Raymond J. Jeon

Nonintrusive, noncontacting frequency-domain photothermal radiometry and luminescence depth profilometry of carious and artificial subsurface lesions in human teeth

Nonintrusive, noncontacting frequency-domain photothermal radiometry (FD-PTR or PTR) and frequency-domain luminescence (FD-LUM or LUM) have been used with 659-nm and 830-nm laser sources to detect artificial and natural subsurface defects in human teeth. The major findings of this study are (1) PTR is sensitive to very deep (>5 mm) defects at low modulation frequencies (5 Hz). Both PTR and LUM amplitudes exhibit a peak at tooth thicknesses of ca. 1.4 to 2.7 mm. Furthermore, the LUM amplitude exhibits a small trough at ca. 2.5 to 3.5 mm. (2) PTR is sensitive to various defects such as a deep carious lesion, a demineralized area, an edge, a crack, and a surface stain, while LUM exhibits low sensitivity and spatial resolution. (3) PTR frequency scans over the surface of a fissure into demineralized enamel and dentin show higher amplitude than those for healthy teeth, as well as a pronounced curvature in both the amplitude and phase signal channels. These can be excellent markers for the diagnosis of subsurface carious lesions. (4) PTR amplitude frequency scans over the surface of enamels of variable thickness exhibit strong thickness dependence, thus establishing depth profilometric sensitivity to subsurface interfaces such as the dentin/enamel junction.

Diagnosis of Pit and Fissure Caries Using Frequency-Domain Infrared Photothermal Radiometry and Modulated Laser Luminescence

Non-intrusive, non-contacting frequency-domain photothermal radiometry (FD-PTR or PTR) and frequency-domain luminescence (FD-LUM or LUM) have been used with 659- and 830-nm laser sources to assess the pits and fissures on the occlusal surfaces of human teeth. Fifty-two human teeth were examined with simultaneous measurements of PTR and LUM and were compared to conventional diagnostic methods including continuous (dc) luminescence (DIAGNOdent), visual inspection and radiographs. To compare each method to the others, sensitivities and specificities were calculated by using histological observations as the gold standard. With the combined criteria of four PTR and LUM signals (two amplitudes and two phases), it was found that the sensitivity of this method was much higher than any of the other methods used in this study, whereas the specificity was comparable to that of dc luminescence diagnostics. Therefore, PTR and LUM, as a combined technique, has the potential to be a reliable tool to diagnose early pit and fissure caries and could provide detailed information about deep lesions. Using the longer wavelength (830-nm) laser source, it has been shown that detection of deeper subsurface lesions than the 659-nm probe provides is possible.

In vitro detection and quantification of enamel and root caries using infrared photothermal radiometry and modulated luminescence

Artificially created demineralized and remineralized carious lesions on the root and enamel of human teeth were examined by photothermal radiometry (PTR) and modulated luminescence (LUM). Fourteen extracted human teeth were used and a lesion was created on a 1 mmx4 mm rectangular window, spanning root to enamel, using a lactic acid-based acidified gel to demineralize the tooth surface. The lesion was then exposed to a remineralization solution. Each sample was examined with PTR/LUM on the root and enamel before and after treatment at times from 1 to 10 (5 on root) days of demineralization and 2 to 10 days of remineralization. Ten-day (5 on root) demineralized samples were remineralized. After completing all the experiments, transverse microradiography (TMR) analysis was performed to compare and correlate the PTR/LUM signals to the depth of lesions and mineral losses. The PTR and LUM amplitudes and phases showed gradual and consistent changes with treatment time. In this study, TMR showed good correlation coefficients with PTR and LUM. It was also found that the length of the treatment time did not correlate very well to any technique, PTR/LUM or TMR, which implies a significant degree of inhomogeneity of the demireralization and remineralization rates in each and every tooth.

