The Ability of Optical Coherence Tomography to Characterize the Root Canal Walls

Microtensile bond strength to sealer-contaminated dentin after using different cleaning protocols

Background/purpose

Sealer residues on dentin may affect bonding to restorative materials. This study aimed to evaluate the bond strength to sealer-contaminated dentin after using different cleaning protocols.

Materials and methods

Freshly extracted bovine incisors were prepared and exposed the buccal pulp chamber dentin, obtaining segments measuring 5 mm × 5 mm with a height of 3 mm. The segments were randomly distributed into 4 groups (n = 7) according to different protocols. Control group: no contamination was performed. In the three experimental groups, the segments were contaminated with epoxy resin-based sealer for 5 min, and different cleaning protocols were performed. Acetone group: acetone-saturated cotton pellets were used to wipe the sealer. Ultrasound group: ultrasonic ET-20D tip cleaning. Acetone combined with ultrasound group: cleaning with acetone-saturated cotton pellets and ultrasonic tip. All segments were bonded using a self-etch adhesive. Two samples in each group were scanned by swept-source optical coherence tomography (SS-OCT) to evaluate sealer residues. A microtensile test was performed on the remaining 5 samples, which were built up with composite resin.

Results

Sealer residues were observed in 3 of 14 (21.4%) sections of acetone group by SS-OCT. Compared to the control, ultrasound alone or in combination with acetone preserved the bond strength (P > .05). The ultrasound group exhibited the highest bond strength (39.38 MPa), which differed from that of the acetone group, which provided the lowest bond strength (32.88 MPa) (P < .05).

Conclusion

Cleaning epoxy resin-based sealer-contaminated dentin surfaces using ultrasound or combined with acetone could preserve the bond strength.

Comparison of microtomography and optical coherence tomography on apical endodontic filling analysis

OBJECTIVES

To comparein vitro differences in the apical filling regarding working length (WL) change and presence of voids and to validate optical coherence tomography (OCT) in comparison with computerized microtomography (µCT) for the detection of failures in the apical filling.

METHODS

Forty-five uniradicular teeth with round canals, divided into groups (n = 15) following the obturation protocols: LC (lateral condensation), TMC (thermomechanical compaction) and SC (single cone). Samples were scanned using µCT (parameters: 80 kV, 222 µA, and resolution of 11 µm), OCT (parameters: SSOCT, 1300 nm and axial resolution of 12 µm), and periapical digital radiography. The images were analyzsed by two blind and calibrated observers using ImageJ software to measure the boundary of the obturation WL and voids presence. Categorical and metric data were submitted to inferential analysis, and the validity of the OCT as a diagnostic test was assessed with performance and reliability tests.

RESULTS

The WL average remained constant for all obturation techniques and image methods. OCT showed adequate sensitivity and specificity to detect voids in the WL of apical obturations in vitro in comparison with µCT. Both image methods found a higher number of voids for LC technique (µCT p = 0.011/OCT p = 0.002).

CONCLUSIONS

OCT can be used in apical obturation voids assessment and the LC technique revealed more voids with larger dimensions.

The Use of Optical Coherence Tomography in Dental Diagnostics: A State-of-the-Art Review

Optical coherence tomography provides sections of tissues in a noncontact and noninvasive manner. The device measures the time delay and intensity of the light scattered or reflected from biological tissues, which results in tomographic imaging of their internal structure. This is achieved by scanning tissues at a resolution ranging from 1 to 15 μm. OCT enables real-time in situ imaging of tissues without the need for biopsy, histological procedures, or the use of X-rays, so it can be used in many fields of medicine. Its properties are not only particularly used in ophthalmology, in the diagnosis of all layers of the retina, but also increasingly in cardiology, gastroenterology, pulmonology, oncology, and dermatology. The basic properties of OCT, that is, noninvasiveness and low wattage of the used light, have also been appreciated in analytical technology by conservators, who use it to identify the quality and age of paintings, ceramics, or glass. Recently, the OCT technique of visualization is being tested in different fields of dentistry, which is depicted in the article.

Detection of Apical Root Cracks Using Spectral Domain and Swept-source Optical Coherence Tomography

INTRODUCTION

This study aimed to evaluate the ability of 2 optical coherence tomographic (OCT) systems to detect apical dentinal microcracks.

