Fluorescence Aided Caries Excavation(FACE) - Precision in caries excavation
Most people know that the most common form of oral disease is tooth decay, Caries (tooth decay) produces acids that wear away at the healthy tooth structure over time, meaning it is extremely important to prevent the progress of the lesion to preserve sound tooth structure.
As a dentist you know the constant challenge faced when removing caries is to accurately identify the size of an infection and remove it all to ensure there is no chance of reinfection whilst simultaneously preserving as much of the healthy tooth structure as possible. There are numerous methods of carious dentine identification and removal, these include chemo-mechanical agents (chemicals used to soften the lesion for gentle removal), caries disclosing dyes, air abrasion, and of course the conventional mechanical caries removal using hand or rotary instruments, but now there is a new kid on the block.
FACE
Fluorescence aided caries excavation (FACE) makes it possible to view bacterially infected areas by using violet light to indicate carious areas of the tooth, which fluoresce orange-red, making it instantly recognisable to the dentist. The violet light is fed through the fibre optics of the handpiece so that it can be emitted straight into the patients mouth. To gain best visibility of the lesion it is recommended to work in a dim light setting, turning off overhead fluorescent lighting, and directing the operating light away from the subject.
FACE VS Other Methods
With the several different methods of caries excavation it can be hard to decide which method to use. Most dentists would have been taught the conventional method of caries removal and will stick with what they know. Some dentists will choose to use caries disclosing dyes to ensure accuracy and that there is less risk of reinfection, whilst others prefer to go for chemomechanical solutions as the process is quicker than caries disclosing dyes.
A study carried out by Operative Dentistry looks into the comparison of caries excavation methods and the efficiency of each method by time taken to excavate and the success of removing bacterially infected dentine. The study compared FACE, caries detector dye, chemomechanical excavation and conventional excavation. One hundred permanent molars with occlusal dentin caries were collected and stored in 0.01% thymol solution at 4°C in the dark. The sample teeth were sectioned using a water-cooled hard tissue saw through the centre of the lesion. Lesion depth and width were measured using stereomicroscopy. This allowed for a stratified randomisation of the samples into 4 groups of 25, according to lesion size (depth x width). The tooth halves were reassembled and embedded in acrylic resin.
The results of the study carried out proved that the excavation time was significantly shorter for FACE (3 minutes, 3 seconds) compared to chemomechanical excavation (5 minutes, 8 seconds), caries detector dye (5 minutes, 26 seconds) and conventional excavation (4 minutes, 2 seconds). Histology showed remaining bacteria in significantly fewer (5/25) FACE samples compared to chemomechanical excavation (15/25) caries detector dye (12/25 ) but not significantly fewer than conventional excavation (11/25).
In conclusion this particular study showed the best combination of excavation time and successful removal of infected dentine was achieved using FACE. The improved removal of infected dentine achieved using this new technique may be appealing to the clinical dentist, because it reduces working time and the need to change instruments.
Read the full study article here.
Fluoresce HD
Lares Research have utilised FACE technology by integrating it into a coupling that can be attached to Lares Research and Kavo MULTIflex compatible turbines, and a low speed optic motor that can be used with stand E-fitting optic contra-angles. To enable FACE, the white light LED is to 405 nm (UV) LED. The handpiece remains unchanged and the 405 nm light is transmitted through the handpiece fibre optics to the tip of the bur and the surrounding tooth. The dentist wears safety glasses with a yellow colour tint during the procedure.
When the dentist views the tooth illuminated by the 405 nm light through the yellow colour glasses, the healthy tooth appears bright green and cavities appear bright orange and red. The bacteria that cause tooth decay emit chemicals that fluoresce when absorbing 405 nm light, thereby creating dramatic visual contrast between caries and healthy tooth. The dentist removes only the red and orange areas with the handpiece/bur. When no more red/orange areas remain, the preparation is complete.
Fluoresce HD 405 nm light causes restorative materials such as resins, cements, etc. to appear a different colour compared to healthy tooth structure, enabling dentists to easily see the margins between healthy tooth structure and common restorative materials. This further minimises the removal of healthy tooth and saves significant chair time.
No probing, caries indicator dye, DiagnoCam photos, etc., are necessary, saving substantial chair time. Caries removal becomes “paint by numbers”.
Benefits:
- Achieve TRUE Minimally Invasive Dentistry by preserving 100% of the healthy natural tooth structure
- Reduce chair time with a vertically integrated caries detection during in-vivo caries excavation
- Reduce your cost by utilizing a 2 in 1 handpiece and caries detection product for a minimal cost increase in your LED coupling
