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Low invasive fluorescence guided dentistry

Techniques and methods that allow the preservation of dental tissues.

Low invasive fluorescence guided dentistry

Low-invasive dentistry encompasses a philosophy that integrates prevention, remineralization, and minimal intervention for the placement and replacement of dental restorations. The purpose of any treatment used based on the least invasive restorative approach is to remove the minimum amount of healthy tissue. Thus, the use of techniques and methods that allow the preservation of dental tissues is the desire for the realization of this work. The diverse characteristics and optical properties such as translucency, opalescence, and fluorescence of the dental hard tissues that we face in the removal and preparation of restorations, give us the necessary information to not go beyond our objective, thus trying to preserve and conserve their natural and aesthetic structure.


The fluorescence of natural teeth is of great interest to the clinician because it is associated, among other things, with a dental vitality effect, the absence of which is evident in greyish restorations. In today's world, surrounded by the artificial light influence of UV radiation (blacklight in bars, fluorescent tubes in studios, game centers, discotheques), as well as frequent exposure to the sun effect, all these factors influence the level of perceived vitality of restorations and, therefore, their naturalness. Human teeth are naturally fluorescent or are auto-fluorescent, as UV rays are easily absorbed by the luminescent components present in the dental tissues

So how important would fluorescence and UV be in minimally invasive restorative dentistry? What if we want to copy the characteristics of our dental issues we must take into account the presence of organic substances, both dentin, and enamel. These structures emit different degrees of fluorescence and being able to distinguish them will manage to preserve the greatest amount of tissue and use resins whose property of emitting such a light characteristic is similar to the tooth to be restored. 

How does fluorescence occur in dental tissues? 

When UV light A of the non-visible spectrum (between 350 and 400 nm) strikes dental tissues, it is initially absorbed and then emitted in the visible spectrum at longer wavelengths (between 410 and 500 nm) (5). In general, the teeth show an intensely white and bluish color under UV light, making them appear bright and vital. Dentin and enamel are dental structures with fluorescent properties. However, in dentin, it is more accentuated due to the higher amount of organic components, such as proteins and photosensitive collagen fibers. In enamel, the low content of organic components is responsible for its lower fluorescence. This is also the reason why the cervical area of the tooth fluoresces more than the incisal area. 

 The fluorescence of aesthetic restorative materials 

The use of new aesthetic materials, such as composite resins and ceramics that meet the optical characteristics similar to the tooth structure, has led manufacturers to incorporate various chemicals and minerals such as fluorophores type europium oxide, cerium, iterbium, and samarium or so-called rare-earth to achieve the naturalness of dental restorations. However, advances in the composition of new dental resins are a challenge for manufacturers to reproduce the optical properties of dental tissues in a satisfactory manner due to factors such as ambient light conditions and the dental aging process, among others. In the case of dental ceramics, there are many differences in composition and it also depends on their sintering processes and cycles and the effects of temperature, which reduce and affect the intensity of fluorescence. Traditional zirconium is a non-fluorescent material. Different products have been commercialized with the aim of improving the optical behavior of traditional zirconium oxides, such as coatings (to be applied on its surface) and fluorescence modifying liquids to immerse the zirconium oxide parts before sintering. Despite the limited research on the behavior of fluorescence in these aesthetic materials, there is increasing interest from manufacturing companies to develop this field.

Material and methods for the use of fluorescence assisted identification 

The technique of assisted or fluorescence-induced identification in dental practice consists of the use of an auxiliary UV A light whose spectrum is between 360-410 nm. Currently, the search to design an electronic device of an auxiliary and complementary diagnostic nature when evaluating the aesthetics of restorations has been the initial motivation to create K-Lite (Smileline-Switzerland & Dr. Katherine Losada), a lightweight double LED (White Light for use in translumination and violet light to induce fluorescence) electronic device with a 3mm diameter fiberglass guide and without wires, for daily use whose wavelength close to 400 nm has proven to be effective in easy identification of enamel and dentin dental tissues (increased fluorescence, brightness, and white-blue intensity), important when making less invasive enamel preparations. 

- Identification of enamel caries, as well as initial white lesions due to decreased fluorescence from demineralization. Also the differentiation of affected dentin and infected dentin in the presence of certain bacteria, whose by-product is porphyrins, which in the presence of UV light type A emit intense reddish-pink fluorescence. 

- Simple recognition of calculus or tartar both supra and subgingival (emits red-orange fluorescence). 

- Distinguishing and identifying aesthetic restorative materials that are in contact with natural dental underlying tissues (to assist in the removal of old and defective restorations and/or dental adhesives such as orthodontic anchors) 

- Control of the margins of pre-existing restorations without the need for routine and decrease the use of radiographs for location and extension.  

Summary

In daily dental practice, we must take into account that we commonly perform the evaluation of restorations and dental tissues in an artificial light environment that simulates natural light. However, this lighting does not simply allow us to identify the enamel and dentin for the purpose of the minimal tissue preparation. The margins of restorations that are tooth-colored and also the limit of dental adhesives and their possible excesses are not simple to perceive. The replacement of restorations, the use of aesthetic materials, the placement of transparent aligners, as well as the identification of the initial carious lesions and the removal of dental calculus are part of the main reasons for the patient to attend a dental consultation. The use of fluorescence through an ultraviolet light device would benefit the removal of such materials by avoiding excessive removal, iatrogeny, and/or involuntary contact with the underlying healthy dental tissues. 

Currently, tests performed on clinical cases, as well as the compliance and certification of K-Lite as a device for dental medical use, have shown the effectiveness in its daily use as an easy and routine tool to assist the clinician during dental diagnosis and treatment.

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