The document describes two complementary diagnostic technologies - Dexis Carivu, which provides visual diagnostic data through transillumination and photography, and Rapid Mechanical Diagnostics (RMDx), which provides mechanical diagnostic data to detect micro-movement from cracks, defects, and structural breakdown. A case study showed how the synergistic use of Carivu and RMDx allowed clinicians to more comprehensively diagnose treatment needs, determining whether immediate treatment or ongoing monitoring was required by providing both visual images and numerical metrics on teeth and implants.

1. Dexis Carivu
&
Rapid Mechanical Diagnostics(RMDx)
A Powerful Diagnostic Team Of Complementary & Innovative Solutions
CONFIDENTIAL - SUBJECT TO NON-DISCLOSURE AGREEMENT

2. Visual diagnostic data
based upon
Transillumination & Photography
Mechanical diagnostic data
based upon
Rapid Mechanical Diagnostics
Combined
with

3. Carivu RMDx
Detects Caries & Enamel Cracks Micro-Movement From Cracks,
Defective Restorations, Bone or PDL
Primary Purpose Detect Caries Early Detect Structural Breakdown Early
Where Visible Areas Of Teeth Visible & Non-Visible
Areas Of Teeth
Science
Utilized
Transillumination
And Photography
Mechanical
Testing
Form Of
Diagnosis
Visual Images Numerical Metrics
And Graphs
For Teeth or Implants Teeth Teeth and Implants
Synergistic Use Of
Carivu With RMDx
Allows clinician to confidently determine whether a tooth needs monitoring
over time or requires immediate treatment
Summary of
Technologies

4. Mechanical diagnostic data based upon percussion
- Innovative way to identify defects without radiation
- Detects pathological micro-movement in a structure
- Measures severity of micro-movement under loading
- Monitors micro-movement stability over time
- Not dependent on visibility
- Effective for teeth & implants
- Not able to detect incipient caries

5. Visual diagnostic data based upon transillumination
- Innovative way of detecting caries without radiation
- Combination of transillumination and video capture
- Detection of enamel cracks
- Qualitative
- Limited to areas that will allow light penetration
- Unable to assess severity of defects
- Unable to detect internal cracks

6. Potential Carivu & RMDx Claim
Carivu & RMDx are a synergistic combination of visual and mechanical data that
can “confidently determine whether [a site] needs immediate treatment or monitoring.”

7. Ultimate Question Regarding The
Synergy between Dexis Carivu and RMDx
-Was the the clinician provided:
1. More comprehensive information to allow a more accurate diagnosis of
treatment options?
2. Knowledge of whether to treat now, monitor or treat later?
Yes or No

8. Case studies showing synergistic technology usage
Patient #1—no decay, history of structural
pathology
Patient #2—interproximal decay, no history of
structural pathology

9. Case Study: Patient #1
Upper Teeth:
2 3 9 14
• Male, age 60
• Caries stable
• History of football trauma at college
o 2 Avulsed/reimplanted centrals (8 & 9)
o 2 fractured molars requiring Full Gold Crown
& Onlay
o 2 fractures fillings
o 2 fractured lower incisors, unrestored
Lower Teeth:
24 25

10. Patient #1
Full Mouth - DEXIS Dashboard
February 2015

11. Patient #1
Full Mouth - RMDx Dashboard
February 2015
Blue Band =
Highest-Risk
Sites in Red
Zone
[Teeth 2 & 3]

12. negative
enamel cracks
Serious Pathology
X-Rays Dexis Carivu
RMDx
dashboard: Patient #1, Tooth #2

13. Disassembly Images: Patient #1, tooth #2
Early dentinal fracture distal to mesial 1/3 across preparation floor
Marginal ridge fracture

14. Synergistic clinical significance: Patient #1, Tooth #2
-X-Ray: Negative
-Carivu: Supragingival enamel crazing (no decay)
-RMDx: Severe Levels of Pathological Micro-Movement (DSQ = 56)
History: 2 prior cracked molars/2 prior cracked fillings
High risk for fractures/2 successive high readings
Recommendation: Disassemble & replace old composites.
Check for fractures

15. Complementarity: Patient #1, Tooth #2
SUMMARY
Findings: Minor enamel cracks (Carivu)
Severe pathological micro-movement (RMDx)
Diagnosis: Micro-leakage, enamel crazing
Early serious dentinal crack (predicted by RMDx, confirmed)
Final Proposed Treatment Plan: Onlay for further fracture prevention

16. Why treat now: Patient #1, Tooth #2
Based upon findings:
•The early crack that was located was serious
•The replacement of the old restoration did not make an appreciable change in the DSQ
reading, signifying that the defect was more structural and not restoration related
•Immediate actions taken: POS, habit controls, inform patient of need for restoration
•Needs protective onlay to halt/slow crack progression
•If not treated, tooth could easily develop symptoms & ultimate catastrophic fracture.

