Ana Marly Araújo Maia

Evaluation of two imaging techniques: near-infrared transillumination and dental radiographs for the detection of early approximal enamel caries

OBJECTIVES The aim of this paper was to evaluate a transillumination (TI) system using near-infrared (NIR) light and bitewing radiographs for the detection of early approximal enamel caries lesions. METHODS Mesiodistal sections of teeth (n = 14) were cut with various thicknesses from 1.5 mm to 4.75 mm. Both sides of each section were included, 17 approximal surfaces with natural enamel caries and 11 surfaces considered intact. The approximal surfaces were illuminated by NIR light and X-ray. Captured images were analysed by two calibrated specialists in radiology, and re-analysed after 6 months using stereomicroscope images as a gold standard. RESULTS The interexaminer reliability (Kappa test statistic) for the NIR TI technique showed moderate agreement on first (0.55) and second (0.48) evaluation, and low agreement for bitewing radiographs on first (0.26) and second (0.32) evaluation. In terms of accuracy, the sensitivity for the NIR TI system was 0.88 and the specificity was 0.72. For the bitewing radiographs the sensitivity ranged from 0.35 to 0.53 and the specificity ranged from 0.50 to 0.72. CONCLUSION In the same samples and conditions tested, NIR TI images showed reliability and the enamel caries surfaces were better identified than on dental radiographs.

Characterization of enamel in primary teeth by optical coherence tomography for assessment of dental caries.

BACKGROUND Caries is a disease that affects both primary and permanent dentitions, therefore new methods of caries diagnosis need to be tested on primary teeth as well as on permanent teeth. AIM This study reports the application of optical coherence tomography (OCT) to characterize sound dental structure and detect natural caries of human primary teeth. DESIGN Six primary teeth were sectioned into thin slices ( approximately 1.5 mm), and analysed perpendicular to the enamel surface by two home-made OCT systems operating around 1280 and 840 nm. The generated images were compared with histology as the gold standard. RESULTS We demonstrated the efficacy of the OCT technique to measure the depth of the enamel layer, whose result was statistically compared with histology (P = 0.823; P > 0.05) with good agreement. We also determined, through measurement of contrast values, an increase in backscattered intensity of the order of two to three times between sound and caries regions. CONCLUSIONS We employed OCT generated images to characterize the enamel layer. The technique showed great potential to be used on paediatric dentistry clinical on early caries detection with no pain, as it is a noninvasive method.

Optical Coherence Tomography as an Auxiliary Tool for the Screening of Radiation-Related Caries

OBJECTIVE The aim of this study was to evaluate the morphological alterations of radiation-related caries using optical coherence tomography. METHODS Thirty-six extracted teeth from 11 patients who had undergone radiotherapy were sectioned in the sagittal axis in the center of the carious lesion, and 100 μm thick sections were obtained from each specimen. One sample from each tooth was investigated by an optical coherence tomography (OCT) system, and the results were compared with histological images from polarized light microscopy. RESULTS In OCT dentin caries images, the demineralized area appeared as a white region, whereas the translucent zone appeared as a dark area, a similar pattern also seen in coronal caries. In noncavitated enamel lesions clinically observed as brown discoloration, the area of high porosity, and also the dark color, absorbs part of the light, resulting in a dark pattern. Finally, the involvement of dentin-enamel junction (DEJ) or cement-enamel junction (CEJ) could be clearly observed, when present and marked alterations along the CEJ could be noted, as junction continuity loss, gap formation, and mineral loss tissue. CONCLUSIONS The OCT technique was able to characterize radiation-related caries, from a morphological point of view. Also demonstrated was its potential benefit for use in the clinical monitoring of radiation-related carious process.

In vitro imaging of remaining dentin and pulp chamber by optical coherence tomography: comparison between 850 and 1280 nm.

We report the application of optical coherence tomography (OCT) to generate images of the remaining dentin and pulp chamber of in vitro human teeth. Bidimensional images of remaining dentin and of the pulp chamber were obtained parallel to the long axis of the teeth, by two OCT systems operating around 1280 and 850 nm, and compared to tomography images using the i-CAT(R) Cone Beam Volumetric Tomography system as the gold standard. The results demonstrated the efficacy of the OCT technique; furthermore, the wavelength close to 1280 nm presented greater penetration depth in the dentine than 850 nm, as expected from scattering and absorption coefficients. The OCT technique has great potential to be used on clinical practice, preventing accidental exposure of the pulp and promoting preventive restoration treatment.

Evaluation of dental enamel caries assessment using Quantitative Light Induced Fluorescence and Optical Coherence Tomography.

