This PDF file contains the front matter associated with SPIE Proceedings volume 7549, including Title page, Copyright information, Table of Contents, Introduction (if any), and Conference Committee listing.

The objective of this work was to observe the various thermal-induced optical changes that occur in the near-infrared (NIR) during drilling in dentin and enamel with the laser and the high-speed dental handpiece. Tooth sections of ~ 3 mm-thickness were prepared from extracted human incisors (N=60). Samples were ablated with a mechanically scanned CO2 laser operating at a wavelength of 9.3-μm, a 300-Hz laser pulse repetition rate, and a laser pulse duration of 10-20 μs. An InGaAs imaging camera was used to acquire real-time NIR images at 1300-nm of thermal and mechanical changes (cracks). Enamel was rapidly removed by the CO2 laser without peripheral thermal damage by mechanically scanning the laser beam while a water spray was used to cool the sample. Comparison of the peripheral thermal and mechanical changes produced while cutting with the laser and the high-speed hand-piece suggest that enamel and dentin can be removed at high speed by the CO₂ laser without excessive peripheral thermal or mechanical damage. Only 2 of the 15 samples ablated with the laser showed the formation of small cracks while 9 out of 15 samples exhibited crack formation with the dental hand-piece. The first indication of thermal change is a decrease in transparency due to loss of the mobile water from pores in the enamel which increase lightscattering. To test the hypothesis that peripheral thermal changes were caused by loss of mobile water in the enamel, thermal changes were intentionally induced by heating the surface. The mean attenuation coefficient of enamel increased significantly from 2.12 ± 0.82 to 5.08 ± 0.98 with loss of mobile water due to heating.

Aim and objectives. Abfraction is the pathological loss of cervical hard tooth substance caused by biomechanical overload. High horizontal occlusal forces result in large stress concentrations in the cervical region of the teeth. These stresses may be high enough to cause microfractures in the dental hard tissues, eventually resulting in the loss of cervical enamel and dentin. The present study proposes the microstructural characterization of these cervical lesions by en face optical coherence tomography (eFOCT). Material and methods: 31 extracted bicuspids were investigated using eFOCT. 24 teeth derived from patients with active bruxism and occlusal interferences; they presented deep buccal abfractions and variable degrees of occlusal pathological attrition. The other 7 bicuspids were not exposed to occlusal overload and had a normal morphology of the dental crowns. The dental samples were investigated using an eFOCT system operating at 1300 nm (B-scan at 1 Hz and C-scan mode at 2 Hz). The system has a lateral resolution better than 5 μm and a depth resolution of 9 μm in tissue. OCT images were further compared with micro - computer tomography images. Results. The eFOCT investigation of bicuspids with a normal morphology revealed a homogeneous structure of the buccal cervical enamel. The C-scan and B-scan images obtained from the occlusal overloaded bicuspids visualized the wedge-shaped loss of cervical enamel and damage in the microstructure of the underlaying dentin. The high occlusal forces produced a characteristic pattern of large cracks, which reached the tooth surface. Conclusions: eFOCT is a promising imaging method for dental abfractions and it may offer some insight on the etiological mechanism of these noncarious cervical lesions.

The clinical diagnosis of secondary caries has been found to account for the replacement of the majority of intra-coronal restorations. Current methods to diagnose the presence of these lesions at early stages are considered insufficient due to their low sensitivity. Polarization-sensitive optical coherence tomography (PS-OCT) imaging studies have confirmed its effectiveness for imaging carious subsurface lesions in enamel and dentin. The objective of this study was to determine if PS-OCT can be used to nondestructively image demineralization through resin restorations on extracted teeth with both simulated and natural lesions. Simulated secondary caries lesions were created by exposing cavity preparations made in extracted human teeth to a demineralizing solution for 48 hours and subsequently restoring with resin. Negative control restorations were also prepared on each tooth. Optical changes in demineralized versus control preparations beneath restorations were measured as a function of depth using PS-OCT. PS-OCT images indicated that a significant increase in reflectivity and depth occurred in the simulated lesions compared with the control preparations. This study suggests that PS-OCT is well-suited to nondestructively detect early caries lesions in enamel beneath composite restorations.

