Near-infrared (NIR) dental imaging using scanning fiber endoscope (SFE) is being developed with advantages of miniature size (1.6mm), flexible shaft, video frame rate (7Hz), and expandable field of view (60 degrees). Using 1310, 1460, and 1550 nm laser diodes, the multispectral NIR SFE provides high contrast of lesion with transparency of stained and non-calcified plaque. However, capabilities of scanned NIR imaging remain unknown. Artificial interproximal lesions are created in extracted human posterior teeth by preparing a cavitation on the mesial or distal surface and then the cavitated artificial lesions were filled with hydroxyapatite powder and sealed with cyanoacrylate resin. Lesions are prepared at different occlusal-gingival depths from marginal ridges, lesion drilling depths and lesion size. Endoscopic reflectance images were acquired and compared to micro-CT scans and 1310 nm OCT images of the lesions to evaluate performance of the nirSFE. Results show that NIR SFE can image deep lesions under sound enamel with thickness of ≤4mm. All three wavelengths can detect deep lesions through the occlusal enamel which are not visible by naked-eye. 1460 nm has the highest contrast between lesion and sound enamel while 1310nm more clearly shows the contrast between enamel and dentin. Our nirSFE system can detect artificial interproximal lesions less than 4 mm below the occlusal surface, distinguish different drilling depth both in enamel and in dentin layer. Furthermore, the nirSFE realtime imaging and video functionality renders better lesion contrast and helps distinguish specular reflection and lesion signal. In conclusion, the NIR SFE has the potential to measure volume of these lesions due to the many viewing angles achievable by the miniature and flexible probe tip.
Near-infrared (NIR) wavelength range of 1300-1500nm has the potential to outperform or augment other dental imaging modalities such as fluorescence imaging, owing to its lower scattering coefficient in enamel and trans- parency on stains and non-cariogenic plaque. However, cameras in this wavelength range are bulky and expensive, which lead to difficulties for in-vivo use and commercialization. Thus, we have proposed a new imaging device combining the scanning fiber endoscopy (SFE) and NIR imaging technology. The NIR SFE system has the advantage of miniature size (1.6 mm), flexible shaft, video frame rate (7Hz) and expandable wide field-of-view (60 degrees). Eleven extracted human teeth with or without occlusal caries were scanned by micro-computed X-ray tomography (micro-CT) to obtain 3D micro-CT images, which serve as the standard for comparison. NIR images in reflection mode were then taken on all the occlusal surfaces, using 1310nm super luminescent diode and 1460nm laser diode respectively. Qualitative comparison was performed between near-infrared im- ages and micro-CT images. Enamel demineralization in NIR appeared as areas of increased reflectivity, and distinguished from non-carious staining at the base of occlusal fissures or developmental defects on cusps. This preliminary work presented proof for practicability of combining NIR imaging technology with SFE for reliable and noninvasive dental imaging with miniaturization and low cost.
Previous studies have demonstrated that the permeability changes due to the surface modification of dentin can be quantified via thermal imaging during dehydration. The CO2 laser has been shown to remove the smear layer and disinfect root canals. Moreover, thermal modification via CO2 laser irradiation can be used to convert dentin into a highly mineralized enamel-like mineral. The purpose of this study is to evaluate the radicular dentin surface modification after CO2 laser irradiation by measuring the permeability with thermal imaging. Human molar specimens (n=12) were sectioned into 4 axial walls of the pulp chamber and treated with either 10% NaClO for 1 minute, 5% EDTA for 1 minute, CO2 laser or none. The CO2 laser was operated at 9.4 μm with a pulse duration of 26 μs, pulse repetition rate of 300 Hz and a fluence of 13 J/cm2. The samples were dehydrated using an air spray for 60 seconds and imaged using a thermal camera. The resulting surface morphological changes were assessed using 3D digital microscopy. The images from digital microscopy confirmed melting of the mineral phase of dentin. The area enclosed by the time-temperature curve during dehydration, ▵Q, measured with thermal imaging increased significantly with treatments with EDTA and the CO2 laser (P<0.05). These results indicate that the surface modification due to CO2 laser treatment increases permeability of radicular dentin.
UV and IR lasers can be used to specifically target protein, water, and the mineral phase of dental hard
tissues to produce varying changes in surface morphology. In this study, we irradiated enamel and dentin
surfaces with various combinations of lasers operating at 0.355, 2.94, and 9.4 μm, exposed those surfaces
to topical fluoride, and subsequently evaluated the influence of these changes on surface morphology and
permeability. Digital microscopy and surface dehydration rate measurements were used to monitor changes
in the samples overtime. The surface morphology and permeability (dehydration rate) varied markedly with
the different laser treatments on enamel. On dentin, fluoride was most effective in reducing the
permeability.
