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Roointan S, Tavakolian P, Sivagurunathan KS, Mandelis A, Abrams SH. Detection and monitoring of early dental caries and erosion using three-dimensional enhanced truncated-correlation photothermal coherence tomography imaging. J Biomed Opt 2021; 26:JBO-210053R. [PMID: 33928770 PMCID: PMC8084349 DOI: 10.1117/1.jbo.26.4.046004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/16/2021] [Indexed: 05/08/2023]
Abstract
SIGNIFICANCE Dental caries is the most common oral disease, with significant effects on healthcare systems and quality of life. Developing diagnostic methods for early caries detection is key to reducing this burden and enabling non-invasive treatment as opposed to the drill-and-fill approach. AIM The application of a thermophotonic-based 3D imaging modality [enhanced truncated-correlation photothermal coherence tomography (eTC-PCT)] to early dental caries is investigated. To this end, the detection threshold, sensitivity, and 3D lesion reconstruction capability of eTC-PCT in imaging artificially generated caries and surface erosion are evaluated. APPROACH eTC-PCT employs a diode laser with pulsed excitation, a mid-IR camera, and an in-house developed image reconstruction algorithm to produce depth-resolved 2D images and 3D reconstructions. Starting with healthy teeth, dental caries and surface erosion are simulated in vitro through application of specific demineralizing/eroding acidic solutions. RESULTS eTC-PCT can detect artificial caries as early as 2 days after onset of artificial demineralization and after 45 s of surface erosion, with a laser power equivalent to 64% of maximum permissible exposure. In both cases, the lesion is not visible to the eye and undetected by x-rays. eTC-PCT is capable of monitoring lesion progression in 2-day increments and generating 3D tomographic reconstructions of the advancing lesion. CONCLUSIONS eTC-PCT shows great potential for further development as a dental imaging modality combining low detection threshold, high sensitivity to lesion progression, 3D reconstruction capability, and lack of ionizing radiation. These features enable early diagnosis and frequent monitoring, making eTC-PCT a promising technology for facilitating preventive dentistry.
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Affiliation(s)
- Sohrab Roointan
- University of Toronto, Center for Advanced Diffusion-Wave and Photoacoustic Technologies, Department of Mechanical and Industrial Engineering, Toronto, Ontario, Canada
- University of Toronto, Institute of Biomedical Engineering, Toronto, Ontario, Canada
| | - Pantea Tavakolian
- University of Toronto, Center for Advanced Diffusion-Wave and Photoacoustic Technologies, Department of Mechanical and Industrial Engineering, Toronto, Ontario, Canada
- University of Toronto, Institute for Advanced Non-Destructive and Non-Invasive Diagnostic Technologies, Toronto, Ontario, Canada
| | - Koneswaran S. Sivagurunathan
- University of Toronto, Center for Advanced Diffusion-Wave and Photoacoustic Technologies, Department of Mechanical and Industrial Engineering, Toronto, Ontario, Canada
- University of Toronto, Institute of Biomedical Engineering, Toronto, Ontario, Canada
- University of Toronto, Institute for Advanced Non-Destructive and Non-Invasive Diagnostic Technologies, Toronto, Ontario, Canada
- Quantum Dental Technologies, Toronto, Ontario, Canada
| | - Andreas Mandelis
- University of Toronto, Center for Advanced Diffusion-Wave and Photoacoustic Technologies, Department of Mechanical and Industrial Engineering, Toronto, Ontario, Canada
- University of Toronto, Institute of Biomedical Engineering, Toronto, Ontario, Canada
- University of Toronto, Institute for Advanced Non-Destructive and Non-Invasive Diagnostic Technologies, Toronto, Ontario, Canada
- Quantum Dental Technologies, Toronto, Ontario, Canada
- Address all correspondence to Andreas Mandelis,
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Abrams TE, Abrams SH, Sivagurunathan KS, Silvertown JD, Hellen WMP, Elman GI, Amaechi BT. In Vitro Detection of Caries Around Amalgam Restorations Using Four Different Modalities. Open Dent J 2018; 11:609-620. [PMID: 29290839 PMCID: PMC5738745 DOI: 10.2174/1874210601711010609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/20/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022] Open
Abstract
Objective: The aim of this study was to evaluate the ability of PTR-LUM (The Canary System, CS), laser fluorescence (DIAGNOdent, DD), LED fluorescence (Spectra), and visual inspection (ICDAS II) to detect natural decay around bonded amalgam restorations in vitro. Methods: Seventeen extracted human molars and premolars, consisting of visually healthy (n=5) and natural cavitated (n=12) teeth were selected. For the carious teeth, caries was removed leaving some decayed tissue on the floor and or wall of the preparation. For sound teeth, 3 mm. deep cavity preparations were made and teeth were restored with bonded-amalgam restorations. Thirty-six sites (13 sound sites; 23 carious sites) were selected. CS and DD scans were performed in triplicate at 2, 1.5, 0.5, and 0 mm away from the margin of the restoration (MOR). Spectra images were captured for the entire surface, and dentists blinded to the samples provided ICDAS II scoring. Results: Canary Numbers (Mean±SE) for healthy and carious sites at 2, 1.5, 0.5, and 0 mm from the MOR ranged from 12.9±0.9 to 15.4±0.9 and 56.1±4.0 to 56.3±2.0, respectively. DD peak values for healthy and carious sites ranged from 4.7±0.5 to 13.5±2.99, and 16.7±3.7 to 24.5±4.4, respectively. For CS and DD, sensitivity/specificity for sites at 2.0, 1.5, 0.5, 0 mm ranged from 0.95-1.0/0.85-1.0, and 0.45-0.74/0.54-1.0, respectively. For ICDAS II, sensitivity and specificity were 1.0 and 0.17, respectively. For Spectra, data and images were inconclusive due to signal intereference from the amalgam restoration. Conclusions: Using this in-vitro model, CS and DD were able to differentiate between sound and carious tissue at the MOR, but larger variation, less reliability, and poorer accuracy was observed for DD. Therefore, CS has the potential to detect secondary caries around amalgam restorations more accurately than the other investigated modalities.
