Sleiman R. Ghorayeb

Ultrasonography in dentistry

This paper reviews diagnostic applications of ultrasound to dentistry, or dental ultrasonography, beginning with pioneering work of the 1960s up through present lines of research. Clinical, in vivo applications that are of direct interest to dental practice are reviewed here, including measurements of enamel thickness and periodontal pocket depth. In vitro research that involves destructive tooth preparation or procedures, such as sound speed measurements or scanning acoustic microscopy, also are included. Although dental ultrasonography has been studied for over 40 years, most methods are not quite ready for routine clinical use, and there remains much opportunity for diagnostic ultrasonography to significantly impact the practice of dentistry.

Experimental evaluation of human teeth using noninvasive ultrasound: echodentography

Anomalies present in the hard tissue of teeth are manifested in several ways such as cavities, decay, and caries. The most extensively and commonly used diagnostic modality for the assessment of these abnormalities are x-rays. Unfortunately, these rays are harmful to the human body and may be a source of health risk. This work describes the development of a new testing technique that uses ultrasound designed to complement, or even replace, existing tools used in dentistry applications. Previous studies have shown several models of acoustic field simulation, propagation, and interaction of ultrasound with the layers of several tooth structures. In this paper, experimental data is gathered for the purpose of assessing the viability of this technique in an attempt to detect cavities and fractures in extracted human teeth. A low-intensity, high-frequency ultrasonic set-up is used in all in vitro tests. Four cases have been examined: an intact tooth, a tooth containing an amalgam restoration and a natural surface fissure, a tooth containing a machine side-drilled hole that mimics a cavity, and a calcified tooth-a rare naturally occurring condition. Upon analysis of the obtained A-scans and B-scans, it is verified that these experimental measurements confirm predictions reported in earlier finite element and transmission line studies and suggest that ultrasound is a valuable tool which has the potential to be an addition to, or even an improvement upon, current dental imaging systems.

A Finite Element Study of Ultrasonic Wave Propagation in a Tooth Phantom

Ultrasound is used extensively in industry for the detection and characterization of defects in critical engineering structures. Similar techniques could be used in dentistry if a thorough understanding of ultrasonic wave propagation in teeth were available. This paper presents a hypothesis that finite element analysis can be used to solve the hyperbolic partial differential equation which governs ultrasonic wave propagation in teeth. A three-layer tooth phantom based on the geometry of a human second molar is used to illustrate the validity of this hypothesis. Simulated wave propagation studies are described for the tooth phantom with a gold crown layer, with an amalgam restoration insertion, and containing a cavity. Results clearly show the finite element codes ability to predict and visualize ultrasonic wave propagation in complex dental structures.

Modeling of ultrasonic wave propagation in teeth using PSpice: a comparison with finite element models

Ultrasound is used extensively in the medical field for the detection and characterization of a variety of features in the human body. Finite element models used to understand ultrasonic wave propagation in teeth have been developed so that ultrasound techniques could be realized in dentistry. This paper presents a hypothesis that underlies one possible design of an ultrasonic tool that can be used in a clinical environment, as well as several models that describe acoustic field simulation, propagation, and interaction with the layers of several tooth structures. A complete PSpice model of a single-element transducer based on Redwoods version of Masons equivalent circuit, a focusing lens, and a multi-layer tooth structure is used to illustrate the validity of this hypothesis. Transmission line theory is employed as a basis for the models of the piezoceramic, the lens, and the different tooth layers. The results clearly depict the transmission and reflection of the ultrasonic waves as they travel through the layers within the tooth structure and point out the noticeable similarity to longitudinal L-wave signatures produced by axisymmetric finite element models presented in earlier studies.