A noncontact profilometer (laser triangulation) was used to measure the removal rates of subgingival dental calculus irradiated with a frequency-doubled Ti:sapphire laser (60-ns pulse duration, 400-nm wavelength, 10-Hz repetition rate, 7-mJ pulse energy). Profilometer traces before and after irradiation were used to create a removal map with 4-μm axial and 15-μm transverse resolution. Twenty-three teeth (15 with calculus and 8 pristine) were irradiated at 90° and 45° under a cooling water spray with a super-Gaussian beam (~300-μm diameter). Subgingival calculus was selectively removed at 5.6 and 4.0 J/cm² for 90° and 45°, respecetively, within a range of rates, between 2 to 9 μm/pulse. These ablation rates were constant during these exposures. For comparison, pristine cementum irradiated for 10 min at the same peak fluence and pulse repetition rate showed only craters, 15 to 50 μm deep, corresponding to an equivalent removal rate three orders of magnitude smaller than that obtained for calculus. Pristine enamel was not removed under the same irradiation conditions.

A mechanically scanned CO₂ laser operated at high laser pulse repetition rates can be used to rapidly and precisely remove dental decay. This study aims to determine whether these laser systems can safely ablate enamel and dentin without excessive heat accumulation and peripheral thermal damage. Peripheral thermal damage can adversely impact the mechanical strength of the irradiated tissue, particularly for dentin, and reduce the adhesion characteristics of the modified surfaces. Samples were derived from noncarious extracted molars. Pulpal temperatures were recorded using microthermocouples situated at the pulp chamber roof of samples (n=12), which were occlusally ablated using a rapid-scanning, water-cooled 300 Hz CO₂ laser over a two minute time course. The mechanical strength of facially ablated dentin (n=10) was determined via four-point bend test and compared to control samples (n=10) prepared with 320 grit wet sand paper to simulate conventional preparations. Composite-to-enamel bond strength was measured via single-plane shear test for ablated/non-etched (n=10) and ablated/acid-etched (n=8) samples and compared to control samples (n=9) prepared by 320 grit wet sanding. Thermocouple measurements indicated that the temperature remained below ambient temperature at 19.0°C (s.d.=0.9) if water-cooling was used. There was no discoloration of either dentin and enamel, the treated surfaces were uniformly ablated and there were no cracks observable on the laser treated surfaces. Fourpoint bend tests yielded mean mechanical strengths of 18.2 N (s.d.=4.6) for ablated dentin and 18.1 N (s.d.=2.7) for control (p>0.05). Shear tests yielded mean bond strengths of 31.2 MPa (s.d.=2.5, p<0.01) for ablated/acid-etched samples, 5.2 MPa (s.d.=2.4, p<0.001) for ablated/non-etched samples, and 37.0 MPa (s.d.=3.6) for control. The results indicate that a rapid-scanning 300 Hz CO₂ laser can effectively ablate dentin and enamel without excessive heat accumulation and with minimal thermal damage. It is not clear whether the small (16%) but statistically significant reduction in the shear bond strength to enamel is clinically significant since the mean shear bond strength exceeded 30 MPa.

The study demonstrates the possibility of using Tm:YAP laser radiation for the removing ceramic brackets. The amount of enamel loss and residual resin on teeth has been evaluated. A diode-pumped Tm:YAP microchip laser generating at wavelength 1.9 μm was used for the debonding process. The transmission and absorption measurement of the basic elements - bracket, adhesive resin, and enamel was analyzed to explain the source of the heat and bracket debonding. Quantitative measurements are made for visualizing enamel surface before and after a self-ligating bonding technique. Temperature rise observation during the debonding procedure - from 0.5 to 2 W power - has improved the accuracy of assessment. The results were evaluated by CCD camera and scanning electron microscope. From the measurements it is possible to conclude that continuously running small diode pumped Tm:YAP microchip laser having output power 1W can remove the ceramic bracket without enamel iatrogenic damage.

