This study investigated the utility of using OCT to monitor SDF application over time. Twenty dentin blocks each with 5 windows were exposed to a demineralization solution to produce carious lesions. Treatment windows included sound, sound+SDF, lesion, lesion+SDF, lesion+SDF+SDF. Lesion depth, mean reflectivity over the lesion depth and optical penetration through the lesions were monitored with OCT for 12 weeks. OCT was able to show changes in the reflectivity and optical penetration in demineralized and sound dentin after SDF application over time. Such changes can potentially be monitored to determine if and when re-application of SDF is needed.
New imaging technologies are needed for the clinical assessment of lesions on root surfaces. It is not sufficient to simply detect caries lesions; methods are needed to assess lesion depth, structural composition and activity to determine if chemical intervention has the potential to be effective and if remineralization has occurred. Lesions were monitored using CP-OCT during lesion dehydration to assess the lesion structure and any shrinkage. Thermal imaging at 6-10 μm wavelengths and short wavelength-IR imaging at 1450-1750-nm were used to monitor thermal emission during lesion dehydration to assess lesion activity. Imaging probes were custom fabricated for clinical use. We present the first clinical results of a small feasibility study employing CP-OCT, thermal and SWIR imaging to assess lesion activity in vivo on thirty test subjects with suspected root caries lesions.
Most new caries lesions are found in the pits and fissures of the occlusal surface. Radiographs have extremely low sensitivity for early occlusal decay, and by the time the lesion is severe enough to appear on a radiograph, it typically has penetrated well into the dentin and surgical intervention is required. The occlusal surfaces are often heavily stained, and visual and tactile detection have poor sensitivity and specificity. Previous near-infrared imaging studies at wavelengths beyond 1300 nm have demonstrated that stains are not visible and demineralization on the occlusal surfaces can be viewed without interference from stains. The objective of our study is to determine how the contrast between sound and lesion areas on occlusal surfaces varies with wavelength from the visible to 2350 nm and determine to what degree stains interfere with that contrast. The lesion contrast for reflectance is measured in 55 extracted teeth with suspected occlusal lesions from 400 to 2350 nm employing silicon and indium gallium arsenide imaging arrays. In addition, the lesion contrast is measured on 25 extracted teeth with suspected occlusal lesions from 400 to 1600 nm in reflectance and from 830 to 1400 nm in transillumination before and after stains are removed using a ultrasonic scaler. The highest lesion contrast in reflectance is measured at wavelengths >1700 nm. Stains interfere significantly at wavelengths <1150 nm (400 to 1150) for both reflectance and transillumination measurements. Our study suggests that the optimum wavelengths for imaging decay in the occlusal surfaces are >1700 nm for reflectance (1700 to 2350 nm) and near 1300 nm (1250 to 1350 nm) for transillumination.
Selective removal of dental calculus with high precision is best accomplished using lasers operating at high pulse repetition rates focused to a small spot size to limit damage to sound tissues. Conventional flashlamp pumped Er:YAG lasers are poorly suited for this purpose, but new diode-pumped solid state (DPSS) Er:YAG lasers have become available operating at high pulse repetition rates. The purpose of this study was to determine if image-guided laser ablation can be used to selectively remove calculus from tooth surfaces with minimal damage to the underlying sound cementum and dentin. A DPSS Er:YAG laser system was used to selectively remove calculus from ten extracted teeth using sequential SWIR images at 1500-1750-nm. The selectivity of removal was assessed using digital microscopy and optical coherence tomography. Calculus was removed with minimal damage to the underlying sound cementum and dentin.
Near Infrared Reflectance (NIR) is a new imaging technology that detects dental caries (decay) on tooth occlusal surfaces and in the interproximal contact sites between teeth. Conventional techniques, mostly dental x-rays, do not provide the high sensitivity and specificity at the vulnerable pits and fissure regions. The contrast of demineralization on tooth surfaces changes with increasing severity and the magnitude of that change with depth depends on the wavelength. The purpose of this study is to determine how the contrast changes with depth as a function of wavelength. Demineralization of varying depth was produced in 1.5 × 1.5 mm exposed windows after 1, 2, 3, 4, and 5 days of exposure to a demineralizing solution at pH 4.5. Lesions were imaged at 405, 630, 850, 1300, 1460, 1535, 1675, and 1950-nm with multiple imaging systems. The highest lesion contrast was measured at 1950-nm.
In vivo and in vitro studies have demonstrated that near-infrared (NIR) light at λ=1300-1700-nm can be used to acquire high contrast images of enamel demineralization without interference of stains. The objective of this study was to determine if a relationship exists between the NIR image contrast of occlusal lesions and the depth of the lesion. Extracted teeth with varying amounts of natural occlusal decay were measured using a multispectral-multimodal NIR imaging system which captures λ=1300-nm occlusal transillumination, and λ=1500-1700-nm cross-polarized reflectance images. Image analysis software was used to calculate the lesion contrast detected in both images from matched positions of each imaging modality. Samples were serially sectioned across the lesion with a precision saw, and polarized light microscopy was used to measure the respective lesion depth relative to the dentinoenamel junction. Lesion contrast measured from NIR crosspolarized reflectance images positively correlated (p<0.05) with increasing lesion depth and a statistically significant difference between inner enamel and dentin lesions was observed. The lateral width of pit and fissures lesions measured in both NIR cross-polarized reflectance and NIR transillumination positively correlated with lesion depth.
Most new lesions are found in the pits and fissures of the occlusal surface. Radiographs have extremely low sensitivity for early occlusal decay and by the time the lesion is severe enough on a radiograph it typically has penetrated well into the dentin and surgical intervention is required. The occlusal surfaces are heavily stained and visual and tactile methods for their detection also have poor sensitivity and specificity. Previous studies at wavelengths beyond 1300-nm have demonstrated that stains are not visible and demineralization on the occlusal surfaces can be viewed without interference from stains. New extended range InGaAs near- IR cameras allow access to wavelengths beyond 1700-nm. The objective of this study was to determine how the contrast of occlusal lesions varies with wavelength from the visible to 2350-nm. The lesion contrast was measured in 55 extracted teeth with suspected occlusal lesions using reflectance measurements from 400- 2350-nm using Si and InGaAs imaging arrays. The highest lesion contrast in reflectance was measured at wavelengths greater than 1700-nm. Stains interfered significantly at wavelengths shorter than 1150-nm. This study indicates that the optimum wavelengths for reflectance imaging decay in the occlusal surfaces are greater than 1700-nm.
The optical properties of human dentin can change markedly due to aging, friction from opposing teeth,
and acute trauma, resulting in the formation of transparent or sclerotic dentin with increased mineral
density. The objective of this study was to determine the optical attenuation coefficient of human dentin
tissues with different mineral densities in the near-infrared (NIR) spectral regions from 1300-2200 nm
using NIR transillumination and optical coherence tomography (OCT). N=50 dentin samples of varying
opacities were obtained by sectioning whole extracted teeth into ~ 150 μm transverse sections at the
cemento-enamel junction or the apical root. Transillumination images were acquired with a NIR camera
and attenuation measurements were acquired at various NIR wavelengths using a NIR sensitive
photodiode. Samples were imaged with transverse microradiography (gold standard) in order to determine
the mineral density of each sample.
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.
