This PDF file contains the front matter associated with SPIE Proceedings Volume 9306, including the Title Page, Copyright information, Table of Contents, Invited Panel Discussion, and Conference Committee listing.

The goal of the work was the investigation of powerful Er: YSGG radiation (wavelength 2.79 um) interaction with ivory and dentin. The main goal was an investigation of powerful Er: YSGG radiation interaction with ivory and dentin. As source of radiation was used a free-running or Q-switched Er: YSGG laser generating 250 us or 100 ns long pulses with pulse energy of 123 mJ or 41 mJ, respectively. The lens with the focal length 85 mm was used for concentration of the radiation on interacting material. The ablation rate was checked for case of both above mentioned regimes as well as for the cases of without and with water cooling of interacting material. It was found that for long pulse with the energy density of 176 J/cm² the ablation rate was 0.033 mm³/J (without water cooling), while for short 100 ns with the energy density of 46 J/cm² the ablation rate was 0.012 mm³/J (with water cooling).

Flash lamp pumped Er:YAG-lasers are used in clinical practice for dental applications successfully. As an alternative, several diode pumped Er:YAG laser systems (Pantec Engineering AG) become available, with mean laser power of 2W, 15W, and 30W. The aim of the presented study is to investigate the potential of the 2W Er:YAG laser system for oral surgery. At first an appropriate experimental set-up was realized with a beam delivery and both, a focusing unit for non-contact tissue cutting and a fiber tip for tissue cutting in contact mode. In order to produce reproducible cuts, the samples (porcine gingiva) were moved by a computer controlled translation stage. On the fresh samples cutting depth and quality were determined by light microscopy. Afterwards histological sections were prepared and microscopically analyzed regarding cutting depth and thermal damage zone. The experiments show that low laser power ≤ 2W is sufficient to perform efficient oral soft tissue cutting with cut depth up to 2mm (sample movement 2mm/s). The width of the thermal damage zone can be controlled by the irradiation parameters within a range of about 50μm to 110μm. In general, thermal injury is more pronounced using fiber tips in contact mode compared to the focused laser beam. In conclusion the results reveal that even the low power diode pumped Er:YAG laser is an appropriate tool for oral surgery.

The introduction of diode lasers in dentistry has several advantages, mainly consisting on the reduced size, reduced cost and possibility to beam delivering by optical fibers. At the moment the two diode wavelengths normally utilized in the dental field are 810 and 980 nm for soft tissues treatments. The aim of this study was to compare the efficacy of four different diode wavelengths: 810, 980, 1470 and 1950 nm diode laser for the ablation of soft tissues. Several samples of veal tongue were exposed to the four different wavelengths, at different fluences. The internal temperature of the soft tissues, in the area close to the beam, was monitored with thermocouple during the experiment. The excision quality of the exposed samples have been characterized by means of an optical microscope. Tissue damages and the cut regularity have been evaluated on the base of established criteria. The lowest thermal increase was recorded for 1950 nm laser. Best quality and speed of incision were obtained by the same wavelength. By evaluating epithelial, stromal and vascular damages for all the used wavelengths, the best result, in terms of “tissue respect”, have been obtained for 1470 and 1950 nm exposures. From the obtained results 1470 and 1950 nm diode laser showed to be the best performer wavelengths among these used in this “ex vivo” study, probably due to their greatest affinity to water.

Glass-ceramic materials are increasingly becoming the material of choice in the field of dental prosthetics, as they can feature both high strength and very good aesthetics. It is believed that their color, microstructure and mechanical properties can be tuned such as to achieve an optimal lifelike performance. In order to reach that ultimate perfection a controlled arrangement of amorphous and crystalline phases in the material is required. A phase transformation from amorphous to crystalline is achieved by a heat treatment at defined temperature levels. The traditional approach is to perform the heat treatment in a furnace. This, however, only allows a homogeneous degree of crystallization over the whole volume of the parent glass material. Here a novel approach using a local heat treatment by laser irradiation is presented. To investigate the potential of this approach the crystallization process of SiO₂-Li₂O-Al₂O₃-based glass has been studied with laser systems (pulsed and continuous wave) operating at different wavelengths. Our results show the feasibility of gradual and partial crystallization of the base material using continuous laser irradiation. A dental prosthesis machined from an amorphous glassy state can be effectively treated with laser irradiation and crystallized within a confined region of a few millimeters starting from the body surface. Very good aesthetics have been achieved. Preliminary investigation with pulsed nanosecond lasers of a few hundreds nanoseconds pulse width has enabled more refinement of crystallization and possibility to place start of phase change within the material bulk.

