Performance differences in the detection of subgingival calculus by laser fluorescence devices

A Life-Size Three-Dimensional Phantom for Periodontal Imaging Development and Treatment-Planning

RATIONALE AND OBJECTIVES

This study aims to (1) describe a periodontal and implant ultrasound imaging phantom designed for training of common periodontal and peri-implant soft- and hard-tissue deficiencies, and (2) detail the specific anatomical phantom features and showcase imaging data obtained from intraoral scans, cone beam computed tomography (CBCT) as well as ultrasound.

MATERIALS AND METHODS

A prototype, full-sized, three-dimensional (3D), periodontal ultrasound phantom was created. To mimic periodontal and peri-implant soft-tissue, a phantom material similar to soft-tissue was attached. Several features were added to imitate clinical scenarios and enable use as a teaching tool. To understand hard-tissue anatomy, the phantom was imaged using a commercially available CBCT scanner. In addition, an optical scan was taken to generate a 3D surface model. Images obtained were analyzed using a public domain software (3D Slicer). Ultrasound brightness mode images (B-mode) were taken of the regions of interest.

RESULTS

CBCT and intraoral reference scans are overlaid with the ultrasound images obtained. Four different views are provided: facial, occlusal, lingual, and transverse. Our group was able to scan and delineate in ultrasound images vertical and horizontal bone loss, peri-implant bone loss, buccal dehiscence, apical fenestrations, and edentulous crest soft- and hard-tissue.

CONCLUSION

To our knowledge, this is the first study to present a prototype (full-sized, 3D, for periodontal ultrasound) phantom for intraoral periodontal and peri-implant ultrasound scanning training. Creating training scenarios that mimic clinical reality might allow trainees to obtain skills and build toward acceptable and individualized technical performance.

Novel Approaches to Detect and Treat Biofilms within the Root Canals of Teeth: A Review

Biofilms located within the root canals of teeth are a unique and pressing concern in dentistry and in medical microbiology. These multispecies biofilms, which include fungi as well as bacteria, form in a protected site with low shear stress and low oxygen tension. Systemic antibiotics are of limited value because of the lack of blood flow of the site, and issues with innate and acquired resistance. Physical disruption using hand or rotary powered instruments does not reach all locations in the root canal system where biofilms are present. Alternative strategies including agitated irrigation fluids, continuous chelation, materials with highly alkaline pH, and antimicrobial nanoparticles are being explored to meet the challenge. Detection and quantification of biofilms using fluorescence-based optical methods could provide an indication of successful biofilm removal and an endpoint for physical and chemical treatments.

Evaluation of calculus imaging on root surfaces by spectral-domain optical coherence tomography

OBJECTIVE

The aim of this in vitro study was to evaluate the ability of optical coherence tomography (OCT) to display calculus on root surfaces.

MATERIAL AND METHODS

Ten teeth with calculus on the root surface were embedded in resin, omitting the root surface. A region of interest (ROI) was marked by small drill holes coronally and apically of the calculus and imaged by spectral-domain optical coherence tomography ([SD OCT], Telesto SP5, centre wavelength 1310 nm) and light microscopy (LM). To evaluate the impact of different fluids on calculus visualisation, using OCT, root surfaces were covered by a layer of NaCl and blood and displayed by OCT. Subsequently, teeth were completely covered with resin and sectioned for histological evaluation. Within the ROI, lengths of root surface and calculus were measured by LM and OCT, and the ratio [%] was calculated. In addition, at three sites of each ROI, agreement of presence and length of calculus was evaluated. Both methods were compared using Pearson's correlation.

RESULTS

Regarding the presence of calculus, agreement between LM and OCT was strong (κ_i = 0.783, p = 0.033), and measurements regarding the length of the calculus were strongly correlated (r_i >0.906; p_i <0.001). However, the values differed for dry (p = 0.023) and NaCl-covered root surfaces (p = 0.035).

CONCLUSION

Calculus on the root surface can be displayed by SD-OCT, which therefore may be suited as imaging technology for subgingival calculus in periodontal pockets.

Cross-polarization reflectance imaging of root caries and dental calculus on extracted teeth at wavelengths from 400 to 2350 nm

The identification of root caries and calculus on tooth roots is of increasing importance with our aging population. Exposed root surfaces are often impacted by erosion, abrasion, calculus and staining which can make the identification and management of caries challenging. Identification of dental calculus on root surfaces and verification of its removal is also important for patient education and to decrease susceptibility to caries and periodontal disease. The objective of this study was to determine how the contrast of root caries lesions and dental calculus varies with wavelength in the visible to near-infrared. The contrast of suspected root caries lesions and dental calculus on 30 extracted teeth was measured using cross-polarization reflectance measurements at wavelengths from 400 to 2350 nm. Significantly higher (P < 0.05) lesion contrast was measured at wavelengths greater than 1460 nm. Stains interfered significantly at wavelengths less than 850 nm yielding non-diagnostic contrast for root caries lesions. We postulate that the high absorption of water at longer wavelengths reduced the light scattering from the surrounding and underlying normal dentin, thus increasing the lesion contrast. This study indicates that wavelengths beyond 1400 nm are advantageous for imaging calculus and caries lesions on root surfaces due to the high contrast and lack of interference from stain.

Violet and blue light-induced green fluorescence emissions from dental caries

BACKGROUND

The objective of this laboratory study was to compare violet and visible blue LED light-elicited green fluorescence emissions from enamel and dentine in healthy or carious states.