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Affiliation(s)
| | - Stephen H Abrams
- Quantum Dental Technologies Inc, Toronto, Ontario, Canada.,Cliffcrest Dental Office, Scarborough, Ontario, Canada
| | | | | | | | - Gary I Elman
- Cliffcrest Dental Office, Scarborough, Ontario, Canada
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Abrams SH, Sivagurunathan KS, Silvertown JD, Wong B, Hellen A, Mandelis A, Hellen WMP, Elman GI, Mathew SM, Mensinkai PK, Amaechi BT. Correlation with Caries Lesion Depth of The Canary System, DIAGNOdent and ICDAS II. Open Dent J 2017; 11:679-689. [PMID: 29387284 PMCID: PMC5750685 DOI: 10.2174/1874210601711010679] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/17/2017] [Accepted: 11/06/2017] [Indexed: 12/04/2022] Open
Abstract
Introduction: The aim of this study was to correlate lesion depth of natural caries, measured with Polarized Light Microscopy (PLM), to Canary Numbers (CN) derived from The Canary System™ (CS), numerical readings from DIAGNOdent (DD), and lesion scores from ICDAS II. Methods: A total of 20 examination sites on extracted human molars and premolars were selected. The selected examination sites consisted of healthy and enamel caries on smooth and occlusal surfaces of each tooth. Two blinded dentists ranked each examination site using ICDAS II and the consensus score for each examined site was recorded. The same examination sites were scanned with CS and DD, and the CN and DD readings were recorded. After all the measurements were completed, the readings of the three caries detection methods were validated with a histological method, Polarized Light Microscopy (PLM). PLM performed by blinded examiners was used as the ‘gold standard’ to confirm the presence or absence of a caries lesion within each examined site and to determine caries lesion depth. Results: Pearson’s coefficients of correlation with caries lesion depth of CNs, DD readings and ICDAS scores were 0.84, 0.21 and 0.77, respectively. Mean ± SD CN for sound sites (n=3), caries lesion depths <800 µm (n=11), and caries lesion depths >800 µm (n=6) were 11±1, 55±15, and 75±22, respectively. Mean ± SD DD readings for sound sites, caries lesion depths <800 µm, and caries lesion depths >800 µm were 1±1, 7±11, and 8±9, respectively. Mean ± SD ICDAS II scores for sound sites, caries lesion depths <800 µm, and caries lesion depths >800 µm were 0±0, 2±1, and 2±1, respectively. The intra-operator repeatability for the Canary System was .953 (0.913, 0.978). Conclusion: This study demonstrated that the CS exhibits much higher correlation with caries lesion depth compared to ICDAS II and DD. CS may provide the clinician with more information about the size and position of the lesion which might help in monitoring or treating the lesion. The present extracted tooth study found that The Canary System correlates with caries lesion depth more accurately that ICDAS II and DIAGNOdent.
