Effect of wavelength and bandwidth on the clinical reliability of laser Doppler recordings

Diagnosis of Skin Vascular Complications Revealed by Time-Frequency Analysis and Laser Doppler Spectrum Decomposition

Nowadays, photonics-based techniques are used extensively in various applications, including functional clinical diagnosis, progress monitoring in treatment, and provision of metrological control. In fact, in the frame of practical implementation of optical methods, such as laser Doppler flowmetry (LDF), the qualitative interpretation and quantitative assessment of the detected signal remains vital and urgently required. In the conventional LDF approach, the key measured parameters, index of microcirculation and perfusion rate, are proportional to an averaged concentration of red blood cells (RBC) and their average velocity within a diagnostic volume. These quantities compose mixed signals from different vascular beds with a range of blood flow velocities and are typically expressed in relative units. In the current paper we introduce a new signal processing approach for the decomposition of LDF power spectra in terms of ranging blood flow distribution by frequency series. The developed approach was validated in standard occlusion tests conducted on healthy volunteers, and applied to investigate the influence of local pressure rendered by a probe on the surface of the skin. Finally, in limited clinical trials, we demonstrate that the approach can significantly improve the diagnostic accuracy of detection of microvascular changes in the skin of the feet in patients with Diabetes Mellitus type 2, as well as age-specific changes. The results obtained show that the developed approach of LDF signal decomposition provides essential new information about blood flow and blood microcirculation and has great potential in the diagnosis of vascular complications associated with various diseases.

Changes in human pulp blood flow during canine retraction

AIM

To evaluate the effects of maxillary canine retraction on pulpal blood flow (PBF) in humans as recorded by laser Doppler flowmetry (LDF).

METHODS

Maxillary canines of 24 participants were divided into two groups (n = 12 each). Teeth in the study group underwent maxillary canine retraction using mini-implants as anchorage for approximately 4 months, with 100 g of force applied via coil springs. Subjects in the control group received no orthodontic treatment. LDF measurements were recorded at baseline (T0); during retraction, at 24 hours (T1), 3 days (T2), 7 days (T3) and 1 month (T4); and at the end of retraction (T5) in the study group and at similar time-points in control subjects. Data were analyzed using the Friedman, Wilcoxon signed rank and Mann-Whitney U tests, with the significance level set at 0.05.

RESULTS

No significant changes in PBF perfusion units (PU) were observed in the control group over the course of the study. However, PBF in the study group increased significantly from T0 (3.6 ± 0.2 PU) to T1 (3.7 ± 0.2 PU, p < 0.001) and decreased severely from T1 to T2 (3.3 ± 0.1, p < 0.001). PBF in the study group was still significantly lower at T3 (3.4 ± 0.1 PU, p < 0.001) in comparison to T0; however, at T4 and T5, PBF was found to have returned to pre-retraction levels.

CONCLUSION

The fact that PBF values returned to initial levels within one month of the initiation of retraction despite short-term, hyperaemic, regressive changes demonstrates that the changes observed in PBF during canine retraction are reversible.

Changes in Maxillary Canine Pulpal Blood Flow During Dentoalveolar Distraction Osteogenesis

OBJECTIVE

The aim of this study was to assess the effects of dentoalveolar distraction osteogenesis (DD) on the pulpal blood flow (PBF) of maxillary canines.

MATERIALS AND METHODS

A laser Doppler flowmeter (LDF) was used to measure PBF in maxillary canines of 10 patients undergoing DD (study group) and 10 nonsurgical subjects who received no orthodontic treatment (control group). PBF was measured at baseline, at 4 and 7 days postoperatively, at the end of distraction and at the end of consolidation in the study group and at similar time-points in nonsurgical control subjects. Data were analyzed using paired and Student t tests, with the significance level set at 0.05.

RESULTS

Study findings showed that baseline PBF values did not differ significantly between groups. PBF in the control group did not vary over time; however, in the study group, an initial decrease in PBF was observed at 4 days postoperatively and was followed by a gradual increase to preoperative levels at the end of distraction.

CONCLUSIONS

During the DD latency period, there appears to be a short-lived ischemic phase when perfusion of pulp tissue declines; however, blood-flow returns to normal by the end of distraction.