Ultrasonic assessment of extracellular matrix content in healing achilles tendon

Although several imaging modalities have been utilized to observe tendons, assessing injured tendons by tracking the healing response over time with ultrasound is a desirable method which is yet to be realized. This study examines the use of ultrasound for non-invasive monitoring of the healing process of Achilles tendons after surgical transection. The overall extracellular matrix content of the transection site is monitored and quantified as a function of time. B-mode images (built from successive A-scan signatures) of the injury site were obtained and compared to biomechanical properties. A quantitative measure of tendon healing using the extracellular matrix (ECM) content of the injury site was analyzed using linear regression with all biomechanical measures. Contralateral tendons were used as controls. The trend in the degree of ECM regrowth in the 4 weeks following complete transection of excised tendons was found to be most closely paralleled with that of linear stiffness (R2 = 0.987, p <; .05) obtained with post-ultrasound biomechanical tests. Results suggest that ultrasound can be an effective imaging technique in assessing the degree of tendon healing, and can be used to correlate structural properties of Achilles tendons.

Sonographic evaluation of knee cartilage defects implanted with preconditioned scaffolds.

The purpose of this study was to develop a novel method for creating an acellular bioactive scaffold, to prove its efficacy in vivo and in vitro for the augmentation of biological repair, and to confirm that sonographic microscopy is a viable modality for monitoring the healing process of osteochondral defects implanted with preconditioned bioactive scaffolds.

Biophysical characterization of low-frequency ultrasound interaction with dental pulp stem cells

BackgroundLow-intensity ultrasound is considered an effective non-invasive therapy to stimulate hard tissue repair, in particular to accelerate delayed non-union bone fracture healing. More recently, ultrasound has been proposed as a therapeutic tool to repair and regenerate dental tissues. Our recent work suggested that low-frequency kilohertz-range ultrasound is able to interact with dental pulp cells which could have potential to stimulate dentine reparative processes and hence promote the viability and longevity of teeth.MethodsIn this study, the biophysical characteristics of low-frequency ultrasound transmission through teeth towards the dental pulp were explored. We conducted cell culture studies using an odontoblast-like/dental pulp cell line, MDPC-23. Half of the samples underwent ultrasound exposure while the other half underwent ‘sham treatment’ where the transducer was submerged into the medium but no ultrasound was generated. Ultrasound was applied directly to the cell cultures using a therapeutic ultrasound device at a frequency of 45 kHz with intensity settings of 10, 25 and 75 mW/cm2 for 5 min. Following ultrasound treatment, the odontoblast-like cells were detached from the culture using a 0.25% Trypsin/EDTA solution, and viable cell numbers were counted. Two-dimensional tooth models based on μ-CT 2D images of the teeth were analyzed using COMSOL as the finite element analysis platform. This was used to confirm experimental results and to demonstrate the potential theory that with the correct combination of frequency and intensity, a tooth can be repaired using small doses of ultrasound. Frequencies in the 30 kHz–1 MHz range were analyzed. For each frequency, pressure/intensity plots provided information on how the intensity changes at each point throughout the propagation path. Spatial peak temporal average (SPTA) intensity was calculated and related to existing optimal spatial average temporal average (SATA) intensity deemed effective for cell proliferation during tooth repair.ResultsThe results demonstrate that odontoblast MDPC-23 cell numbers were significantly increased following three consecutive ultrasound treatments over a 7-day culture period as compared with sham controls underscoring the anabolic effects of ultrasound on these cells. Data show a distinct increase in cell number compared to the sham data after ultrasound treatment for intensities of 10 and 25 mW/cm2 (p < 0.05 and p < 0.01, respectively). Using finite element analysis, we demonstrated that ultrasound does indeed propagate through the mineralized layers of the teeth and into the pulp chamber where it forms a ‘therapeutic’ force field to interact with the living dental pulp cells. This allowed us to observe the pressure/intensity of the wave as it propagates throughout the tooth. A selection of time-dependent snapshots of the pressure/intensity reveal that the lower frequency waves propagate to the pulp and remain within the chamber for a while, which is ideal for cell excitation. Input frequencies and pressures of 30 kHz (70 Pa) and 45 kHz (31 kPa), respectively, with an average SPTA of up to 120 mW/cm2 in the pulp seem to be optimal and agree with the SATA intensities reported experimentally.ConclusionsOur data suggest that ultrasound can be harnessed to propagate to the dental pulp region where it can interact with the living cells to promote dentine repair. Further research is required to analyze the precise physical and biological interactions of low-frequency ultrasound with the dental pulp to develop a novel non-invasive tool for dental tissue regeneration.

