激光荧光检测技术诊断恒牙邻面龋的临床效果评价
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摘要
目的:探讨激光荧光检测仪(DIAGNOdent,DD)检测恒牙邻面龋时测量值和临床视诊检查的符合率,了解厂家给出的DD界值是够适用于诊断恒牙邻面龋,并对DD检查恒牙邻面龋的效果进行评价。方法:选择到吉林大学口腔医院就诊的成年患者若干例,根据改良的EKstrand视诊分级标准判断是否需要磨开,排除不需要磨开的病例。选择磨牙115例,前磨牙50例,前牙50例作为研究对象,用DD对其邻面龋坏进行检查,以磨开后实际龋坏深度为金标准,分析DD测量值的分布规律,与金标准做统计学分析。结果:DD诊断恒牙邻面龋界值与金标准即临床磨开后的诊断一致性较好,差异无统计学意义,DD诊断的灵敏度,准确度,特异度均高。与磨牙和前磨牙相比,DD检测前牙邻面龋的界值与临床检查金标准的一致性稍差,灵敏度稍低。结论:DD在检测恒牙邻面龋方面效果较好,有较高的灵敏度,准确度和特异度,界值与厂家提供的界值基本一致。
In the past, the development of dental caries was more often than not considered as a process which is progressive and irreversible and hard tissue demineralization is at the first stage, then the degradation of biopeptide. Therefore, in the traditional treatment, the result of applying mechanical preparation to exorcise cavities, and using restorative materials instead leads to the deprivation of tissue of tooth, and the crown to be thinner. Actually, dental caries is not just the demineralization of tissue of tooth, but also a demineralization process referring to chemical and ecological unbalance between biomembrane and tooth interface. Diet, life style, drinking and smoking have important effect on lesions of biological membrane. Along with the further study on the theory of ecological plaque, people began to know that demineralization of the enamel and the dentin is not an irreversible process, but a circular process with demineralization-mineralization. With the effect of the micro-circumstance, tissue of tooth has the possibility of losing or obtaining calcium and phosphorus ion.
Minimal Invasive Dentistry can best be defined as the management of caries with a biological approach, rather than with a traditional surgical operative dentistry approach. Where operative dentistry is required, this is now carried out in the most conservative manner with minimal destruction of tooth structure. This new approach to caries management changes the emphasis from diagnosing carious lesions as cavities (and a repeating cycle of restorations), to one of diagnosing the oral ecological imbalance and effecting biological changes in the biofilm. The goal of MI is to stop the disease process and then to restore lost tooth structure and function, maximizing the healing potential of the tooth.
Minimally invasive dentistry assesses the dangerous factors of leading caries at the individual lay, can measure and quantize the factors which lead caries, can understand the patient's eating habits, whether lack fluoride ,thereby help find more caries risk. communicating with patients in the relaxed environment, we can know the correlation factors to patients and caries (such as medical conditions, lifestyle, socio-economic background, oral hygiene habits, etc.), as well as degree of cooperation in the future health interventions. Synthesizing all the information has a complete evaluation on the risk of leading caries. At the same time, based on good communication with patients and communication, the patient can have sufficient confidence in the personalized treatment project to cooperate. Such a treatment plan, includes interventing all of the factors that trigger and impact caries, as well as control of bacterial infections.
Minimally invasive dentistry emphasis on the treatment of patients with minimum intervention, maximum retention of patients’odontal tissue, minimally invasive treatment include: Preparation of holes (such as the use of cavitation, laser processing and the sound of corrosion); clear up of caries (for example, getting rid of caries optionally and / or laser processing); cavity filling (such as preventive resin filling, sandwich filling). Once caries is controlled, you can use the Minimally invasive, easy way for patients to receive treatment to deal with odontal tissue and part whose function is irreversible loss. Filler is usually very small, and we need operate it in a relatively painless situation.
