Abstract
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.
Keywords caries detection - caries diagnostics - fluorescence - ICDAS
