This PDF file contains the front matter associated with SPIE Proceedings Volume 10473, including the Title Page, Copyright information, Table of Contents, and Conference Committee listing.

Background and Objective: White spot lesions (WSLs) are commonly seen after completing orthodontic treatment. Different approaches have been suggested to avoid such a complication. Recently, 45S5 bioglass (BG) was introduced as remineralizing agent. Therefore, the objective of this in-vitro study was to assess the effect of BG in remineralizing WSLs using Optical coherence tomography (OCT). Methods: Fifteen human premolar teeth were sectioned and bonded to orthodontic brackets with Transbond XT primer followed by Transbond PLUS color change adhesive (3M Unitek, USA) on their smooth surfaces according to the manufacturer’s instructions. Then, all specimens were varnished excluding the area of interest (AOI) around the bonded restoration, immersed in demineralizing solution and imaged by cross-polarization OCT (CONT group), and the maximum pixel value (MPV) of the AOI were calculated. Then, they were subjected to remineralizing solutions and BG application followed by OCT imaging (REM group). Results: Mann-Whitney test showed the MPV of the AOI in REM was greatly increased and was significantly different from CONT (p<0.05). Conclusion: CP-OCT is a useful diagnostic tool that can be used to detect surface changes in enamel by MPV technique. The BG has a great potential to remineralize enamel defects, however further investigation is required.

Dental caries is a microbial disease that results in localized dissolution of the mineral content of dental tissue. Despite considerable decline in the incidence of dental caries, it remains a major health problem in many societies. Early detection of incipient lesions at initial stages of demineralization can result in the implementation of non-surgical preventive approaches to reverse the demineralization process. In this paper, we present a novel approach combining deep convolutional neural networks (CNN) and optical coherence tomography (OCT) imaging modality for classification of human oral tissues to detect early dental caries. OCT images of oral tissues with various densities were input to a CNN classifier to determine variations in tissue densities resembling the demineralization process. The CNN automatically learns a hierarchy of increasingly complex features and a related classifier directly from training data sets. The initial CNN layer parameters were randomly selected. The training set is split into minibatches, with 10 OCT images per batch. Given a batch of training patches, the CNN employs two convolutional and pooling layers to extract features and then classify each patch based on the probabilities from the SoftMax classification layer (output-layer). Afterward, the CNN calculates the error between the classification result and the reference label, and then utilizes the backpropagation process to fine-tune all the layer parameters to minimize this error using batch gradient descent algorithm. We validated our proposed technique on ex-vivo OCT images of human oral tissues (enamel, cortical-bone, trabecular-bone, muscular-tissue, and fatty-tissue), which attested to effectiveness of our proposed method.

In vivo and in vitro studies have demonstrated that near-infrared (NIR) light at λ=1300-1700-nm can be used to acquire high contrast images of enamel demineralization without interference of stains. The objective of this study was to determine if a relationship exists between the NIR image contrast of occlusal lesions and the depth of the lesion. Extracted teeth with varying amounts of natural occlusal decay were measured using a multispectral-multimodal NIR imaging system which captures λ=1300-nm occlusal transillumination, and λ=1500-1700-nm cross-polarized reflectance images. Image analysis software was used to calculate the lesion contrast detected in both images from matched positions of each imaging modality. Samples were serially sectioned across the lesion with a precision saw, and polarized light microscopy was used to measure the respective lesion depth relative to the dentinoenamel junction. Lesion contrast measured from NIR crosspolarized reflectance images positively correlated (p<0.05) with increasing lesion depth and a statistically significant difference between inner enamel and dentin lesions was observed. The lateral width of pit and fissures lesions measured in both NIR cross-polarized reflectance and NIR transillumination positively correlated with lesion depth.

Computer vision technologies for diagnostic imaging applied to oral lesions, specifically, carious lesions of the teeth, are in their early years of development. The relevance of this public problem, dental caries, worries countries around the world, as it affects almost the entire population, at least once in the life of each individual. The present work demonstrates current techniques for obtaining information about lesions on teeth by segmentation laser speckle imagens (LSI). Laser speckle image results from laser light reflection on a rough surface, and it was considered a noise but has important features that carry information about the illuminated surface. Even though these are basic images, only a few works have analyzed it by application of computer vision methods. In this article, we present the latest results of our group, in which Computer vision techniques were adapted to segment laser speckle images for diagnostic purposes. These methods are applied to the segmentation of images between healthy and lesioned regions of the tooth. These methods have proven to be effective in the diagnosis of early-stage lesions, often imperceptible in traditional diagnostic methods in the clinical practice. The first method uses first-order statistical models, segmenting the image by comparing the mean and standard deviation of the intensity of the pixels. The second method is based on the distance of the chi-square (χ² ) between the histograms of the image, bringing a significant improvement in the precision of the diagnosis, while a third method introduces the use of fractal geometry, exposing, through of the fractal dimension, more precisely the difference between lesioned areas and healthy areas of a tooth compared to other methods of segmentation. So far, we can observe efficiency in the segmentation of the carious regions. A software was developed for the execution and demonstration of the applicability of the models

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.