17. Dashboard: Patient #1, tooth #3
negative
enamel cracks
Serious Pathology
X-Rays DEXIS Carivu
RMDx

18. Disassembly Images: Patient #1, Tooth #3
Post-Disassembly: Mesial buccal cusp advancing fracture
Mesial
Buccal

19. Synergistic clinical significance: Patient #1, Tooth #3
-X-Ray: Negative
-Carivu: Supragingival enamel crazing (no decay)
-RMDx: Severe Levels of Pathological Micro-Movement (DSQ = 67)
History: 2 prior cracked molars/2 prior cracked fillings
High risk for fractures/2 successive high readings
Recommendation: Disassemble, check for fractures & replace old comp
Protect with restoration from additional destruction

20. Summary
Findings: Significant enamel cracks (Carivu)
Severe pathological micro-movement (RMDx)
Diagnosis: Enamel cracks, serious dentinal cracks under MB cusp
Future Proposed Treatment Plan: Onlay to protect from further fracture, POS
Complementarity: Patient #1, Tooth #3

21. why treat now: Patient #1, Tooth #3
Based upon findings:
•The early cracks were serious and surrounded the MB cusp
•If not protected, the MB cusp would eventually fracture
•Immediate actions taken: POS, habit controls, inform patient of need for restoration
•Needs protective onlay placed to halt/slow crack progression
•If not treated, tooth could easily develop symptoms and a coronal fracture of the MB cusp .
•Depending on the direction of the fracture, endodontic involvement could occur

22. dashboard: Patient #1, Tooth #9
negative enamel cracks
Mild Pathology
RMDx
DEXIS CarivuX-Rays

23. Synergistic clinical significance: Patient #1, Tooth #9
-X-Ray: Negative
-Carivu: Supragingival enamel crazing
-RMDx: Mild Levels of Pathological Micro-Movement & Structural Instability (DSQ = 21)
History: 2 prior cracked molars/2 prior cracked fillings
8 & 9 avulsed in college football injury
Recommendation: Monitor, structurally sound

24. Complementarity: Patient #1, Tooth #9
Summary
Findings: Superficial enamel cracks (Carivu)
Mild pathological micro-movement (RMDx)
Diagnosis: Tooth Structurally Sound/no disassembly needed
Future Proposed Treatment Plan: Monitor, PV if desired

25. Why no treatment now: Patient #1, Tooth #9
Based upon findings:
•The enamel cracks appeared serious, but were not.
•If a crown was placed based on only enamel cracking, the tooth’s structure would be
compromised

26. Dashboard: Patient #1, Tooth #24
negative
Negative Pathology
enamel cracks & chip
RMDxDEXIS CarivuX-Rays

27. Complementarity: Patient #1, Tooth #24
Summary
Findings: Serious enamel cracks (Carivu)
Non-pathological micro-movement (RMDx)
Diagnosis: Structurally strong
Future Treatment Plan: Monitor, esthetic restoration optional

28. Why not treat now: Patient #1, Tooth #24
Based upon findings:
•Enamel cracks and fractured incisal appeared serious, but were not.
•If a crown was placed based on only enamel cracking, the tooth’s structure would be
compromised
•Tooth could be restored for esthetics with a porcelain veneer if desired to correct
traumatic fracture and esthetic compromise

29. dashboard: Patient #1, Tooth #25
negative
enamel cracks & chip
Mild Pathology
DEXIS Carivu
RMDxX-Rays

30. Complementarity: Patient #1, Tooth #25
Summary
Findings: Serious enamel cracks (Carivu)
Mild pathological micro-movement (RMDx)
Diagnosis: Structurally sound
Future Treatment Plan: Monitor, esthetic restoration optional

