Virgil-Florin Duma

Fluorescence influence on screening decisions for oral cancer

Objectives: The aim of the present study was to assess the capability of the VELscope system to image the tissue autofluorescence of potentially malignant oral lesions and to assess the diagnostic accuracy, sensitivity, and specificity of this method. Methods: 10 patients were evaluated by conventional oral examination (COE) followed by direct visual fluorescence evaluation (DVFE) using VELscope. Areas clinically suspicious detected by COE or with positive DVFE (visual fluorescence loss (VFL)) have been further investigated using surgical biopsy. The association between COE and DVFE has also been assessed and compared with the gold standard, i.e. histopathology. Results: Eight positive biopsies for malignant lesions were detected using COE and DVFE. Only one positive biopsy for a premalignant lesion was not in accordance with COE and DVFE. One of the lesions, determined on the VELscope and COE as a non-malignant lesion was also confirmed by the biopsy. Therefore, the VELscope system had a sensitivity of 100% and specificity of 50% in discriminating in situ normal mucosa from carcinoma or invasive carcinoma, compared with histology. The predictive positive value was 88.89% and the negative predictive value was 100% (95% confidence interval). Conclusions: DFVE allows for simple and cost-effective margin determinations, in order to detect and screen oral precancerous and early cancerous disorders. We found that for the moment the VELscope system could not replace the histopathology procedure. Nonetheless, its usefulness for clinical examination was determined, as well as for monitoring oral lesions and guiding biopsies. Therefore, this method may add sensitivity to oral tissue examinations and be an effective adjunct procedure for high-risk patients.

Temperature variations in sintering ovens for metal ceramic dental prostheses: Non-destructive assessment using OCT

We present a recent investigation regarding the use of optical coherence tomography (OCT) in the monitoring of the calibration loss of sintering ovens for the manufacturing of metal ceramic dental prostheses. Differences in the temperatures of such ovens with regard to their specifications lead to stress and even cracks in the prostheses material, therefore to the failure of the dental treatment. Evaluation methods of the ovens calibration consist nowadays of firing supplemental samples; this is subjective, expensive, and time consuming. Using an in-house developed swept source (SS) OCT system, we have demonstrated that a quantitative assessment of the internal structure of the prostheses, therefore of the temperature settings of the ovens can be made. Using en-face OCT images acquired at similar depths inside the samples, the differences in reflectivity allow for the evaluation of the differences in granulation (i.e., in number and size of ceramic grains) of the prostheses material. Fifty samples, divided in five groups, each sintered at different temperatures (lower, higher, or equal to the prescribed one) have been analyzed. The consequences of the temperature variations with regard to the one prescribed were determined. Rules-of-thumb were extracted to monitor objectively, using only OCT images of currently manufactured samples, the settings of the oven. The method proposed allows for avoiding producing prostheses with defects. While such rules-of-thumb achieve a qualitative assessment, an insight in our on-going work on the quantitative assessment of such losses of calibration on dental ovens using OCT is also made.

Front Matter: Volume 9670

This PDF file contains the front matter associated with SPIE Proceedings Volume 9670 including the Title Page, Copyright information, Table of Contents, Introduction, and Conference Committee listing.

Evaluation of Tizian overlays by means of a swept source optical coherence tomography system

The teeth affected by pathologic attrition can be restored by a minimally invasive approach, using Tizian overlays. In this study we prove the advantages of a fast swept source (SS) OCT system in the evaluation of Tizian overlays placed in an environment characterized by high occlusal forces. 12 maxillary first premolars were extracted and prepared for overlays. The Tizian overlays were subjected to 3000 alternating cycles of thermo-cycling (from -10°C to +50°C) and to mechanical occlusal overloads (at 800 N). A fast SS OCT system was used to evaluate the Tizian overlays before and after the mechanical and thermal straining. The SS (Axsun Technologies, Billerica, MA) has a central wavelength of 1060 nm, sweeping range of 106 nm (quoted at 10 dB) and a 100 kHz line rate. The depth resolution of the system, measured experimentally in air was 10 μm. The imaging system used for this study offers high spatial resolutions in both directions, transversal and longitudinal of around 10 μm, a high sensitivity, and it is also able to acquire entire tridimensional (3D)/volume reconstructions as fast as 2.5 s. Once the full dataset was acquired, rendered high resolutions en-face projections could be produced. Using them, the overlay (i.e., cement) abutment tooth interfaces were remarked both on B-scans/two-dimensional (2D) sections and in the 3D reconstructions. Using the system several open interfaces were possible to detect. The fast SS OCT system thus proves useful in the evaluation of zirconia reinforced composite overlays, placed in an environment characterized by high occlusal forces.

