ACCURACY OF DETECTING CARIES BENEATH COMPOSITE RESIN RESTORATIONS USING THE CANARY SYSTEM, BITEWING RADIOGRAPHS AND CONEBEAM CT SCAN


A new paper was just published in Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology that evaluated the accuracy of The Canary System, Bitewing Radiographs and Cone Beam CT for detecting natural caries under composite restorations in interproximal regions (https://doi.org/10.1016/j.oooo.2019.09.006).  This study found that The Canary System was more accurate than Bitewing Radiographs and Cone Beam CT in detecting caries on the gingival floor beneath composite restorations.  The sensitivity and specificity data (table on the right) indicates that The Canary System could find 89% of the caries where the other devices found 40% of the lesions.
One of the major reasons for replacing restorations is tooth decay that develops around the edges of the filling.  This study found that “Radiographs though valuable in the detection of advanced caries lesions, are less sensitive for early or recurrent lesions under restorations.”  The Canary System which does not use ionizing radiation can serve as a sensitive tool in early caries detection.
The findings in this study mirror the findings from other studies done by Dr. Amaechi’s group at the University of Texas at San Antonio.  A clinical trial, which was reported at a research conference in 2015, found The Canary System was superior to bitewing radiography for the detection of proximal caries.  The Canary System found 92% of the caries while bitewing radiographs found only 67%.
Radiographs including bitewings are commonly used to detect caries at the interproximal or contact areas but they do not reveal enamel white-spot lesions or all recurrent caries around restorations.  Approximately 30%–40% mineral loss is necessary before an early enamel caries lesion is visible radiographically and demineralization may not appear radiographically until at least 9 months or longer after initiation.
Finding decay early may allow oral health providers to use various preventive / remineralization products to help stabilize the lesion or re-harden it. 
The Canary System, with its unique crystal structure diagnostics, can quantify, image, monitor and record changes in the structure of enamel, dentin and cementum. It can detect caries beneath opaque sealants, around the margins of restorations, around orthodontic brackets and beneath interproximal, occlusal and smooth surfaces.
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