Selectivity, efficiency, and surface characteristics of hard dental tissues ablated with ArF pulsed excimer lasers

Lasers are finding expanding applications in the field of dentistry. Cutting in soft tissue, hard dental material ablation, caries removal, and root canal therapy are only a few examples of dental laser uses. In this article, the application of short pulse ArF excimer laser to ablation of dentin and enamel is investigated. In particular, the effect of laser pulse repetition rates (PRR) and fluence levels on the efficiency of the ablation process and on the average thermal response of ablated surfaces is investigated. Ablation of dentin was found to be considerably more efficient than the ablation of enamel and depends exponentially on the laser fluence. Both dentin and enamel surfaces showed an increase in surface temperature with repetition rate. At lower PRR, however, temperature increases are very small. Surface temperature was also found to increase with laser fluence, although this increase is very small at laser PRR of 5 Hz or less. Tissue ablation rates were found to be comparable to or better than other nanosecond lasers, and left smooth surfaces, free of thermal damage. Microscopic examination of the ablated surface shows no crack formation, charring, discoloration, or any other thermal damage. The ablated surfaces appear to be very smooth, highly polished, and glossy looking as if they were subjected to thermal melting. This observation is indeed confirmed under scanning electron microscopy (SEM), where evidence of localized melting of the tissue is observed. Furthermore, a close SEM examination of the dentin surface reveals a selectively ablated intertubular dentin, while the remaining pillar-like dentin tubules are sealed off with fused peritubular dentin. At all fluence levels and PRR, the first three to four pulses impinging on an untreated enamel surface produced unusually large plumes of debris which were different in size, texture, and fluorescence emission characteristics from the ablation products of subsequent pulses. It is believed that these different ablation characteristics are a consequence of the pulsed ArF laser's ability to selectively remove residual matter from the more resistant enamel surface.

Laser induced cell fusion in combination with optical tweezers: the laser cell fusion trap

A single-beam gradient force optical trap was combined with a pulsed UV laser microbeam in order to perform laser induced cell fusion. This combination offers the possibility to selectively fuse two single cells without critical chemical or electrical treatment. The optical trap was created by directing a Nd:YAG laser, at a wavelength of 1.06 microns, into a microscope and focusing the laser beam with a high numerical aperture objective. The UV laser microbeam, produced by a nitrogen-pumped dye laser (366 nm), was collinear with the trapping beam. Once inside the trap, two cells could be fused with several pulses of the UV laser microbeam, attenuated to an energy of approximately 1 microJ/pulse in the object plane. This method of laser induced cell fusion should provide increased selectivity and efficiency in generating viable hybrid cells.

Excimer laser radiation for endarterectomy of experimental atheromas

Open laser endarterectomy produces a smooth arterial surface with welded distal end points. This report evaluates 308-nm excimer laser radiation for the laser endarterectomy operation. Arteriosclerotic New Zealand white rabbits (N = 15) were studied. A thoraco-abdominal exploration was performed, the aorta was isolated, heparin was administered, and multiple endarterectomies were performed in each rabbit. A line of laser craters was created at the proximal and distal ends of an atheroma. Laser radiation was used to connect the craters to form the proximal and distal end points. The atheromas were dissected from the aorta with laser light and the end points were fused. The aortas were removed for light and electron microscopy and the animals were sacrificed. Excimer radiation was delivered by a 600-microns fiber at 50 mJ/pulse, 120-ns pulses and either 15- or 20-Hz frequency. At 15 Hz excimer laser endarterectomies showed no perforations along the surface or at the end points. The surfaces were smooth but the end points were not welded in place. At 20 Hz, perforations were seen along 7/11 surfaces and at 5/11 end points. Excimer laser endarterectomy is best performed at 15 Hz. The end points, however, cannot be welded with excimer laser radiation.

