Photoacoustic imaging of posterior periodontal pocket using a commercial hockey-stick transducer

Ex vivo human teeth imaging with various photoacoustic imaging systems

Dental caries cause pain and if not diagnosed, it may lead to the loss of teeth in extreme cases. Dental X-ray imaging is the gold standard for caries detection; however, it cannot detect hidden caries. In addition, the ionizing nature of X-ray radiation is another concern. Hence, other alternate imaging modalities like photoacoustic (PA) imaging are being explored for dental imaging. Here, we demonstrate the feasibility of acoustic resolution photoacoustic microscopy (ARPAM) to image a tooth with metal filling, circular photoacoustic computed tomography (cPACT) to acquire images of teeth with caries and pigmentation, and linear array-based photoacoustic imaging (lPACT) of teeth with caries and pigmentation. The cavity measured with lPACT imaging is compared with the X-ray computed tomography image. The metal filling and its boundaries are clearly seen in the ARPAM image. cPACT images at 1064 nm were a better representative of the tooth surface compared to the images acquired at 532 nm. It was possible to detect the cavities present in the dentine when lPACT imaging was used. The PA signal from the pigmented caries on the lateral surface (occlusion view) of the tooth was high when imaged using the lPACT system.

Photoacoustic imaging plus X: a review

Significance

Photoacoustic (PA) imaging (PAI) represents an emerging modality within the realm of biomedical imaging technology. It seamlessly blends the wealth of optical contrast with the remarkable depth of penetration offered by ultrasound. These distinctive features of PAI hold tremendous potential for various applications, including early cancer detection, functional imaging, hybrid imaging, monitoring ablation therapy, and providing guidance during surgical procedures. The synergy between PAI and other cutting-edge technologies not only enhances its capabilities but also propels it toward broader clinical applicability.

Aim

The integration of PAI with advanced technology for PA signal detection, signal processing, image reconstruction, hybrid imaging, and clinical applications has significantly bolstered the capabilities of PAI. This review endeavor contributes to a deeper comprehension of how the synergy between PAI and other advanced technologies can lead to improved applications.

Approach

An examination of the evolving research frontiers in PAI, integrated with other advanced technologies, reveals six key categories named "PAI plus X." These categories encompass a range of topics, including but not limited to PAI plus treatment, PAI plus circuits design, PAI plus accurate positioning system, PAI plus fast scanning systems, PAI plus ultrasound sensors, PAI plus advanced laser sources, PAI plus deep learning, and PAI plus other imaging modalities.

Results

After conducting a comprehensive review of the existing literature and research on PAI integrated with other technologies, various proposals have emerged to advance the development of PAI plus X. These proposals aim to enhance system hardware, improve imaging quality, and address clinical challenges effectively.

Conclusions

The progression of innovative and sophisticated approaches within each category of PAI plus X is positioned to drive significant advancements in both the development of PAI technology and its clinical applications. Furthermore, PAI not only has the potential to integrate with the above-mentioned technologies but also to broaden its applications even further.

Three-dimensional mapping of the greater palatine artery location and physiology

OBJECTIVE

To develop a novel technique for localizing and reconstructing the greater palatine artery (GPA) using three-dimensional (3D) technology.

METHODS

A miniaturized intraoral ultrasound transducer was used to imaging landmarks including the GPA, gingival margin (GM), and palatal masticatory mucosa (PMM). A 5-mm-thick solid hydrogel couplant was integrated to replace traditional ultrasound gel and avoid bubbles when moving the transducer.

RESULTS

A panorama image provided the relative localization of landmarks including the GPA, PMM, and hard palate. Short- and long-axis imaging of GPA was performed in five subjects including 3D mapping of GPA branches and surrounding tissues in a volume of 10 mm × 8 mm × 10 mm. Full-mouth Doppler imaging was also demonstrated on both the dorsal and ventral tongue as well as buccal mucosa and sublingual region on two subjects.

CONCLUSIONS

This study can measure the vertical distance from the GM to the GPA and depth from PMM to GPA and visualize the GPA localization in a 3D manner, which is critical to evaluate the available volume of palatal donor tissues and avoid sectioning of GPA during surgical harvesting of the tissues. Finally, the transducer's small size facilitates full-mouth Doppler imaging with the potential to improve the assessment, diagnosis, and management of oral mucosa.