Selective removal of caries lesions with high precision is best accomplished using lasers operating at high pulse repetition rates utilizing small spot sizes. Conventional flash-lamp pumped Er:YAG lasers are poorly suited for this purpose, but new diode-pumped solid-state (DPSS) Er:YAG lasers have become available operating at high pulse repetition rates. Microradiography was used to determine the mineral content of the demineralized dentin of 200-μm thick sections with natural caries lesions prior to laser ablation. The purpose of this study was to explore the use of a DPSS Er:YAG laser for the selective removal of demineralized dentin and natural occlusal lesions on extracted teeth.
A major advantage of composite restoration materials is that they can be color matched to the tooth.
However, this presents a challenge when composites fail and they need to be replaced. Dentists typically
spend more time repairing and replacing composites than placing new restorations. We have shown in
previous studies that high-contrast images of composite can be acquired in occlusal transmission mode at
near-IR wavelengths coincident with higher water absorption. The purpose of this study was to determine if
similar high-contrast images can be acquired in reflectance mode at longer wavelengths where water
absorption is even higher. Extracted human teeth with existing composite restoration (n=14) were imaged at
wavelengths from 900-2300 using an extended range InGaAs camera. Our results indicate that NIR
wavelengths longer than 1400-nm coincident with higher water absorption yield the highest contrast between
dental composites and tooth structure in reflectance.
Bitewing radiography is still considered state-of-the-art diagnostic technology for assessing cavitation within
approximal carious dental lesions, even though radiographs cannot resolve cavitated surfaces but instead are
used to measure lesion depth in order to predict cavitation. Clinicians need new technologies capable of
determining whether approximal carious lesions have become cavitated because not all lesions progress to
cavitation. Assessing lesion cavitation from near-infrared (NIR) imaging methods holds great potential due to
the high transparency of enamel in the NIR region from λ=1300-1700-nm, which allows direct visualization
and quantified measurements of enamel demineralization. The objective of this study was to measure the
change in lesion appearance between non-cavitated and cavitated lesions in artificially generated lesions
using NIR imaging modalities (two-dimensional) at λ=1300-nm and λ=1450-nm and cross-polarization
optical coherence tomography (CP-OCT) (thee-dimensional) λ=1300-nm. Extracted human posterior teeth
with sound proximal surfaces were chosen for this study and imaged before and after artificial lesions were
made. A high speed dental hand piece was used to create artificial cavitated proximal lesions in sound
samples and imaged. The cavitated artificial lesions were then filled with hydroxyapatite powder to simulate
non-cavitated proximal lesions.
The purpose of this study is to show that optical clearing agents can be used to increase the visibility of deeply penetrating occlusal lesions that have reached the underlying dentin and spread laterally under the enamel. Previous studies have shown that high refractive index fluids can increase the contrast of caries lesions. Extracted teeth with natural occlusal lesions were imaged with optical coherence tomography (OCT) with and without the addition of a transparent vinyl polysiloxane impression material (VPS) currently used in vivo. The relative intensity of the reflectivity from the underlying lesion area for each sample was measured before and after application of the VPS. Lesion presence was confirmed with polarized light microscopy and microradiography. Application of VPS significantly increased (P<0.0001) the integrated reflectivity of subsurface dentinal lesions. This study shows that optical clearing agents can be used to increase the optical penetration and the visibility of subsurface lesions and the dentinal–enamel junction under sound and demineralized enamel in OCT images.
Selective removal of dental composite with high precision is best accomplished using lasers operating at
high pulse repetition rates focused to a small spot size. Conventional flash-lamp pumped Er:YAG lasers
are poorly suited for this purpose, but new diode-pumped Er:YAG lasers have become available operating
at high pulse repetition rates. The purpose of this study was to compare the ablation rates and selectivity of
enamel and composite for a 30 W diode-pumped Er:YAG laser operating with a pulse duration of 30-50-μs
and evaluate it's suitability for the selective removal of composite from tooth surfaces. The depth of
ablation and changes in surface morphology were assessed using digital microscopy. The fluence range
of 30-50 J/cm2 appeared optimal for the removal of composite, and damage to sound enamel was limited to
less than 100-μm after the removal of composite as thick as 700-800-μm. Future studies will focus on the
use of methods of feedback to further increase selectivity.
For over one hundred years, x-rays have served as a cornerstone of dentistry. Dental radiographic imaging
technologies have constantly improved, however, detecting occlusal lesions remains as one of the greatest
challenges due to the low sensitivity of radiographs and the overlap of enamel. Once detected, occlusal lesions have
penetrated far into the dentin, necessitating invasive restorative treatment. The adoption of near-infrared (NIR)
systems in dentistry introduces the potential for early detection of occlusal lesions. Commercially available NIR
systems for intra-oral applications currently operate near 800-nm; however, extrinsic stains may interfere with the
detection of demineralization of the underlying enamel surface. Higher wavelengths such as 1300-nm render stains
nearly transparent and enhances the contrast of sound enamel to demineralized enamel. This novel finding promotes
minimally invasive dentistry and allows oral health professionals the ability to detect, image, track, and monitor
early lesions without repeated exposure to ionizing radiation nor invasive treatment.
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.
Clinicians need technologies to improve the diagnosis of questionable occlusal carious lesions (QOC’s) and
determine if decay has penetrated to the underlying dentin. Assessing lesion depth from near-infrared (NIR) images
holds great potential due to the high transparency of enamel and stain to NIR light at λ=1300-1700-nm, which
allows direct visualization and quantified measurements of enamel demineralization. Unfortunately, NIR reflectance
measurements alone are limited in utility for approximating occlusal lesion depth >200-μm due to light attenuation
from the lesion body. Previous studies sought to combine NIR reflectance and transillumination measurements taken
at λ=1300-nm in order to estimate QOC depth and severity. The objective of this study was to quantify the change in
lesion contrast and size measured from multispectral NIR reflectance and transillumination images of natural
occlusal carious lesions with increasing lesion depth and severity in order to determine the optimal multimodal
wavelength combinations for estimating QOC depth. Extracted teeth with varying amounts of natural occlusal
decay were measured using a multispectral-multimodal NIR imaging system at prominent wavelengths within the
λ=1300-1700-nm spectral region. Image analysis software was used to calculate lesion contrast and area values
between sound and carious enamel regions.
Several studies have shown that optical coherence tomography (OCT) can be used to measure the remaining enamel
thickness and detect the location of subsurface lesions hidden under the sound enamel. Moreover studies have
shown that high refractive index liquids can be used to improve the visibility of subsurface lesions in OCT images.
In this study, we demonstrate that vinyl polysiloxane (VPS) impression materials which are routinely used in
dentistry can be used to enhance the detection of dentinal lesions on tooth occlusal surfaces. Lesion presence was
confirmed with polarized light microscopy and microradiography.
Dental composites are used for a wide range of applications such as fillings for cavities, adhesives for
orthodontic brackets, and closure of gaps (diastemas) between teeth by esthetic bonding. Anterior
restorations are used to replace missing, diseased and unsightly tooth structure for both appearance and
function. When these restorations must be replaced, they are difficult to remove mechanically without
causing excessive removal or damage to enamel because dental composites are color matched to teeth.