The introduction of photo-activators, with absorption spectra in the violet region, in composite resins raised interest in the use of 405 nm diode lasers for polymerization. The purpose of this research is the evaluation of the resins polymerization by means of violet diode laser compared to traditional lamps. Two different resins have been used for the experiments: Filtek Supreme XT flow (3M ESPE, USA) and Tetric Evo flow (Ivoclar, Vivadent). The photo-activator used is Camphoroquinone, alone, or in combination with Lucirin TPO. The resins have been cured with an halogen lamp (Heliolux DXL, Vivadent Ivoclar, Austria), a broadband LED curing light (Valo Ultradent, USA) and a 405 nm laser (Euphoton, Italy). The measure of cure depth, of the volumetric shrinkage, and the conversion degree (DC%) of the double bond during the curing process have been evaluated. A composite layer of 3 mm was cured in Filtek Supreme resin (Camphoroquinone activator), lower if compared to the use of the other two light sources. Tests on Tetric Evo (Camphoroquinone + Lucirin) didn’t show any improvement of the use of laser compared to the halogen lamp and the broadband LED. By measuring the volumetric shrinkage the laser induced the lower change with both the composites. In terms of DC% the lower performance was obtained with the laser. Considering that the polymerization process strongly depends on the kind of composite used the effectiveness of 405 nm laser proved to be lower than halogen lamps and broadband LEDs.

In this work the application of different laser wavelengths, in combination with different photosensitizing dyes, to bacterial cultures, in liquid or solid mean, has been investigated. Two types of Streptococcus mutans cultures have been used for the experiments, inside agar and saline solution. Three different laser wavelengths have been applied to the bacterial cultures together with a photosensitizing dye: red diode (650 nm) on cultures stained with Toluidine Blue, blueviolet diode (450 nm) on cultures stained with Curcumin and KTP laser (532 nm) on cultures stained with Erythrosine. The choice of the dye has been made considering the color affinity with the used wavelength. Tests without dyes have also been performed. Experimental results show that the maximum inhibition of bacterial growth with the blue laser has been obtained in a saline solution with a growth of 40.77%. While the combination with Curcumin lead to an inhibition growth of about 99.1%, for a laser fluence of 30J/cm². No inhibition has been observed using the red laser in saline solution without dye, while the combination with Toluidine Blue resulted in a 100% inhibition growth for 20 and 30 J/cm² fluences. An inhibition growth of just 16.26% has been obtained with the use of KTP laser in saline solution without dye. The use of Erythrosine had the effect of a complete inhibition growth. From the obtained results it is possible to observe that the combination of laser wavelength with a particular photosensitizing dye can dramatically increase the bacterial growth.

Various test objects, plaster models, partially equipped with extracted teeth and pig jaws representing various clinical situations of tooth preparations were used for in-vitro scanning tests with an experimental intra-oral scanning system based on chromatic-dispersive confocal technology. Scanning results were compared against data sets of the same object captured by an industrial μCT measuring system. Compared to μCT data an average error of 18 – 30 μm was achieved for a single tooth scan area and less than 40 to 60 μm error measured over the restoration + the neighbor teeth and pontic areas up to 7 units. Mean error for a full jaw is within 100 – 140 μm. The length error for a 3 – 4 unit bridge situation form contact point to contact point is below 100 μm and excellent interproximal surface coverage and prep margin clarity was achieved.

An ultrathin scanning fiber endoscope, originally developed for cancer diagnosis, was used in a case study to locate plaque and caries. The imaging system incorporated software mitigation of background auto-fluorescence (AF). In conventional fluorescence imaging, varying AF across a tooth surface can mask low-level porphyrin signals. Laser-induced auto-fluorescence signals of dental tissue excited using a 405-nm laser typically produce fluorescence over a wavelength range extending from 440-nm to 750-nm. Anaerobic bacterial metabolism produces various porphyrin species (eg. protoporphyrin IX) that are located in carious enamel, dentin, gingivitis sites, and plaque. In our case study, these porphyrin deposits remained as long as one day after prophylaxis. Imaging the tooth surface using 405-nm excitation and subtracting the natural AF enhances the image contrast of low-level porphyrin deposits, which would otherwise be masked by the high background AF. In a case study, healthy tissues as well as sites of early and advanced caries formations were scanned for visual and quantitative signs of red fluorescence associated with porphyrin species using a background mitigation algorithm. Initial findings show increasing amplitudes of red fluorescence as caries severity increases from early to late stages. Sites of plaque accumulation also displayed red fluorescence similar to that found in carious dental tissue. The use of real-time background mitigation of natural dental AF can enhance the detection of low porphyrin concentrations that are indicators of early stage caries formation.