Changes in maxillary incisor dental pulp blood flow during intrusion by mini-implants

AIM

The aim of this clinical study was to identify changes in pulpal blood flow (PBF) in human central incisors resulting from short- and long-term intrusive orthodontic forces from mini-implants.

MATERIALS AND METHODS

A total of 40 sound upper central and lateral incisors in 20 patients scheduled for intrusion for orthodontic reasons were divided into two groups. From each group, 20 teeth were subjected to intrusive force from mini-implants (Group 1 = Light Force: 40 g; Group 2 = Heavy Force: 120 g), whereas the remaining 20 contralateral teeth were not subjected to forces from mini-implants and served as controls. Laser-Doppler flowmetry (LDF) measurements were recorded at baseline and at 3 days and 3 weeks following intrusion.

RESULTS

PBF decreased significantly at 3 days (Light Force Group: 7.72 ± 0.50; Heavy Force Group: 7.72 ± 0.52) and then increased towards baseline at 3 weeks (Light Force Group: 10.37 ± 0.58; Heavy Force Group: 10.31 ± 0.45) following intrusion.

CONCLUSIONS

In other words, despite slight regressive changes in pulpal tissue in the short-term, PBF improved after 3 weeks following intrusion by mini-implants, indicating that the changes observed in PBF is reversible, even following radical incisor intrusion.

Improvement of the detection of human pulpal blood flow using a laser Doppler flowmeter modified for low flow velocity

OBJECTIVE

Human pulpal blood flow (PBF) signals as measured by laser Doppler flowmeter (LDF) decrease with age. Although this decrease is considered to be due in part to slow blood flow, information regarding this velocity in humans has been lacking. The aims of the present study were to estimate the blood flow velocity in human dental pulp and to evaluate the validity of LDF modified for the measurement of slow blood flow.

DESIGN

Mean blood flow velocities at the upper central incisor, gingiva, fingertip and forearm of 28 volunteers (mean age: 38.6 years old) were estimated using LDF with a frequency analyser. Blood flow signals at these measurement areas were recorded using two different LDFs: (a) one with a standard blood flow range; and (b) one modified for low blood flow velocity.

RESULTS

The frequency range of the Doppler shift measured at the teeth with an opaque rubber dam was the narrowest (median: 4.3kHz) among all of the measurement areas. The estimated mean blood flow velocity was the slowest at the teeth with a dam (median: 0.18mm/s). LDF for low blood flow velocity detected larger and clearer pulsatile blood flow signals from the teeth with dams than did standard LDF.

CONCLUSIONS

The present results indicate that the velocity of PBF in humans is very low and that LDF modified for the measurement of slow blood flow is appropriate for PBF measurement in humans.

Dental pulp testing: a review

Dental pulp testing is a useful and essential diagnostic aid in endodontics. Pulp sensibility tests include thermal and electric tests, which extrapolate pulp health from sensory response. Whilst pulp sensibility tests are the most commonly used in clinical practice, they are not without limitations and shortcomings. Pulp vitality tests attempt to examine the presence of pulp blood flow, as this is viewed as a better measure of true health than sensibility. Laser Doppler flowmetry and pulse oximetry are examples of vitality tests. Whilst the prospect is promising, there are still many practical issues that need to be addressed before vitality tests can replace sensibility tests as the standard clinical pulp diagnostic test. With all pulp tests, the results need to be carefully interpreted and closely scrutinised as false results can lead to misdiagnosis which can then lead to incorrect, inappropriate, or unnecessary treatment.

Possible application of transmitted laser light for the assessment of human pulp vitality. Part 2. Increased laser power for enhanced detection of pulpal blood flow