The increasing prevalence of mild hypomineralization due to developmental defects on tooth surfaces poses a
challenge for caries detection and caries risk assessment and reliable methods need to be developed to discriminate
such lesions from active caries lesions that need intervention. Previous studies have demonstrated that areas of
hypomineralization are typically covered with a relatively thick surface layer of highly mineralized and transparent
enamel similar to arrested lesions. Seventy-six extracted human teeth with mild to moderate degrees of suspicious
fluorosis were imaged using near-infrared reflectance and transillumination. Enamel hypomineralization was clearly
visible in both modalities. However, it was difficult to distinguish hypomineralization due to developmental defects
from caries lesions with contrast measurements alone. The location of the lesion on tooth coronal surface (i.e.
generalized vs. localized) seems to be the most important indicator for the presence of enamel hypomineralization
due to developmental defects.
Accurate detection and measurement of the highly mineralized surface layer that forms on caries lesions is important
for the diagnosis of lesion activity. Previous studies have demonstrated that optical imaging methods can be used to
measure the degree of remineralization on enamel lesions. The purpose of this study was to determine if thermal and
near-IR reflectance imaging could be used to assess the remineralization process in simulated dentin lesions.
Artificial bovine (n=15) dentin lesions were prepared by immersion in a demineralization solution for 24 hours and
they were subsequently placed in an acidic remineralization solution for up to 12 days. The samples were
dehydrated using an air spray for 30 seconds and imaged using thermal and InGaAs cameras. The area enclosed by
the time-temperature curve, ΔQ, from thermal imaging decreased significantly with longer periods of
remineralization. However, near-IR reflectance intensity differences, ΔI, before and after dehydration failed to show
any significant relationship with the degree of remineralization. This study shows that thermal imaging can be used
for the assessment of the remineralization of dentin lesions.
Previous studies have demonstrated that the structural changes on enamel due to demineralization and
remineralization can be exploited through optical imaging methods such as QLF, thermal and NIR imaging. The
purpose of this study is to investigate whether PS-OCT and NIR reflectance imaging can be utilized to assess lesion
structure in artificial enamel lesions on the smooth surfaces of primary teeth exposed to fluoride. The smooth
coronal surfaces of primary teeth (n=25) were divided into 4 windows: sound, demineralization, demineralization
with remineralization and APF with demineralization. Windows were treated with either acidulated phosphate
fluoride (APF) for 1 minute, a demineralization solution for 4 days, and/or an acidic remineralization solution for 12
days. The samples were imaged using PS-OCT, QLF and NIR reflectance at 1400–1700 nm wavelengths. This study
demonstrated that both PS-OCT and NIR reflectance imaging were suitable for assessing lesion structure in the
smooth surfaces of primary dentition.
Previous studies have demonstrated that near-IR imaging can be used to nondestructively monitor the severity of enamel lesions. Arrested lesions typically have a highly mineralized surface layer that reduces permeability and limits diffusion into the lesion. The purpose of this study was to investigate whether the rate of water loss correlates with the degree of remineralization using near-IR reflectance imaging. Artificial bovine (n=15) enamel lesions were prepared by immersion in a demineralization solution for 24 hours and they were subsequently placed in an acidic remineralization solution for different periods. The samples were dehydrated using an air spray for 30 seconds and surfaces were imaged using an InGaAs camera at 1300-1700 nm wavelengths. Near-IR reflectance intensity differences before and after dehydration decreased with longer periods of remineralization. This study demonstrated that near-IR reflectance imaging was suitable for the detection of remineralization in simulated caries lesions and near-IR wavelengths longer than 1400 nm are well suited for the assessment of remineralization.
