Wavelength-independent microradiography: a method for non-destructive quantification of enamel and dentin mineral concentrations using polychromatic x-rays

Accuracy Assessment of Three-dimensional Surface Reconstructions of In vivo Teeth from Cone-beam Computed Tomography

Background:

The accuracy of three-dimensional (3D) reconstructions from cone-beam computed tomography (CBCT) has been particularly important in dentistry, which will affect the effectiveness of diagnosis, treatment plan, and outcome in clinical practice. The aims of this study were to assess the linear, volumetric, and geometric accuracy of 3D reconstructions from CBCT and to investigate the influence of voxel size and CBCT system on the reconstructions results.

Methods:

Fifty teeth from 18 orthodontic patients were assigned to three groups as NewTom VG 0.15 mm group (NewTom VG; voxel size: 0.15 mm; n = 17), NewTom VG 0.30 mm group (NewTom VG; voxel size: 0.30 mm; n = 16), and VATECH DCTPRO 0.30 mm group (VATECH DCTPRO; voxel size: 0.30 mm; n = 17). The 3D reconstruction models of the teeth were segmented from CBCT data manually using Mimics 18.0 (Materialise Dental, Leuven, Belgium), and the extracted teeth were scanned by 3Shape optical scanner (3Shape A/S, Denmark). Linear and volumetric deviations were separately assessed by comparing the length and volume of the 3D reconstruction model with physical measurement by paired t-test. Geometric deviations were assessed by the root mean square value of the imposed 3D reconstruction and optical models by one-sample t-test. To assess the influence of voxel size and CBCT system on 3D reconstruction, analysis of variance (ANOVA) was used (α = 0.05).

Results:

The linear, volumetric, and geometric deviations were −0.03 ± 0.48 mm, −5.4 ± 2.8%, and 0.117 ± 0.018 mm for NewTom VG 0.15 mm group; −0.45 ± 0.42 mm, −4.5 ± 3.4%, and 0.116 ± 0.014 mm for NewTom VG 0.30 mm group; and −0.93 ± 0.40 mm, −4.8 ± 5.1%, and 0.194 ± 0.117 mm for VATECH DCTPRO 0.30 mm group, respectively. There were statistically significant differences between groups in terms of linear measurement (P < 0.001), but no significant difference in terms of volumetric measurement (P = 0.774). No statistically significant difference were found on geometric measurement between NewTom VG 0.15 mm and NewTom VG 0.30 mm groups (P = 0.999) while a significant difference was found between VATECH DCTPRO 0.30 mm and NewTom VG 0.30 mm groups (P = 0.006).

Conclusions:

The 3D reconstruction from CBCT data can achieve a high linear, volumetric, and geometric accuracy. Increasing voxel resolution from 0.30 to 0.15 mm does not result in increased accuracy of 3D tooth reconstruction while different systems can affect the accuracy.

Evaluation of Mineral Content and Photon Interaction Parameters of Dental Enamel After Phosphoric Acid and Er:YAG Laser Treatment

OBJECTIVE

The purpose of this study was to evaluate the effects of laser and acid etching on the mineral content and photon interaction parameters of dental enamel in human teeth.

BACKGROUND DATA

The composition of dental enamel may vary, especially at the surface, depending on the reactions that occur during dental treatment.

MATERIALS AND METHODS

Forty maxillary premolars were divided randomly into 2 groups of 20 teeth. In the first group, half of teeth crowns were etched by using 37% phosphoric acid; in the second group, half of teeth crowns were etched by using an erbium:yttrium-aluminum-garnet (Er:YAG) laser. The remaining half crowns in each group were used as untreated controls. We characterized the calcium (Ca), phosphorus (P), magnesium (Mg), sodium (Na), and potassium (K) contents in each specimen by using wavelength dispersive X-ray fluorescence spectrometry. The total atomic cross-section ([Formula: see text]), effective atomic number ([Formula: see text]), and electron density (N_e) of the tooth samples were determined at photon energies of 22.1, 25, 59.5, and 88 keV by using a narrow beam transmission method. Data were analyzed statistically by using the Mann-Whitney U test.

RESULTS

The mineral contents after Er:YAG laser and phosphoric acid etching did not differ significantly (p > 0.05), and no significant variation in [Formula: see text], [Formula: see text], or N_e was observed.

CONCLUSIONS

Therefore, we conclude that the Er:YAG laser and phosphoric acid systems used in this study did not affect mineral composition or photon interaction parameters of dental enamel.

