Waiting
登录处理中...

Trial ends in Request Full Access Tell Your Colleague About Jove
JoVE Journal Medicine

Medicine

Detection and Removal of Tooth-Colored Composite Resin Using the Fluorescence-Aided Identification Technique

Published: July 27, 2022 doi: 10.3791/63656
Automatic Translation
*1, *1, 2, 1, 1
1Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, 2Department of Restorative Dentistry, Periodontology, Endodontology and Pediatric Dentistry, School of Dental Medicine, Eberhard-Karls University
* These authors contributed equally

Summary

The Fluorescence-aided Identification Technique is a practicable, fast, and reliable approach for the differentiation of composite resin restorations from tooth substance, and facilitates the minimally invasive and complete removal of composite resin restorations and composite bonded trauma splints.

Abstract

The detection and removal of tooth-colored filling materials is a major challenge for every dentist. The Fluorescence-aided Identification Technique (FIT) is a noninvasive tool to facilitate the distinction of composite resin material from sound tooth substance. Compared to conventional illumination, FIT is a very accurate, reliable, and fast diagnostic method. When composite resin is illuminated with a wavelength of approximately 398 ± 5 nm, certain fluorescent components make the composite resin appear brighter than the tooth structure. Any fluorescence-inducing light source with the appropriate wavelength can be used for this method. Optimally, this technique is used without additional natural or artificial lighting. The application of FIT can be used for diagnostic purposes, for example, dental charts, and additionally for the complete and minimally invasive removal of composite resin restorations, bracket debonding, and trauma splint removal. The assessment of volumetric changes after composite removal can be provided by overlapping pre- and postoperative scans and subsequent calculation using suitable software.

Introduction

The application of FIT facilitates the distinction of composite resin materials from sound tooth substance compared to conventional illumination, for example, by a dental unit lamp1,2. Fluorescence occurs when a material emits the light at a higher wavelength than it has been absorbed. As a result of this illumination, the material appears brighter than the tooth3. The maximum fluorescence of composite resin materials occurs when illuminated by a wavelength of 398 ± 5 nanometers3. Fluorescence in composite resin materials appears due to rare earth oxides added to the glass fillers, some of the main components of composite resins4,5. The addition of these fluorescent substances intends to adapt the optical properties of composite resins to the tooth structure to improve the esthetic properties of composite resins4,5. FIT is applicable on many composite resin materials as they show these fluorescence properties3. However, fluorescence decreases with the ageing of the composite resin materials6,7,8,9.

The distinguishment of composite resin materials from tooth structure with conventional illumination is a challenge since modern composite resin materials match the optical properties of tooth substance almost perfectly10,11. The misdiagnosis of composite resin results in inaccurate dental charts, false caries risk assessment, and inappropriate treatment planning11. Moreover, epidemiological data is falsified12.

Composite resin is the material of choice for direct restorations due to its straightforward handling, esthetic properties, and clinical performance13. Nevertheless, many composite restorations must be renewed due to secondary caries, fractures, or other reasons14,15. However, the removal of residual composite resin materials can be demanding under conventional light conditions. Even with the application of a magnification aid and the use of tactile probes or extensive drying of the teeth, composite residues are sometimes difficult to distinguish from sound tooth structure. Leftovers of composite remnants during the removal of the adhesive restoration lower the quality of further restorations and have an esthetic impairment due to possible discoloration of the margins1,16,17,18,19,20,21,22. On the contrary, an overpreparation due to misdiagnosis of composite resin versus tooth structure may result in unnecessary substance loss1,2.

In dental traumatology, fixation of the injured teeth using trauma splints is frequent and mandatory in many cases23. The trauma splints are usually fixed on the teeth using a flowable composite resin material. Incomplete removal of the composite resin material in this scenario may lead to the impairments described above. Since dental trauma occurs mostly in front teeth, an impairment of the esthetics and sufficient adhesion of further reconstructions are crucial. Therefore, the aim of the article is to demonstrate the application of the FIT method as an efficient and straightforward approach for detecting and removing composite resin materials.