The purpose of this study was to investigate the effect of an increase in laser power on the transmitted laser signals from vital and non-vital teeth, in the hope of achieving a better assessment of human pulp vitality with the transmitted laser-light flowmeter. The experiments were carried out on total of 61 vital teeth with no restoration (19 upper central incisors, 16 upper lateral incisors, 16 upper canines, and 10 first premolars) and five non-vital upper central incisors (the root canals of which were filled with gutta-percha) in 15 subjects aged 22-28 years. For use with transmitted laser light, the fibers within the probe of a conventional laser Doppler flowmeter (LDF) apparatus were used, one for transmitting light onto the labial surface, the other for receiving it at the palatal surface of the same tooth, as reported previously. Laser output power was set at the original 2 mW and also at 5, 7, and 10 mW. The number of vital teeth displaying a blood flow (BF) signal at each laser power setting was: 1) 12/19 central incisors at 2 mW, 19/19 at 5, 7, and 10 mW, 2) 19/19 lateral incisors at 2, 5, 7, and 10 mW, 3) 0/16 canines at 2 mW, but eight, 12, and 14 at 5, 7, and 10 mW, 4) 0/10 first premolars at 2, 5, 7, and 10 mW. Thus, an increase in laser power increased BF detection from the thicker teeth (but not from premolars). In addition, clearer BF signals synchronized with heart rate, and greater passive BF changes secondary to blood pressure (BP) changes were observed at higher laser settings. In non-vital teeth, no signals synchronized with heart rate or BP changes were observed, indicating that no BF signal of non-pulpal origin was ever monitored with this ballistic light even when the laser power was increased. These results indicate that high-powered transmitted laser light could be a useful tool both for monitoring pulpal BF and for the assessment of tooth-pulp vitality.

The effect of short-term tooth intrusion on human pulpal blood flow measured by laser Doppler flowmetry

The purpose was to examine the effect of brief intrusive forces on human pulpal blood flow (PBF). Laser Doppler flowmetric measurements were made from 17 vital upper left central incisors of 17 participants who had clinically healthy tooth crowns and periodontal tissues. Brief intrusive forces (0.5,1,5 N; duration 20 s) were applied to the incisal edges of the examined teeth, and apical displacement of the teeth and the PBF were measured simultaneously. Recordings were made with and without an opaque rubber dam applied to the examined teeth. Intrusive force significantly reduced PBF flux both with and without the dam (P<0.05, Friedman analysis). The results indicate that transient apical displacement can reduce PBF.

The effect of wavelength, bandwidth, and probe design and position on assessing the vitality of anterior teeth with laser Doppler flowmetry

OBJECTIVES

To investigate the effect of four variables: wavelength (633 nm and 780 nm), bandwidth filter (3 kHz, 15 kHz, 22 kHz), probe fibre separation (250 microns) and 500 microns) and distance of the probe from the gingival margin (2-3 mm and 4-5 mm) when assessing the vitality of anterior teeth with a laser Doppler flowmetry system.

DESIGN

Split-mouth cohort clinical trial.

SETTING

Childrens dental clinic, Glasgow Dental Hospital and School.

SAMPLE AND METHODS

Sample included 11 non-vital maxillary incisors with necrotic pulps in 10 patients (mean age 12.25 years old). Recordings were taken from the non-vital tooth and from a vital maxillary incisor from the same patient, using all 24 combinations of the recording variables listed above. The vital/non-vital ratios of the signals from the 11 pairs of teeth were calculated and discriminant analysis applied to the data.

RESULTS

Of the variables investigated, the combination of a 633 nm laser source with a 3 kHz bandwidth filter using a probe with a 500 microns fibre separation placed 2-3 mm from the gingival margin was the most reliable, with 10 out of a possible 11 true positives for pulpal necrosis, no false positives, and one equivocal diagnosis, and was the only combination that recorded a smaller blood flow from the non-vital tooth compared with the vital control tooth for all 11 pairs of teeth investigated.

CONCLUSIONS

It was concluded, therefore, that laser Doppler flowmetry can be of use in assessing the vitality of anterior teeth and that this is the preferred combination of recording variables for further investigations.

Lasers in endodontics: a review

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of papers on potential applications for lasers in endodontics have been published. The purpose of this paper is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilization of root canals, root canal shaping and obturation and apicectomy. The effects of laser on root canal walls and periodontal tissues are also reviewed. The essential question is whether a laser can provide equal or improved treatment over conventional care. Secondary issues include treatment duration and cost/benefit ratio. This article reviews the role of lasers in endodontics since the early 1970s, summarizes many research reports from the last decade, and surmises what the future may hold for lasers in endodontics. With the potential availability of many new laser wavelengths and modes, much interest is developing in this promising field.

