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66 American Society for Laser Medicine and Surgery Abstracts
#224
OPTICAL COHERENCE TOMOGRAPHY CAN
DETECT AND QUANTIFY
CHEMOTHERAPY-INDUCED ORAL MUCOSITIS
Michael Hoang
Irvine, CA
Background: A preliminary study to assess non-invasive optical
coherence tomography (OCT) for early detection and evaluation of
chemotherapy-induced oral mucositis in 48 patients, 12 of whom
developed clinical mucositis.
Study: In 48 patients receiving neoadjuvant chemotherapy for
primary breast cancer, oral mucositis was assessed clinically,
and imaged using non-invasive OCT. Imaging was scored using a
novel imaging-based scoring system ranging from 0 to 6.
Conventional clinical assessment using the Oral Mucositis
Assessment Scale (OMAS) scale was used as the gold standard.
Patients were evaluated on days 0, 2, 4, 7, 11 after commencement
of chemotherapy. OCT images were visually examined by three
blinded investigators.
Results: The following events were identified using OCT: (1)
change in epithelial thickness and subepithelial tissue integrity
(beginning on day 2), (2) loss of surface keratinized layer
continuity (beginning on day 4), (3) loss of epithelial integrity
(beginning on day 4). Imaging data gave higher scores
compared to clinical scores earlier in treatment, suggesting that
the imaging-based diagnostic scoring was more sensitive to
early mucositic change than the clinical scoring system. Once
mucositis was established, imaging and clinical scores
converged.
Conclusion: Chemotherapy-induced oral changes were
identified prior to their clinical manifestation using OCT, and the
proposed scoring system for oral mucositis was validated for the
semi-quantification of mucositic change.
#225
OCT VERSUS CURRENT CLINICAL STANDARDS
FOR EARLY-STAGE CARIES DETECTION
Jennifer Holtzman, Kathryn Osann,
Sandeep Potdar, Steven Duong, Yeh-chan Ahn,
Zhongping Chen, Petra Wilder-Smith
Beckman Laser Institute and Medical Clinic,
University of California, Irvine, CA; Herman Ostrow School of
Dentistry, Los Angeles, CA
Background: To compare optical coherence tomography (OCT)
with current clinical standard treatment to detect and monitor
early natural caries. Clinicians currently rely on clinical
observations and radiography to detect caries, however, these
methods are unable to reliably diagnose early primary or monitor
possible disease activity under restorations. Clinicians may be
unnecessarily placing, and replacing, restorations on teeth that
are stained or discolored, but otherwise sound. Clinicians require
better tools that they can use clinically to detect early stages of
caries, including recurrent caries, to reduce overtreatment, and
make the best use of health care providers’ resource, and health
care dollars.
Study: Two hundred teeth in various stages of soundness
including occlusal, proximal and radicular decay (determined
clinically) were photographed, radiographed, and imaged with
OCT (512 sequential 2D-OCT images). Teeth were then
restored, imaged again and radiographed, and then sectioned.
Blinded examiners reviewed radiographic and OCT images and
assigned decay status. Decay status was confirmed with
histological examination after sectioning and microscopic
evaluation.
Results: Clinician agreement (k) regarding tooth diagnosis
with OCT was overall 0.907 (SE ¼ 0.034). OCT was able to
detect early caries more reliably that visual, radiographic, or
combined methods. Areas that were truly carious were identify
as such (sensitivity > 90%); teeth that identified as sound were
truly sound (specificity > 85%). Radiographs outperformed OCT
only when decay was > 2 mm below the tooth surface. OCT
images of sound tooth showed an area of intense light
backscattering at the tooth surface, with a rapid reduction of
backscattered light beyond the initial first few microns. In
contrast, carious sites appeared as areas of diffuse nonhomogenous
scattering intensity and reduced macrostructure
definition.
Conclusion: These findings support the potential clinical utility
of OCT for early caries detection and monitoring under dental
restorations.
#226
NEW TOTAL COMBINATION TECHNIQUES WITH
PUNCH, FRACTIONAL AND LONG-PULSED
ER:YAG LASER FOR THE TREATMENT OF ACNE
SCARS COMPARED WITH THE CLASSIC
SEQUENTIAL COMBINATION THERAPY
Eun Ju Hwang, Jeanne Jung, Jong Hee Lee,
Hun Suh Dae
Klaripa Clinic; Boramae Hospital; Seoul National Hospital,
Seoul, Korea
Background: Many lasers have been used to treat acne scars.
Deep acne scars require punch or surgical methods. For better
results, a combination of procedures may be needed. However, a
comparative study to combine surgical techniques with lasers is
very limited. We investigated the effects and safety of new
developed combination therapy using punch, fractional and
Er-YAG laser.
Study: In Group I, 26 patients with moderate to severe atrophic
acne scars received new combination techniques using punch,
Profractional 1 and long-pulsed Er-YAG laser all together in a
session. Each patient was treated with a combination
procedure depending on the type and depth of their scars.
In Group II, 10 patients were sequentially treated with punch
excisions followed by laser skin resurfacing. In Group III, three
patients were treated with two sessions of laser skin
resurfacing and another three patients over three sessions with a
fractional laser in Group IV. Comparative photographs were
taken immediately before and 5 months after the end of the
treatment. Physician evaluations and patient satisfaction was
graded on a numerical scale. Three dermatologists not involved in
this study evaluated the improvement with blinded method on a
score of 0–100. Side effects were recorded during the follow-up
visit.
Results: Clinical improvement of acne scar treatment assessed by
dermatologists the mean clinical score difference was
72.30 13.54, 43.83 22.41, 60.00 2.88 and 15.00 7.26 in
Group I, II, III and IV, respectively. Long-lasting erythema at
2 months post-treatment decreased in the following order: Group
III, Group I, Group II and Group IV. Ten of 26 patients in Group I
showed hyperpigmentation. Scarring, suture marks or secondary
widening occurred, especially in Group II. Hypopigmentation also
occurred in Group II.