The treatment concepts of Minimally invasive dentistry is fused into all areas of oral cavity clinical treatment, new treatment model replace traditional one so that patients can get more biological treatment. It is the inevitable development trend of oral medicine. The prerequisite of realizing the Minimally invasive dentistry is the early diagnosis of dental caries. The current clinical diagnostic methods commonly used (for example, inspection, probing, radiological examination) have lower sensitivity .they can’t give an accurate diagnosis of early caries loss, therefore, often lost the praticality of early treatment. In recent years, scholars carry out more discoveries according to early diagnosis of caries, in addition to traditional methods, some new technologies, new ways have gradually been taken seriously.
At present, the new method of early diagnosis of Dental caries includes Electric impedance technology, DIAGNOdent(DD), QLF etc. DD is a recent instrument which detects caries by laser. Its principle is that laser is absorbed by the mineral and organics of teeth. Then it produces fluorescence. We can judge the depth of caries according to value and alarm. At present, its study is centered the sensitivity and specificity.
The advantages of DD are as follows:First, it fit the diagnosis of early caries. Dental caries-photon excited fluorescence detection to reach DD Detector is farther away from the probe, absorption of photon being scattered or dentin and on the cover of its enamel is more, so DD is more suitable to detect the smaller, more superficial, and the caries confined to enamel. Second, more suitable for deciduous caries diagnosis. it turns out that DD in the diagnosis of caries of deciduous teeth have a higher sensitivity, specificity and reliability according to the Foreign reports. Studies have shown that enamel of deciduous teeth has more reflective and refractive index than that of permanent teeth, and enamel crystal’s diameter is less than permanent teeth, and has a porous nature, permanent teeth have weak fluorescence than deciduous teeth. In contrast, DD is more suitable for deciduous caries diagnosis. our study show that, the inspection index of the clinical diagnosis increased as deciduous caries aggravates, DD measurement values are also elevated. Third, DD can be used for long-term monitoring of the progress of caries loss.
The impact factors of DD diagnosis: first, the natural luster of tooth, plaque, pigmentation on the surface of tooth, food residue, the enamel of decalcification, the caries enamel and dentin. However, in recent years, researchers found that sealant, clean filling, dental plaque and so forth did not significantly affect DD readings, and it will affect the larger the of DD values if the wet degree on the surface of the teeth is biggish. Second, the impact of the external environment. it must maintain the same external environment during the using period of DD, such as temperature, surgery light intensity. Because the light reflected from the surface of teeth may affect the reading of DD. Third, the other effects. Scholars found that continuous autoclave will change DD readings, reducing its performance, and battery power did not significantly affect the device performance.
It still has some problems on the DD Research, for example, DD border value still has no clear setting standards, so far there is very little research in this field. And what’s the relationship of DD measurement value and the depth of caries , the study to clinical trials is less because DD standard to determine is difficult. Therefore, DD can not be used as a sole method to determine the need for filling treatment. according to this new technology ,we need more clinical practice and validation in order to better extend and apply.
In the past, the development of dental caries was more often than not considered as a process which is progressive and irreversible and hard tissue demineralization is at the first stage, then the degradation of biopeptide. Therefore, in the traditional treatment, the result of applying mechanical preparation to exorcise cavities, and using restorative materials instead leads to the deprivation of tissue of tooth, and the crown to be thinner. Actually, dental caries is not just the demineralization of tissue of tooth, but also a demineralization process referring to chemical and ecological unbalance between biomembrane and tooth interface. Diet, life style, drinking and smoking have important effect on lesions of biological membrane. Along with the further study on the theory of ecological plaque, people began to know that demineralization of the enamel and the dentin is not an irreversible process, but a circular process with demineralization-mineralization. With the effect of the micro-circumstance, tissue of tooth has the possibility of losing or obtaining calcium and phosphorus ion.
Minimal Invasive Dentistry can best be defined as the management of caries with a biological approach, rather than with a traditional surgical operative dentistry approach. Where operative dentistry is required, this is now carried out in the most conservative manner with minimal destruction of tooth structure. This new approach to caries management changes the emphasis from diagnosing carious lesions as cavities (and a repeating cycle of restorations), to one of diagnosing the oral ecological imbalance and effecting biological changes in the biofilm. The goal of MI is to stop the disease process and then to restore lost tooth structure and function, maximizing the healing potential of the tooth.
