The effect of lasers on dental hard tissues

Scanning electron microscopic evaluation of enamel and dentin surfaces after Er:YAG laser preparation and laser conditioning

OBJECTIVE

The aim of this study was to observe and evaluate the micro-morphology of enamel and dentin surfaces after Er:YAG laser preparation and conditioning.

BACKGROUND DATA

Information regarding micro-morphologic changes of tooth substance as a result of a change of Er:YAG laser parameters for cavity preparation is limited.

METHODS

Human enamel and dentin surfaces were irradiated with an Er:YAG laser with the following parameters : (1) energy output: 200 mJ, 250 mJ, 300 mJ, 350 mJ, and 400 mJ; (2) repetition rate: 5 Hz and 10 Hz; (3) pulse duration: 100 mus/VSP (very short pulse); (4) 5 and 10 passes over the surface at a distance of 7 mm, speed: 4 mm/s using a non-contact delivery tip; (5) water cooling: 5 mL/min. The hand piece was fixed in a power driven x-y moving table. Subsequently, half of the samples were laser-conditioned at 100 mJ, 10 Hz, 250 mus/SP (short pulse) for enamel, and 80 mJ, 10 Hz, SP for dentin at a distance of 10 mm. Surface morphology and surface alterations were evaluated using scanning electron microscopy (SEM).

RESULTS AND CONCLUSION

SEM evaluation showed the characteristics of Er:YAG-lased enamel and dentin surfaces: irregular enamel surfaces with typical keyhole shaped prisms and rods, and protrusion of dentinal tubules with a cuff-like appearance. Laser conditioning rounded off the sharp edges on the enamel irregularities and dentin surface structures. First signs of vitrification were seen at 250 mJ for enamel samples and 300 mJ for dentin samples. Increase of the pulse repetition rate from 5 Hz to 10 Hz did not result in changes of surface morphology. Laser conditioning did not result in additional vitrification.

The use of Er:YAG laser for cavity preparation: an SEM evaluation

OBJECTIVE

The purpose of this study was to evaluate morphological changes in cavities prepared by the Er:YAG laser (2.94 mum) at different parameters of irradiation and by a diamond bur.

EXPERIMENTAL DESIGN

Cavities were prepared on 27 human molars (n = 3): G1, 15 Hz/160 mJ enamel/6 Hz/200 mJ dentin; G2, 15 Hz/180 mJ enamel/6 Hz/200 mJ dentin; G3, 15 Hz/160 mJ enamel/6 Hz/250 mJ dentin; G4, 15 Hz/180 mJ enamel/6 Hz/250 mJ dentin; G5, 15 Hz/180 mJ enamel/10 Hz/180 mJ dentin; G6, 15 Hz/160 mJ enamel/10 Hz/180 mJ dentin; G7, 15 Hz/160 mJ enamel/10 Hz/160 mJ dentin; G8, 15 Hz/180 mJ enamel/10 Hz/160 mJ dentin; G9, diamond bur. For SEM analysis, samples were fixed (2.5% glutaraldheyde, 12 h, 4 degrees C), dehydrated (25-100% ethanol), dried, and sputter-coated with gold.

RESULTS

Despite the changes on energy and repetition-rate settings, all laser-treated samples showed no evidence of thermal damage or signs of burning and melting. Er:YAG laser ablated dental hard tissues showed exposed enamel prisms, dentin surface without smear layer, and opened dentinal tubules.

CONCLUSION

Different Er:YAG laser parameters were effective for ablation of hard tissues, creating an irregular and microretentive morphological pattern without hard tissue damage.

Erbium, chromium:yttrium scandium gallium garnet laser for caries removal: influence on bonding of a self-etching adhesive system

This study evaluated the influence of the dental substrates obtained after the use of different caries removal techniques on bonding of a self-etching system. Forty, extracted, carious, human molars were ground to expose flat surfaces containing caries-infected dentine surrounded by sound dentine. The caries lesions of the specimens were removed or not (control--G1) either by round steel burs and water-cooled, low speed, handpiece (G2), or by irradiation with an erbium, chromium:yttrium scandium gallium garnet (Er,Cr:YSGG) laser (2W, 20 Hz, 35.38 J/cm(2), fiber G4 handpiece with 0.2826 mm(2), non-contact mode at a 2 mm distance, 70% air/20% water--G3) or using a chemo-mechanical method (Carisolv--G4). Caries-infected, caries-affected and sound dentines were submitted to a bonding system followed by construction of a resin-based composite crown. Hour-glass shaped samples were obtained and submitted to a micro-tensile bond test. The bond strength data were compared by analysis of variance (ANOVA), complemented by Tukey's test (P <or= 0.05). The samples of sound dentine presented higher bond strengths than did samples of caries-affected dentine, except for the groups treated with the Er,Cr:YSGG laser. The highest bond strengths were observed with the sound dentine treated with burs and Carisolv. The bond strengths to caries-affected dentine were similar in all groups. Additionally, bonding to caries-affected dentine of the Er,Cr:YSGG laser and Carisolv groups was similar to bonding to caries-infected dentine. Thus, caries-affected dentine is not an adequate substrate for adhesion. Moreover, amongst the caries removal methods tested, the Er,Cr:YSGG laser irradiation was the poorest in providing a substrate for bonding with the tested self-etching system.