A comparison of laser Doppler flowmetry with other methods of assessing the vitality of traumatised anterior teeth

Laser Doppler flowmetry is a non-invasive electrooptical technique which allows the semi-quantitative recording of pulpal blood flow. This study aimed to determine the reliability (measured as the sensitivity and specificity) of laser Doppler flowmetry as a method of assessing the vitality of traumatised anterior teeth, and to compare it with standard pulpal diagnostic tests. Recordings of pulpal blood flow were taken from 67 non-vital anterior teeth (55 patients), where the pulpal status was confirmed by pulpectomy. For comparison, recordings were also taken from 84 vital anterior teeth (84 patients). Analysis of the recordings allowed diagnostic criteria to be developed which gave the technique a sensitivity and specificity of 1.0 for this sample. None of the other standard pulpal diagnostic methods tested was as reliable. This was usually due to low sensitivities, which ranged between 0.92 for sensibility testing with ethyl chloride down to 0.36 for periapical radiolucency and 0.16 for a history of pain. Laser Doppler flowmetry was found to be a reliable method of assessing the pulpal status of traumatised anterior teeth, although it is technique-sensitive and time-consuming to use.

Scattering of laser light directed onto the labial surface of extracted human upper central incisors

The purpose of this study was to evaluate the scatter of light through human teeth with laser Doppler flowmetry. An optical probe (probe 1), which mounted two optical fibers (one for light illumination and another for the measurement of backscattered light intensity) was placed on the labial surface of the extracted teeth. Another optical probe (probe 2) for the measurement of transmitted-light intensity was placed either on the mesial, distal, or palatal surface or in the canal of the teeth. The light intensity at probe 1 was stable, irrespective of the location of probe 2, whereas the transmitted light intensity at probe 2 tended to increase as probe 2 moved to more incisal positions on the mesial, distal, and palatal tooth surfaces. The results indicate that the light scatters to a wide area outside the tooth and provides information regarding the surrounding tissue blood flow.

Laser Doppler flowmetry: an aid in differential diagnosis of apical radiolucencies

The case of a patient having 2 teeth with associated apical radiolucencies that responded to conventional pulp tests is presented. A decision was made to reexamine the patient at intervals rather than perform root canal treatment. During a recall visit, use of an available laser Doppler flowmeter allowed detection of blood flow within the affected teeth. A diagnosis of periapical cemental dysplasia (cementoma) was made.

Comparison of two laser Doppler systems on the measurement of blood flow of premolar teeth under different pulpal conditions

An in vivo investigation was conducted to assess the ability of two laser Doppler flowmeters (DRT4, Moor Instruments Ltd; Laserflo BPM2, Vasamedics) to differentiate between vital pulp, ischaemically necrosed pulp, and an empty pulp chamber in premolar teeth in children. Sixteen intact, vital teeth in need of extraction for orthodontic purposes were identified. Laser Doppler blood flow readings were taken prior to (T1) and after the administration of adrenaline-free local anaesthetic (T2), after extraction and replantation of the teeth (T3), and after broaching the pulp tissue and replanting the teeth (T4). The data collected (flux values) for both instruments were analysed using a repeated measures ANOVA. Significant differences were found for vital pulp (T1, T2) versus ischaemically necrosed pulp (T3), and for vital pulp (T1, T2) versus an empty pulp chamber (T4), with the Moor DRT4 instrument. This instrument also detected a significant difference in pulpal blood flow to the vital pulp, before and after the administration of local anaesthetic. No other significant differences were found.

Effects of pulsatile versus non-pulsatile pulpal pressure simulations on diffusional transport across human dentine in vitro

The influence of a simulated pulsatile pulpal pressure on the diffusion of NaCl through slices of human dentine (n = 12) was evaluated in vitro. The average hydraulic conductance of the slices of dentine was 0.0131 +/- 0.0031 microliter/cm2 per min per cmH2O(x +/- SD). A 1 mol/l NaCl solution was placed on one side of the slices of dentine and deionized water on the other side. The time needed to reach a steady state and the quantity of NaCl that diffused through the slice were successively measured on the same slice of dentine, under three conditions: without pressure simulation, with a static pressure of 1.5 kPa, and with a pulsatile pressure varying from 1.2 to 1.8 kPa. The pressure was applied to the deionized water. When a static pressure was applied, the time required to reach a steady state increased from 24 to 30 h. When a pulsatile pressure was applied the time required to reach a steady state decreased from 24 to 12 h. No statistically significant difference was found between the quantity of NaCl that had diffused when the steady state was reached.