DIFOTI (Digital fiberoptic transillumination) [Elektronische Ressource] : validität in vitro / vorgelegt von Cecilia Gutierrez

Cecilia Gutierrez

Sujets

• Gesundheit

Informations

• Publié par: ludwig-maximilians-universitat_munchen
• Publié le: 01 janvier 2008
• Nombre de lectures: 40
• Poids de l'ouvrage: 2 Mo

Extrait

AusderPoliklinikfürZahnerhaltungundParodontologie
KlinikumderLudwigMaximiliansUniversitätMünchen
Direktor:Prof.Dr.ReinhardHickel



DIFOTI (DIGITAL FIBEROPTIC TRANSILLUMINATION):
VALIDITÄT IN VITRO




Dissertation
ZumErwerbdesDoktorgradesderZahnheilkunde
anderMedizinischenFakultätder
LudwigMaximiliansUniversitätzuMünchen



Vorgelegtvon
CECILIAGUTIERREZ
aus
Manila,Philippinen



2008MitGenehmigungderMedizinischenFakultät
derUniversitätMünchen



















Berichterstatter: Prof.Dr.med.dent.KarlHeinzKunzelmann

Mitberichterstatter: Prof.Dr.WolfgangPlitz

Dekan: Prof.Dr.med.Dr.H.c.M.Reiser,FACR,FRCR

Tag der mündlichen Prüfung: 8.Dezember.2008




























...tohimwhosefaceIhavesoughtbothintheRhineandintheAlpsandinthe
worldofmachines.…Intheheightsandinthedeep,inallthemathematical
equations,Iamthevariableandyouaretheconstant.
TABLE OF CONTENTS

1. Introduction……………………………………….………………………………....1
1.1Background…………………………………….…………………………………..3
1.2ObjectivesoftheStudy…………………………..5
1.3ScopeandLimitation……………………………………………………………...5
1.4 DefinitionofTerms………………………………………………………………...6
1.5WorkingHypothesis…………………………………………………………….....7
1.6SchematicFrameworkoftheStudy………...……………………………….....9
2. Literature Review……………..………………...…………………………………10
2.1CariesDiagnosticMethods…..…...………10
2.1.1ConventionalCariesDiagnosticMethods.………………………………..10
2.1.1.1Visualinspection………………………………………………………...10
2.1.1.2Tactileexaminationwiththeuseofdentalexplorerorprobe..……..11
2.1.1.3Combinationofvisualandtactileexamination..……………………..11
2.1.1.4Radiography .…………………………………………………………....12
2.1.2AlternativeCariesDiagnosticMethods…………………………………......12
2.1.2.1Opticalmethods…………….…………………………………...……...13
2.1.2.1.1FOTI………………………………………………………………….14
2.1.2.1.2DIFOTI……………………………………………………………….15
2.1.2.2Fluorescencebaseddevices………………………………...……......20
2.1.2.2.1QLF………….………….…………………………………………....20
2.1.2.2.2DIAGNOdent………………………………………………………...23
2.1.2.3ECM.....................28
2.2ArtificialCariesProduction…………………………………………………......30
3. Materials and Methods……………………………………………………………41
3.1ToothPreparation……………………………………………………………….41
3.2LesionProduction41
3.3ImageAcquisition44
3.4ImageObservations(CariesDetection)………………………………………45
3.5LightPenetrationMeasurementsorAbsorbanceValues…………………...45
3.6HistologicalSections..……..……………………………………………………46
3.9LesionDepthCalculation..…………………………………………………...48
3.10ValidationoftheDIFOTIDiagnosticSystem……………………………….49
3.10.1SensitivityandSpecificity………………………………………………..49
3.10.2AreaUndertheROCCurve……………………………………………..49
3.10.3CorrelationofLightPenetrationValuesoftheDIFOTIandof
LesionDepthofTeeth…………………..……………………………….50
4. Results…………………………..…………………………………………………51
4.1DichotomousClassificationofTeethBasedonVisualObservationsof
theDigitizedImagesofDIFOTIandofHistologicalSections
(QualitativeMeasurements)….…………………………………..……..…....51
4.2LesionDepthofTeethandLightPenetrationPercentageValuesofthe
DIFOTI(QuantitativeMeasurements..……..….…………………………….53
4.3ValidityoftheDIFOTISystem………………..……………………………....55
4.3.1SensitivityandSpecificity………………………………………………........55
4.3.2ROCCurves…………………………………………………………….......55
4.3.3CorrelationofLesionDepthofTeethandLightPenetration
PercentageValuesoftheDIFOTI.........................................................57
5. Discussion.............................…...................................................................59
5.1InvitroEvaluationoftheValidityofaCariesDiagnosticSystem………...59
5.1.1MicroscopyasGoldStandard...............................................................59
5.1.2ArtificialCariestoSimulateNaturalLesions.........................................61
5.2ParametersforAssessingValidityoftheDIFOTISystem.........................63
5.2.1SensitivityandSpecificity…………………………………………………..63
5.2.2ReceiverOperatingCharacteristicsCurve…………………………….....66
5.2.3CorrelationofLesionDepthandAbsorbanceValuesObtained
fromDIFOTIGraylevelImages……………………………………………67
5.3IdealCharacteristicsofMeasurements………………………………………67
5.4DIFOTIinComparisonwiththeExistingDiagnosticSystem/s(e.g.QLF,
DIAGNOdent,ECM)……………………………………………………………68
5.5ResponsetoNewConceptsinCariesManagement……………………….71
6. Conclusion…………………………..…………………………………………….72
7. Summary
7.1InEnglish..……………………………...73
7.2AufDeutsch……………………………………………………………………..74
8. References…………………………………………………………………….….76
9. Appendix..………...93
9.1ListofFigures…………………………………………………………………...93
9.2ListofTables..96
9.3PreparingtheDIFOTISystem…………………………………………………96
9.4ImageProduction96
9.5View3DSoftwareOperation…………………………………………………...97
9.6SensitivityandSpecificity…..99
10. Acknowledgment……………………………………………………………….100
11. Curriculum Vitae.102




