Previous studies have shown that CO2 lasers have high ablation selectivity and are well suited for removal
of composite on occlusal surfaces while minimizing healthy tissue loss. A spectral feedback guidance
system may be used to discriminate between dental composite and dental hard tissue for selective ablation
of composite material. The removal of composite restorations filling diastemas is more challenging due to
the esthetic concern for anterior teeth. The objective of this study is to determine if composite spanning a
diastema between anterior teeth can be removed by spectral guided laser ablation at clinically relevant rates
with minimal damage to peripheral healthy tissue and with higher selectivity than a high speed dental handpiece.
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.
Several studies have shown that optical coherence tomography (OCT) can be used to measure the remaining enamel thickness and detect the location of subsurface lesions hidden under the sound enamel. The purpose of this study was to develop algorithms to enhance the visibility of subsurface structures such as hidden occlusal lesions and the dentinal-enamel junction. Extracted teeth with natural occlusal lesions were imaged with OCT with and without added high index fluids. A Rotating Kernel Transformation (RKT) nonlinear image processing filter was applied to PS-OCT images to enhance the visibility of the subsurface lesions under the sound enamel. The filter significantly increased (P<0.05) the visibility of the subsurface lesions.
Selective removal of caries lesions with high precision is best accomplished using lasers operating at high pulse repetition rates utilizing small spot sizes. Conventional flash-lamp pumped Er:YAG lasers are poorly suited for this purpose, but new diode-pumped Er:YAG lasers have become available operating at high pulse repetition rates. The purpose of this study was to measure the ablation rate and selectivity of sound and demineralized enamel and dentin for a 30 W diode-pumped Er:YAG laser operating with a pulse duration of 20-30-μs and evaluate it's potential for the selective removal of natural occlusal lesions on extracted teeth. Microradiography was used to determine the mineral content of the demineralized enamel and dentin of 300-μm thick sections with natural caries lesions prior to laser ablation. The ablation rate was calculated for varying mineral content. In addition, near-IR reflectance measurements at 1500-1700- nm were used to guide the laser for the selective ablation of natural occlusal caries lesions on extracted teeth.
Previous studies have shown that near-IR transillumination is well suited for imaging deep occlusal lesions. The purpose of this study was to determine if near-IR images can be used to guide a CO2 laser for the selective removal of natural occlusal lesions on extracted teeth. Near-IR occlusal transillumination images of extracted human teeth with natural occlusal caries lesions were acquired using an InGaAs camera and near-IR light at wavelengths from 1290 to 1470-nm from a filtered tungsten halogen source. A CO2 laser operating at 9.3-μm with a pulse duration of 10-15-μs and a pulse repetition rate of 100-300-Hz was used for caries removal. Optical Coherence tomography was used to confirm lesion presence and serial scans were used to assess selective removal. Teeth were also sectioned for histological examination using polarized light microscopy. This study suggests that near-infrared transillumination is a promising method for the image guided laser ablation of occlusal caries lesions but the use of serial near-IR transillumination imaging for monitoring lesion removal was limited.
Previous studies have established that caries lesions can be imaged with high contrast without the interference of stains at near-IR wavelengths greater than 1300-nm. It has been demonstrated that computer controlled laser scanning systems utilizing IR lasers operating at high pulse repetition rates can be used for serial imaging and selective removal of caries lesions. In this study, we report our progress towards the development of algorithms for generating rasterized ablation maps from near-IR reflectance images for the removal of natural lesions from tooth occlusal surfaces. An InGaAs camera and a filtered tungsten-halogen lamp producing near-IR light in the range of 1500-1700-nm were used to collect crosspolarization reflectance images of tooth occlusal surfaces. A CO2 laser operating at a wavelength of 9.3- μm with a pulse duration of 10-15-μs was used for image-guided ablation.
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 studies have shown that near-infrared (NIR) reflectance and transillumination imaging can be used to acquire high contrast images of early caries lesions and composite restorative materials. The aim of the study was to determine the optimum NIR wavelengths for imaging demineralized areas under dental sealants. Fifteen natural human premolars and molars with occlusal lesions were used in this in vitro study. Images before and after application of sealants were acquired using NIR reflectance and NIR transillumination at wavelengths of 1300, 1460, and 1500 to 1700 nm. Images were also acquired using polarization sensitive optical coherence tomography (OCT) for comparison. The highest contrast for NIR reflectance was at 1460 nm and 1500 to 1700 nm. These NIR wavelengths are coincident with higher water absorption. The clear Delton sealant investigated was not visible in either copolarization or cross-polarization OCT images. The wavelength region between 1500 and 1700 nm yielded the highest contrast of lesions under sealants for NIR reflectance measurements.
One major advantage of composite restoration materials is that they can be color matched to the
tooth. However, this presents a challenge when composites fail and they need to be replaced. Dentists
typically spend more time repairing and replacing composites than placing new restorations. Previous
studies have shown that near-infrared imaging can be used to distinguish between sound enamel and decay
due to the differences in light scattering. The purpose of this study was to use a similar approach and
exploit differences in light scattering to attain high contrast between composite and tooth structure.
Extracted human teeth with composites (n=16) were imaged in occlusal transmission mode at wavelengths
of 1300-nm, 1460-nm and 1550-nm using an InGaAs image sensor with a tungsten halogen light source
with spectral filters. All samples were also imaged in the visible range using a high definition 3D digital
microscope. Our results indicate that NIR wavelengths at 1460-nm and 1550-nm, coincident with higher
water absorption yield the highest contrast between dental composites and tooth structure.
Previous studies have shown that near-IR reflectance and transillumination imaging can be used to acquire
high contrast images of early caries lesions and composite restorative materials. The aim of the study was
to determine the optimum near-IR wavelengths for imaging demineralized areas under dental sealants.
Fifteen natural human premolars and molars with occlusal lesions were used in this in vitro study. Images
before and after application of sealants were acquired using near-IR reflectance and near-IR
transillumination at wavelengths of 1300 nm, 1460 nm, and 1500 - 1700 nm. Images were also acquired
using polarization sensitive optical coherence tomography for comparison. The highest contrast for near-
IR reflectance was at 1460 nm and 1500 - 1700 nm. These near-IR wavelengths are coincident with higher
water absorption. The clear Delton sealant investigated was not visible in either co-polarization or crosspolarization
OCT images. The wavelength region between 1500-1700-nm yielded the highest contrast of
lesions under sealants for near-IR reflectance measurements.
KEYWORDS: Light scattering, Signal attenuation, Scattering, Absorption, Reflectivity, Dental caries, Optical coherence tomography, In vivo imaging, Teeth, Water
Light scattering in dental enamel decreases markedly from the UV to the near-IR and recent studies
employing near-IR transillumination and reflectance imaging including optical coherence tomography
indicate that this wavelength region is ideally suited for imaging dental caries due to the high transparency
of enamel. The opacity of dentin is an important factor in optimizing the contrast of demineralization in
reflectance measurements. It also influences the contrast of occlusal lesions in transillumination. Light
scattering in dentin is an order of magnitude larger than in enamel, it is highly anisotropic and has a
different spectral light scattering dependence than enamel. The objective of this study was to measure the
optical attenuation of near-IR light through dentin at near-IR wavelengths from 1300-1650-nm. In this
study the collimated transmission of near-IR light through polished thin sections of dentin of 0.05 to 0.6
mm thickness was measured. Beer-Lambert plots show that the attenuation coefficients range in
magnitude from 20 to 40 cm-1. Attenuation increased significantly with increasing wavelength and the
increases were not entirely consistent with increased water absorption.
