The use of transillumination in detecting subclinical extensions of enamel opacities

Objective: Accurate detection of enamel opacities in reflected light is limited in terms of discriminating between affected and unaffected enamel. The aim of this study was to compare the ability of transilluminated photography in distinction between healthy and unhealthy enamel in comparison with reflected photography. Materials and Methods: Patients presenting enamel opacities were selected during their regular dental visits and for each tooth, standardized photographs were taken in transmitted and reflected light. For each lighting condition, the ratio of the opacity surface area to the entire buccal enamel area was calculated. The difference in the ratio of the opacity surface area to the entire buccal enamel area was compared using the Wilcoxon paired test. Results: The results of this study showed that the ratio of the opacity surface area to the entire buccal enamel area calculated in transilluminated photography is significantly higher in comparison with its calculation in reflected photography. The means ratios (SD) of the opacity to the entire buccal enamel area are in transmitted light and reflected light respectively 18% (12) and 15% (11). Conclusions: In comparison with reflected photography, transilluminated photography significantly increases the ratio of the opacity surface area to the entire buccal enamel area. Transilluminated photography allows better detection of enamel opacities on anterior teeth by aiding clinical discrimination between healthy an unhealthy enamel. Clinical Significance: Being simple, noninvasive, painless and without any risk to the patient, transillumination represents a promising imaging method for detecting enamel opacities and for discriminating healthy and unhealthy enamel.