Current Approaches to Diagnosis of Early Proximal Carious Lesion: A Literature Review

Integrating technological tools with clinical visual examination for caries detection and diagnosis can improve preventative measures in dentistry, resulting in decreased treatment expenses and reduced time and costs associated with testing potential anticaries agents. This article provides an overview of the conventional and new emerging modern technologies that can assist dental professionals in the early detection and diagnosis of dental caries. These technologies aid in assessing the progression of carious lesions and monitoring them quantitatively or qualitatively over time. Traditional techniques (visual, tactile, and radiographic) have limitations in diagnosing early proximal caries accurately. Novel methods like fluorescence and transillumination, as well as advanced tools like OCT (optical coherence tomography), laser fluorescence, and QLF (quantitative light-induced fluorescence), are effective for early caries detection. Optical methods like fluorescence and transillumination are particularly successful in identifying initial caries stages. Moreover, this review highlights the clinical relevance of these methods and discusses potential future technologies like terahertz imaging and artificial intelligence (AI)-based approaches.

Synchrotron X-ray Studies of the Structural and Functional Hierarchies in Mineralised Human Dental Enamel: A State-of-the-Art Review

Hard dental tissues possess a complex hierarchical structure that is particularly evident in enamel, the most mineralised substance in the human body. Its complex and interlinked organisation at the Ångstrom (crystal lattice), nano-, micro-, and macro-scales is the result of evolutionary optimisation for mechanical and functional performance: hardness and stiffness, fracture toughness, thermal, and chemical resistance. Understanding the physical-chemical-structural relationships at each scale requires the application of appropriately sensitive and resolving probes. Synchrotron X-ray techniques offer the possibility to progress significantly beyond the capabilities of conventional laboratory instruments, i.e., X-ray diffractometers, and electron and atomic force microscopes. The last few decades have witnessed the accumulation of results obtained from X-ray scattering (diffraction), spectroscopy (including polarisation analysis), and imaging (including ptychography and tomography). The current article presents a multi-disciplinary review of nearly 40 years of discoveries and advancements, primarily pertaining to the study of enamel and its demineralisation (caries), but also linked to the investigations of other mineralised tissues such as dentine, bone, etc. The modelling approaches informed by these observations are also overviewed. The strategic aim of the present review was to identify and evaluate prospective avenues for analysing dental tissues and developing treatments and prophylaxis for improved dental health.

Physical–chemical and biological properties of novel resin-based composites for dental applications

Insufficient mechanical properties of hydroxyapatite-based composites prompted the search for new and effective solutions for dental applications. To improve the mechanical properties without losing the remineralization potential, the use of hybrid fillers was proposed. The first of them was based on the formation of hydroxyapatite (HA) layer on the surface of SYLOID®244 silica. The second of the investigated fillers was created by simultaneous synthesis of nanoparticles from precursors of HA and silica. The obtained fillers were extensively characterized by spectral methods including X-ray Diffractometry (XRD), Fourier-Transform Infrared Spectroscopy (FT-IR), and X-ray fluorescence (XRF), as well as by Scanning Electron Microscopy (SEM)/Energy Dispersive Spectroscopy (EDS). Tests using probiotic microorganisms were an important part of the analysis, indicating that there was no potential interaction of the materials with microflora. The tests of degree of conversion, depth of cure, opacity, sorption, solubility, flexural and compressive strength, and the remineralizing potential also showed that the composites with nano-sized silica/HA showed better mechanical properties than the composites with HA alone or commercial silica and at the same time the remineralization remained at the desired level. Thus, the proposed composite has a high application potential in the creation of implants and dental materials.

Graphical abstract

Development of a Visualisation Approach for Analysing Incipient and Clinically Unrecorded Enamel Fissure Caries Using Laser-Induced Contrast Imaging, MicroRaman Spectroscopy and Biomimetic Composites: A Pilot Study

This pilot study presents a practical approach to detecting and visualising the initial forms of caries that are not clinically registered. The use of a laser-induced contrast visualisation (LICV) technique was shown to provide detection of the originating caries based on the separation of emissions from sound tissue, areas with destroyed tissue and regions of bacterial invasion. Adding microRaman spectroscopy to the measuring system enables reliable detection of the transformation of the organic–mineral component in the dental tissue and the spread of bacterial microflora in the affected region. Further laboratory and clinical studies of the comprehensive use of LICV and microRaman spectroscopy enable data extension on the application of this approach for accurate determination of the boundaries in the changed dental tissue as a result of initial caries. The obtained data has the potential to develop an effective preventive medical diagnostic approach and as a result, further personalised medical treatment can be specified.

