Determination of Caries Lesion Activity: Reflection and Roughness for Characterization of Caries Progression

Used by permission. © Operative Dentistry, Inc. Transmission or reproduction of protected items beyond that allowed by fair use requires the written permission of Operative Dentistry, Inc.Caries lesion progression is difficult to determine with visual and tactile examinations. The hypothesis of this study was that reflection and roughness measurements could determine caries progression. Ground/polished sound human enamel specimens were analyzed at baseline (sound) and after two four-day demineralization periods for reflection using optical reflectometry (ORef) and for roughness using optical surface profilometry (SPro). Specimens were demineralized using a microbial–Streptococcus mutans aries model. Comparisons among the periods for ORef and SPro were performed using repeated measures analysis of variance. Two-sample t-tests were used for differences in transverse microradiography. The integrated mineral loss and depth of the four-day demineralization period were significantly smaller than those for the eight-day demineralization period (p<0.01). With increased demineralization time, reflection was significantly decreased and roughness was significantly increased (p<0.01). Correlation between ORef and SPro was moderate (r=−0.63). Both reflection and roughness can be characterized for nondestructive longitudinal assessment of caries lesion progression

In Vitro Performance of Near Infrared Light Transillumination at 780-nm and Digital Radiography for Detection of Non-Cavitated Approximal Caries

Objectives To evaluate the ability of a Near Infrared Light Transillumination (NILT) device to detect non-cavitated approximal caries lesions; and to compare its performance to Digital Radiography (DR). Methods Thirty human extracted premolars (sound to lesions into the outer one-third of dentin) were selected. Lesion depth was confirmed by micro-computed tomography (μ-CT). Teeth were mounted in a custom-made device to simulate approximal contact. DR and NILT (CariVu™, DEXIS, LLC, Hatfield, PA, USA) examinations were performed and repeated by three trained and calibrated examiners. Sensitivity, specificity, area under ROC curve (Az), inter- and intra-class correlation coefficients (ICCs) for each method, and correlation among the methods were determined. Results ICCs for intra-/inter-examiner agreement were substantial for NILT (0.69/0.64), and moderate for DR (0.52/0.48). Sensitivity/specificity for NILT and DR were 0.68/0.93 and 0.50/0.64, respectively. Az for NILT was 0.81, while for DR it was 0.61. Spearman correlation coefficient with μ-CT for NILT (0.65, p<0.001) demonstrated moderate association, while that of DR suggested no association (0.19, p = 0.289). Conclusion Within the limitations of this in vitro study, NILT demonstrated a potential for early approximal caries detection. NILT and DR performed the same regarding the accuracy for non-cavitated approximal caries detection; however, NILT was superior to DR in terms of repeatability, agreement and correlation with μ-CT

Imaging of demineralized enamel in intact tooth by epidetected stimulated Raman scattering microscopy

Stimulated Raman scattering microscopy (SRS) was deployed to quantify enamel demineralization in intact teeth. The surfaces of 15 bovine-enamel blocks were divided into four equal-areas, and chemically demineralized for 0, 8, 16, or 24 h, respectively. SRS images (spectral coverage from ∼850 to 1150  cm  −  1) were obtained at 10-μm increments up to 90  μm from the surface to the dentin–enamel junction. SRS intensities of phosphate (peak: 959  cm  −  1), carbonate (1070  cm  −  1), and water (3250  cm  −  1) were measured. The phosphate peak height was divided by the carbonate peak height to calculate the SRS-P/C-ratio, which was normalized relative to 90  μm (SRS-P/C-ratio-normalized). The water intensity against depth decay curve was fitted with exponential decay. A decay constant (SRS-water-content) was obtained. Knoop-hardness values were obtained before (SMHS) and after demineralization (SMHD). Surface microhardness-change (SMH-change) [  (  SMHD  −  SMHS  )    /  SMHS] was calculated. Depth and integrated mineral loss (ΔZ) were determined by transverse microradiography. Comparisons were made using repeated-measures of analysis of variance. For SRS-P/C-ratio-normalized, at 0-μm (surface), sound (0-h demineralization) was significantly higher than 8-h demineralization and 24-h demineralization; 16-h demineralization was significantly higher than 24-h demineralization. For SRS-water-content, 24-h demineralization was significantly higher than all other demineralization-groups; 8-h demineralization and 16-h demineralization were significantly higher than 0-h demineralization. SRS-water-content presented moderate-to-strong correlation with SMH-change and weak-to-moderate correlation with depth. These results collectively demonstrate the potential of using SRS microscopy for in-situ chemical analysis of dental caries