Detection of interproximal demineralized lesions on human teeth in vitro using frequency-domain infrared photothermal radiometry and modulated luminescence

Frequency-domain photothermal radiometry (FD-PTR or PTR) is used to detect mechanical holes and demineralized enamel in the interproximal contact area of extracted human teeth. Thirty-four teeth are used in a series of experiments. Preliminary tests to detect mechanical holes created by dental burs and 37% phosphoric acid etching for 20 s on the interproximal contact points show distinct differences in the signal. Interproximal contact areas are demineralized by using a partially saturated acidic buffer system. Each sample pair is examined with PTR before and after micromachining or treating at sequential treatment periods spanning 6 h to 30 days. Dental bitewing radiographs showed no sign of demineralized lesion even for samples treated for 30 days. Microcomputer tomography (micro-CT), transverse microradiography (TMR), and scanning electron microscopy (SEM) analyses are performed. Although micro-CT and TMR measured mineral losses and lesion depths, only SEM surface images showed visible signs of treatment because of the minimal extent of the demineralization. However, the PTR amplitude increased by more than 300% after 80 h of treatment. Therefore, PTR is shown to have sufficient contrast for the detection of very early interproximal demineralized lesions. The technique further exhibits excellent signal reproducibility and consistent signal changes in the presence of interproximal demineralized lesions, attributes that could lead to PTR as a reliable probe to detect early interproximal demineralization lesions. Modulated luminescence is also measured simultaneously, but it shows a lower ability than PTR to detect these interproximal demineralized lesions.

Theoretical analysis of coupled diffuse-photon-density and thermal-wave field depth profiles photothermally generated in layered turbid dental structures

During the past 3 decades, we have become witnesses to an ever accelerating growth of laser applications, for both clinical treatment and noninvasive diagnostics, in medicine and biology. This is why the processes governing laser-tissue interactions are so thoroughly investigated nowadays. These processes include two main components: optical, i.e., light propagation, and thermal, i.e., energy distribution following optical-to-thermal energy conversion. In order to understand and describe these processes, it is crucial to have accurate information on optical and thermal properties of biological tissues. Moreover, high-resolution noninvasive measurements of optical and thermal properties of tissues can be used as diagnostics of early stages of pathological changes. Numerous studies have been focused on the in vivo evaluation of optical properties of biological tissues. In many cases, these results are based on the radiative transport theory with various modifications particularly, the diffusion approximation 1 depending on the applied measurement technique. The main restriction to applications of the diffusion theory is that scattering effects must be significant, which is, however, usually the case with tissues. Particularly, the requirement that the mean free path for photon scattering should be much larger than the wavelength of light and much smaller than the thickness of the medium allows the description of multiply scattered light intensity by means of a diffusion equation. 2 Additional constraints are related to the size of the scattering particles, which should be small compared to the optical wavelength. 2

Depth profilometric case studies in caries diagnostics of human teeth using modulated laser radiometry and luminescence

Simultaneous measurements from human teeth of photothermal radiometric (PTR) and luminescence (LM) signals induced by an intensity modulated laser have been performed to assess the feasibility of detecting deep lesions and near-surface cracks, to examine the effects of varying enamel thicknesses, the presence of fillings, and stains on the surface of teeth. A commercial dc luminescence monitoring instrument (DIAGNOdent by KaVo) was also used to examine a set of teeth for comparison purposes with PTR and LM. PTR amplitude signals from carious regions and from thin enamel were higher than those from healthy regions and thicker enamel. A crack produces a peak in the PTR amplitude scan, as well as a sudden change in the luminescence amplitude at the corresponding point. At low frequencies (5 Hz), the PTR amplitude showed high sensitivity to a deep (about 2 mm) lesion, while at high frequencies (700 Hz) it was more sensitive to surface cracks. It was concluded that by selecting proper modulation frequencies of...

Quantitative analysis of incipient mineral loss in hard tissues

A coupled diffuse-photon-density-wave and thermal-wave theoretical model was developed to describe the biothermophotonic phenomena in multi-layered hard tissue structures. Photothermal Radiometry was applied as a safe, non-destructive, and highly sensitive tool for the detection of early tooth enamel demineralization to test the theory. Extracted human tooth was treated sequentially with an artificial demineralization gel to simulate controlled mineral loss in the enamel. The experimental setup included a semiconductor laser (659 nm, 120 mW) as the source of the photothermal signal. Modulated laser light generated infrared blackbody radiation from teeth upon absorption and nonradiative energy conversion. The infrared flux emitted by the treated region of the tooth surface and sub-surface was monitored with an infrared detector, both before and after treatment. Frequency scans with a laser beam size of 3 mm were performed in order to guarantee one-dimensionality of the photothermal field. TMR images showed clear differences between sound and demineralized enamel, however this technique is destructive. Dental radiographs did not indicate any changes. The photothermal signal showed clear change even after 1 min of gel treatment. As a result of the fittings, thermal and optical properties of sound and demineralized enamel were obtained, which allowed for quantitative differentiation of healthy and non-healthy regions. In conclusion, the developed model was shown to be a promising tool for non-invasive quantitative analysis of early demineralization of hard tissues.