Investigation of the protective suitability of a dental fluorinated varnish by means of X Ray fluorescence and Raman spectroscopy

BACKGROUND AND AIM

Evaluating the protective effect in human enamel of a fluorinated varnish after enduring a citric acid erosive challenge.

METHODS

An in vitro model was developed considering the intraoral environment, human saliva and acid erosive procedures. The evaluation of the enamel specimens was undertaken through the direct analysis of enamel by means of Raman spectroscopy and Energy Dispersive X Ray Fluorescence (EDXRF). Ten tooth specimens per group were analysed during three stages: 1- before treatment; 2- After varnish (treatment group) or toothpaste (control) application; 3- After citric acid cycle. Additionally, Particle Induced Gamma Ray emission (PIGE) was used to gauge the fluorine uptake by enamel after the application of the varnish (stage 2). Results were presented as mean and standard deviation with ANOVA and Tukey post hoc performed considering a significance level of 0.05.

RESULTS

A significant (p < 0.05) higher Ca levels were detected in treatment group at stage 2 (37.4 ± 0.4 w/w%) and 3 (37.1 ± 0.1) when compared to the control group. After varnish application in treatment group, depolarization ratios were significant lower (p < 0.05) and anisotropy were significant higher (p < 0.05), however no differences were detected in FWHM.

CONCLUSIONS

The use of a fluorinated dental varnish suggests a protective effect for human enamel against dental erosion demineralization process which was detectable in an in vitro model.

Application of Unsupervised Multivariate Analysis Methods to Raman Spectroscopic Assessment of Human Dental Enamel

This work explores the suitability of data treatment methodologies for Raman spectra of teeth using multivariate analysis methods. Raman spectra were measured in our laboratory and obtained from control enamel samples and samples with a protective treatment before and after an erosive attack. Three different approaches for data treatment were undertaken in order to evaluate the aptitude of distinguishing between groups: A—Principal Component Analysis of the numerical parameters derived from deconvoluted spectra; B—PCA of average Raman spectra after baseline correction; and C—PCA of average raw Raman spectra. Additionally, Hierarchical Cluster Analysis were applied to Raman spectra of enamel measured with different laser wavelengths (638 nm or 785 nm) to evaluate the most suitable choice of illumination. According to the different approaches, PC1 scores obtained between control and treatment group were A—50.5%, B—97.1% and C—83.0% before the erosive attack and A—55.2%, B—93.2% and C—87.8% after an erosive attack. The obtained results showed that performing PCA analysis of raw or baseline corrected Raman spectra of enamel was not as efficient in the evaluation of samples with different treatments. Moreover, acquiring Raman spectra with a 785 nm laser increases precision in the data treatment methodologies.

Vibrational Imaging Techniques for the Characterization of Hard Dental Tissues: From Bench-Top to Chair-Side

Currently, various analytical techniques, including scanning electron microscopy, X-Ray diffraction, microcomputed tomography, and energy dispersive X-ray spectroscopy, are available to study the structural or elemental features of hard dental tissues. In contrast to these approaches, Raman Microspectroscopy (RMS) has the great advantage of simultaneously providing, at the same time and on the same sample, a morpho-chemical correlation between the microscopic information from the visual analysis of the sample and its chemical and macromolecular composition. Hence, RMS represents an innovative and non-invasive technique to study both inorganic and organic teeth components in vitro. The aim of this narrative review is to shed new light on the applicative potential of Raman Microspectroscopy in the dental field. Specific Raman markers representative of sound and pathological hard dental tissues will be discussed, and the future diagnostic application of this technique will be outlined. The objective and detailed information provided by this technique in terms of the structure and chemical/macromolecular components of sound and pathological hard dental tissues could be useful for improving knowledge of several dental pathologies. Scientific articles regarding RMS studies of human hard dental tissues were retrieved from the principal databases by following specific inclusion and exclusion criteria.

