MX2008000862A - Method and apparatus using infrared photothermal radiometry (ptr) and modulated laser luminescence (lum) for diagnostics of defects in teeth - Google Patents

Abstract

There is provided a high-spatial-resolution dynamic diagnostic instrument which can provide simultaneous measurements of laser-induced frequency-domain infrared photothermal radiometric and alternating-current (ac) modulated luminescence signals from defects, demineralization, remineralization and caries in teeth intraorally. The emphasis is on the abilities of this instrument to approach important problems such as the detection, diagnosis and ongoing monitoring of carious lesions and or defects on the occlusal pits and fissures, smooth surfaces and interproximal areas between teeth which normally go undetected by x-ray radiographs or visual examination. The instrument is also able to detect early areas of demineralized tooth and or areas of remineralized tooth as well as defects along the margins of restorations. This capability of inspecting a local spot can be extended to a modulated imaging of sub-surface of target tooth by using a multi-array infrared camera. Two configurations of the instrument are presented.

Description

METHOD AND APPARATUS USING PHOTOTERMIC RADIOMETRY INFRARROJA fPTR) AND MODULATED LASER LUMINISCENCE (LUM) FOR DIAGNOSING DEFECT IN THE TEETH CRUCIAL REFERENCE WITH PATENT APPLICATIONS OF E.U.A.

This patent application refers to the U.S. Patent Utility Application. Serial No. 60 / 699,878 filed July 18, 2005, entitled SIMULTANEOUS FREQUENCY-DOMAIN INFRARED PHOTOTHERMAL RADIOMETRY (PTR) AND MODULATED LASER LUMINESCENCE (LUM) APPARATUS FOR DIAGNOSTICS OF DEFECTS IN TEETH, presented in English, which is incorporated herein by reference in its entirety.

FIELD OF THE INVENTION The present invention relates to an apparatus based on infrared photothermal radiometry of laser frequency domains (hereinafter referred to as FD-PTR or simply PTR) and frequency domain luminescence (hereinafter referred to as FD-LUM, or simply LUM) ), for the detection of dental defects, demineralization and / or remineralization of hard tissues, defects around the restorations and caries in intraoral form.

BACKGROUND OF THE INVENTION Nowadays, with the wide use of fluoride, the predominance of caries, particularly smooth surface caries, has been reduced considerably, although the development of non-contact, non-invasive techniques, which can detect and monitor early demineralization in or under enamel, dentin or root surface or dental restorations is essential for the clinical management of this problem. A novel biotermofotonic technique has been introduced based on the modulated infrared thermal response (black body or Planck radiation) of a turbid medium, which results from radiation absorption and non-radiant energy conversion followed by a small increase in temperature. Therefore, the PTR has the ability to penetrate, and produce information about, an opaque medium beyond the range of optical imaging. Specifically, the frequency dependence of the penetration depth of the thermal waves makes it possible to perform a deep profiling of materials. In applications of PTR to turbid media, such as hard dental tissue, the depth information is obtained after the conversion of optical to thermal energy and the transport of incidental laser power in two different modes: conductive, from a distance close to the surface (50 ~ 500 μm) controlled by the thermal diffusion capacity of the enamel; and radiation capacity, through black-body emissions from considerably deeper regions corresponding to the optical penetration of the laser-induced optical field scattered diffusely (several mm). Trends in improved diagnostic capabilities, coupled with significantly higher optical damage thresholds for tissues, point to the use of frequency domain techniques such as next-generation technologies to complement or replace pulsed photothermal or photoacoustic laser detection with due attention to the physics of the propagation of photons in the diffusion medium. The use of biotermophotonics laser for diagnosis, detection and monitoring in dental process, is considered a promising technique, complementary to the phenomenon of laser-induced fluorescence of the enamel or to the fluorescence produced by the porphyrins present in the tissue with caries [R. Hibst, K. Konig, "Device for dental caries detection", Patent of E.U.A. No. 5,306,144 (1994)]. The first attempt to apply the depth profilometric capability of the photometric infrared laser frequency domain (PTR) radiometry to the inspection of dental defects was reported by Andelis et al [A. Mandelis L. Nicolaides, C. FENA, and S.H. Abrams, "Novel Dental depth profilometric imaging using simultaneous frequency-domain infrared photothermal radiometry and laser luminescence", Biomedical Optoacuoustics. Proc SPIE, A. Oraevsky (ed), 3916, pages 130 to 137 (2000)] and Nicolaides et al. [L. Nicolaides, A. Mandelis, and S.H. Abrams, "Novel dental dynamic depth profilometric imaging using simultaneous frequency-domain infrared photothermal radiometry and laser luminescence", J. Biomed Opt. 5, pages 31 to 39 (2000)]. More recently, this technology has been used for closed cavities and fissures [R.J. Jeon C. Han A. Mandelis V. Sanchez S.H. Abrams "Diagnosis of pit and fissure caries using frequency domain infrared photothermal radiometry and modulated laser luminescence" Caries Research 38, pages 497 to 513 (2004)] smooth surface and detection of interproximal injury.

BRIEF DESCRIPTION OF THE INVENTION The present invention provides an apparatus with infrared photothermal frequency domain infrared radiometry (FD-PTR) and modulated laser luminescence (FD-LUM), as complementary dynamic dental detection and diagnostic tools, to inspect sound points and defective (broken, with caries, demineralized) on the lateral surface (smooth surface), supepor surface (bite or closed), region of interproximal contact between the adjacent teeth intraorally and the surfaces of the teeth. The device has the ability to monitor ongoing demineralization and / or remineralization of various areas of the tooth surface either in vivo or in vitro. This method can be extended to the formation of modulated images of the sub-surface of the target teeth, using a multi-series infrared camera. In addition, this method could include a conventional visible spectrum range camera for capturing and storing images of the surface of the teeth for continuous reference. All this information can be stored on a computer's hard drive or other types of memory devices that include paper printing for recovery during continuous patient monitoring. Additionally, the present technology can be used in conjunction with conventional spectral techniques for dental inspection, such as QLF or OCT in order to expand the range and resolution of the sub-surface and detection of the near surface. In one aspect of the present invention there is provided an apparatus for photothermal radiometry and modulated luminescence for the inspection of dental tissues of a patient, comprising: at least one laser light source for irradiating a portion of a tissue surface dental with an effective wavelength, wherein the modulated photothermal radiometric signals and the modulated luminescence signals are emitted in response from said portion of the tooth surface; detection means for detecting said emitted modulated photothermal signals and said modulated luminescence signals; a manual probe head, and a flexible fiber optic package having a distal end connected to said probe head manual, said fiber optic package including a first optical fiber having a proximal end in optical communication with said light source and a distal end terminated in said manual probe head for transmitting light from said light source to a dental tissue of the patient by the physician's management of said manual probe head, said fiber optic package including a plurality of multi-mode optical fibers having distal ends terminated in said manual probe head and proximal ends optically coupled to said detection means , a first previously selected number of said optical fibers of multiple mode being optical fibers of near infrared transmission to transmit said modulated luminescence signals to said detection means, and a second previously selected number of said optical fibers of multiple modes being optical fibers of medium infrared transmission for tr Answers said photothermal radiometry signals; demodulation means for demodulating said modulated photothermal signals emitted in the photothermal phase and amplitude components and said modulated luminescence signals in phase and luminescence amplitude signals; and processing means for comparing said photothermal phase and amplitude signals with the phase and photothermal amplitude signals of a reference sample and comparing said luminescence phase and amplitude signals with the luminescence phase and amplitude signals of a reference sample. to obtain the differences, if any, between portion of said dental tissue and said reference sample and correlating said differences with the defects in said dental tissue. The present invention also provides a method for detecting defects in dental tissue including erosive lesions, crevice cavities and lesions, interproximal lesions, smooth surface lesions and / or root lesions with caries in dental tissue, comprising steps of: a) illuminating a portion of a surface of a dental tissue with at least one wavelength of light using a manual probe head, which is attached to a distal end of a flexible fiber optic package, said package fiber optic includes a first optical fiber having a proximal end in optical communication with a light source, which emits said at least one wavelength, and a distal end terminated in said manual probe head to transmit the light from said light source to a dental tissue of the patient by the physician's management of said manual probe head, said fiber optic bundle includes a plurality of fibers multi-mode optics having distal ends terminated in said manual probe head and proximal ends optically coupled to said detection means, a first previously selected number of said multifunctional optical fibers being the optical fibers of near infrared transmission to transmit said luminescence signals modulated to said detection means, and a second previously selected number of said optical fibers of multiple modes being medium infrared transmission optical fibers for transmitting said photothermal radiometry signals, wherein from the illumination of said portion of a surface of a dental tissue with at least one wavelength of light-modulated radiometric photometric signals and luminescence signals modulated, are emitted in response from said portion of said surface of the tooth surface; b) detecting said emitted modulated photothermal signals and said modulated luminescence signals; c) demodulating said modulated photothermal signals emitted in photothermal phase and amplitude components and demodulating said modulated luminescence signals into phase and luminescence amplitude signals; and d) comparing said photothermal phase and amplitude signals to phase and photothermal amplitude signals of a reference sample and comparing said luminescence phase and amplitude signals with the phase and luminescence amplitude signals of a reference sample to obtain the differences , if any, between said portion of said dental tissue and said reference sample and correlating said differences with the defects in said dental tissue. The present invention also provides an apparatus for creating dental tissue images using photothermal modulated radiometry and luminescence for inspection of dental tissues of a patient, comprising: at least one laser light source modulated to irradiate a portion of a tooth tissue surface with a beam of light of an effective wavelength wherein the modulated photothermal radiometric signals and the modulated luminescence signals are emitted in response to said portion of the tooth surface; image forming detection means positioned with respect to said dental tissue to detect the images of said emitted modulated photothermal signals and said modulated luminescence signals; demodulation means for demodulating said photothermal signal images modulated in images of the photothermal phase and amplitude components and said luminescence signal images modulated in phase and luminescence amplitude signal images; and processing means for comparing said images of photothermal phase and amplitude signals in photothermal phase and amplitude signal images of a reference sample and comparing said images of phase and luminescence amplitude signals with phase and amplitude signal images of luminescence of a reference sample to obtain the differences, if any, between said portion of said dental tissue and said reference sample and correlate said differences with the defects in said dental tissue; and an image display to display said images.

