The purpose of this study is to show that optical clearing agents can be used to increase the visibility of deeply penetrating occlusal lesions that have reached the underlying dentin and spread laterally under the enamel. Previous studies have shown that high refractive index fluids can increase the contrast of caries lesions. Extracted teeth with natural occlusal lesions were imaged with optical coherence tomography (OCT) with and without the addition of a transparent vinyl polysiloxane impression material (VPS) currently used in vivo. The relative intensity of the reflectivity from the underlying lesion area for each sample was measured before and after application of the VPS. Lesion presence was confirmed with polarized light microscopy and microradiography. Application of VPS significantly increased (P < 0.0001) the integrated reflectivity of subsurface dentinal lesions. This study shows that optical clearing agents can be used to increase the optical penetration and the visibility of subsurface lesions and the dentinal–enamel junction under sound and demineralized enamel in OCT images.

Accurate measurement of the highly mineralized transparent surface layer that forms on caries lesions is important for diagnosis of the lesion activity because chemical intervention can slow or reverse the caries process via remineralization. Previous in-vitro and in-vivo studies have demonstrated that polarization-sensitive optical coherence tomography (PS-OCT) can nondestructively image the subsurface lesion structure and the highly mineralized transparent surface zone of caries lesions. The purpose of this study was to develop an approach to automatically process 3-dimensional PS-OCT images and to accurately assess the remineralization process in simulated enamel lesions. Artificial enamel lesions were prepared on twenty bovine enamel blocks using two models to produce varying degree of demineralization and remineralization. The thickness of the transparent surface layer and the integrated reflectivity of the subsurface lesion were measured using PS-OCT. The automated transparent surface layer detection algorithm was able to successfully detect the transparent surface layers with high sensitivity ( = 0.92) and high specificity ( = 0.97). The estimated thickness of the transparent surface layer showed a strong correlation with polarized light microscopy (PLM) measurements of all regions (R(2) = 0.90). The integrated reflectivity, ΔR, and the integrated mineral loss, ΔZ, showed a moderate correlation (R(2) = 0.32). This study demonstrates that PS-OCT can automatically measure the changes in artificial enamel lesion structure and severity upon exposure to remineralization solutions.

Objectives

The aim of this study was to test the hypothesis that cross-polarization optical coherence tomography (CP-OCT) can be used to longitudinally monitor demineralization peripheral to orthodontic brackets in an extended clinical study.

Methods

A high-speed CP-OCT system was used to acquire 3D volumetric images of the area at the base of orthodontic brackets over a period of 12 months after placement. The reflectivity was measured at 3-month intervals for 12 months to determine if there was increased demineralization. Two teeth were monitored on 20 test subjects and the brackets were bonded using two types of adhesives. This was a randomized controlled clinical study with a split mouth design such that each subject served as his or her own control. On one side, the control premolar was bonded with a bonding agent (Adper Scotchbond from 3M ESPE, St. Paul, MN) and composite (Transbond XT from 3M Unitek, Monrovia, CA) that lacked fluoride. On the other side, the experimental premolar was bonded with a fluoride releasing glass ionomer cement (GC Fuji Ortho LC from GC America, Alsip, IL).

Results

There was a small but significant increase in the calculated lesion depth and integrated reflectivity over that depth (ΔR) for both adhesive types (p<0.0001) indicating increasing demineralization with time. There was no significant difference in the lesion depth (p=0.22) and ΔR (p=0.91) between the groups with the fluoride releasing glass ionomer cement and the conventional composite.

Conclusions

CP-OCT was able to measure a significant increase in demineralization (p<0.0001) at the base of orthodontic brackets over a period of 12 months.

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. Moreover studies have shown that high refractive index liquids can be used to improve the visibility of subsurface lesions in OCT images. In this study, we demonstrate that vinyl polysiloxane (VPS) impression materials which are routinely used in dentistry can be used to enhance the detection of dentinal lesions on tooth occlusal surfaces. Lesion presence was confirmed with polarized light microscopy and microradiography.