Minimally invasive dentistry assesses the dangerous factors of leading caries at the individual lay, can measure and quantize the factors which lead caries, can understand the patient's eating habits, whether lack fluoride ,thereby help find more caries risk. communicating with patients in the relaxed environment, we can know the correlation factors to patients and caries (such as medical conditions, lifestyle, socio-economic background, oral hygiene habits, etc.), as well as degree of cooperation in the future health interventions. Synthesizing all the information has a complete evaluation on the risk of leading caries. At the same time, based on good communication with patients and communication, the patient can have sufficient confidence in the personalized treatment project to cooperate. Such a treatment plan, includes interventing all of the factors that trigger and impact caries, as well as control of bacterial infections.
Minimally invasive dentistry emphasis on the treatment of patients with minimum intervention, maximum retention of patients’odontal tissue, minimally invasive treatment include: Preparation of holes (such as the use of cavitation, laser processing and the sound of corrosion); clear up of caries (for example, getting rid of caries optionally and / or laser processing); cavity filling (such as preventive resin filling, sandwich filling). Once caries is controlled, you can use the Minimally invasive, easy way for patients to receive treatment to deal with odontal tissue and part whose function is irreversible loss. Filler is usually very small, and we need operate it in a relatively painless situation.
The treatment concepts of Minimally invasive dentistry is fused into all areas of oral cavity clinical treatment, new treatment model replace traditional one so that patients can get more biological treatment. It is the inevitable development trend of oral medicine. The prerequisite of realizing the Minimally invasive dentistry is the early diagnosis of dental caries. The current clinical diagnostic methods commonly used (for example, inspection, probing, radiological examination) have lower sensitivity .they can’t give an accurate diagnosis of early caries loss, therefore, often lost the praticality of early treatment. In recent years, scholars carry out more discoveries according to early diagnosis of caries, in addition to traditional methods, some new technologies, new ways have gradually been taken seriously.
At present, the new method of early diagnosis of Dental caries includes Electric impedance technology, DIAGNOdent(DD), QLF etc. DD is a recent instrument which detects caries by laser. Its principle is that laser is absorbed by the mineral and organics of teeth. Then it produces fluorescence. We can judge the depth of caries according to value and alarm. At present, its study is centered the sensitivity and specificity.
The advantages of DD are as follows:First, it fit the diagnosis of early caries. Dental caries-photon excited fluorescence detection to reach DD Detector is farther away from the probe, absorption of photon being scattered or dentin and on the cover of its enamel is more, so DD is more suitable to detect the smaller, more superficial, and the caries confined to enamel. Second, more suitable for deciduous caries diagnosis. it turns out that DD in the diagnosis of caries of deciduous teeth have a higher sensitivity, specificity and reliability according to the Foreign reports. Studies have shown that enamel of deciduous teeth has more reflective and refractive index than that of permanent teeth, and enamel crystal’s diameter is less than permanent teeth, and has a porous nature, permanent teeth have weak fluorescence than deciduous teeth. In contrast, DD is more suitable for deciduous caries diagnosis. our study show that, the inspection index of the clinical diagnosis increased as deciduous caries aggravates, DD measurement values are also elevated. Third, DD can be used for long-term monitoring of the progress of caries loss.
The impact factors of DD diagnosis: first, the natural luster of tooth, plaque, pigmentation on the surface of tooth, food residue, the enamel of decalcification, the caries enamel and dentin. However, in recent years, researchers found that sealant, clean filling, dental plaque and so forth did not significantly affect DD readings, and it will affect the larger the of DD values if the wet degree on the surface of the teeth is biggish. Second, the impact of the external environment. it must maintain the same external environment during the using period of DD, such as temperature, surgery light intensity. Because the light reflected from the surface of teeth may affect the reading of DD. Third, the other effects. Scholars found that continuous autoclave will change DD readings, reducing its performance, and battery power did not significantly affect the device performance.
It still has some problems on the DD Research, for example, DD border value still has no clear setting standards, so far there is very little research in this field. And what’s the relationship of DD measurement value and the depth of caries , the study to clinical trials is less because DD standard to determine is difficult. Therefore, DD can not be used as a sole method to determine the need for filling treatment. according to this new technology ,we need more clinical practice and validation in order to better extend and apply.
