Search

Improved methods are needed to assess the structure and activity of lesions on root surfaces in order to improve clinical decision making. Conventional visual and tactile methods for assessing lesion activity are not reliable, and the clinician is often unable to evaluate if the lesion is progressing or has remineralized. An important marker of an arrested lesion is a highly mineralized surface zone that forms when mineral is deposited in the outer layer of the lesion. In vitro studies have shown that a mineralized surface zone influences the kinetics of water evaporation and the surface temperature while drying. Temperature changes can be monitored by measuring the thermal emission with thermal imaging. Studies have also shown that the depth and severity of demineralization and the thickness of the highly mineralized transparent surface zone on arrested lesions can be measured nondestructively with optical coherence tomography (OCT). Thermal imaging at 8-µm to 13-µm wavelengths was completed on 30 test subjects with a suspected active root caries lesion by monitoring thermal emission from the tooth surfaces during 30 s of air drying. Lesions were also evaluated using cross-polarization OCT (CP-OCT) during lesion dehydration to identify transparent surface zones indicative of arrested lesions and determine if shrinkage occurred during drying. The overall thermal emission recorded during drying was significantly different (P < 0.001) when comparing sound tooth surfaces, lesion areas identified as arrested, and lesion areas identified as active, demonstrating that thermal imaging is a promising approach for the clinical assessment of lesion activity on root surfaces. Ten of the lesions in this study had distinct areas with transparent surface zones that were visible in CP-OCT images. Shrinkage was detected with CP-OCT during drying for 12 lesions. This study confirms that these novel approaches for assessing lesion activity on root surfaces can be implemented in vivo.

Objective: To identify associations between microbes and host genes in cats with feline chronic gingivostomatitis (FCGS), a debilitating inflammatory oral mucosal disease with no known cause, compared with healthy cats and cats with periodontitis (control cats)., Animals: 19 control cats and 23 cats with FCGS., Procedures: At least 1 caudal oral mucosal swab specimen was obtained from each cat. Each specimen underwent unbiased metatranscriptomic next-generation RNA sequencing (mNGS). Filtered mNGS reads were aligned to all known genetic sequences from all organisms and to the cat transcriptome. The relative abundances of microbial and host gene read alignments were compared between FCGS-affected cats and control cats and between FCGS-affected cats that did and did not clinically respond to primary treatment. Assembled feline calicivirus (FCV) genomes were compared with reverse transcription PCR (RT-PCR) primers commonly used to identify FCV., Results: The only microbe strongly associated with FCGS was FCV, which was detected in 21 of 23 FCGS-affected cats but no control cats. Problematic base pair mismatches were identified between the assembled FCV genomes and RT-PCR primers. Puma feline foamy virus was detected in 9 of 13 FCGS-affected cats that were refractory to treatment and 5 healthy cats but was not detected in FCGS-affected cats that responded to tooth extractions. The most differentially expressed genes in FCGS-affected cats were those associated with antiviral activity., Conclusions and Clinical Relevance: Results suggested that FCGS pathogenesis has a viral component. Many FCV strains may yield false-negative results on RT-PCR-based assays. Coinfection of FCGS-affected cats with FCV and puma feline foamy virus may adversely affect response to treatment.

Background and Objectives: Recent studies have demonstrated that near-infrared (IR) imaging can be used to acquire high-contrast images of root caries and calculus on the root surfaces of extracted teeth at wavelengths longer than 1450 nm. The purpose of this study was to determine if image-guided laser ablation can be used to selectively remove calculus from tooth surfaces with minimal damage to the underlying sound cementum and dentin., Materials and Methods: In this study, sequential near-IR images at 1500-1700 nm were used to guide a diode-pumped (DPSS) Er:YAG laser for the removal of calculus from the root surfaces of 10 extracted teeth. The selectivity of removal was assessed using digital microscopy, optical coherence tomography, and surface profilometry., Results: Calculus was removed rapidly with minimal damage to the underlying sound cementum and dentin. Image-guided ablation achieved high-selectivity, the mean volume of calculus removal was more than 27 times higher than the mean loss of cementum., Conclusions: We have demonstrated that near-IR image-guided laser ablation can be used for the selective removal of calculus from root surfaces ex vivo. Additionally, we have demonstrated that a diode-pumped solid-state Er:YAG laser is well suited for selective removal. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc., (© 2019 Wiley Periodicals, Inc.)

