Effect of pre-diagnostic stain removal on the detection of occlusal fissure caries: A laboratory study

Abstract

Purpose: To evaluate the laboratory cleaning efficacy of six commonly used non-invasive methods for removing stains from occlusal fissures before caries diagnosis. Methods: 60 extracted, caries-free permanent molars with visible occlusal staining were divided into six groups (n= 10): AquaCare air abrasion, Kerr prophylactic paste, Whiteness HP (35% H₂O₂), HealOzone, oxygenated water + pumice, and Opalustre. All samples were analyzed pre- and post-treatment using a dental microscope, Diagnodent Pen, QLF imaging (Qraypen), 3D Geomagic Control X software for volumetric evaluation and photo editing software for pixel evaluation. Statistical analyses were performed with Kruskal-Wallis and the Friedman’s two-way ANOVA test (P< 0.05). Results: All methods significantly reduced surface discoloration (P< 0.05). AquaCare showed the least residual staining, while HealOzone had the highest (P= 0.043). Volumetric analysis revealed no intergroup enamel loss (P> 0.05), although a significant change was noted in the Whiteness HP group (P= 0.017). QLF parameters (ΔF and ΔQ) improved significantly in Aquacare, HealOzone, and Opalustre (P< 0.05). Diagnodent Pen readings decreased significantly in the Aquacare, Kerr paste, HealOzone, and oxygenated water + pumice groups (P< 0.05). All tested methods effectively removed fissure stains without causing measurable enamel loss. HealOzone, Aquacare, and Opalustre demonstrated the most balanced performance, combining high cleaning efficacy with minimal surface alteration. The findings emphasize the value of multimodal, minimally invasive approaches for optimizing diagnostic accuracy in occlusal fissure caries detection.