Laser based methods are well suited for automation and can be used to selectively remove dental caries to
minimize the loss of healthy tissues and render the underlying enamel more resistant to acid dissolution.
The purpose of this study was to determine which imaging methods are best suited for image-guided
ablation of natural non-cavitated carious lesions on occlusal surfaces. Multiple caries imaging methods
were compared including near-IR and visible reflectance and quantitative light fluorescence (QLF). In
order for image-guided laser ablation to be feasible, chemical and physical modification of tooth surfaces
due to laser irradiation cannot greatly reduce the contrast between sound and demineralized dental hard
tissues. Sound and demineralized surfaces of 48 extracted human molar teeth with non-cavitated lesions
were examined. Images were acquired before and after laser irradiation using visible and near-IR
reflectance and QLF at several wavelengths. Polarization sensitive-optical coherence tomography was
used to confirm that lesions were present. The highest contrast was attained at 1460-nm and 1500-1700-nm,
wavelengths coincident with higher water absorption. The reflectance did not decrease significantly after
laser irradiation for those wavelengths.
Dental enamel is highly transparent at near-IR wavelengths and several studies have shown that these
wavelengths are well suited for optical transillumination for the detection and imaging of tooth decay. We
hypothesize that these wavelengths are also well suited for imaging cracks in teeth. Extracted teeth with
suspected cracks were imaged at several wavelengths in the near-IR from 1300-1700-nm. Extracted teeth
were also examined with optical coherence tomography to confirm the existence of suspected cracks.
Several teeth of volunteers were also imaged in vivo at 1300-nm to demonstrate clinical potential. In
addition we induced cracks in teeth using a carbon dioxide laser and imaged crack formation and
propagation in real time using near-IR transillumination. Cracks were clearly visible using near-IR imaging
at 1300-nm in both in vitro and in vivo images. Cracks and fractures also interfered with light propagation
in the tooth aiding in crack identification and assessment of depth and severity.
In a previous study, we investigated the influence of several high refractive index fluids on the performance of
polarization sensitive optical coherence tomography (PS-OCT). That study showed that these liquids can increase
the effective imaging depth and lesion contrast. Other in vitro and in vivo studies have shown that OCT can be used
to show whether occlusal lesions have penetrated to the dentinal-enamel junction (DEJ) and spread laterally under
the enamel. The purpose of this study was to determine if high index fluids can enhance the ability of OCT to detect
hidden occlusal lesions and show if these lesions have penetrated through the enamel into the underlying dentin.
Ten extracted teeth with occlusal lesions were imaged using OCT after the application of water, glycerol, BABB
(33% Benzyl Alcohol + 67% Benzyl Benzoate) and a Cargille Liquid (Cedar Grove, NJ) (hydrogenated terphenyl 1-
bromo-naphthalene) with a refractive index of 1.61. The intensity of the reflectance from the underlying lesion area
for each sample was compared with the reflectance of the sound tooth surface for each fluid. The use of high index
fluids significantly (P< 0.0001) increased the reflectivity of subsurface occlusal lesions under the surrounding sound
enamel.
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.
Previous studies have demonstrated the utility of near infrared (NIR) imaging for caries detection employing
transillumination and reflectance imaging geometries. Three intra-oral NIR imaging probes were fabricated for the
acquisition of in vivo, real time videos using a high definition InGaAs SWIR camera and near-IR broadband light
sources. Two transillumination probes provide occlusal and interproximal images using 1300-nm light where water
absorption is low and enamel manifests the highest transparency. A third reflectance probe utilizes cross polarization
and operates at >1500-nm, where water absorption is higher which reduces the reflectivity of sound tissues,
significantly increasing lesion contrast. These probes are being used in an ongoing clinical study to assess the
diagnostic performance of NIR imaging for the detection of caries lesions in teeth scheduled for extraction for
orthodontic reasons.
Since optical coherence tomography is well suited for measuring small dimensional changes on tooth surfaces it has great potential for monitoring tooth erosion. The purpose of this study was to explore different approaches for monitoring the erosion of enamel. Application of an acid resistant varnish to protect the tooth surface from erosion has proven effective for providing a reference surface for in vitro studies but has limited potential for in vivo studies. Two approaches which can potentially be used in vivo were investigated. The first approach is to measure the remaining enamel thickness, namely the distance from the tooth surface to the dentinal-enamel junction (DEJ). The second more novel approach is to irradiate the surface with a carbon dioxide laser to create a reference layer which resists erosion. Measuring the remaining enamel thickness proved challenging since the surface roughening and subsurface demineralization that commonly occurs during the erosion process can prevent resolution of the underlying DEJ. The areas irradiated by the laser manifested lower rates of erosion compared to the non-irradiated areas and this method appears promising but it is highly dependent on the severity of the acid challenge.
New methods are needed for the nondestructive measurement of tooth demineralization and remineralization and 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 present early results from two clinical studies underway to measure the effect of fluoride intervention on early lesions. CP-OCT was used to monitor early lesions on enamel and root surfaces before and after intervention with fluoride varnish. The lesion depth and internal structure were resolved for all the lesions examined and some lesions had well defined surface zones of lower reflectivity that may be indicative of arrested lesions. Changes were also noted in the structure of some of the lesions after fluoride intervention.
In vivo and in vitro studies have shown that high contrast images of tooth demineralization can be acquired in the near-IR due to the high transparency of dental enamel. The purpose of this study is to compare the lesion contrast in reflectance at near-IR wavelengths coincident with high water absorption with those in the visible, the near-IR at 1300-nm and with fluorescence measurements for early lesions in occlusal surfaces. Twenty-four human molars were used in this in vitro study. Teeth were painted with an acidresistant varnish, leaving a 4×4 mm window in the occlusal surface of each tooth exposed for demineralization. Artificial lesions were produced in the exposed windows after 1 and 2-day exposure to a demineralizing solution at pH 4.5. Lesions were imaged using NIR reflectance at 3 wavelengths, 1310, 1460 and 1600-nm using a high definition InGaAs camera. Visible light reflectance, and fluorescence with 405-nm excitation and detection at wavelengths greater than 500-nm were also used to acquire images for comparison. Crossed polarizers were used for reflectance measurements to reduce interference from specular reflectance. The contrast of both the 24 hr and 48 hr lesions were significantly higher (P<0.05) for NIR reflectance imaging at 1460-nm and 1600-nm than it was for NIR reflectance imaging at 1300-nm, visible reflectance imaging, and fluorescence. The results of this study suggest that NIR reflectance measurements at longer near-IR wavelengths coincident with higher water absorption are better suited for imaging early caries lesions.
If caries lesions are detected early enough they can be arrested by chemical intervention and dietary changes without the need for chemical intervention. Optical coherence tomography is ideally suited to monitor the changes that occur in caries lesions as a result of nonsurgical intervention, since OCT can nondestructively image the internal structure of the lesion. One of the most important changes that occurs in a lesion is preferential deposition of mineral in the outer surface zone. The deposition creates a highly mineralized and weakly scattering surface zone that is clearly visible in OCT images. Since this zone is near the highly reflective surface it is necessary to use cross-polarization OCT imaging to resolve this zone. Several CP-OCT studies have been conducted employing different remineralization models that produce lesions with varying mineral gradients. Previous studies have also demonstrated that automated algorithms can be used to assess the lesion depth and severity even with the presence of the weakly reflective surface zone. In this study we investigated the remineralization of lesions of varying severity using a pH cycling remineralization model and the change of the lesion was monitored using CP-OCT. Although the lesion depth and severity decreased after remineralization, there was still incomplete remineralization of the body of the lesion.
