This PDF file contains the front matter associated with SPIE Proceedings Volume 8566, including the Title Page, Copyright information, Table of Contents, and Conference Committee listing.

Early detection, monitoring and remineralization repair of enamel lesions are top research priorities in the modern dentistry focusing on minimal intervention concept for caries management. We investigate the use of swept-source optical coherence tomography system (SS-OCT) without polarization-sensing at 1319 nm wavelength developed for clinical dentistry (Dental OCT System Prototype 2, Panasonic Healthcare Co., Ltd., Japan) in quantitative assessment of artificial enamel lesions and their remineralization. Bovine enamel blocks were subjected to demineralization to create subsurface lesions approximately 130 μm in depth over 2 weeks, and subjected to remineralization in solution containing bioavailable calcium and 1ppm fluoride at pH 6.5 for 2 weeks. Cross-sectional images of sound, demineralized and remineralized specimens were captured under hydrated conditions by the OCT. Finally, the specimens were cut into sections for nanoindentation to measure hardness through the lesion under 2mN load. Reflectivity had increased with demineralization. OCT images of lesions showed a boundary closely suggesting the lesion depth that gradually progressed with demineralization time. After remineralization, the boundary depth gradually decreased and nanoindentation showed over 60% average hardness recovery rate. A significant negative correlation was found between the slope power-law regression as a measure of attenuation and overall nanohardness for a range of data covering sound, demineralized and remineralized areas. In conclusion, OCT could provide clear images of early enamel lesion extent and signal attenuation could indicate its severity and recovery. Clinical data of natural lesions obtained using Dental OCT and analyzed by this approach will also be presented. Study supported by GCOE IRCMSTBD and NCGG.

There is currently a need for a safe and effective way to detect and diagnose early childhood caries. We have developed a multimodal optical clinical prototype for testing in vivo. The device can be used to quickly image and screen for any signs of demineralized enamel by obtaining high-resolution and highcontrast surface images using a 405-nm laser as the illumination source, as well as obtaining autofluorescence and bacterial fluorescence images. Then, when a suspicious region is located, the device can perform dual laser fluorescence spectroscopy using 405-nm and 532-nm laser excitation which is used to compute an autofluorescence ratio. This ratio can be used to quantitatively diagnose enamel health. The device is tested on four in vivo test subjects as well as 17 extracted teeth with clinically diagnosed carious lesions. The device was able to provide detailed images which served to screen for suspected early caries. The autofluorescence ratios obtained from the extracted teeth were able to discriminate between healthy and unhealthy enamel. Therefore, the clinical prototype demonstrates feasibility in screening for and in quantitatively diagnosing healthy from demineralized enamel.

New methods are needed for the nondestructive measurement of tooth demineralization and remineralization and 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 present early results from two clinical studies underway to measure the effect of fluoride intervention on early lesions. CP-OCT was used to monitor early lesions on enamel and root surfaces before and after intervention with fluoride varnish. The lesion depth and internal structure were resolved for all the lesions examined and some lesions had well defined surface zones of lower reflectivity that may be indicative of arrested lesions. Changes were also noted in the structure of some of the lesions after fluoride intervention.

Due to a frequent consumption of acidic food and beverages, the prevalence of dental erosion increases worldwide. In an initial erosion stage, the hard dental tissue is softened due to acidic demineralization. As erosion progresses, a gradual tissue wear occurs resulting in thinning of the enamel. Complete loss of the enamel tissue can be observed in severe clinical cases. Therefore, it is essential to provide a diagnosis tool for an accurate detection and monitoring of dental erosion already at early stages. In this manuscript, we present the development of a polarization sensitive imaging camera for the visualization and quantification of dental erosion. The system consists of two CMOS cameras mounted on two sides of a polarizing beamsplitter. A horizontal linearly polarized light source is positioned orthogonal to the camera to ensure an incidence illumination and detection angles of 45°. The specular reflected light from the enamel surface is collected with an objective lens mounted on the beam splitter and divided into horizontal (H) and vertical (V) components on each associate camera. Images of non-eroded and eroded enamel surfaces at different erosion degrees were recorded and assessed with diagnostic software. The software was designed to generate and display two types of images: distribution of the reflection intensity (V) and a polarization ratio (H-V)/(H+V) throughout the analyzed tissue area. The measurements and visualization of these two optical parameters, i.e. specular reflection intensity and the polarization ratio, allowed detection and quantification of enamel erosion at early stages in vitro.

