journal of dentistry 36 (2008) 10331040

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Clinical performance of a new laser fluorescence device for

detection of occlusal caries lesions in permanent molars
K.C. Huth a,*, K.W. Neuhaus b, M. Gygax b, K. Bucher a, A. Crispin c,
E. Paschos d, R. Hickel a, A. Lussi b
a

Department of Restorative Dentistry, Periodontology and Paediatric Dentistry, Ludwig-Maximilians-University, Munich, Germany
Department of Preventive, Restorative and Paediatric Dentistry, University of Bern, Switzerland
c
Department of Medical Informatics, Biometry & Epidemiology, Ludwig-Maximilians-University, Munich, Germany
d
Department of Orthodontics, Ludwig-Maximilians-University, Munich, Germany
b

article info

abstract

Article history:

Objectives: To determine the clinical performance of a laser fluorescence device (DIAGNO-

Received 21 May 2008

dent pen, KaVo) to discriminate between different occlusal caries depths (D0D14; D02D3,4)

Received in revised form

in permanent molars.

20 August 2008

Methods: In this prospective, randomized two-centre-study 120 sound/uncavitated carious

Accepted 26 August 2008

sites in 120 patients were measured after visual and radiographic caries assessment. In
cases of operative intervention (n = 86), the lesion depths after caries removal were recorded
(reference). In cases of preventive intervention (n = 34), the sites were reassessed visually/

Keywords:

radiographically after 12 months to verify the status assessed before (reference). The

Occlusal caries

discrimination performance was determined statistically (MannWhitney test, Spearmans

Caries detection

rho coefficient, and areas under the receiver operating characteristic curves (AUCs)).

Laser fluorescence

Sensitivities (SE) and specificities (SP) were plotted as a function of the measured values

DIAGNOdent pen

and cut-off values for the mentioned thresholds suggested.

Randomized clinical trial

Results: Sound sites (n = 13) had significantly minor fluorescence values than carious sites

Permanent molars

(n = 107) (P < 0.0001) as had sites with no/enamel caries (n = 63) compared to dentinal caries
(n = 57). The AUCs for the same discriminations were 0.92 and 0.78 (P < 0.001). For the D0D14
threshold, a cut-off at a value of 12 (SE: 0.88, SP: 0.85) and for the D02D3,4 threshold at 25
(SE: 0.67, SP: 0.79) can be suggested. A moderate positive correlation between the measurements and the caries depths was calculated (rho = +0.57, P = 0.01).
Conclusion: Within this study, the devices discrimination performance for different caries
depths was moderate to very good and it may be recommended as adjunct tool in the
diagnosis of occlusal caries.
# 2008 Elsevier Ltd. All rights reserved.

1.

Introduction

In its early stages, caries detection and diagnosis is often

difficult. A correct diagnosis is required in order to apply
appropriate preventive measures or operative procedures.

While in most industrialized nations there has been a

substantial decline in caries prevalence in children, much
attention has now been drawn to monitoring of the early
stages of the carious process.1 The occlusal fissures in children
and adolescents are most prone to developing caries, and

* Corresponding author at: Department of Restorative Dentistry, Periodontology and Pedodontics, Dental School, Ludwig-MaximiliansUniversity, Goethestr. 70, 80336 Munich, Germany. Tel.: +49 89 5160 9411; fax: +49 89 5160 9302.
E-mail address: khuth@dent.med.uni-muenchen.de (K.C. Huth).
0300-5712/$ see front matter # 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jdent.2008.08.013