Previous remineralization studies employing cross polarization sensitive optical coherence tomography (CP-OCT),
have been limited to the repair of artificial enamel-like lesions. In this study we attempted to remineralize existing
occlusal lesions on extracted teeth. Lesions were imaged before and after exposure to an acidic remineralization
regimen and the integrated reflectivity and lesion depth was calculated. Automated integration routines worked well
for assessing the integrated reflectivity for the lesion areas after remineralization. Polarized light microscopy was
also used to examine the lesions areas after sectioning the teeth. An acidic remineralization solution was used to
remineralize the lesions. The integrated reflectivity significantly increased after exposure to the remineralization
solution which suggests that the acidic solution caused additional demineralization as opposed to the desired
remineralization.
Previous studies have demonstrated that polarization sensitive optical coherence tomography (PS-OCT) can
be used to image caries lesions in dentin, measure nondestructively the severity of dentin demineralization,
and determine the efficacy of intervention with anticaries agents including fluoride and lasers. However,
those studies were limited to artificial lesions on dentin and roots surfaces. The objective of this study is to
determine if a cross polarization OCT system (CP-OCT) can be used to nondestructively measure a
reduction in the reflectivity of natural root caries lesions after exposure to a remineralization solution. CPOCT
images of 11 teeth with existing root lesions were acquired before and after exposure to a
remineralizing solution for 20 days. The integrated reflectivity was calculated after integrating to a fixed
depth of 200-μm. There was a significant decrease in the integrated reflectivity after exposure to the
remineralizing solution.
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 present early
results using a new cross-polarization OCT system introduced by Santec. This system utilizes a swept laser source
and a MEMS scanner for rapid acquisition of cross polarization images. Preliminary studies show that this system is
useful for measurement of the severity of demineralization on tooth surfaces and for showing the spread of occlusal
lesions under the dentinal-enamel junction.
Near-IR (NIR) imaging is a new technology that is currently being investigated for the detection and
assessment of dental caries without the use of ionizing radiation. Several papers have been published on the
use of transillumination and reflectance NIR imaging to detect early caries in enamel. The purpose of this
study was to investigate alternative near infrared wavelengths besides 1300-nm in the range from 1200-
1600-nm to determine the wavelengths that yield the highest contrast in both transmission and reflectance
imaging modes. Artificial lesions were created on thirty tooth sections of varying thickness for
transillumination imaging. NIR images at wavelengths from the visible to 1600-nm were also acquired for
fifty-four whole teeth with occlusal lesions using a tungsten halogen lamp with several spectral filters and a
Ge-enhanced CMOS image sensor. Cavity preparations were also cut into whole teeth and Z250 composite
was used as a restorative material to determine the contrast between composite and enamel at NIR
wavelengths. Slightly longer NIR wavelengths are likely to have better performance for the
transillumination of occlusal caries lesions while 1300-nm appears best for the transillumination of
proximal surfaces. Significantly higher performance was attained at wavelengths that have higher water
absorption, namely 1460-nm and wavelengths greater than 1500-nm and these wavelength regions are
likely to be more effective for reflectance imaging. Wavelengths with higher water absorption also
provided higher contrast of composite restorations.
A thorough understanding of how polarized near-IR light is reflected from and transmitted through sound
and carious dental hard tissues is important for the development of optical imaging devices. New optical
imaging tools employing non-ionizing radiation are needed for the detection and assessment of dental
caries. 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 is reflected from the occlusal surface or transmitted
through thin sections of extracted human whole teeth. Previous near-IR imaging studies suggest that
polarization imaging can be exploited to obtain higher contrast images of early dental caries due to the
rapid depolarization of incident polarized light by the highly scattering areas of decay. In this study, the
reflectance from tooth occlusal surfaces with demineralization and transmitted light through tooth thin
sections with caries lesions were investigated. Major differences in the Mueller matrix elements were
observed in both sound and demineralized enamel. This study suggests that polarization resolved optical
imaging can be exploited to obtain higher contrast images of dental decay.
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.
It is difficult to completely remineralize carious lesions because diffusion into the interior of the lesion is inhibited
as new mineral is deposited in the outermost layers. In previous remineralization studies employing polarization
sensitive optical coherence tomography (PS-OCT), two models of remineralization were employed and in both
models there was preferential deposition of mineral in the outer most layer. In this study we attempted to
remineralize the entire lesion using an acidic remineralization model and demonstrate that this remineralization can
be monitored using PS-OCT. Artificial lesions approximately 100-150 μm in-depth were exposed to an acidic
remineralization regimen and the integrated reflectivity from the lesions was measured before and after
remineralization. Automated integration routines worked well for assessing the integrated reflectivity for the lesion
areas after remineralization. Although there was a higher degree of remineralization, there was still incomplete
remineralization of the body of the lesion.
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.
Several studies have demonstrated that polarization-sensitive optical coherence tomography (PS-OCT) can be used to
nondestructively measure the severity of demineralization in the important occlusal surfaces. The purpose of this study
was to assess the potential of PS-OCT and OCT methods for the measurement of the depth of natural occlusal carious
lesions. Teeth were screened for potential occlusal lesions using near infrared imaging (NIR). A PS-OCT system
operating at 1310-nm was used to acquire polarization resolved images of the area of interest on the occlusal surface.
The teeth were serial sectioned to 200 μm thickness and examined with polarized light microscopy (PLM) and
Transverse Microradiography (TMR) for comparison. The lesion depth measured nondestructively with PS-OCT was
compared to the lesion depth measured with PLM and TMR to assess the performance of these methods and determine
if polarization sensitivity is required. The lesion depth measured using OCT correlated well with the lesion depths
measured with TMR and PLM. Although polarization sensitivity provided better contrast it was not necessary to have
polarization sensitivity to identify deep occlusal lesions.
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.
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.
Previous studies have demonstrated that polarization-sensitive optical coherence tomography (PS-OCT) can be used to image caries lesions in dentin, measure nondestructively the severity of dentin demineralization, and determine the efficacy of intervention with anticaries agents including fluoride and lasers. The objective of this study is to determine if PS-OCT can be used to nondestructively measure a reduction in the reflectivity of dentin lesions after exposure to a remineralization solution. Although studies have shown the ability of PS-OCT to image the remineralization of lesions in enamel, none have included dentin. PS-OCT images of dentin surfaces are acquired after exposure to an artificial demineralizing solution for six days and a remineralizing solution for 20 days. The integrated reflectivity, depth of demineralization, and thickness of the layer of remineralization are calculated for each of the two treatment groups on each sample. Polarized light microscopy and microradiography are used to measure lesion severity on histological thin sections for comparison. PS-OCT successfully measured the formation of a layer of increased mineral content near the lesion surface. Polorized light microscopy (PLM) and transverse microradiography (TMR) corroborated those results. PS-OCT can be used for the nondestructive measurement of the remineralization of dentin.
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.