METHODS

Twenty extracted human single-rooted mandibular incisors were selected. After root canal preparation with an R40 Reciproc file (VDW, Munich, Germany), the specimens presenting apical microcracks were identified using micro-computed tomographic (micro-CT) scanning as the gold standard. Then, the apical portions of the roots were imaged with spectral domain OCT (SD-OCT) and swept-source OCT systems, and the resulting images were blindly evaluated by 3 independent examiners to detect microcracks. The diagnostic performance of each OCT device was calculated, and statistical analysis was performed.

RESULTS

Based on the micro-CT images, 12 (60%) roots presented dentinal microcracks in the apical region. The images generated by the OCT systems were able to show microcrack lines at the same location as the corresponding micro-CT cross sections. Although the diagnostic performance of the SD-OCT device was superior, there were no statistically significant differences between the 2 OCT devices (P > .05). Interexaminer agreement was substantial to almost perfect for the SD-OCT system and moderate to almost perfect for the swept-source OCT system, whereas intraexaminer agreement was substantial to almost perfect for both OCT devices.

CONCLUSIONS

The detection ability verified for both OCT systems renders them promising tools for the diagnosis of apical microcracks.

Optical changes of dentin in the near-IR as a function of mineral content

The optical properties of human dentin can change markedly due to aging, friction from opposing teeth, and acute trauma, resulting in the formation of transparent or sclerotic dentin with increased mineral density. The objective of this study was to determine the optical attenuation coefficient of human dentin tissues with different mineral densities in the near-infrared (NIR) spectral regions from 1300-2200 nm using NIR transillumination and optical coherence tomography (OCT). N=50 dentin samples of varying opacities were obtained by sectioning whole extracted teeth into ~ 150 μm transverse sections at the cemento-enamel junction or the apical root. Transillumination images were acquired with a NIR camera and attenuation measurements were acquired at various NIR wavelengths using a NIR sensitive photodiode. Samples were imaged with transverse microradiography (gold standard) in order to determine the mineral density of each sample.

Nondestructive observation of teeth post core space using optical coherence tomography: a pilot study

Coronal tooth lesions, such as caries, enamel cracking, and composite resin restoration cavities, have been observed by optical coherence tomography (OCT). This pilot study was performed to verify whether OCT could reveal details of root canals filled with resin core build-up. A dual-cure, one-step, self-etch adhesive system-bonding agent (Clearfil Bond SE ONE, Kuraray Noritake Dental) and dual-cure resin composite core material (Clearfil DC Core Automix ONE, Kuraray Noritake Dental) were used according to the manufacturer's instructions in root canals. OCT was performed at three stages of the core build-up: after the post space preparation, after bonding application, and after resin core fabrication. The cementum was removed in the cementum absent group and the root was left untreated in the cementum present group. Bubbles were observed in the resin cores and gaps formed between the resin core and dentin. In the cementum absent group, the internal structure of the root could be visualized clearly compared with the cementum present group. The root internal structure could be observed by OCT and the image became clearer when cementum was removed.

Detection of root surface fractures with swept-source optical coherence tomography (SS-OCT)

OBJECTIVE

The purpose of this study was to compare optical coherence tomography (OCT) with the existing technologies, to assess its accuracy and utility in detecting vertical root fractures of extracted human teeth.

BACKGROUND DATA

The detection of root fractures in teeth that have undergone root canal treatment is challenging because of the great difficulty in differentiating these fractures from morphologic or radiographic anomalies. OCT methods are based on depth-resolved optical reflectivity and have been developed to reduce the invasiveness and radiation exposure inherent to other techniques.

METHODS

Twelve extracted human mandibular teeth (totaling 25 roots) that were free of caries, calculus, and root treatment were used, and assessed by microfocus computed tomography, the current gold standard for fracture detection. The ability of appropriately trained observers to detect root fractures using visual, microscopic, and swept-source OCT (SS-OCT) techniques were compared. micro-CT and SS-OCT produce three-dimensional images of the tooth from which to diagnose fractures, but CT scanning involves radiation exposure that is not required in SS-OCT.

RESULTS

Seventeen of the 25 roots were found to have fractures by microfocus CT. These findings were replicated by SS-OCT, which revealed fractures exhibiting identical origin, size, and angulation within the root. We found that SS-OCT gave results compatible to the gold standard technique, and that SS-OCT and microscopy were more effective for identifying root fractures than was visual observation alone.

CONCLUSIONS

SS-OCT may represent a novel, noninvasive, noncontact and nonexposure alternative to the conventional methods used for assessing root fractures in teeth.