1034

journal of dentistry 36 (2008) 10331040

should therefore be screened frequently.2 The visual appearance of initial caries has recently been described and scored
using the ICDAS system.3,4 In addition to visual inspection,
non-destructive methods using optical instruments may be
used in order to detect early changes in enamel indicating
caries. Quantitative light-induced fluorescence (QLF) has been
proven to be a useful, but time-consuming adjunct tool to aid
caries diagnosis.5 A laser fluorescence (LF) device (DIAGNOdent 2095, KaVo, Biberach, Germany) has also been shown to
be of additional clinical value in the detection of occlusal
caries. Changes in the optical properties of the mineral are
caused by an increased pore volume in demineralised
enamel.6 It has been suggested that LF detects substantially
more fluorophores within these pores than within unaltered,
healthy enamel.7,8 Recently, a new laser fluorescence device
has been introduced (DIAGNOdent pen, KaVo, Biberach,
Germany)9 with proven reproducibility in vitro.10,11 This
prospective, randomized two-center-study (reported according to the CONSORT statement12) aimed to determine the
clinical performance of LFpen in detecting occlusal caries
lesions in permanent molars.
It has been reported that readings from LF devices are more
indicative of the quality of the enamel surface rather than
giving quantitative information that indicates the actual depth
of the carious lesion.13,14 Furthermore, the threshold values as
reported by Lussi and Hellwig9 in vitro, have not yet been
verified in vivo. Therefore, the aim of this study was to test the
ability of the LFpen to differentiate between carious and noncarious enamel and between enamel and dentinal caries and
the capacity to predict lesion depth. Appropriate cut-off values
and intra- and inter-examiner reliability and the repeatability
would be measured. The null hypothesis I was that it is not
possible to distinguish between the presence (D14) or absence
(D0) of occlusal caries in permanent molars with the
DIAGNOdent pen (LFpen). Null hypothesis II was that it is
not possible to differentiate between caries-free enamel,
enamel-only caries (D02) and dentinal caries (D3,4). Null
hypothesis III was that it is not possible to predict the depth
of caries as determined by the measured fluorescence values.

2.

Materials and methods

2.1.

Participants

Voluntary participants were recruited from the Department of

Preventive, Restorative and Paediatric Dentistry, University of

Bern, Switzerland and the Department of Restorative Dentistry, Periodontology and Paediatric Dentistry, University of
Munich, Germany. Ethical approval (Bern No. 71/05, Munich
No. 258-05) and participants and/or parental informed written
consent were obtained. Measurements were performed by
four experienced, calibrated dentists from the above institutions. Inclusion criteria for the participants (6 years old) were
the presence of a minimum of one permanent molar with at
least one occlusal sound or macroscopically uncavitated
carious site. Exclusion criteria included patients who were
uncooperative, those with disabilities, severe systemic diseases and those with language difficulties. Further exclusion
criteria included enamel anomalies, such as hypomineralisation or hypoplasia or any intrinsic or extrinsic staining, any
restorations or fissure sealants as well as the presence of
amalgam fillings, gold or steel crowns in adjacent teeth. No
compensation was provided to either the study participants or
investigators.

2.2.

Interventions and follow up

The assigned occlusal sites were cleaned (Prophyflex, KaVo),

rinsed and air-dried followed by a visual assessment of the
caries status using dental light and mirror (Table 1). If clinically
indicated, digital bitewing radiographs were taken or already
available recent radiographs were used (Sidexis, Sirona,
Bensheim, Germany) and the presence of possible radiolucencies determined (Table 1). Based on the visual and
radiographic findings, the decision was made for operative
or preventive intervention. Thereafter, measurements with
the DIAGNOdent pen (occlusal tip) were carried out.9 After
calibration with a ceramic standard, the fluorescence of a
sound spot on the coronal part of the buccal surface was
recorded (zero value). The tip was then moved along the
occlusal fissure system and moved around in order to measure
the fluorescence from the slopes of the fissure walls and the
peak value recorded. The whole procedure was then repeated.
For statistical analysis, the mean of the two peak values minus
the mean of the two zero values was used. If operative
intervention was indicated, the lesion was opened with a
fissurotomy bur (SSWhite, USA), the caries removed using a
round bur and the extent of the lesion determined by
inspection and probing (reference, Table 1). This was followed
by an appropriate restorative therapy. In cases where no
operative intervention was indicated, the measurement site
was recorded (description or photograph) and a sodium
fluoride varnish applied (Duraphat, Colgate, NY, USA). After

Table 1 Criteria used for visual and radiographic examination and actual lesion depth after caries removal
Visual examination
Occlusal sites
No caries detectable (V0)
Enamel caries, white surface (V1)
Enamel caries, brown surface (V2)
Dentinal caries (V3)

Radiographic examination

Lesion depth after caries removal or recall

No radiolucency or radiolucency in enamel (R02)

No caries (D0)
Enamel caries (D1, D2)

Radiolucency in the outer half of dentine (R3)

Radiolucency in the inner half of dentine (R4)
No radiograph

Superficial dentinal caries (D3)

Deep dentinal caries (D4)

journal of dentistry 36 (2008) 10331040

12  2 months, the site was reassessed visually and radiographically in order to reassess the caries status. These
records were then used as reference in the further validation
analysis of the laser fluorescence values.