引文
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[8]杨是,用Kappa值衡量龋病检查结果的可靠度.临床口腔医学杂志.1990;6(1);9.
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[12]Xie QS,Tran Ous S,Angmar-Mansson B.Conparison of QL Fand DIAGNOdent for quantification of smooth surface caries.Caries Res,2001,35(1): 21-26
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[14]Ekstrand KR,Ricketts DNJ,Kidd EAM.Detection diagnosing monitoring and logical treatment of occlusal caries in relation to lesion activity and severity.An in vivo examinationwith histological validation[J].Caries Res,1998, 32:247-254.
[15]何美英,朱玲.DIAGNOdent在龋病诊断中的应用.临床口腔医学,2006,22(11): 691-692.
[16]Yumiko H,Kenichi M,Takashi I.Influence of tooth-polishing pastes and sealants on DIAGNOdent valies.Quintessence Int.2004,35(8):183-185.
[17]Frentzen M,Sanraella MRLA,Matsin E,et al.The influence of polishing and calibration on laser florescence caries detection.Quiritessence Int,2004, 35(8):181-182.
[18]PinelliC,Serra MC,de Castro Monr eiroLoffredo L.Validity and repro- ducibility of a laser fluorescence system for detecting theactivity of white-spot lesion on free smooth surface in vivo.Caries Res,2002,36(1):19-24.
[19]Autoclaving and battery capacity influence on laser fluorescence measurements. Rocha-Cabral, Renata Maciel; Mendes, Fausto Medeiros; Miura, Fabiana; Ribeiro, Adriana Da Costa; Braga, Mariana Minatel; Zezell, Denise Maria Acta Odontol Scand Volume: 66 Issue: 2 Pages: 122-7 Published: 2008 Apr.
[20]Reich E,Berakdar M,Netuschil L,rt sl.Clinical caries siagnosis compared to DIAGNOdent evaluations.Caries Res,1999,33(5):299.
[21]Comparison of visual inspection, radiographic examination, laser fluorescence and their combinations on treatment decisions for occlusal surfaces. Valera, Fabiano Bassalobre; Pessan, Juliano Pelim; Valera, Rubens Carneiro; Mondelli, Jose; Percinoto, Celio. Am J Dent Volume: 21 Issue: 1 Pages: 25-9 Published: 2008 Feb.
[2]Tyas MJ,Amisiview KJ,Frencken JE,et al.Minimal intervention dentistry-a review.FDI Commission Project1-97[J].Int Dent J,2000.50(1);1-12.
[3]Huysmans MC,Long bottom.The challenges of validating diagnostic methods and selecting appropriate gold standards[J].J Dent Res,2004,83:C48-C52.
[4]王宇明,朱长连主编,临床医学科研方法.人民军医出版社.1999;122-126.
[5]杨是,用Kappa值衡量龋病检查结果的可靠度.临床口腔医学杂志.1990;6(1);9.
[6]Bocci V. Oxygen-zone therapy. Acritical evaluation [M]. Dordrecht.The Netherlands: Kluwer Academic Publishers,2002:1-440.
[7]Claxson AWD,Smith C,Turner MD,et al.Oxidative Modification of Salivary Biomo- lecules with Therapeutic Levels of Ozone[J].J Dent Res,2002,81:A-502.
[8]Lynch E,Silwood C,Simth C,et al.Oxidising actions of anti-bacterial ozone-generating device towords root caries biomolecules[J]J Dent Res,2002,81:A138.
[9]Celiberti P,Pazera P,Lussi A.The impact of ozone treatment on enamel physical properties[J].Am J Dent,2006,19(1):67-72.
[10]Schmidlin PR,Zimmermann J,Bindl A.Effect of ozone on enamel and dentin bond strength[J].Adhes Dent,2005,7(1):29-32.
[11]Summits JB.Conservative cavity preparation[J].Int Dent J.2000.50(1);1-12.
[12]Mjor IA,Gordan VV,A review of atraumatic restorative treatment(ART)[J].Int Dent J,1999,49(3);127-131.
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