Across all medical disciplines, therapeutic interventions are based on previously acquired diagnostic information. In cariology, which includes the detection and assessment of the disease “caries” and its lesions, as well as non-invasive to invasive treatment and caries prevention, visual inspection and radiology are routinely used as diagnostic tools. However, the specificity and sensitivity of these standard methods are still unsatisfactory and the detection of defects is often afflicted with a time delay. Numerous novel methods have been developed to improve the unsatisfactory diagnostic possibilities in this specialized medical field. These newer techniques have not yet found widespread acceptance in clinical practice, which might be explained by the generated numerical or color-coded output data that are not self-explanatory. With optical coherence tomography (OCT), an innovative image-based technique has become available that has considerable potential in supporting the routine assessment of teeth in the future. The received cross-sectional images are easy to interpret and can be processed. In recent years, numerous applications of OCT have been evaluated in cariology beginning with the diagnosis of different defects up to restoration assessment and their monitoring, or the visualization of individual treatment steps. Based on selected examples, this overview outlines the possibilities and limitations of this technique in cariology and restorative dentistry, which pertain to the most clinical relevant fields of dentistry.

Caries, the world’s most common chronic disease, remains a major cause of invasive restorative dental treatment. To take advantage of the diagnostic potential of optical coherence tomography (OCT) in contemporary dental prevention and treatment, an intraorally applicable spectral-domain OCT probe has been developed based on an OCT hand-held scanner equipped with a rigid 90°-optics endoscope. The probe was verified in vitro. In vivo, all tooth surfaces could be imaged with the OCT probe, except the vestibular surfaces of third molars and the proximal surface sections of molars within a "blind spot" at a distance greater than 2.5 mm from the tooth surface. Proximal surfaces of 64 posterior teeth of four volunteers were assessed by intraoral OCT, visual-tactile inspection, bitewing radiography and fiber-optic transillumination. The agreement in detecting healthy and carious surfaces varied greatly between OCT and established methods (18.2–94.7%), whereby the established methods could always be supplemented by OCT. Direct and indirect composite and ceramic restorations with inherent imperfections and failures of the tooth-restoration bond were imaged and qualitatively evaluated. The intraoral OCT probe proved to be a powerful technological approach for the non-invasive imaging of healthy and carious hard tooth tissues and gingiva as well as tooth-colored restorations.