Understanding that dental carious lesions occur as a result of the action of micro-organisms in the dental plaque biofilm, where demineralisation on the tooth surface is the first sign of the disease, such incipient lesions can be treated using preventive, non-operative and minimally invasive operative dentistry. If the caries process is left unmanaged, the lesions progress towards cavitation, leading to more invasive treatments. This article discusses the principles of preventive, non-invasive and micro-invasive treatments of early carious lesions, outlining the clinical situations where these therapies can be applied.

The contemporary approach for operative caries management emphasizes personalized interventions for each patient, dependent upon the individual's caries susceptibility/risk, the stage of the carious lesion and its activity. The clinician's challenge is to optimize the extent of cavity preparation and the choice of dental restorative biomaterials, appreciating the benefits offered by ion-releasing restorative materials. There is a growing application of bioactive/bio-interactive materials in minimally invasive operative dentistry, as they may help with tissue recovery by ion release. In case of moderate or extensive occlusal cavitation, the clinical criteria include the individual caries susceptibility and carious lesion activity. In high caries risk cases, ion-releasing biomaterials (IRB) can be used, as well as for active carious lesions. In proximal lesions, the clinical criteria include the individual caries susceptibility, the lesion activity and presence of cavities with little or no enamel at the gingival margin. This article aims to discuss the restorative ion-releasing options, according to different clinical situations, and the caries susceptibility to manage cavitated carious lesions in permanent adult teeth.

Objective: The aim of this article is to analyze the chemical mapping of tufts and spindles of the human dental enamel using confocal Raman microscopy measuring length, structuration and composition of spindles and tufts. Design: we used Raman diffusion, based on the interaction between photons and optic phonons, to reveal chemical bound. Adult molars were selected and longitudinally sectioned. Areas of 120 * 120 um were scanned near the dentin-enamel junction and grooves. Spectra were collected and phosphate and proteins peak intensities images were reconstructed, related to HPA concentration. Images of Phosphate (PO43-, 960 cm-1) and protein (CH, 2800/3000 cm-1) intensities have been reconstructed. K-mean cluster has been calculated to compare centroid spectra from enamel, dentin and tuft or spindle. Results: intensity profile revealed spindles as less mineralized areas than enamel, from 5 to 10 mu m large. In the groove of molar, long tufts were found, more than 150 mu m. Conclusions: Confocal Raman microscopy is a very interesting tool to characterize chemically secondary structure of enamel. The size of a tuft in the groove allows us make the hypothesis that they could play a role in long term resilience of mechanical stress.

Minimal intervention dentistry is now accepted as the contemporary approach for caries management. The development of adjunctive technologies to assist early lesion detection has led to widespread marketing of various devices over the past two decades. A thorough understanding of the clinical relevance and limitations of such devices is required to make valid interpretation of their results. This paper will discuss the most common commercially available carious lesion detection technologies in order to give dental practitioners clear information about the devices' scientific principles, advantages and limitations within a clinical context.

Dental enamel is the most mineralized tissue in the human body and has a very complex organization. The aim of the present study was to evaluate chemical composition and orientation of crystals in human enamel cross striation using confocal Raman microscope. Slices of teeth were prepared and scanned using a confocal Raman microscope. Cross striation spacing was calculated according to the variation of PO43- peak intensity. The measurements showed a characteristic length between two cross striations of 2.70 (SD 0.43) mu m for permanent teeth and 1.75 (SD 0.37) for deciduous teeth. Ratios between OH and PO43- peaks, for 0 and 90 degrees angulation, are, respectively, 9.18 (SD 0.80) and 44.74 (SD 3.12) for decidual teeth, and 11.72 (SD 1.46) and 22.12 (SD 3.15) for adult teeth. This confirmed that the hydroxyapatite crystal is well oriented along the enamel prism, as reported in the literature, but with a significant increase in deciduous teeth. K-mean cluster binary images were calculated to compare the ratio of the centroid peaks of the cross striation zone and inter cross striation material. The regions corresponding to inner prism, included cross striations, are more mineralized than the outer part of enamel prism. In the prism, the Pearson correlation test was performed based on the intensity of hydroxyapatite characteristic peaks (nu(1) PO43-, nu(1) CO3,2- and OH). The variations were well correlated: These results indicated that cross striations corresponded to the variation of hydroxyapatite concentration and not to a variation of crystals orientation.

