Early diagnosis and minimally invasive treatment of occlusal caries--a clinical approach

Oral Health Prev Dent. 2004;2 Suppl 1:313-9. Related Articles, Links. Brostek A. School of Dentistry, University of Western Australia, Oral Health Centre, Nedlands, Western Australia, Australia. andrew@mylaberdental.com

This report summarizes the clinical experiences and recommendations for use of the KaVo DIAGNOdent laser fluorescence device and of air abrasion (Kinetic cavity preparation). A major diagnostic problem facing clinicians today is the difficulty of achieving accurate occlusal caries diagnosis. Diagnostic accuracy is important because it determines the quality of the treatment decisions made, particularly with regard to the possibility of unnecessary operative intervention. The decrease in incidence of cavitated caries in Western countries, followed by the change in common presentation to non-cavitated caries, has made this accurate diagnosis more difficult. The deficiencies of using traditional methods of occlusal diagnosis are discussed and examined, along with the need for new, more accurate techniques. The use of the new technology of laser fluorescence is explained in detail with a discussion of the advantages and limitations of a commercial device: the KaVo DIAGNOdent. A minimal cavity outline philosophy is suggested for operative intervention, with particular emphasis on the advantages of using Kinetic cavity preparation (KCP) non-rotary method of tooth cutting. It should be noted that treatment options such as operative intervention should never precede adequate diagnosis and the use of preventive treatments such as sealants, should be utilized where indicated.