An Intraoral OCT Probe to Enhanced Detection of Approximal Carious Lesions and Assessment of Restorations

Optical coherence tomography and gray scale digital analysis as noninvasive techniques for evaluating molar-incisor hypomineralization severity: A comparative study with microcomputed tomography

Molar-incisor hypomineralization (MIH) is a qualitative defect of dental enamel characterized by demarcated opacities present in permanent first molars and other teeth. It is considered a major clinical challenge in dentistry because it makes affected teeth more susceptible to fractures and dental caries. Its diagnosis is mainly clinical and there are few technological resources that allow for a more accurate diagnosis, especially with respect to the depth of the defect in the dental enamel. In this context, optical coherence tomography (OCT), which is routinely used in ophthalmology, can produce images of the depth of the dental enamel, making it a promising method. In this study, 33 teeth with different MIH severities were evaluated using OCT and microcomputed tomography (microCT). Semi-quantitative methods of grayscale pattern analysis were used to compare images obtained from different severities of MIH with the mineral density obtained through microCT. MicroCT evaluation revealed that hypomineralized enamel had a significantly lower mineral density than intact enamel. However, this difference was not observed between the mild and severe MIH lesions. In the OCT evaluation, significant differences were observed between the intact and hypomineralized enamel, and the gray value comparison provided a method for quantitative differentiation between the two. This study suggests that OCT could be a useful adjunct to traditional diagnostic methods for MIH, offering a noninvasive approach to evaluate enamel defects. RESEARCH HIGHLIGHTS: Combining optical coherence tomography with grayscale digital analysis shows potential as a promising method for diagnosing molar-incisor hypomineralization and assessing its level of severity.

Tooth-composite bond failure with a universal and an etch-and-rinse adhesive depending on mode and frequency of application

OBJECTIVES

To evaluate the effect of an additional layer of universal adhesive on the interfacial enamel/dentin-composite gap formation in relation to application mode and aging, via spectral domain optical coherence tomography (SD-OCT) and scanning electron microscopy (SEM).

METHODS

In vitro class V cavities in 114 caries-free premolars were restored by applying one or two layers of a universal adhesive (Scotchbond Universal, SBU) in self-etch (se) and etch-and-rinse (er) mode or the reference adhesive OptiBond FL (OFL-er). The restorations were imaged by SD-OCT (six groups, n = 8) and SEM (n = 3) directly after filling (t1), water storage (t2, 24 h), embedding (t3), and thermo-mechanical loading (t4, TCML). The interfacial gaps were quantified using 26 parameters and analyzed using principal component analysis and linear mixed effect models.

RESULTS

Gap formation at enamel and dentin was significantly influenced by the adhesive, the application mode and number of layers (p < 0.001). This was due to the influence of the SBU-er mode (p < 1e-05), which showed significantly more gap formation and a greater range of variation with double application when compared to SBU-se and OFL. The fewest interfacial gaps occurred with one or two applications of OFL-er and one layer of SBU-er.

SIGNIFICANCE

Adhesive application mode and the number of adhesive layers are relevant factors in the tooth-composite bond failure. Double application worsened the adaptation of SBU to freshly prepared dentin conditioned with phosphoric acid.

Application of three-dimensional reconstruction technology in dentistry: a narrative review

BACKGROUND

Three-dimensional(3D) reconstruction technology is a method of transforming real goals into mathematical models consistent with computer logic expressions and has been widely used in dentistry, but the lack of review and summary leads to confusion and misinterpretation of information. The purpose of this review is to provide the first comprehensive link and scientific analysis of 3D reconstruction technology and dentistry to bridge the information bias between these two disciplines.

METHODS

The IEEE Xplore and PubMed databases were used for rigorous searches based on specific inclusion and exclusion criteria, supplemented by Google Academic as a complementary tool to retrieve all literature up to February 2023. We conducted a narrative review focusing on the empirical findings of the application of 3D reconstruction technology to dentistry.

RESULTS

We classify the technologies applied to dentistry according to their principles and summarize the different characteristics of each category, as well as the different application scenarios determined by these characteristics of each technique. In addition, we indicate their development prospects and worthy research directions in the field of dentistry, from individual techniques to the overall discipline of 3D reconstruction technology, respectively.

CONCLUSIONS

Researchers and clinicians should make different decisions on the choice of 3D reconstruction technology based on different objectives. The main trend in the future development of 3D reconstruction technology is the joint application of technology.

