Chulsung Lee

Nondestructive Assessment of Early Tooth Demineralization Using Cross-Polarization Optical Coherence Tomography

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 anticaries 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, a review of the use of polarization-sensitive-OCT for the measurement of tooth demineralization is provided along with some recent results regarding improved methods for the detection of caries lesions in the earliest stages of development. Automated methods of analysis were used to measure the depth and severity of demineralized bovine enamel produced using simulated caries models that emulate 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.

Polarization-sensitive optical coherence tomographic imaging of artificial demineralization on exposed surfaces of tooth roots.

BACKGROUND AND OBJECTIVES The purpose of this study was to assess the potential of polarization-sensitive optical coherence tomography (PS-OCT) to non-destructively measure the depth and severity of artificial demineralization on exposed root surfaces and measure the degree of inhibition by topical fluoride. Although PS-OCT imaging studies have demonstrated the utility of PS-OCT for imaging carious lesions on enamel and dentin surfaces the influence of the cementum layer that is present on intact root surfaces has not been investigated. MATERIALS AND METHODS In this study, extracted human tooth roots were partitioned into three sections with one partition treated with topical fluoride, one partition protected from demineralization with acid resistant varnish, and one partition exposed to a demineralization solution, producing artificial lesions approximately 200-mum deep in root dentin. The lesion depth, remaining cementum thickness and the integrated reflectivity for lesion areas were measured with PS-OCT. These measurements were also compared with more established methods of measuring demineralization, namely transverse microradiography (TMR) and polarized light microscopy (PLM). RESULTS PS-OCT was able to measure a significant increase in the reflectivity between lesion areas and sound root surfaces. In contrast to dentin, the cementum layer manifests minimal reflectivity in the PS-OCT images allowing non-destructive measurement of the remaining cementum thickness. The reflectivity of the cementum layer did not increase significantly after substantial demineralization, however it did manifest considerable shrinkage in a fashion similar to dentin and that shrinkage could be measured with OCT. SIGNIFICANCE This study demonstrates that PS-OCT can be used to measure demineralization non-destructively on root surfaces and assess inhibition of demineralization by anti-caries agents.

Clinical assessment of early tooth demineralization using polarization sensitive optical coherence tomography

The aims of this study were to test the hypothesis that polarization sensitive‐optical coherence tomography (PS‐OCT) can be used to non‐destructively measure and quantify the severity of the early demineralization of enamel on buccal and occlusal surfaces and assess the inhibitory effect of fluoride varnish in vivo.

In vivo near-IR imaging of approximal dental decay at 1,310 nm.

The high transparency of dental enamel in the near‐IR (NIR) light at 1,310‐nm can be exploited for imaging dental caries without the use of ionizing radiation (X‐rays). We present the results of the first in vivo imaging study in which NIR images were acquired of approximal contact surfaces.

In vivo Near-IR Imaging of Occlusal Lesions at 1310-nm

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.

Influence of wavelength and pulse duration on peripheral thermal and mechanical damage to dentin and alveolar bone during IR laser ablation

The objective of this study was to measure the peripheral thermal damage produced during the laser ablation of alveolar bone and dentin for clinically relevant IR laser systems. Previous studies have demonstrated that a char layer produced around the laser incision site can inhibit the wound healing process. Moreover, in the case of dentin, a char layer is unsightly and is difficult to bond to with restorative materials. Thermal damage was assessed using polarized light microscopy for laser pulse widths from 500 ns to 300 microseconds at 2.94 micrometer and 9.6 micrometer. Water- cooling was not employed to alleviate thermal damage during the laser irradiation. At 9.6 micrometer, minimal thermal damage was observed for pulse widths on the order of the thermal relaxation time of the deposited laser energy in the tissue, 3 - 4 microseconds, and peripheral thermal damage increased with increasing pulse duration. At 2.94 micrometer, thermal damage was minimal for the Q-switched (500 ns) laser system. This study shows that 9.6 micrometer CO2 laser pulses with pulse widths of 5 - 10 microseconds are well suited for the efficient ablation of dentin and bone with minimal peripheral damage. This work was supported by NIH/NIDCR R29DE12091.

In vitro near-infrared imaging of occlusal dental caries using germanium enhanced CMOS camera

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.

Imaging early demineralization with PS-OCT.

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.

Near-IR polarization imaging of sound and carious dental enamel

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.

Dentin bond strength after ablation using a CO2 laser operating at high pulse repetition rates

Pulsed CO2 lasers show great promise for the rapid and efficient ablation of dental hard tissues. Our objective was to demonstrate that CO2 lasers operated at high repetition rates can be used for the rapid removal of dentin without excessive thermal damage and without compromising adhesion to restorative materials. Human dentin samples (3x3mm2) were rapidly ablated with a pulsed CO2 laser operating at a wavelength of 9.3-µm, pulse repetition rate of 300-Hz and an irradiation intensity of 18-J/cm2. The bond strength to composite was determined by the modified single plane shear test. There were 8 test groups each containing 10 blocks: negative control (non-irradiated non-etched), positive control (non-irradiated acid-etched), and six laser treated groups (three etched and three non-etched sets). The first and second etched and non-etched sets were ablated at a speed of 25 mm/sec and 50 mm/sec with water, respectively. The third set was also ablated at 50 mm/sec without application of water during laser irradiation. Minimal thermal damage was observed on the dentin surfaces for which water cooling was applied. Bond strengths exceeded 20 MPa for laser treated surfaces that were acid-etched after ablation (25-mm/sec: 29.9-MPa, 50-mm/sec: 21.3-MPa). The water-cooled etched laser groups all produced significantly stronger bonds than the negative control (p<0.001) and a lower bond strength than the positive control (p<0.05). These measurements demonstrate that dentin surfaces can be rapidly ablated by a CO2 lasers with minimal peripheral thermal damage. Additional studies are needed to determine if a lower bond strength than the acid-etched control samples is clinically significant where durability of these bonded restoration supersedes high bond strength.