Einsatz eines Biolumineszenzverfahrens bei der Erfassung von erosiven Veränderungen im Schmelz an Glattflächen von bleibenden Zähnen – eine In-vitro-Studie
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Philipps-Universität Marburg
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Abstract
Use of the bioluminescence method for detection of erosive changes in enamel on smooth surfaces of permanent teeth - an in-vitro study
Objective: Due to the increasing presence of tooth erosion in modern societies, the detection and monitoring of early lesions has become an important issue. Nowadays, evaluation of dental erosion is performed visually by using the Basic Erosive Wear Examination Index (BEWE) - an international, standardized and validated index. However, and most problematic, for erosions to become clinically detectable through inspection of visual changes, they are often already far advanced. Therefore a well-founded diagnosis supported by digital technical aids is indispensable for modern dentistry.
Aim: The aim of this study was to detect the applicability of the Calcivis system for early detection of artificially produced erosions on human permanent teeth. Quantitative light-induced fluorescence (QLF) was used as reference for the detection of erosions. In addition, it was examined how the pixel measurement correlates with the fluorescence loss (∆F) and whether acids with different pH values can represent the bioluminescence.
Material and Method: The sample comprises 90 tooth from extracted human permanent molars. In order to create an internal control group for each sample, one side of each tooth (sample) was masked with tape after cleaning and polishing.
Afterwards, six groups were formed by randomly assigning 15 tooth samples to each group. Each group was assigned to one particular acid (0.01 mol hydrochloric acid, 6% citric acid, Coca-Cola, apple juice, orange juice and RedBull). Consequently, the tooth samples were demineralized for three minutes in their respective acid. After rinsing with distilled water and drying the tooth, samples were recorded with the Calcivis system for in-vitro studies. Based on digital images taken from this system, the presence of erosion (blue fields caused by bioluminescence) has been evaluated. The images were first analyzed by a yes/no decision and then further processed with the ImageJ software and pixel measurement. The reference to detect dental erosion was QLF. The measurement with QLF was carried out in two ways. On the one hand, the whole side of the tooth samples was examined for the presence of erosion. On the other hand, the contour of the bioluminescence spot was traced on the QLF image using the Calcivis image.
Statistical analysis of the data was performed by MedCalc 18.11.6. Using the McNemar Qui-square test, it was examined whether the non-eroded and eroded side could be clearly distinguished by the Calcivis measurement. Calcivis findings are reported in cross tables and the frequency distributions of the erosion by Calcivis and QLF are illustrated in box plot diagrams. Statistical difference between the pixel values of the non-eroded and eroded side was analyzed by means of a paired t-test. Analysis of variance (ANOVA) was used to investigate how the six groups differ from each other.
Results: The Calcivis system was able to distinguish between non-eroded and eroded tooth substance by a yes/no decision (p<0.0001). The system correctly detected 90% of the eroded side as demineralized and incorrectly classified 10% as not demineralized. With the exception of group E (p=0.1470), the non-eroded and eroded side could also be clearly distinguished by pixel measurement (p<0.0001). The pixel measurement and the fluorescence loss ∆F showed no statistically significant correlation, neither by the Calcivis image measurement (p=0.342) nor by applying QLF measurement for the entire tooth side (p=0.273). Both the mean pixel values (p=0.235 and p=0.644) and the mean ∆F values (p=0.103 and p=0.141) showed homogeneous groups.
Conclusion: In conclusion, the Calcivis system provided good results in detecting early erosive changes in human enamel. The non-eroded and eroded tooth surface could be clearly distinguished. The digital representation of the erosion in an initial stage allows the optimal diagnosis and enables early prevention. Furthermore, it visualizes the urgency of a treatment even for supposedly symptom-free patient in a comprehensible manner. In addition, the stored images enable benefit in follow-up and can indicate the need for intervention. The Calcivis system makes it possible to display eroded dental hard tissue and offers great benefits for noninvasive dental medicine. In this study the pixel measurement did not provide any supplementary quantification and clinically relevant statement in addition to the yes/no decision. For the clinical practice, this means that the diagnosis will be a yes/no decision based on luminescence. Further studies on luminescence are required to explore possible diagnosis based on quantitative methods beyond the simple yes/no decision.
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Created: 2019Issued: 2020-01-13Updated: 2020-01-13
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
luminescenceLQuantitative light-induced fluorescence (QLF)tooth erosionDemineralisationCalcivis Activitiy Imaging SystemZahnerosionenacidsquantitative lichtinduzierte Fluoreszenz (QLF)lichtoptische VerfahrenCalcivis Activitiy Imaging SystemdemineralisationSäuren
DFG-subjects
ZahnmedizinErosionLumineszenzStomatologieDemineralisation
DDC-Numbers
610
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Scheipers, Kathrin: Einsatz eines Biolumineszenzverfahrens bei der Erfassung von erosiven Veränderungen im Schmelz an Glattflächen von bleibenden Zähnen – eine In-vitro-Studie. : Philipps-Universität Marburg 2020-01-13. DOI: https://doi.org/10.17192/z2020.0008.