I was reading an article today which I may have ripped out of Compendium Mag. which indicated dye will stain a number of things beside infection and is not recommended as a diagnostic tool for decay.

Jose,

Como esta? Cada ano en Marzo me esposa e me vamos a Bolivia para trabajo in Cochabamba e Trinidad hacienda restorativa por los pobre indigenous y los chicos de la calle. Hacemos para doce anos pasado.

In my practice I am working to first assess caries risk based upon dental history, recent experience with decay, diet patterns, salivary flow, compliance with recare and oral hygiene and other items. This helps me to set a baseline number for the diagnodent reading. If I decide to treat based upon inspection, diagnodent reading and x-rays then I begin with the tooth surface with the highest number and judge from the presence or absence of decay what to do with other areas with positive readings on the diagnodent so treatment verys from patient to patient based upon the above listed risk items. I use the laser and high magnification so what ever I do to the tooth is minimal. I am sure others can expand on these comments.
Pat

I use the Diagnodent to diagnose and CDD to guide me regarding what I need to remove.  Once you have decided to treat following DD diagnosis, clean the fissure entranc with CDD.  This will remove the very extreme outer layer of tooth structure (VELOTS)  This is where the pellicle becomes part of the tooth.  It is a high lipid layer with gradated mineral content that increases the deep into the velots you go.
Often if you stain with CDD befoer removing this, you can get a false negative.  Once it is removed, CDD with go where acid has been.

In slow onset caries (most common presentation  in fissures ) interprismatic enamel is lost, but macrostructure is maintained.  When you place CDD, it will soak into the carious enamel, accuately identifying all the acid damaged, nonprismatic enamel that MUST be removed if you are using resin bonded restorations.

You cannot bond to carious enamel.  It is non prismatic, ergo no bond, leaking seal, recurrent caries.

This use of CDD has been writen up in the peer reviewed literature, but is not well understood by most, ebcause CDD was first designed to be used on carious dentin.  The fact there is another application that is even more valid seems to escape some people.  Once you have used it this way, you will recognize how helpful it is.

Re using the Diagnodent.  I have created a comprehensive CD on how to use it, covering the caries process, diagnosis, false positives, false negatives etc

have a look at

http://www.advancedental-ltd.com

for some more info on the CD
Regards

(Edited by gwmilicich at 4:20 am on Nov. 6, 2002)

Graeme–nice post, good read.

Pat, very nice gesture to Jose.

Bob

Glen
I have not found the laser that good for fissure microdentistry
1. Even with 400micron saphire tips it doesn’t cut as fine as AA.
2. It is not as selective as AA
3. It gets hung up on stained fissures
4. It is slower that AA in the fissures

I use AA to do initial entry and disection of carious fissure enamel. If it turns to custard and I am into reaonable dentin caries, I use the laser. Interestingly, the parallel H2O airabrasion has slightly less sensitivity cutting dentin compared to the laser. They cut at about the same speed.

Regarding using AA around the scope. I have not had any problems. I have got a protective cap over the main lens that I can remove and wash when needed. Dry AA doesn’t affect it at all. I make the mess with the laser and llH2O AA.