2.3.

Outcomes

As primary outcome measures, the numerical laser fluorescence pen values were referenced against the scores of the
actual caries depths (reference). Secondary outcome measures
were the visual and radiographic scores of the caries status.
To enhance the quality of measurements, the investigators
were experienced dentists who were familiar with the
problems of diagnosing fissure caries and interpreting digital
bitewing radiographs. They received a tutorial regarding the
principles of operating and handling of the DIAGNOdent pen
device using extracted teeth and they had used the device
clinically regularly 1 month prior to the start of the study. The
intra- and inter-examiner reliability was assessed in addition
to the reproducibility of the device itself by repeated
measurements.

2.4.

Sample size and power calculation

The sample size calculation (PS Power and Sample Size

Calculation Program, Version 2.1.31) was based on an internal
pilot study. The means of laser fluorescence pen values of 20
occlusal sites without or with enamel caries (D02) and 20 sites
with dentinal caries (D3,4) were compared (a-level, 0.05; power,
0.90; outcome difference, 21.4; S.D., 22.4; ratio, 1), which led to
a required sample size of at least 34 in each group. Based on
the results of the presented study, a power analysis was
performed.15

2.5.

Random assignment and blinding

In cases where more than one occlusal site per patient fulfilled
the inclusion criteria, one test tooth was chosen by drawing
lots from a black box by an independent assistant. Participants
and operators were blinded to this assignment procedure.

2.6.

well as the significance of difference to the plotted diagonal.

Additionally, the sensitivity, specificity and their sum as a
function of the measured LFpen values were shown and cutoff values for the mentioned thresholds suggested. The
correlation between the fluorescence values and the caries
depths (D0D4) was performed using the Spearmans rho
coefficient and graphically visualised by a box-and-whisker
plot.

3.

Results

Participants were recruited from January to December 2006,

with the follow-up period ending in December 2007. The
study population included 120 participants with 120 sound
or carious occlusal sites in permanent molars (1 per patient).
In 86 cases, the actual caries depths (reference) were
determined directly by operative intervention following
LFpen measurements. In 34 cases a reassessment of the
caries status after 12 months was required. There were no
dropouts. And thus, all measurements could be statistically
analysed. The flow of participants through the study is
shown in Fig. 1 and the baseline demographic and clinical
characteristics of the study population are shown in Table 2.
Evaluation of the actual caries depths (reference) revealed 13
sound occlusal sites, enamel caries in 50 cases, superficial
dentinal caries in 41 teeth and deep dentinal caries in
16 teeth.
The intra-examiner reliabilities for the LFpen measurements of the four operators were very good with intraclass
correlations (ICCs) between 0.94 (CI: 0.840.98) and 0.998 (CI:
0.9940.999) at a high significance level (<0.0001). The intraexaminer reliabilities for the radiographic scoring were very
good between 0.94 and 1 (Cohens k) and also for the visual
scoring (k = 1). The inter-examiner reliabilities for the LFpen
measurements were good with ICCs between 0.88 (CI: 0.63
0.96) and 0.98 (CI: 0.930.99), for the radiographic scoring

Statistical methods

The statistical analysis of the data was performed using SPSS

software (Version 15, SPSS Inc., Chicago, IL, USA). The
repeatability of the LFpen with the occlusal tip was assessed
by comparing the two repeated measurements of each site by
the Bland & Altman plot (mean  2 standard deviations,
S.D.).16 The intra- and inter-examiner reliabilities were
calculated using intraclass correlations17 and for the visual
and radiographic caries scoring using Cohens unweighted
kappa statistic.18 The differences between LFpen measurements of different groups of actual caries depths (D0 versus D1
4, D02 versus D3,4) were analysed by the non-parametric
MannWhitney test for independent samples (two-sided, alevel = 0.05, corrected according to the Bonferroni adjustment
to 0.025 for 2 multiple tests). For the same clinical discriminations, the sensitivities versus 1-specificities were plotted in
receiver operating characteristic (ROC) curves indicating the
area under the curve (AUC), the 95% confidence interval (CI) as

1035

Fig. 1 Flow diagram of participants in the study

population.