Secondary caries stands as the leading reason for the failure of composite restorations and dentists spend more time replacing existing restorations than placing new ones. Current clinical strategies, and even modern visible light methods designed to detect decay, lack the sensitivity to distinguish incipient lesions, are confounded by staining on the surface and within the tooth, or are limited to detecting decay on the tooth surface. Near-IR (NIR) imaging methods, such as NIR reflectance and transillumination imaging, and optical coherence tomography are promising strategies for imaging secondary caries. Wavelengths longer than 1300-nm avoid interference from stain and exploit the greater transparency of sound enamel and dental composites, to provide increased contrast with demineralized tissues and improved imaging depth. The purpose of this study was to determine whether NIR transillumination (λ=1300-nm) and NIR crosspolarized reflectance (λ=1500-1700-nm) images can serve as reliable indicators of demineralization surrounding composite restorations. Twelve composite margins (n=12) consisting of class I, II and V restorations were chosen from ten extracted teeth. The samples were imaged in vitro using NIR transillumination and reflectance, polarization sensitive optical coherence tomography (PS-OCT) and a high-magnification digital visible light microscope. Samples were serially sectioned into 200–μm slices for histological analysis using polarized light microscopy (PLM) and transverse microradiography (TMR). The results presented demonstrate the utility of NIR light for detecting recurrent decay and suggest that NIR images could be a reliable screening tool used in conjunction with PS-OCT for the detection and diagnosis of secondary caries.
Previous in vitro and in vivo studies have demonstrated that polarization-sensitive optical coherence tomography
(PS-OCT) can be used to nondestructively image the subsurface structure and measure the thickness of the highly
mineralized transparent surface zone of caries lesions. There are structural differences between active lesions and
arrested lesions, and the surface layer thickness may correlate with activity of the lesion. The purpose of this study
was to develop a method that can be used to automatically detect and measure the thickness of the transparent
surface layer in PS-OCT images. Automated methods of analysis were used to measure the thickness of the
transparent layer and the depth of the bovine enamel lesions produced using simulated caries models that emulate
demineralization in the mouth. The transparent layer thickness measured with PS-OCT correlated well with
polarization light microscopy (PLM) measurements of all regions (r2=0.9213). This study demonstrates that PS-OCT
can automatically detect and measure thickness of the transparent layer formed due to remineralization in simulated
caries lesions.
Several in vitro studies have demonstrated the potential for transillumination imaging and optical coherence
tomography operating at 1310-nm for imaging caries lesions on tooth proximal and occlusal surfaces.
Recently, we demonstrated that lesions on proximal surfaces could be imaged in vivo using NIR
transillumination and that PS-OCT can be used in vivo to measure early demineralization on tooth buccal
and occlusal surfaces. In this paper we report the first in vivo measurements using OCT and NIR imaging
of occlusal lesions that have been scheduled for restoration. Occlusal lesions were chosen that were
scheduled for restoration based on conventional diagnosis that consists of visual and tactile examination.
Occlusal lesions were visible in the NIR. OCT looks promising for confirming the lateral spread of
occlusal caries under the dentinal-enamel junction adjacent to fissures. These studies suggest that both near
infrared transillumination imaging at 1310-nm and OCT provide valuable information about the severity of
caries lesions.
The high transparency of dental enamel in the near-infrared (NIR) at 1310 nm can be exploited for imaging dental caries without the use of ionizing radiation. The objective of this study is to determine whether the lesion contrast derived from NIR imaging in both transmission and reflectance can be used to estimate lesion severity. Two NIR imaging detector technologies are investigated: a new Ge-enhanced complementary metal-oxide-semiconductor (CMOS)-based NIR imaging camera, and an InGaAs focal plane array (FPA). Natural occlusal caries lesions are imaged with both cameras at 1310 nm, and the image contrast between sound and carious regions is calculated. After NIR imaging, teeth are sectioned and examined using polarized light microscopy (PLM) and transverse microradiography (TMR) to determine lesion severity. Lesions are then classified into four categories according to lesion severity. Lesion contrast increases significantly with lesion severity for both cameras (p<0.05). The Ge-enhanced CMOS camera equipped with the larger array and smaller pixels yields higher contrast values compared with the smaller InGaAs FPA (p<0.01). Results demonstrate that NIR lesion contrast can be used to estimate lesion severity.
New methods are needed for the nondestructive measurement of tooth demineralization and remineralization to
monitor the progression of incipient caries lesions (tooth decay) for effective nonsurgical intervention and to
evaluate the performance of anti-caries treatments such as chemical treatments or laser irradiation. Studies have
shown that optical coherence tomography (OCT) has great potential to fulfill this role since it can be used to
measure the depth and severity of early lesions with an axial resolution exceeding 10-μm, it is easy to apply in vivo
and it can be used to image the convoluted topography of tooth occlusal surfaces. In this paper we attempt to
determine the earliest stage at which we can detect significant differences in lesion severity. Automated methods of
analysis were used to measure the depth and severity of demineralized bovine enamel produced using a simulated
caries model that emulates demineralization in the mouth. Significant differences in the depth and integrated
reflectivity from the lesions were detected after only a few hours of demineralization. These results demonstrate
that cross polarization OCT is ideally suited for the nondestructive assessment of early demineralization.