The present invention also provides a method for forming dental tissue images for the detection of defects in a patient's dental tissue, comprising the steps of: a) illuminating a portion of a surface of a dental tissue with a light beam of an effective wavelength wherein modulated photothermal radiometric signals and modulated luminescence signals are emitted in response from said portion of the tooth surface; b) detecting images of said emitted modulated photothermal signals and said modulated luminescence signals; c) demodulating said images of modulated photothermal signals emitted in images of phase and photothermal amplitude components and demodulating said images of modulated luminescence signals into phase and luminescence amplitude signal images; d) comparing said images of phase signals and photothermal amplitude with images of phase signals and photothermal amplitude of a reference sample and comparing said signals phase images and luminescence amplitude with images of phase and luminescence amplitude signals of a sample reference to obtain the differences, if any, between said portion of said dental tissue and said reference sample and correlate said differences with the defects in said dental tissue; Y e) display representative images of the defects, if any, of the dental tissue in a computer display. In one aspect, the present invention comprises irradiating the dental surface with an excitation source (laser) of emission of suitable wavelength in the near-visible-ultraviolet infrared spectral range; provide degrees of freedom rotation to the source of excitation to inspect tooth surfaces or teeth at various angles; produce periodic frequency pulses of laser beam within the range that include (but are not confined to) cd at 100 kHz; deliver the radiation and collect the emission by means of optical fibers or off-axis mirror configuration, generate a start-point signal transfer function, H (f) by obtaining the frequency scan data of a reference sample with the response of well-known properties and frequencies of luminescence (ca) radiometric and dynamic. compare by means of differences in proportions and amplitude phase of healthy, defective, eroded, demineralized or decayed dental tissue at various frequencies (eg, 10 Hz and 1 kHz) for optimal contrast and cancellation of the frequency response of the instrumental. perform diagnosis and detection of deep profilometric caries, demineralization and erosion through the acquisition of frequency exploration data. store the data on the examined area to allow comparing changes in the future, provide an impression or hard copy of the state of the examined area, if the data and experience of the doctor indicate the presence of pathology, provide the ability to treat the teeth using laser beams for: removing decayed or decayed dental material, removing the tooth structure for the placement of materials, preparing the teeth using the known principles of dental preparation design using hum, ultrasonic energy, laser beams or other devices for the preparation of teeth, cure or place a filling material in the teeth preparation that restores the teeth to form and function, using the appropriate laser-flow delivery protocols through the waveform-pulse engineering, for the Optimized, precise control of optical radiation delivery and power generation thermal if the data and clinical experience indicate the presence of demineralization, provide the ability to treat the teeth using lasers for; alter the surface or sub-surface using a laser beam, alter the surface or sub-surface to allow the application of various means to improve remineralization, apply a means that will either seal the surface or promote remineralization of the surface cure or place a material on the tooth surface to restore teeth to form and operate, using the appropriate laser-flow delivery protocols through waveform-pulse engineering, for optimized, precise control of optical radiation delivery of thermal energy generation. To monitor such alterations of intervention in the condition of the teeth by means of PTR and LUM combined to monitor the surface of the teeth for continuous changes before any intervention. Monitor the surface of the teeth to demonstrate in vitro demineralization and remineralization after the application of various therapies and solutions. A further understanding of the functional and advantageous aspects of the present invention can be observed with reference to the following detailed description and drawings.

BRIEF DESCRIPTION OF THE DRAWINGS The apparatus for detecting defects in the teeth according to the present invention will now be described only by way of example, with reference to the accompanying drawings, in which: Figure 1 shows a schematic diagram of a first embodiment of an infrared photothermal radiometry of simultaneous frequency domain and frequency domain luminescence instrument for the detection of defects in the teeth with added rotational degrees of freedom for the source of excitation for the inspection of the surfaces of the teeth at various angles of agreement with the present invention; Figures 2A-2E, shows the surface of the upper part (bite or closed) and the cross-section photographs at each measurement point, F1, F2, F3 and F4 of a typical caries lesion in cavities and fissures of a sample of human teeth; Figures 2F-2I, illustrates the typical PTR and LUM responses in the frequency domain for healthy spots and caries in a human tooth shown in Figures 2A-2G, using 659-nm semiconductor laser excitation, 50mW; Figure 3A illustrates a spatially scanned line through the inter-point contact points of two teeth; Figures 3B-3E show graphs illustrating the PTR and LUM spatial exploration responses through the mechanical holes interpróximos to a fixed frequency, 5Hz. The excitation source is a semiconductor laser beam of 670 nm, 450 mW; Figures 4A-4D show graphs illustrating the PTR and LUM responses of space exploration through the artificial interproximal caries lesion, which is created by a demineralization-remineralization solution (2.2 mM of monobasic potassium phosphate (KH2PO4). , 50 nM of acetic acid (NaOAc), 2.2 mM of 1 M calcium chloride (CaCl2), 0.5 ppm of fluorine (F), and potassium hydroxide (KOH) to balance the pH to 4.5) at a fixed frequency, 30 Hz. The excitation source is a semiconductor laser beam of 670 nm, 450 mW; Figures 5A-5H show the PTR / LUM signals against the treatment time for multiple samples with treatment time intervals from 6 hours to 30 days at 5 Hz (a) and at 500 Hz (b); Figure 6 illustrates a schematic diagram of the handheld apparatus for the infrared photothermal radiometry of the simultaneous frequency domain and the frequency domain luminescence instrument for the detection of defects in the teeth, which allow an improved reduced size and access to the covered geometries or interproximal, buccal or lingual (smooth surface) or root, as well as for the efficiency of collecting substantially improved infrared emission using fiber optic light delivery and IR radiation collection instead of solid angle collection configuration -limited rigidity of off-axis paraboidal mirrors; Y Figure 7 illustrates a schematic diagram of a two dimensional sealing imaging system by means of modulated infrared cameras.