Early detection of dental caries, cracks and lesions is needed to prevent complicated root canal treatment and tooth extraction procedures. Resolution of clinically used x-ray imaging is low, hence optical imaging techniques such as optical coherence tomography, fluorescence imaging, and Raman imaging are widely experimented for imaging dental structures. Photoacoustic effect is used in photon induced photoacoustic streaming technique to debride the root canal. In this study, the extracted teeth were imaged using photoacoustic tomography system at 1064 nm. The degradation of enamel and dentine is an indicator of onset of dental caries. Photoacoustic microscopy (PAM) was used to study the tooth enamel. Images were acquired using acoustic resolution PAM system. This was done to identify microscopic cracks and dental lesion at different anatomical sites (crown and cementum). The PAM tooth profile is an indicator of calcium distribution which is essential for demineralization studies.

A pH measurement of oral biofilms is helpful for monitoring the impact of acidogenic bacteria in the caries process. Demineralization of dental enamel is closely related to the time dependent pH of human plaque. Therefore, providing a means to easily measure the local pH of biofilms is a useful clinical diagnostic in the arsenal of caries prevention tools. Optical measurement methods of plaque metabolism can use intrinsic fluorescence or extrinsic fluorescence from added dyes. Autofluorescence spectral features of human oral biofilms at green (500 nm) and red (634 nm) fluorescence wavelengths using 405 nm excitation did not demonstrate a spectral or intensity shift between neutral and acidic conditions. Chlorin e6, an ingredient in chlorophyllin food supplement, exhibited a spectral and intensity shift of fluorescence emission in buffered solutions, but this quantitative pH-dependence was not transferable to a human plaque environment. Finally, a ratiometric quantitative pH measure was achieved by exciting (405 nm laser) a mixture of two dyes, fluorescein and rhodamine B. This two-dye mixture produced two strong fluorescent bands centered at 515 nm (fluorescein) and 580 nm (rhodamine B), where the 515 nm band was pH sensitive and the 580 nm band served as a pH insensitive reference. This dual-dye fluorescence ratio exhibited a linear response over pH 7 to 5 in human oral biofilms during a sugar challenge. We have explored methods to use non-contact, optical measures of local acidity levels in difficult to access dental locations such as occlusal fissures using various pH sensitive fluorescent dye systems.

We present a recent investigation regarding the use of optical coherence tomography (OCT) in the monitoring of the calibration loss of sintering ovens for the manufacturing of metal ceramic dental prostheses. Differences in the temperatures of such ovens with regard to their specifications lead to stress and even cracks in the prostheses material, therefore to the failure of the dental treatment. Evaluation methods of the ovens calibration consist nowadays of firing supplemental samples; this is subjective, expensive, and time consuming. Using an in-house developed swept source (SS) OCT system, we have demonstrated that a quantitative assessment of the internal structure of the prostheses, therefore of the temperature settings of the ovens can be made. Using en-face OCT images acquired at similar depths inside the samples, the differences in reflectivity allow for the evaluation of the differences in granulation (i.e., in number and size of ceramic grains) of the prostheses material. Fifty samples, divided in five groups, each sintered at different temperatures (lower, higher, or equal to the prescribed one) have been analyzed. The consequences of the temperature variations with regard to the one prescribed were determined. Rules-of-thumb were extracted to monitor objectively, using only OCT images of currently manufactured samples, the settings of the oven. The method proposed allows for avoiding producing prostheses with defects. While such rules-of-thumb achieve a qualitative assessment, an insight in our on-going work on the quantitative assessment of such losses of calibration on dental ovens using OCT is also made.

