Transcript
Dexis Carivu &
Rapid Mechanical Diagnostics(RMDx)
A Powerful Diagnostic Team Of Complementary & Innovative Solutions
CONFIDENTIAL - SUBJECT TO NON-DISCLOSURE AGREEMENT
Visual diagnostic databased upon
Transillumination & Photography
Mechanical diagnostic databased upon
Rapid Mechanical Diagnostics
Combinedwith
Carivu RMDx
Detects Caries & Enamel Cracks Micro-Movement From Cracks,Defective Restorations, Bone or PDL
Primary Purpose Detect Caries Early Detect Structural Breakdown Early
Where Visible Areas Of Teeth Visible & Non-VisibleAreas Of Teeth
ScienceUtilized
TransilluminationAnd Photography
MechanicalTesting
Form OfDiagnosis
Visual Images Numerical MetricsAnd Graphs
For Teeth or Implants Teeth Teeth and Implants
Synergistic Use OfCarivu With RMDx
Allows clinician to confidently determine whether a tooth needs monitoring over time or requires immediate treatment
Summary of Technologies
Mechanical diagnostic data based upon percussion- Innovative way to identify defects without radiation
- Detects pathological micro-movement in a structure- Measures severity of micro-movement under loading- Monitors micro-movement stability over time- Not dependent on visibility - Effective for teeth & implants- Not able to detect incipient caries
Visual diagnostic data based upon transillumination- Innovative way of detecting caries without radiation- Combination of transillumination and video capture- Detection of enamel cracks- Qualitative- Limited to areas that will allow light penetration- Unable to assess severity of defects- Unable to detect internal cracks
Potential Carivu & RMDx Claim
Carivu & RMDx are a synergistic combination of visual and mechanical data that can “confidently determine whether [a site] needs immediate treatment or
monitoring.”
Ultimate Question Regarding The Synergy between Dexis Carivu and RMDx-Was the the clinician provided:
1. More comprehensive information to allow a more accurate diagnosis of treatment options? 2. Knowledge of whether to treat now, monitor or treat later?
Yes or No
Case studies showing synergistic technology usage
Patient #1—no decay, history of structural pathologyPatient #2—interproximal decay, no history of structural pathology
Case Study: Patient #1
Upper Teeth: 2 3 9 14
• Male, age 60• Caries stable• History of football trauma at collegeo 2 Avulsed/reimplanted centrals (8 & 9)o 2 fractured molars requiring Full Gold
Crown & Onlayo 2 fractures fillingso 2 fractured lower incisors, unrestored
Lower Teeth: 24 25
Patient #1
Full Mouth - DEXIS Dashboard
February 2015
Patient #1
Full Mouth - RMDx Dashboard
February 2015
Blue Band = Highest-Risk Sites
in Red Zone
[Teeth 2 & 3]
negative enamel
cracks Serious Pathology
X-Rays Dexis CarivuRMDx
dashboard: Patient #1, Tooth #2
Disassembly Images: Patient #1, tooth #2
Early dentinal fracture distal to mesial 1/3 across preparation floor
Marginal ridge fracture
Synergistic clinical significance: Patient #1, Tooth #2-X-Ray: Negative-Carivu: Supragingival enamel crazing (no decay)-RMDx: Severe Levels of Pathological Micro-Movement (DSQ = 56) History: 2 prior cracked molars/2 prior cracked
fillings High risk for fractures/2 successive high readings Recommendation: Disassemble & replace old composites. Check for fractures
Complementarity: Patient #1, Tooth #2SUMMARY
Findings: Minor enamel cracks (Carivu) Severe pathological micro-movement (RMDx)
Diagnosis: Micro-leakage, enamel crazing Early serious dentinal crack (predicted by RMDx, confirmed)
Final Proposed Treatment Plan: Onlay for further fracture prevention
Why treat now: Patient #1, Tooth #2Based upon findings:
•The early crack that was located was serious •The replacement of the old restoration did not make an appreciable change in the DSQ reading, signifying that the defect was more structural and not restoration related•Immediate actions taken: POS, habit controls, inform patient of need for restoration•Needs protective onlay to halt/slow crack progression•If not treated, tooth could easily develop symptoms & ultimate catastrophic fracture.