DETAILED DESCRIPTION OF THE INVENTION The present invention is based on low-flow photometric photometric photometric microscopy and modulated luminescence detection, which detects the emission of infrared radiation from a hot region of the sample without thermally altering it. A temperature oscillation due to modulated heating produces a variation in thermal emissions, which is monitored using an infrared detector. The temperature modulation allows the thermal energy to reach the surface in the form of diffusion (or conduction) from a depth? Lh (f) = 2p ^ a? Pf approximately equal to the thermal wavelength, where a is the capacity of thermal diffusion of the material [cm2 / s] and f is the frequency of modulation of laser beam. Additionally, black-body radiation (Planck) is emitted from all depths to the inverse of the optical attenuation coefficient at the wavelength of laser excitation; the portion that is not absorbed again from this radiation is propagated back out of the surface of the photo-excited tooth and in a suitable infrared detector that transports the information from those depths.

A schematic diagram of the apparatus is shown generally with the number 10 in Figure 1. The semiconductor laser beam 12 with the wavelength of 659 nm (for example, Mitsubishi ML120G21, maximum power of 50 mW) or with 830 nm ( for example, Sanyo DL-7032-001, maximum power of 100 mW) are used as the source of both PTR and LUM signals. A laser diode conductor 13 (e.g., Coherent 6060) is used for the laser beam 12 and is activated by the built-in function generator 16 of the sealed amplifier 18 (e.g., Stanford Research SR830), modulating the laser current in a harmonic manner . The laser beam 20 is focused on the tooth sample 22. The modulated infrared PTR signal of the tooth is collected and focused by means of two off-axis paraboidal mirrors 26 (for example, Melles Griot 02POA019, coated with Rhodium) on an infrared detector 30, such as the Mercury Cadmium Tellurium detector (HgCdTe or MCT) (for example, EG &G Judson J15D12-M204-S05U). Before being sent to the sealed amplifier, the PTYR signal is amplified by a preamplifier 32 (EG &G Judson PA-300). For simultaneous measurement of PTR and LUM signals, a germanium window 36 is placed between the paraboloidal mirrors 26, such that wavelengths up to 1.85 μm (Ge band hole) could be reflected and absorbed, while that infrared radiation with longer wavelengths could be transmitted. The reflected luminescence is focused on a photodetector 38 of spectral bandwidth of 300 nm ~ 1.1 μm (e.g., Newport 818-BB- twenty). A color-cut glass filter 40 (e.g., Oriel 51345, cut-off wavelength: 715 nm) is placed in front of the photodetector 38 for luminescence to block the laser light reflected or diffused by the tooth or the root surface or the interproximal contact surfaces of the teeth 22. Luminescence data under the excitation of 830 nm were not possible, because the photoluminescence emission requires irradiation with photons greater than the luminescence peaks in ca. 636, 673 and 700nm [R. Hibst, K. Konig, "Device for dental caries detection", Patent of E.U.A. No. 5,306,144 (1994)]. 695-nm and 725-nm filters were tested as well as a 715-nm filter, and it was found that the 715-nm filter is optimal for cutting the laser source (659 nm) and cutting the luminescence with a negligible leak (ca. 190 times less than the minimum LUM dental signals that were obtained). Accordingly, the 715 nm) cut-off filter 40 was used to measure luminescence only for the 659-nm laser beam. To monitor the modulated luminescence, another sealed amplifier 42 was used (e.g., EG &G Model 5210). Both sealed amplifiers 18 and 42 were connected to, and controlled by, the 50 computer, via an RS-232 port or other equivalent ports. A pair of teeth 22 were mounted on the LEGO bricks 52. This configuration allowed the teeth 22 to be separated and mounted again on the exact position after creating the artificial lesions.

The modulated PTR and LUM emissions were then demodulated into phase and photothermal amplitude components and said luminescence signals modulated into luminescence phase and amplitude signals by a sealed amplifier and processed to compare the phase and photothermal amplitude signals to phase signals. and photothermal amplitude of a reference sample and comparing luminescence phase and amplitude signals with luminescence phase and amplitude signals from a reference sample to obtain differences, if any, between the portion of the dental tissue and the reference sample and correlate these different with the defects in the dental tissue. Additional details are described in the U.S. Patent. No. 6,584,341 issued on June 24, 2003 to Mandelis in al., which is incorporated in the present description as a reference in its entirety. The apparatus of Figure 1 provides an optomechanical design, which allows approximate tooth scans with three degrees of freedom of rotation (angle of teeth and mirror, angle of laser beam and tooth and angle of laser beam incident to tooth). Figures 2A-2I show a second premolar of the jaw illustrating the diagnostic and detection capability of the PTR and LUM. The tooth has a DIAGNOdent reading of maximum 10 and an average visual inspection interval of 2.2 which indicates that a physician would need to see or monitor the fissures. There is no indication on the radiographs of any caries present. However, the PTR and LUM signals, which include all the Information of the amplitude and phase responses on the full frequency scan (1 Hz ~ 1 kHz), indicated that the measurement points F2 and F3 have caries in the dentin. The histological observation results showed that this is, in fact, the case for these two points, as well as for the F1 point. The signs of the fissure F1, show the influence of the geometry of the fissure, the angle of the mouth of the fissure or the direction of the base of the fissure can have in the generation of signals PTR and LUM. The PTR amplitude of F1 in Figures 2F-2I is above the healthy band and the PTR phase also shows a clear departure from the healthy band in the high frequency range. This case illustrates the depth profileometric capabilities of PTR. In the case of the curved fissure caries, inclined F1 was illuminated by the incident laser beam in such a way that the decayed region formed a surface layer, succeeded by a layer of healthy sub-surface enamel much thinner. In response, the phase of the PTR signal for F1, in Figures 2F-2I, falls within the healthy band at low frequencies as expected from the long thermal diffusion length, which mostly tests the sub- healthy enamel layer with the surface layer with decay as a disturbance to the signal. However, at high frequencies, the thermal diffusion length (short) lies mostly within the cavity surface layer and, as a result, the PTR phase arises below the healthy band over ca. 50 Hz and joins the phases of the points with caries F2 and F3. In principle, the frequency of removal of the healthy band can be used to estimate the thickness of the surface layer with caries. The PTR and LUM curves of the healthy fissure F4 are located within the healthy band, confirming the histological observations. In order to evaluate PTR and LUM as caries detection and diagnosis techniques and compare them (combined and separately) with other conventional detectors, the sensitivities and specificities were calculated in two different thresholds (D2) and (D3) as defined in Table 1 for all diagnostic methods. While the PTR and LUM signals were taken from the 280 closed measuring points, only 1 or 2 points were evaluated on each tooth by the other methods of examination. Therefore, each calculation used only the corresponding measurement points. To create a suitable criterion for the evaluation of a caries state by means of the PTR and LUM, the general characteristics of the respective signals and their conversion equations were used, which are listed in Table 2. These characteristics were established from the experimental results of frequency scans with samples of healthy and decayed teeth. In the case of the PTR amplitude, the shape of the frequency scan curve for the healthy point on a record-record plot is almost linear from low frequency (1 Hz) to high frequency (1000 Hz), while the points do not healthy (demineralized surface, enamel caries or caries in the dentin) exhibited a larger amplitude than healthy spots over the full frequency range and a pronounced curvature with a "joint" at certain frequency intervals on the logarithmic graph. The PTR phase form for the healthy mineralized point on a linear (phase) - record (frequency) plot is practically linear across all frequencies (1 Hz ~ 1 kHz), while the decayed points exhibit larger phases at low frequencies and large slopes, through the healthy phase interval at the intermediate frequencies. There is no difference in the LUM amplitude form between the healthy and caries / demineralized points. The shape of the amplitude curves is consistent throughout, decreasing from low to high frequencies. The LUM amplitude curves for the demineralized points reside above the healthy band over the entire frequency range. The LUM phase shows slight differences between healthy points and spots with decay. In general, decayed or demineralized regions exhibit slightly changed LUM phase delays per enzyme of the healthy average across the entire measured frequency range. Healthy points may exhibit slight deviations, although only at the high frequency end (>; 100 Hz). Establishing the mean values for the PTR amplitude and phase, and the LUM amplitude and phase from all points of healthy smooth enamel surface on the samples, allowed us to examine the behavior of the structure of the healthy tooth without the influence of fissure geometry or the effects of variable enamel thicknesses in the fissure. A series of mean values and standard deviations against the frequency curves for each signal was developed and plotted for each tooth. This allowed the comparison of the behavior of each point detected for a healthy smooth surface area. Using these characteristics, the (conversion) characteristic equations were generated from the graphs to produce numerical values that define the state of the teeth, as it is related in Table 2. Additionally, from the full frequency scan, each signal (amplitude and phase PTR and LUM) was examined on 3 or 4 frequencies, if it deviated from the healthy norm band, and the number of points that deviated from this band was counted. After calculating all these values, each group number was normalized in such a way that the numbers assigned in each group had a value between 0 for intact teeth and 1 for the case of caries. Then, these normalized numbers were added and used to evaluate the points detected. Finally, a value was recorded for each measurement point, which included all the available information of the frequency response. The thresholds of D2 and D3 were determined by trial and error to comply with the histological observations as closely as possible. The results of the statistical analysis are presented in Table 3. Using the combined criteria of PTR and LUM, the sensitivities and higher specificities, of 0.81 and 0.87, respectively, were calculated at threshold D2 among all examination methods in the cases of the PTR criteria only or only LUM, the sensitivities are between 0.52 and 0.69, while the specificities are relatively older, between 0.72 and 0.86. In a similar way for other discoveries, visual inspection resulted in poor sensitivities (0.51 in D2 and 0.26 in D3) and particularly high specificities (1.00 in both thresholds). Radiographs also showed poor sensitivities (0.29 in D2 and 0.36 in D3) and high specificities (1.00 in D2, 0.85 in D3). The continuous luminescence (cd) method (DIAGNOdent) showed sensitivities of 0.60 in D2 and 0.76 in D3; the specificities were 0.78 in D2 and 0.85 in D3. However, from Table 3, it can be seen that a relatively small sub-group of all the measured points was used to obtain the visual and radiographic statistics, compared to the much larger sample sizes used for the other methods , especially for PTR and LUM. Additionally, the DIAGNOdent measurements were made with the optical fiber waveguide of the instruments, while the LUM and PTR measurements used direct incidence of light on the surface of the teeth and were subjected to the limitations of solid angle of incidence variable. This will be improved by introducing optical fibers such as those described in Figures 5A-5H.