Subscription Required. Please recommend JoVE to your librarian.

Protocol

The teeth used in this study were part of a project approved by the local Ethics Committee (EKNZ UBE-15/111). The participants provided written informed consent, and all data were de-identified to protect patient confidentiality.

1. Detection of tooth colored composite resin material using FIT

  1. Darken the room (natural and artificial light).
  2. Wear clear or yellow-tinted safety glasses with UV protection.
  3. Use a fluorescence-inducing light source to illuminate the tooth substance and tooth-colored composite resin restoration (Figure 1).
    NOTE: The composite resin material will appear brighter than the tooth substance (Figure 2). Any device with a wavelength of 398 ± 5 nm might be used as a fluorescence-inducing light source. Headlamp systems appear to be particularly suitable since the light spot illuminates the entire oral cavity and enables simultaneous tactile examination. Obstructive factors such as saliva and plaque do not interfere with the FIT method; therefore, previous cleaning and repeated drying of the teeth is not necessary.

2. Removal of composite resin-bonded trauma splints using FIT

  1. Preoperative scan with an intraoral scanning device and appropriate software for experimental evaluation purposes
    1. Start the intraoral scanning device and open the software (see the Table of Materials).
    2. Press Add New Patient to register your patient, fill in the gaps Last Name, First Name, Date of Birth, and Patient ID, and press Add Case.
    3. Choose Jaw Scan and Impressions under the section Indications. Then, press Next.
    4. Darken the room (natural and artificial light) and dry the field of operation to ease the scanning procedure.
    5. Start the intraoral scanner and perform a digital surface scan of the field of operation (Figure 3A).
  2. Visualization of the composite resin material
    1. Repeat steps 1.1-1.3.
    2. Remove the composite resin material using the common methods (e.g., a high-speed contra-angle handpiece with diamond burs and polishing devices) (Figure 4).
      NOTE: Remove the composite resin remnants close to the enamel with a carbide bur designed for debonding.
  3. Postoperative scan for experimental volumetric assessment
    1. Repeat steps 2.1.1-2.1.5.
       
       
  4. Experimental volumetric assessment
    1. Press Export to export the pre- and postoperative scans as surface tessellation language (STL) in highest resolution.
    2. Open suitable software and press recombine.
    3. Upload the pre- and postoperative scans to the software by pressing Import.
    4. Press Arrangement to superimpose the pre- and postoperative scans by the best fit method.
    5. Press Analysis to visualize the volumetric changes from pre- to postoperative scans. Select the tooth sites where volumetric changes presumably occurred by choosing Region under the section Tools. Analyze volumetric changes by using the linear and volumetric measurement software tools, Distances tool and Volume Analysis tool, respectively.
      1. Press Distances under the section Tools for linear quantification of tooth substance loss and composite resin remnants in color (e.g., unchanged areas: green, substance loss: blue and violet, excess material: yellow and red, Figure 3B). Use the color bar on the left to quantify linear volumetric changes. Additionally, locate the cursor on the relevant tooth sites; look for the exact cursor distance in the box on the left.
      2. Press Volume Analysis under the section Tools for volumetric quantification of tooth substance loss and composite resin remnants . Look for the volumetric change in the box on the left.

Subscription Required. Please recommend JoVE to your librarian.

Representative Results

Usage of the FIT method makes most composite resin materials appear brighter than sound tooth structure (Figure 2 and Figure 5). Therefore, FIT is applicable not only in the detection of composite resin material, but it also facilitates the removal of composite resin materials in general, and explicitly in posterior teeth, during orthodontic bracket debonding and in trauma splint removal1,2,24,25,26,27,28,29,30,31,32.