The influence of hardness and chemical composition on enamel demineralization and subsequent remineralization

Objectives The objectives were to investigate the hardness and chemical composition of sound, demineralized and pH-cycled bovine enamel and determine their influence on demineralization and remineralization behavior. Methods Ninety-four, 5 × 5 × 2-mm bovine enamel specimens were demineralized using three different times [(24 h (n = 33), 48 h (n = 30), 96 h (n = 31)]. The specimens were then pH-cycled using either 367 ppm F sodium fluoride or deionized water. Knoop hardness (HK) and energy-dispersive X-ray spectroscopy (measured elements: Ca, P, F, C, Mg, N) were performed at three stages (sound, after demineralization, after pH-cycling) and transverse microradiography was performed after demineralization and pH-cycling. Comparisons were determined by ANOVA. Results Results showed that HK, integrated mineral loss and lesion depth were significantly different between stages, demineralization times and treatments. The weight% of F at the surface was significantly affected by treatment, irrespective of demineralization time, while the Ca:P ratio of the enamel remained stable even after de- and remineralization protocols. The F in fluoride groups and the artificial saliva in non-fluoride groups were both able to induce enamel remineralization, indicating the protective effect of salivary pellicle against demineralization even in the absence of fluoride. Conclusions Harder specimens and those with greater surface F weight% were less susceptible to demineralization and were more likely to remineralize. However, the amount of surface Ca and P did not influence de- or remineralization behavior

Detection and analyzing plane of non-cavitated approximal caries by cross-polarized optical coherence tomography (CP-OCT)

Objective The objective was to assess the detection ability and the effect of analyzing plane of CP-OCT for non-cavitated approximal caries. Methods Thirty human extracted premolars were selected based on micro-computed tomography [μ-CT: μ- CT = 0: sound (n = 12), μ-CT = 1/2: caries into outer-/inner-half of enamel (n = 6 each), μ-CT = 3: caries into outer one-third of dentine (n = 6)]. Teeth were mounted in a custommade device to simulate approximal contact, and scanned from the marginal ridge above the contact area. CP-OCT images were analyzed by deepest caries extension from horizontal and coronal planes, and repeated 48-hrs later. Sensitivity, specificity,percent correct, area under the ROC curve (Az), intra-examiner repeatability and correlation with μ-CT were determined. Results Sensitivity/specificity/Az for Horizontalplane, Coronal-plane, and Deepest from both planes were 94percent/58percent/0.76,81percent/100percent/0.90, and 94 %/58 %/0.82. Coronal-plane had significantly higher specificity than Horizontal-plane and Deepest (p = 0.004) but Horizontal-plane and Deepest were not different (p = 1.00). Horizontal-plane had significantly lower Az than Deepest (p = 0.048), but Coronal-plane was not different than Horizontal-plane (p = 0.07) or Deepest (p = 0.20). Correlation coefficients were Horizontal-plane (0.53, p < 0.001), Coronal-plane (0.84, p < 0.001), and Deepest (0.66, p < 0.001). Conclusion Within the limitations of this study, CP-OCT could be used to detect non-cavitated approximal caries. Analysis using the Coronal-plane is superior to the Horizontal-plane. Clinical Significance: It is challenging to detect non-cavitated approximal caries clinically due to the adjacent tooth. CP-OCT is a nondestructive, no ionized-radiation caries detection technique. CP-OCT seems suitable to detect non-cavitated approximal caries and observing the Coronal-plane appears better than Horizontal-plane

A case of biopsy-proven cardiac sarcoidosis without any other extracardiac manifestations

SummaryA 49-year-old woman was referred to our hospital for uncontrollable heart failure. She had never been diagnosed as having sarcoidosis. Chest X-ray showed cardiomegaly without bilateral hilar lymphadenopathy. Echocardiography showed diffuse hypokinesis of the left ventricle mimicking idiopathic dilated cardiomyopathy. No specific manifestations implying sarcoidosis were observed. On cardiac catheterization, coronary angiograms were normal, whereas concurrent routine endomyocardial biopsy showed foci of non-caseating granuloma, indicating sarcoidosis. Pathological finding was the only clue to diagnose cardiac sarcoidosis among our standard examinations for heart failure. No other additional investigations found any extracardiac features of sarcoidosis. All serological and immunological examinations were within normal range. This is a challenging case of biopsy-proven cardiac sarcoidosis without any other extracardiac involvement

