Enamel caries, both occlusal and proximal, can generally be managed without operative intervention.
The diagnosis of occlusal decay is highly subjective, 7 and there is considerable variation in opinion among clinicians as to appropriate diagnosis and treatment of early carious lesions on occlusal surfaces. The inherent diagnostic uncertainties have led to differing treatment decisions by clinicians. Conversely, inadequate detection precludes appropriate management. It is generally accepted that, especially in an era of lower disease prevalence, unnecessary restorations are unacceptable.
Such restorations increase health care costs for patients and health care systems, and submit patients and their teeth to the ongoing re-restoration cycle over their lifetime, which may compromise long-term tooth survival. Individual factors such as case history, age and probability of disease activity must be considered in all decisions concerning preventive and restorative care. Visual and Tactile Diagnosis To ensure that maximum information is obtained during a visual examination, the teeth should be clean, completely dry and well illuminated.
Even so, in vitro visual examination of macroscopically intact occlusal surfaces in an effort to detect caries generally has limited sensitivity i. Fissure morphology and discolouration black or brown are unreliable for definitive diagnosis of caries.
Pigmentation of dentine
Other studies have also found that the presence of stain is not necessarily indicative of caries. The advisability of applying pressure with a sharp explorer has been called into question, particularly in Europe and Scandinavia, because of documented damage to surface integrity and possible implantation of organisms, both of which may increase lesion susceptibility.
Elle apparait là où il y a des puits trous et des fissures occlusales naturelles. La deuxième sorte se porte sur les surfaces lisses de l'émail, sur les côtés des dents et entre elles, surfaces que la brosse à dents et la soie dentaire peuvent atteindre.
La troisième sorte est localisée sur la racine. Elle peut s'installer quand les dents se déchaussent et, qu'ainsi, une partie plus fragile est exposée. Nous recommandons que les caries soient enlevées et que des restaurations ou des couronnes dentaires soient utilisées pour fermer et protéger la dent concernée. Les restaurations de dents sont faites à l'aide de matériaux biocompatibles i. Pour les puits et fissures, nous recommandons de la résine pour remplir et protéger les petites cavités qui abritent les bactéries à la source des caries.
That is, following the application of heat and analysis with thermal imaging, a difference between the thermal response of enamel and dentin was detectable, with enamel tending to conduct heat quicker than dentin.
The data from this study agrees with that baseline principle and within the two samples presented - sound and demineralized - the thermal properties indicate that enamel conducts heat quicker than dentin within each sample. Two exceptions are seen - one for carious enamel and one for the root-dentin outlier. The carious lesion will have a reduced mineral content - not quantified in this study - and returns a thermal conductivity which lies between the crown-dentin and carious dentin of the same tooth-slice.
Comparison between sample-values does not agree with this principle and may be due to the natural variation of the samples from different people, the age of the teeth, the orientation of enamel prisms and dentinal tubules or the carious process. Further work is needed to investigate these relationships. The purpose of this study was to see if enamel and dentin could be visualized from their individual thermal properties within a map.
A thermal map provides a 2-dimensional diagram of the spatial relationship of every thermal value per pixel calculated across the whole tooth-slice. This advances the techniques previously described and adds to the information of an optical image. The thermal maps are produced from the gradient of the rewarming curve - characteristic-time-to-relaxation - and the integral of the curve - heat-exchange.
As seen in Figure 5the two types of thermal map do characterize enamel and dentin. The characteristic-time-to-relaxation map of sample one, the sound tooth-slice, shows a diffuse boundary between enamel and dentin and is sensitive to the tissue-thickness, as shown from the sloping-sides of the tooth-slice in the root-area.
This is radiolucent on the X-ray. The heat-exchange thermal map shows distinct contrast between enamel and dentin and the carious change within the enamel and dentin is clearly visible, compared to the characteristic-time-to-relaxation thermal map, where there is less contrast of the carious lesion within enamel and diffuse change is seen in dentin. All the advantages of the characteristic-time-to-relaxation thermal map are retained by the heat-exchange thermal map.
The spatial resolution defines the ability to distinguish two separate points but this does not necessarily transfer to diagnostic ability for the human operator. The lesion shown within the demineralized tooth-slice is large, and the minimum size and level of demineralization detectable with this system is currently unknown and requires additional work with suitable test-objects.
Spatial resolution can be limited due to equipment and the infra-red wavelength nm to 1 mm which will always be less than that of X-rays 0. This study has viewed slices of teeth in-vitronot a whole tooth, and the findings can underpin future models on whole teeth. Two studies have investigated carious lesions in whole human teeth in-vitro - one looking at artificially-created lesions on the smooth labial surface of incisors Kaneko et al.
The theory of a thermal difference between sound tooth-tissue and carious tissue was based on evaporative cooling due to an increase in moisture-content within the micro-pores of the carious lesion.
This was found to provide a positive outcome in both studies. Consideration of the thermal properties of the tissues, as seen in this study, were not presented in either of the whole-tooth studies, but their outcomes positively reinforce the need for further work. This is being investigated for comfort and time-of-application.
The use of thermal imaging to detect approximal caries is unlikely as it cannot penetrate tissues in the way X-rays do. However, detection of early smooth-surface lesions and occlusal lesions would allow preventive measures to be prescribed.
X-rays have limitations, as previously mentioned, as do optical detection methods. Thermal imaging may complement our current armamentarium. Detection of active and arrested caries remains uninvestigated with thermal imaging and consideration will be needed for other potential causes of difference in tooth structure and composition, e.
The enamel and dentin of tooth-slices can be characterized in-vitro from their thermal properties, as seen in the thermal maps of heat-exchange and characteristic-time-to-relaxation. The heat-exchange map produces better contrast between enamel and dentin than the characteristic-time-to-relaxation map. Within enamel and dentin, demineralized tissue can be detected in both maps, with heat-exchange providing the greatest contrast within both tissues.
These thermal maps support further investigation of thermal imaging to complement diagnosis of caries. PL, DB, designed the Study, undertook the acquisition, analysis and interpretation of data, wrote the first draft of the manuscript, provided contribution to revision and final approval of the manuscript and are accountable for the work presented.
FC, VC, were involved with conception of the design, revision and approval of the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Some data within this manuscript was presented at the Enamel 9 Conference, 30th October to 3rd November, and PL's attendance at the Conference was supported by an Early Career Research Award from Enamel 9, which was gratefully received.
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Les lésions carieuses et le premier traitement restaurateur
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