METHODS

Microscopic digital photography was undertaken using violet and blue LED illumination (405 nm and 455 nm wavelengths) of tooth surfaces, which were photographed through a custom-made stack of green compensating filters which removed the excitation light and allowed green fluorescence emissions to pass. Green channel pixel data were analysed.

RESULTS

Dry sound enamel and sound root surfaces showed strong green fluorescence when excited by violet or blue lights. Regions of cavitated dental caries gave lower green fluorescence, and this was similar whether the dentine in the lesions was the same colour as normal dentine or was darkly coloured. The presence of saliva on the surface did not significantly change the green fluorescence, while the presence of blood diluted in saliva depressed green fluorescence.

CONCLUSIONS

Using violet or blue illumination in combination with green compensating filters could potentially aid in the assessment of areas of mineral loss.

In vitro performance of DIAGNOdent laser fluorescence device for dental calculus detection on human tooth root surfaces

OBJECTIVE

This study assessed the reproducibility of a red diode laser device, and its capability to detect dental calculus in vitro on human tooth root surfaces.

MATERIAL AND METHODS

On each of 50 extracted teeth, a calculus-positive and calculus-free root surface was evaluated by two independent examiners with a low-power indium gallium arsenide phosphide diode laser (DIAGNOdent) fitted with a periodontal probe-like sapphire tip and emitting visible red light at 655 nm wavelength. Laser autofluorescence intensity readings of examined root surfaces were scored on a 0-99 scale, with duplicate assessments performed using the laser probe tip directed both perpendicular and parallel to evaluated tooth root surfaces. Pearson correlation coefficients of untransformed measurements, and kappa analysis of data dichotomized with a >40 autofluorescence intensity threshold, were calculated to assess intra- and inter-examiner reproducibility of the laser device. Mean autofluorescence intensity scores of calculus-positive and calculus-free root surfaces were evaluated with the Student's t-test.

RESULTS

Excellent intra- and inter-examiner reproducibility was found for DIAGNOdent laser autofluorescence intensity measurements, with Pearson correlation coefficients above 94%, and kappa values ranging between 0.96 and 1.0, for duplicate readings taken with both laser probe tip orientations. Significantly higher autofluorescence intensity values were measured when the laser probe tip was directed perpendicular, rather than parallel, to tooth root surfaces. However, calculus-positive roots, particularly with calculus in markedly-raised ledges, yielded significantly greater mean DIAGNOdent laser autofluorescence intensity scores than calculus-free surfaces, regardless of probe tip orientation. DIAGNOdent autofluorescence intensity values >40 exhibited a stronger association with calculus (36.6 odds ratio) then measurements of ≥5 (20.1 odds ratio) when the laser probe tip was advanced parallel to root surfaces.

CONCLUSIONS

Excellent intra- and inter-examiner reproducibility of autofluorescence intensity measurements was obtained with the DIAGNOdent laser fluorescence device on human tooth roots. Calculus-positive root surfaces exhibited significantly greater DIAGNOdent laser autofluorescence than calculus-free tooth roots, even with the laser probe tip directed parallel to root surfaces. These findings provide further in vitro validation of the potential utility of a DIAGNOdent laser fluorescence device for identifying dental calculus on human tooth root surfaces.

Dental calculus detection using the VistaCam

The VistaCam® intra-oral camera system (Dürr Dental, Bietigheim-Bissingen, Germany) is a fluorescence system using light emitting diodes that produce a 405-nm violet light. This wavelength has potential application for detection of dental calculus based on red emissions from porphyrin molecules. This study assessed the digital scores obtained for both supragingival and subgingival calculus on 60 extracted teeth and compared these with lesions of dental caries. It has also examined the effect of saliva and blood on the fluorescence readings for dental calculus. VistaCam fluorescence scores for both supragingival (1.7-3.3) and subgingival calculus (1.3-2.4) were higher than those for sound root surfaces (0.9-1.1) and dental caries (0.9-2.2) (p < .05). The readings for calculus samples were not affected by the presence of saliva or blood. These results suggest that the use of violet light fluorescence could be a possible adjunct to clinical examination for deposits of dental calculus.

Effect of oral fluids on dental caries detection by the VistaCam

The VistaCam® system (Durr Dental, Bietigheim‐Bissingen, Germany) has been suggested as an adjunct to clinical examination for dental caries. This study assessed whether the digital scores obtained for tooth surfaces were affected by the colour of the carious lesions present and by the presence of saliva or blood on the tooth surface. The VistaCam intra‐oral ries, or with sound enamel and root surfaces, with or without overlying dental plaque biofilm. Teeth that had undergone root treatment or were stained by tetracycline were also assessed. Readings were taken in the dry state and after application of human stimulated saliva or venous blood onto the surface of the samples. VistaCam fluorescence scores for all samples were similar in the dry state, and when covered with saliva (P > 0.05), however a coating of dilute blood elevated the readings for most samples to a high level (P < 0.01), other than tetracycline stained teeth and dental caries (P > 0.05). Readings for healthy enamel were 0.9–1.1, and these increased up to 2.8 in the presence of blood. VistaCam fluorescence scores are not affected by dryness or moisture from the presence of saliva but increase when traces of blood are present. This problem needs to be taken into account when the device is used clinically, because blood from the gingival crevice is a common contaminant of tooth surfaces when patients have widespread gingival inflammation. There are also issues with elevated scores from background fluorescence from tetracyclines, which need to be considered when the system is in clinical use.