Laser-induced breakdown spectroscopy: a tool for real-time, in vitro and in vivo identification of carious teeth

BACKGROUND: Laser Induced Breakdown Spectroscopy (LIBS) can be used to measure trace element concentrations in solids, liquids and gases, with spatial resolution and absolute quantifaction being feasible, down to parts-per-million concentration levels. Some applications of LIBS do not necessarily require exact, quantitative measurements. These include applications in dentistry, which are of a more "identify-and-sort" nature – e.g. identification of teeth affected by caries. METHODS: A one-fibre light delivery / collection assembly for LIBS analysis was used, which in principle lends itself for routine in vitro / in vivo applications in a dental practice. A number of evaluation algorithms for LIBS data can be used to assess the similarity of a spectrum, measured at specific sample locations, with a training set of reference spectra. Here, the description has been restricted to one pattern recognition algorithm, namely the so-called Mahalanobis Distance method. RESULTS: The plasma created when the laser pulse ablates the sample (in vitro / in vivo), was spectrally analysed. We demonstrated that, using the Mahalanobis Distance pattern recognition algorithm, we could unambiguously determine the identity of an "unknown" tooth sample in real time. Based on single spectra obtained from the sample, the transition from caries-affected to healthy tooth material could be distinguished, with high spatial resolution. CONCLUSIONS: The combination of LIBS and pattern recognition algorithms provides a potentially useful tool for dentists for fast material identification problems, such as for example the precise control of the laser drilling / cleaning process

Fluorescence-Based Methods for Detecting Caries Lesions: Systematic Review, Meta-Analysis and Sources of Heterogeneity

Background Fluorescence-based methods have been proposed to aid caries lesion detection. Summarizing and analysing findings of studies about fluorescence-based methods could clarify their real benefits. Objective We aimed to perform a comprehensive systematic review and meta-analysis to evaluate the accuracy of fluorescence-based methods in detecting caries lesions. Data Source Two independent reviewers searched PubMed, Embase and Scopus through June 2012 to identify papers/articles published. Other sources were checked to identify non-published literature. Study Eligibility Criteria, Participants and Diagnostic Methods The eligibility criteria were studies that: (1) have assessed the accuracy of fluorescence-based methods of detecting caries lesions on occlusal, approximal or smooth surfaces, in both primary or permanent human teeth, in the laboratory or clinical setting; (2) have used a reference standard; and (3) have reported sufficient data relating to the sample size and the accuracy of methods. Study Appraisal and Synthesis Methods A diagnostic 2×2 table was extracted from included studies to calculate the pooled sensitivity, specificity and overall accuracy parameters (Diagnostic Odds Ratio and Summary Receiver-Operating curve). The analyses were performed separately for each method and different characteristics of the studies. The quality of the studies and heterogeneity were also evaluated. Results Seventy five studies met the inclusion criteria from the 434 articles initially identified. The search of the grey or non-published literature did not identify any further studies. In general, the analysis demonstrated that the fluorescence-based method tend to have similar accuracy for all types of teeth, dental surfaces or settings. There was a trend of better performance of fluorescence methods in detecting more advanced caries lesions. We also observed moderate to high heterogeneity and evidenced publication bias. Conclusions Fluorescence-based devices have similar overall performance; however, better accuracy in detecting more advanced caries lesions has been observed

Surfing the spectrum - what is on the horizon?

Diagnostic imaging techniques have evolved with technological advancements - but how far? The objective of this article was to explore the electromagnetic spectrum to find imaging techniques which may deliver diagnostic information of equal, or improved, standing to conventional radiographs and to explore any developments within radiography which may yield improved diagnostic data. A comprehensive literature search was performed using Medline, Web of Knowledge, Science Direct and PubMed Databases. Boolean Operators were used and key-terms included (not exclusively): terahertz, X-ray, ultraviolet, visible, infra-red, magnetic resonance, dental, diagnostic, caries and periodontal. Radiographic techniques are primarily used for diagnostic imaging in dentistry, and continued developments in X-ray imaging include: phase contrast, darkfield and spectral imaging. Other modalities have potential application, for example, terahertz, laser doppler and optical techniques, but require further development. In particular, infra-red imaging has regenerated interest with caries detection in vitro, due to improved quality and accessibility of cameras. Non-ionising imaging techniques, for example, infra-red, are becoming more commensurate with traditional radiographic techniques for caries detection. Nevertheless, X-rays continue to be the leading diagnostic image for dentists, with improved diagnostic potential for lower radiation dose becoming a reality