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Affiliation(s)
- Stephen H Abrams
- Quantum Dental Technologies Inc, Toronto, Ontario, Canada.,Cliffcrest Dental Office, Scarborough, Ontario, Canada
| | | | | | - Bonny Wong
- Quantum Dental Technologies Inc, Toronto, Ontario, Canada
| | - Adam Hellen
- Quantum Dental Technologies Inc, Toronto, Ontario, Canada
| | - Andreas Mandelis
- Quantum Dental Technologies Inc, Toronto, Ontario, Canada.,Center for Advanced Diffusion Wave and Photoacoustic Technologies (CADIPT), University of Toronto, Ontario, Canadas
| | | | - Gary I Elman
- Cliffcrest Dental Office, Scarborough, Ontario, Canada
| | - S M Mathew
- University of Texas Health Science Center, San Antonio, Texas, USA
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Silvertown JD, Abrams SH, Sivagurunathan KS, Kennedy J, Jeon J, Mandelis A, Hellen A, Hellen W, Elman G, Ehrlich R, Chouljian R, Finer Y, Amaechi BT. Multi-Centre Clinical Evaluation of Photothermal Radiometry and Luminescence Correlated with International Benchmarks for Caries Detection. Open Dent J 2017; 11:636-647. [PMID: 29290842 PMCID: PMC5738748 DOI: 10.2174/1874210601711010636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/25/2017] [Accepted: 11/12/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION A clinical study was initiated to investigate a caries detection device (The Canary System (CS)), based on photothermal radiometry and modulated luminescence (PTR-LUM). The primary objective of this study was to determine if PTR-LUM values (in the form of Canary Numbers; CN) correlate with International Caries Diagnostic and Assessment System (ICDAS II) scores and clinical situations. The secondary objectives of this study were to monitor the safety of PTR-LUM, and collect data to determine how CN values could be used to differentiate healthy from decayed tooth surfaces on a normalized scale. METHODS The trial was a four site, non-blinded study. Data was collected from 92 patients, resulting in 842 scanned tooth surfaces over multiple appointments. Surfaces were assessed according to ICDAS II, and further stratified into five clinical situation categories: 1) healthy surface, 2) non-cavitated white and/or brown spots; 3) caries lesions; 4) cavitation and 5) teeth undergoing remineralization therapy.CN data was analyzed separately for smooth and occlusal surfaces. Using a semi-logarithmic graph to plot raw CN (rCN) and normalized (CN) values, rCN data was normalized into a scale of 0-100. RESULTS Linear correlations (R2) between CN and ICDAS II groupings for smooth and occlusal surfaces were calculated as 0.9759 and 0.9267, respectively. The mean CN values derived from smooth (20.2±0.6) and occlusal (19±1.0) surfaces identified as healthy had significantly lower CN values (P<0.05) compared with the values from the other clinical situation categories. No adverse events were reported. CONCLUSION The present study demonstrated the safety of PTR-LUM for clinical application and its ability to distinguish sound from carious tooth surfaces. A clear shift from the baseline in both PTR and LUM in carious enamel was observed depending on the type and nature of the lesion, and correlated to ICDAS II classification codes, which enabled the preliminary development of a Canary Scale.
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Affiliation(s)
| | - Stephen H. Abrams
- Quantum Dental Technologies Inc, Toronto, Ontario, Canada
- Cliffcrest Dental Office, Scarborough, Ontario, Canada
| | | | - Julia Kennedy
- Quantum Dental Technologies Inc, Toronto, Ontario, Canada
| | - Jinseok Jeon
- Quantum Dental Technologies Inc, Toronto, Ontario, Canada
| | - Andreas Mandelis
- Quantum Dental Technologies Inc, Toronto, Ontario, Canada
- Center for Advanced Diffusion Wave and Photoacoustic Technologies (CADIPT), University of Toronto, Ontario, Canada
| | - Adam Hellen
- Quantum Dental Technologies Inc, Toronto, Ontario, Canada
- Cliffcrest Dental Office, Scarborough, Ontario, Canada
| | - Warren Hellen
- Cliffcrest Dental Office, Scarborough, Ontario, Canada
| | - Gary Elman
- Downsview Plaza Dental Office, Toronto Ontario, Canada
| | | | | | - Yoav Finer
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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Silvertown JD, Wong BPY, Sivagurunathan KS, Abrams SH, Kirkham J, Amaechi BT. Remineralization of natural early caries lesions in vitro by P11-4 monitored with photothermal radiometry and luminescence. ACTA ACUST UNITED AC 2017; 8. [DOI: 10.1111/jicd.12257] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 10/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | - Jennifer Kirkham
- Department of Oral Biology; University of Leeds; St. James's University Hospital; Leeds UK
| | - Bennett T. Amaechi
- Department of Comprehensive Dentistry; University of Texas Health Science Center at San Antonio; San Antonio TX USA
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Silvertown JD, Wong BPY, Abrams SH, Sivagurunathan KS, Mathews SM, Amaechi BT. Comparison of The Canary System and DIAGNOdent for the in vitro detection of caries under opaque dental sealants. ACTA ACUST UNITED AC 2016; 8. [DOI: 10.1111/jicd.12239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/07/2016] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Stephen H. Abrams
- Quantum Dental Technologies; Toronto ON Canada
- Cliffcrest Dental Office; Scarborough ON Canada
| | | | - Sapna M. Mathews
- Department of Comprehensive Dentistry; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Bennett T. Amaechi
- Department of Comprehensive Dentistry; University of Texas Health Science Center at San Antonio; San Antonio TX USA
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