Quantitative label-free optical technique to analyze the ultrastructure changes and spatiotemporal relationship of enamel induced by Msx2 deletion

New advances in the molecular mechanism of enamel mineralization reveal the practical significance of regenerative medicine in clinical transformation. Muscle segment homeobox 2 (MSX2), a transcription factor, is recently reported to be closely associated with the amelogenesis imperfecta (AI). To elucidate the biomineralization framework of AI enamel, herein, Msx2 gene mutant mice are investigated by dual-mode noninvasive spectroscopic analytical techniques for the first time. Optical coherence tomography (OCT) records the depth-resolved structural information of mice teeth, where a dramatic decrease in enamel thickness and quality occurred in Msx2 deficient (Msx2^-/- ) enamel. And it has the advantages of fast, noninvasive and low cost. Raman spectroscopy, a powerful molecular fingerprint tool, further witnesses an imbalance of inorganic and organic contents in Msx2^-/- enamel. In addition, abnormal expression of MSX2 also influences the spatial distribution of phosphate in enamel according to the Raman spectral imaging. Therefore, OCT integrated with Raman spectroscopy provides the quantitative label-free optical parameters of both the physical structure and chemical component in mice enamel, which strengthens the understanding of the biomineralization process underlying the Msx2-related amelogenesis imperfect.

Raman Spectroscopy for Assessment of Hard Dental Tissues in Periodontitis Treatment

The objective of this work was to use Raman spectroscopy to assess hard dental tissues after professional oral hygiene treatment and curettage. Spectral changes were identified, and the discriminant model of the specific changes of intensity of the Raman lines (i.e., of dentin, cementum, and enamel), before and after the dental procedures, was developed. This model showed that 6 weeks after the procedures, the hard dental tissues did not have differences and, thus, provided similar conditions for bio-film and dental plaque formation, tissue repair, and new attachment to the surface of the root.

Studying the Degree of Tooth Enamel Mineralization through Raman Spectroscopy in Various Spectral Ranges

In vitro and in vivo methods of Raman spectroscopy have been developed to assess the degree of mineralization of the enamel of different functional groups. This article presents comparative studies that were carried out using scanning Raman microspectroscopy with various sources of laser excitation with wavelengths of 532, 785, and 1064 nm. It is shown that the intensity of Raman scattering of enamel can be a measure of its thickness. The obtained dependence of the Raman scattering intensity on the distance from the incisal edge is in good agreement with the literature data, where two independent methods (computer tomography and electron microscopy) are used to determine the enamel thickness values. The proposed methods can be considered as potential quantitative methods for express diagnostics of the state of tooth enamel in vivo.

Mineralization of dental tissues and caries lesions detailed with Raman microspectroscopic imaging

Dental caries is the most common oral disease that causes demineralization of the enamel and later of the dentin. Depth-wise assessment of the demineralization process could be used to help in treatment planning. In this study, we aimed to provide baseline information for the development of a Raman probe by characterizing the mineral composition of the dental tissues from large composition maps (6 × 3 mm2 with 15 μm step size) using Raman microspectroscopy. Ten human wisdom teeth with different stages of dental caries lesions were examined. All of the teeth were cut in half at representative locations of the caries lesions and then imaged with a Raman imaging microscope. The pre-processed spectral maps were combined into a single data matrix, and the spectra of the enamel, dentin, and caries were identified by K-means cluster analysis. Our results showed that unsupervised identification of dental caries is possible with the K-means clustering. The compositional analysis revealed that the carious lesions are less mineralized than the healthy enamel, and when the lesions extend into the dentin, they are even less mineralized. Furthermore, there were more carbonate imperfections in the mineral crystal lattice of the caries tissues than in healthy tissues. Interestingly, we observed gradients in the sound enamel showing higher mineralization and greater mineral crystal perfection towards the tooth surface. To conclude, our results provide a baseline for the methodological development aimed at clinical diagnostics for the early detection of active caries lesions.

Development of a new approach to diagnosis of the early fluorosis forms by means of FTIR and Raman microspectroscopy

This study is aimed at investigating the features of mineralization of the enamel apatite at initial stages of fluorosis development. Samples of teeth with intact and fluorotic enamel in an early stage of the disease development (Thylstrup-Fejerskov Index = 1-3) were studied by Raman scattering and FTIR using Infrared Microspectroscopy beamline at Australian Synchrotron equipment. Based on the data obtained by optical microspectroscopy and calculation of the coefficient R [A-type/B-type], which represents the ratio of carbonation fraction of CO32-, replacing phosphate or hydroxyl radicals in the enamel apatite lattice, the features of mineralization of enamel apatite in the initial stages of development of the pathology caused by an increased content of fluorine in the oral cavity were established. Statistical analysis of the data showed significant differences in the mean values of R [A-type/B-type] ratio between the control and experimental groups for surface layers (p < 0.01). The data obtained are potentially significant as benchmarks in the development of a new approach to preventive diagnostics of the development of initial and clinically unregistered stages of human teeth fluorosis, as well as personalized control of the use of fluoride-containing caries-preventive agents.

