Measuring the activity of oral-bacteria in plaque, the sticky biofilm on enamel, can provide the presently lacking oral feedback to patients. We have developed O-pH, optical pH monitor that measures pH in the range of 4-7.5 and tested in vivo on 25 pediatric subjects (10-18 years) with high caries risk, 18 of these subjects had a dental cleaning within last two months and 7 didn’t have a cleaning in over 2 months. The average pH after a sugar rinse from regions of biofilm associated with caries was 5.8 and 0.5 units lower than the biofilm of sound enamel.
We have developed a new tool to measure the acid production by plaque oral bacteria. Many species of oral bacteria metabolize sugars in food and produce organic acids that demineralize the dental enamel leading to the formation of cavities. Measuring the acidity level before and after a sugar rinse can indicate the susceptibility of an individual to tooth decay and location of active caries. In a case study on two subjects, a non-contact optics-based pH device was able to track pH before and after a sugar rinse. The fiber optic probe measures acidity level in difficult to access dental locations such as occlusal pits and fissures based on changes in the spectral fluorescence profile of fluorescein (FL) dye.
Fiber coupled 420 nm LED excites 200uM aqueous FL solution in the mouth. The fluorescence spectrum in 450-650 nm range is obtained using an adjacent fiber optic cable coupled to a spectrometer. Chemometric analysis of endmember dianion and anion species using least-square fitting is performed to determine the pH of the FL absorbed into the extracellular region of the oral biofilm. Other unwanted noise, like background light and auto-fluorescence in the range of 450-650 nm is removed before calculating biofilm pH.
Using this device in a darkened room on two subjects, we were able to measure resting pH (before a sugar rinse) and track time dependent change in pH (after a sugar rinse) in the range of pH 4-7 paving the way for first clinical optical pH measurement in the mouth.
Near-infrared (NIR) dental imaging using scanning fiber endoscope (SFE) is being developed with advantages of miniature size (1.6mm), flexible shaft, video frame rate (7Hz), and expandable field of view (60 degrees). Using 1310, 1460, and 1550 nm laser diodes, the multispectral NIR SFE provides high contrast of lesion with transparency of stained and non-calcified plaque. However, capabilities of scanned NIR imaging remain unknown. Artificial interproximal lesions are created in extracted human posterior teeth by preparing a cavitation on the mesial or distal surface and then the cavitated artificial lesions were filled with hydroxyapatite powder and sealed with cyanoacrylate resin. Lesions are prepared at different occlusal-gingival depths from marginal ridges, lesion drilling depths and lesion size. Endoscopic reflectance images were acquired and compared to micro-CT scans and 1310 nm OCT images of the lesions to evaluate performance of the nirSFE. Results show that NIR SFE can image deep lesions under sound enamel with thickness of ≤4mm. All three wavelengths can detect deep lesions through the occlusal enamel which are not visible by naked-eye. 1460 nm has the highest contrast between lesion and sound enamel while 1310nm more clearly shows the contrast between enamel and dentin. Our nirSFE system can detect artificial interproximal lesions less than 4 mm below the occlusal surface, distinguish different drilling depth both in enamel and in dentin layer. Furthermore, the nirSFE realtime imaging and video functionality renders better lesion contrast and helps distinguish specular reflection and lesion signal. In conclusion, the NIR SFE has the potential to measure volume of these lesions due to the many viewing angles achievable by the miniature and flexible probe tip.
Near-infrared (NIR) wavelength range of 1300-1500nm has the potential to outperform or augment other dental imaging modalities such as fluorescence imaging, owing to its lower scattering coefficient in enamel and trans- parency on stains and non-cariogenic plaque. However, cameras in this wavelength range are bulky and expensive, which lead to difficulties for in-vivo use and commercialization. Thus, we have proposed a new imaging device combining the scanning fiber endoscopy (SFE) and NIR imaging technology. The NIR SFE system has the advantage of miniature size (1.6 mm), flexible shaft, video frame rate (7Hz) and expandable wide field-of-view (60 degrees). Eleven extracted human teeth with or without occlusal caries were scanned by micro-computed X-ray tomography (micro-CT) to obtain 3D micro-CT images, which serve as the standard for comparison. NIR images in reflection mode were then taken on all the occlusal surfaces, using 1310nm super luminescent diode and 1460nm laser diode respectively. Qualitative comparison was performed between near-infrared im- ages and micro-CT images. Enamel demineralization in NIR appeared as areas of increased reflectivity, and distinguished from non-carious staining at the base of occlusal fissures or developmental defects on cusps. This preliminary work presented proof for practicability of combining NIR imaging technology with SFE for reliable and noninvasive dental imaging with miniaturization and low cost.
