Hiltch Gal, Steier Liviu, de Figueiredo José Antonio Poli
Department of Dentistry, Federal University of Rio Grande do Sul-UFRGS, Porto Alegre, Brazil.
Department of Preventive and Restorative Sciences, Dental School, University of Pennsylvania- UPENN, Philadelphia, Pennsylvania, United States.
Eur J Dent. 2023 Oct;17(4):1356-1362. doi: 10.1055/s-0043-1764423. Epub 2023 Apr 27.
The purpose of this case report was to evaluate an approach for enhanced clinical decision-making while providing minimally invasive treatment, using the combined International Caries Classification and Management System (ICCMS 4D) with hands-free fluorescence-enhanced loupes (Reveal, Designs for Vision Inc., New York City, NY, United States) and a chemo-mechanical caries removal agent (Papacárie Duo Gel, Formula & Acao, Sao Paulo, Brazil). In recent decades, a shift towards a conservative approach to caries management has developed. The use of adequate operative techniques and correct decision-making are of paramount importance for early caries detection and tooth-preserving operative care. The use of noninvasive fluorescence-based adjuncts for enhanced diagnostic accuracy has gained popularity. Fluorescence describes the absorption of photons by a molecule, followed by its partial emission at a longer wavelength. Fluorescence detection of bacterial activity is largely based on the red/orange fluorescence emanating from bacterial metabolism, and has been shown to be found particularly in active caries and mature anaerobic plaque. The combined approach of using the standardized visual International Caries Detection and Assessment System (ICDAS) with fluorescence as an operative adjunct was shown to enhance the advantages of both systems. The approach may potentially increase detection sensitivity without compromising the specificity of the visual tactile method. A recent hands-free device is aimed to combine simultaneous diagnosis and therapy (theragnosis) using fluorescence, while overcoming possible obstacles to workflow continuity. The "Reveal" fluorescence-enhanced loupes are fitted with a dual white light/fluorescence light, and are said to allow the clinician to conduct any operational procedure with optional fluorescence guidance, from detection to caries removal, to treatment completion. Using the described method, a comprehensive pathway that emphasizes evidence-based information, correct clinical decision-making, and a minimally invasive therapeutic approach was proposed. The approach may represent a potential advancement in providing minimally invasive caries care.
本病例报告的目的是评估一种在提供微创治疗的同时增强临床决策的方法，该方法结合了国际龋病分类和管理系统（ICCMS 4D）、免手持荧光增强放大镜（Reveal，美国纽约市Vision Inc.设计公司）以及化学机械去龋剂（Papacárie Duo Gel，巴西圣保罗Formula & Acao公司）。近几十年来，龋病管理已朝着保守方法转变。采用适当的手术技术和正确的决策对于早期龋病检测和保留牙齿的手术治疗至关重要。使用基于非侵入性荧光的辅助手段提高诊断准确性已越来越普遍。荧光是指分子吸收光子，随后在较长波长处部分发射。细菌活性的荧光检测主要基于细菌代谢产生的红/橙色荧光，已证明在活动性龋病和成熟厌氧菌斑中尤为明显。将标准化的视觉国际龋病检测和评估系统（ICDAS）与荧光作为手术辅助手段相结合的方法，已显示出增强了这两种系统的优势。该方法可能在不影响视觉触觉方法特异性的情况下提高检测灵敏度。最近的一种免手持设备旨在利用荧光结合同步诊断和治疗（诊疗一体化），同时克服工作流程连续性可能遇到的障碍。“Reveal”荧光增强放大镜配备了双白光/荧光灯，据说可让临床医生在可选的荧光引导下进行从检测到去龋再到治疗完成的任何操作程序。采用所述方法，提出了一条强调循证信息、正确临床决策和微创治疗方法的综合路径。该方法可能代表了在提供微创龋病治疗方面的一项潜在进展。