Ultrasonographic Assessment of Testicular Viability Using Heterogeneity Levels in Torsed Testicles

Purpose: Gross testicular heterogeneity on ultrasound has been associated with testis loss following testicular torsion in children. We aimed to quantify the extent of temporal heterogeneity associated with testis loss in testicular torsion cases using a noninvasive technique to determine a HI (heterogeneity index) on ultrasound images. Materials and Methods: We retrospectively studied the records of patients who presented with acute scrotal pain to the Pediatric Emergency Department over a 6‐year period. Ultrasound images of the affected testis and the unaffected contralateral testis were examined using a proprietary program to determine the extent of heterogeneity of each image. The difference between the HI of the torsed testis and that of the contralateral normal testis was termed &Dgr;HI. Receiver operating characteristics curve analysis was performed to determine the &Dgr;HI threshold for nonviability. Results: Among 529 patients who presented with acute scrotal pain 147 had testicular torsion based on surgical findings. Of these 147 patients 110 (74.8%) were found to have a viable testis while 37 (25.2%) had a nonviable testis. Using the &Dgr;HI cutoff of 0.394 or greater for nonviability, sensitivity and specificity were 100% and 94.5%, respectively. Positive and negative predictive values were 86% and 100%, respectively. Conclusions: Our results demonstrate that a quantifiable temporal gradation of heterogeneity exists and the heterogeneity index can be used as an objective parameter to determine the viability of a torsed testicle. By developing the technology to measure the heterogeneity index in real time, we could potentially identify which patients with testicular torsion have a nonviable testicle and, thus, would not require immediate surgical exploration.

Experimental determination of ultrasonic phase velocities in human teeth along arbitrary symmetry directions

Ultrasound has been used extensively in medicine such as obstetrics and ophthalmology, and in the nondestructive testing of engineered materials such as isotropic and anisotropic composite structures. One area where ultrasound has found a new place for its application is dentistry. Several laboratory studies have shown great promise for this newly developed application. However, all of the inquiries assumed that the tooth is isotropic and homogeneous. The purpose of this project is to account for the multilayering and anisotropy nature of teeth by determining the phase velocities associated with several directions and orientations of ultrasonic wave propagation. Time-of-flight (TOF) information from A-scan signatures obtained at various angles of inclination and rotation are used in order to calculate the phase velocities. Slowness curves that would eventually lead to the determination of the independent elastic constants in human teeth are generated and reported in this paper.

Diagnostic ultrasound for the imaging of teeth: a comparison between experimental results and simulation models

Diagnostic ultrasound is being applied to teeth in order to detect cavities, decay, fractures and even early indication of abscesses. Ultrasonic waves are particularly sensitive to tight cracks and interface conditions between layers-dental features often difficult to interpret from X-ray images. Most importantly, due to its nonionizing nature, ultrasound acquires a potential advantage over conventional X-ray imaging. When ultrasonic waves are used at low intensity levels, they do not cause any health risks. This paper presents the results of laboratory experiments conducted on extracted human second and third molars using a low-intensity, high-frequency setup. Three cases have been examined: an intact tooth, a tooth containing an amalgam restoration, and a tooth containing a machine-side-drilled hole in order to mimic a cavity at the enamel-dentin interface. However, due to this paper length limitation only the first two cases are presented. A- and C-scans have been acquired in this study. Initial analysis of these results reveals similarities to those produced earlier by finite element and transmission-line methods insofar the identification of the different layers in the host teeth, and that such results could be used to realize the design of appropriate transducers and equipment for dentistry applications.