We developed a clinical probe capable of acquiring simultaneous short wavelength infrared (SWIR) reflectance and occlusal transillumination images of lesions on tooth proximal and occlusal surfaces to reduce the potential of false positives. The dual probe is 3D-printed and the imaging system uses a Ge-enhanced camera and fiber-optic light sources that use SWIR light at 1300-nm for occlusal transillumination and SWIR 1450-nm light for reflectance measurements. The purpose of this study was to test the performance of the probe on extracted teeth prior to commencing clinical studies. The dual probe was used to image extracted teeth with proximal and occlusal lesions. SWIR images of each tooth were compared with micro-CT images to assess performance.

New imaging technologies are needed for the clinical assessment of lesions on root surfaces. It is not sufficient to simply detect caries lesions; methods are needed to assess lesion depth, structural composition and activity to determine if chemical intervention has the potential to be effective and if remineralization has occurred. Lesions were monitored using CP-OCT during lesion dehydration to assess the lesion structure and any shrinkage. Thermal imaging at 6-10 μ m wavelengths and short wavelength-IR imaging at 1450-1750-nm were used to monitor thermal emission during lesion dehydration to assess lesion activity. Imaging probes were custom fabricated for clinical use. We present the first clinical results of a small feasibility study employing CP-OCT, thermal and SWIR imaging to assess lesion activity in vivo on thirty test subjects with suspected root caries lesions.

New imaging methods are needed to assess the activity of caries lesions on tooth surfaces. Recent studies have shown that changes in the contrast of lesions during dehydration with air at SWIR wavelengths can be used to determine if lesions are active or arrested. In this study changes in the reflectance of caries lesions during dehydration with air was monitored at 1500-1750-nm on extracted teeth using an imaging system with an InGaAs camera, a light source and a 3D printed handpiece with an integrated air nozzle suitable for clinical use. Lesion structure was also assessed with optical coherence tomography and microCT for comparison. This small preclinical study demonstrated that a 3D printed appliance with integrated air for dehydration can be used to acquire SWIR dehydration curves similar to those acquired previously for benchtop imaging systems.

Selective removal of dental calculus with high precision is best accomplished using lasers operating at high pulse repetition rates focused to a small spot size to limit damage to sound tissues. Conventional flash-lamp pumped Er:YAG lasers are poorly suited for this purpose, but new diode-pumped solid state (DPSS) Er:YAG lasers have become available operating at high pulse repetition rates. The purpose of this study was to determine if image-guided laser ablation can be used to selectively remove calculus from tooth surfaces with minimal damage to the underlying sound cementum and dentin. A DPSS Er:YAG laser system was used to selectively remove calculus from ten extracted teeth using sequential SWIR images at 1500-1750-nm. The selectivity of removal was assessed using digital microscopy and optical coherence tomography. Calculus was removed with minimal damage to the underlying sound cementum and dentin.

New diode-pumped solid state (DPSS) Er:YAG lasers have become available operating at high pulse repetition rates. These lasers are ideally suited for integration with laser scanning systems for the selective removal of dental decay and composite restorative materials from tooth surfaces. The purpose of this study was to determine if a DPSS Er:YAG laser system is suitable for the selective removal of composite from tooth surfaces. Relative ablation rates of composite and enamel were determined and composite was removed from tooth surfaces using a DPSS Er:YAG laser. Composite was removed very rapidly with ablation rates approaching 50-µm per pulse. A fluence of ~50 J/cm 2 appeared optimal for the removal of composite and damage to the enamel was limited to less than 100-µm after the removal of composite as thick as 700-800-µm; however, dentin is removed at similar rates to composite. The DPSS Er:YAG laser appears to be better suited for the removal of composite than conventional flash-lamp pumped Er:YAG lasers since composite is ablated at higher rates than dental enamel and the high pulse repetition rates enable greater selectivity while maintaining high removal rates., Competing Interests: The authors declare that there are no conflicts of interest related to this article.