A transparent highly mineralized outer surface zone is formed on caries lesions during remineralization that reduces the permeability to water and plaque generated acids. However, it has not been established how thick the surface zone should be to inhibit the penetration of these fluids. Near-IR (NIR) reflectance coupled with dehydration can be used to measure changes in the fluid permeability of lesions in enamel and dentin. Based on our previous studies, we postulate that there is a strong correlation between the surface layer thickness and the rate of dehydration. In this study, the rates of dehydration for simulated lesions in enamel with varying remineralization durations were measured. Reflectance imaging at NIR wavelengths from 1400-2300 nm, which coincides with higher water absorption and manifests the greatest sensitivity to contrast changes during dehydration measurements, was used to image simulated enamel lesions. The results suggest that the relationship between surface zone thickness and lesion permeability is highly non-linear, and that a small increase in the surface layer thickness may lead to a significant decrease in permeability.

Previous studies have shown that reflectance imaging at wavelengths greater than 1200-nm can be used to image demineralization on tooth occlusal surfaces with high contrast and without the interference of stains. In addition, these near-IR imaging systems can be integrated with laser ablation systems for the selective removal of carious lesions. Higher wavelengths, such as 1950-nm, yield higher lesion contrast due to higher water absorption and lower scattering. In this study, a point-to-point scanning system employing diode and fiber lasers operating at 1450, 1860, 1880, and 1950-nm was used to acquire reflected light images of the tooth surface. Artificial lesions were imaged at these wavelengths to determine the highest lesion contrast. Near-IR images at 1880-nm were used to demarcate lesion areas for subsequent selective carious lesion removal using a new compact air-cooled CO₂ laser prototype operating at 9.3-μm. The highest lesion contrast was at 1950-nm and the dual NIR/CO₂ laser system selectively removed the simulated lesions with a mean loss of only 12-μm of sound enamel.

Ultrashort lasers are promising tools for surgical and dental applications where precise cutting of hard tissue is required with minimal collateral tissues damage. We report the use of an amplified femtosecond laser (800 nm, 210 fs, 1 kHz, and up to 200 µJ) to generate high aspect ratio structures on bovine bone samples. The ablation fluence threshold of bovine bone was determined and the incubation effect was observed. The incubation coefficient and the single-pulse ablation threshold were calculated to be 0.90±0.02 and 1.43±0.09 J/cm2, respectively. The influence of experimental conditions on laser ablation were also investigated by performing craters with dimensions of 1000 x 220 µm under dry, compressed air, and flowing water treatments during ablation. Our results show that compressed air treatment produced the lower roughness of crater walls as well as highest depth, compared with those of dry and water conditions. The craters produced in dry and compressed air treatment have a “V” shape, while a “U” shape was observed when using flowing water treatment.

In the last decade, lasers found a number of indications in dentistry. However, there is still one problem: the narrow spectrum of usefulness for individual radiation wavelengths. The aim of our study is to demonstrate the use of a compact three-frequency pulsed Nd-YAG laser for more than one treatment, namely disinfection, coagulation, selective ablation, and soft tissue removal. The laser wavelengths and the maximal energies achieved were the following: 1.06 um, 1.32 um, 1.44 um and 830 mJ, 425 mJ, and 200 mJ, respectively. It has been found that all of the investigated wavelengths exhibit disinfection properties. Moreover, radiation of 1.06 um wavelength removes soft tissue and exhibits also coagulation properties. Radiation of 1.44 um is most useful for selective ablation of initial caries and disinfection, and 1.32 um radiation can be used for precise ablation when higher energy is applied.

Oral examination requires comprehensive visual assessment of microcirculatory tissue bed as guidance for acquiring biopsy samples. Due to limited visual resolution and subjective evaluation criteria, physicians usually have limited access to the detailed state of diseases, consequently have difficulty in managing oral treatment at early stage. An endoscopic microscopy may help improve the detectable resolution on regional mucosa surface, but hardly reach deeper structures/vasculatures that reveals pathological origination and development. We propose a novel use of long ranging swept source optical coherence tomography (SS-OCT) system with unprecedented imaging field of view of 1600 mm2 for anatomic and microvascular imaging of human oral mucosa tissue in vivo. This system is further applied to identify and analyze oral mucosa lesions in situ without a need for invasive biopsy. Qualitative assessment of the structure characteristics (i.e. collagen fibrosis, volume of salivary glands, and tissue scattering) during wound healing delineates the anatomical lesion development accompanied with tissue inflammation. Quantitative assessment of the vasculature network (i.e. capillary loop density and vessel morphological orientations) reveals pathological and nutritional underpinnings of microcirculation for oral lesion recovery. Specifically, the progression of oral capillary angiogenesis, indicated by elevations in capillary loop density, occurs within 12 hours of disease onset and peaks at day 7 thereafter, which provide invaluable information for the time course of therapeutic treatment. Our demonstration shows potential movement of oral cavity OCT microangiography toward clinical translations.