Detection of dentinal microcracks using infrared thermography

INTRODUCTION

It is difficult to make a definite diagnosis of a cracked tooth solely based on an inspection within the root canal, especially in case of microcracks. At present, there seems to be no established method to detect dentinal microcracks in roots; therefore, the current detection techniques need to be improved. Vibrothermography (VibroIR) helps to detect microcracks by the friction heat generated from ultrasonic vibration. The purpose of this study was to establish a novel method using VibroIR to detect dentinal microcracks.

METHODS

The root canals of 20 roots with cracks and control roots were prepared after removing the tooth crowns. A tapered indenter was inserted into the root canal and pressed until a microcrack was created under an optical microscope. Using VibroIR, the detection trials for dentinal microcracks were performed with an ultrasonic vibration power ranging from 0.43 to 1.48 W at an angle of 0°, 30°, 45°, 60°, and 90° between the ultrasonic vibration point and the microcrack line. After the detection test, the microcrack width was measured with an optical microscope.

RESULTS

Frictional heat was detected in the microcracks with thermography at 0.89 to 1.48 W and at an ultrasonic vibration point angle less than 60° from the crack line for 10 seconds. Microcracks with a width of 4 to 35.5 μm were detected with this method.

CONCLUSIONS

VibroIR may be an effective method for the diagnosis of root dentinal microcracks.

An imaging-based approach to the evaluation of xerostomia

BACKGROUND AND OBJECTIVE

Goal was to evaluate the potential of in vivo optical coherence tomography (OCT) imaging to determine the response of patients with xerostomia to a dry mouth toothpaste versus fluoride toothpaste placebo.

STUDY DESIGN/MATERIALS AND METHODS

Ten subjects with xerostomia participated in this double-blind, crossover, placebo-controlled study. After examination and OCT imaging, subjects used the first product for 15 days, followed by a 7-day washout period, and then they used the second product for 15 days. Data were acquired at 5-day intervals, also before and after the washout.

RESULTS

Visual examination and tongue blade adhesion test did not reflect response to the product. Two imaging-based markers were identified: (i) In OCT images, epithelial thickness increased significantly (P < 0.05) after use of the dry mouth toothpaste, but did not change significantly (P > 0.05) after the use of a fluoride toothpaste and (2) Optical backscattering data showed progressive characteristic changes from baseline with use of the active product.

CONCLUSIONS

In this pilot study using in vivo OCT imaging, it was possible to detect and measure oral epithelial response to the dry mouth product versus placebo in patients with xerostomia.

CLINICAL IMPLICATIONS

This approach may permit site-specific assessment of xerostomia, individualized treatment planning and monitoring, and sequential mucosal mapping in patients with dry mouth.

Remineralization of Root Caries Monitored Using Cross-Polarization Optical Coherence Tomography

Previous studies have demonstrated that polarization sensitive optical coherence tomography (PS-OCT) can be used to image caries lesions in dentin, measure nondestructively the severity of dentin demineralization, and determine the efficacy of intervention with anticaries agents including fluoride and lasers. However, those studies were limited to artificial lesions on dentin and roots surfaces. The objective of this study is to determine if a cross polarization OCT system (CP-OCT) can be used to nondestructively measure a reduction in the reflectivity of natural root caries lesions after exposure to a remineralization solution. CP-OCT images of 11 teeth with existing root lesions were acquired before and after exposure to a remineralizing solution for 20 days. The integrated reflectivity was calculated after integrating to a fixed depth of 200-µm. There was a significant decrease in the integrated reflectivity after exposure to the remineralizing solution.

Optical diagnostics in the oral cavity: an overview

As the emphasis shifts from damage mitigation to disease prevention or reversal of early disease in the oral cavity, the need for sensitive and accurate detection and diagnostic tools become more important. Many novel and emergent optical diagnostic modalities for the oral cavity are becoming available to clinicians with a variety of desirable attributes including: (i) non-invasiveness, (ii) absence of ionizing radiation, (iii) patient-friendliness, (iv) real-time information (v) repeatability, and (vi) high-resolution surface and subsurface images. In this article, the principles behind optical diagnostic approaches, their feasibility and applicability for imaging soft and hard tissues, and their potential usefulness as a tool in the diagnosis of oral mucosal lesions, dental pathologies, and other dental applications will be reviewed. The clinical applications of light-based imaging technologies in the oral cavity and of their derivative devices will be discussed to provide the reader with a comprehensive understanding of emergent diagnostic modalities.