A Protease-Responsive Polymer/Peptide Conjugate and Reversible Assembly of Silver Clusters for the Detection of Porphyromonas gingivalis Enzymatic Activity

We report the reversible aggregation of silver nanoparticle (AgNP) assemblies using the combination of a cationic arginine-based peptide and sulfur-capped polyethylene glycol (PEG). The formation and dissociation of the aggregates were studied by optical methods and electron microscopy. The dissociation of silver clusters depends on the peptide sequence and PEG size. A molecular weight of 1 kDa for PEG was optimal for the dissociation. The most important feature of this dissociation method is that it can operate in complex biofluids such as plasma, saliva, bile, urine, cell media, or even seawater without a significant decrease in performance. Moreover, the peptide-particle assemblies are highly stable and do not degrade (or express of loss of signal upon dissociation) when dried and resolubilized, frozen and thawed, or left in daylight for a month. Importantly, the dissociation capacity of PEG can be reduced via the conjugation of a peptide-cleavable substrate. The dissociation capacity is restored in the presence of an enzyme. Based on these findings, we designed a PEG-peptide hybrid molecule specific to the Porphyromonas gingivalis protease RgpB. Our motivation was that this bacterium is a key pathogen in periodontitis, and RgpB activity has been correlated with chronic diseases including Alzheimer's disease. The RgpB limit of detection was 100 pM RgpB in vitro. This system was used to measure RgpB in gingival crevicular fluid (GCF) samples with a detection rate of 40% with 0% false negatives versus PCR for P. gingivalis (n = 37). The combination of PEG-peptide and nanoparticles dissociation method allows the development of convenient protease sensing that can operate independently of the media composition.

Recent development of photoacoustic imaging in dentistry: A review on studies over the last decade

Background

This work performs a literature review of photoacoustic imaging (PAI) in dentistry and discusses the development of PAI in relation to oral health.

Methods

A search method was used to locate papers published between 2011 and 2023 in Google Scholar and PubMed databases, and 25 studies were selected. Reports on PAI in dentistry were included. Articles not written in English or whose full text could not be accessed were excluded. The remaining publications were checked and evaluated to determine whether they contain supportive materials for PAI in dentistry.

Results

The majority of articles about PAI in dentistry are associated with caries studies. Photoacoustic microscopy is the most commonly utilized PAI system. PAI studies generally focus on ex-vivo investigations using extracted human teeth. The acoustic signal obtained from carious teeth is greater than that obtained from normal teeth. In addition to imaging oral soft tissues from animal models and the periodontal pocket depth in human volunteers, PAI is applied to evaluate dental implants and oral biofilms.

Conclusion

There have been numerous investigation on PAI in dentistry, but it is not yet applicable in dental practice. In the future, PAI studies are expected to contribute to the invention of an alternative non-ionizing imaging technology that is comfortable for patients, user friendly, and capable of providing reliable information at a reasonable cost.

Performance of Oral Cavity Sensors: A Systematic Review

Technological advancements are enabling new applications within biomedical engineering. As a connection point between the outer environment and the human system, the oral cavity offers unique opportunities for sensing technologies. This paper systematically reviews the performance of measurement systems tested in the human oral cavity. Performance was defined by metrics related to accuracy and agreement estimation. A comprehensive search identifying human studies that reported on the accuracy or agreement of intraoral sensors found 85 research papers. Most of the literature (62%) was in dentistry, followed by neurology (21%), and physical medicine and rehabilitation (12%). The remaining papers were on internal medicine, obstetrics, and aerospace medicine. Most of the studies applied force or pressure sensors (32%), while optical and image sensors were applied most widely across fields. The main challenges for future adoption include the lack of large human trials, the maturity of emerging technologies (e.g., biochemical sensors), and the absence of standardization of evaluation in specific fields. New research should aim to employ robust performance metrics to evaluate their systems and incorporate real-world evidence as part of the evaluation process. Oral cavity sensors offer the potential for applications in healthcare and wellbeing, but for many technologies, more research is needed.

A miniaturized ultrasound transducer for monitoring full-mouth oral health: a preliminary study

OBJECTIVE

To customize a miniaturized ultrasound transducer to access full-mouth B-mode, color Doppler, and spectral Doppler imaging for monitoring oral health.

