White lesions represent an early phase of caries formation. 20 human sound premolars were subjected to pH cycling procedure to induce subsurface lesions (SLs) in vitro. In addition, 2 teeth with ...naturally developed white spot lesions (WSLs) were used as references. All specimens characterized by confocal Raman microscopy being used for the first time in examining white & subsurface lesions and providing a high resolution chemical and morphological map based on phosphate peak intensity alterations at 960 cm
. Nanoindentation technique was used to measure Hardness (H) and Young's modulus (E) of enamel. Phosphate map of examined samples exhibited presence of intact surface layer (ISL) followed by severe depletion in (PO
) peak in the area corresponding to the body of the lesion. In all examined groups, the mechanical properties of enamel were decreased in lesion area and found to be inversely related to penetration depth of indenter owing to enamel hierarchical structure. By combining the above two techniques, we linked mechanical properties of enamel to its chemical composition and ensured that the two methods are highly sensitive to detect small changes in enamel composition. Further work is required to bring these two excellent tools to clinical application to perceive carious lesions at an early stage of development.
Preservation of natural tooth structure requires early detection of the carious lesion and is associated with comprehensive patient dental care. Processes aiming to detect carious lesions in the ...initial stage with optimum efficiency employ a variety of technologies such as magnifying loupes, transillumination, light and laser fluorescence (QLF® and DIAGNOdent®) and autofluorescence (Soprolife® and VistaCam®), electric current/impedance (CarieScan®), tomographic imaging and image processing. Most fluorescent caries detection tools can discriminate between healthy and carious dental tissue, demonstrating different levels of sensitivity and specificity. Based on the fluorescence principle, an LED camera (Soprolife®) was developed (Sopro‐Acteon, La Ciotat, France) which combined magnification, fluorescence, picture acquisition and an innovative therapeutic concept called light‐induced fluorescence evaluator for diagnosis and treatment (LIFEDT). This article is rounded off by a Soprolife® illustration about minimally or even non‐invasive dental techniques, distinguishing those that preserve or reinforce the enamel and enamel‐dentine structures without any preparation (MIT1– minimally invasive therapy 1) from those that require minimum preparation of the dental tissues (MIT2 – minimally invasive therapy 2) using several clinical cases as examples. MIT1 encompasses all the dental techniques aimed at disinfection, remineralizing, reversing and sealing the caries process and MIT2 involves a series of specific tools, including microburs, air abrasion devices, sonic and ultrasonic inserts and photo‐activated disinfection to achieve minimal preparation of the tooth. With respect to minimally invasive treatment and prevention, the use of lasers is discussed. Furthermore, while most practices operate under a surgical model, Caries Management by Risk Assessment (CaMBRA) encourages a medical model of disease prevention and management to control the manifestation of the disease, or keep the oral environment in a state of balance between pathological and preventive factors. Early detection and diagnosis and prediction of lesion activity are of great interest and may change traditional operative procedures substantially. Fluorescence tools with high levels of magnification and observational capacity should guide clinicians towards a more preventive and minimally invasive treatment strategy.
Multiphoton confocal microscopy and nonlinear spectroscopy are used to investigate the caries process in dentin. Although dentin is a major calcified tissue of the teeth, its organic phase comprises ...type I collagen fibers. Caries drive dentin demineralization and collagen denaturation. Multiphoton microscopy is a powerful imaging technique: the biological materials are transparent to infrared frequencies and can be excited to penetration depths inaccessible to 1-photon confocal microscopy. The laser excitation greatly reduces photodamage to the sole focal region, and the signal-to-noise ratio is improved significantly. The method has been used to follow pathologic processes involving collagen fibrosis or collagen destruction based on their 2-photon excited fluorescence (2PEF) emission and second harmonic generation (SHG). Combining multiphoton imaging with nonlinear spectroscopy, we demonstrate that both 2PEF and SHG intensity of human dentin are strongly modified during the tooth caries process, and we show that the ratio between SHG and 2PEF signals is a reliable parameter to follow dental caries. The ratio of the SHG/2PEF signals measured by nonlinear optical spectroscopy provides valuable information on the caries process, specifically on the degradation of the organic matrix of dentin. The goal is to bring these nonlinear optical signals to clinical application for caries diagnosis.
Projet e-DENT : téléconsultation bucco-dentaire en EHPAD Giraudeau, N.; Valcarcel, J.; Tassery, H. ...
European Research in Telemedicine / La Recherche Européenne en Télémédecine,
June 2014, 2014-06-00, Letnik:
3, Številka:
2
Journal Article
Recenzirano
De nos jours, les personnes en perte d’autonomie, notamment institutionnalisées, ont de grandes difficultés pour consulter un chirurgien-dentiste alors qu’elles en ont un grand besoin. Pour améliorer ...la qualité de prise en charge des personnes en perte d’autonomie institutionnalisées, l’ASIP santé a mis comme une des priorités du développement de la télémédecine, la prise en charge des résidents d’établissements médico-sociaux.
Douze EHPAD de la région Languedoc-Roussillon, soit 600 patients, vont bénéficier de deux téléconsultations bucco-dentaires asynchrones avec 6 mois d’intervalle. Une infirmière formée spécifiquement passera une caméra Soprocare®, utilisant la lumière fluorescente qui permet de détecter plus facilement les lésions carieuses et les inflammations gingivales, dans la bouche du patient et enregistrera des vidéos et des photos. Ces images seront ensuite envoyées vers le CHRU de Montpellier pour être analysées. Un diagnostic sera posé, un plan de traitement proposé et un parcours de soins adapté envisagé.