Since optical coherence tomography is well suited for measuring small dimensional changes on tooth surfaces it has great potential for monitoring tooth erosion. The purpose of this study was to explore different approaches for monitoring the erosion of enamel. Application of an acid resistant varnish to protect the tooth surface from erosion has proven effective for providing a reference surface for in vitro studies but has limited potential for in vivo studies. Two approaches which can potentially be used in vivo were investigated. The first approach is to measure the remaining enamel thickness, namely the distance from the tooth surface to the dentinal-enamel junction (DEJ). The second more novel approach is to irradiate the surface with a carbon dioxide laser to create a reference layer which resists erosion. Measuring the remaining enamel thickness proved challenging since the surface roughening and subsurface demineralization that commonly occurs during the erosion process can prevent resolution of the underlying DEJ. The areas irradiated by the laser manifested lower rates of erosion compared to the non-irradiated areas and this method appears promising but it is highly dependent on the severity of the acid challenge.

Optical Coherence Tomography (OCT) has seen broad application in dentistry including early carious lesion detection and imaging defects in resin composite restorations. This study investigates expanding the clinical usefulness by investigating methods to use OCT for obtaining three-dimensional (3D) digital impressions, which can be integrated to CAD/CAM manufacturing of indirect restorations. 3D surface topography ‘before’ and ‘after’ a cavity preparation was acquired by an intraoral cross polarization swept source OCT (CP-OCT) system with a Micro-Electro-Mechanical System (MEMS) scanning mirror. Image registration and segmentation methods were used to digitally construct a replacement restoration that modeled the original surface morphology of a hydroxyapatite sample. After high resolution additive manufacturing (e.g. polymer 3D printing) of the replacement restoration, micro-CT imaging was performed to examine the marginal adaptation. This study establishes the protocol for further investigation of integrating OCT with CAD/CAM of indirect dental restorations.

Less-invasive treatment of caries has been needed in laser dentistry. Based on the absorption property of dentin substrates, 6 μm wavelength range shows specific absorptions and promising characteristics for the excavation. In our previous study, 5.8 μm wavelength range was found to be effective for selective excavation of carious dentin and restoration treatment using composite resin from the irradiation experiment with bovine sound and demineralized dentin. In this study, the availability of 5.8 μm wavelength range for selective excavation of human carious dentin was investigated for clinical application. A mid-infrared tunable nanosecond pulsed laser by difference-frequency generation was used for revealing the ablation property of human carious dentin. Irradiation experiments indicated that the wavelength of 5.85 μm and the average power density of 30 W/cm² realized the selective excavation of human carious dentin, but ablation property was different with respect to each sample because of the different caries progression. In conclusion, 5.8 μm wavelength range was found to be effective for selective excavation of human carious dentin.

The aim of study is to compare the ablation effect of contact and non-contact interaction of Er:YAG and CTH:YAG laser radiation with artificial enamel caries lesion. The artificial caries was prepared in intact teeth to simulate demineralized surface and the laser radiation was applied. Contact and non-contact ablation was compared. Two laser systems Er:YAG 2.94 μm and CTH:YAG 2.1 μm were used. The enamel artificial caries were gently removed by laser radiation and flow Sonic fill composite resin was inserted. Scanning electron microscope was use to evaluate the enamel surface.

