Laser removal of dental hard tissue can be combined with optical, spectral or acoustic feedback systems to selectively ablate dental caries and restorative materials. Near-infrared (NIR) imaging has considerable potential for the optical discrimination of sound and demineralized tissue. Last year we successfully demonstrated that near-IR images can be used to guide a CO 2 laser ablation system for the selective removal of artificial caries lesions on smooth surfaces. The objective of this study was to test the hypothesis that two-dimensional near-infrared images of natural occlusal caries can be used to guide a CO 2 laser for selective removal. Two-dimensional NIR images were acquired at 1310-nm of extracted human molar teeth with occlusal caries. Polarization sensitive optical coherence tomography (PS-OCT) was also used to acquire depth-resolved images of the lesion areas. An imaging processing module was developed to analyze the NIR imaging output and generate optical maps that were used to guide a CO 2 laser to selectively remove the lesions at a uniform depth. Post-ablation NIR images were acquired to verify caries removal. Based on the analysis of the NIR images, caries lesions were selectively removed with a CO 2 laser while sound tissues were conserved. However, the removal rate varied markedly with the severity of decay and multiple passes were required for caries removal. These initial results are promising but indicate that the selective removal of natural caries is more challenging than the selective removal of artificial lesions due to varying tooth geometry, the highly variable organic/mineral ratio in natural lesions and more complicated lesion structure.
Keywordsimage-guided laser ablation; near-infrared imaging; CO 2 laser; selective caries removal; polarization sensitive optical coherence tomography
INTRODUCTIONNew optical caries imaging systems have been recently developed that are ideally suited to interface with lasers for the selective removal of dental caries. The most promising caries imaging systems employ fluorescence and near-IR imaging methods, including quantitative light fluorescence (QLF) 1 , near-IR fluorescence 2 , polarization sensitive-optical coherence tomography (PS-OCT) 3-5 and near-IR (NIR) imaging 4,6,7 . These imaging systems can be * daniel.fried@ucsf.edu, phone 415-502-6641, fax 415-476-0858.
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Author ManuscriptAuthor Manuscript used for the acquisition of 2-D or even 3-D images of tooth demineralization on proximal and occlusal surfaces. Lasers have been used for many years for industrial marking and computer aided design/machining (CAD/CAM) and high-speed scanning systems are in routine use. Other approaches involving acoustic and spectral feedback have already demonstrated that lasers can be scanned over tooth surfaces to remove dental composite and pigmented caries using acoustic and spectral feedback to differentiate these materials from sound enamel 8,9 . However, these approaches proved to be unsuccessful...