Dashboard: Patient #1, tooth #3
negative enamel
cracksSerious Pathology
X-Rays DEXIS Carivu RMDx
Disassembly Images: Patient #1, Tooth #3
Post-Disassembly: Mesial buccal cusp advancing fracture
Mesial
Buccal
Synergistic clinical significance: Patient #1, Tooth #3-X-Ray: Negative-Carivu: Supragingival enamel crazing (no decay)-RMDx: Severe Levels of Pathological Micro-Movement (DSQ = 67)
History: 2 prior cracked molars/2 prior cracked fillings High risk for fractures/2 successive high readings Recommendation: Disassemble, check for fractures & replace old composite Protect with restoration from additional destruction
SummaryFindings: Significant enamel cracks (Carivu) Severe pathological micro-movement (RMDx)
Diagnosis: Enamel cracks, serious dentinal cracks under MB cuspFuture Proposed Treatment Plan: Onlay to protect from further
fracture, POS
Complementarity: Patient #1, Tooth #3
why treat now: Patient #1, Tooth #3Based upon findings:•The early cracks were serious and surrounded the MB cusp•If not protected, the MB cusp would eventually fracture•Immediate actions taken: POS, habit controls, inform patient of need for restoration•Needs protective onlay placed to halt/slow crack progression•If not treated, tooth could easily develop symptoms and a coronal fracture of the MB cusp .•Depending on the direction of the fracture, endodontic involvement could occur
dashboard: Patient #1, Tooth #9
negative
enamel cracks Mild
Pathology
RMDxDEXIS Carivu X-Rays
Synergistic clinical significance: Patient #1, Tooth #9-X-Ray: Negative-Carivu: Supragingival enamel crazing-RMDx: Mild Levels of Pathological Micro-Movement & Structural
Instability (DSQ = 21)
History: 2 prior cracked molars/2 prior cracked fillings 8 & 9 avulsed in college football injury Recommendation: Monitor, structurally sound
Complementarity: Patient #1, Tooth #9Summary
Findings: Superficial enamel cracks (Carivu) Mild pathological micro-movement (RMDx)
Diagnosis: Tooth Structurally Sound/no disassembly neededFuture Proposed Treatment Plan: Monitor, PV if desired
Why no treatment now: Patient #1, Tooth #9Based upon
findings:•The enamel cracks appeared serious, but were not.•If a crown was placed based on only enamel cracking, the tooth’s structure would be compromised
Dashboard: Patient #1, Tooth #24
negative Negative
Pathology
enamel cracks & chip
RMDxDEXIS CarivuX-Rays
Complementarity: Patient #1, Tooth #24Summary
Findings: Serious enamel cracks (Carivu) Non-pathological micro-movement (RMDx)
Diagnosis: Structurally strongFuture Treatment Plan: Monitor, esthetic restoration
optional
Why not treat now: Patient #1, Tooth #24Based upon findings:
•Enamel cracks and fractured incisal appeared serious, but were not.•If a crown was placed based on only enamel cracking, the tooth’s structure would be compromised •Tooth could be restored for esthetics with a porcelain veneer if desired to correct traumatic fracture and esthetic compromise
dashboard: Patient #1, Tooth #25
negative
enamel cracks & chip
Mild Pathology
DEXIS CarivuRMDxX-Rays
Complementarity: Patient #1, Tooth #25Summary
Findings: Serious enamel cracks (Carivu) Mild pathological micro-movement (RMDx)
Diagnosis: Structurally soundFuture Treatment Plan: Monitor, esthetic restoration optional
Why no treatment now: Patient #1, Tooth #25Based upon findings:•The superficial cracks and fractured piece appeared serious, but were not.•If a crown was placed based on a belief that the tooth was cracking, the incisor would be structurally compromised•Tooth could be restored for esthetics with a porcelain veneer if desired to correct traumatic fracture and esthetic compromise
Mid-treatment use of Carivu: Patient #1, Tooth #14
CASE STUDYHISTORY: Provisional onlay placed July 2014 due to symptoms &
Severe pathological micro-movement (RMDx) Carivu used to capture partial image of dentinal crack in preparation
Dashboard: Patient #1, Tooth #14
negative Severe expanding
pathology
Carivu: Not
Available in July 2014
X-RaysRMDx
Disassembly Images: Patient #1, Tooth #14
Disassembly findings: Patient #1, Tooth #14Post-Disassembly Defects Found:
-Serious Dentinal Cracks Mesial To Distal On The Preparation Floor
-Carivu captured partial image of crack after preparation
(see illustrations on following slide)
Complementarity: Patient #1, Tooth #14Summary
Findings: Indication of dentinal cracks seen post-preparation (Carivu) Severe pathological structural instability pre-preparation (RMDx)
Diagnosis: Complex vertical & horizontal dentinal fractures, preparation floorFuture Treatment Plan: Positive response to provisional.