Until recently, Laser Diodes (LD) have been limited in their ability to deliver high peak power levels, which, in turn, limited their clinical capabilities. New technological developments made possible advent of “super pulse” LD (SPLD). Moreover, advanced means of smart thermal feedback enable precise control of laser power, thus ensuring safe and optimally efficacious application. In this work, we have evaluated a prototype SPLD system ex vivo. The device provided up to 25 W average and up to 150 W pulse power at 940 nm wavelength. The laser was operated in the thermal feedback-controlled mode, where power of the laser was varied automatically as a function of real-time thermal feedback to maintain constant tip temperature. The system was also equipped with a fiber tip initiated with advanced TiO₂ /tungsten technique. Evaluation methods were designed to assess: 1) Speed and depth of cutting; 2) Dimensions of coagulative margin. The SPLD system was compared with industry-leading conventional diode and CO₂ devices. The results indicate that the SPLD system provides increase in speed of controlled cutting by a factor of >2 in comparison with the conventional diode laser and approaching that of CO₂ device. The produced ratio of the depth of cut to the thermal damage margin was significantly higher than conventional diodes and close to that of the CO₂ system, suggesting optimal hemostasis conditions. SPLD technology with real-time temperature control has a potential for creating a new standard of care in the field of precision soft tissue surgery.

In this work, we present the first histological in vivo and ex vivo study of effects of fractional Er fiber laser (wavelength 1550 nm, peak power 25 W) on keratinized gum and alveolar mucosa for gum regeneration. Biopsy with subsequent NBTC staining was used as primary evaluation technique. Ex vivo, porcine tissue model was used. Effects of pulse energy, beam diameter, and beam divergence were investigated in detail. It has been demonstrated that under optimal conditions columns up to 800 μm in depth could be reliably produced with 130 mJ pulses. Clinically, 2 subjects were treated and 4 punch biopsies were collected. The results were compared with ex vivo data. Both ex vivo and in vivo datasets suggest feasibility of a dental fractional system intended for gum regeneration.

Laser Induced Breakdown Spectroscopy (LIBS) is a technique capable to perform elemental analyses of a variety of samples, independent of matter state. Other spectroscopy techniques may require a destructive and time-consuming sample preparation. On the other hand, LIBS is a less destructive technique with no (or considerably less) sample preparation, using a relatively simple experimental setup. LIBS also provides a multielement analysis into one single spectrum acquisition, applying a Nd:YAG short-pulsed laser to ensure the stoichiometry between the sample and the generated plasma. LIBS have been applied on the study of carious lesions using a Nd:YAG into its fundamental emission at 1064 nm. It was shown that ratio of P/Ca and Zn/Ca can be used to monitor the cariogenic process. Another minor elements, e.g. C and Cu, associated with bacteria biofilm were also measured with the Nd:YAG laser. The fundamental wavelength emission (1064 nm) of Nd:YAG is coincident with a hydroxyapatite transmission window and it may affect the result. In order to address this issue a study used the second harmonic of the Nd:YAG laser at 532 nm. It was show that it is also possible perform LIBS on carious lesion using the Nd:YAG at 532 nm. However, there is not a work direct comparing the LIBS at 532 nm and 1064 nm for carious lesion detection. So, the aim of this work was to investigate the influence of laser wavelength on the LIBS performance for carious lesion detection. In both cases the carious lesion was detected with the advantage of no interference with hydroxyapatite at 532 nm.

The aim of this study was to evaluate the enamel demineralization around cavities prepared by Er,Cr:YSGG laser (2780 nm) and restored with different materials after an acid challenge. The human dental enamel samples were randomly divided in 12 groups (n=10): G1- high-speed drill (HD); G2- Er,Cr:YSGG laser L (3 W, 20 Hz, 53.05 J/cm²)(air 65% - water 55%); G3– L (4 W, 20 Hz, 70.74 J/cm²); G4– L (5 W, 20 Hz, 88.43 J/cm²). Each group was divided in subgroups: 1- glass ionomer cement (GIC), 2- resin modified GIC (RMGIC), 3- composite resin (C). Samples were submitted to an acid challenge (4.8 pH) for7 days. The calcium ion contend (ppm/mm²) from demineralizing solutions were analyzed by atomic emission spectrometry. ANOVA and LSD tests were performed (α=5%). The significant lower average values of calcium loss were observed on G2 + GIC, G2 + RMGIC, G1 + RMGIC (p<0.05); the significant higher values were observed on G1 + C, G4 +GIC, G4 + C (p<0.05). The composite resin showed higher calcium loss than RMGIC and GIC (p<0.05). The lased cavities using lower fluence (53.05J/cm²) showed significant reduced demineralization than higher fluences (70.74 and 88.43J/cm²) (p<0.05). Neither the techniques nor the restorative materials used were able to avoid the enamel demineralization. The findings of this in vitro study suggest that the Er,Cr:YSGG lased cavities restored with GIC or RMGIC or conventional drill cavities with RMGIC were effective on reducing the demineralization around restorations, showing an important potential in preventing secondary caries.