Figures 3A-3E illustrate a sample result of interproximal spatial scans of mechanical hole detection. Samples were stored in saline and removed from the container just before the experiments, rinsed thoroughly with tap water for more than 20 seconds, and then left in the air for 20 minutes to dry properly. After the experiments, these samples were immediately placed in the container. Each pair of teeth was mounted on the LEGO partitions and explored at 30 Hz from left to right across the inter-point contact point as shown by the arrows in Figure 3A. These samples were scanned and radiographed at each step of machining or treatment with an artificial caries agent. In order to observe if small artificial holes could be detected by the PTR and / or LUM, a 1/4 mm round carbide bur was used to make the holes with a depth of about 1/4 mm on the sides of both teeth at the contact location. As shown in Figures 3B-3E, the hole on the left side was deeper than that on the right side, such that it could be visible on the X-ray image. The PTR and LUM signals are shown in Figures 3B- 3E. The PTR amplitudes were clearly greater after the sequential drilling of the holes, to the left and to the right of the contact point at 1.2- ~ 2.3 mm. The PTR phases also showed large changes around the holes at 1.5 ~ 2.5 mm. In the PTR phase, some signal changes also appeared in the far regions of the drilled holes, 0 ~ 1.5 mm and 2.5 ~ 4 mm. The hypothesis was generated that microfractures may have been created due to perforation and caused such signal changes. The PTR amplitude also showed a similar behavior. The LUM amplitude and the phase did not show clear differences around the holes because the LUM is essentially a surface phenomenon while the PTR delivers deep sub-surface information. The LUM amplitude and phase showed slight decreases in all the scans, possibly because the LUM is very sensitive to changes in humidity. Another sample group was treated with a demineralization-remineralization solution (2.2 mM potassium phosphate monobasic KH2PO4), 50 mM acetic acid (NaOAc), 2.2 mM calcium chloride 1 M (CaCl2), 0.5 ppm fluorine ( F), and potassium hydroxide (KOH) to balance the pH to 4-4.5). Figures 4A-4D show that both the amplitude and the PTR phase clearly showed monotonic increases after each treatment while LUM was almost insensitive, only for the light rigid change (decrease) of the curves across the explored region considered to be due to changes in humidity. Another 7 pairs were treated with saturated regulator solution and examined in a similar manner, except for the treatment time. Each pair was treated during different periods; For example, the first pair was treated for 6 hours only and the last pair He was treated for 30 days. The lesions created had both mineralized surfaces and demineralized sub-surfaces such as those found in early caries lesions. The PTR signals, shown in Figures 5A-5H at 5 Hz and 500 Hz, respectively, increased with the treatment time, while the LUM signals decreased slightly, consistent with the trends in Figures 4A-4D. The observed LUM amplitude that decreased with the degree of demineralization increase was also consistent with previous findings, in which quantitative light induced fluorescence (QLF), a form of cd luminescence, was used. Figure 6 illustrates an alternate modality of a configuration for an apparatus 80 for interproximal scans involving three different modules, 1) an optical "optical head" pickup unit / fiber optic laser beam signal unit that can be manually control flexible 82; b) a compact electrical and optical power delivery / signal processing unit with an ambient temperature IR emission detection module 88, which includes a diode laser conductor 104, electrically connected to a generation and detection module signal 91, which uses a new ambient temperature mercury-cadmium-zinc-tellurium (MCZT) detector in the state of the art 84, and a temperature controller 93 for the detector 84; 3) a control system and signal analysis unit 86. This detector represents the infrared technology in the state of matter. In addition to the detector of mercury-cadmium-zinc-tellurium (MCZT), other detectors that could be used include a mercury-cadmium-zinc-tellurium detector (MCZT), a lead-selenium detector (PbSe), and an indium arsenide detector ( InAs), a detector of Indium antimony (InSb), and a detector of indium gallium arsenide (InGaAs). Referring to the detailed view of the detection module 88, one of the two semiconductor laser beams 90 and 92, which emit light with a wavelength of 670 nm (for example, maximum power of 500 mW; photonic products) and of 830 nm, respectively (for example, a maximum power of 100 mW; optimum precision), were used as the PTR / LUM sources coupled by the optical coupler 94 and the optical fiber 96 coupled in optical form to the coupler 94 at one end thereof in a fiber optic pack 100, which includes in addition to the fiber 96, several multimode large-diameter silver halide core optical fibers (e.g., Ceramoptec) 98 through a multi-channel fiber optic coupler design (e.g., OZ) Optics) which is optically coupled to the manual optical head 82 at the other end thereof. The fiber optic bundle 100 terminates in an optical end section 144, which is a handpiece mounted to a micro-planer 140 that is comprised of a 3-axis translation stage and a rotation step to maintain the section of fiber optic end 144 in such a way that the position of the sample can be controlled accurately with a better resolution than 5 μm. This device Precise placement is only for research in laboratory experiments, and for clinical application, only handpiece 144 is used by a physician who moves his handpiece 144 around a suspicious tooth in a patient's mouth. Other more effective future combinations of laser lines and powers are also possible, which are or will become apparent to those skilled in the art, depending on the evolution of the laser technology and as claimed within this description. The use of two laser light sources at two different wavelengths is advantageous in order to refacilitate the interpretation of data. The two sources of wavelength represent different depths of optical penetration controlled by the total extinction coefficient associated with each wavelength, a function of optical absorption and the reduced dispersion coefficient of enamel (or other dental tissue). The inventors' studies using thermocouples inside the pulp chamber of the teeth irradiated by a 450 mW 670 mW laser showed temperature increases of ~ 1 ° C. Such elevated temperature levels are considered safe for clinical use, and will not cause damage to the pulp tissue of the teeth, while producing acceptable PTR signal-to-noise ratios (-5-80). The very recent deep caries exploration measurements with these types of laser diodes have shown that the PTR with the 830 nm source exhibit a higher spatial resolution of the sub-surface caries than a source of 659 nm at a value of a lower signal level [Jeon RJ, Mandelis A, Sanchez V and Abrams SH., "Non-intrusive, non-contacting frequency-domain photothermal radiometry and luminiscence depth profilometry of carious and artificial sub -surface lesions in human teeth ", J. Biomed Opt. 9: 904-819 (2004), Jeon RF, Han C, Mandelis A, Sanchez V, and Abrams SH., "Diagnosis of pit and fissure caries using frequency-domain infrared photothermal radiometry and modulated laser luminescence", Caries Res. 38 : 497-513 (2004)]. On the other hand, for lesions or erosions produced with acid on the enamel surface in which it was incurred after a short exposure to an enamel corrosion agent, the shorter wavelength source offers a higher PTR signal contrast for the shortest optical extinction depth (a few micrometers). The detection and monitoring of these erosion-type lesions is another application of this technology. The laser diode conductor 104 (e.g., Coherent 6060, Figure 1) was used to harmonically modulate the semiconductor laser current (and thus the power output) at a range from 1 Hz to 1000 Hz, activated by the function generator of a sealed software amplifier consisting of a PC card [eg NI PCI-5122 (signal analyzer 106 and for example, NI PCI-5401 (function generator 108) and the appropriate software 110 (eg example, LabView.) A computer fast enough to process the signals is required The laser driver 104 drives only one laser beam at a time, and as can be seen in Figures 4A-4D, there is a switch for coupling the laser conductor 104 to a laser beam or the other separately. The laser light will be delivered to the dental sample or tooth 120 (for example, a dentist who uses the hand unit 144 to illuminate a patient's tooth) by placing the end of the fiber optic bundle 100 in close proximity to the dental sample or tooth 120, in such a way that the dental sample is illuminated by one of the two wavelengths of laser light emitted from the distal end of the optical fiber 96 located in the hand-held probe 82. The near infrared LUM modulated signal of the Tooth 120 will be collected by the same delivery optical fiber 96 through the reverse splicer 130 to the active area of a Si 132 photodiode., it will be understood that other optical fibers in addition to the fiber 96 could be used to collect the modulated near infrared LUM signal of the tooth 120. For example, one or more fibers identical to the fiber 96 can be included in the fiber bundle 100 and the fiber 96 could only be dedicated to delivering laser light to the tooth and these other fibers identical to fiber 96 could be used to collect the modulated LUM signals and could have proximal ends coupled in optical form to the detector 132 without the need for the reverse splicer 130. Other detectors may also be used in addition to the Si 132 photodiode, including any semiconductor-based photocell with a narrower bandwidth than the luminescence photon energy, and any other energy conversion device. optoelectronic, such as a photomultiplier or any photon luminescence detector, which may include a germanium photodiode (Ge), an indium gallium arsenide photodiode (InGaAs), or a lead sulfide photodiode (PbS). A cut color glass filter 134 (e.g., Oriel 51345, cut-off wavelength, 715 nm) is placed on a U 136 support in front of the photodetector 132 for the LUM measurements generated by the 670-nm laser, to block the laser light reflected or diffused by the tooth 120. The apparatus 80 may include optics for expansion and focus of beam to adjust a size of the beam leaving the optical fiber attached to the end of the fiber to adjust a size of the area of the fiber. dental tissue that is being represented in image. The non-luminescence data are possible under the excitation of 830 nM, because the photoluminescence emission requires the irradiation with photons of higher energy (shorter wavelength) than the peaks of the luminescence at ca 636, 673 and 700 nm. Therefore, the PTR signal is collected by a concentric group of six silver halide optical fibers or other infrared optical fibers, appropriately transparent 98 and will be directed to the MCZT 84 detector, using elliptical optics 142 without the intervention of IR lens elements, for a maximum IR power transmission. Optical infrared focusing elements other than mirrors are also possible, which are well known to those skilled in the art.