Initial clinical evaluation of carotid artery laser endarterectomy

Clinical study of carotid artery laser endarterectomy began April 15, 1988. This report describes the first 10 cases that were performed in nine patients (five men and four women, mean age 70 years). Indications were asymptomatic stenosis (5), transient ischemic attacks (4), and stroke in evolution (1). There were two emergency cases and eight elective cases (including one reoperative case). Surgical exposure, systemic heparinization, vascular control, and a longitudinal arteriotomy were used. The cleavage plane between atheromas and media was developed with argon ion laser radiation (488 and 514.5 nm) directed through a 300 microns quartz fiber at power 1.0 W. Laser radiation was used to cut the atheromas out of the arteries and weld the end points. Residual atheromatous debris were vaporized with individual laser exposures. Arteriotomies were closed with sutures, and blood flow was restored. The endarterectomies were 3.9 +/- 1.1 cm long and required 330 +/- 97 joules. Mean clamp time was 22.5 +/- 7.9 minutes. Shunts were used in two cases. There were no arterial perforations or injuries as a result of laser light. Complications were hematoma (1), respiratory arrest (1), and transient neurologic deficit (1). Carotid endarterectomy is technically feasible with argon ion laser radiation. In the present series, postoperative observations, averaging 12 months and ranging from 5 to 19 months, have shown satisfactory results. No angiographic follow-up examinations were carried out.

In vivo tumor oxygen tension measurements for the evaluation of the efficiency of photodynamic therapy

Among the sequence of events which occur during photodynamic therapy (PDT) are depletion of oxygen and disruption of tumor blood flow. In order to more clearly understand these phenomena we have utilized transcutaneous oxygen electrodes to monitor tissue oxygen disappearance. These results provide, for the first time, non-invasive real-time information regarding the influence of light dose on tissue oxygenation during irradiation. Measurements were conducted on transplanted VX-2 skin carcinomas grown in the ears of New Zealand white rabbits. Rabbits were treated with Photofrin II and tumors were irradiated with up to 200 kJ/m2 (500 W/m2) of 630-nm light. Substantial reductions in tumor oxygen tension were observed upon administration of as little as 20 kJ/m2. For a series of brief irradiations, oxygen tension was modulated by the appearance of laser light. Tissue oxygen reversibility appeared to be dependent upon PDT dose. Long-term, irreversible tissue hypoxia was recorded in tumors for large (200 kJ/m2) fluences. These results suggest that transcutaneous oxygen tension may be useful as a general indicator of the effectiveness of PDT and as an in situ predictor of the energy required to elicit tumor damage.

Initial trial of argon ion laser endarterectomy for peripheral vascular disease

In the initial of open laser endarterectomy, 16 patients underwent 18 reconstructions for claudication (13 patients), rest pain (3 patients), and gangrene (2 patients). The mean (+/- SD) preoperative ankle arm index was 0.53 +/- 0.18. The laser endarterectomies were aorto-bi-iliac (1 patient), iliac (1 patient), superficial femoral (7 patients), profunda femoral (7 patients), and popliteal-posterior tibial (2 patients). All operations included surgical exposure, vascular control, administration of heparin, and an arteriotomy. Atheromas were dissected from arteries with argon ion laser radiation (power, 1.0 W). End points were welded with laser light. Arteries were closed primarily. The laser endarterectomies were 6 to 60 cm long and required 168 J to 2447.5 J. All patients had symptomatic relief, with a postoperative ankle arm index of 0.97 +/- 0.10. There were no arterial perforations from laser radiation. Surgical complications included early thrombosis requiring thrombectomy (3 patients) and hematoma requiring evacuation (1 patient). The laser endarterectomies have an 88% patency at 1 year. Open endarterectomy can be performed with laser radiation. A larger clinical trial is necessary to define the indications for laser endarterectomy in peripheral vascular disease.