If caries lesions are detected early enough they can be arrested by chemical intervention and dietary changes without the need for chemical intervention. Optical coherence tomography is ideally suited to monitor the changes that occur in caries lesions as a result of nonsurgical intervention, since OCT can nondestructively image the internal structure of the lesion. One of the most important changes that occurs in a lesion is preferential deposition of mineral in the outer surface zone. The deposition creates a highly mineralized and weakly scattering surface zone that is clearly visible in OCT images. Since this zone is near the highly reflective surface it is necessary to use cross-polarization OCT imaging to resolve this zone. Several CP-OCT studies have been conducted employing different remineralization models that produce lesions with varying mineral gradients. Previous studies have also demonstrated that automated algorithms can be used to assess the lesion depth and severity even with the presence of the weakly reflective surface zone. In this study we investigated the remineralization of lesions of varying severity using a pH cycling remineralization model and the change of the lesion was monitored using CP-OCT. Although the lesion depth and severity decreased after remineralization, there was still incomplete remineralization of the body of the lesion.

Introduction

Studies have shown that cross-polarization optical coherence tomography (CP-OCT) can be used to image the internal structure of carious lesions in vivo. The objective of this study was to show that CP-OCT can be used to monitor changes in the internal structure of early active carious lesions on smooth surfaces during non-surgical intervention with fluoride.

Methods

Lesions on the smooth surfaces of teeth were imaged using CP-OCT on 17 test subjects. Lesion structural changes were monitored during fluoride varnish application at 6-week intervals for 30 weeks. The lesion depth (L_d ), integrated reflectivity (ΔR), and surface zone thickness (S_z ) were monitored.

Results

A distinct transparent surface zone that may be indicative of lesion arrestment was visible in CP-OCT images on 62/63 lesions before application of fluoride varnish. The lesion depth and internal structure were resolved for all the lesions. The overall change in the mean values for L_d , ΔR, and S_z for all the lesions was minimal and was not significant during the study (P > 0.05). Only 5/63 lesions manifested a significant increase in S_z during intervention.

Conclusion

Even though it appears that most of the lesions manifested little change with fluoride varnish application in the 30 weeks of the study, CP-OCT was able to measure the depth and internal structure of all the lesions including the thickness of the important transparent surface zone located at the surface of the lesions, indicating that CP-OCT is ideally suited for monitoring lesion severity in vivo. Lasers Surg. Med. 48:915-923, 2016. © 2016 Wiley Periodicals, Inc.

Introduction

Radiographic methods have poor sensitivity for occlusal lesions and by the time the lesions are radiolucent they have typically progressed deep into the dentin. New more sensitive imaging methods are needed to detect occlusal lesions. In this study, cross-polarization optical coherence tomography (CP-OCT) and near-IR imaging were used to image questionable occlusal lesions (QOC's) that were not visible on radiographs but had been scheduled for restoration on 30 test subjects.

Methods

Near-IR reflectance and transillumination probes incorporating a high definition InGaAs camera and near-IR broadband light sources were used to acquire images of the lesions before restoration. The reflectance probe utilized cross-polarization and operated at wavelengths from 1,500 to 1,700 nm where there is an increase in water absorption for higher contrast. The transillumination probe was operated at 1,300 nm where the transparency of enamel is highest. Tomographic images (6 × 6 × 7 mm³ ) of the lesions were acquired using a high-speed swept-source CP-OCT system operating at 1,300 nm before and after removal of the suspected lesion.

Results

Near-IR reflectance imaging at 1,500-1,700 nm yielded significantly higher contrast (P < 0.05) of the demineralization in the occlusal grooves compared with visible reflectance imaging. Stains in the occlusal grooves greatly reduced the lesion contrast in the visible range yielding negative values. Only half of the 26 lesions analyzed showed the characteristic surface demineralization and increased reflectivity below the dentinal-enamel junction (DEJ) in 3D OCT images indicative of penetration of the lesion into the dentin.

Conclusion

This study demonstrates that near-IR imaging methods have great potential for improving the early diagnosis of occlusal lesions. Lasers Surg. Med. 49:215-224, 2017. © 2017 Wiley Periodicals, Inc.