Ultra-short pulsed laser (USPL) systems for dental application have overcome many of their initial disadvantages. However, a problem that has not yet been addressed and solved is the beam delivery into the oral cavity. The functional system that is introduced in this study includes an articulated mirror arm, a scanning system as well as a handpiece, allowing for freehand preparations with ultra-short laser pulses. As laser source an Nd:YVO₄ laser is employed, emitting pulses with a duration of t_p < 10 ps at a repetition rate of up to 500 kHz. The centre wavelength is at 1064 nm and the average output power can be tuned up to 9 W. The delivery system consists of an articulated mirror arm, to which a scanning system and a custom made handpiece are connected, including a 75 mm focussing lens. The whole functional system is compact in size and moveable. General characteristics like optical losses and ablation rate are determined and compared to results employing a fixed setup on an optical table. Furthermore classical treatment procedures like cavity preparation are being demonstrated on mammoth ivory. This study indicates that freehand preparation employing an USPL system is possible but challenging, and accompanied by a variety of side-effects. The ablation rate with fixed handpiece is about 10 mm³/min. Factors like defocussing and blinding affect treatment efficiency. Laser sources with higher average output powers might be needed in order to reach sufficient preparation speeds.

A desired outcome of scaling and root planing is the complete removal of calculus and infected root tissue and preservation of healthy cementum for rapid healing of periodontal tissues. Conventional periodontal treatments for calculus removal, such as hand instrument scaling and ultrasonic scaling, often deeply scrape the surface of the underlying hard tissue and may leave behind a smear layer. Pulsed lasers emitting at violet wavelengths (specifically, 380 to 400 nm) are a potential alternative treatment since they can selectively ablate dental calculus without ablating pristine hard tissue (i.e., enamel, cementum, and dentin). In this study, light and scanning electron microscopy are used to compare and contrast the efficacy of in vitro calculus removal for several conventional periodontal treatments (hand instruments, ultrasonic scaler, and Er:YAG laser) to calculus removal with a frequency-doubled Ti:sapphire (λ = 400 nm). After calculus removal, enamel and cementum surfaces are investigated for calculus debris and damage to the underlying hard tissue surface. Compared to the smear layer, grooves, and unintentional hard tissue removal typically found using these conventional treatments, calculus removal using the 400-nm laser is complete and selective without any removal of pristine dental hard tissue. Based on these results, selective ablation from the 400-nm laser appears to produce a root surface that would be more suitable for successful healing of periodontal tissues.

Due to the high intensities of USP laser radiation, the interaction with matter is always attended with a plasma formation. Therefore the surrounding tissue can be influenced by heat generation and additional light emission from the UV up to the near and mid infrared. In dentistry it is of importance that the treatment of bone and soft tissues, i.e. oral mucosa, with a USP laser should not cause any kind of morphological changes on the cell level leading to a delayed wound healing or cell mutation.

HaCaT keratinocyte cells were used for epidermal (soft tissue) and MG-63 osteoblast-like cells for hard tissue (bone) modelling. Cell growing was realized on glas cover slips. Irradiation was carried out with a USP Nd:YVO4 laser having a center wavelength at 1064 nm. Based on the pulse duration of 8 ps and a pulse repetition rate of 500 kHz the laser emits an average power of 9 W. For efficiency testing of cell removal on glas cover slips, 1, 5, 25, 50 and 75 repetitions of the scanning pattern (scan loops) were used. Heat distribution during laser irradiation was measured with an infrared camera system. Subsequently haematoxylin staining and SEM investigations were used to analyse the morphological changes.

Differences of cell removal efficiency were observed with repetitions ≤25. Irradiated areas with repetitions ≥50 were cell-free. Additionally, repetitions ≥25 showed side effects for both cell lines. Cell destruction in both cell lines could be verified using the haematoxylin staining and the SEM pictures.