Use of multiple photosensitizers and wavelengths during photodynamic therapy: a new approach to enhance tumor eradication

Several studies have examined the synergism of hyperthermia or chemotherapy agents in combination with photodynamic therapy (PDT) to enhance tumor eradication. In our unique approach to treatment, multiple photosensitizers and wavelengths were used: two photosensitizers, Photofrin II and meso-tetra-(4-sulfonatophenyl)-porphine (TPPS4), irradiated at the appropriate therapeutic wavelength for each photosensitizer. EMT-6 mammary tumors were induced in the flanks of BALB/c mice. The mice were assigned to a control group (50 mice) or treatment group (150 mice). All treatment animals and some control animals received photosensitizing drug (5 mg/kg of TPPS4, 5 mg/kg of Photofrin II, or 2.5 mg/kg of both TPPS4 and Photofrin II). All treatment animals and some control animals also received light treatment (630 nm for TPPS4 and/or 658 nm for Photofrin II). The results show that the approach using both drugs and the corresponding therapeutic wavelengths enhanced the effectiveness of PDT. This approach achieved a cure rate of up to 100%, which was, depending on the light intensity used, as much as 40% greater than the rate achieved by the approach using one drug and one wavelength. The results also show that lesser amounts of drug and/or light may be required if both drugs and wavelengths are used, thus lowering the chances of side effects common to PDT. Furthermore, the results indicate that the increased tumor kill is due to a synergistic effect of the two photosensitizers that was tested on the tumor microvasculature in the first few hours after PDT.

Force generated by human sperm correlated to velocity and determined using a laser generated optical trap

The development of the single beam gradient force optical trap has made it possible to manipulate cells solely by laser light. A continuous wave Nd:YAG (1.06 microns) laser beam was directed into a conventional microscope and focused onto the viewing plane by the objective lens. The laser beam power at which human sperm were released from the trap was measured and correlated to the sperm's linear velocity before trapping. The mean trapping power readings for slow, medium, and fast motile sperm were 57, 73, and 84 mW, respectively. The analysis of measurements over the total population demonstrated that zig-zag motile sperm had significantly higher mean power readings when compared with straight motile sperm with similar mean linear velocities. In two cases, specimens required significantly less trapping power when the measurements were repeated 24 hours later.

Free electron laser irradiation at 200 microns affects DNA synthesis in living cells

We describe the effect of a 200-microns wavelength free electron laser beam on the ability of asynchronized and synchronized mammalian tissue culture cells to incorporate tritiated thymidine. Compared to controls (unexposed cells), a significant proportion of exposed cells exhibited a reduction in isotope incorporation. The results suggest that this wavelength may affect DNA synthesis.

Comparison of contact and free beam laser endarterectomy

Free beam laser endarterectomy (LE) and contact laser endarterectomy (CLE) were compared in 15 arteriosclerotic New Zealand white rabbits. The rabbits underwent balloon catheter trauma to the thoracoabdominal aorta and were fed a 2% cholesterol diet for 18 weeks. Thoracoabdominal exploration was performed under general anesthesia and multiple endarterectomies were performed in each rabbit. Atheromas were dissected from arteries with laser radiation and end points were welded in place with laser radiation. LEs (N = 8) were performed with argon ion radiation delivered through a 400 microns fiberoptic. Power was kept constant at 1 W and the average fluence was 97.5 +/- 6.6 J/cm2. CLEs were performed with conical sapphire probes powered by either argon ion radiation (N = 12) or Nd-YAG radiation (N = 10). Power used was 1 W to 4 W for each laser. Average argon ion fluence was 117.8 +/- 3.1 J/cm2 and average Nd-YAG fluence was 611.1 +/- 34.4 J/cm2. Following the operations, aortas were removed, fixed, serially sectioned, and stained. Microscopic study revealed welded end points with LE but not with CLE. There were no perforations with LE. There were 11/12 perforations with argon ion CLE and 8/10 perforations with Nd-YAG CLE. Free beam laser endarterectomy is superior to contact laser endarterectomy for experimental atheromas.

Long-term survival of a lung cancer patient treated with photodynamic therapy

A 63-year-old male, status post-right pneumonectomy, presented with hemoptysis. Although chest X-ray and CAT scan film findings were negative, bronchoscopy with biopsy from the left mainstem bronchus demonstrated squamous cell carcinoma. Because of the inoperable location of the lesion, the patient was treated with photodynamic therapy (PDT) in February 1984. At present, the patient is cancer free more then 6 years after PDT.