Dental erosion is a non-carious lesion that causes progressive tooth wear of structure through chemical processes that do not involve bacterial action. Its origin is related to eating habits or systemic diseases involving tooth contact with substances that pose a very low pH. This work demonstrates a new methodology to quantify the erosion by coherent light scattering of tooth surface. This technique shows a correlation between acid etch duration and laser speckle contrast map (LASCA). The experimental groups presented a relative contrast between eroded and sound tissue of 17.8(45)%, 23.4 (68)% 39.2 (40)% and 44.3 (30)%, for 10 min, 20 min, 30 min and 40 min of acid etching, respectively.

Dental caries remain one of the most common oral diseases in the world. Current detection methods, such as dental explorer and X-ray radiography, suffer from poor sensitivity and specificity at the earliest (and reversible) stages of the disease because of the small size (< 100 microns) of early-stage lesions. We have developed a fine-resolution (480 nm), ultra-broadband (1 GHz), all-optical photoacoustic imaging (AOPAI) system to image and detect early stages of tooth decay. This AOPAI system provides a non-contact, non-invasive and non-ionizing means of detecting early-stage dental caries. Ex-vivo teeth exhibiting early-stage, white-spot lesions were imaged using AOPAI. Experimental scans targeted each early-stage lesion and a reference healthy enamel region. Photoacoustic (PA) signals were generated in the tooth using a 532-nm pulsed laser and the light-induced broadband ultrasound signal was detected at the surface of the tooth with an optical path-stabilized Michelson interferometer operating at 532 nm. The measured time-domain signal was spatially resolved and back-projected to form 2D and 3D maps of the lesion using k-wave reconstruction methods. Experimental data collected from areas of healthy and diseased enamel indicate that the lesion generated a larger PA response compared to healthy enamel. The PA-signal amplitude alone was able to detect a lesion on the surface of the tooth. However, time- reversal reconstructions of the PA scans also quantitatively depicted the depth of the lesion. 3D PA reconstruction of the diseased tooth indicated a sub-surface lesion at a depth of 0.6 mm, in addition to the surface lesion. These results suggest that our AOPAI system is well suited for rapid clinical assessment of early-stage dental caries. An overview of the AOPAI system, fine-resolution PA and histology results of diseased and healthy teeth will be presented.

Secondary caries stands as the leading reason for the failure of composite restorations and dentists spend more time replacing existing restorations than placing new ones. Current clinical strategies, and even modern visible light methods designed to detect decay, lack the sensitivity to distinguish incipient lesions, are confounded by staining on the surface and within the tooth, or are limited to detecting decay on the tooth surface. Near-IR (NIR) imaging methods, such as NIR reflectance and transillumination imaging, and optical coherence tomography are promising strategies for imaging secondary caries. Wavelengths longer than 1300-nm avoid interference from stain and exploit the greater transparency of sound enamel and dental composites, to provide increased contrast with demineralized tissues and improved imaging depth. The purpose of this study was to determine whether NIR transillumination (λ=1300-nm) and NIR crosspolarized reflectance (λ=1500-1700-nm) images can serve as reliable indicators of demineralization surrounding composite restorations. Twelve composite margins (n=12) consisting of class I, II and V restorations were chosen from ten extracted teeth. The samples were imaged in vitro using NIR transillumination and reflectance, polarization sensitive optical coherence tomography (PS-OCT) and a high-magnification digital visible light microscope. Samples were serially sectioned into 200–μm slices for histological analysis using polarized light microscopy (PLM) and transverse microradiography (TMR). The results presented demonstrate the utility of NIR light for detecting recurrent decay and suggest that NIR images could be a reliable screening tool used in conjunction with PS-OCT for the detection and diagnosis of secondary caries.

