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Professional News Articles : : ON PRACTICE MANAGEMENT by Janyce Hamilton : Comparing ADA-accepted caries diagnosis machines: What's the difference and is it time to get one?

Comparing ADA-accepted caries diagnosis machines: What's the difference and is it time to get one?

May 08, 2006

Perhaps instead of “machines,” the word “systems” better describes the caries diagnostic tools available to supplement traditional diagnostics. The ADA Council on Scientific Affairs (CSA) has given its Seal of Acceptance to only two caries detection devices: DIAGNOdent 2095 and QLF Inspektor Pro. The CSA does not consider either to be a replacement for traditional methods of caries detection such as probing and radiographs. But, the CSA believes these devices can provide additional information to help the dentist make a diagnosis.

The CSA statements for the two caries detection devices on the market are different because the supporting data provided by the companies for each product was different: DIAGNOdent provided data on caries detection and monitoring; Inspektor Pro provided data on demineralization. The statements are as follows.

DIAGNOdent 2095: “The ADA Council on Scientific Affairs' Acceptance of DIAGNOdent 2095 is based on its finding that the product is effective as an aid in the detection and monitoring of coronal dental caries on sound (unrestored or unsealed) and thoroughly cleaned and accessible tooth surfaces.”

QLF Inspektor Pro: “The ADA Council on Scientific Affairs' Acceptance of QLF Inspektor Pro System is based on its finding that the product is effective in monitoring changes in tooth mineralization (demineralization/reminderalization) over time, which may help dentists with early caries detection and prevention.”

Besides what the ADA thinks about the two caries detector devices to which they have granted their Seal of Acceptance, what do company representatives have to say about them?

I interviewed both devices' spokespersons to learn how they work and how one is different from the other. Steven Pardue works for the maker of Inspektor Pro: OMNII, A 3M Company, in West Palm Beach, FL. Jeff Thibadeau works for the maker of DIAGNOdent: KaVo Dental Corporation in Lake Zurich, IL.

The aim of this month's column is to provide dentists with some introductory information to help them weigh whether or not it's time to think about test-driving this technology and using it on patients.

The interviews

Janyce Hamilton (JH):  Tell me what DIAGNOdent is.

Jeff Thibadeau (JT): The DIAGNOdent Classic and DIAGNOdent pen are caries detection laser instruments that aid in the early detection of dental caries lesions. Both the DIAGNOdent Classic and DIAGNOdent pen are highly effective at detecting incipient pit and fissure caries that may otherwise test negative using X-rays, explorers or other diagnostic means. They aid in differentiating healthy from diseased tooth structure without resorting to guesswork. The DIAGNOdent pen allows the dentist or hygienist to quantify and monitor caries over time.  In use, the tip of the instrument is scanned over [the] tooth surface, propagating harmless laser light into the underlying tooth surface, thus identifying early stages of decay.  The instrument emits an audible tone of varying levels depending upon the level of caries detected.  The DIAGNOdent provides instantaneous data to the operator on a display, which quantifies the findings on a scale from 0-99.  The dentist then uses the data as part of an overall diagnostic exam to determine what treatment may be necessary.  The technology is painless, and does not emit ionizing radiation which makes it safe for the patient and the dental team.

Janyce Hamilton (JH):  Tell me what Inspektor Pro is.

Steven Pardue (SP):  The Inspektor Pro system is an early caries detection system designed to locate carious lesions very early in the demineralization process.  It uses the natural fluorescence of the tooth structure to locate these demineralized locations.

JH: Tell me how much it costs and the options dentists have for financing owning/leasing one of your systems.

JT:  The cost of the DIAGNOdent is $2,995.00 retail and is sold exclusively through authorized KaVo dealers.

SP:  The [Inspektor Pro] system costs $24,785.  There are financing options available through MBNA, or an organization of your choice.  

 JH: Tell me how and why a dentist having DIAGNOdent as an aid in the detection and monitoring of coronal dental caries on sound and thoroughly clean and accessible tooth surfaces is of value over and beyond the traditional caries detection approach.

JT: There is no question that the dental profession has been highly dissatisfied with the accuracy and sensitivity of traditional caries diagnostic methods, particularly in pit and fissure sites, where 85 percent of carious lesions develop.  Research proves that the traditional armamentarium, consisting of the explorer, bitewing radiograph and perhaps magnification loupes, are not effective in detecting lesions until the lesion progresses significantly, resulting in possibly irreversible damage to the tooth.  

What further confounds the profession is the increasing prevalence of “hidden caries,” which is often attributed to the success of fluoride.  Because fluoride has effectively hardened tooth enamel in much of our population, when caries is able to penetrate the underlying dentin, the decay process can progress under seemingly healthy enamel, effectively evading detection. 

