Wednesday, July 19, 2017

Canary Dental Laser - The Future of Diagnosing Cavities Today

Well into the 20th century coal miners used to bring caged Canary birds with them into mine shafts to warn them of dangerously high carbon monoxide gas levels. The birds would die before the men acting as early warning detectors of an unseen danger. Paying homage to this ingenuity the Canary system was designed to provide an early warning from the unseen danger of cavities developing in teeth.

Over the last decade the Canary system has gained more and more importance as an integral part of a dental exam because of its repeatable and dependable results. A lot of the time we need to wait until we can see a cavity on a digital X-ray or visually before we can suggest treatment. Ultimately, this results in larger fillings and the potential for more invasive treatment. With the Canary it’s actually possible to treat cavities during their inception resulting in a drastically improved long term prognosis for any tooth. The laser technology can detect a cavity in between a tooth up to 5 times faster than a dental X-ray. 

Take a look at the following example. In between the teeth a X-ray was inconclusive because of tooth overlap. 

When we used the Canary we found mineral breakdown of the enamel crystal structure underlined by the Canary scores of 35 and 42. The Canary grades tooth enamel matrix on a scale of 0-100 letting us know as clinicians how severe the cavity is. Lower numbers suggest healthy enamel whereas higher numbers suggest the presence of cracks or caries  In the past with no definitive evidence no restoration would of been recommended but now we can easily see that treatment was required.

So how does it work? When placed on the tooth surface, a pulsating 2Hz low level-laser light passes into the tooth during a 3 second scan. 

The temperature is raised approximately 1 degree Celsius, which is imperceptible by the tooth, but generates a photothermal (heat) signature and a luminescence (light) response. Think of your tooth like a diamond, if the crystal is perfect it transmits heat and light very well, if there are impurities then heat is increased and light is absorbed. The Canary uses an advanced algorithm to compute Canary scores that we can use to assign a severity to the size of cavity. The Canary can detect cavities as small as 1/20th of a millimeter and up to 5 mm below the surface of the tooth.

The University of Texas conducted it’s own independent human study and found the accuracy of the Canary system to be 92% comapared to 67% for traditional X-rays. Ultimately visual inspection and X-rays are of little use when trying to detect and monitor the early signs of tooth decay. Traditional techniques involves pushing on the tooth to see if any cavitated lesions are present on the surface but inherently this can be detrimental because this probing can damage the tooth structure even more by introducing bacteria into deeper areas of pits and fissures.

There are other technologies on the market that use different methods to diagnose cavities. They mostly differ by the methodology in which they can scan the tooth. One such method is to use Fluorescence to measure the porphyrins, a pigment, that is released by cavity causing bacteria, i.e. the Diagnodent. While there is evidence to support the use of the Diagnodent it is subject to false positives due to stain, plaque, calculus and prophy paste. It also can’t detect cavities underneath sealants or in between teeth.

Another popular technology is transillumination. Dexis produced the CariVue system that shines infrared light through a tooth and then produces a live thermal image of the interproximal tooth architecture. While this is great for detecting cavities in between teeth it doesn’t work great for cavities under sealants. It is also subjective as to whether a dark area on a gray scale image is a cavity or just an artifact in the tooth. On top of that there is no method to quantify the cavity when it is detected.

Another bonus with the Canary wand is that it houses a state of the art intraoral camera to take high resolution intraoral images.

OUsing the Canary we can monitor a suspicious lesion that is borderline and treat it non-invasively. We can remineralize an area using high fluoride gel and/or toothpaste. There is also a product called MI paste which uses a proprietary recalcification agent to remineralize a decaying tooth. When using these techniques we can check the same area over 2-3 years and make sure that the cavity is decreasing in size while being as conservative as possible.

The Canary really is the new age of dentistry and is a great tool that every dentist should have!

Wednesday, June 7, 2017

Pelican 1510 Canary Dental Laser Transport Case

Pick and Pluck foam modification of the Pelican 1510 case allows for easy transport of the Canary System while giving it superior protection 

Canary Dental Laser System Office Installation - USB Quick Connect

The Canary system can be a great way to diagnose and treatment plan lesions that cannot be detected through traditional methods. The 2Hz laser allows us to find cavities 5 times quicker that X-rays allowing us to have smaller access preps, quicker dental visits and prevent tooth decay progressing to the point where root canals or crowns become a concern.

There are two ways primarily to install and run the system in an office:

Option 1: Using a cart system. The Canary is placed on moveable rolling unit and it can be moved operatory to operatory as required.

  • It does not require an independent power source in each operatory
  • Can leave the Canary unit plugged in to the back of the unit
  • No other computers are required in the operatory
  • Need to have an electrical socket near canary to plug in the power supply cable
  • Will necessitate purchasing a new laptop as the unit that come with the Canary is slow
  • The laptop will need to be kept charged to operate all day
  • The cart can be obtrusive to move in and out of the operatory

Option 2: Using the power supply upgrade kit you can have a power supply in each room and just lift and move the Canary console

  • Limited space taken up by the Canary
  • Can use the operatory screens and computer systems for the user interface
  • Requires a speaker in each operatory
  • Continuous plugging in and unplugging of the console required
For our office we prefer having the power hardware upgrade kits and have come up with a novel solution to make it quick and easy to transfer the unit from room to room:

The USB Quick Connect System

1. Take two USB 2.0 A-Male to B-male 6 inch high speed scanner device cables, plug into the Canary console and Zap strap in two locations. The Canary system is a USB 2.0 device and does not require 3.0 capability.

2. Plug these two 6-inch cables into two female USB 2.0 extensions that run back into either a USB Powered Hub or directly into the USB ports of the computer. Once lined up use black electrical tape to secure both ends together. This allows for quick release of both USB cables together in 1 motion while leaving connection in place in the back on the Canary system reducing wear and preventing loose connections over time. If cables wear over time they can be easily replaced without damaging the Canary system ports. It’s quite common to have fatigue in the ports of any electronic device from constant in and out motion so reducing the number of times you need to do this will increase the longevity of the electronic components.

3. Yellow EZ ID sterilization tape (obtained through Dental supplier) is placed so assistant can easily see which side of quick connect to plug in. 6 inch cables are also marked with blue and red tape so if these cables are removed they can be plugged back into same ports while maintaining the same wire orientation.  This allows for USB extension cables to remain plugged into the same ports on the computer or hub to reduce error messages/driver issues since windows can sometimes map the driver to a particular port.

++ The cables needed to install the Canary using this method can all be purchased through Amazon