The aim of this study was to evaluate the signal intensity and signal attenuation of swept source optical coherence tomography (SS-OCT) for dental caries in relation to the variation of mineral density. SS-OCT observation was performed on the enamel and dentin artificial demineralization and on natural caries. The artificial caries model on enamel and dentin surfaces was created using Streptococcus mutans biofilms incubated in an oral biofilm reactor. The lesions were centrally cross sectioned and SS-OCT scans were obtained in two directions to construct a three-dimensional data set, from the lesion surface (sagittal scan) and parallel to the lesion surface (horizontal scan). The integrated signal up to 200 μm in depth (IS200) and the attenuation coefficient (μ) of the enamel and dentin lesions were calculated from the SS-OCT signal in horizontal scans at five locations of lesion depth. The values were compared with the mineral density obtained from transverse microradiography. Both enamel and dentin demineralization showed significantly higher IS200 and μ than the sound tooth substrate from the sagittal scan. Enamel demineralization showed significantly higher IS200 than sound enamel, even with low levels of demineralization. In demineralized dentin, the μ from the horizontal scan consistently trended downward compared to the sound dentin.
Exposed root surfaces due to gingival recession are subject to biofilm stagnation that can result in caries formation. Cervical enamel and dentin demineralization induced by a cariogenic biofilm was evaluated using swept-source optical coherence tomography (SS-OCT). The cementoenamel junction (CEJ) sections of extracted human teeth were subjected to demineralization for 1, 2, or 3 weeks. A suspension of Streptococcus mutans was applied to form a cariogenic biofilm using an oral biofilm reactor. After incubation, demineralization was observed by SS-OCT. For the analysis of SS-OCT signal, the value of the area under the curve (AUC) of the signal profile was measured. Statistical analyses were performed with 95% level of confidence. Cervical demineralization was displayed as a bright zone in SS-OCT. The demineralization depth of dentin was significantly deeper than that of enamel (p<0.05). Enamel near the CEJ demonstrated a significant increase of AUC over the other enamel region after the demineralization. The gaps along the dentinoenamel junction were additionally observed in SS-OCT. SS-OCT was capable of monitoring the cervical demineralization induced by a cariogenic biofilm and is considered to be a promising modality for the diagnosis of cervical demineralization.
A technology to characterize early enamel lesions is needed in dentistry. Optical coherence tomography (OCT) is a noninvasive method that provides high-resolution cross-sectional images. The aim of this study is to compare OCT with microfocus x-ray computed tomography (μCT) for assessment of natural enamel lesions in vitro. Ten human teeth with visible white spot-like changes on the enamel smooth surface and no cavitation (ICDAS code 2) were subjected to imaging by μCT (SMX-100CT, Shimadzu) and 1300-nm swept-source OCT (Dental SS-OCT, Panasonic Health Care). In μCT, the lesions appeared as radiolucent dark areas, while in SS-OCT, they appeared as areas of increased signal intensity beneath the surface. An SS-OCT attenuation coefficient based on Beer–Lambert law could discriminate lesions from sound enamel. Lesion depth ranged from 175 to 606 μm in SS-OCT. A correlation between μCT and SS-OCT was found regarding lesion depth (R=0.81, p<0.001) and also surface layer thickness (R=0.76, p<0.005). The images obtained clinically in real time using the dental SS-OCT system are suitable for the assessment of natural subsurface lesions and their surface layer, providing comparable images to a laboratory high-resolution μCT without the use of x-ray.