Evaluation of the effect of fluorinated tooth bleaching products using polarized Raman microscopy and particle induced gamma-ray emission

In this in vitro study, the effect of the application of tooth bleaching products in human enamel was evaluated using polarized Raman microscopy, particle induced gamma-ray emission (PIGE) and Vickers Hardness test. Due to their acidic nature, teeth whitening products are associated with changes in enamel mineralization. Consequently, products have appeared in the market that promote the incorporation of fluorine in order to decrease the solubility of the hydroxyapatite in enamel and prevent demineralization. This way, four commercial products with different active principle concentrations: 16% carbamide peroxide (Opalescence PF® and VivaStyle®) or 6% hydrogen peroxide (Opalescence Go PF® and VivaStyle Paint On®) and presence or not of fluorine were compared. The information on the crystalline state of the enamel was provided by the determination of the depolarization ratio of the symmetric stretching band of phosphate (at 959 cm^-1). Furthermore, the content and uptake of F was evaluated using PIGE in the two fluorinated products as well as in one negative control group. In order to evaluate the microhardness of enamel by means of Vickers test, another group of polished samples was prepared (using Opalescence PF®) and evaluated. Conversely to what could be expected, the obtained results determined a statistically significant decrease of depolarization ratio, leading to an increase of mineralization after the application of the bleaching products, except for VivaStyle®. For this group, no significant variation was obtained before-after treatment, most likely due to the acidity of the product (pH = 5.8). Additionally, an increase of concentration of F in the dental tissues was determined for the fluorinated products. On the other hand, enamel polishing, required for the application of the Vickers test, led to increased susceptibility to erosion, resulting in decreased hardness and an increased enamel depolarization ratio.

The FT-IR and Raman Spectroscopies as Tools for Biofilm Characterization Created by Cariogenic Streptococci

Fourier transform infrared (FT-IR) and Raman spectroscopy and mapping were applied to the analysis of biofilms produced by bacteria of the genus Streptococcus. Bacterial biofilm, also called dental plaque, is the main cause of periodontal disease and tooth decay. It consists of a complex microbial community embedded in an extracellular matrix composed of highly hydrated extracellular polymeric substances and is a combination of salivary and bacterial proteins, lipids, polysaccharides, nucleic acids, and inorganic ions. This study confirms the value of Raman and FT-IR spectroscopies in biology, medicine, and pharmacy as effective tools for bacterial product characterization.

Chemical imaging of human teeth by a time-resolved Raman spectrometer based on a CMOS single-photon avalanche diode line sensor

Raman spectroscopy is a powerful analytical tool to be used in many biomedical applications and could be potentially translated into clinical work. The challenge of Raman spectroscopy in biomedical applications is the high inherent fluorescence of biological samples. One promising method to suppress the fluorescence background is to use pulsed lasers and time-gated detectors but the complexity of time-gated systems has hindered their widespread usage. We present here chemical imaging of human teeth by means of a new kind of compact and practical fluorescence-suppressed Raman spectrometer based on a time-resolved 16 × 256 CMOS single-photon avalanche diode (SPAD) line sensor with an integrated 256-channel 3-bit on-chip time-to-digital converter. The chemical images were constructed by utilizing a simple unsupervised machine learning algorithm (k-means clustering). The high quality of Raman spectra measured with the time-resolved CMOS SPAD-based Raman spectrometer was verified by comparing the spectra to those collected with a commercial conventional continuous wave (CW) Raman spectrometer. The spectra measured by using the time-resolved CMOS SPAD-based Raman spectrometer had 4.4-8.8 times higher signal to peak-to-peak noise ratio values than the spectra from the CW Raman spectrometer when the same radiant exposure (∼300 J mm^-2) was used with both spectrometers. This paper shows in practice the potential of time-resolved CMOS SPAD-based Raman spectroscopy in the field of biomedicine and we expect that the presented technology could pave the way for the development of new kind of compact and practical fluorescence-suppressed Raman spectrometers to be used both in biomedical research and clinical settings.