For the occasional measurement of laser modulated power to test the systematic deviation through the reflection capacity, the power of the reflected source will be collected by removing the filter 134 from the same Si photodetector 132 on which the fiber core is focused. light delivery 96. To monitor the reflection capacity or modulated luminescence, a second channel of the sealed software amplifier 106 will be used. In each measurement, a spatial coordinate scan and / or PTR / LUM frequency can be performed with this instrument. The frequencies can be varied from 0.1 Hz to 1 kHz or greater, guaranteeing the thermal diffusion lengths within the range of 12 μm 1 mm [Jeon RJ, Mandelis A, Sánchez V, and Abrams SH., "Non-intrusive, non- contacting frequency-domain photothermal radiometry and luminescence depth profilometry of carious and artificial sub-surface lesions in Human teeth ", J biomed opt. 9: 804-819 (2004)]. This range of sub-surface depths that can be accessed in photothermal form ensures the ability to monitor deep caries lesions or demineralization under a remineralized enamel surface layer. By using a micro-setter 140, composed of a 3-axis translation stage and a rotation stage to maintain the fiber optic package 100, one can have the ability to accurately control the position of the sample with a higher resolution at 5 μm.

As discussed above with respect to the device of Figure 1, the modulated PTR and LUM emissions are then demodulated into photothermal phase and amplitude components and said luminescence signals modulated into amplitude and luminescence phase signals by a sealed amplifier and processed. for comparing the phase and photothermal amplitude signals with the phase and photothermal amplitude signals of a reference sample and comparing the phase and luminescence amplitude signals with the amplitude and luminescence phase signals of a reference sample to obtain the differences , if they exist, between the portion of the dental tissue and the reference sample and correlate these differences with the defects in the dental tissue. Additional details are described in the U.S. Patent. No. 6,584,341 issued June 24, 2003 to Mandelis et al., Which is incorporated herein by reference in its entirety. The comparison step includes normalizing the photothermal amplitude signals and the luminescence amplitude signals by calibrating the photothermal amplitude signals to at least two different frequencies, calibrating signals of luminescence amplitude signals at these two different frequencies, and taking the difference of photothermal phase signals at the two frequencies and taking the difference of luminescence phase signals at the two different frequencies to cancel the effects of the fluctuations of light source intensity and dependence on the frequency of instruments.

