Within the new decay model, the accuracy of diagnosing "hidden" occlusal caries is recognized to be a challenge. Your visual and radiographic evaluation can be significantly more accurate with the use of KaVo's DIAGNOdent caries detection system.

• Received rave reviews from leading testing facilities (i.e. CRA, REALITY, Dental Advisor) and many practicing dentists all over the world.
• High level of patient acceptance and satisfaction.
• Proven to be over 90% accurate.
• Ideal adjunct to minimally invasive techniques (air abrasion, micro rotary instrumentation, etc.).
• Allows monitoring of caries progression.
• Small portable device which is simple to operate.
• Ideal device for both hygienist and doctor.
• Practice building, revenue enhancing.
   

Detecting the invisible:

With today's widespread use of fluoride, the presentation of occlusal pit and fissure caries has changed. Caries may often begin in the walls of the fissure or in the dentine without any decalcification of the enamel (see figure B). This type of lesion is extremely difficult to diagnose with an explorer. Additionally, with bitewings this type of caries cannot be detected.

However, the DIAGNOdent is a reliable tool to diagnose this type of lesion with over a 90% accuracy rate
 

Benefits to you and your patients:

• Permits use of minimally invasive treatments without unnecessary preparation - ideal adjunct to air abrasion and micro rotary instruments.
• For the first time, allows the quantification of caries activity over time with a precise and reliable measurement.
• Reproducible results permit checking, stabilization and documentation of caries.
• Ideal device for the hygienist to detect suspicious areas needing further examination.
• Is conservative by avoiding "exploratory" excavation of suspect teeth.
• Extremely accurate diagnostic aid. Proven to be over 90% accurate.
• Early detection of pathological changes that are undiagnosed by conventional examination methods (e.g. intial lesions, demineralization and changes in the enamel, fissure caries).
• No scratching probe: simple, fast and painless examination.
• Increases operator and patient confidence about treatment decisions due to accurate visual and acoustic representation of measured values.
• No x-ray exposure.
• Practice building, revenue enhancing.
• High level of patient acceptance and satisfaction.
   

Proportion of "correct diagnoses" using various diagnostic methods (in the case of seemingly intact occlusal surfaces).

In a study conducted by Dr. Lussi of Berne University, Switzerland, general practioniners correctly diagnosed hidden fissure areas by visual inspection in only 57% of all cases. The same group achieved an impressive success rate of 90% with the DIAGNOdent. In fact, DIAGNOdent was far more accurate than any other method in the study including bitewing x-rays.
 

Altered tooth substances and bacteria fluoresce when they are exposed to a specific wavelength of light.

The DIAGNOdent operates at a wavelength of 655 nm. At this specific wavelength, clean healthy tooth structure exhibits little or no fluorescence, resulting in very low scale readings on the display. However, carious tooth structure will exhibit fluorescence, proportionate to the degree of caries, resulting in elevated scale readings on the display of the DIAGNOdent.
 

The DIAGNOdent measures laser fluorescence within the tooth structure. As the incident laser light is propagated into the site, two-way hand piece optics allows the unit to simultaneously quantify the reflected laser light energy. At the specific wavelength that the DIAGNOdent laser operates, clean healthy tooth structure exhibits little or no fluorescence, resulting in very low scale readings on the display. However, carious tooth structure will exhibit fluorescence, proportionate to the degree of caries, resulting in elevated scale readings on the display.

2. What is the difference between the Moment and Peak?

The Moment is the number that is occurring at that exact spot on the tooth and changes as you move across the tooth. The Peak is the highest number recorded before the unit is reset. As you are doing your examination it is the Peak number that you should look at.

3. What do you mean by a clean tooth?

To get consistent readings, it is essential to have a clean tooth. This is especially important when monitoring values at future examinations. We suggest that the teeth are cleaned thoroughly using any acceptable means. The use of a powder jet cleaner, e.g. KaVo PROPHYflex 2, is a rapid and effective method to clean stain and debris from complex occlusal anatomy.

4. Can the unit diagnose inter-proximal caries?

No. Limited accessibility to the embrasure prevents accurate reading of approximal surfaces.

5. Can the unit be used around existing composite resin restorations?

No. Because composite resins can fluoresce, prompting elevated readings, the DIAGNOdent should not be used on these materials.

6. Can the unit read caries under an existing amalgam?

If there is caries at the margin, it will give an accurate reading; however if the caries is under the floor of the amalgam the reading will not be accurate.

7. If I see stain under a sealant, will the unit tell me if this is decay or not?

No. The sealant must first be removed and then an accurate reading can be taken.

8. Can the DIAGNOdent be used to determine if caries excavation is complete?

Not always; some conservative preparations designs, particularly those with small access openings, limit proper tip angulations within a preparation. Furthermore, independent research indicates that when used in deep preparations in close proximity to the pulp, elevated values may be obtained, possibly resulting from fluorescence of underlying pulp and not necessarily as a result of caries. Therefore, the use of other methods to determine extent of affected tooth structure should be employed in these situations.

9. What do you mean by risk assessment?

It is necessary to consider a patient's dental history, dietary sugar intake, oral hygiene, history of maintaining regular recalls, caries status (the number of carious teeth in their mouth), as well as any other information such as that from radiographs or other diagnostic modalities.

10. What does a very high number mean?

This may occur when there is an open lesion at the surface or if there is a lot of debris where the reading is being taken. The tooth should be cleaned thoroughly and a second reading taken.

11. Can the unit be used on both primary and permanent teeth?

Studies have shown the unit is equally accurate in both primary and permanent teeth.

12. How much change in the reading between visits is considered significant?

The margin of error is (+) or (-) 3 so a change greater than this would be necessary before the tooth should be considered to exhibit a changing condition.

13. Can the tone be used to identify caries?

No. The audible tone function is an operator convenience, which allows the dentist to focus on the tooth while scanning, only sounding variably as different value thresholds are reached. The signal is intended to direct the operator to the visual display. Tone volume can be changed or altogether switched off as desired.

14. I cannot calibrate the unit. I continuously get an error message on the display.

Nearly all calibration errors are attributed to user error. It is necessary to follow calibration instructions carefully. If error persists, contact KaVo Customer Service. (link zu "Talk to KaVo)

15. As the device is a laser, is protective eyewear required?

No. The device is harmless when used as directed.

16. How deep does the laser penetrate the tooth?

Approximately 2mm.

17. Which tip should I use, A or B?

Tip A is conical in shape and designed for fissure areas. Tip B is broader and designed for flat surfaces.

18. What is the recommenced asepsis protocol for the DIAGNOdent?

Clean the control unit and the tubing surfaces with a soft cloth dampened with a mild soap solution. The remaining hand piece sheath and tips can be steam sterilized. Chemical vapor sterilization is also acceptable, however, components will eventually discolor and degrade at an accelerated rate. Many clinicians sterilize the tips but prefer to barrier protect the sleeve portion. Other clinicians fit barriers over the entire sleeve and tip assembly to eliminate the need for tip sterilization. When tips are barrier protected, unit must be calibrated with barrier in place. Tips can be cleaned with a soft cotton swab moistened with water.

19. Does ambient light affect DIAGNOdent readings?

The photo-optic measuring system in the DIAGNOdent has filters to eliminate the influences of most ambient light. However, when calibrating the device, avoid exposing the probe tip to direct halogen light.