TBU # 031 Caires Detector and Mentors!

 New Issue of The Biomimetic Uprising

Read Time: 4 min

Caries detector is a super easy thing to use in your daily work flow. It really only adds a few steps to what you are already doing, but the reasoning behind it adds a lot of benefits.

In dental school they teach us to explore the area and use our tactile sensations to see if the area is hard right? They also tell us to look at the color.  They say to look to see how the area is cutting with the bur, etc.  Problem is, all these methods are so subjective.  They totally can be interpreted differently between people, cases, experience, etc.  It really is a poor way to teach us to detect decay.  I've always thought it was interesting that there never has been a more common method. After all, isn't our main job to treat disease? 

Well, that wasn't until I learned about caries dye and what it does.  USC basically limited our use of it.  I think I used it a handful of times and that was only when I was in Pascal's section.  They didn't want us to become reliant on it so we could build our explorer skills.  

OK... I get that.  It's a school and thats their job.  But, shouldn't we be exposed to all of the tools? 

The application of caries dye is super easy.  The interpretation of it, however, can be tricky if not careful. 

I use Caries Detector from Kuraray.  I got indoctrinated with the Kuraray brand early on and have stuck with it for numerous reasons.  Dave Alleman is definitely one of those early influences.  

Caries Detector stains shades of red - to pink - to a semi clear haze (if at all). In deeper areas of the tooth, darker shades should be removed.

Buuuut.  What does that all mean? It kind of sounds like words, words, and more words... It kind of sounds like the subjective methods from dental school? Cant some red tones be interpreted as pink?

Well yes it can.

This is where a friend and mentor can help.

A real mentor shows how it should be.  They have learned it from their own experience but also from the help of others.

The biomimetic community is strong and growing.  I have been publicly preaching these concepts since 2015. Pascal, Dave, Simone, tons of others have been going since the early 2000s and before.  Many of you the same thing!  Many early adopters were using biomimetic concepts of IDS, caries dye, or even gold inlays without having things defined as 'Biomimetic'.  The point is, everyone here is involved and influencing this change and elevating the standard of care for our patients.  If you have questions about 'best practices' or how to do something, just reach out. There are many that can help along the way.  

The Biomimetic Study Club is a place where I promote the work of others.  I'm not too interested in building myself up but rather those around me that are doing a fantastic job!  What gets me excited is seeing others adopting these concepts, growing, and doing fantastic work. The BSC is meant to be platform for learning, networking, and discussion.  Its place about change!

Ok, cool.  I still want to know about the caries detector and what gets removed. 

This all has a point...

Here you go.  This picture is what you need to know here.  This is from an article called 

So my problem when I was first getting comfortable wasn't the outline, or creating the peripheral seal zone, it was removing the deeper areas with the darker colors.  Looking back at some earlier cases, I  could have removed more.  Removing deep decay right over the pulp horn can make you sweat like you're in a sauna.  But not the enjoyable kind.  Its stressful.  I knew that decay wouldn't bond well, but I also knew there wasn't great bond strengths to that deep of the tooth. But I knew it was something I needed to improve.  

The point of caries dye is find the dentin that has been permanently denatured versus the areas that hasn't.  With this comparison, it tells us whats left, it tells us the depth of the tooth, and it tells is when we can stop. 

In this first picture, I could have removed more between the pulp horns to remove the dentin that can't be remineralized.  I was really fine leaving it how it was because I had more than 2mm of sound dentin circumferentially around the deep decay to predictably bond to.  Talked with my employer and mentors, Wendell Robertson and Dave Alleman, a months later, I was doing better.  Both of these cases were in 2017.  First was February and the second was in March.  

We have the initial photo showing recurrent decay of a leaky previous restoration.  At first, I expected this to be more contained than what it was.

Here is me caries endpoints.  I was about 4.5mm deep. Horrible lighting here, but you can see enough. These were taken on an early iPhone.  Not great. 

This is showing my Ribbond placement in the biobase. I always like to get some form of fiber in my preps.  Lately its been more of everX.

Here we have the final restoration.  So far with follow up, my previous employer states no complications, symptoms, etc and the tooth is doing just fine.  Wish I had the 5 yr follow up picture tho...

So dont put yourself in a 'sauna'.  Try and get 1% better everyday.  Reach out to someone whom you trust and respect if need some help.  Use a form of caries dye.  It helps a ton!

If you're questioning the efficacy of caries dye, there's tons of articles out there.  Obviously you can find them for or against it.  Mentors are a great resource for helping to interpret or suggest relevant articles. You just have to decide if you like using caries dye or not.

Here is another study guide goodie. 😊

Download now

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