Reflectance and transillumination imaging show demineralization with high contrast in the near-IR. The objective of this study is to use lesion size and contrast acquired in reflectance and transillumination near-infrared imaging modes to estimate the severity of natural occlusal caries lesions. Previous studies have shown that near-infrared (NIR) light can be used to effectively image artificial carious lesions. However, its efficacy on natural lesions requires further exploration. Fifty extracted teeth with varying amounts of occlusal decay were examined using a NIR imaging system operating at 1310-nm. Image analysis software was used to calculate contrast values between sound and carious tooth structure. After imaging, teeth were histologically sampled at 1-mm intervals in order to determine lesion depth. Lesion contrast in transillumination mode significantly increased with lesion depth (p<0.001), while lesion contrast in reflectance mode did not increase. The lesion area demonstrated a significant increase with lesion severity in both imaging modes. These results suggest that lesion contrast and area can be used to estimate lesion severity in NIR images.
Digital Transverse microradiography (TMR) offers several advantages over film based methods including real-time image acquisition, excellent linearity with exposure, and it does not require expensive specialized film. The purpose of this work was to demonstrate that a high-resolution digital microradiography system can be used to measure the volume percent mineral loss for sound and demineralized enamel and dentin thin sections from 150-350-µm in thickness. A custom fabricated digital microradiography system with ~ 2-µm spatial resolution consisting of a digital x-ray imaging camera, a computerized high-speed motion control system and a high-intensity copper Kα x-ray source was used to determine the volume percent mineral content of sound and demineralized tooth sections. The volume percent mineral loss was compared with cross-sectional microhardness measurements on sound extracted human teeth. The correlation between microhardness and microradiography was excellent (Pr=0.99) for section thickness ranging from 59-319-µm (n=11). The attenuation was linear with varying exposure time from 1-10 seconds. Digital TMR is an effective and rapid method for the assessment of the mineral content of enamel and dentin thin sections.
Several studies have demonstrated that polarization sensitive optical coherence tomography (PS-OCT) can be used to nondestructively measure the severity of subsurface demineralization in enamel and dentin. The reflectivity in the polarization state orthogonal to the initial linear polarization incident on the tissue is low at sound tissues interfaces and high in demineralized areas that strongly scatter and depolarize the light. The purpose of this study was to develop improved algorithms for assessing the depth and severity of demineralization from PS-OCT scans for use with 2D and 3D tomographic images. Subsurface caries-like lesions of increasing depth and severity were produced in adjoining windows on ten bovine enamel samples by exposure to demineralization over periods of 1 to 4 days. Each sample also had a sound window to be used as a control. PS-OCT scans were acquired for each sample and analyzed using various methods to calculate the lesion depth and area. Algorithms were developed and used to automatically detect the lesion depth and area, and calculate the volume for improved assessment of lesion severity. Both fixed-depth and automatic edge-finding algorithms were able to detect significant differences between each of the days and sound enamel. The lesion depth and mineral loss were also measured with polarized light microscopy and transverse microradiography after sectioning the teeth. Mean lesion depths ranged from 40 to 100 µm. This demonstrates the edge-finding algorithm can be used to automatically determine the depth and severity of early lesions for the rapid analysis of PS-OCT images.
Previous studies have demonstrated that polarization sensitive optical coherence tomography (PS-OCT) can be used to image natural root caries lesions, measure non-destructively the severity of dentin demineralization and determine the efficacy of intervention with anti-caries agents including fluoride and lasers. The objective of this study was to determine if PS-OCT could be used to nondestructively measure the formation of a layer of remineralized dentin on the surface of dentin lesions after exposure to a remineralization solution. In this study images of artificial dentin lesions on extracted human teeth were acquired using PS-OCT after exposure to an artificial demineralizing solution at pH 4.9 for six days and after subsequent exposure to a remineralizing solution at pH 7.0 for 20 days. Polarized light microscopy and microradiography were used to examine histological thin sections from the samples for comparison. PS-OCT successfully measured the formation of a layer of increased mineral content near the lesion surface. PLM and TMR corroborated those results. This study demonstrates the potential use of PS-OCT for the nondestructive measurement of the remineralization of dentin surfaces.
Studies have shown that lasers can be used to modify the chemical composition of tooth enamel to render it less soluble. The purpose of this study was to determine if polarization-sensitive optical coherence tomography (PS-OCT) can be used to nondestructively assess the inhibition of demineralization after CO2 laser irradiation. Human and bovine enamel specimens were irradiated by a microsecond pulsed CO2 laser operating at a wavelength of 9.3 µm. Some specimen areas were also treated with topical fluoride to create six treatment groups on each sample, including protected surface (no demineralization), protected +laser, laser, fluoride, laser+fluoride, and unprotected surface. Samples were placed in an artificial demineralization solution to create lesions approximately 100–200 µm in depth and were subsequently scanned with a PS-OCT system to assess lesion severity before sectioning for analysis by polarized light microscopy and transverse microradiography for comparison. PS-OCT was able to measure a significant reduction in the integrated reflectivity due to inhibition by the laser on both human and bovine enamel even though the laser modification of the enamel surface did cause an increase in reflectivity and decrease in optical penetration. This study shows that the PS-OCT is well suited for the clinical assessment of caries inhibition after laser treatments.
Polarization-sensitive optical coherence tomography (PS-OCT) and near-infrared (NIR) imaging are promising new technologies under development for monitoring early carious lesions. Fluorosis is a growing problem in the United States, and the more prevalent mild fluorosis can be visually mistaken for early enamel demineralization. Unfortunately, there is little quantitative information available regarding the differences in optical properties of sound enamel, enamel developmental defects, and caries. Thirty extracted human teeth with various degrees of suspected fluorosis were imaged using PS-OCT and NIR. An InGaAs camera and a NIR diode laser were used to measure the optical attenuation through transverse tooth sections (~200 µm). A digital microradiography system was used to quantify the enamel defect severity by measurement of the relative mineral loss for comparison with optical scattering measurements. Developmental defects were clearly visible in the polarization-resolved OCT images, demonstrating that PS-OCT can be used to nondestructively measure the depth and possible severity of the defects. Enamel defects on whole teeth that could be imaged with high contrast with visible light were transparent in the NIR. This study suggests that PS-OCT and NIR methods may potentially be used as tools to assess the severity and extent of enamel defects.
Previous studies have demonstrated that Polarization Sensitive Optical Coherence Tomography (PS-OCT) can be used
to image the remineralization of early artificial caries lesions. However, the depth resolution of the imaging system
employed in those previous studies was limited and the outer surface structure of the lesions were not resolved as
clearly as desired. The purpose of this study was to repeat the earlier remineralization study using a broadband light-source
of higher resolution to determine if there can be improved resolution of the remineralized surface zones of the
lesions. An all polarization-maintaining fiber based PS-OCT system operating at 1310-nm was used to acquire
polarization resolved images of bovine enamel surfaces exposed to a demineralizing solution at pH-4.9 followed by a
fluoride containing remineralizing solution at pH-7.0 containing 2-ppm fluoride. The structure of surface zones could be
clearly resolved in the samples that remineralized using PS-OCT. PS-OCT measured 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 was also measured with polarized light microscopy and
transverse microradiography after sectioning the enamel blocks. These results show that PS-OCT can be used to non-destructively
monitor the remineralization potential of anti-caries agents.