Complex nature of bacterial cell membrane and structure of biofilm has challenged the efficacy of antimicrobial photodynamic therapy (APDT) to achieve effective disinfection of infected root canals. In addition, tissue-inhibitors present inside the root canals are known to affect APDT activity. This study was aimed to assess the effect of APDT on bacterial biofilms and evaluate the effect of tissue-inhibitors on the APDT. Rose-bengal (RB) and methylene-blue (MB) were tested on Enterococcus faecalis (gram-positive) and Pseudomonas aeruginosa (gram-negative) biofilms. In vitro 7- day old biofilms were sensitized with RB and MB, and photodynamically activated with 20-60 J/cm². Photosensitizers were pre-treated with different tissue-inhibitors (dentin, dentin-matrix, pulp tissue, bacterial lipopolysaccharides (LPS), and bovine serum albumin (BSA)) and tested for antibacterial effect of APDT. Microbiological culture based analysis was used to analyze the cell viability, while Laser Scanning Confocal Microscopy (LSCM) was used to examine the structure of biofilm. Photoactivation resulted in significant reduction of bacterial biofilms with RB and MB. The structure of biofilm under LSCM was found to be disrupted with reduced biofilm thickness. Complete biofilm elimination could not be achieved with both tested photosensitizers. APDT effect using MB and RB was inhibited in a decreasing order by dentin-matrix, BSA, pulp, dentin and LPS (P< 0.05). Both strains of bacterial biofilms resisted complete elimination after APDT and the tissue inhibitors existing within the root canal reduced the antibacterial activity at varying degrees. Further research is required to enhance the antibacterial efficacy of APDT in an endodontic environment.

In vivo and in vitro studies have shown that high contrast images of tooth demineralization can be acquired in the near-IR due to the high transparency of dental enamel. The purpose of this study is to compare the lesion contrast in reflectance at near-IR wavelengths coincident with high water absorption with those in the visible, the near-IR at 1300-nm and with fluorescence measurements for early lesions in occlusal surfaces. Twenty-four human molars were used in this in vitro study. Teeth were painted with an acidresistant varnish, leaving a 4×4 mm window in the occlusal surface of each tooth exposed for demineralization. Artificial lesions were produced in the exposed windows after 1 and 2-day exposure to a demineralizing solution at pH 4.5. Lesions were imaged using NIR reflectance at 3 wavelengths, 1310, 1460 and 1600-nm using a high definition InGaAs camera. Visible light reflectance, and fluorescence with 405-nm excitation and detection at wavelengths greater than 500-nm were also used to acquire images for comparison. Crossed polarizers were used for reflectance measurements to reduce interference from specular reflectance. The contrast of both the 24 hr and 48 hr lesions were significantly higher (P<0.05) for NIR reflectance imaging at 1460-nm and 1600-nm than it was for NIR reflectance imaging at 1300-nm, visible reflectance imaging, and fluorescence. The results of this study suggest that NIR reflectance measurements at longer near-IR wavelengths coincident with higher water absorption are better suited for imaging early caries lesions.

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.

The acoustics of a dental hard tissue laser (Er,Cr:YSGG laser, Waterlase MD, Biolase, USA) and a traditional dental high speed hand piece (Midwest®, Dentsply International, USA) were compared in vitro using a simple approach that can be easily adapted for in vivo studies. Thirty one extracted caries and restoration free primary anterior teeth were selected. These teeth were sectioned along a symmetry axis to give two identical halves for use in a split study. These halves were randomly assigned to either the laser (experimental) or the high speed (control) group. A miniature electret microphone was coupled to the sample using a polymer and used to collect the acoustic signal at the interface of the pulp chamber. This signal was captured periodically by a digitizing oscilloscope and multiple traces were stored for subsequent analysis. 2x1x1mm³ preparations were made according to manufacturers recommendations for the given method. Each cavity was prepared by the same clinician and calibration tests were performed to ensure consistency. The measurements indicated that the peak acoustic pressures as well as cumulative acoustic effects (due to duty cycle) were significantly higher (P<0.001, T-test) with the dental hand piece than with the dental laser. Our study suggests the need for further investigations into the neurological implications of acoustic effects in dental patient care such as pain studies.

In the present study, artificial type I and type II erosions were created on dental specimen using acetic acid and EDTA respectively. Specimens were prepared by etching extracted teeth samples in acid to varying degrees, after which the absolute fluorescence intensity ratio of the etched enamel relative to sound enamel was recorded for each specimen using 405 and 532 nm laser excitation. Results showed differences in the fluorescence ratio of etched to sound enamel for type I and II erosions. These findings suggest a non-uniform distribution of fluorescent species in the interprismatic region as compared to the prismatic region.