AIM:Modern clinical caries management involves early stage caries diagnosis and should fit with dental health policy. The objective of this study was to achieve early caries detection in enamel and dentine with a laser-based system (DIAGNOdent™ pen) first and secondary with a new fluorescence intra-oral camera (Soprolife®). A visual inspection with a loupe was used as control.MATERIALS AND METHODS:Following the consolidated standards of reporting trials recommendations, 628 occlusal fissures were included for analysis.RESULTS:The sensitivity and specificity of both devices varied depending on the cutoff threshold of the caries score, and the ROC curve showed higher values for the Soprolife® than for DIAGNOdent™ pen. The values of the area under the curve decreased from 0.81 (Soprolife® in daylight) to 0.79 (Soprolife® in fluorescent mode) and 0.67 for DIAGNOdent™ pen. DIAGNOdent™ pen reproducibility (intra and inter-investigator) showed a wide dispersion, with many values scattered beyond the confidence limits (±2 SD), and the weighted kappa coefficient, which was quite low (0.58), confirmed this tendency.CONCLUSION:Caries prevalence in terms of public health policy is of interest and caries detection increased significantly when using an fluorescence-based intra-oral camera.CLINICAL SIGNIFICANCE:The clinical significance of these findings is that fluorescence could help improve caries diagnosis, reduce clinical misinterpretations, and finally benefit the patients. How to cite this article: Terrer E, Slimani A, Giraudeau N, et al. Performance of Fluorescence-based Systems in Early Caries Detection: A Public Health Issue. J Contemp Dent Pract 2019;20(10):1126-1132.

Dentin carious lesion is a dynamic process that involves demineralization and collagen denaturation. Collagen type I is the major protein in dentin and it has been investigated based on its optical properties. Multiphoton microscopy (MPM) is a nonlinear imaging technique that reveals the caries process using the collagen two-photon excitation fluorescence (2PEF) and its second-harmonic generation (SHG). Combining the histological and the International Caries Detection and Assessment System (ICDAS) classifications with nonlinear optical spectroscopy (NLOS), 2PEF and SHG intensities of enamel and dentin were highly altered during the caries process. It has been proven that the ratio SHG/2PEF is a relevant indicator of the organic matrix denaturation [Terrer et al.: J Dent Res 2016; 96: 574–579]. In the present study, a series of measurable signals is made to detect early stages of carious lesion according to the ICDAS classification and to explore the relationship between these measures and the ICDAS scale. Comparison of the efficiency of nonlinear optical signals for caries detection with the ICDAS classification is essential to evaluate their potential for clinical application. In our study, the use of the NLOS measured by MPM allowed us to monitor a quantitative parameter (SHG/2PEF ratio) according to the dentin carious lesion state (ICDAS and histological examination). Three coherent new groups were defined (ICDAS 0/1; ICDAS 2/3; ICDAS 4/5/6), where the carious process can be clearly described with a statistically significant decrease of the SHG/2PEF ratio.

The separation zone between enamel and dentin [dentin-enamel junction (DEJ)] with different properties in biomechanical composition has an important role in preventing crack propagation from enamel to dentin. The understanding of the chemical structure (inorganic and organic components), physical properties, and chemical composition of the human DEJ could benefit biomimetic materials in dentistry. Spatial distribution of calcium phosphate crystallinity and the collagen crosslinks near DEJ were studied using confocal Raman microscopy and calculated by different methods. To obtain collagen crosslinking, the ratio of two peaks 1660  cm-1 over 1690  cm-1 (amide I bands) is calculated. For crystallinity, the inverse full-width at half maximum of phosphate peak at 960  cm-1, and the ratio of two Raman peaks of phosphate at 960/950  cm-1 is provided. In conclusion, the study of chemical and physical properties of DEJ provides many benefits in the biomaterial field to improve the synthesis of dental materials in respect to the natural properties of human teeth. Confocal Raman microscopy as a powerful tool provides the molecular structure to identify the changes along DEJ and can be expanded for other mineralized tissues.

ABSTRACT Proper treatment of dental caries demands detection of carious lesions at an early stage and a minimal invasive cavity preparation to preserve the maximum tooth structure. Various devices use fluorescence for caries detection via recording the red fluorescence generated by dentin caries under illumination. The aim of this study was to evaluate the porphyrin and pentosidine involvement in the red fluorescence observed in enamel and dentin caries when illuminated with the Soprolife® camera (Sopro, Acteon Group, La Ciotat, France) and Vistacam® camera (Dürr Dental AG, Bietigheim-Bissingen, Germany). Three techniques were used: single photon fluorescence spectroscopy, micro-Raman spectroscopy, and color analysis with ImajeJ software. Cross-sections of human teeth, scored from 0–6 with the International Caries Detection and Assessment System (ICDAS), were examined by fluorescence microscopy. Teeth spectra of each ICDAS score were compared with those of protoporphyrin IX (PpIX), porphyrin I, and pentosidine solutions. A specific confocal Raman microscopy analysis was realized and a Red–Green–Blue model analysis of Soprolife® images was performed using ImageJ software to compare the color variations on ICDAS score 1 and 2. Fluorescence spectroscopy and micro-Raman spectroscopy revealed the presence of PpIX in carious enamel and dentin. The clinical relevance of this experimentation was that the increased knowledge of the fluorescence aids for caries detection could improve the preventive approach, thus reducing the operative one. How to cite this article Slimani A, Nouioua F, Panayotov I, Giraudeau N, Chiaki K, Shinji Y, Cloitre T, Levallois B, Gergely C, Cuisinier F, Tassery H. Porphyrin and Pentosidine Involvements in the Red Fluorescence of Enamel and Dentin Caries. Int J Experiment Dent Sci 2016;5(1):1-10.