Dental diagnostic clinical instrument ("Canary") development using photothermal radiometry and modulated luminescence

Since 1999, our group at the CADIFT, University of Toronto, has developed the application of Frequency Domain Photothermal Radiometry (PTR) and Luminescence (LUM) to dental caries detection. Various cases including artificial caries detection have been studied and some of the inherent advantages of the adaptation of this technique to dental diagnostics in conjunction with modulated luminescence as a dual-probe technique have been reported. Based on these studies, a portable, compact diagnostic instrument for dental clinic use has been designed, assembled and tested. A semiconductor laser, optical fibers, a thermoelectric cooled mid-IR detector, and a USB connected data acquisition card were used. Software lock-in amplifier techniques were developed to compute amplitude and phase of PTR and LUM signals. In order to achieve fast measurement and acceptable signal-to-noise ratio (SNR) for clinical application, swept sine waveforms were used. As a result sampling and stabilization time for each measurement point was reduced to a few seconds. A sophisticated software interface was designed to simultaneously record intra-oral camera images with PTR and LUM responses. Preliminary results using this instrument during clinical trials in a dental clinic showed this instrument could detect early caries both from PTR and LUM signals.

Trends in biothermophotonics and bioacoustophotonics of tissues

Recent trends in bioacoustophotonics and biothermophotonics of tissues are presented. The presentation is centered on the development of well-known frequency-domain photothermal and photoacoustic techniques to address issues associated with diffuse photon density waves during optical excitation of turbid media, both in hard tissues (teeth) and soft tissues. These methods have concrete advantages over the conventional pulsed-laser counterparts. In Part I we present biothermophotonic principles and applications to the detection of the carious state in human teeth as embodied by laser photothermal radiometry supported by modulated luminescence. The emphasis is on the abilities of these techniques to approach important problems such as the diagnosis of occlusal pits and fissures and interproximal lesions between teeth which normally go undetected by x-ray radiographs. In Part II we present theoretical and experimental results in frequency-domain bioacoustophotonics of turbid media, such as soft tissues, and we describe the development of sensitive sub-surface imaging methodologies which hold the promise for sensitive diagnostics of cancerous lesions in e.g. a human breast. Results using tissue phantoms and ex-vivo specimens are discussed and the current level of subsurface lesion sensitivity compared to state-of-the-art pulsed photoacoustic techniques is examined. In summary, advances in coupled frequency-domain diffuse-photon-density-wave and thermal or thermoelastic responses of turbid media constitute new trends in bioacoustophotonics and biothermophotonics promising for their signal quality and high dynamic range.

Experimental Investigation of Demineralization and Remineralization of Human Teeth Using Infrared Photothermal Radiometry and Modulated Luminescence

Photothermal radiometry (PTR) and modulated luminescence (LUM) were applied to detect and monitor the demineralization of root and enamel surfaces of human teeth to produce caries lesions and the subsequent remineralization of the produced lesions. The experimental set-up consisted of a semiconductor laser (659 nm, 120 mW), a mercury-cadmium-telluride IR detector for PTR, a photodiode for LUM, and two lock-in amplifiers. A lesion was created on a 1-mm × 4-mm rectangular window, spanning root to enamel surface, using an artificial caries lesion gel to demineralize the tooth surface and create small carious lesions. The samples were subsequently immersed in a remineralization solution. Each sample was examined with PTR/LUM on root and enamel before and after treatment at times from 1 to 10 days of demineralization and 2 to 10 days of remineralization. PTR/LUM signals showed gradual and consistent changes with treatment time. At the completion of the experiments, transverse micro-radiography (TMR) analysis was performed to correlate the PTR/LUM signals to depth of the carious lesions and mineral losses. In this study, TMR showed good correlation with PTR/LUM. It was also found that treatment duration did not correlate well to any technique, PTR/LUM, or TMR, which is indicative of significant variations in demineralization - remineralization rates among different teeth.