31. Why no treatment now: Patient #1, Tooth #25
Based upon findings:
•The superficial cracks and fractured piece appeared serious, but were not.
•If a crown was placed based on a belief that the tooth was cracking, the incisor would
be structurally compromised
•Tooth could be restored for esthetics with a porcelain veneer if desired to correct
traumatic fracture and esthetic compromise

32. Mid-treatment use of Carivu: Patient #1, Tooth #14
CASE STUDY
HISTORY: Provisional onlay placed July 2014 due to symptoms &
Severe pathological micro-movement (RMDx)
Carivu used to capture partial image of dentinal crack in preparation

33. Dashboard: Patient #1, Tooth #14
negative
Severe expanding pathology
Carivu: Not
Available in
July 2014
X-Rays
RMDx

34. Disassembly Images: Patient #1, Tooth #14

35. Disassembly findings: Patient #1, Tooth #14
Post-Disassembly Defects Found:
-Serious Dentinal Cracks Mesial To Distal On
The Preparation Floor
-Carivu captured partial image of crack after
preparation
(see illustrations on following slide)

36. Complementarity: Patient #1, Tooth #14
Summary
Findings: Indication of dentinal cracks seen post-preparation (Carivu)
Severe pathological structural instability pre-preparation (RMDx)
Diagnosis: Complex vertical & horizontal dentinal fractures, preparation floor
Future Treatment Plan: Positive response to provisional. Placed
permanent bonded restoration (onlay) and will monitor with RMDx

37. Why treat now: Patient #1, Tooth #14
Based upon findings:
•The cracks were symptomatic, serious and complex, heading to pulp chamber
•The defect was structural and not restoration related
•Positive response to provisional onlay and final bonded restoration
•If tooth not treated, could easily develop a catastrophic fracture.

38. Case studies showing synergistic technology usage
• Patient #1—no decay, history of structural
pathology
• Patient #2—interproximal decay, no history
of structural pathology

39. Case Study: Patient #2
Upper Teeth:
15
- Male, age 45
- History of mild arrested caries (19, 20)
- Periodontally stable
- No history of fractures
- Parafunctional history, no POSLower Teeth:
18 19 20

40. Patient #2
Full Mouth - DEXIS Dashboard
February 2015

41. Patient #2
Full Mouth - RMDx Dashboard
February 2015
Blue Band =
Highest-Risk
Sites in Red
Zone
[Teeth 15 & 18]
Caries risk
19 & 20

42. dashboard: Patient #2, Teeth #19 & 20
Positive
More positive
Moderate & Mild Pathology
X-Rays DEXIS Carivu
RMDx

43. Complementarity: Patient #2, Teeth #19 & 20
Summary
Diagnosis: Interproximal Caries (Carivu)
Moderate & Mild Pathological Micro-Movement (RMDx)
Findings: #19 moderate structural instability; #20 mild structural instability
Future Proposed Treatment Plan: Composite Restorations; check for
fractures on #19

44. Why treat now: Patient #2, Tooth #19
Based upon findings:
•Carivu testing showed interproximal caries beyond DEJ
•RMDx testing indicated that a moderate structural crack is present
•A composite restoration could generate sensitivity due to crack
•Patient has been warned about pathology and potential outcomes
•Either a bonded composite restoration covering cusps or an onlay will be placed.
Why treat now: Patient #2, Tooth #19

45. Why treat now: Patient #1, Tooth #20
Based upon findings:
•Carivu shows decay and RMDx shows mild micro movement
•Caries is broken through enamel and will grow faster
•Bonded composite restoration would be appropriate at this stage
•Need to monitor to assure stability of micro-cracks
•If not treated, will only get worse
Why treat now: Patient #2, Tooth #20

46. dashboard: Patient #2, Tooth #15
Negative Enamel cracks
Positive Pathology
DEXIS Carivu
RMDx
X-Rays

47. Synergistic clinical significance: Patient #2, Tooth #15
-X-Ray: Negative
-Carivu: Mild Enamel Cracks
-RMDx: Severe Levels of Pathological Micro-Movement (DSQ = 65)
History: Asymptomatic, no prior fractures, 45 years old, initial baseline RMDx
Recommendation: High alert, possible disassembly, start patient education. For now,
Protective Occlusal Splint, monitor every 3 months with RMDx for
crack progression until restored (suspect balancing interference with

48. Why treat now: Patient #2, Tooth #15
Based upon findings:
•RMDx indicated severe pathological micro-movement
•Occlusal gold inlay does not protect against fractures
•Treat with POS, education of patient, potential future onlay
•Suspect significant dentinal crack that will develop symptoms and fractures in future
•Dependent upon direction of fracture, endodontics or extraction