The Application of in Vitro Models to Research on Demineralization and Remineralization of the Teeth: Reaction Paper

Despite the advantages of in situ model studies, in vitro models are most important to provide insight into the mechanism of dental caries, the mechanisms of fluoride action, and profile screening.

In this reaction paper following Dr. White's review, the emphasis is, first, on the role of mobile fluoride (FL) in fluoride efficacy, the formation of "CaF2-like" material as fluoride reaction product, and on fluoride reaction product localization. Second, mineral assessment techniques are discussed. Finally, the main differences between caries lesion formation in vitro and in situ are considered.

Effects of dentifrices differing in fluoride compounds on artificial enamel caries lesions in vitro

The aim of this study was to compare the caries-preventive effect of a stabilized stannous fluoride/sodium fluoride dentifrice containing sodium hexametaphosphate with those of a regular, solely sodium fluoride-containing and amine fluoride-containing dentifrice on pre-demineralized bovine enamel specimens using a pH-cycling model. Bovine enamel specimens with two artificial lesions each were prepared. Baseline mineral loss of both lesions was analyzed using transversal microradiography (TMR). Eighty-five specimens with a mean (SD) baseline mineral loss of 3393 (683) vol% × µm were selected and randomly allocated to five groups (n = 13/15). Treatments during pH-cycling (28 days and 2 × 20 min demineralization/day) were: brushing twice daily with slurries of AmF (1400 ppm F^-), NaF (1450 ppm F^-), SnF₂/NaF (1100 ppm F^-/350 ppm F^-), and fluoride-free (FF) dentifrices or they were immersed in distilled water and remained unbrushed (NB). Subsequently, from each specimen one lesion was covered with acid-resistant varnish, while the remaining lesion was demineralized for another 14 days. Differences in integrated mineral loss (∆∆Z) were calculated between values before and after pH-cycling (∆∆Z _E1) as well as before pH-cycling and after second demineralization (∆∆Z _E2) using TMR. Treatments AmF and NaF induced a significantly higher mineral gain (∆∆Z _E1/∆∆Z _E2) compared to treatments FF and NB (p < 0.05; ANOVA test). Except for treatments AmF and NaF no significant differences in mineral loss between before and after pH-cycling could be observed (p < 0.05; t test) [∆∆Z _E1: AmF:1563 (767); NaF:1222 (1246); SnF₂/NaF:258 (1259); FF:-52 (1223); NB:-151 (834)]. Both dentifrices with either AmF or NaF promoted remineralization, whereas SnF₂/NaF dentifrice did not promote remineralization in a biofilm-free pH-cycling model.

Transversal Wavelength-Independent Microradiography, a Method for Monitoring Caries Lesions over Time, Validated with Transversal Microradiography

This paper describes a microradiographic method for measuring mineral concentration in a transversal geometry with thick (< or =3.2 mm) sections: transversal wavelength-independent microradiography (T-WIM). It was tested on bovine enamel and dentin samples in vitro, and the results were validated with those of transversal microradiography (TMR). 48 enamel and 48 dentin samples (3.2 x 3.2 x 1.5 mm) were embedded in acrylic resin, randomly divided into six groups of 8 dentin or 8 enamel samples, and demineralized for 0 (sound control), 1, 2, 3, 4, or 5 weeks. For T-WIM, samples were imaged on film with polychromatic 40-kV Cu X-rays with an Al (0.25 mm)/Ni (0.02 mm) filter together with an aluminium/zinc step wedge. TMR slices (about 80 mum for enamel and about 130 mum for dentine) were subsequently cut from the centre of the samples and subjected to TMR. Microradiographs from both methods were digitized and image analysis software was used to calculate lesion depth and mineral loss. The relations between T-WIM and TMR results for mineral loss (DeltaZ) and lesion depth were nearly linear (r > or = 0.96) for both enamel and dentin. The slopes of the regression lines were between 0.99 and 1.02 except for DeltaZ in dentine, which was 0.89. It was concluded that T-WIM is a suitable method for TMR on thick samples.

