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Overview

Overview. Principles of QLF The Equipment The Results Clinical Uses Questions and Demonstration. Why a New Diagnostic Method?. Prevent cavitation Spotting trouble early early lesions (white spots) bacterial activity Follow trouble through time

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Overview

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  1. Overview • Principles of QLF • The Equipment • The Results • Clinical Uses • Questions and Demonstration

  2. Why a New Diagnostic Method? • Prevent cavitation • Spotting trouble early • early lesions (white spots) • bacterial activity • Follow trouble through time • Objective support for the prevention process • Enhance the quality of oral care • Improve the quality of restorations and sealants • Improve, encourage and focus the quality of oral hygiene

  3. Early Lesion Detection • Scattering properties of tooth tissue allow contrast enhancement E D White Spot

  4. Red Fluorescence Detection E D

  5. Pre-invasive Lesion Detection

  6. White Light QLF QLF Contrast Enhancement

  7. Examples of Bacterial Activity

  8. Lightguide Video camera QLF system box PC The System and The Software

  9. Dentistry: QLF-Scan, QLF-Pro

  10. Longitudinal Monitoring

  11. Caries Mapping

  12. White Spot Lesion Exposed After Brushing Area = 9.6 mm2 ΔR = From 51.8% to 30.5 % Before brushing Area = 30.6 mm2 ΔR = 51.8 % Red Fluorescence: Quantification clean RCutoff = 20%

  13. Defective sealant. Red fluorescence indicating caries at the edges of a restoration. Discolored fissure in a molar identified as ‘sensitive’. Note the red hue around the fissure. Sealant applied over unprepared carious tooth The restoration was replaced, yet secondary caries remains. When the fissure was opened, a dentinal lesion was found. Danger Zones: Bacterial Activity Sealants Restorations Hidden Caries

  14. Red fluorescence indicating bacterially affected caries at the edges of a restoration. Corresponding radiograph: red arrows mark the radio-translucency underneath the restoration. The restoration was replaced, yet secondary caries remains. Use During Restorative Procedures • Diagnose presence of secondary caries • Check removal of bacterially affected tooth substance All pictures courtesy of Dr. R. Heinrich-Weltzien and Dr. J. Künisch, Friedrich-Schiller University of Jena, Erfurt, Germany

  15. Area = 2.2 mm2 ΔR = 32.4 % Area = 3.2 mm2 ΔR = 47.5 % Area = 0.7 mm2 ΔR = 25.3 % Red Fluorescence: Caries Excavation RCutoff = 20% P. Sas 2003

  16. No RF Red Fluorescence: Sealants Sound Sealant Leaking Sealant R. Heinrich et al. 2001

  17. Conclusions • Agreement with visual inspection (Radike) • better sensitivity • very good specificity • Quick patient assessment • Amount of initial lesions detected with QLF-Vision indicates caries risk • Longitudinal monitoring of lesions • follow de- and remineralization in time • QLF-Vision is a reliable method for early lesion monitoring

  18. QLF™ makes the invisible visible

  19. Clinical Validation • 1994 Øgaard and ten Bosch: demonstration of lesion tracking by measuring scattering properties • 1995 de Josselin de Jong ea: Improvement of QLF system • 1997 Al-Khateeb ea: detection of remin with QLF in weekly intervals consistent with microradiography • 1998 Al-Khateen ea: QLF can be used to evaluate pre-invasive treatment • 1998 Connersville study (IU): • QLF appropriate for use on occlusal as well as buccal-lingual surfaces • QLF is practical for large-scale clinical studies • QLF detects 4-9 times as many lesions vs. visual inspection • QLF validity for caries detection supported (ten Cate ea, 1999)

  20. Clinical Validation • 2001 Traneus ea: QLF is a sensitive method for longitudinal monitoring of incipient lesions on smooth surfaces • Heinrich ea (to be published): QLF was able to separate groups of high-caries patients (33) that were given prophylaxis with or without the application of fluoride varnish, every 8 weeks for 6 months.

  21. Clinical Validation in Progress • At IUPUI (Dr. George Stookey): • 2-Year study to validate QLF for the detection of primary caries • 2-Year study to validate QLF for the detection of secondary caries • 18-Month study of QLF to monitor caries in orthodontic patients • 18-Month study of ability of QLF to detect differences in caries rates in patients provided toothpastes with different concentrations of fluoride • At Inspektor: • Correlation between red fluorescence and specific bacterial strains. • Clinical study on bracket related incipient caries

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