Figure 6 shows a tooth model after trauma splint removal under conventional illumination (teeth 13, 12, 11) and with the aid of FIT (teeth 21, 22, 23). Figure 6C shows the quantification of composite remnants and tooth substance loss in the software (unchanged areas: green, substance loss: blue and violet, excess material: yellow and red). The discrepancy of the pre- and postoperative scan measured by the Distance tool revealed composite remnants and substance loss of ± 0.1 mm in teeth 13, 12, and 11. Teeth 21, 22, and 23 showed nearly no changes in the surface (± 0.01 mm) after trauma splint removal. Moreover, the composite remnants are made visible by the FIT method (Figure 6B), whereas they remain undetected under conventional light illumination (Figure 6A).

Figure 1
Figure 1: Fluorescence-inducing light source. Please click here to view a larger version of this figure.

Figure 2
Figure 2: Tooth model with several composite resin restorations. (A) Conventional illumination, (B) FIT. Abbreviation: FIT = Fluorescence-aided Identification Technique. Please click here to view a larger version of this figure.

Figure 3
Figure 3: Preoperative scan and visualization of the volumetric changes after trauma splint removal. (A) Preoperative surface scan. (B) Visualization of the volumetric changes from pre- to postoperative scans in color (unchanged areas: green, substance loss: blue and violet, excess material: yellow and red). The color bar on the left enables the quantification of tooth substance loss and composite resin remnants. Please click here to view a larger version of this figure.

Figure 4
Figure 4: Suitable devices for the removal of composite resin during trauma splint removal. Left to right: diamond bur, bonding resin remover, mandrel, contouring and polishing discs, brush polishing system. Please click here to view a larger version of this figure.

Figure 5
Figure 5: Tooth model with trauma splint fixed with composite resin. (A) Conventional illumination, (B) FIT. Abbreviation: FIT = Fluorescence-aided Identification Technique. Please click here to view a larger version of this figure.

Figure 6
Figure 6: Tooth model after trauma splint removal under conventional illumination (teeth 13, 12, 11) and with the aid of FIT (teeth 21, 22, 23). (A) Under conventional light illumination, (B) illuminated by FIT (marked: composite remnants), (C) volumetric assessment (marked: composite remnants and substance loss). Abbreviation: FIT = Fluorescence-aided Identification Technique. Please click here to view a larger version of this figure.

Subscription Required. Please recommend JoVE to your librarian.

Discussion

The conventional illumination (for example by a dental unit lamp) is an unsatisfactory diagnostic tool for the identification of composite resin restorations. For superior diagnostics with conventional illumination, a magnification aid, drying, or even effortful cleaning of the teeth is necessary. Even under ideal circumstances, conventional illumination seems to be insufficient. A study showed that conventional illumination may lead to misdetection of composite resin restorations and sound tooth substance33. The FIT method seems to be superior in many ways. FIT is a diagnostic tool with a high accuracy, reproducibility, and repeatability1,2. Even obstructive factors such as saliva or biofilm do not influence the result of FIT1.

FIT also shows excellent inter- and intraoperator agreement1. Studies have shown FIT to provide satisfying results when used by dentists with different levels of experience1,33. Even dental students showed comparable results with experienced dentists using FIT1,33. However, the visual acuity which shows individual variation is influenced by many factors. In people above the age of 40 years, a physiological loosening of accommodation (presbyopia) occurs34. In studies, younger examiners under 40 years showed a higher sensitivity in detecting a composite resin restoration than a group older than 40 years33.

Any fluorescence-inducing light source is applicable for the FIT method33. Expensive and tedious systems can be avoided, and straightforward and low-cost systems, such as head-lamps, hand-lamps, or a modified micromotor can be favored. Given the availability of a suitable system for the FIT method, FIT is a diagnostic tool with a wide range of applications. FIT can be used for diagnostic purposes and as an additional tool for the removal of composite resin materials in reconstructive dentistry, dental traumatology (trauma splint removal), and orthodontics (bracket debonding)24,25,26,27,28,29,30,31,32. FIT is also advantageous in dental forensics, as several studies have found that more restoration sites can be detected using FIT35,36,37,38,39.