Previous studies have established that caries lesions can be imaged with high contrast without the interference of stains at near-IR wavelengths greater than 1300-nm. It has been demonstrated that computer controlled laser scanning systems utilizing IR lasers operating at high pulse repetition rates can be used for serial imaging and selective removal of caries lesions. In this study, we report our progress towards the development of algorithms for generating rasterized ablation maps from near-IR reflectance images for the removal of natural lesions from tooth occlusal surfaces. An InGaAs camera and a filtered tungsten-halogen lamp producing near-IR light in the range of 1500-1700-nm were used to collect crosspolarization reflectance images of tooth occlusal surfaces. A CO₂ laser operating at a wavelength of 9.3- μm with a pulse duration of 10-15-μs was used for image-guided ablation.

Previous studies have demonstrated that near-IR imaging can be used to nondestructively monitor the severity of enamel lesions. Arrested lesions typically have a highly mineralized surface layer that reduces permeability and limits diffusion into the lesion. The purpose of this study was to investigate whether the rate of water loss correlates with the degree of remineralization using near-IR reflectance imaging. Artificial bovine (n=15) enamel lesions were prepared by immersion in a demineralization solution for 24 hours and they were subsequently placed in an acidic remineralization solution for different periods. The samples were dehydrated using an air spray for 30 seconds and surfaces were imaged using an InGaAs camera at 1300-1700 nm wavelengths. Near-IR reflectance intensity differences before and after dehydration decreased with longer periods of remineralization. This study demonstrated that near-IR reflectance imaging was suitable for the detection of remineralization in simulated caries lesions and near-IR wavelengths longer than 1400 nm are well suited for the assessment of remineralization.

Cone-beam computed tomography (CBCT) is one of the most useful diagnostic techniques in dentistry but it involves ionizing radiation, while swept source optical coherence tomography (SS-OCT) has been introduced recently as a nondestructive, real-time, high resolution imaging technique using low-coherence interferometry, which involves no ionizing radiation. The purpose of this study was to evaluate the ability of SS-OCT to detect the pulp horn (PH) in comparison with that of CBCT. Ten extracted human mandibular molars were used. After horizontally removing a half of the tooth crown, the distance from the cut dentin surface to PH was measured using microfocus computed tomography (Micro CT) (SL) as the gold standard, by CBCT (CL) and by SS-OCT (OL). In the SS-OCT images, only when PH was observed beneath the overlying dentin, the distance from the cut dentin surface to PH was recorded. If the pulp was exposed, it was defined as pulp exposure (PE). The results obtained by the above three methods were statistically analyzed by Spearman's rank correlation coefficient at a significance level of p < 0.01. SS-OCT detected the presence of PH when the distance from the cut dentin surface to PH determined by SL was 2.33 mm or less. Strong correlations of the measured values were found between SL and CL (r=0.87), SL and OL (r=0.96), and CL and OL (r=0.86). The results showed that SS-OCT images correlated closely with CBCT images, suggesting that SS-OCT can be a useful tool for the detection of PH.

Apicoectomy is performed for the management of apical periodontitis when orthograde root canal treatment is not possible or is ineffective. Prior to the surgery, cone beam computed tomography (CBCT) examination is often performed to evaluate the lesion and the adjacent tissues. During the surgical procedure, the root apex is resected and the resected surface is usually observed under dental operating microscope (DOM). However, it is difficult to evaluate the details and the subsurface structure of the root using CBCT and DOM. A new diagnostic system, swept source optical coherence tomography (SS-OCT), has been developed to observe the subsurface anatomical structure. The aim of this study was to observe resected apical root canals of human maxillary premolars using SS-OCT and compare the findings with those observed using CBCT and DOM. Six extracted human maxillary premolars were used. After microfocus computed tomography (Micro CT; for gold standard) and CBCT scanning of the root, 1 mm of the apex was cut perpendicular to the long axis of the tooth. Each resected surface was treated with EDTA, irrigated with saline solution, and stained with methylene blue dye. The resected surface was observed with DOM and SS-OCT. This sequence was repeated three times. The number of root canals was counted and statistically evaluated. There was no significant difference in the accuracy of detecting root canals among CBCT, DOM and SS-OCT (p > 0.05, Wilcoxon test). Because SS-OCT can be used in real time during surgery, it would be a useful tool for observing resected apical root canals.