An in vitro study of morphological alterations between sound dental structure and artificially induced white spot lesions in human teeth, was performed through the loss of fluorescence by Quantitative Light-Induced Fluorescence (QLF) and the alterations of the light attenuation coefficient by Optical Coherence Tomography (OCT). To analyze the OCT images using a commercially available system, a special algorithm was applied, whereas the QLF images were analyzed using the software available in the commercial system employed. When analyzing the sound region against white spot lesions region by QLF, a reduction in the fluorescence intensity was observed, whilst an increase of light attenuation by the OCT system occurred. Comparison of the percentage of alteration between optical properties of sound and artificial enamel caries regions showed that OCT processed images through the attenuation of light enhanced the tooth optical alterations more than fluorescence detected by QLF System. QLF versus OCT imaging of enamel caries: a photonics assessment.

Near-infrared transillumination of teeth: measurement of a system performance

Transillumination (TI) of dental enamel with near-infrared light is a promising nonionizing imaging method for detection of early caries lesion. Increased mineral loss (caries lesion) leads to increased scattering and absorption. Caries thus appear as dark regions because less light reaches the detector. The aim of this work was to characterize the performance of a TI system from the resolution of acquired images using the modulation transfer function at two wavelengths, 1.28 and 1.4 mum. Test charts with various values of spatial periods, mimicking a perfect caries lesion, were attached to tooth sections, followed by capture of the transmitted image, using both wavelengths. The sections were then consecutively reduced in thickness, and a sequence of all sizes of the test charts were used for repeatedly imaging procedures. The results show that the TI system can detect feature size of 250 mum with 30% modulation. From the information about how the image degrades as it propagates through enamel, we also examined the possibility of estimating the position of a simulated approximal caries lesion by comparing images obtained from the two sides of a tooth section.

Enamel Erosion and Prevention Efficacy Characterized by Confocal Laser Scanning Microscope

The aim of this study was to evaluate the erosion‐inhibiting effect of two toothpastes on the development of erosion‐like lesions, by a confocal laser scanning microscope (CLSM). Forty human enamel blocks were divided into five groups (n = 8), in accordance to evaluate the GC MI Paste Plus and Oral B with stannous fluoride, applied as slurries and associated with toothbrush. Specimens were submitted to an erosion challenge from citric acid (0.5%, pH = 2.8), for 5 min, six times a day, alternating in artificial saliva immersions. Reference group was not exposed to treatment. Part of specimens (Groups 02 and 03) was exposed twice daily just to slurries, for 2 min, therefore specimens from Groups 04 and 05 were also abraded, for 30 s. The enamel surfaces were morphological characterized using CLSM images, with mineral loss being measured using the resulting 3D images referenced to an un‐challenged portion of the sample. Step values were compared using the one‐way ANOVA test. CLSM was shown to be a viable, noncontact, and simple technique to characterize eroded surfaces. The statistical difference in the step size was significant between the groups (P = 0.001) and using multiple comparisons a statistically significant protective effect of toothpastes was shown when these were applied as slurries. Although groups submitted to tooth brush showed mineral loss similar to reference control group, due to the damages of abrasion associated. Microsc. Res. Tech. 77:439–445, 2014.

Evaluation of sensibility and specificity of NIR transillumination for early enamel caries detection - An in vitro study

Proximal surface lesions are not very often detected by X-Ray examination, suggesting the predominance of a subjective diagnosis on the part of the dentist. Since the magnitude of light scattering within the tooth decreases exponentially at longer wavelengths[1], evaluation of transillumination by near infra red lasers is a new alternative non-invasive technique [2] to detect and quantify demineralization of lesions.

Mitigation of enamel erosion using commercial toothpastes evaluated with optical coherence tomography

The aim of this study was to evaluate the efficacy of commercial toothpastes containing sodium fluoride (NaF), stannous fluoride (SnF2), or casein phosphopeptides (CPP)-amorphous calcium phosphate (ACP)/NaF regarding their potential to inhibit enamel erosion. Twenty-eight 4×4 mm enamel specimens were randomly allocated into 4 groups (n=7): negative control; Pronamel (NaF); Pro Health (SnF2/NaF); Mi Paste Plus (CPP-ACP/NaF). Erosive cycles with 0.5% citric acid, 5 times, 3 minutes/day for 7 days were performed. After the first and last cycle of each day, toothpaste slurries were applied for 2 min. The quantitative analysis was accomplished using Contact Profilometry and Optical Coherence Tomography (OCT), complemented by roughness and qualitative scanning electron microscopy (SEM) analysis. OCT and Profilometry analysis showed similar effectiveness in measuring the reduction of mineral loss. A significant increase in the mean roughness values was observed on eroded surface and also on treated surface as revealed by scanning electron microscopy. The use of SnF2/NaF toothpaste was the most effective method for reducing mineral loss. As quantitative methods, OCT and Contact Profilometry showed no statistical differences. OCT, which was used for this purpose for the first time, has the advantage of being noninvasive, and therefore have the potential for clinical application.