Photochemotherapy of hypervascular dermal lesions: a possible alternative to photothermal therapy?

Continued improvement in the results of laser treatment of port wine stain, with reduction in scarring, will depend on the ability to use lasers to induce selective injury of only the abnormal blood vessels in the dermis while sparing the normal overlying epidermis. Photodynamic therapy, using an exogenous photosensitizing drug specifically activated by certain wavelengths of light, may be used to destroy selectively certain targets in biological systems. The current study demonstrates, in the chicken comb model, that photochemotherapy can be used to treat hypervascular dermal lesions while leaving the normal overlying epidermis completely intact.

Laser assisted fixation of ear prostheses after stapedectomy

Three different lasers (erbium:YAG, holmium:YAG, alexandrite) were used to drill a hole at the end of the long process of the incus in order to fix an ear prosthesis after stapedectomy or small fenestra stapedectomy. The energy was coupled into a 250-microns core diameter zirconium-fluoride fiber. The operations were carried out on human temporal bone models from cadavers. The fiber was guided to the incus under the stereoscopic surgical microscope. The tissue response was examined under the scanning electron microscope, and after decalcification, histologically. These studies suggest the feasibility of using the erbium:YAG laser to improve the anchorage of the prosthesis on the incus and to increase the stability in ossicular chain reconstruction.

Micromanipulation of sperm by a laser generated optical trap

The force generated by the radiation pressure of a low power laser beam induces an optical trap which may be used to manipulate sperm. We studied the effect of the optical trap on sperm motility. A Nd:YAG laser beam was coupled to a conventional microscope and focused into the viewing plane by the objective lens. Sperm were caught in the trap and manipulated by a joy stick controlled motorized stage. After different exposure periods, the velocity and patterns were analysed by a computerized image processor. There were minor changes in sperm velocity when exposed to the trap for 30 seconds or less. A gradual decrease in the mean linear velocity was observed after 45 seconds of exposure. This optical micromanipulator may also be useful for studying the force generated by a single spermatozoa and evaluating the influence of drugs on motility.

Singlet oxygen generation of porphyrins, chlorins, and phthalocyanines

The production of singlet oxygen was measured indirectly for three classes of photosensitizers: porphyrins (Photofrin II, TPPS4), chlorins (MACE, DACE), and a phthalocyanine (CASPc). Buffered solutions of sensitizers and singlet oxygen acceptors were irradiated with a CW dye laser and the oxygen depletion was monitored electrochemically with a Clark-type microelectrode. A comparison of oxygen-depletion rate constants and quantum efficiencies yields the order of efficiency of the sensitizers: TPPS4 greater than MACE greater than PII greater than DACE greater than CASPc. For singlet oxygen acceptors the order was: furfuryl alcohol greater than imidazole greater than tryptophan. CHO cell suspensions were also used as acceptors. Here the order of efficiency (per absorbed photon) was PII greater than MACE approximately CASPc. Expressed in terms of oxygen depletion per cell the order was CASPc approximately PII greater than MACE. When performing cell clonogenicity studies the order of efficiencies, expressed as percentage cell kill per unit weight of sensitizer, was CASPc greater than PII greater than MACE approximately DACE. The discrepancy between the efficiencies of sensitizers to generate singlet oxygen and their cytotoxicity was explained in terms of photodegradation (for the chlorins), intracellular localization (for PII), and contributions from a Type I mechanism (for CASPc).

Ultraviolet 308-nm excimer laser ablation of bone: an acute and chronic study

A comparative study was undertaken in rabbit tibiae to assess the healing of bone in response to osteotomies by a XeCl 308-nm excimer laser and a mechanical saw. The laser parameter producing the most efficient ablation rate for osteotomy was determined and shown to produce deep cuts with sharp edges. However, it was noted histologically that there was a significant delay in healing of the laser osteotomies compared with saw osteotomies. This delay was caused by thermal damage to bone adjacent to the laser cuts. It is suggested that the excimer laser at this wavelength ablates bone primarily through a photothermal as opposed to a photodissociative mechanism.