Ex-vivo analysis of demineralisation on irradiated teeth using optical coherence tomography

Head and neck cancer patients are prone to dental caries after radiotherapy. An ex-vivo study was conducted to assess the feasibility of optical coherence tomography (OCT) to detect tooth demineralization due to caries in irradiated teeth. Thirty-nine human molar teeth were subjected to caries lesion induction through irradiation (Group 1), pH cycling (Group 2-1), and both (Group 2-2). The OCT signal attenuation coefficient, µR was assessed and validated against microhardness test and scanning electron microscope (SEM). The µR for Group 1 increased from 10 Gy to 40 Gy, and subsequently decreased after irradiated to 50 Gy and 60 Gy due to damaged enamel microstructure. In Group 2-1, the µR decreased with duration of pH cycling from day 1 to day 14 due to the increase of porosity in enamel layer. However, the µR showed decreasing trend from day 14 to day 28 of pH cycling, resulted from mineral deposition in the enamel layer. Although no significant difference was found in the µR between Group 2-1 and 2-2, SEM of Group 2-2 demonstrated visually higher porosity and larger gaps between microstructures. Irradiation may accelerate caries damage to tooth microstructure by increasing its porosity and brittleness, but larger sample size may be needed to further prove the effect. OCT could potentially be used for early detection of tooth demineralization in vivo based on the measurable µR changes for all groups which are shown negatively correlated with microhardness value (p < 0.05).

In vivo real-time assessment of developmental defects in enamel of anti-Act1 mice using optical coherence tomography

The purpose of this study was to explore the feasibility of using optical coherence tomography (OCT) for real-time and quantitative monitoring of enamel development in gene-edited enamel defect mice. NF-κB activator 1, known as Act1, is associated with many inflammatory diseases. The antisense oligonucleotide of Act1 was inserted after the CD68 gene promoter, which would cover the start region of the Act1 gene and inhibit its transcription. Anti-Act1 mice, gene-edited mice, were successfully constructed and demonstrated amelogenesis imperfecta by scanning electron microscope (SEM) and energy dispersive X-ray (EDX) spectroscopy. Wild-type (WT) mice were used as the control group in this study. WT mice and anti-Act1 mice at 3 weeks old were examined by OCT every week and killed at eight weeks old. Their mandibular bones were dissected and examined by OCT, micro-computed tomography (micro-CT), and SEM. OCT images showed that the outer layer of enamel of anti-Act1 mice was obviously thinner than that of WT mice but no difference in total thickness. When assessing enamel thickness, there was a significant normal linear correlation between these methods. OCT could scan the imperfect developed enamel noninvasively and quickly, providing images of the enamel layers of mouse incisors.

Assessment of demineralized tooth lesions using optical coherence tomography and other state-of-the-art technologies: a review

Tooth demineralization is one of the most common intraoral diseases, encompassing (1) caries caused by acid-producing bacteria and (2) erosion induced by acid of non-bacterial origin from intrinsic sources (e.g. stomach acid reflux) and extrinsic sources (e.g. carbonated drinks). Current clinical assessment based on visual-tactile examination and standardized scoring systems is insufficient for early detection. A combination of clinical examination and technology is therefore increasingly adapted. This paper reviews various procedures and technologies that have been invented to diagnose and assess the severity of tooth demineralization, with focus on optical coherence tomography (OCT). As a micron-resolution non-invasive 3D imaging modality, variants of OCT are now available, offering many advantages under different working principles for detailed analytical assessment of tooth demineralization. The roles, capabilities and impact of OCT against other state-of-the-art technologies in both clinical and research settings are described. (139 words).

Intraoral optical coherence tomography and angiography combined with autofluorescence for dental assessment

There remains a clinical need for an accurate and non-invasive imaging tool for intraoral evaluation of dental conditions. Optical coherence tomography (OCT) is a potential candidate to meet this need, but the design of current OCT systems limits their utility in the intraoral examinations. The inclusion of light-induced autofluorescence (LIAF) can expedite the image collection process and provides a large field of view for viewing the condition of oral tissues. This study describes a novel LIAF-OCT system equipped with a handheld probe designed for intraoral examination of microstructural (via OCT) and microvascular information (via OCT angiography, OCTA). The handheld probe is optimized for use in clinical studies, maintaining the ability to detect and image changes in the condition of oral tissue (e.g., hard tissue damage, presence of dental restorations, plaque, and tooth stains). The real-time LIAF provides guidance for OCT imaging to achieve a field of view of approximately 6.9 mm × 7.8 mm, and a penetration depth of 1.5 mm to 3 mm depending on the scattering property of the target oral tissue. We demonstrate that the proposed system is successful in capturing reliable depth-resolved images from occlusal and palatal surfaces and offers added design features that can enhance its usability in clinical settings.