Low-Level Laser Therapy (LLLT) for periodontal pockets: a review

The applications of lasers in medicine, both in the field of diagnosis and treatment are gaining momentum. In dentistry in particular, numerous types of lasers with a wide range of characteristics are being utilized in all fields. In consequence, a lot of experience and knowledge has been gained in the last two decades in this domain; this resulted in the development of novel technologies and devices. A brief overview is made in the first part of this article on these topics. The treatment of periodontal disease with laser therapy is pointed out, as well as the photodynamic therapy which is using LLLT for the activation of the sensitizing gel that is introduced in the periodontal pockets. This paper reviews also the application of photodynamic therapy in clinical trials which have different results; a standardization of the protocol utilized for this procedure is concluded to be necessary.

OCT and shear-force evaluations of zirconia Fixed Partial Prosthesis processed with a conventional CAD/CAM technology

Introduction. Dental ceramics show better biocompatibility and aesthetic properties in dental constructs with regard to metals. However, they also have an insufficient mechanical stability, as well as low resistance limits due to their fragility. Taking into account these aspects, glass infiltrated with ceramic materials such as alumina (i.e., zirconiareinforced ceramics) is being nowadays considered a better material for full fixed partial prostheses (FPPs) than ceramics: the former has a higher mechanical resistance, which makes it more appropriate for restoration areas, where there is an increased mechanical stress. The interest for zirconia is growing due both to its resistance and to the possibility to develop such prostheses using the CAD/CAM technology. Materials and methods. 24 all ceramic FPPs created with CAD/CAM technology were used. The models were scanned with Zeno Wieland Scanner, a one touch scanning machine which requires between 45-60 s for a full model scan. The scanner provides 3 axis-architecture and automatic data processing. The zirconia infrastructures resulted from milling zirconia green disks in Wieland units, followed by the deposition of ceramic masses and then by burning procedures. All the samples were assessed with a Time Domain Optical Coherence Tomography (TD-OCT) system working at a wavelenght of 1300 nm. Using OCT investigations, material defects were detected in the areas of maximal tension, i.e. the connectors, the oclusal, and the cervical areas. These samples with defects in the above areas have not been considered for the study further on. Finally, the samples were loaded in a MultiTest 5 i Mecmesin system and tested until fracture occurred. The MultiTest 5-i creates tensile and compression forces of up to 5 kN. Results and discussions. All the test samples survived a dynamic load of 1.2 x 107 cycles and a thermal cycle mixer simulator version; signs of failure in terms of fracture lines were observed in all samples. The average value of the force necessary to break the FPPs obtained from the tests is 1750 N. Conclusions. Conventional metal-ceramic fixed partial dentures are still considered the standard for edentulous spaces in the posterior region. Therefore, the resistance of metal-ceramic fixed partial dentures has served in this study as a guide for new ceramics tests. All the values from this study conducted in FPP with zirconia frames were much lower than the values reported for metal ceramic fixed partial dentures (i.e., 2500-3000 N), but higher that 1000 N, which is considered the lowest resistance point to be utilized in the rear region of the oral cavity.