The evaluation of composite remnants and sound tooth substance loss after trauma splint removal using software after overlapping pre- and postoperative scans illustrates the accuracy of the FIT method. Intraoral scanners are suitable for this purpose since they are accurate and reliable28. Minor volumetric changes can be detected with a high level of precision28. Many of the available composite resin materials show fluorescence properties. However, fluorescence luminosity varies significantly according to the manufacturer and the shade of contemporary composite resin materials39.

Notably, some materials fluoresce less or even not enough for the application of the FIT method3,36,37,39. Moreover, the fluorescence signal of the composite resin materials decreases with time6,7,8,9. It might be harder to identify older composite resin restorations with the FIT method. These factors are the main drawback of the FIT method and must be taken into account when applying FIT. In conclusion, FIT is a reliable, fast, and noninvasive approach for the detection of composite resins.

Subscription Required. Please recommend JoVE to your librarian.

Disclosures

All authors declare that they have no conflict of interest.

Acknowledgments

This study was supported by a research grant from the Swiss Dental Association (SSO Research Grant 292-16).

Materials

Name Company Catalog Number Comments
Bonding Resin Remover, H22ALGK 016 Komet Dental, Lemgo, Germany Any other material/equpiment with the same function/purpose might be used.
Cerec Omicam, Connect SW 5.1.3 Dentsply Sirona, York, PA, USA Any other material/equpiment with the same function/purpose might be used.
Diamant bur Intensiv SA, Montagnola, Switzerland Any other material/equpiment with the same function/purpose might be used.
Mandrell 3M, Saint Paul, MN, USA Any other material/equpiment with the same function/purpose might be used.
MASTERmatic KaVo Dental GmbH, Biberach, Germany Any other material/equpiment with the same function/purpose might be used.
Occlubrush Kerr, Orange, CA, USA brush polishing system
OraCheck Software, Version 5.0.0 Cyfex AG, Zurich, Switzerland Any other material/equpiment with the same function/purpose might be used.
SIROInspect Dentsply Sirona, York, PA, USA Any other material/equpiment with the same function/purpose might be used.
Sof-Lex 3M, Saint Paul, MN, USA Contouring/polishing discs; any other material/equpiment with the same function/purpose might be used.