Use of a laser-induced optical force trap to study chromosome movement on the mitotic spindle

A laser-induced optical force trap was used to alter the movement of chromosomes in mitotic cells in vitro. The trap was produced by using a 1.06-microns neodymium YAG (yttrium/aluminum garnet) laser focused through a phase-contrast microscope. The trap was applied to one side of centrophilic chromosomes off the mitotic spindle and to late-moving chromosomes on the mitotic spindle. In both situations, chromosome movement was initiated in the direction opposite to that of the applied force. When the force was applied, chromosomes moved at velocities 10-20 times normal. These studies verify and extend the feasibility of using this new technique to study factors that influence organelle motility.

Colonic mucosectomy using laser photodynamic therapy

Photodynamic therapy (PDT) involves photosensitizing tissue and then activating it with monochromatic light, causing necrosis. Precise control of the extent of injury should be possible by varying the energy density of the light applied to the target tissue. We tested the sensitivity of colonic tissue to PDT by injecting 10 mg/kg Photofrin II intraperitoneally in 10 rats. After 24 hr the left colon was opened and cleansed. A 1.0-cm2 area of mucosa was exposed to 630 nm (red) light produced by an argon-pumped dye laser. Pairs of rats were treated with energy densities of either 10, 20, 40, 60, or 80 J/cm2, controlled by varying exposure times. After 48 hr, we sacrificed the rats and fixed, sectioned, and stained the left colons. The depth of injury was measured with an ocular micrometer and expressed as a percentage of normal bowel wall thickness. A curve was fit to the data points by computerized nonlinear regression. The relationship between depth of injury (Y) and energy density (X) was found to fit the equation Y = 1 - aebx, where constants a = 1.15 and b = -0.0353, (R2 = 0.93, P less than 0.001). The relationship between injury and energy density is biphasic, rising rapidly from 0 to 40 J/cm2 and more slowly after this point, suggesting that colonic mucosa is more sensitive to PDT than muscularis, providing a margin of safety against perforation. Bowel perforation did not occur in this study but is predicted by extrapolation for energy densities of 100 J/cm2 or greater. These data indicate that photodynamic colonic mucosectomy is possible.

Skin photosensitivity and photodestruction of several potential photodynamic sensitizers

The major side effect associated with porphyrins (Photofrin II) in clinical photodynamic therapy is skin photosensitivity. In order to avoid this deleterious reaction, patients must remain out of the sunlight for approximately 1 month. A possible procedure to reduce the amount of skin photosensitivity is to photodegrade (photobleach) the compound in the skin. In this study, we report a series of experiments describing the photodegradation rates of two photosensitizers currently receiving attention due to their potential for use in PDT (mono L-aspartyl chlorin e6 and chloroaluminum sulfonated phthalocyanine). These compounds are compared to Photofrin II (PfII). Experiments consisted of determining photodegradation rates and efficiencies of the sensitizers in (i) phosphate buffered saline (PBS), (ii) PBS with fetal calf serum (to enhance absorption and simulate cellular binding or deaggregation), (iii) Chinese Hamster Ovary cells, and (iv) Balb/c mice. We performed two standardized skin sensitivity assays using the Hartely albino guinea pig irradiated with a UV blue point lamp and Balb/c mice irradiated with the therapeutic wavelength of each sensitizer. In addition, we performed a cell clonogenicity assay comparing photodegraded and fresh PfII on CHO cells. The photodegraded PfII exhibited significant phototoxicity, although the fluorescence was bleached by more than 70%. The results show that PfII causes major skin photosensitization and that the other compounds produce no substantial skin sensitivity. Our studies suggest that photodegradation of PfII with 630 nm light has little influence on the phototoxicity of the compound. In addition, skin sensitivity was not alleviated with prior photobleaching with 405 nm light.