All ceramic table tops analyzed using swept source optical coherence tomography

Erosion is the progressive loss of tooth substance by chemical processes that do not involve bacterial action. The affected teeth can be restored by using IPS e.max Press “table tops”, which replace the occlusal surfaces. In this study we applied a fast in-house Swept Source Optical Coherence Tomography (SS OCT) system to analyze IPS e.max Press “table tops”. 12 maxillary first premolars have been extracted and prepared for “table tops”. These restorations were subjected to 3000 alternating cycles of thermo-cycling in a range from -10°C to +50°C; mechanical occlusal loads of 200 N were also applied. Using SS OCT we analyze the marginal seal of these restorations, before and after applying the mechanical and thermal strain. The characteristics of the SS OCT system utilized are presented. Its depth resolution, measured in air is 10 μm. The system is able to acquire entire volumetric reconstructions in 2.5 s. From the dataset acquired high resolution en-face projections were also produced. Thus, the interfaces between all ceramic “table tops” and natural teeth were analyzed on the cross-sections (i.e., the B-scans) produced and also on the volumetric (tri-dimensional (3D)) reconstructions, several open interfaces being detected. The study therefore demonstrates the utility of SS OCT for the analysis of lithium disilicate glass ceramic “table tops”.

OCT evaluation of single ceramic crowns: comparison between conventional and chair-side CAD/CAM technologies

Digital impressions were introduced to overcome some of the obstacles due to traditional impression materials and techniques. The aim of this in vitro study is to compare the accuracy of all ceramic crowns obtained with digital impression and CAD-CAM technology with the accuracy of those obtained with conventional impression techniques. Two groups of 10 crowns each have been considered. The digital data obtained from Group 1 have been processed and the all-ceramic crowns were milled with a CAD/CAM technology (CEREC MCX, Sirona). The all ceramic crowns in Group 2 were obtained with the classical technique of pressing (emax, Ivoclar, Vivadent). The evaluation of the marginal adaptation was performed with Time Domain Optical Coherence Tomography (TD OCT), working at a wavelength of 1300 nm. Tri-dimensional (3D) reconstructions of the selected areas were obtained. Based on the findings in this study, one may conclude that the marginal accuracy of all ceramic crowns fabricated with digital impression and the CAD/CAM technique is superior to the conventional impression technique.

Retractions of the gingival margins evaluated by holographic methods

The periodontal disease is one of the most common pathological states of the teeth and gums system. The issue is that its evaluation is a subjective one, i.e. it is based on the skills of the dental medical doctor. As for any clinical condition, a quantitative evaluation and monitoring in time of the retraction of the gingival margins is desired. This phenomenon was evaluated in this study with a holographic method by using a He-Ne laser with a power of 13 mW. The holographic system we have utilized – adapted for dentistry applications - is described. Several patients were considered in a comparative study of their state of health – regarding their oral cavity. The impressions of the maxillary dental arch were taken from a patient during his/her first visit and after a period of six months. The hologram of the first model was superposed on the model cast after the second visit. The retractions of the gingival margins could be thus evaluated three-dimensionally in every point of interest. An evaluation of the retraction has thus been made. Conclusions can thus be drawn for the clinical evaluation of the health of the teeth and gums system of each patient.

MicroCT and optical coherence tomography imagistic assessment of the dental roots adhesive

Several obturation methods are available today to study the 3D filling of the root canal. There are also several methods capable to evaluate the ability to seal apically the root canals. However, the common methods of investigation are invasive; they also lead to the destruction of the samples. If the sectioning differs slightly from the desired area, the investigation is non-conclusive regarding the micro-leakages. Also, although the use of Cone-Beam Micro Computer Tomography (CBCT) appears to be most promising for endodontic purposes, its effective radiation doses are higher than with conventional intra-oral and panoramic imaging. In contrast, enface (ef) Optical Coherence Tomography (OCT) proves to be efficient for the investigation of material defects of dental restorations, dental materials, and micro-leakage at the interfaces, where the penetration depth depends on the material. Therefore, ef OCT has been proposed in our studies as a potential tool for in vivo endodontic imaging. Twenty five recently extracted human maxillary molars were selected for the study for caries or periodontal reasons. The pulp chambers were completely opened, the dental pulp was removed, and the root canals were shaped. Silver nanoparticles were used in half of the samples in order to increase the scattering of the adhesive material in comparison with the dental roots walls. The sample teeth were then probed using Time Domain (TD) OCT working at 1300 nm. A synchrotron radiation X-Ray microCT experiment was also performed. The imagistic results pointed out the efficiency of the silver nanoparticle layer used in order to increase the scattering of the root canal adhesive scattering for the OCT non-invasive investigation. MicroCT allowed for obtaining qualitative data related to the depth penetration of the root canal adhesive into the dentin walls.