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An Update on Demineralization/Remineralization

Mark E. Jensen, MS, DDS, PhD; Robert V. Faller, BS

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Electrical resistance has been used over the years in various forms in an attempt to detect caries. It basically uses a change in resistance to indicate mineral content. It has been used for occlusal caries detection27, and recently it was used for an in vitro and in vivo assessment of remineralization of lesions with toothpaste. Some difficulties existed and statistical significance was not seen, but the conclusions indicated that with modifications, ". . . electrical resistance measurements may be a means of comparing the remineralization performance of toothpastes." Even more recently, electrical resistance (using the Electric Caries Monitor – ECM) has been used in vitro in a comparison to transversal micro-radiography to measure remineralization (root lesion depth and mineral loss) with several fluoride treatment regimes. It appears ECM specificity is only 80%, which makes it inappropriate for clinical use at this time.28 Although not ready for clinical application, it does indicate possibilities for measuring remineralization/demineralization of difficult to detect root surface lesions.

 

Clearly there is a need to increase the sensitivity of our methods of caries detection while maintaining the highest level of specificity. Our desire is to be able to detect caries activity even before it is clinically or radiographically visible when we can institute effective methods for remineralization and stop the net demineralization. The caries process is a dynamic continuum, and current detection methods need more study and comparison to the "gold standard."29 With improved methods for caries detection, Ekstrand30 suggests the need for potential clinical trials using non-cavitated lesions. These early detection methods need evaluation but are suggested for clinical trials of therapies aimed at correcting the demineralization/remineralization imbalance in individuals at risk. Imrey and Kingman31 recently reviewed this area and suggested data analysis will be needed that fully exploits ordinal or continuous-scale outcome measures. Hopefully, we will see more clinical trial data with methods that measure early carious lesions in a quantitative manner. Perhaps we will see the improvement of methods such as the 3D cone-beam technology that can provide three dimensional images. It is not that far fetched to think one can imagine a device such as J Morita's Accuitomo (Click to view) that would provide a 3D image of early caries lesions. Unfortunately, the resolution is just slightly better than 2 line pairs per mm when we need 22 lp/mm or greater. When resolution increases, we may very well see programs that analyze the mineral content changes within a lesion in three dimensions. Using subtraction analysis, we would be able to monitor the status of the lesion and effectiveness of our treatment. We will then be able to apply these methods for individual patient therapy involving remineralization approaches?

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