The high transparency of dental enamel in the near-infrared (NIR) at 1310-nm can be exploited for imaging
dental caries without the use of ionizing radiation. The objective of this study was to determine whether the
lesion contrast derived from NIR transillumination can be used to estimate lesion severity. Another aim
was to compare the performance of a new Ge enhanced complementary metal-oxide-semiconductor
(CMOS) based NIR imaging camera with the InGaAs focal plane array (FPA). Extracted human teeth
(n=52) with natural occlusal caries were imaged with both cameras at 1310-nm and the image contrast
between sound and carious regions was calculated. After NIR imaging, teeth were sectioned and examined
using more established methods, namely polarized light microscopy (PLM) and transverse
microradiography (TMR) to calculate lesion severity. Lesions were then classified into 4 categories
according to the lesion severity. Lesion contrast increased significantly with lesion severity for both
cameras (p<0.05). The Ge enhanced CMOS camera equipped with the larger array and smaller pixels
yielded higher contrast values compared with the smaller InGaAs FPA (p<0.01). Results demonstrate that
NIR lesion contrast can be used to estimate lesion severity.
The objective of this work was to observe the various thermal-induced optical changes that occur in the
near-infrared (NIR) during drilling in dentin and enamel with the laser and the high-speed dental handpiece.
Tooth sections of ~ 3 mm-thickness were prepared from extracted human incisors (N=60). Samples
were ablated with a mechanically scanned CO2 laser operating at a wavelength of 9.3-μm, a 300-Hz laser
pulse repetition rate, and a laser pulse duration of 10-20 μs. An InGaAs imaging camera was used to
acquire real-time NIR images at 1300-nm of thermal and mechanical changes (cracks). Enamel was rapidly
removed by the CO2 laser without peripheral thermal damage by mechanically scanning the laser beam
while a water spray was used to cool the sample. Comparison of the peripheral thermal and mechanical
changes produced while cutting with the laser and the high-speed hand-piece suggest that enamel and
dentin can be removed at high speed by the CO2 laser without excessive peripheral thermal or mechanical
damage. Only 2 of the 15 samples ablated with the laser showed the formation of small cracks while 9 out
of 15 samples exhibited crack formation with the dental hand-piece. The first indication of thermal change
is a decrease in transparency due to loss of the mobile water from pores in the enamel which increase lightscattering.
To test the hypothesis that peripheral thermal changes were caused by loss of mobile water in
the enamel, thermal changes were intentionally induced by heating the surface. The mean attenuation
coefficient of enamel increased significantly from 2.12 ± 0.82 to 5.08 ± 0.98 with loss of mobile water due
to heating.
A mechanically scanned CO2 laser operated at high laser pulse repetition rates can be used to rapidly and
precisely remove dental decay. This study aims to determine whether these laser systems can safely ablate
enamel and dentin without excessive heat accumulation and peripheral thermal damage. Peripheral thermal
damage can adversely impact the mechanical strength of the irradiated tissue, particularly for dentin, and
reduce the adhesion characteristics of the modified surfaces. Samples were derived from noncarious
extracted molars. Pulpal temperatures were recorded using microthermocouples situated at the pulp
chamber roof of samples (n=12), which were occlusally ablated using a rapid-scanning, water-cooled 300
Hz CO2 laser over a two minute time course. The mechanical strength of facially ablated dentin (n=10) was
determined via four-point bend test and compared to control samples (n=10) prepared with 320 grit wet
sand paper to simulate conventional preparations. Composite-to-enamel bond strength was measured via
single-plane shear test for ablated/non-etched (n=10) and ablated/acid-etched (n=8) samples and compared
to control samples (n=9) prepared by 320 grit wet sanding.