The comparison step also includes generating a start point signal transfer function, H (f), obtaining frequency scan data from the reference sample with the known radiometric and luminance (ca) luminance properties and the frequency response, and comparing the portion of a surface and the known healthy portion of a tooth by means of proportions of photothermal amplitudes, proportions of luminescence amplitudes and phase differences between the photothermal phases and luminescence phases at different frequencies for cancellation of the frequency response of the instruments. The demodulation step of the photothermal signals emitted inside the photothermal phase and the amplitude components and the luminescence signals in the luminescence phase and the amplitude signals is done using a sealed amplifier and the frequency dependence of the instruments is the response of the amplifier. The reference sample can be a known healthy portion of a tooth or other dental tissue depending on the tissue being examined. The apparatus of Figure 6 is very useful for examining the portions of a tooth, for example, and the size of the point is determined by the core of the fiber, the presence or absence of focusing optics at the end of the fiber (for example). example, selfoc lenses) and the distance of the ray of light emerging from the surface of the tooth. Under the normal operation of the instruments, the fiber optic package will be in contact with the tooth surface that is being examined. Increasing or decreasing the diameter of the beam allows the doctor to examine a closed fissure and deny the influence of geometry or angle of fissure. With a wider beam a signal from a wider area of the fissure can be detected. Figure 7 illustrates a sealed infrared-modulated imaging system shown generally at number 160. Function generator 162 provides a waveform The sinusoidal modulates the laser conductor 164 to supply modulated current to the laser 166 which is a light source that is suitably expanded, such that it excites a desired area of the surface of a dental tissue sample 168. The PTR signals and LUM are collected by a combined infrared camera 170 (a near infrared camera, such as InGaAs for ca luminescence and a medium infrared camera, such as HgCdTe for photothermal detection) which is activated by function generator 162 to synchronize with the laser driver 164. Camera 170, equal to any camera (film or digital), includes a lens or a combination of lenses to project an image a detection provision. The images are composed of multiple pixels. The disposition detector in the modulated IR camera is similar to the image cell in a digital camera. Each detection element (pixel) will generate a signal due to the excitation of the photons. In the present application, the signal is being modulated, such that it is a CA signal. The AC signals are sent to the computer 172, which is equipped with a sealed amplifier, such that the computer demodulates the signals, which are sent from the camera 170, pixel by pixel, in two components; amplitude and phase. Then these signals, amplitude and phase, are used to create a visible image on the monitor for the observation of the doctor. The complete images of the cameras are collected at an index of at least double that required by the sampling theorem (4 images / modulation period) and are stored in the computer, each image averaged over an appropriate number of periods. The sealed software applied to those images produces amplitude and phase images displayed on the computer screen by the operator. These signals from the cameras sent to the computer 172 show two-dimensional sealed images at the modulation frequency of the laser beam. Particularly, the images of the modulated photothermal signals emitted from the camera 170 are demodulated into photothermal phase signals and amplitude components and the images of the modulated luminescence signals are demodulated into luminescence phase signals and amplitude signals. The demodulated signals are converted into images and then the comparison of the images of phase signals and photothermal amplitude with the images of phase signals and photothermal amplitude of a reference sample and the images of luminescence phase and amplitude signals are compared with the phase and luminescence amplitude signal images of a reference sample to obtain differences, if any, between the portion of the dental tissue and said reference sample and the differences are correlated with the defects in the dental tissue. In addition to using an infrared camera 170, in another embodiment of the image forming apparatus, a modulated visible light chamber 174 (preferably a CCD camera) can also be used in addition to the IR camera 170, which allows images of the teeth at visible wavelengths. An advantage of this combination is that it provides better control of the site where the laser beam is located on the tooth and for the firing of the IR camera that the doctor wishes to take from the teeth or the root surface under inspection. The visible modulated cameras can be used to take blocked phase LUM images, in addition to taking closed PTR images. An advantage of using the CCD 174 visible interval camera is that it provides the physician with an image of the teeth or root surface under examination and allows the physician to mark the areas in the image that need to be examined. This provides the doctor with a permanent record of areas that need to be monitored on a long-term basis. Changes in color, especially the appearance of white or brown spots, may indicate the presence of demineralized or remineralized enamel lesions. Once located and stored, the doctor can monitor the changes in PTR and LUM of these areas, as well as provide the patient with an impression of the areas in question.

The conventional CCD camera 174 can be used in the cd mode to monitor the position and exact location of the region to be detected photothermally. In addition, the same camera with optical filters suitable for excluding contributions outside the LUM spectrum range (700 A 850 NM) can be used in a modulated mode to generate LUM images at some suitable frequency as explained in the previous margin; with a change of the computer control software. Accordingly, the apparatuses described herein provide a very useful method for making sense of important dental problems, such as the detection and / or diagnosis of smooth surface lesions, closed cavities and cleft lesions and interproximal lesions between teeth. which are usually not detected by X-ray radiographs and visual examination. The instrument also has the ability to detect early areas of demineralized teeth and / or root and / or areas or root of remineralized teeth, as well as defects along the margins of restorations that include crowns, inlays, fillings, etc. The instrument shown in Figure 6 described herein has the ability to inspect a local point on a tooth, and the instrument in Figure 7, has the ability to create modulated images of the sub-surface of a target tooth using a camera infrared of multiple series (Figure 7). A visible camera is used to monitor changes on tooth surfaces such as white spots and other surface signs of demyelinated or remineralized teeth.

Accordingly, based on the results of examinations of the patient's tooth using the apparatus of Figures 6 and / or 76, if the physician detects, for example, enamel lesions or root caries that includes both demineralization and remineralization , erosion injuries that include both demineralization and remineralization or any of the dental surfaces, he / she can then monitor the area in question or institute corrective measures to treat the tooth using lasers to i) remove the decayed or decayed tooth material , ii) prepare the tooth using the known principles of tooth preparation, iii) alter the surface using a laser beam, iv) alter the surface to allow the application of various means to improve remineralization, v) apply a medium that will either seal the surface or promote remineralization of the surface, vi) cure or place a material on the surface of the teeth that restores the teeth in shape and function, use laser-flow delivery protocols suitable through the pulse-waveform engineering, for the optimized, precise control of the delivery of optical radiation and generation of thermal energy. During this procedure to perform these various corrective steps to restore the tooth, the physician can monitor the dental tissue during these alterations of intervention in the condition of the tooth by means of PTR and LUM combined using the apparatuses of Figures 6 or 7.

The devices described herein that use combined PTR / LUM can be combined with other detection systems such as Digital Fiber Optic Transillumination 8DIFOTI), Quantitative Laser Fluorescence (QLF), Optical Coherence Tomography (OCT) and / or Monitoring Electrical caries resistance (ECM) to provide additional information about the state of the injury or defect that is being examined. Each of these mentioned techniques has existing descriptions in the literature about how they detect injuries and their various disadvantages. The QLF has the ability to detect luminescence through the entire length of the enamel surface for bonding with the next layer or dentin. The color change in luminescence is used to detect and monitor demineralization and remineralization. The QLF does not have the capability of deep profilometric examination although it can monitor changes in size of the lesion, provided that the surface points of the reference teeth do not change in their orientation. The resistance of electric caries monitors the change in electrical potential through a surface of the dried tooth. The technique is described in the literature and requires a dry field for monitoring. Currently it does not have the capacity to provide any depth information about a caries lesion or demineralization area. Additionally, the current laboratory apparatus can be used to detect and monitor artificially created injuries and / or natural injuries in vitro. This can be used to test in vitro the effects of various techniques, materials or substances to create erosion lesions, demineralized lesions or artificial caries lesions on the surface of the teeth that include a root surface. Additionally, the PTR and LUM can then be used to detect changes in these lesions induced by the application of various substances. The PTR and LUM can be used to detect the amount and extent of demineralization and / or remineralization after the application of various substances to the tooth or root surface. The PTR can then be combined with other sensitive but destructive techniques, such as MicroCT and TMR to measure changes in the lesion and provide a visual representation of the lesions. As used in the present description, the terms "comprises", "comprising", "includes" and "including" will be interpreted as inclusive and undefined, and not exclusive. Specifically, when used in this specification, including the claims, the terms "comprises", "comprising", "includes" and "including" and variations thereof, mean that the features, steps or components specified , are included. These terms will not be interpreted to exclude the presence of other characteristics, steps or components. The above description of the preferred embodiments of the present invention has been presented to illustrate the principles of the present invention and not to limit the present invention to the particular embodiment illustrated. It is intended that the scope of the present invention be defined by all the embodiments encompassed within the following claims and their equivalents.