Mutation and sister chromatid exchange induction in Chinese hamster ovary (CHO) cells by pulsed excimer laser radiation at 193 nm and 308 nm and continuous UV radiation at 254 nm

We compared mutagenesis and sister chromatid exchange (SCE) induction by 193 nm and 308 nm pulsed excimer laser radiation with 254 nm low intensity continuous wave UV light in Chinese hamster ovary (CHO) cells in culture. The 254 nm radiation was most mutagenic of the radiations, in accordance with expectation, and also was most effective in increasing the level of SCEs. The 193 nm radiation was mutagenic at the ouabain resistance locus, but not at the HGPRT locus. However, 193 nm radiation was also strongly cytotoxic at energies producing measurable mutations. This radiation also caused a dose-related increase in SCEs. Pulsed excimer radiation at 308 nm was mutagenic at both loci, and also increased the incidence of SCEs. Comparison of the ratio of mutants/surviving cells at the D37 after radiation showed similar values for 254 nm and 308 nm at the HGPRT locus, but at the ouabain resistance locus, the ratio for the 308 nm radiation was about 5 times that for 254 nm radiation. These results indicate that some risk for mutagenesis may accompany the use of excimer radiation in the UVA region in therapeutic applications.

Mid-infrared erbium:YAG laser ablation of bone: the effect of laser osteotomy on bone healing

A comparative study was undertaken in rabbit tibiae to assess the healing of bone in response to osteotomies by a mid-infrared erbium: YAG (2.94 microns) laser or a mechanical saw. Laser parameters necessary for osteotomy were shown to produce deep cuts with sharp edges and no gross charring or burning of adjacent bone. However, it was noted histologically that there was a delay in healing of the laser osteotomies as compared to saw osteotomies. This delay was caused by a microscopic zone of damage to bone adjacent to the laser cuts. It is concluded that, although the erbium: YAG laser may be a useful tool in orthopaedic surgery to ablate bone, under the conditions used in this study, there will be a delay in the healing process after laser osteotomy.

Ablation of bone and polymethylmethacrylate by an XeCl (308 nm) excimer laser

One of the main problems in orthopaedics is the surgical removal of hard substances, such as bone and polymethylmethacrylate (PMMA). Such materials are often very difficult to remove without mechanical trauma to the remaining tissue. This study investigated the feasibility of the ultraviolet 308 nm excimer laser in the ablation of these materials. The beam was delivered through a 1 mm-diameter fiber optic at 40 Hz with energy densities at the target surface of 20-80 J/cm2 per pulse. The goal of the study was to establish the ideal dosimetry for removing bone and PMMA with minimum trauma to the adjacent tissue. Histology revealed that the 308 nm laser effectively removed bone leaving a thermal damage zone of only 2-3 microns in the remaining tissue. Increasing the energy per pulse gave correspondingly larger and deeper cuts with increasing zones of thermal damage. The excimer laser was also effective in the ablation of PMMA, creating craters in the substrate with a thermal damage zone of 10-40 microns. The debris from both substrates was evaluated.

In vitro photosensitization I. Cellular uptake and subcellular localization of mono-L-aspartyl chlorin e6, chloro-aluminum sulfonated phthalocyanine, and photofrin II

The mechanisms of cellular uptake, subcellular localization, and cellular retention kinetics of the photosensitizers photofrin II (PfII), mono-L-aspartyl chlorin e6 (MACE), and chloro-aluminum sulfonated phthalocyanine (CASPc) are reported in this paper. Each photosensitizer's cellular uptake mechanism was determined by preferentially inhibiting endocytosis by chilling cells to 2 degrees C, while allowing diffusion across the membrane. Subcellular localization was studied by computer-enhanced low-light level video fluorescence microscopy, while flow cytometry was used to determine uptake and retention kinetics. The results indicate that PfII enters the cell primarily by diffusion across the membrane, whereas MACE and CASPc enter the cell through endocytosis.