Thermocouple measurements indicated that the temperature remained below ambient temperature at 19.0°C
(s.d.=0.9) if water-cooling was used. There was no discoloration of either dentin and enamel, the treated
surfaces were uniformly ablated and there were no cracks observable on the laser treated surfaces. Fourpoint
bend tests yielded mean mechanical strengths of 18.2 N (s.d.=4.6) for ablated dentin and 18.1 N
(s.d.=2.7) for control (p>0.05). Shear tests yielded mean bond strengths of 31.2 MPa (s.d.=2.5, p<0.01) for
ablated/acid-etched samples, 5.2 MPa (s.d.=2.4, p<0.001) for ablated/non-etched samples, and 37.0 MPa
(s.d.=3.6) for control. The results indicate that a rapid-scanning 300 Hz CO2 laser can effectively ablate
dentin and enamel without excessive heat accumulation and with minimal thermal damage. It is not clear
whether the small (16%) but statistically significant reduction in the shear bond strength to enamel is
clinically significant since the mean shear bond strength exceeded 30 MPa.
A thorough understanding of how polarized near-IR light propagates through sound and carious dental hard tissues is important for the development of dental optical imaging systems. New optical imaging tools for the detection and assessment of dental caries (dental decay) such as near-IR imaging and optical coherence tomography can exploit the enhanced contrast provided by polarization sensitivity. In this investigation, an automated system was developed to collect images for the full 16-element Mueller Matrix. The polarized
light was controlled by linear polarizers and liquid crystal retarders and the 36 images were acquired as the polarized near-IR light propagates through the enamel of extracted human thin tooth sections. In previous work, we reported that polarized light is rapidly depolarized by demineralized enamel, and sound and
demineralized dentin.1 The rapid depolarization of polarized light by dental caries in the near-IR provides high contrast for caries imaging and detection. In this initial study, major differences in the Mueller matrix elements were observed in both sound and demineralized enamel which supports this approach and
warrants further investigation.
Pulsed CO2 lasers show great promise for the rapid and efficient ablation of dental hard tissues. Our objective was to demonstrate that CO2 lasers operated at high repetition rates can be used for the rapid removal of dentin without excessive thermal damage and without compromising adhesion to restorative materials. Human dentin samples (3x3mm2) were rapidly ablated with a pulsed CO2 laser operating at a wavelength of 9.3-µm, pulse repetition rate of 300-Hz and an irradiation intensity of 18-J/cm2. The bond strength to composite was determined by the modified single plane shear test. There were 8 test groups each containing 10 blocks: negative control (non-irradiated non-etched), positive control (non-irradiated acid-etched), and six laser treated groups (three etched and three non-etched sets). The first and second etched and non-etched sets were ablated at a speed of 25 mm/sec and 50 mm/sec with water, respectively. The third set was also ablated at 50 mm/sec without application of water during laser irradiation. Minimal thermal damage was observed on the dentin surfaces for which water cooling was applied. Bond strengths exceeded 20 MPa for laser treated surfaces that were acid-etched after ablation (25-mm/sec: 29.9-MPa, 50-mm/sec: 21.3-MPa). The water-cooled etched laser groups all produced significantly stronger bonds than the negative control (p<0.001) and a lower bond strength than the positive control (p<0.05). These measurements demonstrate that dentin surfaces can be rapidly ablated by a CO2 lasers with minimal peripheral thermal damage. Additional studies are needed to determine if a lower bond strength than the acid-etched control samples is clinically significant where durability of these bonded restoration supersedes high bond strength.
Previous studies have demonstrated that Polarization Sensitive Optical Coherence Tomography (PS-OCT) can be used to image the remineralization of early artificial caries lesion on smooth enamel surfaces of human and bovine teeth. However, most new dental decay is found in the pits and fissures of the occlusal surfaces of posterior dentition and it is in these high risk areas where the performance of new caries imaging devices need to be investigated. The purpose of this study was to demonstrate that PS-OCT can be used to measure the subsequent remineralization of artificial lesions produced in the pits and fissures of extracted 3rd molars. A PS-OCT system operating at 1310-nm was used to acquire polarization resolved images of occlusal surfaces exposed to a demineralizing solution at pH-4.5 followed by a fluoride containing remineralizing solution at pH-7.0 containing 2-ppm fluoride. The integrated reflectivity was calculated to a depth of 200-µm in the entire lesion area using an automated image processing algorithm. Although a well-defined surface zone was clearly resolved in only a few of the samples that underwent remineralization, the PS-OCT measurements indicated a significant (p<0.05) reduction in the integrated reflectivity between the severity of the lesions that were exposed to the remineralization solution and those that were not. The lesion depth and mineral loss were also measured with polarized light microscopy and transverse microradiography after sectioning the teeth. These results show that PS-OCT can be used to non-destructively monitor the remineralization potential of anti-caries agents in the important pits and fissures of the occlusal surface.
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