In-vivo dynamic characterization of microneedle skin penetration using optical coherence tomography

The use of microneedles as a method of circumventing the barrier properties of the stratum corneum is receiving much attention. Although skin disruption technologies and subsequent transdermal diffusion rates are being extensively studied, no accurate data on depth and closure kinetics of microneedle-induced skin pores are available, primarily due to the cumbersome techniques currently required for skin analysis. We report on the first use of optical coherence tomography technology to image microneedle penetration in real time and in vivo. We show that optical coherence tomography (OCT) can be used to painlessly measure stratum corneum and epidermis thickness, as well as microneedle penetration depth after microneedle insertion. Since OCT is a real-time, in-vivo, nondestructive technique, we also analyze skin healing characteristics and present quantitative data on micropore closure rate. Two locations (the volar forearm and dorsal aspect of the fingertip) have been assessed as suitable candidates for microneedle administration. The results illustrate the applicability of OCT analysis as a tool for microneedle-related skin characterization.

Nondestructive assessment of dentin demineralization using polarization-sensitive optical coherence tomography after exposure to fluoride and laser irradiation

Previous studies have demonstrated that polarization-sensitive optical coherence tomography (PS-OCT) can be used to image natural and artificial caries in dentin. The purpose of this study was to measure nondestructively the severity of artificial caries lesions in dentin and determine the efficacy of intervention with anticaries agents including fluoride and lasers. Although several studies have assessed the utility of PS-OCT to image caries lesions in enamel and to quantify the lesion severity, only a few studies have focused on lesions in dentin. In this study, images of artificial dentin lesions on extracted human teeth were acquired with PS-OCT. Before exposure to an artificial demineralizing solution, three incisions were made on the sample surfaces using either Er:YAG, Nd:YAG (lambda = 355 nm), or TEA CO(2) lasers and selected areas were treated with topical fluoride to create six unique treatment areas for each of the three laser conditions investigated. The integrated reflectivity and depth of demineralization were calculated for each of the six areas on each sample using the PS-OCT images. Polarized light microscopy (PLM) and transverse microradiography (TMR) were used to measure lesion severity on histological thin sections for comparison. PS-OCT successfully measured the inhibition of demineralization by topical fluoride. Laser irradiation was not particularly effective in increasing or decreasing the rate of dentin demineralization. PLM and TMR corroborated those results. This study demonstrates that PS-OCT can be used to measure demineralization on dentin surfaces and determine the degree of inhibition of demineralization by anticaries agents.

In vitro incidence of root canal bifurcation in mandibular incisors by radiovisiography

OBJECTIVE

The aim of this study was to verify, in vivo and in vitro, the prevalence of root canal bifurcation in mandibular incisors by digital radiography.

MATERIAL AND METHODS

Four hundred teeth were analyzed for the in vivo study. Digital radiographs were taken in an orthoradial direction from the mandibular incisor and canine regions. The digital radiographs of the canine region allowed visualizing the incisors in a distoradial direction using 20 masculine deviation. All individuals agreed to participate by signing an informed consent form. The in vitro study was conducted on 200 mandibular incisors positioned on a model, simulating the mandibular dental arch. Digital radiographs were taken from the mandibular incisors in both buccolingual and mesiodistal directions.

RESULTS

The digital radiography showed presence of bifurcation in 20% of teeth evaluated in vitro in the mesiodistal direction. In the buccolingual direction, 17.5% of teeth evaluated in vivo and 15% evaluated in vitro presented bifurcation or characteristics indicating bifurcation.

CONCLUSIONS

Digital radiography associated with X-ray beam distally allowed detection of a larger number of cases of bifurcated root canals or characteristics of bifurcation.

Polarization-sensitive optical coherence tomography for the nondestructive assessment of the remineralization of dentin

Previous studies have demonstrated that polarization-sensitive optical coherence tomography (PS-OCT) can be used to image caries lesions in dentin, measure nondestructively the severity of dentin demineralization, and determine the efficacy of intervention with anticaries agents including fluoride and lasers. The objective of this study is to determine if PS-OCT can be used to nondestructively measure a reduction in the reflectivity of dentin lesions after exposure to a remineralization solution. Although studies have shown the ability of PS-OCT to image the remineralization of lesions in enamel, none have included dentin. PS-OCT images of dentin surfaces are acquired after exposure to an artificial demineralizing solution for six days and a remineralizing solution for 20 days. The integrated reflectivity, depth of demineralization, and thickness of the layer of remineralization are calculated for each of the two treatment groups on each sample. Polarized light microscopy and microradiography are used to measure lesion severity on histological thin sections for comparison. PS-OCT successfully measured the formation of a layer of increased mineral content near the lesion surface. Polorized light microscopy (PLM) and transverse microradiography (TMR) corroborated those results. PS-OCT can be used for the nondestructive measurement of the remineralization of dentin.