DOWNLOAD MATERIALS LIST

References

  1. Meller, C., Connert, T., Löst, C., ElAyouti, A. Reliability of a Fluorescence-aided Identification Technique (FIT) for detecting tooth-colored restorations: an ex vivo comparative study. Clinical Oral Investigations. 21 (1), 347-355 (2017).
  2. Kiran, R., Chapman, J., Tennant, M., Forrest, A., Walsh, L. J. Fluorescence-aided selective removal of resin-based composite restorative materials: An in vitro comparative study. Journal of Esthetic and Restorative Dentistry. 32 (3), 310-316 (2020).
  3. Meller, C., Klein, C. Fluorescence properties of commercial composite resin restorative materials in dentistry. Dental Materials Journal. 31 (6), 916-923 (2012).
  4. Uo, M., et al. Rare earth oxide-containing fluorescent glass filler for composite resin. Dental Materials Journal. 24 (1), 49-52 (2005).
  5. Fondriest, J. Shade matching in restorative dentistry: the science and strategies. International Journal of Periodontics and Restorative Dentistry. 23, 467-479 (2003).
  6. Takahashi, M. K., et al. Fluorescence intensity of resin composites and dental tissues before and after accelerated aging: a comparative study. Operative Dentistry. 33 (2), 189-195 (2008).
  7. Klein, C., Wolff, D., Ohle, C. V., Meller, C. The fluorescence of resin-based composites: An analysis after ten years of aging. Dental Materials Journal. 40 (1), 94-100 (2020).
  8. Lee, Y. K., Lu, H., Powers, J. M. Changes in opalescence and fluorescence properties of resin composites after accelerated aging. Dental Materials. 22 (7), 653-660 (2006).
  9. Lee, Y. K., Lu, H., Powers, J. M. Optical properties of four esthetic restorative materials after accelerated aging. American Journal of Dentistry. 19 (3), 155-158 (2006).
  10. Dietschi, D. Free-hand composite resin restorations: a key to anterior aesthetics. Practical Periodontics and Aesthetic Dentistry. 7 (7), 15-25 (1995).
  11. Bush, M. A., Hermanson, A. S., Yetto, R. J., Wieczkowski, G. The use of ultraviolet LED illumination for composite resin removal: an in vitro study. General Dentistry. 58 (5), 214-218 (2010).
  12. Baelum, V., Fejerskov, O. How big is the problem? Epidemiological features of dental caries. Dental Caries-the Disease and its Clinical Management. 3rd edn. Fejerskov, O., Nyvad, B., Kidd, E. A. M. , Blackwell Publishing. Iowa. 25 (2015).
  13. Lynch, C. D., et al. Guidance on posterior resin composites: Academy of Operative Dentistry - European Section. Journal of Denistry. 42 (4), 377-383 (2014).
  14. Demarco, F. F., Corrêa, M. B., Cenci, M. S., Moraes, R. R., Opdam, N. J. Longevity of posterior composite restorations: not only a matter of materials. Dental Materials Journal. 28 (1), 87-101 (2012).
  15. Eltahlah, D., Lynch, C. D., Chadwick, B. L., Blum, I. R., Wilson, N. H. F. An update on the reasons for placement and replacement of direct restorations. Journal of Dentistry. 72, 1-7 (2018).
  16. Bonstein, T., Garlapo, D., Donarummo, J., Bush, P. J. Evaluation of varied repair protocols applied to aged composite resin. Journal of Adhesive Dentistry. 7 (1), 41-49 (2005).
  17. Crumpler, D. C., Bayne, S. C., Sockwell, S., Brunson, D., Roberson, T. M. Bonding to resurfaced posterior composites. Dental Materials Journal. 5 (6), 417-424 (1989).
  18. Kupiec, K. A., Barkmeier, W. W. Laboratory evaluation of surface treatments for composite repair. Opererative Dentistry. 21 (2), 59-62 (1996).
  19. Lucena-Martín, C., González-López, S., Navajas-Rodríguez de Mondelo, J. M. The effect of various surface treatments and bonding agents on the repaired strength of heat-treated composites. Journal of Prosthetic Dentistry. 86 (5), 481-488 (2001).
  20. Hannig, C., Laubach, S., Hahn, P., Attin, T. Shear bond strength of repaired adhesive filling materials using different repair procedures. Journal of Adhesive Dentistry. 8 (1), 35-40 (2006).
  21. Eliades, T., Gioka, C., Heim, M., Eliades, G., Makou, M. Color stability of orthodontic adhesive resins. Angle Orthodontist. 74 (3), 391-393 (2004).
  22. Quirynen, M., et al. The influence of surface free energy and surface roughness on early plaque formation. An in vivo study in man. Journal of Clinical Periodontology. 17 (3), 138-144 (1990).
  23. Diangelis, A. J., et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 28 (1), 2-12 (2012).
  24. Tani, K., Watari, F., Uo, M., Morita, M. Discrimination between composite resin and teeth using fluorescence properties. Dental Materials Journal. 22 (4), 569-580 (2003).