Objective: Ultraviolet (UV) and infrared (IR) lasers can be used to specifically target protein, water, and mineral, respectively, in dental hard tissues to produce varying changes in surface morphology, permeability, reflectivity, and acid resistance. The purpose of this study was to explore the influence of laser irradiation and topical fluoride application on the surface morphology, permeability, reflectivity, and acid resistance of enamel and dentin to shed light on the mechanism of interaction and develop more effective treatments., Methods: Twelve bovine enamel surfaces and twelve bovine dentin surfaces were irradiated with various combinations of lasers operating at 0.355 (Freq.-tripled Nd:YAG (UV) laser), 2.94 (Er:YAG laser), and 9.4 μm (CO 2 laser), and surfaces were exposed to an acidulated phosphate fluoride gel and an acid challenge. Changes in the surface morphology, acid resistance, and permeability were measured using digital microscopy, polarized light microscopy, near-IR reflectance, fluorescence, polarization sensitive-optical coherence tomography (PS-OCT), and surface dehydration rate measurements., Results: Different laser treatments dramatically influenced the surface morphology and permeability of both enamel and dentin. CO 2 laser irradiation melted tooth surfaces. Er:YAG and UV lasers, while not melting tooth surfaces, showed markedly different surface roughness. Er:YAG irradiation led to significantly rougher enamel and dentin surfaces and led to higher permeability. There were significant differences in acid resistance among the various treatment groups., Conclusion: Surface dehydration measurements showed significant changes in permeability after laser treatments, application of fluoride and after exposure to demineralization. CO 2 laser irradiation was most effective in inhibiting demineralization on enamel while topical fluoride was most effective for dentin surfaces. Lasers Surg. Med. 49:913-927, 2017. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

UV and IR lasers can be used to specifically target protein, water, and the mineral phase of dental hard tissues to produce varying changes in surface morphology. In this study, we irradiated enamel and dentin surfaces with various combinations of lasers operating at 0.355, 2.94, and 9.4 μm, exposed those surfaces to topical fluoride, and subsequently evaluated the influence of these changes on surface morphology and permeability. Digital microscopy and surface dehydration rate measurements were used to monitor changes in the samples overtime. The surface morphology and permeability (dehydration rate) varied markedly with the different laser treatments on enamel. On dentin, fluoride was most effective in reducing the permeability.

A major advantage of composite restoration materials is that they can be color matched to the tooth. However, this presents a challenge when composites fail and they need to be replaced. Dentists typically spend more time repairing and replacing composites than placing new restorations. We have shown in previous studies that high-contrast images of composite can be acquired in occlusal transmission mode at near-IR wavelengths coincident with higher water absorption. The purpose of this study was to determine if similar high-contrast images can be acquired in reflectance mode at longer wavelengths where water absorption is even higher. Extracted human teeth with existing composite restoration (n=14) were imaged at wavelengths from 900-2300 using an extended range InGaAs camera. Our results indicate that NIR wavelengths longer than 1400-nm coincident with higher water absorption yield the highest contrast between dental composites and tooth structure in reflectance.

Selective removal of dental composite with high precision is best accomplished using lasers operating at high pulse repetition rates focused to a small spot size. Conventional flash-lamp pumped Er:YAG lasers are poorly suited for this purpose, but new diode-pumped Er:YAG lasers have become available operating at high pulse repetition rates. The purpose of this study was to compare the ablation rates and selectivity of enamel and composite for a 30 W diode-pumped Er:YAG laser operating with a pulse duration of 30-50-μs and evaluate it's suitability for the selective removal of composite from tooth surfaces. The depth of ablation and changes in surface morphology were assessed using digital microscopy. The fluence range of 30-50 J/cm 2 appeared optimal for the removal of composite, and damage to sound enamel was limited to less than 100-μm after the removal of composite as thick as 700-800-μm. Future studies will focus on the use of methods of feedback to further increase selectivity.

Several studies have demonstrated the potential of cross-polarization optical coherence tomography (CP-OCT) to quantify the severity of early caries lesions (tooth decay) on tooth surfaces. The purpose of this study is to show that 2D images of the lesion depth and the integrated reflectivity can be used to accurately represent the severity of early lesions. Simulated early lesions of varying severity were produced on tooth samples using simulated lesion models. Methods were developed to convert the 3D CP-OCT images of the samples to 2D images of the lesion depth and lesion integrated reflectivity. Calculated lesion depths from OCT were compared with lesion depths measured from histological sections examined using polarized light microscopy. The 2D images of the lesion depth and integrated reflectivity are well suited for visualization of early demineralization., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

One major advantage of composite restoration materials is that they can be color matched to the tooth. However, this presents a challenge when composites fail and they need to be replaced. Dentists typically spend more time repairing and replacing composites than placing new restorations. Previous studies have shown that near-infrared imaging can be used to distinguish between sound enamel and decay due to the differences in light scattering. The purpose of this study was to use a similar approach and exploit differences in light scattering to attain high contrast between composite and tooth structure. Extracted human teeth with composites (n=16) were imaged in occlusal transmission mode at wavelengths of 1300-nm, 1460-nm and 1550-nm using an InGaAs image sensor with a tungsten halogen light source with spectral filters. All samples were also imaged in the visible range using a high definition 3D digital microscope. Our results indicate that NIR wavelengths at 1460-nm and 1550-nm, coincident with higher water absorption yield the highest contrast between dental composites and tooth structure.

