The Canary System
PTR-LUM technology to detect early caries and monitor remineralization therapy
Canary Quick Facts
What is The Canary System®?
The Canary System is a precise, low-powered, laser-based instrument with an integrated intraoral camera that detects the presence of cracks and caries (tooth decay) before they are large enough to appear on dental X-rays. Intraoral camera images can be displayed for immediate chair side review with the patient. A patient report is generated containing an odontogram with Canary Numbers, which are color-coded for the examined teeth, along with the dentist’s treatment recommendation. This report can also be examined by the patient on The Canary Cloud (www.thecanarycloud.com).
How does The Canary System Work?
When placed on the tooth surface, a low-powered, pulsating laser light is shone on the tooth during a 3 second scan. The pulses of laser light generate photothermal (PTR) and luminescence (LUM) responses. By using a laser pulse at a frequency of 2Hz, the laser light can penetrate below the tooth surface and permit detection of a carious lesion as small as 50 microns (20 times smaller than a millimeter) and as deep as 5 mm from the tooth surface.
What are Canary Numbers?
A Canary Number is the output generated by The Canary System to inform the oral health care professional about the probable health status of a given tooth. Using a complex algorithm, The Canary System converts the unique PTR/LUM signatures into a Canary Number on a scale from 0 to 100 which appears on a monitor screen and is also audible. Lower numbers suggest healthy enamel and higher numbers suggest the presence of cracks and caries.
What does The Canary System mean for Dentists?
For proximal caries diagnosis, The Canary System is more accurate than bitewing radiography. The Canary had a sensitivity of 92% compared to 67% for bitewing radiography, according to an independent human clinical study conducted at the University of Texas and released at the International Association for Dental Research Meeting in March 2015.
The Canary System can detect cracks and caries that are not seen with other devices and do require treatment. Patients become engaged in their treatment and understand the need for operative intervention.
The Canary System is the only caries detection system that:
- Analyzes and measures the crystal structure of the tooth
- Measures up to a depth of 5 mm
- Detects decay on all tooth surfaces including:
- Around and beneath the intact margins of restorations including amalgam, composites and crowns
- Smooth surfaces,
- Occlusal pits and fissures, including beneath stained areas
- Around orthodontic brackets
- Interproximal regions
- Beneath opaque and transparent dental sealants
The Canary System is bridged to most practice management software.
What's wrong with traditional diagnostic technologies?
Traditional diagnostic technologies, visual inspection, manual probing and X-rays, are of little use if the decayed area is very small or below the tooth surface. They limit the ability of dentists to detect and monitor the early stages of tooth decay.
- The Canary System does not use ionizing radiation.
- X-rays can only find caries on proximal surfaces once the lesion has grown to involve ½ the thickness of enamel. Radiographs can’t detect lesions on smooth or occlusal surfaces until the lesions is very large
- For proximal caries detection, The Canary System is more accurate than bitewing radiography. Study 1; Study 2; Study 3; Study 4.
- Visual Inspection:
- Caries starts as a small lesion beneath the enamel surface. Visual inspection only examines the tooth surface and may find white or brown spots but visually one can’t determine what has caused these surface changes.
- Explorers and Manual Probing:
- Manual probing can damage tooth structure including pits and fissures and introduce bacteria deep into the pits and fissures of the teeth
How do you select the right caries detection system?
Detecting and treating caries is one of the major therapeutic interventions of clinical practice. Selecting the right caries detection system can be very challenging and wrong choices can lead to wrong treatment decisions. The marketplace is filled with “claims” and information but how do you make sense of it all? We recommend that you ensure that the technology is actually detecting caries and other defects in the tooth structure.
Most technologies on the market today use fluorescence, which permits the detection of some surface bacteria. Fluorescence-based devices cannot give you any information about the crystal structure of the tooth. Fluorescence does not give any information about lesion size or depth. Fluorescence can only penetrate 0.5 mm beneath the tooth surface due to scattering of light from stain, plaque, organic deposits and surface features such as pits and fissures.
Fluorescence is simply the glow from an object that has absorbed light, such as light from LEDs or from specific wavelengths of lasers. What is fluorescing or glowing when we use these systems? The literature indicates that bacterial by-products or porphyrins, stain, tartar and food debris all fluoresce under the wavelengths used in these devices, whether or not caries is present. Stained fissures that are healthy will fluoresce. Some toothpastes, polishing pastes, sealants and restorative materials have been shown to produce fluorescence, all resulting in false-positive readings.
Another technology on the market is transillumination which involves shining white and near-infrared light on a tooth to detect voids in the tooth. Two key limitations with this technique are: 1) No quantitative measurement is produced; and 2) Subjective interpretation of whether a dark area on the gray-scale images is caries or a dental anomaly leads to many false positives.
Here are two articles covering many of the above aspects:
1-Abrams, S. Caries: Tools for Enhancing The Prevention and Management of a Common Oral Disease. March 2018. DentistryIQ. View PDF 2-Abrams, S. Do We Really Need Caries Detection Devices? March 2014. Dental Teamwork. View PDF
How does The Canary System compare with other caries detection devices?
What evidence is there supporting the claims behind The Canary System?
The Canary System is an evidence-based caries detection system built upon a solid foundation of peer-reviewed lab and clinical research. To review the research click here.
What does The Canary System mean for patients?
The Canary System allows dentists to identify decay that would have otherwise gone undetected. A small restoration can avoid the costly and uncomfortable procedures associated with large caries. With early detection, decay can be treated with remineralization therapies and potentially reversed. Restorations do not last a lifetime, and there is a cycle of continued placement and replacement of fillings. Caries can also develop under sealants. The Canary System can detect decay around and beneath the margins of fillings and under sealants.
The Canary System:
- Aids in the detection of cracks and decay without exposure to ionizing radiation from X-rays
- Is comfortable and safe for young children
- Provides early detection of small caries (cavities) that can be remineralized, avoiding the placement of a filling
- Early detection and treatment of small caries and decay under old fillings or sealants avoids invasive, painful and expensive treatment that can be necessary if caries become large
Why the name "Canary"?
The "canary in the mineshaft" was used for centuries to protect people from undetectable hazards. Today, the word is synonymous with an early warning system or alert. Patients will recognize The Canary System™ as a painless, less expensive, friendly (hand-held tool, ergonomic ease and function, yellow in colour) detection system for cavities that reduces the need for painful fillings and needles.