A handheld fiber-optic probe to enable optical coherence tomography of oral soft tissue

This study presents a highly miniaturized, handheld probe developed for rapid assessment of soft tissue using optical coherence tomography (OCT). OCT is a non-invasive optical technology capable of visualizing the sub-surface structural changes that occur in soft tissue disease such as oral lichen planus. However, usage of OCT in the oral cavity has been limited, as the requirements for high-quality optical scanning have often resulted in probes that are heavy, unwieldy and clinically impractical. In this paper, we present a novel probe that combines an all-fiber optical design with a light-weight magnetic scanning mechanism to provide easy access to the oral cavity. The resulting probe is approximately the size of a pen (10 mm 140 mm) and weighs only 10 grams. To demonstrate the feasibility and high image quality achieved with the probe, imaging is performed on the buccal mucosa and alveolar mucosa during routine clinical assessment of six patients diagnosed with oral lichen planus. Results show the loss of normal tissue structure within the lesion, and contrast this with the clear delineation of tissue layers in adjacent inconspicuous regions. The results also demonstrate the ability of the probe to acquire a three-dimensional data volume by manually sweeping across the surface of the mucosa. The findings of this study show the feasibility of using a small, lightweight probe to identify pathological features in oral soft tissue.

Optimization of X-ray Investigations in Dentistry Using Optical Coherence Tomography

The most common imaging technique for dental diagnoses and treatment monitoring is X-ray imaging, which evolved from the first intraoral radiographs to high-quality three-dimensional (3D) Cone Beam Computed Tomography (CBCT). Other imaging techniques have shown potential, such as Optical Coherence Tomography (OCT). We have recently reported on the boundaries of these two types of techniques, regarding. the dental fields where each one is more appropriate or where they should be both used. The aim of the present study is to explore the unique capabilities of the OCT technique to optimize X-ray units imaging (i.e., in terms of image resolution, radiation dose, or contrast). Two types of commercially available and widely used X-ray units are considered. To adjust their parameters, a protocol is developed to employ OCT images of dental conditions that are documented on high (i.e., less than 10 μm) resolution OCT images (both B-scans/cross sections and 3D reconstructions) but are hardly identified on the 200 to 75 μm resolution panoramic or CBCT radiographs. The optimized calibration of the X-ray unit includes choosing appropriate values for the anode voltage and current intensity of the X-ray tube, as well as the patient’s positioning, in order to reach the highest possible X-rays resolution at a radiation dose that is safe for the patient. The optimization protocol is developed in vitro on OCT images of extracted teeth and is further applied in vivo for each type of dental investigation. Optimized radiographic results are compared with un-optimized previously performed radiographs. Also, we show that OCT can permit a rigorous comparison between two (types of) X-ray units. In conclusion, high-quality dental images are possible using low radiation doses if an optimized protocol, developed using OCT, is applied for each type of dental investigation. Also, there are situations when the X-ray technology has drawbacks for dental diagnosis or treatment assessment. In such situations, OCT proves capable to provide qualitative images.

Light-based diagnostic methods for the in vivo assessment of initial caries lesions: Laser fluorescence, QLF and OCT

OBJECTIVES

To evaluate different light-based caries diagnostic methods for assessment of non-cavitated initial carious lesions on smooth surfaces.

METHODS

39 participants were included. For each participant, three regions of interest (ROI) with ICDAS codes 0, 1 or 2 were defined. All ROIs (n = 117) were investigated/imaged with laser fluorescence (LF, DIAGNOdent 2095; KaVo dental GmbH), quantitative light-induced fluorescence (QLF; Biluminator 2+, Inspektor Research Systems B.V.) and spectral-domain optical coherence tomography (SD-OCT; Telesto II, Thorlabs GmbH). The values of LF, ΔF of QLF, and the lesion extent assessed by OCT were categorized. Frequency distribution of LF-/QLF- and OCT-scores was determined for each ICDAS code included. Inter- and intra-examiner reproducibility of QLF and OCT measurements were assessed by unweighted kappa coefficient (ĸ) and Wilcoxon test (α = 0.05).

RESULTS

Compared with LF and QLF, OCT showed various manifestations of carious lesions for visually sound ROIs and a larger variation of caries extent in depth within the same ICDAS code groups. Intra-examiner reproducibility ranged between 0.49 and 1.00 for the QLF analysis and between 0.95 and 0.99 for the OCT analysis. Inter-examiner reproducibility ranged between 0.17 and 0.32 for the QLF analysis and between 0.65 and 0.79 for the OCT analysis.

CONCLUSION

LF and QLF were insensitive to less pronounced smooth-surface lesions while OCT allowed differentiation based on the penetration depth of the carious lesions. This makes OCT a suitable method to complement conventional visual inspection in order to detect and assess (very) early lesions.