Placed permanent bonded restoration (onlay) and will monitor with RMDx
Why treat now: Patient #1, Tooth #14Based upon findings:•The cracks were symptomatic, serious and complex, heading to pulp chamber •The defect was structural and not restoration related •Positive response to provisional onlay and final bonded restoration•If tooth not treated, could easily develop a catastrophic fracture.
Case studies showing synergistic technology usage
• Patient #1—no decay, history of structural pathology
• Patient #2—interproximal decay, no history of structural pathology
Case Study: Patient #2
Upper Teeth: 15
- Male, age 45- History of mild arrested caries (19,
20)- Periodontally stable- No history of fractures- Parafunctional history, no POS
Lower Teeth: 18 19 20
Patient #2
Full Mouth - DEXIS Dashboard
February 2015
Patient #2
Full Mouth - RMDx Dashboard
February 2015
Blue Band = Highest-Risk Sites in Red
Zone [Teeth 15 &
18]
Caries risk19 & 20
dashboard: Patient #2, Teeth #19 & 20
Positive More positive
Moderate & Mild Pathology
X-Rays DEXIS Carivu RMDx
Complementarity: Patient #2, Teeth #19 & 20Summary
Diagnosis: Interproximal Caries (Carivu)Moderate & Mild Pathological Micro-Movement (RMDx)
Findings: #19 moderate structural instability; #20 mild structural instability
Future Proposed Treatment Plan: Composite Restorations; check for fractures on #19
Why treat now: Patient #2, Tooth #19Based upon findings:
•Carivu testing showed interproximal caries beyond DEJ•RMDx testing indicated that a moderate structural crack is present•A composite restoration could generate sensitivity due to crack•Patient has been warned about pathology and potential outcomes•Either a bonded composite restoration covering cusps or an onlay will be placed.
Why treat now: Patient #2, Tooth #19
Why treat now: Patient #1, Tooth #20Based upon findings:
•Carivu shows decay and RMDx shows mild micro movement•Caries is broken through enamel and will grow faster•Bonded composite restoration would be appropriate at this stage•Need to monitor to assure stability of micro-cracks•If not treated, will only get worse
Why treat now: Patient #2, Tooth #20
dashboard: Patient #2, Tooth #15
Negative Enamel
cracks Positive Pathology
DEXIS Carivu RMDx
X-Rays
Synergistic clinical significance: Patient #2, Tooth #15-X-Ray: Negative-Carivu: Mild Enamel Cracks-RMDx: Severe Levels of Pathological Micro-Movement (DSQ = 65) History: Asymptomatic, no prior fractures, 45 years old, initial baseline RMDx Recommendation: High alert, possible disassembly, start patient education. For now, Protective Occlusal Splint, monitor every 3 months with RMDx for crack progression until restored (suspect balancing interference with #18)
Why treat now: Patient #2, Tooth #15Based upon findings:•RMDx indicated severe pathological micro-movement•Occlusal gold inlay does not protect against fractures•Treat with POS, education of patient, potential future onlay•Suspect significant dentinal crack that will develop symptoms and fractures in future•Dependent upon direction of fracture, endodontics or extraction
dashboard: Patient #2, Tooth #18
Negative
Enamel Cracks Severe
Pathology
DEXIS Carivu RMDxX-Ray
Synergistic clinical significance: Patient #2, Tooth #18-X-Ray: Negative-Carivu: Enamel Cracks-RMDx: Severe Levels of Pathological Micro-Movement (DSQ = 55)
History: Asymptomatic, no prior fractures, 45 years old, initial baseline RMDx Recommendation: Protect with Protective Occlusal Splint, monitor every 3
months with RMDx, restore if increasing
Complementarity: Patient #2, Tooth #18Summary
Findings: Enamel Cracks (Carivu)Severe Pathological Micro-Movement (RMDx)
Diagnosis: Dentinal crack, potential parafunctional balancing interference with #15.