Vertical misfit of implant–abutment interface can affect the success of implant treatment; however, currently available modalities have limitations to detect these gaps. This study aimed to evaluate implant–abutment gaps in vitro using optical coherence tomography (OCT). Vertical misfit gaps sized 50, 100, 150, or 200 μm were created between external hexagonal implants and titanium abutments (Nobel Biocare, Göteborg, Sweden). A porcine gingival tissue slice, 0.5, 1.0, 1.5, or 2.0 mm in thickness, was placed on each implant–abutment interface. The gaps were evaluated by swept-source OCT at a center wavelength of 1330 nm (Panasonic Healthcare, Ehime, Japan) with beam angles of 90, 75 and 60 deg to the implant long-axis. The results suggested that while the measurements were precise, gap size and gingival thickness affected the sensitivity of detection. Gaps sized 100 μm and above could be detected with good accuracy under 0.5- or 1.0-mm-thick gingiva (GN). Around 70% of gaps sized 150 μm and above could be detected under 1.5-mm-thick GN. On the other hand, 80% of gaps under 2.0-mm-thick GN were not detected due to attenuation of near-infrared light through the soft tissue. OCT appeared as an effective tool for evaluating the misfit of implant–abutment under thin layers of soft tissue.
This study aimed to investigate swept source optical coherence tomography (SS-OCT) as a detecting tool for occlusal caries in primary teeth. At the in vitro part of the study, 38 investigation sites of occlusal fissures (noncavitated and cavitated) were selected from 26 extracted primary teeth and inspected visually using conventional dental equipment by six examiners without any magnification. SS-OCT cross-sectional images at 1330-nm center wavelength were acquired on the same locations. The teeth were then sectioned at the investigation site and directly viewed under a confocal laser scanning microscope (CLSM) by two experienced examiners. The presence and extent of caries were scored in each observation. The results obtained from SS-OCT and conventional visual inspections were compared with those of CLSM. Consequently, SS-OCT could successfully detect both cavitated and noncavitated lesions. The magnitude of sensitivity for SS-OCT was higher than those for visual inspection (sensitivity of visual inspection and SS-OCT, 0.70 versus 0.93 for enamel demineralization, 0.49 versus 0.89 for enamel cavitated caries, and 0.36 versus 0.75 for dentin caries). Additionally, occlusal caries of a few clinical cases were observed using SS-OCT in vivo. The results indicate that SS-OCT has a great detecting potential for occlusal caries in primary teeth.
This study aimed to nondestructively evaluate sealing performance of eight one-step self-etch adhesives (1-SEAs) using optical coherence tomography (OCT). The two-step self-etch adhesive (2-SEA) served as the control. Round tapered class-I cavities (D=4 mm , H=2 mm ) were prepared in bovine incisors, treated with each adhesive (n=5 ), and restored with a flowable resin composite. Cross-sections were obtained from each restoration using swept-source OCT with 1310-nm laser. The average percentage of the sealed interface (SI%) for each adhesive was calculated using image analysis software, considering increased signal intensity at the interface as gap. Samples were then sectioned and observed under confocal laser scanning microscope (CLSM). Significantly different SI% values were found among different adhesives (analysis of variance, Bonferroni, p<0.05 ). There was also a significant correlation in SI% between OCT and CLSM (p<0.0001 , r=0.96 ). Additionally, microscopic analysis revealed that the gaps in 1-SEAs occurred not only at dentine–adhesive interfaces but also frequently at adhesive–composite interfaces. Some recent 1-SEAs could achieve reliable short-term sealing comparable to 2-SEA. OCT is a unique tool to nondestructively evaluate the sealing performance of the restoratives through the cavity, provided that cavity walls have a certain minimum inclination with respect to the beam.
Optical coherence tomography (OCT) is a potential clinical tool for enamel lesion monitoring. Swept-source OCT findings were compared with cross-sectional nanohardness findings of enamel. Subsurface bovine enamel lesions in three groups were subjected to (1) deionized water (control), (2) phosphoryl oligosaccharide of calcium (POs-Ca) or (3) POs-Ca with 1 ppm fluoride for 14 days. B-scans images were obtained at 1310-nm center wavelength on sound, demineralized and remineralized areas after 4, 7, and 14 days. The specimens were processed for cross-sectional nanoindentation. Reflectivity from enamel that had increased with demineralization decreased with remineralization. An OCT attenuation coefficient parameter (μ t ), derived based on the Beer-Lambert law as a function of backscatter signal slope, showed a strong linear regression with integrated nanohardness of all regions (p<0.001 , r=−0.97 ). Sound enamel showed the smallest, while demineralized enamel showed the highest μ t . In group three, μ t was significantly lower at four days than baseline, but remained constant afterwards. In group two, the changes were rather gradual. There was no significant difference between groups two and three at 14 days in nanohardness or μ t POs-Ca with fluoride-enhanced nanohardness of the superficial zone. OCT signal attenuation demonstrated a capability for monitoring changes of enamel lesions during remineralization.