The removal of porcelain veneers using Er:YAG lasers has not been previously described in the scientific literature. This study was designed to systematically investigate the efficacy of an Er:YAG laser on veneer debonding without damaging the underlying tooth structure, as well as preserving a new or misplaced veneer. Initially, Fourier Transform Infrared Spectroscopy (FTIR) was used on flat porcelain veneer samples (IPS Empress Esthetic; Ivoclar Vivadent, Amherst, NY) to assess which infrared laser wavelengths are transmitted through the veneer. Additionally, FTIR spectra from a veneer bonding cement (RelyX Veneer Cement A1; 3M ESPE, St. Paul, MN) were obtained. While the veneer material showed no characteristic water absorption bands in the FTIR, the bonding cement has a broad H2O/OH absorption band coinciding with the ER:YAG laser emission wavelength. Consequently Er:YAG laser energy transmission through different veneer thicknesses was measured. The porcelain veneers transmitted 11 - 18 % of the incident Er:YAG laser energy depending on their thicknesses (Er:YAG laser: LiteTouch by Syneron; wavelength 2,940 nm, 10 Hz repetition rate, pulse duration 100 μs at 133 mJ/pulse; straight sapphire tip 1,100 μm diameter; Syneron, Yokneam, Israel). Initial signs of cement ablation occurred at approximately 1.8 - 4.0 J/cm². This can be achieved by irradiating through the veneer with the fiber tip positioned at a distance of 3-6 mm from the veneer surface, and operating the Er:YAG laser with 133 mJ output energy. All eleven veneers bonded on extracted anterior incisor teeth were easily removed using the Er:YAG laser. The removal occurred without damaging underlying tooth structure as verified by light microscopic investigation (Incident Light Microscope Olympus B 50, Micropublisher RTV 3.3 MP, Image Pro software, Olympus). The debonding mainly occurred at the cement/veneer interface. When the samples were stored in saline solution for 5 days and/or an air-waterspray was used during irradiation, there was a high chance that the veneer would fractured during debonding. However if samples were not stored in water and only air spray was used, 75% of the veneers could be removed without any fracture. The use of an Er:YAG laser can be effective in not only debonding porcelain veneers and preserving tooth structure, but also in maintaining veneer integrity.

The aim of the study was to assess the impact of laser induced antimicrobial photodynamic therapy on the viability of Streptococcus mutans cells employing an aritificial biofilm model. Employing sterile chambered coverglasses, a salivary pellicle layer formation was induced in 19 chambers. Streptococcus mutans cells were inoculated in a sterile culture medium. Using a live/dead bacterial viability kit, bacteria with intact cell membranes stain fluorescent green. Test chambers containing each the pellicle layer and 0.5 ml of the bacterial culture were analyzed using a confocal laser scan microscope within a layer of 10 μm at intervals of 1 μm from the pellicle layer. A photosensitizer was added to the test chambers and irradiated with a diode laser (wavelength: 660 nm, output power: 100 mW, Helbo) for 2 min each. Comparing the baseline fluorescence (median: 13.8 [U], min: 3.7, max: 26.2) with the values after adding the photosensitizer (median: 3.7, min: 1.1, max: 9), a dilution caused decrease of fluorescence could be observed (p<0.05). After irradiation of the samples with a diode laser, an additional 48 percent decrease of fluorescence became evident (median: 2.2, min: 0.4, max: 3.4) (p<0.05). Comparing the samples with added photosensitizer but without laser irradiation at different times, no decrease of fluorescence could be measured (p>0.05). The present study indicates that antimicrobial photodynamic therapy can reduce living bacteria within a layer of 10 μm in an artificial biofilm model. Further studies have to evaluate the maximum biofilm thickness that still allows a toxic effect on microorganisms.

In vitro and in situ studies have demonstrated that the photodynamic antimicrobial therapy (PACT) is effective in reducing Streptococcus mutans population in artificially carious dentin. This pilot in vivo study evaluated the antimicrobial effect of PACT using toluidine blue O (TBO) and a light-emitting diode (LED) in carious dentin lesions. Five healthy adult volunteers (19-36 yr), with at least 4 active carious cavities each, participated in this study. Teeth of each volunteer were randomly divided into four groups: (1) without TBO and without light (Control); (2) with TBO alone (TBO); (3) with LED at 94/J cm² alone (LED); and (4) with TBO plus LED at 94 J/cm² (PACT). Each cavity was divided into two halves. The baseline carious dentin sample was collected from half of each cavity. Following, the treatments were performed using a random distribution of tooth into treatments. Then, the second collection of carious dentin samples was performed. Before and after treatments, dentin samples were analyzed with regard to the counts of total viable microorganisms, total streptococci, mutans streptococci, and lactobacilli. The data were statistically analyzed by Kruskal-Wallis and Student-Newman-Keuls tests (α=5%). Log reductions ranged from -0.12 to 2.68 and significant reductions were observed for PACT (group 4) when compared to the other groups (1, 2, and 3) for total streptococci and mutans streptococci. Concluding, PACT was effective in killing oral microorganisms present in in vivo carious dentin lesions and may be a promising technique for eliminating bacteria from dentin before restoration.