Third molar extractions in general anesthesia have become a standard procedure in dentistry. There is an effort to shorten healing time and decrease the number of complications as well as increase comfort after the treatment. Low-level lasers are known for their analgesic, anti-inflammatory, and stimulatory effect. The aim of the study is to evaluate the effect of low-level laser after surgery in general anesthesia reducing the patient's discomfort, i.e. mainly pain, and also, to monitor the biostimulation process. Our study included 79 patients treated at the Department of Maxilofacial Surgery, diagnosed with third molar retention. Diode low-level laser radiation (wavelength 830 nm, output power 270 mW, probe aperture of 6.4 mm²) with dose ~ 3 mJ was applied. The control group was treated by using placebo - red light. The exposure time was 11 seconds immediately after the suture; the treatment was repeated every day for the following 3 days. To evaluate the effect of laser biostimulation, the objective markers for immunological determination of healing - sIgA and lysozyme in non-stimulated saliva of patients - were used. The sIgA decreases after laser application from 546.91 mg/l to 304. 91mg/l and in the control group from 602.25mg/l to 425.62 mg/l. The results were statistically significant. The level of lysozyme decreases from 54.27 mg/l to 2.45mg/l after laser biostimulation, from 304.371mg/l to 11.08mg/l after placebo effect. The study has confirmed a low-level laser healing effect not directly related to pain.

Detection and diagnosis of early dental caries lesions can be difficult due to variable tooth coloration, staining of the teeth and poor contrast between sound and demineralized enamel. These problems can be overcome by using near-infrared (NIR) imaging. Previous studies have demonstrated that lasers can be integrated with NIR imaging devices, allowing image-guided ablation. The aim of this study was to demonstrate that NIR light at 1500 – 1700 nm can be used to guide a 9.3-μm CO₂ laser for the selective ablation of early demineralization on tooth occlusal surfaces. The occlusal surfaces of ten sound human molars were used in this in-vitro study. Shallow simulated caries lesions of varying depth and position were produced on tooth occlusal surfaces using a demineralization solution. Sequential NIR reflectance images at 1500 – 1700 nm were used to guide the laser for selective ablation of the lesion areas. Digital microscopy and polarization sensitive optical coherence tomography (PS-OCT) were used to assess the selectivity of removal. This study demonstrates that high contrast NIR reflectance images can be used for the image-guided laser ablation of early demineralization from tooth occlusal surfaces.

Previous studies have shown that near-IR transillumination is well suited for imaging deep occlusal lesions. The purpose of this study was to determine if near-IR images can be used to guide a CO₂ laser for the selective removal of natural occlusal lesions on extracted teeth. Near-IR occlusal transillumination images of extracted human teeth with natural occlusal caries lesions were acquired using an InGaAs camera and near-IR light at wavelengths from 1290 to 1470-nm from a filtered tungsten halogen source. A CO₂ laser operating at 9.3-μm with a pulse duration of 10-15-μs and a pulse repetition rate of 100-300-Hz was used for caries removal. Optical Coherence tomography was used to confirm lesion presence and serial scans were used to assess selective removal. Teeth were also sectioned for histological examination using polarized light microscopy. This study suggests that near-infrared transillumination is a promising method for the image guided laser ablation of occlusal caries lesions but the use of serial near-IR transillumination imaging for monitoring lesion removal was limited.

Selective removal of caries lesions with high precision is best accomplished using lasers operating at high pulse repetition rates utilizing small spot sizes. Conventional flash-lamp pumped Er:YAG lasers are poorly suited for this purpose, but new diode-pumped Er:YAG lasers have become available operating at high pulse repetition rates. The purpose of this study was to measure the ablation rate and selectivity of sound and demineralized enamel and dentin for a 30 W diode-pumped Er:YAG laser operating with a pulse duration of 20-30-μs and evaluate it's potential for the selective removal of natural occlusal lesions on extracted teeth. Microradiography was used to determine the mineral content of the demineralized enamel and dentin of 300-μm thick sections with natural caries lesions prior to laser ablation. The ablation rate was calculated for varying mineral content. In addition, near-IR reflectance measurements at 1500-1700- nm were used to guide the laser for the selective ablation of natural occlusal caries lesions on extracted teeth.

Several studies have shown that optical coherence tomography (OCT) can be used to measure the remaining enamel thickness and detect the location of subsurface lesions hidden under the sound enamel. The purpose of this study was to develop algorithms to enhance the visibility of subsurface structures such as hidden occlusal lesions and the dentinal-enamel junction. Extracted teeth with natural occlusal lesions were imaged with OCT with and without added high index fluids. A Rotating Kernel Transformation (RKT) nonlinear image processing filter was applied to PS-OCT images to enhance the visibility of the subsurface lesions under the sound enamel. The filter significantly increased (P<0.05) the visibility of the subsurface lesions.