Introduction 1
1. INTRODUCTION


Fig. 1. DiagnosticImagingintheDentalPracticewiththe IFOTI
System[ElectroOpticalSciences,Inc.,2004].

Dentistshavebeeninsearchoftheidealmethodfordiagnosisofincipient
cariouslesions[Convissar,2001].Cariesprevalencehasdecreasedinmost
industrializedcountriesasaresultofimprovedoralhygieneand/orchangesin
dietcombinedwithregularfluorideexposure.Ithasbecomedifficult,atthesame
time,todetectcariouslesions.Fluoridecontainingdentifriceshavechangedthe
patternofthediseasesothat:acariouslesionindentinmayprogressbeneatha
clinicallyintactenamelsurfacewithcavitationoccurringlater,orarrestofincipient
lesionsmayoccur.Consequently,theconventionalmethodsfordiagnosingthe
diseaseareinadequate[Bamzahimet al., 2002;Pineandten Bosch,1996;Shiet
al.,2000;Stookey et al., 1999;Verdonschotet al., 1999].Cariesdiagnostic
methodsshouldallowforearlydetectionofthelesionandforallpathologic
changesattributabletothedisease[Stookey et al., 1999].Theseareimportantin
primaryteethmostespeciallybecauseoftherapidprogressionofcarieswhich
resultsfromthereducedenamelthickness.Smallcariouslesionsmaynotrequire
localanaesthesiaforcariesremovalandthusdonotcallfortreatmentwhich
couldcausefearinyoungpatients[AttrillandAshley,2001].Moreimportantly,
cariesisnowrecognizedasadynamicprocess.Intheinitialstage,thecaries
processcanstillbehaltedandevenreversedbynonsurgicaltherapyorIntroduction 2
minimallyinvasiverestorativetechniques.Innoninvasivetherapy,fluoride
applicationservestoarrestdemineralizationandfacilitateremineralizationofthe
carieslesionbeforeitbecomesirreversible[Bühleretal.,2005;MalmöUniversity
DepartmentofCariology,2004].Indentalpractice,however,cliniciansstill
measurethecariesprocessasadichotomousvariableofpresenceorabsenceof
disease.Diagnosticmethodswhichareobjectiveandquantitativeareneeded.
Scientificinnovationsindentaldiagnosticsarepotentialaidsinthedecision
makingwhetherlesionmustberestoredorpreventivetechniquesmaystillbe
employed.Moreover,obtainingaccuratemeasurementsoflesionsovertime,
monitoring,allowsassessmentofthebehavioroflesionsinresponsetofluoride
treatments.Suchconceptsstimulateeffortsindevelopingcariesdiagnostic
methods[Bamzahim et al., 2002;Pitts,1997;Pitts,2004;Stookey et al., 1999].
Radiographs,althoughtheycouldstillbeconsideredausefuldiagnostictool,
poseconcernovertheuseofionizingradiation.Theseinitiatedinvestigationof
transilluminationasameansofcariesdetectionandstudiesonthepotentialof
fiberoptictransillumination(FOTI) todetectearlycariouslesions.However,due
totheperceivedshortcomingofFOTI, diagnosisofwhichbyeyehasbeen
reportedtohaveledtoahighlevelofintraandinterexaminervariability,itwas
thencombinedwithadigitalCCD(chargecoupleddevice)camera[Stookey et
al., 1999].DIFOTI(DigitalImagingFiberOpticTransIllumination),amodern
technologyindentaldiagnosticimaging,demonstratespotentialfordetectionand
monitoringofsaidlesionswithouttheharmfuleffectofradiation[ElectroOptical
Sciences,Inc.,2004;Schneidermannetal.,1997;KeemandElbaum,1997]and
attemptingtoovercomethereportedlargeinterandintraexaminervariability
encounteredwithitspredecessor[Stookey et al., 1999].







Introduction 3
1.1 Background

BasicguidingconceptsinCariologyarestatedbelowinTable1andaredivided
intopreviousandlatestknowledge.Thelatterhasledtothedevelopmentof
modernclinicalcariesmanagementandthusdiagnosticdevicessuchasDIFOTI.

Previous Knowledge Latest Knowledge

Cariesdefinition[Ismail,categoricaldiseaseprocess
2004;Warren,1997]

Diagnosisdefinitiondeterminationof evaluationofthe
[tenBoschandAngmardiseasesbytheirdiseaseactivity
Månsson,2000] signsandsymptoms

Diagnosticquestion descriptionofthe predictionofthe
[tenBoschandAngmar presentstate futureprogress
Månsson,2000]

Fissuremorphology Vhape likeaCokebottlein
(asabasisofcaries crossection(cavitation