Objective: This study compared the effect of 980 Diode laser + scaling and root planing (SRP) versus SRP alone in the treatment of chronic periodontitis. Method: 21 healthy patients with moderate periodontitis with a probing depth of at least 5mm were included in the study. A total of 42 sites were treated during 6weeks with a combination of 980 Diode laser and SRP (21 sites) or SRP alone (21 sites). The gingival index (GI), probing pocket depth (PPD) and bleeding on probing (BOP) were examined at the baseline and after 6 weeks after the start of treatment. Results: Both groups showed statistically significant improvements in GI, BOP and PPD after treatment. The results also showed significant improvement from laser+ SRP group to SRP alone group. Conclusion: The present data suggest that treatment of chronic periodontitis with either 980 Diode laser + SRP or SRP alone results in statistically significant improvements in the clinical parameters. The combination of 980 Diode laser irradiation in the gingival sulcus and SRP, was significantly better as compared to SRP alone.

This study investigated the compositional and crystallographic changes on enamel when irradiated by Er,Cr:YSGG (λ=2.7μm, 8.5J/cm²) or Nd:YAG (λ=1064nm, 84.9J/cm² associated with black coating), its resistance to demineralization when irradiation is associated with fluoride (APF-gel), and CaF₂-like material formation and retention. Sample surfaces were analyzed by ATR-FTIR (4000-650cm^-1, 4cm^-1) resolution. Irradiation with Er,Cr:YSGG laser promoted a significant decrease on carbonate content of enamel. After Nd:YAG irradiation, it was observed a significant decrease of carbonate and amides I and II. X-ray diffraction showed that both laser irradiations promoted formation of α-tricalcium phosphate and tetracalcium phosphate, and a significant increase on the crystal growth of the enamel apatite (ANOVA, p<0.05 was used for all analysis). These changes can explain the improved resistance of enamel to demineralization observed in the second part of the study, in which 240 enamel slices were divided in 8 groups, received 4 min of professional fluoride gel (APF-gel 1.23%F^-) applied before or after irradiation. After treatments, the formation of calcium fluoride (CaF₂) was determined. The remaining slabs of each group were submitted to a 10-day pH-cycling model and, subsequently, enamel demineralization was evaluated by cross-sectional microhardness. Both lasers significantly reduced enamel demineralization (ANOVA, p<0.05), and the previous APF-gel application followed by laser showed the higher reduction of enamel demineralization. CaF₂ formed before pH-cycling was significantly higher in groups were APF was associated with laser irradiation. After demineralization, these groups also presented higher CaF₂ retention in respect to isolated treatments (only APF or only laser), suggesting its anticaries potential.

The aim of the study was to assess the ability of a fluorescence based optical system to detect secondary caries. The optical detecting system (VistaProof) illuminates the tooth surfaces with blue light emitted by high power GaN-LEDs at 405 nm. Employing this almost monochromatic excitation, fluorescence is analyzed using a RGB camera chip and encoded in color graduations (blue - red - orange - yellow) by a software (DBSWIN), indicating the degree of caries destruction. 31 freshly extracted teeth with existing fillings and secondary caries were cleaned, excavated and refilled with the same kind of restorative material. 19 of them were refilled with amalgam, 12 were refilled with a composite resin. Each step was analyzed with the respective software and analyzed statistically. Differences were considered as statistically significant at p<0.05. There was no difference between measurements at baseline and after cleaning (Mann Whitney, p>0.05). There was a significant difference between baseline measurements of the teeth primarily filled with composite resins and the refilled situation (p=0.014). There was also a significant difference between the non-excavated and the excavated group (Composite p=0.006, Amalgam p=0.018). The in vitro study showed, that the fluorescence based system allows detecting secondary caries next to composite resin fillings but not next to amalgam restorations. Cleaning of the teeth is not necessary, if there is no visible plaque. Further studies have to show, whether the system shows the same promising results in vivo.

The aim of the present study was to evaluate the combined in vitro effects a pulsed 10.6 μm CO₂ laser and fluoride on the reduction of carious lesion progression in root dentin. Sixty five slabs of previously demineralized bovine root dentin were assigned into five groups (n=13): control (no treatment), acidulated phosphate fluoride gel 1.23% (FFA), CO₂ Laser (L), FFA+L, L+FFA. The lasered groups were irradiated with 4.0J/cm2. After a 7 day pH cycling regime, the knoop hardness number (KHN) was determined by cross-sectional microhardness testing (5g, 5s, 10-60 μm, 10 μm interval). The data was analyzed by ANOVA and Student's t-test (α= 0.05). A significant interaction between KHN and the indentation depths was found (p<0.05). At 10-20 μm, FFA+L (KHN:12.12±0.95/13.07±1.03) and FFA (KHN:12.86±4.54/12.60±3.93) inhibited caries progression when compared to control group (KHN:8.76±0.95/9.50±1.03) (p<0.05), but did not differ with neither each other nor from group L (p>0.05). At 30 μm, the KHN was significantly higher than the control only in the FFA group (KHN:15.35±1.16). At 40 μm, the groups FFA (KHN: 15.87±3.76), L (KHN: 15.57±5.71) and L+FFA (KHN:15.50±5.08) were capable of significantly inhibiting caries progression, however they did not differ each other (p>0.05). At depths of 50-60 μm, only group L (KHN:17.05±1.29/18.26±1.30) differed statistically from the control (KHN:13.43±1.24/13.81±1.25), but not from the other groups. In conclusion, CO₂ laser alone was able to inhibit caries progression in the deepest layers. However, no synergistic effect was obtained when CO₂ laser irradiation and FFA application and were combined.

