|Year : 2013 | Volume
| Issue : 1 | Page : 26-30
Reliability of electronically detection of fissure caries (by using a prototype device): An alternative diagnostic electronic caries monitor device
Abdulkadir Sengun1, Yüksel Özbay2, Bayram Akdemir2, Bora Öztürk3, Füsun Özer4, Serdar Baglar1
1 Faculty of Dentistry, Kirikkale University, Kirikkale, Turkey
2 Faculty of Engineering and Architecture, Selçuk University, Konya, Turkey
3 Faculty of Dentistry, Selçuk University, Philadelphia, PA, USA
4 School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
|Date of Web Publication||29-Apr-2013|
Faculty of Dentistry, Kirikkale University, Kirikkale
Source of Support: None, Conflict of Interest: None
Objective: The purpose of this in vitro study was to investigate the reliability of a prototype electronic caries monitor (ECM) for diagnosis of the dental caries on the occlusal surfaces of posterior teeth and to compare using histological examination as gold standard. Materials and Methods: Data were obtained from 93 occlusal sites of 33 extracted human molars. Electrical resistance to alternative currency of 21 Hz and 24 Vpp of the teeth was measured with the ECM, which produced in Selcuk University. After obtaining electrical conductance values, each tooth was then sectioned into two pieces mesiodistally and examined histologically for occlusal caries under the stereomicroscope. Statistical evaluations were made using Pearson correlation test. Results: A statistically significant negative correlation was found between electrical resistance of the teeth and occlusal caries presence ( P < 0.05). Conclusion: As a result, it is suggested that ECM is a nondestructive and suitable method at detection of occlusal caries.
Keywords: Dental caries detection, electronic caries monitor, occlusal caries
|How to cite this article:|
Sengun A, Özbay Y, Akdemir B, Öztürk B, Özer F, Baglar S. Reliability of electronically detection of fissure caries (by using a prototype device): An alternative diagnostic electronic caries monitor device. J Res Dent 2013;1:26-30
|How to cite this URL:|
Sengun A, Özbay Y, Akdemir B, Öztürk B, Özer F, Baglar S. Reliability of electronically detection of fissure caries (by using a prototype device): An alternative diagnostic electronic caries monitor device. J Res Dent [serial online] 2013 [cited 2019 Jun 15];1:26-30. Available from: http://www.jresdent.org/text.asp?2013/1/1/26/111230
| Introduction|| |
Fissure caries continues to be a significant clinical problem, despite overall reductions in the prevalence of smooth-surface caries since the advent of fluoride. The point at which operative intervention is required depends on the presence of significant dentinal infection, and this diagnosis can be difficult in the absence of cavitation. Visual occlusal cavitation has been shown to be synonymous with dentinal involvement, but it is generally accepted that diagnosis of dentinal decay beneath discolored and slightly defective fissures, or even under apparently sound occlusal fissures, can be challenging. The success rates of traditional diagnostic methods for fissure caries are between 62-90%, thus some teeth that do not need any restoration may be accidentally open cavity.  Traditional diagnostic methods include probing (which may actually cause infection or traumatic micro-cavitation), optical criteria, and radiography methods. In addition to these, there are some new methods recently developed ,, which are:
Ideal caries diagnostic methods reduce the risk of unnecessary operative intervention. Early detection of occlusal lesions is advantageous primarily because it enables the benefits of therapeutic prevention with sealants. , In March 2001, the National Institutes of Health, or NIH, published a consensus statement on diagnosis and management of dental caries, expressing a need for advances in radiographic methods of diagnosing noncavitated lesions and a need for both clinical trials and laboratory studies to evaluate the efficacy of new methods. 
- Electrical methods
- Impedance spectroscopy,
- Electrical conductance measurements
- Elecrical resistance monitors (Electronic Caries Monitor
- Light illumination methods
- Laser fluorescense
- Fiberoptic transillumination
- Strip mutans tests (for risk evaluation)
- Ultrasonic imaging
- Less invasive tooth preparation techniques
Demineralizied dental hard tissues have more electrical conductivity than the sound ones. Thus, decayed tooth regions show less resistance to electrical current. And also electrical resistance decreases closer to the pulp. ,,,
The electronic caries monitor (ECM) has been developed as clinical diagnostic aids in the detection and quantification of occlusal carious lesions. , The diagnosis of occlusal caries at non-cavitated sites remains problematic, especially since clinical visual detection has limited sensitivity. Recently, electrical methods of detection show considerable promise. ,,, The ECM device measures the bulk resistance of tooth tissue. ,, As the tooth demineralized in caries process, the loss of mineral leads to increased porosity in the tooth structure. Increased porosity leads to decreased electrical resistance. 