Une évaluation sera réalisée une fois cette expérimentation terminée. Il sera étudié les questions juridiques restant en suspens, le coût réel d’une telle activité, le modèle économique de la téléconsultation bucco-dentaire, l’acceptabilité du système par les différents acteurs et l’état bucco-dentaire des résidents de ce type d’établissement.
La télémédecine n’est actuellement que très peu utilisée en odontologie (Australie, États-Unis). Les mentalités vont donc être difficiles à faire évoluer. Ces téléconsultations doivent être envisagées à chaque nouvelle entrée en établissement médico-social et vont devoir être intégrées dans une nouvelle organisation de la prise en charge bucco-dentaire.
Currently, people with decreasing independence, particularly those in institutions, have difficulties consulting a dentist despite a real need for dental care. To improve the quality of care of such patients, ASIP santé determined the care of residents in medico-social establishments as a priority in the development of telemedicine.
Six hundred patients from 12 care homes in Languedoc-Roussillon will benefit from two oral teleconsultations at 6-monthly intervals. A specifically trained nurse will record videos and photos of patients’ mouths with a SOPROCARE® camera, which uses fluorescent light to detect more easily tooth decay and gum inflammation. These pictures will be sent to Montpellier University Hospital for analysis. Dentists will make diagnosis and establish a treatment program. They will evaluate the dental emergency and propose the type of dentist or intervention needed.
At the end of this experiment an evaluation will be made. Legal aspects, real costs of such an intervention, the economic model of dental teleconsultation, acceptability of the system by different actors and patients’ dental status will be studied.
Telemedicine is rarely used in dentistry (only in Australia and United States). Changing opinions with regards to this new practice could be very hard. Dental teleconsultations should be carried out at each new admission to long-term care homes and should be integrated in a new oral health care organisation.
The purpose of the present study was to assess the irrigant penetration and cleaning ability of a new irrigation system, the Clean Jet Endo (Produits Dentaires SA, Switzerland) in comparison to ...conventional irrigation followed or not by sonic activation. Irrigant penetration was evaluated on resin blocks simulators by measuring the methylene blue absorbance thanks to a UV/visible spectrophotometer and cleaning ability was assessed in an ex vivo experiment according to the debris score in an artificial canal extension before and after the final irrigation protocol. A statistical analysis was carried out in order to highlight the significant differences between the irrigation techniques. Clean Jet Endo permitted to better eliminate the methylene blue into the simulated canals. A significant difference between the 2 techniques was observed in the middle third (p = 0.005) as well as in the apical third (p < 0.2). An additional microscope observation (16X) confirmed that Clean Jet Endo@ usage led to a better penetration of irrigant within the lateral canals of the simulators. Likewise, this irrigating system permitted to better eliminate the debris in the lateral groove than the other techniques. In conclusion, our findings implied the potential of this new irrigation system to enhance root canal debridement and disinfection.
Télémédecine bucco-dentaire : projet e-DENT Giraudeau, N.; Valcarcel, J.; Tassery, H. ...
European Research in Telemedicine / La Recherche Européenne en Télémédecine,
March 2014, 2014-03-00, Letnik:
3, Številka:
1
Journal Article
A new method for studying leakage of root fillings using the bacterium
Pseudomonas fluorescens ATCC 13525 is described. The presence of the microorganism is detected by fluorimetry and can thus be ...used to measure the depth of penetration from the root apex toward the crown of the tooth. This system, applied to a number of methods of root canal filling, showed that procedures involving compaction of the gutta-percha gave a more effective seal than the use of a paste sealer with uncondensed gutta-percha. There was no statistically significant difference between the leakage results from the lateral, vertical, and thermomechanical condensed techniques.
Objectives. An extensive number of investigations have focused in recent years on the process of fluoride release by glass–ionomer cements. In order to compare the fluoride release of two recent ...resin-modified glass–ionomer cements (RMGICs) and one compomer, we investigated the initial and subsequent fluoride release in distilled water and in a mineral medium with composition similar to saliva (SAGF), as well as the renewal effect of the media on the release.
Method. A preliminary thermodynamic study defined conditions under which the measurements by fluoride-selective electrode potentiometry were not affected by the presence of Ca
2+ ions in SAGF. Disk-shaped samples (5
mm×3
mm) for each material were placed in 5
ml of distilled water (
n=12) or 5
ml of SAGF (
n=12) and fluoride released was measured after 1, 2 and 7
days. For the investigation of medium renewal effect, RMGIC samples were dipped into distilled water for 5
days. Subsequently 12 samples of each material were placed for 7
days into water or SAGF, with or without daily renewal of the medium before fluoride-release measurements. The elements present on the surface of the RMGICs were analyzed by scanning electron microscopy.
Results. RMGICs released significantly more fluoride in water than in artificial saliva. The presence of CaF
2 at the interface accounts for this phenomenon. The thickness of the CaF
2 layer depends on the speed of its initial formation and renewal of the testing medium. A pattern of CaF
2 formation was proposed.
Aim: The aim of this study was to evaluate a new endodontic leakage measurement method. Materials and methods: Permeability was assessed measuring the gas flow passing through the root. Positive and ...negative tests were carried out to assess the validity of the method. We used glass capillaries for calibration (diameters of 15, 30, 40, 50 and 75 μm). The applicability of the method was assessed with human teeth using three sealing methods: GuttaFlow (GF) and a single cone; Pulp Canal Sealer (PCS) and a single cone; PCS and system B. Results: This method demonstrated to be highly reproducible as the standard deviation was approximately 1% on average with glass capillaries. Significantly higher leakage (p<0.05) was recorded for endodontic treatment with GF and single cone compared to PCS and single cone and PCS with system B. Conclusion: Gas permeability is quantitative, sensitive, non-destructive and reproducible and seems appropriate for endodontic tests. It would participate in the indirect comprehension of leakage phenomena.
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