The purpose of this study was to assess the potential of polarization sensitive optical coherence tomography (PS-OCT) to measure non-destructively the severity of natural and artificial caries lesions in dentin and determine the efficacy of intervention with anti-caries agents. Although several studies have demonstrated the utility of PS-OCT to image caries lesions in enamel and quantify the lesion severity, only a few studies have focused on lesions in dentin. In this study images of natural root caries lesions on extracted human teeth were acquired with PS-OCT. In addition artificial lesions were produced in dentin after 12 days of exposure to a demineralization solution at a pH of 5.0. Before exposure, three incisions were made on the sample surfaces using Er:YAG laser irradiation and selected areas were treated with topical fluoride. PS-OCT images were acquired using a high power (45-mw) 1310-nm superluminescent diode with a bandwidth of 35-nm. PS-OCT was able to measure demineralization in dentin to a depth of ~ 1 mm. Polarized light microscopy and microradiography were used to measure lesion severity on histological thin sections for comparison. PS-OCT successfully measured the inhibition of demineralization by topical fluoride. Er:YAG laser irradiation did not significantly increase or decrease the rate of dentin demineralization.
Several studies have shown that lasers can be used to modify the surface morphology and chemical composition of
tooth enamel to render it less soluble. Other studies have shown that Polarization Sensitive Optical Coherence
Tomography (PS-OCT) can be used to non-destructively measure the efficacy of fluoride in inhibiting the
development of artificial caries lesions. The purpose of this study was to determine if PS-OCT can be used to
measure inhibition of enamel demineralization after CO2 laser irradiation. Polarized light microscopy and
microradiography were used to measure lesion severity on histological thin sections for comparison. PS-OCT was
able to measure a significant reduction in the integrated reflectivity due to inhibition by the laser even though the
laser modification of the enamel surface caused a slight increase in reflectivity. This study shows that the PS-OCT
is well-suited for in vivo measurements of caries inhibition after laser treatments.
Near-IR (NIR) imaging can be used to view the formation of ablation craters during laser ablation since the enamel of the tooth is almost completely transparent near 1310-nm1. Laser ablation craters can be monitored under varying irradiation conditions to assess peripheral thermal and transient-stress induced damage, measure the rate and efficiency of ablation and provide insight into the ablation mechanism. There are fundamental differences in the mechanism of enamel ablation using erbium lasers versus carbon dioxide laser systems due to the nature of the primary absorber and it is necessary to have water present on the tooth surface for efficient ablation at erbium laser wavelengths. In this study, sound human tooth sections of approximately 2-3-mm thickness were irradiated by free running and Q-switched Er:YAG & Er:YSGG lasers under varying conditions with and without a water spray. The incision area in the interior of each sample was imaged using a tungsten-halogen lamp with a band-pass filter centered at 1310-nm combined with an InGaAs area camera with a NIR zoom microscope. Obvious differences in the crater evolution were observed between CO2 and erbium lasers. Ablation stalled after a few laser pulses without a water spray as anticipated. Efficient ablation was re-initiated by resuming the water spray. Micro-fractures were continuously produced apparently driven along prism lines during multi-pulse ablation. These fractures or fissures appeared to merge together as the crater evolved to form the leading edge of the ablation crater. These observations support the proposed thermo-mechanical mechanisms of erbium laser involving the strong mechanical forces generated by selective absorption by water.
Polarization sensitive optical coherence tomography (PS-OCT) and near-IR (NIR) imaging are promising new
technologies under development for monitoring early carious lesions. Fluorosis is a growing problem in the U.S.,
and the more prevalent mild fluorosis can be visually mistaken for early enamel demineralization. Some initial NIR
images suggest that enamel defects and dental caries manifest different optical behavior in the NIR. Unfortunately,
there is little quantitative information available regarding the differences in optical properties of sound enamel,
enamel developmental defects, and demineralized enamel due to caries. This study tested the hypothesis that
hypomineralized enamel due to fluorosis can be differentiated from demineralized enamel due to caries using NIR
and PS-OCT imaging because of different optical behavior in the NIR. Thirty extracted human teeth with various
degrees of suspected fluorosis and/or caries were imaged using PS-OCT and NIR transillumination. An InGaAs
camera and a near-IR diode laser were used to measure the optical attenuation through transverse tooth sections
(~200 &mgr;m). Developmental defects were clearly visible in the polarization-resolved OCT images, demonstrating
that PS-OCT can be used to nondestructively measure the depth and possible severity of the defects. Enamel defects
on whole teeth that could be imaged with high contrast with visible light were transparent in the near-IR while
demineralized areas due to caries were opaque. In contrast, dental caries could be clearly distinguished from sound
enamel. This study suggests that PS-OCT and NIR methods may potentially be used as tools to assess the severity
and extent of enamel defects and for the differentiation of mild fluorosis defects from early carious lesions.
We have shown that the enamel of the tooth is almost completely transparent near 1310-nm in the near-infrared and
that near-IR (NIR) imaging has considerable potential for the optical discrimination of sound and demineralized
tissue and for observing defects in the interior of the tooth. Lasers are now routinely used for many applications in
dentistry including the ablation of dental caries. The objective of this study was to test the hypothesis that real-time
NIR imaging can be used to monitor laser-ablation under varying conditions to assess peripheral thermal and
transient-stress induced damage and to measure the rate and efficiency of ablation. Moreover, NIR imaging may
have considerable potential for monitoring the removal of demineralized areas of the tooth during cavity
preparations. Sound human tooth sections of approximately 3-mm thickness were irradiated by a CO2 laser under
varying conditions with and without a water spray. The incision area in the interior of each sample was imaged
using a tungsten-halogen lamp with band-pass filter centered at 131--nm combined with an InGaAs focal plane
array with a NIR zoom microscope in transillumination. Due to the high transparency of enamel at 1310-nm, laser-incisions
were clearly visible to the dentin-enamel junction and crack formation, dehydration and irreversible
thermal changes were observed during ablation. This study showed that there is great potential for near-IR imaging
to monitor laser-ablation events in real-time to: assess safe laser operating parameters by imaging thermal and
stress-induced damage, elaborate the mechanisms involved in ablation such as dehydration, and monitor the
removal of demineralized enamel.
Previous studies have demonstrated that Polarization Sensitive Optical Coherence Tomography (PS-OCT) can be used
to image early dental caries. The purpose of this study was to compare the measured integrated reflectivity of natural
caries lesions with the mineral loss measured using digital microradiography in order to determine if PS-OCT can be
used as a nondestructive in vivo method to measure the severity of dental decay in the important occlusal surfaces. A
PS-OCT system operating at 1310-nm was used to acquire polarization resolved images of natural caries lesions on the
occlusal surfaces of extracted teeth. The integrated reflectivity from lesion areas was compared to the integrated
mineral loss from the same lesion area measured using digital microradiography. There was a strong correlation
between the integrated mineral loss of the caries lesion measured using high resolution digital microradiography and the
integrated reflectivity in the perpendicular polarization axis of the PS-OCT system demonstrating the potential for this
method to nondestructively monitor the severity of caries lesion in the occlusal pit and fissure where most new decay is
found. Although we find these results encouraging, we desire a higher correlation between the integrated mineral loss
and the integrated reflectivity and we believe a higher correlation is attainable with better matching of the PS-OCT
scans and the histological thin sections.