1036

journal of dentistry 36 (2008) 10331040

Table 2 Baseline demographic and clinical characteristics of the study population (n, number; OI, operative
intervention)
Study population with
occlusal measurements
Number (n)

Participants: n = 120
Measured sites: n = 120

Age (years)

Mean: 17
Range: 651
15: n = 64
>15: n = 56

Gender

Males: n = 60
Females: n = 60

Jaw

Upper: n = 65
16/26: n = 37
17/27: n = 26
18/28: n = 2
Lower: n = 55
36/46: n = 33
37/47: n = 19
38/48: n = 3

With OI
Without OI

n = 86
n = 34

moderate to good with k-values between 0.66 and 0.79 and

for the visual scoring very good with k-values between 0.85
and 1 (<0.0001). In assessing the repeatability of the LFpen
device, the Bland & Altman plot revealed a mean difference
between the two repeated measurements of 0.18 values
with a two times standard deviation of 11.8 LFpen values. The
median of the measured zero values was at a fluorescence
value of 3.
The LFpen measurements of the different caries depths
(D0D4) were graphically described in a box-and-whisker
plot, revealing a larger variation of measurements with

increasing caries depths (Fig. 2). A cross tabulation showed

the different visual and radiographic scores as well as the
mean and standard error, the median and the range of the
LFpen measurements for the different real caries depths
(Table 3).
The LFpen values of sound occlusal sites (D0, n = 13) were
significant less than those where caries was present (D14,
n = 107) (MannWhitney test, P < 0.0001; calculated power:
96.3%) (Table 4). Furthermore, the LFpen values of sound sites
or sites with enamel caries (D02, n = 63) were significantly
lower than those of sites with dentinal caries (D3,4, n = 57)
(P < 0.0001; power: 99.6%). Therefore, null hypotheses I and II
could be rejected.
To graphically demonstrate the performance of the
LFpen device for the same caries depths discriminations,
the sensitivities were plotted versus the 1-specificities in
ROC curves (Fig. 3). With an AUC of 0.92 (CI: 0.811.0,
P < 0.0001), the discrimination performance of the LFpen
between D0 and D14 was very good (Table 4). The AUC for
differentiation between D02 and D3,4 was good to moderate
with 0.78.
Further, the sensitivity, specificity and the sum of both as a
function of the different LFpen values for the mentioned caries
depths thresholds were plotted (Fig. 4). The sensitivity and
specificity was high at the D0D14 threshold with 0.88 and 0.85
at a LFpen cut-off value of 12 (Table 4). For the threshold
between enamel and dentinal caries (D02D3,4), the LFpen cutoff could be suggested at a value of 25 with an appropriate
specificity of 0.79 to avoid over-treatment and an acceptable
sensitivity of 0.67.
Altogether, correlating the LFpen occlusal measurements
with the different caries depths, a Spearmans rho coefficient
of +0.57 at a high significance level of 0.01 was calculated,
revealing a moderate positive correlation, which means the
higher the values the deeper the caries (Table 4). Therefore,
null hypothesis III could also be rejected.
No adverse events or side effects took place within the
study period.

4.

Fig. 2 Box-and-whisker plot of the LFpen measurements

for the different caries depths. The boxes show the lower
quartile, the median (horizontal line) and the upper
quartile of the measurements.

Discussion

As there is a substantial decline in caries prevalence, the early

detection of occlusal caries plays a major role in dental
practice. The occlusal fissure system is most susceptible to
caries in children and young adolescents and should be
inspected regularly for signs of caries.2 Visual inspection may
underestimate occlusal dentin caries in teeth without cavitation19, and so there is a need to be able to detect or
quantitatively monitor such lesions to support treatment
decisions.
An older LF device has been studied widely.2022 The LFpen,
introduced recently, is equipped with two tips, one tip for
occlusal measurements and a tapered one for measurements
of proximal surfaces. The present two-center study of the
LFpen device with its occlusal tip investigated its in vivo
performance for the first time.
Old LF devices readings may have been influenced by
several factors such as calculus7, plaque23, prophylaxis
pastes24 and adjacent fillings or even caries may influence

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journal of dentistry 36 (2008) 10331040

Table 3 Cross-tabulation of the actual lesion depth according to the reference and evaluated by visual scoring,
radiographic scoring and occlusal laser fluorescence measurements (LFpen, mean W S.E., standard error, median, range)
Reference
(D0D4)

Visual scoring

Radiographic scoring

Laser fluorescence pen

measurements

V0

V1

V2

V3

R02

R3

R4

No

LFpen
mean  S.E.

