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Development of Imaging Diagnosis of Dental Diseases and Conditions (Caries, cracked teeth, pulp vitality, and periodontal disease)

Integrative Biology and Infectious Diseases Branch
Division of Extramural Research

OBJECTIVE:

The intent of this SBIR/STTR initiative is to accelerate the advanced development and clinical implementation of reliable, reproducible, highly specific and sensitive diagnostic instruments for dental caries, cracked teeth, pulp vitality and periodontal diseases. These new instruments must demonstrate superior specificity and sensitivity than current diagnostic methods, such as the visual + tactile + radiographic examination for detection of caries, while not increasing health risks for patients. Approaches that could be explored include those outlined by Hall and Girkin (2004): optical coherence tomography (OCT) with or without Raman spectroscopy, MRI image analysis, electrical conductivity measurement (ECM), quantitative laser fluorescence (QLF), alternating current impedance spectroscopy, multi-photon imaging, infrared thermography, infrared fluorescence (IR), ultrasound, and terahertz imaging. The development of novel modalities is also encouraged.

BACKGROUND:

The focus of this initiative is to develop instruments that will improve diagnosis of dental diseases and conditions. These include instruments that could assess 1) caries after the appearance of white spot lesions and before penetration through the enamel-dentin junction, 2) cracks in teeth and the depth of their extension into the tooth, 3) pulp vitality, or 4) periodontal disease. Developed devices must be accurate, reliable, and produce reproducible data.

The mission of the National Institute of Dental and Craniofacial Research (NIDCR) is to improve oral, dental and craniofacial health through research. During the last decade, researchers supported by NIDCR have focused on developing more accurate and reproducible methods to diagnose dental caries, and to determine if carious lesions are active or inactive. These methods could provide practitioners with additional information so they can choose to treat caries either surgically or with preventive agents. In 2005, NIDCR funded several projects submitted in response to RFA-DE-06-008, Validation of New Technologies for Clinical Assessment of Tooth Surface Demineralization. These projects focused on the development of instrumentation for early diagnosis of carious lesions. Approaches supported by this RFA include the fundamental technical methods (OCT or IR) in conjunction with Raman spectroscopy to determine caries activity, mainly in occlusal or facial lesions. At present, these new methods require expensive instrumentation and are not ready for use in a dental operatory. Other new caries detection instruments on the market detect only smooth surface lesions, and utilize fluorescence of enamel (green emission) and the presence of porphyrin from oral bacteria (red emission) as the basis for caries detection. Evidence supporting this approach for caries detection is limited. Review of the literature suggests these instruments may have been used as an adjunct to the standard clinical diagnostic evaluation (visual+ tactile +radiographic examination), while other publications indicate these instruments add no value to the current standard diagnostic method.

Other areas needing improved diagnostic instrumentation include an accurate three dimensional representation of cracks in teeth. The ultimate goal is to have a system that would predict which cracks will lead to fracture of the tooth and which cracks are arrested and are unlikely to progress. Additional clinical needs include methods to measure pulp vitality, such as using a miniature coil for MRI analysis of pulp status and oximetry to determine pulpal perfusion. Any new instrumentation will require clinical studies tailored to the expected clinical use to establish and validate the diagnostic efficacy, reliability and reproducibility.

The diagnosis of periodontal diseases continues to rely on the probing of periodontal pockets and the radiographic assessment of alveolar bone height and loss. However, these diagnostic techniques have weak predictive value in determining current disease activity and appropriate future treatment. While new periodontal diagnostic strategies are likely to include the identification of biomarkers that are indicative of current disease activity and predictive of future disease progression, novel technologies for diagnosing periodontal disease could involve imaging technologies capable of accurately measuring subtle changes in periodontal attachment levels or alveolar bone integrity.

  

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This page last updated: March 14, 2014