values from the other clinical situation categories. No adverse events were reported. CONCLUSION: The present study demonstrated the safety of PTR-LUM for clinical application and its ability to distinguish sound from carious tooth surfaces. A clear shift from the baseline in both PTR and LUM in carious enamel was observed depending on the type and nature of the lesion, and correlated to ICDAS II classification codes, which enabled the preliminary development of a Canary Scale.

Correlation with Caries Lesion Depth of The Canary System, DIAGNOdent and ICDAS II.

INTRODUCTION: The aim of this study was to correlate lesion depth of natural caries, measured with Polarized Light Microscopy (PLM), to Canary Numbers (CN) derived from The Canary System™ (CS), numerical readings from DIAGNOdent (DD), and lesion scores from ICDAS II. METHODS: A total of 20 examination sites on extracted human molars and premolars were selected. The selected examination sites consisted of healthy and enamel caries on smooth and occlusal surfaces of each tooth. Two blinded dentists ranked each examination site using ICDAS II and the consensus score for each examined site was recorded. The same examination sites were scanned with CS and DD, and the CN and DD readings were recorded. After all the measurements were completed, the readings of the three caries detection methods were validated with a histological method, Polarized Light Microscopy (PLM). PLM performed by blinded examiners was used as the 'gold standard' to confirm the presence or absence of a caries lesion within each examined site and to determine caries lesion depth. RESULTS: Pearson's coefficients of correlation with caries lesion depth of CNs, DD readings and ICDAS scores were 0.84, 0.21 and 0.77, respectively. Mean ± SD CN for sound sites (n=3), caries lesion depths <800 µm (n=11), and caries lesion depths >800 µm (n=6) were 11±1, 55±15, and 75±22, respectively. Mean ± SD DD readings for sound sites, caries lesion depths <800 µm, and caries lesion depths >800 µm were 1±1, 7±11, and 8±9, respectively. Mean ± SD ICDAS II scores for sound sites, caries lesion depths <800 µm, and caries lesion depths >800 µm were 0±0, 2±1, and 2±1, respectively. The intra-operator repeatability for the Canary System was .953 (0.913, 0.978). CONCLUSION: This study demonstrated that the CS exhibits much higher correlation with caries lesion depth compared to ICDAS II and DD. CS may provide the clinician with more information about the size and position of the lesion which might help in monitoring or treating the lesion.The present extracted tooth study found that The Canary System correlates with caries lesion depth more accurately that ICDAS II and DIAGNOdent.