  25. Carson, D. O., Orihara, Y., Sorbie, J. L., Pounder, D. J. Detection of white restorative dental materials using an alternative light source. Forensic Science International. 88 (2), 163-168 (1997).
  26. Kiran, R., Chapman, J., Tennant, M., Forrest, A., Walsh, L. J. Fluorescence-aided selective removal of resin-based composite restorative materials: An in vitro comparative study. Journal of Esthetic and Restorative Dentistry. 32 (3), 310-316 (2020).
  27. Dettwiler, C., et al. Fluorescence-aided composite removal in directly restored permanent posterior teeth. Operative Dentistry. 45 (1), 62-70 (2020).
  28. Dettwiler, C., et al. Evaluation of a Fluorescence-aided Identification Technique (FIT) for removal of composite bonded trauma splints. Dental Traumatology. 34 (5), 353-359 (2018).
  29. Schott, T. C., Meller, C. A. new Fluorescence-aided Identification Technique (FIT) for optimal removal of resin-based bracket bonding remnants after orthodontic debracketing. Quintessence International. 49 (10), 809-813 (2018).
  30. Stadler, O., et al. Evaluation of a Fluorescence-aided Identification Technique (FIT) to assist clean-up after orthodontic bracket debonding. Angle Orthodontist. 89 (6), 876-882 (2019).
  31. Ribeiro, A. A., Almeida, L. F., Martins, L. P., Martins, R. P. Assessing adhesive remnant removal and enamel damage with ultraviolet light: An in-vitro study. American Journal of Orthodontics and Dentofacial Orthopedics. 151 (2), 292-296 (2017).
  32. Klein, C., et al. Minimally invasive removal of tooth-colored restorations: evaluation of a novel handpiece using the fluorescence-aided identification technique (FIT). Clinical Oral Investigations. 28 (8), 2735-2743 (2019).
  33. Leontiev, W., et al. Accuracy of the fluorescence-aided identification technique (FIT) for detecting tooth-colored restorations utilizing different fluorescence-inducing devices: an ex vivo comparative study. Clinical Oral Investigations. 25 (9), 5189-5196 (2021).
  34. Eichenberger, M., Perrin, P., Neuhaus, K. W., Bringolf, U., Lussi, A. Influence of loupes and age on the near visual acuity of practicing dentists. Journal of Biomedical Optics. 16 (3), 035003 (2011).
  35. Hermanson, A. S., Bush, M. A., Miller, R. G., Bush, P. J. Ultraviolet illumination as an adjunctive aid in dental inspection. Journal of Forensic Sciences. 53 (2), 408-411 (2008).
  36. Kiran, R., Chapman, J., Tennant, M., Forrest, A., Walsh, L. J. Detection of tooth-colored restorative materials for forensic purposes based on their optical properties: an in vitro comparative study. Journal of Forensic Sciences. 64 (1), 254-259 (2019).
  37. Kiran, R., Walsh, L. J., Forrest, A., Tennant, M., Chapman, J. Forensic applications: Fluorescence properties of tooth-coloured restorative materials using a fluorescence DSLR camera. Forensic Science International. 273, 20-28 (2017).
  38. Pretty, I. A., Smith, P. W., Edgar, W. M., Higham, S. M. The use of quantitative light-induced fluorescence (QLF) to identify composite restorations in forensic examinations. Journal of Forensic Sciences. 47 (4), 831-836 (2002).
  39. Kiran, R., Chapman, J., Tennant, M., Forrest, A., Walsh, L. J. Direct tooth-colored restorative materials: a comparative analysis of the fluorescence properties among different shades. International Journal of Esthetic Dentistry. 15 (3), 318-332 (2020).

Tags

Tooth-colored Composite Resin Fluorescence-aided Identification Technique FIT Minimal Invasive Removal Composite Resin Restorations Composite-bonded Trauma Splints Diagnostic Approach Clear Or Yellow-tinted Safety Glasses UV Protection Fluorescence-inducing Light Source Intraoral Scanning Device Experimental Evaluation Purposes Patient Registration Jaw Scan And Impressions Darkened Room Field Of Operation Digital Surface Scan High-speed Contra Angle Handpiece Diamond Burs Bonding Resin Remover
Detection and Removal of Tooth-Colored Composite Resin Using the Fluorescence-Aided Identification Technique
Play Video
PDF DOI DOWNLOAD MATERIALS LIST

Cite this Article

Magni, E., Leontiev, W., Meller, C., … More

Magni, E., Leontiev, W., Meller, C., Weiger, R., Connert, T. Detection and Removal of Tooth-Colored Composite Resin Using the Fluorescence-Aided Identification Technique. J. Vis. Exp. (185), e63656, doi:10.3791/63656 (2022).

Less
Copy Citation Download Citation Reprints and Permissions
View Video

Get cutting-edge science videos from JoVE sent straight to your inbox every month.

Waiting X
Simple Hit Counter