Advanced Physics Topics in Oral and Maxillofacial Surgery
I was recently introduced to two tissue analysis methods that are on the cutting edge and give us a glimpse of the future of oral and maxillofacial surgery and medicine.
Optical Coherence Tomography
OCT uses an optical signal to process three-dimensional images that can be taken from biological tissues. The light is from the infrared region of the electromagnetic spectrum, and this long wavelength helps to non-invasively produce images of tissue morphology. It is currently used in ophthalmology to assess the retina and progression of glaucoma and in cardiology to assess plaque development in coronary arteries. Its applicability in OMS could be even more versatile than what is seen in other medical specialties.
Current OCT technology allows for penetration of approximately 1 to 2 mm, which is appropriate for analyzing superficial lesions which might occur on the tissues in the mouth. The present screening technology that we have involves using stains and light refraction to just analyze tissue thickening. Images from the OCT system have been shown to effectively diagnose and identify indicators for oral cancer and pre-cancer such as dysfunction of the epithelial layer. This does not eliminate the need for a biopsy, but it appears to be a more effective screening method.
Raman spectroscopy is a noninvasive technique that uses vibrational energy to assess scattered light from biological molecules and ions. The wavelength of the difference between the incoming and reflected lights corresponds to the molecular vibrations and leads to characteristic patterns of specific bonds. This can be important in identifying bonds not only in hard tissue, but also in soft tissue. Although many forms of spectroscopy exist, Raman spectroscopy has the advantage of its applications to fresh tissue and a better resolution, providing information regarding molecular structure and osseous structure, including protein structure and mineral crystallinity.
Again, although these methods can provide vital information, they do not describe the detailed molecular and metabolic activities of bone. This method might be extended to evaluate osseous pathologies, because molecular changes occur before the morphologic alterations in hard tissue abnormalities. Thus, Raman spectroscopy might identify bone diseases before the pathology reaches devastating proportions.
I know I have said it before, but I feel very fortunate to be practicing in the present time. New diagnostic and treatment methods during my career such as improved scans/cone beam scans, materials such as titanium dental implants, and improved anesthetic drugs and techniques make it easy and exciting for me to get up and come to my clinic in the morning. I love what I do!
Ref: J Oral Maxillofac Surg 72:1876-1879, 2014
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