Tips for interpreting the Proximal Caries visualization in Dx Plus

Introduction

The Proximal caries visualization in Dx Plus helps clinicians detect interproximal lesions using hyperspectral imaging. This visualization is not AI-based; it relies on 2D occlusal images captured during scanning. Understanding how these images are generated and what influences their appearance is essential for accurate interpretation and to avoid misdiagnosis.

Prerequisites

• Ensure occlusal surfaces are dry to minimize saliva-related artifacts
• Complete a full intraoral scan with TRIOS 6 to enable the scan visualizations in Dx Plus

Illustration for Identifying Proximal Caries 

How It Works

• Technology: The light source is directed onto the occlusal surface of the tooth. The sensor captures the reflected light, and the processed hyperspectral visualization displays the caries lesions as dark defined areas in the interproximal region.
• Image source and scaling: The visualization is based on a 2D occlusal image selected from the 3D scan. It shows proximal caries lesions and internal tooth structure from an occlusal view. Each image is individually scaled (i.e., zoomed in or out) to align interproximal areas. This may cause disproportionate tooth sizes in the visualization.

• Variability across scans: Each scan captures hyperspectral images from slightly different angles and focal points. Dx Plus then selects the single 2D image that best displays the full occlusal and interproximal regions from the 3D data. Because every scan generates a new image set, the chosen visualization may vary—so repeated scans of the same teeth won’t always look identical.
• Restoration limitations: Caries beneath restorations cannot be visualized, because restorations block light transmission. Adjacent caries may be visible if captured at the right angle. Amalgam restorations can cause glare artifacts. Prosthetic restorations (i.e., crowns, bridges) may appear as natural teeth and thus be included in the visualization.
• Diagnostic aid: The visualization serves as an adjunct tool for detecting proximal caries. Clinicians must interpret the image and confirm findings through a clinical examination and, when necessary, radiographic assessment to establish a definitive diagnosis.

Tips for Accurate Interpretation

Tip 1: Identify Proximal Caries

Inspect the interproximal areas for proximal caries. Lesions appear darker and more distinct than surrounding areas. 

Use Contrast and Brightness tools to adjust the visualization. Contrast adjustment increases the distinction between light and dark areas, sharpening or softening details. Brightness adjustment increases or decreases the overall brightness or darkness of the entire visualization.

Examples of proximal caries lesions:

Tip 2: Differentiate Caries from Artifacts

It is crucial to differentiate artifacts from true carious lesions. Artifacts can mimic caries but are usually more diffuse and less distinct. In some cases, caries may be hidden beneath these artifacts. Always examine dark areas in the interproximal regions carefully, distinguish them from artifacts, and confirm any suspected findings through clinical examination and radiographic evaluation when necessary.

Artifacts may present as:

Shadows: Linear, gray, and diffused in interproximal regions (often due to tooth morphology), see examples below.

Reflections: Blackish, diffuse areas caused by external lighting, see examples below.

Dark spots: Round or oval shapes from lighting or scanner illumination, see examples below.

Glare from Amalgam filling resulting in dark spot, see example below.

Tip 3: Understand visualization limitations

Expect variability between scans and be cautious when interpreting areas near restorations or prosthetics.

Next Steps

• Understand the value of Proximal Caries in Dx Plus
• How to achieve the optimal TRIOS 6 scan for Dx Plus
• TRIOS 6 Hyperspectral imaging enablement in EU & EEA

Contact 3Shape Support if you have any further questions.

For full information on correct usage consult the official Safety and Setup Guide and the most current Manual.