Early detection, monitoring and remineralization repair of enamel lesions are top research priorities in the modern dentistry focusing on minimal intervention concept for caries management. We investigate the use of swept-source optical coherence tomography system (SS-OCT) without polarization-sensing at 1319 nm wavelength developed for clinical dentistry (Dental OCT System Prototype 2, Panasonic Healthcare Co., Ltd., Japan) in quantitative assessment of artificial enamel lesions and their remineralization. Bovine enamel blocks were subjected to demineralization to create subsurface lesions approximately 130 μm in depth over 2 weeks, and subjected to remineralization in solution containing bioavailable calcium and 1ppm fluoride at pH 6.5 for 2 weeks. Cross-sectional images of sound, demineralized and remineralized specimens were captured under hydrated conditions by the OCT. Finally, the specimens were cut into sections for nanoindentation to measure hardness through the lesion under 2mN load. Reflectivity had increased with demineralization. OCT images of lesions showed a boundary closely suggesting the lesion depth that gradually progressed with demineralization time. After remineralization, the boundary depth gradually decreased and nanoindentation showed over 60% average hardness recovery rate. A significant negative correlation was found between the slope power-law regression as a measure of attenuation and overall nanohardness for a range of data covering sound, demineralized and remineralized areas. In conclusion, OCT could provide clear images of early enamel lesion extent and signal attenuation could indicate its severity and recovery. Clinical data of natural lesions obtained using Dental OCT and analyzed by this approach will also be presented. Study supported by GCOE IRCMSTBD and NCGG.
We previously demonstrated that a swept-source optical coherence tomography system (SS-OCT) without polarization-sensing
could quantitatively estimate the progress of cavitated dentin lesions in vitro. The purpose of the current study
was to investigate the ability to estimate the lesion development in non-cavitated dentin lesions with a surface layer.
Bovine root dentin specimens were subjected to different periods of demineralization (1 to 14 days). Cross-sectional
images of the specimens before and after the demineralization were captured by SS-OCT at 1310 nm center wavelength.
Following each period, the specimens were cut into sections for transverse microradiography (TMR) and correlations
between SS-OCT data and TMR parameters were examined. TMR images of the specimens showed subsurface lesions
ranging 100 to 400 μm in lesion depth (LD) and 1,000-5,000 volume in mineral loss (ΔZ). SS-OCT images showed a
boundary suggesting the lesion front. Reflectivity increased with demineralization progress. A strong correlation was
found between the boundary depth from the lesion surface and LD. Integrated dB values from the lesion surface to the
boundary depth before and after the demineralization (RS and RD, respectively) were calculated. There was a significant
positive relationship between ΔZ and RD; but not between ΔZ and ΔR, where ΔR=RD-RS. A clear indication of surface
layer thickness was not found on OCT images. In conclusion, SS-OCT system could provide quantitative estimation of
caries progress in artificial subsurface dentin lesion in terms of lesion depth. Further studies are needed to investigate
whether other parameters of the dentin lesion with surface layer could be determined by this technique. Study supported
by Global Center of Excellence at TMDU and NCGG.
Objectives: Formation of microgaps under the composite restorations due to polymerization stress and other
causes compromise the adhesion to the dental substrate and restoration durability. However, the relationship
between cavity adaptation and bond strength is not clear. In this paper, we introduce a new testing method to
assess cavity adaptation by swept-source optical coherence tomography (SS-OCT) and microtensile bond
strength (MTBS) in the same class-I cavity. Methods: Round class-I cavities 3 mm in diameter and 1.5 mm
in depth were prepared on 10 human premolars. After application of Tokuyama Bond Force adhesive, the
cavities were filled by one of the two techniques; incremental technique using Estelite Sigma Quick universal
composite or flowable lining using Palfique Estelite LV with bulk filling using the universal composite. Ten
serial B-scan images were obtained throughout each cavity by SS-OCT. Significant peaks in the signal
intensity were detected at the bonded interface of the cavity floor and to compare the different filling
techniques. The specimens were later cut into beams (0.7x0.7 mm) and tested to measure MTBS at the cavity
floor. Results: Flowable lining followed by bulk filling was inferior in terms of cavity adaptation and MTBS
compared to the incremental technique (p<0.05, t-test). The adaptation (gap free cavity floor) and MTBS
followed similar trends in both groups. Conclusion: Quantitative assessment of dental restorations by OCT
can provide additional information on the performance and effectiveness of dental composites and restoration
techniques. This study was supported by Global Center of Excellence, Tokyo Medical and Dental University
and King Abdulaziz University.