49. dashboard: Patient #2, Tooth #18
Negative Enamel Cracks
Severe Pathology
DEXIS Carivu
RMDx
X-Ray

50. Synergistic clinical significance: Patient #2, Tooth #18
-X-Ray: Negative
-Carivu: Enamel Cracks
-RMDx: Severe Levels of Pathological Micro-Movement (DSQ = 55)
History: Asymptomatic, no prior fractures, 45 years old, initial baseline RMD
Recommendation: Protect with Protective Occlusal Splint, monitor every 3
month
RMDx, restore if increasing

51. Complementarity: Patient #2, Tooth #18
Summary
Findings: Enamel Cracks (Carivu)
Severe Pathological Micro-Movement (RMDx)
Diagnosis: Dentinal crack, potential parafunctional balancing interference
with #15.
Future Proposed Treatment Plan: Protect & monitor every 3 months
Place onlay if DSQ increases

52. Why treat now: Patient #2, Tooth #18
Based upon findings:
•Unrestored second molar with high shearing forces
•RMDx indicated significant pathological micro movement
•Suspect significant dentinal crack that will develop symptoms and fractures in future
•Dependent upon direction of fracture, may need restoration, endodontics, extraction

53. Complementary Case Study Details
Patient # Tooth # Carivu RMDx History of
Fractures
Disassembly Findings Treatment
1 2 Minor Enamel Cracks Severe Pathological Micro-
Movement
Yes Micro-Leakage & Mild To
Moderate Dentinal Cracks
Disassembled + Future Onlay
3 Minor Enamel Cracks Severe Pathological Micro-
Movement
Yes Severe Dentinal Cracks Disassembled + Future Onlay
9 Significant Enamel Cracks Mild Pathological Micro-
Movement
Yes Monitor
14 Picture Of Dentinal Crack In Prepared
Tooth
Severe Pathological Micro-
Movement
Yes Severe Dentinal Cracks Disassembled + Onlay Completed
24 & 25 Multiple Enamel Cracks Non-Pathological Micro-
Movement
Yes Monitor Or Restore For Esthetics
2 19 & 20 Interproximal Caries Mild & Moderate Pathological
Micro-Movement
No Disassembly Scheduled Composite Restorations
Scheduled
15 & 18 Minor Enamel Cracks Severe Pathological Micro-
Movement
No Protect With Protective Occlusive
Splint & Monitor At 3 Month
Intervals or restore

54. add work flow chart 1
New
Patient
Workflow

55. add work flow chart 2
Existing
Patient
Workflow

56. Dexis Carivu Claims
“A detection device …to support the identification of occlusal,
interproximal and recurrent carious lesions and cracks.” (Surface Cracks)
“When used together, a radiograph, a transilluminated image, and an intra-oral photo provide a
comprehensive picture of thehealth of a patient’s tooth.” (A Static Visual Picture)
“If you identify a suspicious area on a radiograph,” the Carivu can help “you confidently determine
whether it needs monitoring over time or requires immediate treatment.” (Mutual goal)

57. Summary of Study Conclusions
• Carivu’s visual data showed the severity of interproximal decay & surface defects
• RMDx’s mechanical data measured the micro-movement & structural damage not
indicated by any other dashboard technology.
• RMDx showed which carious teeth were structurally sound
• Serious dentinal cracks were identified that needed treatment due to mechanical testing
data even with no visual indication of problems.
• Both technologies enhanced patient trust in the diagnosis based on visual & mechanical
data.

58. -Carivu: Visualizes the expansion of decay as the darker image widens.
-RMDx: Quantitatively Measures the progression of pathological micro-movement.
-The combination: Expanded diagnosis & monitoring with easy to use technology
DEXIS Carivu and RMDx…Powerful, Innovative, & Complementary

59. Ultimate Answer Regarding The
Synergy between Dexis Carivu and RMDx
Was the the clinician provided:
1. more comprehensive information to allow a more accurate diagnosis of
treatment options?
2. knowledge of whether to treat now, monitor or treat later?
In all 9 cases…Yes

60. Final Thought…
With the addition of the RMDx System, the DEXIS Dashboard
would be the only dental system in the world to combine
both visual and mechanical diagnostics.

61. Thank You....