TABLE 1. Diagnostic criteria for visual inspection. DIAGNOdent. X-rays and histological observation TABLE 2. Characteristics of frequency scanning curves of PTR and LUM TABLE 3. Sensitivities and specificities in the level of enamel caries (D2) and the level of dentine caries (D3) for various methods of examination

Claims (43)

NOVELTY OF THE INVENTION CLAIMS

1. An apparatus for photothermal radiometry and modulated luminescence for inspection of dental tissues of a patient comprising: at least one laser light source for irradiating a portion of a surface of a dental tissue with a modulated laser beam of effective wavelength, wherein the modulated photothermal radiometric signals and the modulated luminescence signals are emitted in response from said portion of the tooth surface; first detecting means for detecting said emitted modulated luminescence signals and second detecting means for detecting said modulated photometric emitted radiometric signals; a manual probe head, and a flexible fiber optic package having a distal end connected to said manual probe head, said fiber optic package including a first optical fiber having a proximal end in optical communication with said light source and a distal end terminated in said manual probe head for transmitting light from said light source to a dental tissue of the patient by the physician's management of said manual probe head, said fiber optic bundle including a plurality of optical fiber modes manifolds having distal ends terminated in said manual probe head and proximal ends coupled in optical form to said detection means, a first previously selected number of said multi-mode optical fibers being optical fibers of near infrared transmission for transmitting said modulated luminescence signals to said first detection means to which said first previously selected number of said optical fibers of multiple modes are optically coupled and a second previously selected number of said multi-mode optical fibers are medium infrared transmission optical fibers for transmitting said modulated photothermal radiometry signals to said second detection means to which said previously selected second number of said multi-mode optical fibers optically coupled; demodulation means for demodulating said modulated photothermal radiometric signals emitted in the photothermal phase and amplitude components and said luminescence signals modulated in luminescence phase and amplitude signals; and processing means for comparing said photothermal phase and amplitude signals with the phase and photothermal amplitude signals of a reference sample and comparing said luminescence phase and amplitude signals with the luminescence phase and amplitude signals of a reference sample. to obtain the differences, if any, between said portion of said dental tissue and said reference sample and correlate said differences with the defects in said dental tissue.

2. The apparatus according to claim 1, further characterized in that said first previously selected number of said optical fibers of multiple modes is one and is identical to said first optical fiber, said first optical being sensitive in said near infrared spectrum region and used to collect and transmit said modulated luminescence signals emitted from said dental tissue to said first detection means in addition to delivering said laser light to said dental tissue.

3. The apparatus according to claim 1 or 2, including a reverse splicer optically coupled to said first optical fiber, said reverse splicer is optically coupled to said first detection means to detect said modulated luminescence signals, said reverse splicer decouples said laser light from said modulated luminescence signals.

4. The apparatus according to claim 1, 2 or 3, further characterized in that said first detection means are sensitive in a region of near infrared spectrum to detect said modulated luminescence signals, and wherein said second detection means are sensitive in a region of the average infrared spectrum to detect said modulated photometric photometric signals.

5. The apparatus according to claim 1, 2 or 3, further characterized in that said second detection means is one of a mercury cadmium tellurium detector (HgCdTe) (MCT), a mercury-cadmium-zinc-tellurium detector (MCZT) ), a lead selenide detector (PbSe), an indium arsenide detector (InAs), an indium antimony detector (InSb), and an indium gallium arsenide detector (InGaAs).

6. - The apparatus according to claim 1, 2, 3 or 4, further characterized in that said first detection means is one of a silicon photodiode (Si), a germanium photodiode (Ge), a photodiode of Indium gallium arsenide ( InGaAs) and a lead sulfide photodiode (PbS).

7. The apparatus according to claim 1, 2, 3, 4, 5 or 6, further characterized in that said previously selected second number of said multi-mode optical fibers for transmitting said modulated photothermal radiometric signals are multi-mode optical fibers of silver halide.

8. The apparatus according to claim 1, 2, 3, 4, 5 or 6, further characterized in that said at least one laser light source are two semiconductor laser beams, one first of said two semiconductor laser beams emitting light with a wavelength of 670 nm, and a second laser beam emitting with a wavelength of 830 nm.

9. The apparatus according to claim 8, further characterized in that the laser light emitted from said two semiconductor laser beams is coupled in optical form by means of an optical coupler in said first optical fiber.

10. The apparatus according to claim 1, further characterized in that it includes a fiber optic filter placed in front of said first detector to block the laser light reflected or dispersed by the dental tissue.

11. - The apparatus according to claim 1, further characterized in that said processing means are configured to store said differences obtained as unique data points of said detectors.

12. The apparatus according to any of claims 1 to 11, further characterized in that it includes expansion optics and beam focusing to adjust a size of said ray of incident light on the dental tissue to adjust a size of the area of the dental tissue. to be represented in image.

13. The apparatus according to any of claims 1 to 11, further characterized in that said demodulation means is a sealed amplifier based on software.

14. A method for the detection of defects in dental tissue including erosive lesions, lesions of cavities and fissures, interproximal lesions, lesions of the smooth surface and root lesions with caries in dental tissue, comprising the steps of: a ) illuminating a portion of a surface of a dental tissue with at least one wavelength of light using a manual probe head, which is attached to a distal end of a flexible fiber optic package, said fiber optic package includes a first optical fiber having a proximal end in optical communication with a light source, which emits said at least one wavelength, and a distal end terminated in said manual probe head for transmitting light from said source; light to a patient's dental tissue by the physician's management of said manual probe head, said fiber optic package includes a plurality of multi-mode optical fibers having distal ends terminated in said manual probe head and proximal ends optically coupled to said detection means, a first previously selected number of said optical fibers of multiple modes being the optical fibers of near infrared transmission to transmit said modulated luminescence signals emitted from the dental tissue of the patient to said detection means, and a second previously selected number of said optical fibers in multiple modes being medium infrared transmission optical fibers to transmit said modulated photothermal radiometry signals emitted from said dental tissue of the patient, wherein from the illumination of said portion of a surface of a dental tissue with at least one length of signal wave is photometric photometric modulated light and modulated luminescence signals, are emitted in response from said portion of said surface of the dental surface; b) detecting said modulated luminescence signals emitted with a first detection means and detecting said modulated photometric photometric signals emitted with a second detection means; c) demodulating said modulated photothermal radiometric signals emitted in photothermal phase and amplitude components and demodulating said modulated luminescence signals into phase and luminescence amplitude signals; and d) comparing said phase and photothermal amplitude signals to phase and photothermal amplitude signals of a reference sample and comparing said luminescence phase and amplitude signals with the phase and luminescence amplitude signals of a reference sample to obtain the differences, if any, between said portion of said dental tissue and said reference sample and correlate said differences with the defects in said dental tissue.

15. The method according to claim 14, further characterized in that said first detection means is a sensitive infrared detector in a region of near infrared spectrum to detect said modulated luminescence signals (LUM), and wherein said second means of Detection is a medium sensitive infrared detector in a region of mid-infrared spectrum to detect said modulated photothermal radiometric signals.

16. The method according to claim 15, further characterized in that said second detection means is one of a mercury cadmium tellurium (HgCdTe) detector (MCT), a mercury-cadmium-zinc-tellurium (MCZT) detector, a detector of lead selenide (PbSe), an indium arsenide detector (InAs), an indium antimony detector (InSb), and an indium gallium arsenide detector (InGaAs).

17. The method according to claim 14, 15 or 16, further characterized in that said first previously selected number of said multi-mode optical fibers is one and is identical to said first optical fiber, said first optical being sensitive in said region. of near infrared spectrum and is used to collect and transmit said modulated luminescence signals emitted from said dental tissue to said first detection means in addition to delivering said laser light to said dental tissue.

18. The method according to claim 17, further characterized in that said first detection means is one of a silicon photodiode (Si), a germanium photodiode (Ge), a photodiode of Indium gallium arsenide (InGaAs) and a lead sulfide photodiode (PbS).

19. The method according to claim 14, 15, 16, 17 or 18, further characterized in that said second previously selected number of said multi-mode optical fibers for transmitting said photothermal radiometric signals are multi-mode optical fibers of silver halide.