The major benefit of the DIAGNOdent is that it will scan pits and fissures areas, propagating beneath the surface, reaching well beyond the range of a mechanical explorer or visual inspection. The DIAGNOdent will identify problem areas long before they present as enlarged lesions. Early detection of these lesions and minimally or non invasive procedures will preserve tooth structure and increase the longevity of the tooth. 

As dentistry moves further toward recognizing caries as an infectious disease and technologies continually improve, dentistry will benefit from the established medical model of treating the disease without surgical intervention.  

DIAGNOdent represents a major breakthrough for its ability to detect the presence of caries in its early stages allowing the dentist to minimize the loss of vital tooth structure or even reverse the decay process by prescribing remineralization therapies.  KaVo's goal is to develop technologies that will target the bacteriological component of caries and eliminate the need for surgical intervention altogether.  Implementing these new tools can only be made possible with sensitive, accurate detection devices.   

JH: Tell me how and why a dentist having QLF Inspektor Pro is effective in monitoring changes in tooth mineralization (demineralization/remineralization) over time, which may help dentists with early caries detection and prevention is of value over and beyond the traditional caries detection approach.

SP:  Traditional detection methods (i.e. radiograph, visual detection, DIAGNOdent) provide a look at the tooth surface at one point in time.  The Inspektor Pro system will allow the practitioner to see lesions through time by using the patented image recognition software to determine if a lesion has increased or decreased in size through time.  A form of time lapse photography is taken of the progression of a lesion.

JH: Explain how the value of your systems can offset their cost.

JT:  Intuitively, the dental patient or parent appreciates the merits of early detection and minimally invasive treatment concepts.  Also, a detection instrument that is safe and painless is profoundly welcome in the dental practice.  Therefore, dentists that invest in DIAGNOdent have ample opportunity to educate their patients as to the value and benefits of the technology used in the practice.  As for return on investment, dental practice management consultants have concluded that the technology will generally pay for itself in about a month.

SP:  The Inspektor Pro system can be used to locate early lesions that may have otherwise been missed in diagnosis.  This will allow the practice to increase its preventive care operations, and remineralize lesions that have not yet cavitated.  The system also provides a new viewing angle of restorations to assist in locating secondary decay at margins.
JH:  Explain how DIAGNOdent 2095 differs from QLF Inspektor Pro.

JT:   We have limited knowledge of the QLF technology in the private practice; however, it has been lauded in the scientific community as what may become the next gold standard for caries research.   In comparing which instrument is right for the dental practitioner, that decision would be based upon a number of personal and economic factors.

JH:  Explain how Inspektor Pro differs from DIAGNOdent.  

SP:  The Inspektor Pro system will be able to view two phenomena.  The first is the mineral content of the tooth.  The system shows density differences in the mineral of the tooth shown by dark areas on a healthy 'green' fluorescing tooth.  The second is the ability to see metabolic waste products of certain bacteria.  This will show up as a red fluorescence on the screen.  This second phenomenon is the same red fluorescence that DIAGNOdent detects, however, the DIAGNOdent can not see the green fluorescence of the tooth.

JH: Anything interesting on the horizon in terms of larger or longer term research studies comparing DIAGNOdent with traditional methods and/or QLF Inspektor Pro? 

JT:   There is ongoing research in the dental community exploring new expanded indications for the DIAGNOdent.  While the technology is well validated, there is tremendous interest is expanding the role of the technology to answer clinical problems.  Also, the DIAGNOdent is used in many research projects to quantify the effects of caries management regimens.

JH:  Anything interesting on the horizon in terms of larger or longer term research studies comparing QLF Inspektor Pro with traditional methods and/or DIAGNOdent ?  

SP:  There is an abundance of research regarding the Inspektor Pro available online through Pub Med and also many available at www.inspektordentalcare.com.
JH: Anything new that the company may pursue in terms of improvements to your systems?

JT:   KaVo Dental has introduced the new DIAGNOdent Pen, which is a more compact cordless instrument with improved tip design.  Response from the dental profession has been tremendous.  As a rule, KaVo products undergo constant and continual improvement.

SP:  We are always interested in improving our technologies, but it is too soon to know what the future holds for new or improved Inspektor Pro systems.

Conclusion 

I haven't heard of any dentists using these systems to impress their patients by obtaining proof of caries—“objective data” via new technology—as opposed to the explorer and magnification. In fact, I don't know any dentists using them as of 2006. But, with insurers wanting quantification of need, such as is obtained interproximally with radiographic evidence, caries detection devices should be catching on in a few years.

For information on DIAGNOdent, such as testimonials or to have a product demo, e-mail michelle.shakespeare-martin@kavo.com; to learn more about Inspektor Pro, go to www.inspektordentalcare.com.

Janyce Hamilton is a Chicagoland freelance dental writer and editor. Send suggestions for topics to be covered, or any comments on this column, to review@cds.org.

Copyright 2006, Chicago Dental Society