The challenges of validating diagnostic methods and selecting appropriate gold standards

Caries diagnostic methods are usually methods for caries lesion detection and measurement. Caries lesions occur on a continuous scale of tissue damage, from subclinical surface changes to macroscopic cavities reaching the pulp. Any change of a lesion on this continuous scale offers the opportunity for the diagnosis of disease activity or remission. Research aimed at remineralizing agents may focus on lesions that are amenable to remineralization, and select a method that will measure small changes in early lesions. General caries management strategies depend on detecting all stages of lesion development, and methods covering early to late stages are preferred. This paper addresses some methodological issues in validating caries diagnostic methods. The available gold standards for caries lesions are discussed, with their suitability in different applications, and their "validity" as far as it is known or can be inferred. The gold standards are compared as far as their measurement of lesion parameters and reproducibility is concerned. Tentative conclusions are formulated, and recommendations for future research are given.

Quantitative diagnosis of small approximal caries lesions utilizing wavelength-dependent fiber-optic transillumination

The instruments clinically available for the diagnosis of approximal caries lesions are inadequate to detect lesions early and quantitatively. The aim of this study was to investigate whether wavelength-dependent light scattering and absorption of carious tissues may be utilized for the quantitative diagnosis of these small approximal caries lesions. Seventeen extracted premolar teeth were transilluminated at an approximal surface with a glass fiber, which transported the light from a halogen light bulb. Seven approximal surfaces contained a naturally developed small white-spot lesion, and 5 surfaces a small discolored lesion. Five teeth were sound. The occlusal surface was imaged with a CCD camera. Light in the blue and red portions of the electromagnetic spectrum was selected by means of Schott glass filters. From the obtained images, average effective decadic optical thickness differences were determined. These were plotted as a function of average mineral loss assessed by means of wavelength-independent microradiography. The correlation coefficient between the average effective decadic optical thickness difference and average mineral loss was r = 0.79 (95% CI: 0.47 ... 0.93). Different sources of variation that influence the observed correlation were defined and quantified. From these measurements, the correlation coefficient between average effective decadic optical thickness difference and "true' average mineral loss was estimated to be r = 0.92 (95% CI: 0.77 ... 0.97). The results indicate that early and, in principle, also quantitative diagnosis of approximal caries lesions is feasible when wavelength-dependent light propagation through carious tissues is utilized.

Mineral loss in incipient caries lesions quantified with laser fluorescence and longitudinal microradiography. A methodologic study

The laser fluorescence method (LAF) was validated with longitudinal microradiography (LMR) for assessment of mineral loss in incipient caries lesions in human enamel. Fluorescence radiance scans and LMR recordings were made of 36 enamel slabs with incipient lesions. Original sound values for fluorescence radiance and enamel amount (kg.m-2) at the lesion site were reconstructed by a computer algorithm. Changes in fluorescence radiance and amount of enamel in each measuring point were calculated. The reconstruction method was tested on 20 sound enamel surfaces. The differences between measured and reconstructed values were -0.13 +/- 0.17% with LAF and 0.002 +/- 0.005 kg.m-2 with LMR. The repeatability of the caries quantification was tested by measuring one lesion 20 times. The fluorescence loss in this lesion was 18.2 +/- 1.0%. The enamel loss was 0.09 +/- 0.02 kg.m-2. The correlation between measurements with the two methods was r = 0.73. The non-destructive laser fluorescence method was concluded to be a sensitive and valid method for quantification of mineral loss in enamel caries lesions.

Wavelength-independent microradiography used for quantification of mineral changes in thin enamel and dentin samples with natural surfaces, pseudo-thick tooth sections, and whole teeth

Tests of the efficacy of therapeutic agents for caries repair or prevention in vitro or in situ should be performed as realistically as possible. This implies the non-destructive assessment of mineral changes in whole teeth. In this study, Wavelength-independent Microradiography (WIM), a non-destructive form of microradiography that uses polychromatic x-rays, was tested for its use in following mineral changes during demineralization of whole teeth. Since the method was, in a previous paper, only tested on flat samples of about 0.3 mm in thickness, the present study aimed to adapt and test WIM for use on thicker samples. This was done in three steps: In the first step, natural surfaces were introduced. The mineral content of enamel and dentin samples about 0.3 mm in thickness and with natural (curved) surfaces was determined by WIM, and the result was compared with mineral measurements performed with Longitudinal Microradiography (LMR). A correlation of 0.98 was found for both the enamel and the dentin samples. In the second step, the thickness of whole teeth was added. Thick tooth sections were simulated by addition of a 5-mm block of dentin to such thin enamel and dentin samples. Mineral measurements with WIM of the samples plus the dentin block were compared with mineral measurements of the thin samples (without block). A correlation of 0.97 was found for enamel, and one of 0.90 was found for dentin. Finally, in a third step, the demineralization of whole premolars was followed as a function of time.