Diagnóstico e decisões de tratamento para cárie induzido por luz: aplicação de uma câmera intraoral com fluorescência / Diagnosis and treatment decisions for light-induced caries: application of an intraoral fluorescence camera

Objetivou-se verificar se 1) o diagnóstico por fluorescência (DF) e o exame visual (EV), são igualmente eficazes em detectar lesões de mancha branca (MB); 2) verificar se imagens obtidas por uma câmera intraoral, no modo luz branca (LB) ou fluorescente (LF) são comparáveis à radiografia digital (RD) no diagnóstico e no auxílio às decisões de tratamento para cárie oclusal e 3) verificar se a câmera intraoral, no modo LF, comporta-se com precisão, ao definir se a remoção químico-mecânica (RQM) de dentina cariada com gel de papaína estabelece um adequado limite para o preparo. Neste contexto, três estudos foram propostos. O primeiro estudo contou com uma revisão sistemática da literatura, a fim de verificar se o DF e o EV, são comparáveis em detectar lesões de MB relacionada a ortodontia fixa. Cinco estudos foram incluídos nesta revisão. O diagnóstico de MB relacionada a ortodontia fixa, realizado por fluorescência, foi satisfatório em relação ao EV, porém com baixa qualidade das evidências. O segundo estudo contou com uma pesquisa ex vivo, com 10 molares permanentes e 26 dentistas avaliadores, e propôs verificar se imagens obtidas pela câmera intraoral SoproLife®, no modo LB e LF, e as RD, são comparáveis no diagnóstico e decisões de tratamento de cárie oclusal, comparado a um padrão-ouro em microtomografia computadorizada (micro-CT). Para o diagnóstico de cárie, não foi encontrada diferença entre os três métodos (p=0,415), com uma concordância geral baixa (média de 15,3%), enquanto para as decisões de tratamento, o percentual de acertos entre os três métodos foi maior para a LB (48,1%) e LF (51,2%) em relação a RD (30,4%) (p<0,001). O terceiro estudo foi realizado ex vivo, a fim de verificar se a câmera intraoral SoproLife®, no modo LF, comporta-se com precisão, ao definir se a RQM de dentina cariada pelo gel é suficiente comparado a um padrão-ouro em micro-CT. A efetividade de dois géis de papaína na remoção de cárie em dentina também foi estudada. Após o escaneamento inicial, 20 molares permanentes foram pareados e divididos em grupos, (G1) Papacárie Duo® e (G2) Brix3000®. O limiar para a detecção de tecido cariado de <1,11 g/cm3, foi utilizado. A eficácia da RQM foi menor para o Papacárie Duo® comparado ao Brix3000® (p<0,05). Ambos os grupos apresentaram falsos positivos quando a câmera intraoral SoproLife® considerou tecido cariado presente. Deste modo, conclui-se que: 1) O diagnóstico de MB relacionada a ortodontia fixa por DF, mostrou-se satisfatório em relação ao EV; 2) Imagens em LB, LF e RD, foram eficazes nas decisões de tratamento de cárie oclusal; 3) a câmera intraoral SoproLife® não definiu apropriadamente se a RQM pelo gel foi suficiente; 4) a utilização dos géis de papaína resultou em remoção de tecido cariado conservativa, preservando tecido dental sadio. (AU)

The aim was to verify if 1) fluorescence diagnosis (FD) and visual examination (VE) are equally effective in detecting white spot (WS) lesions; 2) to verify whether images transmitted by an intraoral camera in white light (WL) mode or fluorescent (FL) are comparable to digital radiography (DR) in diagnosing and aiding treatment decisions for occlusal caries and 3) verify whether the intraoral camera, in FL mode, behaves accurately, when defining whether chemical-mechanical removal (CMR) of carious dentin with papain gel results in appropriate threshold for cavity preparation. In this context, three studies were proposed. The first study was a systematic review of the literature, in order to verify if FD and VE are comparable in detecting WS lesions related to fixed orthodontics. Five studies were included in this review. The diagnosis of WS, performed by fluorescence, was satisfactory in relation to VE, but with very low quality of evidence. The second study included an ex vivo survey, with 10 permanent molars and 26 examiners, and verified whether images obtained by the SoproLife® intraoral camera, in WL and FL mode, and the DR, are comparable in the diagnosis and treatment decisions of occlusal caries compared to a gold standard in micro-computed tomography (micro-CT). For caries diagnosis, no difference was found between the three methods (p=0.415), with a low overall agreement (mean of 15.3%), while for treatment decisions, the percentage of correct answers between the three methods was higher for WL (48.1%) and FL (51.2%) compared to DR (30.4%) (p<0.001). The third study was performed ex vivo, in order to verify whether SoproLife® intraoral camera, in FL mode, behaves accurately, when defining whether the CMR of carious dentin is sufficient compared to a gold standard in micro-CT. The effectiveness of two papain gels in removing caries in dentin was also studied. After the initial scan, 20 permanent molars were paired and divided into groups, (G1) Papacárie Duo® and (G2) Brix3000®. A threshold for carious tissue (<1.11 g/cm3) was used. The effectiveness of CMR was lower for Papacárie Duo® compared to Brix3000® (p<0.05). Both groups showed false positives when SoproLife® intraoral camera evaluated carious tissue present. Thus, it is concluded that: 1) The diagnosis of WS related to fixed orthodontics due to FD, was satisfactory in relation to VE; 2) WL, FL and DR images were effective in defining occlusal caries treatment decisions and 3) SoproLife® intraoral camera did not properly define whether CMR sufficient and 4) the use of papain gels resulted in conservative removal of carious tissue, preserving sound dental tissue. (AU)

Evaluation of dental enamel caries assessment using Quantitative Light Induced Fluorescence and Optical Coherence Tomography.

An in vitro study of morphological alterations between sound dental structure and artificially induced white spot lesions in human teeth, was performed through the loss of fluorescence by Quantitative Light-Induced Fluorescence (QLF) and the alterations of the light attenuation coefficient by Optical Coherence Tomography (OCT). To analyze the OCT images using a commercially available system, a special algorithm was applied, whereas the QLF images were analyzed using the software available in the commercial system employed. When analyzing the sound region against white spot lesions region by QLF, a reduction in the fluorescence intensity was observed, whilst an increase of light attenuation by the OCT system occurred. Comparison of the percentage of alteration between optical properties of sound and artificial enamel caries regions showed that OCT processed images through the attenuation of light enhanced the tooth optical alterations more than fluorescence detected by QLF System. QLF versus OCT imaging of enamel caries: a photonics assessment.