METHODS

A customized periodontal ultrasound transducer SS-19-128 (19 MHz, 128 channels) 1.8-cm wide and 1-cm thick was developed and connected to a data acquisition (DAQ) system. B-mode, color Doppler, and spectral Doppler data could all be collected with SS-19-128. The imaging resolution and penetration capacity of SS-19-128 were characterized on phantoms. The gingival thickness was measured on 11 swine teeth by SS-19-128 for comparison with conventional transgingival probing via Bland-Altman analysis and Pearson correlation. Five human subjects were then recruited to demonstrate B-mode and Doppler imaging by SS-19-128.

RESULTS

The axial and lateral spatial resolution at 5.5 mm depth is 102.1 µm and 142.9 µm, respectively. The penetration depth in a tissue-mimicking phantom is over 30 mm. In vivo B-mode imaging of all 28 teeth was demonstrated on one human subject, and imaging of tooth #18 was accessed on five human subjects. Gingival thickness measurement compared with transgingival probing showed a bias of -0.015 mm and SD of 0.031 mm, and a r = 0.9235 (p < 0.0001) correlation. In vivo color and spectral Doppler imaging of the supraperiosteal artery in human gingiva was performed to generate hemodynamic information.

CONCLUSIONS

The small size of SS-19-128 offers important advantages over existing ultrasound technology-more specifically, whole-mouth scanning/charting reminiscent of radiography. This is nearly a two-fold increase in the number of teeth that can be assessed versus conventional transducers.

Photoacoustic tomography versus cone-beam computed tomography versus micro-computed tomography: Accuracy of 3D reconstructions of human teeth

OBJECTIVES

In this in-vitro study, teeth were imaged using photoacoustic tomography (PAT), cone-beam computed tomography (CBCT), and micro-computed tomography (μ-CT). The study had aim: to identify the best wavelength for PAT images to determine the accuracy of the three imaging methods, and to determine whether PAT images of teeth can achieve acceptable reconstruction quality.

METHODS

Nineteen human mandibular single-rooted incisors were extracted from patients with trauma or periodontitis. To determine the best wavelength for acquiring photoacoustic images, all 19 teeth were scanned in vitro with PAT, using different laser wavelengths between 680 and 960 nm. The images were analyzed using image analysis software. To assess the accuracy of PAT and compare it with the accuracy of CBCT, each tooth was also scanned in vitro using CBCT and the reference standard technique of μ-CT. Subsequently, three different three-dimensional models, one for each imaging technique, were created for each tooth. Finally, the three different three-dimensional models acquired for the same tooth were matched and analyzed regarding volume and surface.

RESULTS

The highest quality tooth images were achieved using the 680 nm wavelength, which showed the best contrast ratio. The full geometry of the dental root (μ-CT compared with PAT) could be visualized with relative standard deviations of 0.12 mm for the surface and -7.33 mm3 for the volume (n = 19). The full geometry of the dental root (μ-CT compared with CBCT) could be visualized with relative standard deviations of 0.06 mm for the surface and -14.56 mm3 for the volume (n = 19). The difference between the PAT-μ-CT group and CBCT-μ-CT group regarding the total average of the root surface area was not significant (p>0.06).

CONCLUSION

Images, which were acquired using PAT at 680nm showed the best contrast ration, enabling the identification of dentin, cementum and the dental pulp. No significant differences were found between the PAT-μ-CT group and CBCT-μ-CT group regarding the total average of the RSA and the total volume. Thus, three-dimensional reconstructions based on in-vitro PAT are already of acceptable reconstruction quality.

Posterior photoacoustic/ultrasound imaging of the periodontal pocket with a compact intraoral transducer

Periodontitis is a public issue and imaging periodontal pocket is important to evaluate periodontitis. Regular linear transducers have limitations in imaging the posterior teeth due to their geometry restrictions. Here we characterized a transducer that can image the posterior teeth including assessment of periodontal pockets via a combination of photoacoustic and ultrasound imaging. Unlike conventional transducer design, this device has a toothbrush-shaped form factor with a side-view transducer to image molars (total size: 1 ×1.9 cm). A laser diode was integrated as the light source to reduce the cost and size and facilitates clinical transition. The in vivo imaging of a molar of a periodontal patient demonstrated that the transducer could image in the posterior area of gum in vivo; the value determined by imaging was within 7 % of the value measured clinically.