LFpen
median

D0, n = 13
D1,2 n = 50
D3, n = 41
D4, n = 16

10
1
0
0

0
11
0
0

3
38
29
2

0
0
12
14

4
17
8
0

0
0
17
7

0
0
0
4

9
33
16
5

6.8  2.6
21  1.8
35.4  3.5
44.9  6.3

4.5
17.5
31.5
37

035
257
797
1593

Sum n = 120

11

11

72

26

29

24

63

LFpen
range

N, number of evaluated teeth; sum, sum of evaluated teeth; D04, V03, R05, please see explanations in Table 1; no, no radiographs taken.

Table 4 Results of the statistical analysis evaluating the performance of the LFpen to discriminate between D0 and D14
and D02 and D3,4
Lesion depth

LFpen measurements occlusal

ROC

D0D14
D02D3,4

AUC

95% CI

SE

SP

Cut-off

MW-test,
P-value

0.92
0.78

0.811.0
0.70.87

<0.0001
<0.0001

0.88
0.67

0.85
0.79

12
25

<0.0001
<0.0001

Rho
0.57 (P = 0.01)

The areas under the receiver operating characteristic (ROC) curves (AUC) with the 95% confidence interval (CI) and the significance of
difference to the diagonals (P) are given. Further, the sensitivity (SE) and specificity (SP) for the suggested LFpen cut-off values are noted, the Pvalues of the MannWhitney (MW) tests and the Spearman-rho coefficient (Rho) correlating the LFpen measurements and the caries depths
together with its significance level (P).

interproximal readings.25 These possible biases have been

eliminated as much as possible by using strict inclusion
criteria and consistent cleaning procedure of the occlusal
surfaces.
Any diagnostic tool should be both highly sensitive and
highly specific. Visual examination alone has been shown to
have low sensitivity but high specificity.21 Nevertheless,
modern approaches to improve visual inspection have been
proposed.3 Clinical results using the new ICDAS system
appear promising, because they provide an acceptable prediction of the caries depth.26,27 When considering only those
cases requiring operative intervention, the calculated sensitivity and specificity for simple visual inspection in our study
were good for dentin caries (0.73) as well as for deep dentin
caries (0.85). This may be due to the fact, that the operators
were experienced in diagnosing dental caries, and that they
have participated in similar caries detection studies before.
Therefore, it seemed to be feasible in the present study that
visual inspection alone or together with radiography served as
a reference standard in those cases, where no operative
treatment was intended.
Bengtson et al.28 showed in an in vitro study with extracted
primary molars, that the examiners clinical experience is
crucial for detection of dentin caries using visual inspection.
However, when using the old LF device, clinical experience
was less important as there were no differences in interexaminer reliability between final-year dental students,
recently graduated dentists or specialists. Our results also
indicate that there is an excellent intra- and good to excellent
inter-examiner reliability when using LFpen. These results are

consistent with the results reported by Kuhnisch et al.10 in an

in vitro study.
A valuable feature of quantitative caries diagnostic tools is
the possibility to establish cut-off levels in order to determine
caries penetration. However, there are significant differences
between the cut-off values obtained in clinical settings and
those in laboratory settings. In this prospective in vivo study
the cut-off values for different lesion depths were 12 (sound
versus enamel caries) and 25 (enamel versus dentin caries).
Certainly considering visual inspection and individual caries
risk factors, these cut-offs would result in the following
intervals regarding the interpretation of the LFpen values for
occlusal caries detection: 012 (D0), 1325 (D1,2), 26 (D3,4).
However, the corresponding published cut-off limits for LFpen
for occlusal measurements gained by in vitro measurements
were 06 (D0), 6.113 (D1), 13.117 (D2) and >17 (D3, D4).9 Dentin
and deep dentin caries in that study as well as in ours were
pooled. In case the dentist does not calibrate the device at a
healthy coronal site of the individual tooth (zero value), a
fluorescence value of 3 would have to be added to the
suggested cut-offs to use them, as a fluorescence value of 3
was found to be the median zero value in the present in vivo
study.
The higher cut-off levels in vivo are similar to earlier
findings29,30 showing that vital teeth seem to have a greater
fluorescence level than extracted teeth, in spite of proper
storage.31 Table 3 shows a wide measuring range of LFpen
readings for the different caries depths, in accord to in vitro
findings10 and so it must be emphasized that LF should be only
used as an adjunct tool in caries diagnosis. When the question