A fundamental understanding of how near-IR light propagates through sound and carious dental hard tissues is essential for the development of clinically useful optical diagnostic systems, since image contrast is based on changes in the optical properties of these tissues on demineralization. During the caries (decay) process, micropores are formed in the lesion due to partial dissolution of the individual mineral crystals. Such small pores behave as scattering centers, strongly scattering visible and near-IR light. The optical properties of enamel can be quantitatively described by the absorption and scattering coefficients, and the scattering phase function. Our aim is to measure the optical scattering behavior of natural and artificial enamel caries. Near-IR attenuation measurements and angular-resolved goniometer measurements coupled with Monte Carlo simulations are used to determine changes in the scattering coefficient and the scattering anisotropy on demineralization at 1310 nm. An ultra-high resolution digital microradiography system is used to quantify the lesion severity by measurement of the relative mineral loss for comparison with optical scattering measurements. The scattering coefficient increases exponentially with increasing mineral loss. Natural and artificial demineralization increases the scattering coefficient more than two orders of magnitude at 1310 nm, and the scattering is highly forward directed.
Previous studies have demonstrated that Polarization Sensitive Optical Coherence Tomography (PS-OCT) can be used
to image early dental caries. The primary objective of this study was to compare the measured reflectivity of natural
occlusal caries lesions with the relative mineral loss measured using digital microradiography. There was excellent
agreement between the increase in the integrated reflectivity in the perpendicular polarization axis of the PS-OCT
system and the increase in the integrated mineral loss or lesion severity for occlusal lesions. Therefore, PS-OCT is
ideally suited to image natural caries lesions in the important occlusal surfaces for the assessment of the lesion severity
and activity. A secondary objective was to compare the performance of a new autocorrelator-based PS-OCT system
employing a novel polarization-switching probe with our polarization-maintaining fiber based PS-OCT system, both
operating at 1310-nm. The new PS-OCT system produced clean images with no artifacts and achieved high
penetration depth. Yet a third objective was to determine if interproximal lesions can be imaged from the occlusal
surface (from above) since interproximal lesions may only be accessible in vivo from buccal or lingual surfaces or from
the occlusal surface. Simulated and natural interproximal caries lesions were imaged from the occlusal surfaces as long
as there was no intervening dentin.
Dental enamel manifests high transparency in the near-IR (NIR). Our previous work demonstrated that NIR
light at 1310-nm is ideally suited for the transillumination of interproximal dental caries (dental decay in
between teeth) and that it can also be used to image decay in the pits and fissures of the occlusal (biting)
surfaces of posterior teeth where most new dental decay occurs. Early occlusal lesions cannot be detected
by x-rays during the early stages of lesion development due to the overlapping topography of the crown of
the tooth. Stains and non-calcified plaque are not visible in the NIR enabling better discrimination of
demineralized areas. We also demonstrate that interproximal lesions can be imaged from the occlusal
surface (from above). Moreover, multiple illumination and detector angles can be exploited for optimal
contrast between caries and sound tissue. These measurements suggest that NIR imaging offers significant
advantages over the conventional visual, tactile and radiographic caries detection methods and other optical
caries detection and imaging techniques.
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. Stokes
polarimetry was used to monitor the state of polarization (SOP) and degree of polarization (DOP) of
incident linearly and circularly polarized light as it propagates through extracted human whole teeth, thin
tooth sections and single apatite crystals. These measurements at 1310-nm suggest that the DOP is
maintained through sound tooth enamel and transparent dentin and that circularly polarized light is
typically depolarized more rapidly than linearly light. Polarized light is rapidly depolarized by
demineralized enamel and sound and demineralized dentin. The rapid depolarization of polarized light by
dental caries in the near-IR provides high contrast for caries imaging and detection.
Polarization-sensitive optical coherence tomography (PS-OCT) is potentially useful for imaging the nonsurgical remineralization of dental enamel. This study uses an all-fiber-based PS-OCT system operating at 1310 nm to image demineralized and fluoride-enhanced remineralized artificial lesions. PS-OCT images of lesions before and after remineralization are compared with the relative mineral loss Z (%vol×µm), obtained from high resolution digital microradiography (DM), and chemical composition changes by infrared spectroscopy. Severe early artificial caries show a significant increase in perpendicular-axis integrated reflectivity after remineralization. After sectioning the samples, DM demonstrates that the lesions remineralized with new mineral and the lesion surface zone show significant restoration of mineral volume. PS-OCT and DM both do not show a major change in lesion depth. For less severe artificial caries, the perpendicular-axis image resolves the scattering and depolarization of an outer growth layer after remineralization. This outer layer has a mineral volume close to that of sound enamel, and spectroscopic analysis indicates that the layer is a highly crystalline phase of apatite, without carbonate substitutions that increase the solubility of sound enamel. This study determines that PS-OCT can image the effects of fluoride-enhanced remineralization of mild and severe early artificial in vitro caries.
A fundamental understanding of how near-IR light propagates through sound and carious dental hard tissues is essential for the development of clinically useful optical diagnostic systems, since image contrast is based on changes in the optical properties of these tissues upon demineralization. The optical properties of enamel can be quantitatively described by defining the optical constants, the absorption and scattering coefficients, and the scattering phase function. Our aim was to measure the optical scattering properties of natural enamel caries. Near-IR attenuation measurements and angular-resolved goniometer measurements coupled with Monte Carlo simulations were used to determine the optical properties of natural lesions. An ultra-high resolution digital microradiography system was used to quantify the lesion severity by measurement of the relative mineral loss for comparison with optical scattering measurements. Natural demineralization increases the scattering coefficient more than two orders of magnitude at 1310-nm and the scattering is highly forward directed.
Previous studies have demonstrated that Polarization Sensitive Optical Coherence Tomography (PS-OCT) can be used to image early dental caries. The purpose of this study was to compare the measured reflectivity of natural caries lesions with the mineral loss measured using digital microradiography. An all polarization-maintaining fiber based PS-OCT system operating at 1310-nm was used to acquire polarization resolved images of natural white spot lesions and pigmented lesions on the smooth surfaces of extracted teeth. There was a strong positive correlation between the increase in the integrated reflectivity in the perpendicular polarization axis of the PS-OCT system and the increase in the integrated mineral loss or lesion severity for both white-spot and pigmented lesions, P <0.001. Therefore, PS-OCT is well-suited to assess the severity of natural caries lesions and resolve the internal structure of early caries lesions for the potential assessment of the lesion activity.
The first step towards the development of clinically useful optical diagnostic systems is achieving a fundamental understanding of how light propagates through the tooth. The optical properties of dental hard tissue needed to describe light propagation in those tissues have not been determined in the near-IR. Although it is well known that the overall magnitude of light scattering increases due to demineralization of tooth enamel and dentin, the specific nature of those changes, namely quantitative changes in the optical constants and the scattering phase function have not been determined. The objective of this study was to determine the changes in the optical constants and the scattering anisotropy of dental enamel after artificial demineralization at 1310-nm. During the caries process micropores are formed in the lesion due to partial dissolution of the individual mineral crystals. Such small pores are likely to behave as scattering centers, strongly scattering visible and near-IR light. In this study, demineralization increased the scattering coefficient more than two orders of magnitude at 1310-nm and the scattering due to the scattering centers (micropores) is highly forward directed.
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