Dental enamel is highly transparent at near-IR wavelengths and several studies have shown that these wavelengths are well suited for optical transillumination for the detection and imaging of tooth decay. We hypothesize that these wavelengths are also well suited for imaging cracks in teeth. Extracted teeth with suspected cracks were imaged at several wavelengths in the near-IR from 1300-1700-nm. Extracted teeth were also examined with optical coherence tomography to confirm the existence of suspected cracks. Several teeth of volunteers were also imaged in vivo at 1300-nm to demonstrate clinical potential. In addition we induced cracks in teeth using a carbon dioxide laser and imaged crack formation and propagation in real time using near-IR transillumination. Cracks were clearly visible using near-IR imaging at 1300-nm in both in vitro and in vivo images. Cracks and fractures also interfered with light propagation in the tooth aiding in crack identification and assessment of depth and severity.

Introduction: In vivo and in vitro studies have shown that high contrast images of tooth demineralization can be acquired in the near-infrared (near-IR) without the interference of stain. The purpose of this study is to compare the lesion contrast in reflectance at near-IR wavelengths coincident with high water absorption with those in the visible, the near-IR at 1,300 nm and with fluorescence measurements for early lesions in occlusal surfaces., Methods: Twenty-four human molars were used in this in vitro study. Teeth were painted with an acid-resistant varnish, leaving a 4 × 4 mm window in the occlusal surface of each tooth exposed for demineralization. Artificial lesions were produced in the exposed windows after 1- and 2-day exposure to a demineralizing solution at pH 4.5. Lesions were imaged using near-IR reflectance at three wavelengths, 1,300, 1,460, and 1,600 nm using a high definition InGaAs camera. Visible light reflectance, and fluorescence with 405 nm excitation and detection at wavelengths greater than 500 nm were also used to acquire images for comparison. Crossed polarizers were used for reflectance measurements to reduce interference from specular reflectance., Results: The contrast of both the 1- and 2-day lesions were significantly higher (P < 0.05) for near-IR reflectance imaging at 1,460 and 1,600 nm than it was for near-IR reflectance imaging at 1,300 nm, visible reflectance imaging, and fluorescence., Conclusion: The markedly higher contrast at 1,460 and 1,600 nm wavelengths, coincident with higher water absorption, suggest that these wavelengths are better suited than 1,300 nm for imaging early/shallow demineralization on tooth surfaces., (© 2013 Wiley Periodicals, Inc.)

In vivo and in vitro studies have shown that high contrast images of tooth demineralization can be acquired in the near-IR due to the high transparency of dental enamel. The purpose of this study is to compare the lesion contrast in reflectance at near-IR wavelengths coincident with high water absorption with those in the visible, the near-IR at 1300-nm and with fluorescence measurements for early lesions in occlusal surfaces. Twenty-four human molars were used in this in vitro study. Teeth were painted with an acid-resistant varnish, leaving a 4×4 mm window in the occlusal surface of each tooth exposed for demineralization. Artificial lesions were produced in the exposed windows after 1 & 2-day exposure to a demineralizing solution at pH 4.5. Lesions were imaged using NIR reflectance at 3 wavelengths, 1310, 1460 and 1600-nm using a high definition InGaAs camera. Visible light reflectance, and fluorescence with 405-nm excitation and detection at wavelengths greater than 500-nm were also used to acquire images for comparison. Crossed polarizers were used for reflectance measurements to reduce interference from specular reflectance. The contrast of both the 24 hr and 48 hr lesions were significantly higher (P<0.05) for NIR reflectance imaging at 1460-nm and 1600-nm than it was for NIR reflectance imaging at 1300-nm, visible reflectance imaging, and fluorescence. The results of this study suggest that NIR reflectance measurements at longer near-IR wavelengths coincident with higher water absorption are better suited for imaging early caries lesions.

