Robert S. Jones

Near-infrared transillumination at 1310-nm for the imaging of early dental decay

New imaging technologies are needed for the early detection of dental caries (decay) in the interproximal contact sites between teeth. Previous measurements have demonstrated that dental enamel is highly transparent in the near-IR at 1300-nm. In this study, a near-IR imaging system operating at 1300-nm was used to acquire images through tooth sections of varying thickness and whole teeth in order to demonstrate the utility of a near-IR dental transillumination system for the imaging of early dental caries (decay). Simulated lesions, which model the optical scattering of natural dental caries, were placed in plano-parallel dental enamel sections. The contrast ratio between the simulated lesions and surrounding sound enamel was calculated from analysis of acquired projection images. The results show significant contrast between the lesion and the enamel (>0.35) and a spatial line profile that clearly resolves the lesion in samples as thick as 6.75-mm. This study clearly demonstrates that a near-IR transillumination system has considerable potential for the imaging of early dental decay.

Imaging Artificial Caries on the Occlusal Surfaces with Polarization-Sensitive Optical Coherence Tomography

Polarization-sensitive optical coherence tomography (PS-OCT) is a nondestructive imaging system that can utilize near-infrared (IR) light to produce depth-resolved images of dental enamel and has the potential to monitor early enamel occlusal caries. The objective of this study was to investigate the relationship between the magnitude of backscattered light and depolarization recorded by PS-OCT with changes in the enamel mineral volume in an artificial caries model. Artificial lesions were created on a selected region on the occlusal surfaces of sound posterior teeth (n = 10) using a well-characterized 14-day pH cycling model. An all-fiber-based PS-OCT system operating at 1,310 nm was used to collect serial images at day 0 and day 14 prior to tooth sectioning. The quantitative mineral content profile and relative mineral loss, ΔZ (%vol × µm), of the carious enamel samples were obtained from transverse sections using high-resolution digital microradiography (DM). Line profiles of PS-OCT and DM images were used to evaluate the artificial caries severity and depth. The integrated reflectivity of the perpendicular-axis PS-OCT image, quantifying lesion severity, was correlated to the ΔZ of the caries lesions. There was also a strong correlation between the lesion depth calculated from both imaging modalities. PS-OCT can image and quantify artificial occlusal caries by measuring the increase in backscattering and depolarization of near-IR light. This optical method has promising applications for in vivo detection and monitoring of early enamel occlusal caries.

Remineralization of Enamel Caries Can Decrease Optical Reflectivity

The remineralization of enamel caries can lead to distinct optical changes within a lesion. We hypothesized that the restoration of mineral volume would result in a measurable decrease in the depth-resolved reflectivity of polarized light from the lesion. To test this hypothesis, we measured optical changes in artificial caries undergoing remineralization as a function of depth, using Polarization-sensitive Optical Coherence Tomography (PS-OCT). Lesions were imaged non-destructively before and after exposure to a remineralization regimen. After imaging, microradiographs of histological thin sections indicated that the significant reflectivity reduction measured by PS-OCT accurately represented the increase in mineral content within a larger repaired surface zone. Mineral volume changes arising from remineralization can be measured on the basis of the optical reflectivity of the lesion.

Remineralization of in vitro dental caries assessed with polarization-sensitive optical coherence tomography

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 DeltaZ (%vol x microm), 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.

Imaging artificial caries under composite sealants and restorations

Polarization-sensitive optical coherence tomography (PS-OCT) is used to monitor the progression of simulated caries lesions on occlusal surfaces and image the lesions underneath composite sealants. The polarization-sensitive system, recording images in both the parallel and perpendicular axes, is useful for enhancing the image contrast of the artificial caries and minimizing the interference of the strong reflections at surface interfaces. Using the perpendicular-axis signal, the mean reflectivity increase from day 0 to day 14 is 5.1 dB (p<0.01, repeated-measures analysis of variation, Tukey-Kramer). For imaging lesions underneath the sealants, the mean reflectivity of the enamel underneath 250, 500, 750, and 1000 microm of composite is calculated for demineralized and control samples. The artificial lesions can be detected under 750 microm of visibly opaque sealant, with a 5.0-dB difference from the control samples (t-test, p<0.001). Tooth colored sealants allow deeper imaging depth. The artificial lesions could be detected under 1000 microm of sealant, with a 6.6-dB difference from the control samples (t-test, p<0.001). This study demonstrates that PS-OCT can be used to track lesion progression on occlusal surfaces nondestructively with or without sealants.

A reproducible oral microcosm biofilm model for testing dental materials

Most studies of biofilm effects on dental materials use single‐species biofilms, or consortia. Microcosm biofilms grown directly from saliva or plaque are much more diverse, but difficult to characterize. We used the Human Oral Microbial Identification Microarray (HOMIM) to validate a reproducible oral microcosm model.