Pilot clinical study to assess caries lesion activity using quantitative light-induced fluorescence during dehydration

This study aimed to evaluate the ability of quantitative light-induced fluorescence (QLF) to assess caries lesion activity using visual examination (VE) as the gold standard. Twenty-four visible white spot lesions on buccal surfaces were examined from 23 children, ages 9 to 14 years. At baseline, the surface was hydrated with water, and thereafter, it was dehydrated with continuous compressed air during image acquisition. QLF images were acquired at 0 (baseline), 5, and 15 s. QLF variables [ QLF V : fluorescence loss ( ? F ), lesion size (S), ? Q : ? F × S ] was recorded. Changes-in- QLF V per second ( ? QLF V ) were determined: ? QLF V = ( QLF VN ? QLF V Baseline ) / N , where N indicates dehydration time. One experienced dentist conducted VE independently using a dental unit’s light, compressed air, and explorer

Objective and Quantitative Assessment of Caries Lesion Activity

Objectives Evaluate the ability of objectively measured specular reflection, roughness, and fluorescence change during dehydration to assess caries lesion activity. Methods One hundred ninety-five ground/polished 3 × 3 × 2 mm sound human enamel specimens were divided into three groups and demineralized using a multispecies microbial caries model for 3, 6, or 9 days; and then remineralized with 1100 ppm-F as NaF solution for 10 days using a pH-cyclic model. Reflection (amplitude: %), roughness (Ra: μm), fluorescence change during dehydration (ΔQ: %×mm2), and microfocus computed tomography [μ-CT: lesion volume (μm3)] were measured for sound, demineralized and remineralized enamel. The surface was hydrated and fluorescence images were acquired at 1 s intervals for 10 s (ΔQ10). During image acquisition, surface was dehydrated with continuous compressed air. Changes-in-ΔQ per second (ΔQD: %×mm2/sec) at 5 (ΔQD5) and 10 s (ΔQD10) were obtained. Results Reflection decreased from sound to demineralized groups (p  0.32). Roughness increased from sound to demineralized groups (p < 0.0001) and remineralized groups were also higher than sound (p < 0.0001). ΔQ10, ΔQD5 and ΔQD10 increased from sound to demineralized groups (p < 0.0001), and remineralized groups decreased compared to demineralized groups (p < 0.05), but was higher than sound (p < 0.0001). The correlations of μ-CT with reflection, roughness, and ΔQ10 were −0.63, 0.71, and 0.82, respectively (p < 0.0001). Conclusions Reflection, roughness and ΔQ could distinguish between sound and demineralized enamel. Reflection and ΔQ were able to distinguish between demineralized and remineralized enamel. Clinical significance Determination of caries activity, whether a lesion is active or inactive, is an essential and critical component of caries diagnosis. However, especially for enamel lesions, it is difficult to estimate without longitudinal follow-up. Reflection, roughness and fluorescence change during dehydration have the potential to measure caries lesion activity at a-single-appointment

Enamel Carious Lesion Development in Response to Sucrose and Fluoride Concentrations and to Time of Biofilm Formation: An Artificial-Mouth Study

The aim of this study was to evaluate both sucrose and fluoride concentrations and time of biofilm formation on enamel carious lesions induced by an in vitro artificial-mouth caries model. For Study 1, biofilms formed by streptococci and lactobacilli were grown on the surface of human enamel slabs and exposed to artificial saliva containing 0.50 or 0.75 ppmF (22.5 h/d) and broth containing 3 or 5% sucrose (30 min; 3x/d) over 5 d. In Study 2, biofilms were grown in the presence of 0.75 ppmF and 3% sucrose over 3 and 9 days. Counts of viable cells on biofilms, lesion depth (LD), and the integrated mineral loss (IML) on enamel specimens were assessed at the end of the tested conditions. Counts of total viable cells and L. casei were affected by sucrose and fluoride concentrations as well as by time of biofilm formation. Enamel carious lesions were shallower and IML was lower in the presence of 0.75 ppmF than in the presence of 0.50 ppmF (P 0.25). Additionally, deeper lesions and higher IML were found after 9 d of biofilm formation (P < 0.005). Distinct sucrose concentrations did not affect enamel carious lesion development. The severity of enamel demineralization was reduced by the presence of the higher fluoride concentration. Additionally, an increase in the time of biofilm formation produced greater demineralization. Our results also suggest that the present model is suitable for studying aspects related to caries lesion development