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Demineralization detection in orthodontics using an ophthalmic optical coherence tomography device equipped with a multicolor fluorescence module

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Abstract

Objectives

Demineralizations such as white spot lesions are among the most prevalent side effects during orthodontic treatment. Fluorescence devices, including quantitative light-induced fluorescence (QLF), exploiting the intrinsic fluorescence of enamel and teeth and most recently optical coherence tomography (OCT) were introduced for early demineralization detection. In addition to near-infrared OCT scanning, multicolor modules allow for imaging with different laser wavelengths and the detection of reflective- and fluorescent light. The aim of this study was to evaluate a modified multicolor ophthalmic OCT device for the detection of early carious lesions in vitro and in vivo.

Materials and methods

Twenty-seven extracted lesion free human teeth were randomly assigned to three different demineralization protocols. Carious lesion detection was performed using macrophotography, OCT, and reflectance/fluorescence imaging using green laser and blue laser light. In addition, teeth of 5 orthodontic patients were OCT scanned, and fluorescence imaging using blue laser light was performed to assess demineralization after orthodontic therapy.

Results

Both in vitro and in vivo, OCT allowed for precise determination of lesion depth and enamel loss. Fluorescence imaging using blue laser light was most sensitive for the detection of early demineralization in vitro and in vivo. However, established and severe demineralizations were also reliably detected by macrophotography in vitro and in vivo.

Conclusion

Demineralization can be detected with high sensitivity using blue fluorescence imaging with multicolor OCT devices.

Clinical relevance

In the future, OCT fluorescence imaging might be considered for longitudinal monitoring of dental hard tissue during orthodontic treatment in clinical trials.

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Acknowledgments

The authors thank Dr. Gerhard Zinser (in memoriam), Ali Tafreshi, Dr. Tilman Otto, Joerg Fischer, Dr. Julian Weichsel, Dr. Stefan Schmidt and Ege Ilicak (Heidelberg Engineering, Heidelberg, Germany) for providing OCT equipment and software.

Funding

We gratefully appreciate the financial support from the Wissenschaftsfond of the German Society of Orthodontics (DGKFO 113/1016) and from the Physician Scientist Fellowship Program of the Medical Faculty of the University of Heidelberg to S.S.

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Authors and Affiliations

  1. Department of Orthodontics and Dentofacial Orthopaedics, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Sinan Şen, Ralf Erber, Nadine Deurer, Gül Orhan, Christopher J. Lux & Sebastian Zingler

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  1. Sinan Şen
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  2. Ralf Erber
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  3. Nadine Deurer
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  4. Gül Orhan
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Correspondence to Sinan Şen.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol, including the use of extracted human teeth, was approved by the ethics committee of the Medical Faculty of Heidelberg University (approval no.: S-370/2015). Trial registration: NCT03753256. The study conformed to the Declaration of Helsinki and was performed according to the guidelines of Good Clinical Practice. Participants were recruited between May 2017 and December 2017 by interns and residents, including authors of the present study of the Department of Orthodontics and Dentofacial Orthopaedics, Dental School, University of Heidelberg.

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Before participation, all patients or their parents/legal guardians received oral and written study information and signed a written consent form.

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Şen, S., Erber, R., Deurer, N. et al. Demineralization detection in orthodontics using an ophthalmic optical coherence tomography device equipped with a multicolor fluorescence module . Clin Oral Invest 24, 2579–2590 (2020). https://doi.org/10.1007/s00784-019-03116-3

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