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journal of dentistry 36 (2008) 10331040

Fig. 3 Receiver operating characteristics curves (ROC) for

(A) the discrimination threshold between D0 and D14 and
(B) the discrimination threshold between D02 and D3,4.
Graphically plotted is the sensitivity versus the (1specificity) for each discrimination threshold.
The areas under the curves and the significance of
difference between the curves and the diagonals are given
in Table 4.

is about operative or non-operative treatment, in addition

other clinical or patient-centered parameters have to be taken
into account. Furthermore, the cut-off levels of the new LFpen
device should not to be confused with those of the old LF
device published earlier.7
There is a systematic problem regarding the validation of
LF measurements obtained in clinical caries diagnostic
studies. Validation can normally take place under clinical

conditions, if operative/invasive treatment is intended.

However, if no operative intervention is planned, validation
of the results is difficult, since no proper gold standard is at
hand. Bitewing radiography alone is inappropriate for
occlusal enamel caries detection.32 Instead, first permanent
molars bitewing radiography combined with visual inspection lead to correct caries classification in 82% of cases.33 In a
recent study by Valera et al.21 who compared visual inspection, radiographic examination and the old laser fluorescence
device, as well as their combinations in vitro regarding
treatment decisions for occlusal surfaces, visual and radiographic examination resulted in a specificity of 99%. In the
same study, visual inspection alone resulted in a specificity of
100%. For this reason, both visual inspection and radiography
(in about half of the cases) served as a reference in teeth,
where no operative treatment was indicated in our study.
Caries monitoring and reevaluation was performed 12
months later to reassess caries status. If such follow-up of
the true negative cases were not performed, although not
resulting in a 100% assured gold standard, false negative
cases would also become automatically excluded, resulting in
a statistical bias.
False negatives, in this sense, are hidden occlusal caries
lesions, that penetrate into dentin but with the occlusal
surface macroscopically intact. A crucial point appears when
occlusal measurements above 25 are obtained with LFpen and
visual inspection does not indicate the presence of caries. If
possible confounders, such as the presence of restorations,
calculus or staining are eliminated34, this is an indication for
the need for radiography. Thus, the LFpen might also be useful
in detecting occlusal hidden caries in epidemiological studies,
when radiographic screening is either too expensive or
unethical.
Unfortunately, there are few studies investigating the
performance of LF caries detection in vivo and the clinical
extrapolation of in vitro results may be inappropriate.35 In a
recent clinical study, old LF readings have been shown to be
more reliable according to actual lesion depth than visual
inspection or bitewing radiography.36 This is an interesting
observation as old LF readings have been previously reported
to rather describe information about the surface quality than
actual lesion depth.13,14 On the other hand, visual inspection
yielded similar results to laser fluorescence readings in a
clinical study with permanent and primary molars.37 In
comparison, the results of this prospective, randomized twocenter study were very good and good regarding the
discrimination between sound and carious (AUC 0.92) as well
as between enamel and dentin caries (AUC 0.78) (Table 4,
Fig. 3), thus indicating, that lesion detection and lesion depth
prognosis on the D3,4 level can be achieved by LFpen quite
well.
Finally, the involvement of dentine should not necessarily indicate immediate operative intervention. The decision
to intervene is dependent upon a range of other variables,
such as the patients case history, fluoride availability and
sugar intake, as well as the perceived caries activity and the
status of the enamel surface. In no case should early
detection of caries be an excuse for early operative
intervention, unless this is indicated by other clinical
parameters.

journal of dentistry 36 (2008) 10331040

1039

Fig. 4 Sensitivity, specificity and their sum in function of different laser fluorescence pen values (LFpen) for discrimination
of (A) D0 versus D14 and (B) D02 versus D3,4. The sensitivity, specificity and suggested LFpen cut-off values for the
mentioned thresholds are given in Table 4.

5.

Conclusions

Within this study, the devices discrimination performance for

different caries depths was moderate to very good and it may
be recommended as adjunct tool in the diagnosis of occlusal
caries.

Acknowledgements
The authors wish to acknowledge Simone Geiger, Kerstin
Weidlich and Tanja Janzen for their project assistance and Dr.
Jan Kuhnisch for valuable discussion. The study was financed
by departmental funding of both study centers and the KaVo
Company also providing the laser fluorescence devices.

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