Demineralization and remineralization at proximal lesion sites: Digital Imaging Fiber-Optic Transillumination (DIFOTI), digital radiography, with subtraction technique

Introduction. Dental caries involves the demineralization of the hydroxyapatite tooth structure. However, prior to cavitations, this process can be reversed via remineralization. Early detection of the carious lesion and monitoring of the progression of the lesion over time are key factors in the management of the disease. Dental radiograph has been the most common tool for routine proximal caries examination. Intraoral dental radiography is the current diagnostic standard of care. Devices such as Digital Imaging Fiber-Optic Trans Illumination (DIFOTI) have been introduced to improve early detection of carious lesions.;Objective. The aims of the study were (1) to determine if Digital Imaging Fiber-Optic Trans Illumination (DIFOTI) can detect remineralization at proximal enamel lesions; (2) to compare the ability of DIFOTI and digital radiography in the detection of demineralization and remineralization at proximal enamel lesions with use of digital subtraction in conjunction with both imaging modalities.;Material and methods. At alpha=0.025, beta=80%, thirty intact human premolars randomly arranged in pair. Images of sample teeth were taken with DIFOTI and digital radiographs before demineralization process and every week during demineralization until demineralization were detected with DIFOTI and digital radiograph. Sample set were placed into a demineralization solution that simulates the in vivo demineralization process which consisted of a saturated hydroxyapaptite/0.1 M lactic acid in 1% Carbopol C907 solution at a pH of 5 at 37°C. Following the completion of the demineralization, all sample teeth were treated with 35 days of a remineralizing regimen which consist of 2% sodium fluoride and mixture of artificial saliva (Caphosol) and human saliva. Both post-remineralization images of DIFOTI and radiograph were taken. The DIFOTI and radiograph images before demineralization, demineralization and 5 weeks remineralization images were entered the EMAGO software for subtraction. McNemar's test of equality of paired proportions were used to analyze the data. At the end of the remineralization, the mineral content of the lesion were evaluated with microradiographs to compare before and after remineralization.;Results. 100% of the sample exhibited success with DIFOTI and failure with digital radiography at three weeks demineralization and the p-value was less than 0.001. 73% (22/30) exhibited success with DIFOTI and failure with digital radiography in the detection of remineralization; the other 27% exhibited failure with both procedures, the p-value was less than 0.001. DIFOTI was able to show statistically significant differences on detection of demineralization and remineralization compared with digital radiography using a subtraction program.;Conclusion. Since DIFOTI was able to show remineralization with the subtraction technique, therefore it can be used for monitoring carious lesions over time. A recommendation was made to use DIFOTI with digital subtraction as an adjunct tool in routine patient examination. With early caries detection, address risks factors, implement a preventive regimen early and monitor caries lesion over time are the current trend for caries management - that is "caries management by risk assessment" - CAMBRA.