The aim of this work was to investigate relationship between refractive index (n) and mineral content (MC) (vol %) of
enamel and dentin using swept-source optical coherence tomography (SS-OCT) and transverse microradiography (TMR).
Enamel and dentin blocks were partitioned into three regions. The middle partition of each sample was covered with a
nail polish to protect the sound area during exposure to the treatment solutions. Samples were demineralized in a
demineralizing solution, which was refreshed once a week, for 2 months. One window was covered with acid-resistant
varnish, leaving the other window exposed; the samples were placed in a solution for remineralization. Samples then
were sliced into disks with thickness of 300 μm to 400 μm and placed on metal plate in order to capture cross-sectional
images of sound, demineralized and remineralized regions by OCT at 1319 nm center wavelength. The n then was
calculated via formula using image analysis software. Following n measurement, these specimens were further polished
for the TMR analysis. Correlation between OCT n and TMR MC was examined. A significant and highly positive
correlation was found between the measured n and the actual MC at the corresponding locations (Pearson correlation
coefficients (r) were 0.94 and 0.97 in enamel and 0.95 and 0.91 in dentin after de-/remineralization process, respectively
p < 0.05). OCT showed a potential for quantitative analysis of the mineral loss or gain by measuring of the n in vitro.
Supported by the grant from the Japanese Ministry of Education, Global Center of Excellence (GCOE) Program,
"International Research Center for Molecular Science in Tooth and Bone Diseases."
This study aimed to investigate whether swept source optical coherence tomography (SS-OCT) could estimate the lesion depth and mineral loss quantitatively without the use of polarization sensitivity, and to examine a relationship between OCT data and transverse microradiography (TMR) lesion parameters. Twenty-four bovine root dentin specimens were allocated to three groups of 4-, 7-, and 14-day demineralization. Cross-sectional images of the specimens before and after the demineralization were captured by OCT at 1319 nm center wavelength. Following the demineralization, these specimens were cut into sections for TMR analysis. Correlations between the OCT data and TMR lesion parameters were examined. TMR images of the specimens showed cavitated lesions (lesion depth or LDTMR: 200 to 500 μm, ΔZ or mineral loss: 10,000 to 30,000 vol % μm). The OCT images showed "boundaries," suggesting the lesion front. Integrated dB values before and after the demineralization and their difference (RD, RS, and ΔR, respectively) were calculated from the lesion surface to the corrected depth of boundary (LDOCT). A statistically significant correlation was found between LDOCT and LDTMR (p < 0.05, r = 0.68). Similarly, statistically significant correlations were found between ΔZ and RD or ΔR. The OCT showed a potential for quantitative estimation of lesion depth and mineral loss with cavitated dentin lesions in vitro.
The aim of this work was to explore the utility of swept-source optical coherence tomography (SS-OCT) for quantitative
evaluation of dental composite restorations. The system (Santec, Japan) with a center wavelength of around 1300 nm and
axial resolution of 12 μm was used to record data during and after placement of light-cured composites. The Fresnel
phenomenon at the interfacial defects resulted in brighter areas indicating gaps as small as a few micrometers. The gap
extension at the interface was quantified and compared to the observation by confocal laser scanning microscope after
trimming the specimen to the same cross-section. Also, video imaging of the composite during polymerization could
provide information about real-time kinetics of contraction stress and resulting gaps, distinguishing them from those gaps
resulting from poor adaptation of composite to the cavity prior to polymerization. Some samples were also subjected to a
high resolution microfocus X-ray computed tomography (μCT) assessment; it was found that differentiation of smaller
gaps from the radiolucent bonding layer was difficult with 3D μCT. Finally, a clinical imaging example using a newly
developed dental SS-OCT system with an intra-oral scanning probe (Panasonic Healthcare, Japan) is presented. SS-OCT
is a unique tool for clinical assessment and laboratory research on resin-based dental restorations. Supported by GCOE at
TMDU and NCGG.
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