Peri-implantitis is a destructive inflammatory process that affects the tissues that provide support to the dental implant, the bone and gingiva, and can lead to the loss of the implant. Among the treatments of this disease, the irradiation of the contaminated surface with high intensity lasers is considered a promising alternative; Thus, irradiation parameters must be correctly adjusted in order to promote an efficient and safe treatment. This study investigated the temperature changes at the implant-bone interface during simulated implant surface decontamination using an 808nm diode laser. Dental implants were inserted in bovine bone, in which an artificial periimplant bone defect was made. Access holes of 0.5mm diameter were drilled to allow the positioning of four Ktype thermocouples in different regions: T0 Implant-bone interface, T1 inside the implant, T2 In the bone defect, T3 In the apex of the implant. For laser irradiation, an optical fiber was used at a distance of 0.5mm from the implant surface, and the mean output power varied between 0.5 to 3.0W on both pulsed (PW) and continuous (CW) wave modes. Irradiations were performed by 60s, and the temperature rises were registered for a period of 180s. It was observed that the critical threshold of 47ºC was exceeded at T0, T1 e T2 thermocouples when irradiations were performed at 1.0W; for T3 thermocouple, the threshold was exceeded at 3.0W CW mode. For PW mode, the thermocouples T0, T1, T2 had the threshold exceeded at the power of 1,0W and for T3 the threshold was exceeded at 3.0W. Decontamination of implant surfaces using the diode laser did not excessively heat the implant-bone interface within the mean output power ranging from 0.5 to 1.0W; however, the temperature rise is critical when using the mean power of 0.5W CW and 1.0W PW. Thus, using the PW mode up to the power of 1W seems to be a promising parameter for a safe clinical application.

Recent studies have shown that near-IR (NIR) imaging methods such as NIR reflectance can be used to image lesions on proximal surfaces, and optical coherence tomography (OCT) can be used to measure the depth of those lesions below the tooth surface. These imaging modalities can be used to acquire high contrast images of demineralized tooth surfaces, and 2-D and 3-D images can be extracted from this data. At NIR wavelengths longer than 1200-nm, there is no interference from stains and the contrast is only due to the increased light scattering of the demineralization. Previous studies have shown that image-guided laser ablation can be used to remove occlusal lesions, but its use for the removal of subsurface lesions on proximal surfaces has not been investigated. The objective of this study is to demonstrate that simultaneously scanned NIR and CO2 lasers can be used to selectively remove natural and artificial interproximal caries lesions with minimal damage to sound tooth structure. In this study, images of simulated and natural interproximal lesions on extracted teeth were imaged using a digital microscope, a scanned 1460-nm superluminescent laser diode with an InGaAs detector and a cross polarization OCT system operating at 1300-nm. The lesions were subsequently removed with a CO2 laser operating at 9.3-μm and the dental handpiece and the volume of sound tissue removed was compared.

Most new lesions are found in the pits and fissures of the occlusal surface. Radiographs have extremely low sensitivity for early occlusal decay and by the time the lesion is severe enough on a radiograph it typically has penetrated well into the dentin and surgical intervention is required. The occlusal surfaces are heavily stained and visual and tactile methods for their detection also have poor sensitivity and specificity. Previous studies at wavelengths beyond 1300-nm have demonstrated that stains are not visible and demineralization on the occlusal surfaces can be viewed without interference from stains. New extended range InGaAs near- IR cameras allow access to wavelengths beyond 1700-nm. The objective of this study was to determine how the contrast of occlusal lesions varies with wavelength from the visible to 2350-nm. The lesion contrast was measured in 55 extracted teeth with suspected occlusal lesions using reflectance measurements from 400- 2350-nm using Si and InGaAs imaging arrays. The highest lesion contrast in reflectance was measured at wavelengths greater than 1700-nm. Stains interfered significantly at wavelengths shorter than 1150-nm. This study indicates that the optimum wavelengths for reflectance imaging decay in the occlusal surfaces are greater than 1700-nm.