20. The method according to claim 13, 14, 15, 16, 17, 18 or 19, further characterized in that said at least one laser light source are two semiconductor laser beams, a first of said two semiconductor laser beams emitting light with a wavelength of 670 nm, and a second laser beam that emits with a wavelength of 830 nm.

21. The method according to claim 20, further characterized in that the laser light emitted from said two semiconductor laser beams is coupled in optical form by an optical coupler in said first optical fiber.

22. The method according to any of claims 14 to 21, further characterized in that it includes filtering the light incident on said first detector to block the laser light reflected or scattered by the dental tissue.

23. The method according to any of claims 14 to 22, further characterized in that it includes adjusting a size of said ray of incident light on the dental tissue to adjust a size of the area of dental tissue that is being represented in image.

24. The method according to any of claims 14 to 23, further characterized in that said comparison step includes normalizing said photothermal amplitude signals and said luminescence amplitude signals by calibrating the photothermal amplitude signals to at least two different frequencies , calibrating the luminescence amplitude signals to said at least two different frequencies, and taking a difference of the photothermal phase signals in said at least two frequencies and taking a difference of luminescence phase signals in said at least two different frequencies to cancel the effects of light source intensity fluctuations and frequency dependence of the instruments.

25. The method according to claim 24, further characterized in that said demodulation step of said photothermal radiometric signals emitted in the photothermal phase and amplitude components and said luminescence signals in luminescence phase and amplitude signals is performed using a sealed base amplifier. of software and wherein said frequency dependence of the instruments is the response of the sealed amplifier.

26.- The method according to any of claims 14 to 25, further characterized in that said comparison step includes: generating a signal transfer function of starting point H (f), obtaining the frequency scan data from said reference sample with radiometric and dynamic luminescence (ca) and frequency response properties; and comparing said portion of a surface and said known healthy portion of a tooth by means of the proportions of photothermal amplitudes, proportions of luminescence amplitudes, and phase differences between the photothermal phases and the luminescence phases at different frequencies for the cancellation of the frequency response of the instruments.

27. The method according to any of claims 13 to 26, further characterized in that said defects in the dental tissue are detected by including caries lesions in the enamel, dentin and root surfaces, erosion-like lesions on the surface of the teeth. teeth, early demineralization on the surface of the teeth, early remineralization of small lesions, cavities and / or open margins around dental restorations including crowns, inlays, assemblies, fillings and composite fillers.

28. The method according to any of claims 14 to 27, further characterized in that said reference sample is a known healthy portion of a tooth.

29. The method according to any of claims 14 to 28, further characterized in that upon detecting a defective portion of a tooth, such as fractures and fissures in the teeth, caries lesions or damaged portions including the treatment of said tooth by any or combination of the following steps; (i) remove the decayed or decayed dental material, (ii) prepare the tooth for a remedial action, (iii) alter the surface using a laser beam, (iv) alter the surface to allow the application of various means to improve remineralization, (v) applying a means that will seal the surface or promote remineralization of the surface, (vi) cure or place a material on the surface of the tooth that restores the tooth in shape and function, using the laser delivery protocols -fluence through pulse-waveform engineering, for optimized, precise control of optical radiation delivery and thermal energy generation.

30. A system for creating modulated images to form dental tissue images using photothermal modulated radiometry and luminescence for the inspection of dental tissues of a patient, comprising: at least one source of laser light modulated to irradiate a portion of a surface of a dental tissue with a ray of light of an effective wavelength where photometric photometric signals modulated and modulated luminescence signals are emitted in response from said portion of the tooth surface; image forming detection means positioned with respect to said dental tissue to detect the images of said emitted modulated photothermal radiometric signals and said modulated luminescence signals, said image forming detection means includes a combined near infrared camera, synchronized with at least one laser light source modulated to detect emitted modulated luminescence signal images and a medium infrared camera to detect images of said emitted modulated photometric photometric signals; demodulation means for demodulating said images of modulated photometric photometric signals emitted in images of the photothermal phase and amplitude components and said images of modulated luminescence signals emitted in images of phase and luminescence amplitude signals; and processing means for comparing said images of photothermal phase and amplitude signals in photothermal phase and amplitude signal images of a reference sample and comparing said images of phase and luminescence amplitude signals with phase and amplitude signal images of luminescence of a reference sample to obtain the differences, if any, between said portion of said dental tissue and said reference sample and correlate said differences with the defects in said dental tissue; and an image display to display said images.

31. - The system for creating modulated images according to claim 30, further characterized in that said at least one source of laser light modulated includes a laser conductor, and includes a function generator synchronized with the laser beam conductor, and wherein said image formation detection means are connected to said function generator and are activated by the function generator, and wherein the two-dimensional amplitude and phase images are displayed on the computer display at a laser modulation frequency.

32. The system for creating modulated images according to claim 30, further characterized by said near infrared camera is an InGaAs camera, and said middle infrared camera is a HgCdTe camera.

33.- The system for creating modulated images according to claim 30, 31 or 32, further characterized in that it includes expansion optics and beam focusing to adjust a size of said ray of incident light on the dental tissue to adjust a size of the area of the dental tissue that is being represented in image.

34.- The system for creating modulated images according to claim 30, 31, 32 or 33 further characterized in that it includes a camera for recording images of dental tissue at wavelengths in a visible portion of the spectrum.

35. - The system for creating modulated images according to claim 34, further characterized in that said camera is a CCD camera (charge coupled device) sensitive in the visible portion of the spectrum.

36.- The system for creating modulated images according to any of claims 30 to 35, further characterized in that said demodulation means is a sealed amplifier based on software.

37.- A method for forming images of dental tissue for the detection of defects in the dental tissue of a patient, comprising the steps of: a) illuminating a portion of a surface of a dental tissue with a modulated beam of laser light of an effective wavelength wherein modulated photothermal radiometric signals and modulated luminescence signals are emitted in response from said portion of the tooth surface; b) detecting images of said emitted modulated photothermal radiometric signals and said modulated luminescence signals using a combined near infrared camera, synchronized with the modulated beam of laser light to detect said emitted modulated luminescence signal images and a middle infrared camera for detecting images of said emitted modulated photothermal radiometric signals, c) demodulating said images of modulated photothermal radiometric signals emitted in images of phase and photothermal amplitude components and demodulating said luminescence signals images modulated in images of phase and luminescence amplitude signals; d) comparing said images of phase and photothermal amplitude signals with images of phase signals and photothermal amplitude of a reference sample and comparing said images of phase and luminescence amplitude signals with images of phase and luminescence amplitude signals of a reference sample to obtain the differences, if any, between said portion of said dental tissue and said reference sample and correlate said differences with the defects in said dental tissue; and e) display representative images of the defects, if any, of the dental tissue in a computer display.

38.- The method according to claim 37, further characterized in that said step of illuminating a portion of a surface of a dental tissue with an effective wavelength includes illuminating said portion of the dental tissue with at least one laser light source. modulated having a laser driver, and including a function generator synchronized with the laser driver, and wherein said step of detecting images includes using an imaging camera connected to said function generator, which is activated by the function generator, and wherein the amplitude and two-dimensional phase images are displayed on the computer display at a modulation frequency of the laser beam.

39.- The method according to claim 38, further characterized in that said near infrared camera is an InGaAs camera, and said middle infrared camera is a HgCdTe camera.

40. - The method according to any of claims 37 to 39, further characterized in that step c) of demodulating is performed using a sealed amplifier to demodulate said images of modulated photometric photometric signals emitted in photothermal phase and amplitude component images and said images of modulated luminescence signals emitted in images of phase signals and luminescence amplitude.

41. The method according to claim 37, 38, 39, or 40, further characterized in that it includes adjusting a size of said incident ray of light in the dental tissue to adjust a size of the area of dental tissue to be imaged.

42. The method according to claim 37, 38, 39, 40 or 41, further characterized in that said dental tissue is being represented in images as a complete tooth. 43.- The method according to claim 37, 38, 39, 40, 41 or 42, further characterized by including recording dental tissue images at wavelengths in a visible portion of the specimen.