Future Proposed Treatment Plan: Protect & monitor every 3 months Place onlay if DSQ increases
Why treat now: Patient #2, Tooth #18Based upon findings:
•Unrestored second molar with high shearing forces•RMDx indicated significant pathological micro movement•Suspect significant dentinal crack that will develop symptoms and fractures in future•Dependent upon direction of fracture, may need restoration, endodontics, extraction
Complementary Case Study DetailsPatient # Tooth # Carivu RMDx History of
FracturesDisassembly Findings Treatment
1 2 Minor Enamel Cracks Severe Pathological Micro-Movement
Yes Micro-Leakage & Mild To Moderate Dentinal Cracks
Disassembled + Future Onlay
3 Minor Enamel Cracks Severe Pathological Micro-Movement
Yes Severe Dentinal Cracks Disassembled + Future Onlay
9 Significant Enamel Cracks Mild Pathological Micro-Movement
Yes Monitor
14 Picture Of Dentinal Crack In Prepared Tooth
Severe Pathological Micro-Movement
Yes Severe Dentinal Cracks Disassembled + Onlay Completed
24 & 25 Multiple Enamel Cracks Non-Pathological Micro-Movement
Yes Monitor Or Restore For Esthetics
2 19 & 20 Interproximal Caries Mild & Moderate Pathological Micro-Movement
No Disassembly Scheduled Composite RestorationsScheduled
15 & 18 Minor Enamel Cracks Severe Pathological Micro-Movement
No Protect With Protective Occlusive Splint & Monitor At 3 Month
Intervals or restore
add work flow chart 1
New Patient
Workflow
add work flow chart 2
Existing Patient
Workflow
Dexis Carivu Claims“A detection device …to support the identification of occlusal,
interproximal and recurrent carious lesions and cracks.” (Surface Cracks)
“When used together, a radiograph, a transilluminated image, and an intra-oral photo provide a comprehensive picture of the health of a patient’s tooth.” (A Static Visual Picture)
“If you identify a suspicious area on a radiograph,” the Carivu can help “you confidently determine whether it needs monitoring over time or requires immediate treatment.” (Mutual goal)
Summary of Study Conclusions• Carivu’s visual data showed the severity of interproximal decay & surface
defects • RMDx’s mechanical data measured the micro-movement & structural
damage not indicated by any other dashboard technology. • RMDx showed which carious teeth were structurally sound• Serious dentinal cracks were identified that needed treatment due to
mechanical testing data even with no visual indication of problems.• Both technologies enhanced patient trust in the diagnosis based on visual &
mechanical data.
-Carivu: Visualizes the expansion of decay as the darker image widens.-RMDx: Quantitatively Measures the progression of pathological micro-
movement.-The combination: Expanded diagnosis & monitoring with easy to use
technology
DEXIS Carivu and RMDx…Powerful, Innovative, & Complementary
Ultimate Answer Regarding The Synergy between Dexis Carivu and RMDx
Was the the clinician provided: 1. more comprehensive information to allow a more accurate diagnosis of treatment options? 2. knowledge of whether to treat now, monitor or treat later? In all 9 cases…
Yes
Final Thought…With the addition of the RMDx System, the DEXIS
Dashboard would be the only dental system in the world to combine both visual and mechanical diagnostics.
Thank You....
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