Imaging in vivo secondary caries and ex vivo dental biofilms using cross-polarization optical coherence tomography

OBJECTIVE Conventional diagnostic methods frequently detect only late stage enamel demineralization under composite resin restorations. The objective of this study is to examine the subsurface tooth-composite interface and to assess for the presence of secondary caries in pediatric patients using a novel Optical Coherence Tomography System with an intraoral probe. METHODS A newly designed intraoral cross polarization swept source optical coherence tomography (CP-OCT) imaging system was used to examine the integrity of the enamel-composite interfaces in vivo. Twenty-two pediatric subjects were recruited with either recently placed or long standing composite restorations in their primary teeth. To better understand how bacterial biofilms cause demineralization at the interface, we also used the intraoral CP-OCT system to assess ex vivo bacterial biofilm growth on dental composites. RESULTS As a positive control, cavitated secondary carious interfaces showed a 18.2dB increase (p<0.001), or over 1-2 orders of magnitude higher, scattering than interfaces associated with recently placed composite restorations. Several long standing composite restorations, which appeared clinically sound, had a marked increase in scattering than recently placed restorations. This suggests the ability of CP-OCT to assess interfacial degradation such as early secondary caries prior to cavitation. CP-OCT was also able to image ex vivo biofilms on dental composites and assess their thickness. SIGNIFICANCE This paper shows that CP-OCT imaging using a beam splitter based design can examine the subsurface interface of dental composites in human subjects. Furthermore, the probe dimensions and acquisition speed of the CP-OCT system allowed for analysis of caries development in children.

Attenuation of 1310- and 1550-nm laser light through sound dental enamel

Inexpensive laser diodes and fiber-optic technology have revived optical transillumination as a promising diagnostic method for the early detection of dental caries. The principal factor limiting transillumination through dental hard tissue is light scattering in the normal enamel and dentin. Previous studies have shown that the scattering coefficient decreases with increasing wavelength. Therefore, the near-IR region is likely to be well suited for fiber optic transillumination. The objective of this study was to measure the optical attenuation of near-IR light through dental enamel at 1310-nm and 1550-nm. These laser wavelengths are readily available due to their suitability for application to fiber optic communication. In this study the collimated transmission of laser light through polished thin sections of dental enamel for various thickness from 0.1 to 2.5 mm was measured in cuvettes of index matching fluid with n= 1.63. Beer-Lambert plots show that the attenuation coefficients are 3.1+/- 0.17cm-1 and 3.8+/- 0.17cm-1 for 1310-nm and 1550-nm, respectively. This study indicates that near-IR laser wavelengths are well-suited for the transillumination of dental enamel for caries detection since the attenuation through normal tissue is an order of magnitude less than in the visible.

Degradation in the dentin-composite interface subjected to multi-species biofilm challenges

Oral biofilms can degrade the components in dental resin-based composite restorations, thus compromising marginal integrity and leading to secondary caries. This study investigates the mechanical integrity of the dentin-composite interface challenged with multi-species oral biofilms. While most studies used single-species biofilms, the present study used a more realistic, diverse biofilm model produced directly from plaques collected from donors with a history of early childhood caries. Dentin-composite disks were made using bovine incisor roots filled with Z100(TM) or Filtek(TM) LS (3M ESPE). The disks were incubated for 72 h in paired CDC biofilm reactors, using a previously published protocol. One reactor was pulsed with sucrose, and the other was not. A sterile saliva-only control group was run with sucrose pulsing. The disks were fractured under diametral compression to evaluate their interfacial bond strength. The surface deformation of the disks was mapped using digital image correlation to ascertain the fracture origin. Fracture surfaces were examined using scanning electron microscopy/energy-dispersive X-ray spectroscopy to assess demineralization and interfacial degradation. Dentin demineralization was greater under sucrose-pulsed biofilms, as the pH dropped <5.5 during pulsing, with LS and Z100 specimens suffering similar degrees of surface mineral loss. Biofilm growth with sucrose pulsing also caused preferential degradation of the composite-dentin interface, depending on the composite/adhesive system used. Specifically, Z100 specimens showed greater bond strength reduction and more frequent cohesive failure in the adhesive layer. This was attributed to the inferior dentin coverage by Z100 adhesive, which possibly led to a higher level of chemical and enzymatic degradation. The results suggested that factors other than dentin demineralization were also responsible for interfacial degradation. A clinically relevant in vitro biofilm model was therefore developed, which would effectively allow assessment of the degradation of the dentin-composite interface subjected to multi-species biofilm challenge.

Transillumination of interproximal caries lesions with 830-nm light

New imaging technology is needed for the early detection of dental caries (decay) in the interproximal contact sites between teeth. Previous measurements have demonstrated that dental enamel is highly transparent in the near-IR near 1310-nm making that wavelength range ideal for the transillumination of interproximal lesions. However, imaging at 1310-nm involves the use of expensive InGaAs technology. The purpose of this study was to compare the performance of a low cost near-IR sensitive imaging system employing a CCD camera with enhanced near-IR sensitivity operating at 830-nm with the 1310-nm InGaAs system. Images of simulated caries lesions were acquired through tooth sections of varying thickness and whole teeth in order to demonstrate the utility of a near-IR dental transillumination system for the imaging of early dental caries (decay). Simulated lesions, representing the optical scattering of natural dental caries, were placed in plano-parallel dental enamel sections and whole anterior teeth. The contrast ratio between the simulated lesions and surrounding sound enamel was calculated from analysis of the respective spatial intensity profiles in the acquired projection images. This study shows that near-IR transillumination at 830-nm offers significantly improved image contrast over the visible range, but less image contrast than at 1310-nm.