The contribution of lymphatic transport to the oral bioavailability of methylnortestosterone (M) after oral administration of the lipophilic prodrug methylnortestosterone undecanoate (MU) has been evaluated, and the sensitivity of lymphatic MU transport to lymphatic lipid transport has been investigated. M and MU were administered intravenously and orally to greyhound dogs to determine absolute bioavailability after oral dosing of MU. MU was also administered orally with differing quantities of food (lipid) to lymph duct-cannulated greyhound dogs to investigate the relative roles of lymph versus blood transport on M bioavailability and the effect of lipid load on systemic exposure. The relationship between lymphatic lipid and MU transport was further investigated in anesthetized rats. The oral bioavailability of M after administration of MU was found to be highly dependent on coadministration of food, and the bioavailability of M increased approximately 700% in fed versus fasted animals. In both cases, lymph diversion resulted in negligible systemic exposure of M, indicating almost complete dependence on lymphatic transport of MU for systemic exposure of M. Lymphatic transport of MU was even more highly dependent on the quantity of coadministered lipid and increased more than 50-fold with increasing lipid load. Therefore, increasing the quantity of food or lipid coadministered with MU stimulated a significant increase in the lymphatic transport of MU and systemic exposure of M. The lipid sensitivity of lymphatic transport of MU is significantly higher than previously observed for more metabolically stable compounds, suggesting a role for coadministered lipid in promoting avoidance of enterocyte-based cleavage of MU.

Org 45697 (MW 600.7, clogP 7.92, soybean oil solubility 50 mg/g) and Org 46035 (MW 601.6, clog P 8.46, soybean oil solubility 40 mg/g) are two poorly water soluble (<0.1 microg/ml), highly lipophilic drug candidates with immunomodulator activity and highly analogous chemical structures. After oral administration to conscious ambulatory rats in an aqueous-based methylcellulose/Tween 80 suspension, the bioavailability of both compounds was low (< 2% of administered dose). However, bioavailability was significantly increased (> 5 fold) after oral administration in a long chain triglyceride lipid (olive oil) formulation. Subsequent studies have explored the potential for solubilising formulations, including lipid-based formulations, to enhance the oral bioavailability of Org 45697 and Org 46035 and secondly to explore the potential contribution of intestinal lymphatic transport to intestinal absorption. The experimental data show that solubilising formulations may provide for significant increases in oral bioavailability for Org 45697 and Org 46035 and that after co-administration with lipid, 35-50% of the absorbed dose may be transported to the systemic circulation via the intestinal lymph. Interestingly, the lymphatic transport of the less lipid soluble analogue, Org 46035 was approximately 40% lower than that of Org 45697 suggesting that relatively subtle differences in lipid solubility can have significant impact on the extent of lymphatic transport.

Near-IR (NIR) imaging can be used to view the formation of ablation craters during laser ablation since the enamel of the tooth is almost completely transparent near 1310-nm(1). Laser ablation craters can be monitored under varying irradiation conditions to assess peripheral thermal and transient-stress induced damage, measure the rate and efficiency of ablation and provide insight into the ablation mechanism. There are fundamental differences in the mechanism of enamel ablation using erbium lasers versus carbon dioxide laser systems due to the nature of the primary absorber and it is necessary to have water present on the tooth surface for efficient ablation at erbium laser wavelengths. In this study, sound human tooth sections of approximately 2-3-mm thickness were irradiated by free running and Q-switched Er:YAG & Er:YSGG lasers under varying conditions with and without a water spray. The incision area in the interior of each sample was imaged using a tungsten-halogen lamp with a band-pass filter centered at 1310-nm combined with an InGaAs area camera with a NIR zoom microscope. Obvious differences in the crater evolution were observed between CO(2) and erbium lasers. Ablation stalled after a few laser pulses without a water spray as anticipated. Efficient ablation was re-initiated by resuming the water spray. Micro-fractures were continuously produced apparently driven along prism lines during multi-pulse ablation. These fractures or fissures appeared to merge together as the crater evolved to form the leading edge of the ablation crater. These observations support the proposed thermo-mechanical mechanisms of erbium laser involving the strong mechanical forces generated by selective absorption by water.

Clinical and pathologic data of 13 children, aged 5 to 16 years, with acute interstitial nephritis (AIN) are presented. The cause of AIN in these children was assessed as being related to infection in ten and methicillin in one; no infection, drug, or toxin could be implicated in two other patients. In addition to having various degrees of acute renal failure, all patients had systemic symptoms, most common of which were fatigue, fever, sore throat, and gastrointestinal disturbances. In six patients, the diagnosis of AIN was clinically suspected on the basis of tubular dysfunction such as low urinary specific gravity and glucosuria; in seven others the diagnosis was made after examination of the renal biopsy. Two patients had the nephrotic syndrome which resolved only after cytotoxic agents were added to corticosteroid therapy. The remaining 11 patients were given supportive therapy including peritoneal dialysis in one case. Complete recovery of renal function occurred in all patients within a mean interval of 69.5 +/- 34.7 days from the onset of symptoms, and all patients continue to have normal renal function during a follow-up period ranging from 1.5 to 10 years. We conclude that, in children, AIN is underdiagnosed, is most often associated with streptococcal infection, and carries an excellent prognosis.