Inspektor Dental Care Inspek © 2003 Inspektor Dental Care bv, Amsterdam, Netherlands QLF™ Technologies a new approach to caries diagnosis Inspektor Dental

© 2003 Inspektor Dental Care bv, Amsterdam, NetherlandsInsp

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QLF™ Technologiesa new approach to caries diagnosis

Inspektor Dental Care

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Overview

• History• Principles of operation• The Products• Results • Validation• Status quo• Conclusion


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History

• 1978 Effect of lesions on fluorescence first noted by Folke Sundstrom (Karolinska Institutet, Stockholm, Sweden)

• 1987 Inspektor Research Systems bv founded in the Red-light district of Amsterdam (2 emp.)

• 1989 Folke Sundstrom asks Inspektor for help• 1994 Theory explaining fluorescence effects developed by E. de

Josselin de Jong• 1996 Correlation between fluorescence and mineral loss

established• 1997 First clinical trial with QLF prototype• 1999 Introduction of QLF/CLIN• 2000 First recording of Red fluorescence• 2002 Inspektor (10 emp) to enter dental market


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Why a new diagnostic method?

• To create an evidence based pre-invasive dentistry– To identify early lesions long before they

develop to frank caries– To track the development of incipient lesions– To evaluate pre-invasive treatment


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Pre-invasive lesion detection


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QLF contrast enhancement

white light QLF


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Early lesion detection with green fluorescence

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• Contrast enhancement follows from scattering properties of tooth tissue


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Results


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tStandard toothpaste

initial demin New toothpaste


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Research: QLF/CLIN QLF/InVitro


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Dentistry: QLF-SCAN, QLF-PRO


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Acquisition software


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Caries mapping


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Longitudinal monitoring


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Red Fluorescence: how

E D


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Examples of bacterial activity


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Danger zones: bacterial activity

Defective sealant.

Sealant applied over unprepared carious tooth

Red fluorescence indicating caries at the edges of a restoration.

The restoration was replaced, yet secondary caries remains.

sealants restorations hidden caries

Discolored fissure in a molaridentified as ‘sensitive’. Notethe res hue around the fissure

When the fissure was opened, a dentinal lesion was found.


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Before brushing Area = 30.6 mm2

ΔR = 51.8 %

Red Fluorescence: quantification

RCutoff = 20%

clean

After Brushing Area = 9.6 mm2

ΔR = 30.5 %

White spot lesion


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Area = 2.2 mm2

ΔR = 32.4 %Area = 3.2 mm2

ΔR = 47.5 %Area = 0.7 mm2

ΔR = 25.3 %

Red Fluorescence: caries excavationRCutoff = 20%

P. Sas 2003


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Red Fluorescence: sealants

No RF

Sound sealant Leaking sealant

R. Heinrich et al. 2001


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Clinical validation

• 1994 Øgaard and ten Bosch: demonstration of lesion tracking by measuring scattering properties

• 1995 de Josselin de Jong ea: Improvement of QLF system• 1997 Al-Khateeb ea: detection of remin with QLF in weekly

intervals consistent with microradiography• 1998 Al-Khateeb ea: QLF can be used to evaluate pre-

invasive treatment• 1998 Connersville study (IU):

– QLF appropriate for use on occlusal as well as buccal-lingual surfaces

– QLF is practical for large-scale clinical studies – QLF detects 4-9 times as many lesions vs. visual inspection– QLF validity for caries detection supported (ten Cate ea, 1999)


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Clinical validation

• 2001 Tranaeus ea: QLF is a sensitive method for longitudinal monitoring of incipient lesions on smooth surfaces

• Heinrich ea (to be published): QLF was able to separate groups of high-caries patients (33) that were given prophylaxis with or without the application of fluoride varnish, every 8 weeks for 6 months.


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Clinical validation in progress

• At IUPUI (Dr. George Stookey):– 2-Year study to validate QLF for the detection of primary

caries– 2-Year study to validate QLF for the detection of secondary

caries– 18-Month study of QLF to monitor caries in orthodontic

patients– 18-Month study of ability of QLF to detect differences in caries

rates in patients provided toothpastes with different concentrations of fluoride

• At Inspektor:– Correlation between red fluorescence and specific bacterial

strains.– Clinical study on bracket related incipient caries


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Scientific backing

• USA Prof. George Stookey, IUPUI, IN• Japan Prof. M. Kambara, Osaka Un.• D Prof. E. Hellwig, Un. Freiburg• S Prof. Angmar, Karolinska I.• NL Prof. J.J. ten Bosch, RUG• UK Dr. S. Higham, Liverpool


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Patents

•Dehydration (active lesion detection)•VidRep (automatic image capturing)•ToothCare (home-care device)•Red Fluorescence (bacterial activity)•10 patents in preparation

All patents filed in USA (Dehydration also in NL) international extension in progress


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Concluding remarks

• We now live in high-technology world that influences all aspects of our lives.

• Dentistry is no exception and these new technologies for the early detection of dental caries will have a revolutionary impact on dental research and the practice of dentistry.

• Every dental practice will have these technologies and professional treatments for caries prevention and control will be the main activities with restorative dentistry being only the means of last resort for dental health.

George K. Stookey, PhD, FICD, FACD, Indiana University School of Dentistry, Indianapolis, Indiana U.S.A.

Documents

Inspektor Dental Care Inspek © 2003 Inspektor Dental Care bv, Amsterdam, Netherlands QLF™ Technologies a new approach to caries diagnosis Inspektor Dental