The validity of electrical caries detection methods was the subject of a critical review in 2000 by Huysmans.  Huysmans pointed out that ECM measurements provide quantitative data, and thus it was best to use a correlation with a gold standard of lesion progression. ,
The purpose of this in vitro study was to investigate the reliability of a prototype [Figure 1]. Electronic caries monitor (ECM) for diagnosis of the dental caries on the occlusal surfaces of posterior teeth and to compare using histological examination as gold standard.
| Materials and Methods|| |
Thirty-three human third molars were used in this in vitro study which was extracted due to the harmful positions. The teeth were without any visible detected carious cavitations or restorations at occlusal or flat surfaces. Soft tissue remnants on teeth were carefully cleaned. The teeth were stored in formalin solution at 4°C until use. Electrical resistance to alternative currency of 21 Hz and 24 Vpp of the teeth was measured with the ECM, which produced in Selcuk University, Konya-Turkey. 21 Hz, 24 Vpp (Volt, peak-to peak), and a voltage source with internal resistance of about 150 kΩ was created. The signals obtained during the measurements have been passed to a fitler which have 55 dB band. A shielded stainless steel examination probe was connected to the amplifier input (evaluation unit) by means of a shielded cable, as the sensor tip. Signal carrying the second probe was connected to the voltage source again by using a shielded cable and a steel tip. The obtained resistance values which sort of Voltage (V) converted to ohm (Ω).
The teeth were washed with tap water before using and they were dried, but during the measurements, diagnostic probe touched measuring points were provided to be moist. Attention was paid to the examiner to wear gloves for electrical insulation during the measurements. All ECM examinations were performed by the same examiner in order to standardize the measurements.
Electrical voltage values were obtained from three different points (mesial, midpoint, and distal) on the occlusal surfaces of each tooth by using ECM. During the measurement, the reader probe was placed in pulp chamber which was filled with toothpaste to provide electrical conduction, while the other electrode was placed in the occlusal surface of the tooth. After the electronic measurements, the teeth were divided through the mesio-distal direction by using diamond saw. And the occlusal inspection points were scored according to the histological evaluation in terms of caries, under a stereo-microscope (Olimpus Z 40). All histological evaluations were performed by another examiner too, in order to standardization. Twenty teeth were presented at different electrical conductivity values at distinct sites. When these examples were histologically examined, we saw that the demineralization was expanding as lateral in dentin, under the sound enamel tissue. Because of sound enamel the electrical conductivity was low in these sites, but it was high in the demineralization starting sites in enamel especially in central fosses of teeth. So this explains the diffrent scores at distinct sites [Figure 2].
The scores were:
Voltage values of these three categories were averaged [Table 1].
- Sound tissues "0"
- The caries limited to enamel structure "1"
- The caries in the dentine structure "2"
The relationship between the voltage values and the caries scores of the inspection points was tested using Spearman's Correlation analysis. Significant correlation was found between the voltage values and the caries scores (r = 0.538, P = 0.000) [Table 1].
| Discussion|| |
In this study, the findings obtained from electronic tooth decay diagnostic device have given very consistent results with histological findings in the diagnosis of occlusal caries. The diagnosis of occlusal caries which are difficult clinically may be performed reliably with this device and thus appropriate treatment may be possible.
This device allows individual assessment of each point on the occlusal surface and certainly do not harm the tooth structure during the measurements. It is easy to use and cost very low compared to other diagnostic devices.
The first study to carry out longitudinal electrical measurements of teeth was conducted by White et al. using the now-unavailable Vanguard device. In total, 769 tooth sites, in the posterior teeth of a pediatric clinic sample, were measured at 6, 12, and 18 months from baseline. The authors concluded the results that showed the instrument was a better predictor of the "clinically evident anatomical lesions" than was the dental explorer. 
Le et al. in advanced years evaluated the use of electrical conductance measurements (ECMs) to improve the diagnosis of small occlusal carious lesions. Fifty children aged 5-15 years, having first or second permanent molars that were not exposed to the oral environment for more than 6 months, participated in their study. The diagnostic systems evaluated were visual inspection and ECMs. Following baseline data recording, diagnostic measurements were repeated three times within 18 months. The authors concluded that ECM measurements were superior to clinical-visual assessments for the prediction of occlusal caries. 
Fennis et al. compared the performance of visual inspection that focused on finding signs of fissure decalcification and discoloration, visual inspection upon fiber-optic transillumination (FOTI), and electrical conductance measurements (ECMs) in predicting the onset of occlusal caries in 6- and 11-year-old children whose having first or second permanent molar teeth that were not exposed to the oral environment for more than half a year. According to the following baseline data recording, the diagnostic measurements were repeated six times at 6-month intervals over a period of 2.5 years. The authors reported that, ECM is a better predictor of occlusal caries than fissure discoloration and FOTI. 