Polarization-sensitive optical coherence tomographic imaging of artificial demineralization on exposed surfaces of tooth roots

BACKGROUND AND OBJECTIVES

The purpose of this study was to assess the potential of polarization-sensitive optical coherence tomography (PS-OCT) to non-destructively measure the depth and severity of artificial demineralization on exposed root surfaces and measure the degree of inhibition by topical fluoride. Although PS-OCT imaging studies have demonstrated the utility of PS-OCT for imaging carious lesions on enamel and dentin surfaces the influence of the cementum layer that is present on intact root surfaces has not been investigated.

MATERIALS AND METHODS

In this study, extracted human tooth roots were partitioned into three sections with one partition treated with topical fluoride, one partition protected from demineralization with acid resistant varnish, and one partition exposed to a demineralization solution, producing artificial lesions approximately 200-mum deep in root dentin. The lesion depth, remaining cementum thickness and the integrated reflectivity for lesion areas were measured with PS-OCT. These measurements were also compared with more established methods of measuring demineralization, namely transverse microradiography (TMR) and polarized light microscopy (PLM).

RESULTS

PS-OCT was able to measure a significant increase in the reflectivity between lesion areas and sound root surfaces. In contrast to dentin, the cementum layer manifests minimal reflectivity in the PS-OCT images allowing non-destructive measurement of the remaining cementum thickness. The reflectivity of the cementum layer did not increase significantly after substantial demineralization, however it did manifest considerable shrinkage in a fashion similar to dentin and that shrinkage could be measured with OCT.

SIGNIFICANCE

This study demonstrates that PS-OCT can be used to measure demineralization non-destructively on root surfaces and assess inhibition of demineralization by anti-caries agents.

Assessment of Dentin Remineralization with PS-OCT

Previous studies have demonstrated that polarization sensitive optical coherence tomography (PS-OCT) can be used to image natural root caries lesions, measure non-destructively the severity of dentin demineralization and determine the efficacy of intervention with anti-caries agents including fluoride and lasers. The objective of this study was to determine if PS-OCT could be used to nondestructively measure the formation of a layer of remineralized dentin on the surface of dentin lesions after exposure to a remineralization solution. In this study images of artificial dentin lesions on extracted human teeth were acquired using PS-OCT after exposure to an artificial demineralizing solution at pH 4.9 for six days and after subsequent exposure to a remineralizing solution at pH 7.0 for 20 days. Polarized light microscopy and microradiography were used to examine histological thin sections from the samples for comparison. PS-OCT successfully measured the formation of a layer of increased mineral content near the lesion surface. PLM and TMR corroborated those results. This study demonstrates the potential use of PS-OCT for the nondestructive measurement of the remineralization of dentin surfaces.

Limited ability of three commonly used thermoplasticized gutta-percha techniques in filling oval-shaped canals

The present study was designed to compare the percentage of gutta-percha-filled area (PGFA) achieved in oval-shaped canals after filling by 3 thermoplasticized techniques. Eighty-seven oval-shaped root canals were prepared and root-filled as follows: lateral condensation (n = 20), thermomechanical compaction (n = 20), wave of condensation (n = 20), and Thermafil system (n = 20). A cross section of each tooth was made 5 mm from the apex, and the samples were prepared for microscopic analysis. Digital image measurements of the cross-sectioned area of the canal and the gutta-percha were performed, and the PGFA was calculated. Nonparametric statistical analysis was performed with the Kruskal-Wallis H test and post hoc Dunn test. Overall, PGFAs were variable among the experimental groups, ranging from 37.1%-98.5%, and the pooled data from all techniques had a general mean of 69.6% +/- 18%. Thermafil system, wave of condensation, and thermomechanical compaction produced significantly higher PGFAs than lateral condensation (P < .05); however, no significant differences among these techniques were detected (P > .05). Therefore, a limited ability to fill oval-shaped canals was achieved in the 3 thermoplasticized techniques tested.

Quality assessment of dental treatments using en-face optical coherence tomography

The present study evaluates the potential of en-face optical coherence tomography (OCT) as a possible noninvasive high resolution method for supplying necessary information on the material defects of dental prostheses and microleakage at prosthetic interfaces. Teeth are also imaged after several treatment methods to asses material defects and microleakage at the tooth-filling interface, and the presence or absence of apical microleakage, as well as to evaluate the quality of bracket bonding on dental hard tissue. C-scan and B-scan OCT images as well as confocal images are acquired from a large range of samples. Gaps between the dental interfaces and material defects are clearly exposed.