The high transparency of dental enamel in the near-infrared (NIR) at 1310-nm can be exploited for imaging dental caries without the use of ionizing radiation. The objective of this study was to determine whether the lesion contrast derived from NIR transillumination can be used to estimate lesion severity. Another aim was to compare the performance of a new Ge enhanced complementary metal-oxide-semiconductor (CMOS) based NIR imaging camera with the InGaAs focal plane array (FPA). Extracted human teeth (n=52) with natural occlusal caries were imaged with both cameras at 1310-nm and the image contrast between sound and carious regions was calculated. After NIR imaging, teeth were sectioned and examined using more established methods, namely polarized light microscopy (PLM) and transverse microradiography (TMR) to calculate lesion severity. Lesions were then classified into 4 categories according to the lesion severity. Lesion contrast increased significantly with lesion severity for both cameras (p<0.05). The Ge enhanced CMOS camera equipped with the larger array and smaller pixels yielded higher contrast values compared with the smaller InGaAs FPA (p<0.01). Results demonstrate that NIR lesion contrast can be used to estimate lesion severity.

A thorough understanding of how polarized near-IR light propagates through sound and carious dental hard tissues is important for the development of dental optical imaging systems. New optical imaging tools for the detection and assessment of dental caries (dental decay) such as near-IR imaging and optical coherence tomography can exploit the enhanced contrast provided by polarization sensitivity. In this investigation, an automated system was developed to collect images for the full 16-element Mueller Matrix. The polarized light was controlled by linear polarizers and liquid crystal retarders and the 36 images were acquired as the polarized near-IR light propagates through the enamel of extracted human thin tooth sections. In previous work, we reported that polarized light is rapidly depolarized by demineralized enamel, and sound and demineralized dentin.¹ The rapid depolarization of polarized light by dental caries in the near-IR provides high contrast for caries imaging and detection. In this initial study, major differences in the Mueller matrix elements were observed in both sound and demineralized enamel which supports this approach and warrants further investigation.

New methods are needed for the nondestructive measurement of tooth demineralization and remineralization to monitor the progression of incipient caries lesions (tooth decay) for effective nonsurgical intervention and to evaluate the performance of anti-caries treatments such as chemical treatments or laser irradiation. Studies have shown that optical coherence tomography (OCT) has great potential to fulfill this role since it can be used to measure the depth and severity of early lesions with an axial resolution exceeding 10-μm, it is easy to apply in vivo and it can be used to image the convoluted topography of tooth occlusal surfaces. In this paper we attempt to determine the earliest stage at which we can detect significant differences in lesion severity. Automated methods of analysis were used to measure the depth and severity of demineralized bovine enamel produced using a simulated caries model that emulates demineralization in the mouth. Significant differences in the depth and integrated reflectivity from the lesions were detected after only a few hours of demineralization. These results demonstrate that cross polarization OCT is ideally suited for the nondestructive assessment of early demineralization.

Several studies have demonstrated that polarization-sensitive optical coherence tomography (PS-OCT) can be used to nondestructively measure the severity of demineralization in the important occlusal surfaces. The purpose of this study was to assess the potential of PS-OCT and OCT methods for the measurement of the depth of natural occlusal carious lesions. Teeth were screened for potential occlusal lesions using near infrared imaging (NIR). A PS-OCT system operating at 1310-nm was used to acquire polarization resolved images of the area of interest on the occlusal surface. The teeth were serial sectioned to 200 μm thickness and examined with polarized light microscopy (PLM) and Transverse Microradiography (TMR) for comparison. The lesion depth measured nondestructively with PS-OCT was compared to the lesion depth measured with PLM and TMR to assess the performance of these methods and determine if polarization sensitivity is required. The lesion depth measured using OCT correlated well with the lesion depths measured with TMR and PLM. Although polarization sensitivity provided better contrast it was not necessary to have polarization sensitivity to identify deep occlusal lesions.