In the same years, Huysmans et al. made a study to determine in vitro reproducibilty of this technic and the correlation between the ECM and histological lesion depth, similarly like our study. They reported the correlation coefficient between log (resistance), and histological lesion depth was 0.78 for all teeth. According to the results, the authors have concluded that the in vitro reproducibility of the described surface-specific method for electrical resistance measurement is very good. The correlation between measurements and histological lesion depth is moderate to good. The method is sensitive to electrode area differences, which will result in different clinical cut-offs for caries diagnosis in distinct sites. 
Also, in 1998 Ashley et al. evaluated the validation of the use of ECM for the detection of enamel and dentinal caries on the occlusal surfaces of posterior teeth, and they compared it with visual examination, fiber-optic transillumination, conventional, and digital bitewing radiography. Extracted posterior permanent teeth with no apparent occlusal cavitation were selected and examined using each system. Each tooth was then serially sectioned and examined histologically for occlusal caries. The sensitivity and specificity of the ECM were 0.78 and 0.80 for the diagnosis of occlusal dentinal lesions and 0.65 and 0.73 for enamel lesions. Of the other diagnostic systems, visual examination provided the best combination of sensitivity and specificity, 0.24 and 0.97 for dentinal caries and 0.60 and 0.73 for enamel caries, respectively. Researchers indicated that the ECM was the most accurate diagnostic tool for the in vitro diagnosis of early, non-cavitated occlusal lesions on posterior teeth. 
In their study, Ashley, et al., recorded the surface-specific electrical measurements every 6 months during the second 18-month period of a 3-year clinical trial comparing two products whose relative anti-caries effects were unknown. The researchers reported that the findings of this caries clinical trial (CCT) were that, over the 18-month period, ECM measurements demonstrated a significant difference in the mean DFS increment between the test and the control groups at the P < 0.05 level. In contrast, the conventional detection methods used in the trial were unable to discriminate between the products over 3 years. 
Kordic et al. compared the visual inspection (VI) and electrical conductance (ECM) and laser fluorescence (LF) measurements in detecting occlusal caries and to determine the correlation with histological lesions depths. Authers reported that the reproducibility of VI was good than that of EC and was excellent of LF. In identifying caries at both the enamel and dentin level, EC was significantly ( P < 0.05) more specific than others. They concluded that improved diagnoses at the dentinal level were obtained, when ECM and LF were used. And in cases of discolored fissures, the appliance-based methods help to avoid false positive identification of dentinal caries. 
In a review about caries detection and diagnosis, Pretty examines novel technologies and the research supporting their use. Techniques based on visual, optical, radiographic, and some emerging technologies are discussed. Pretty emphasized that each have their benefits although systems based on the auto-fluorescence (such as QLF) of teeth and electrical resistance (such as ECM) seem to offer the most hope for achieving reliable, accurate detection of the earliest stages of enamel demineralization. 
Baysan et al. evaluated the relationship between the ECM and resilience caries monitor (RCM) readings with clinical criteria (like tactile) used to define primary root carious lesions (PRCLs) in vitro. According to the results of their study, ECM readings for lesion color, severity, and hardness were significantly useful and there was a significant correlation for ECM readings and cavitation (P < 0.05). RCM measurements for hardness and severity were significant. However, the RCM readings failed to correlate with color, cavitation, or size. The authors reported that ECM is capable of distinguishing the severity of PRCLs, since it is a less invasive but accurate method of detecting carious lesions when compared to tactile methods. And have some superior capabilities than RCM. 
In their in vitro study, Kühnisch et al. compared the diagnostic performance and reproducibility of Cariometer 800 (CRM) prototype with Electronic Caries Monitor III (ECM) for occlusal caries detection, and to evaluate the effect of staining/discoloration of fissures on diagnostic performance. They used 173 molars with no apparent occlusal cavitation. Six examiners inspected all specimens independently, using the CRM, and a subgroup of four using the ECM. Histological validation using a stereomicroscope was performed after hemisectioning. After the measurements of diagnostic performance parameters included sensitivity (SE), specificity (SP), and area under the ROC curve (Az), the authors reported that ECM was superior than CRM, but it has showed at least equivalent diagnostic performance to the ECM. Thus they concluded that improvement is still desirable. 
As seen in some study results mentioned above, electronic caries monitoring methods are succesfully usable. This electronic method may give more sensitive and real results for detection of fissure caries, especially compared to visual and radiographic diagnostic methods. In this present study, the prototype device can be very useful at the diagnosis of occlusal caries which are difficult to clinically, and by this way it minimizes the risk of unnecessary tissue loss. With this device it can be possible to save the unnecessary radiography taking. The early diagnosis of occlusal caries would be possible. This device gives very consistent results with other modern diagnostic tools. It is easy to use and cost very low compared to other diagnostic devices.
| Conclusions|| |
In vitro study results of this prototype device were clinically acceptable. Results were very consistent with other modern diagnostic tools. It is easy to use and cost very low compared to other diagnostic devices. Because of these useful features it can be recommended to use, however further clinical and laboratory investigations are still needed.
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[Figure 1], [Figure 2]