Effects of Er:YAG laser and Nd:YAG laser treatment on the root canal dentin of human teeth: a SEM study

The objective of the study was to observe the morphological changes on root canal dentin after Er:YAG laser and Nd:YAG laser treatment. Twenty-one teeth biomechanically prepared were divided into three groups with seven teeth of each. Group A was unlased as a control. In group B, Er:YAG laser and in group C, Nd:YAG laser was applied to the root canal dentin. The roots were split longitudinally and examined using a scanning electron microscopy for the evaluation of debris, smear layer, and recrystallization. There was no statistically significant difference between the groups. This study indicates that laser beam is not effective in removing debris and smear layer.

Verifiable CPD paper: laser-tissue interaction

The oral cavity is a unique and complex environment, where hard and soft tissues exist in close proximity, within bacteria-laden saliva. All oral tissues are receptive to laser treatment, but the biophysics governing laser-tissue interaction demands a knowledge of all factors involved in delivery of this modality; through this knowledge, correct and appropriate treatment can be delivered in a predictable manner.

Spectroscopic characterization of enamel surfaces irradiated with Er:YAG laser

The purpose of this study was to investigate the effect of laser irradiation on the enamel surface spectroscopically. Polished bovine enamel surface was irradiated with an Er:YAG laser apparatus and chemically analyzed using X-ray photoelectron spectroscopy (XPS). XPS detected core electron peaks such as carbon (C 1s) and nitrogen (N 1s), as well as calcium (Ca 2s, Ca 2p, Ca 3s, Ca 3p), phosphorous (P 2s, P 2p), and oxygen (O 1s), from the control enamel surface. After irradiation, XPS revealed that the intensity of C 1s peak slightly decreased while that of N 1s diminished below the detection limit. Detailed C 1s narrow scan spectrum of the Er:YAG laser-irradiated enamel surface showed that C-O/C-N, C = O/-CON=, -COO-, and CO,3(2-) components, attributed to the specific composition of enamel and any common carbon contamination in surplus, relatively decreased. The binding energies of Ca 2p and P 2p, delta (Ca 2p, P 2p), and the Ca/P ratio of lased enamel were found to be different from those of non-lased enamel. It was also shown that Er:YAG laser ablation caused surface alterations to the apatitic inorganic components of tooth tissue.

Influence of Er:YAG laser surface treatment and primer application methods on microtensile bond strength self-etching systems

OBJECTIVE

The aim of this in vitro study was to evaluate how surface preparation and primer application technique can influence the microtensile bond strength of self-etching system.

BACKGROUND DATA

One of the possible applications of dental lasers includes increasing the quality of bond strength.

MATERIALS AND METHODS

12 extracted, sound human molars were ground flat to expose occlusal dentin and were then divided into six groups (G1-G6)(n = 30-36) according to surface preparation and primer application (active or passive): G1-diamond bur (DB) + active primer (AP); G2-DB + passive primer (PP); G3-Er:YAG laser (EL) + AP; G4-EL + PP; G5-#600-grit paper disc (PD) + AP; G6-PD + PP. After adhesive procedure, 5-mm high composite buildups were created with Z 250. After storage in water at 37 degrees C for 24 h, teeth were vertically sectioned into serial 1- mm2 sticks. Samples were tested for tension in an Instron machine at 0.5 mm/min. Nine additional molars were prepared to morphological analysis. Regular grit diamond bur, Er:YAG laser, or #600-grit SiC paper was used for SEM observations of dentin surfaces of each group before and after treatment with self-etching primers. Microtensile data were submitted to statistical analysis.

RESULTS

G1-43.85 +/- 9.60 MPa; G2-24.28 +/- 8.90 MPa; G3-24.11 +/- 4.05 MPa; G4-23.30 +/- 4.21 MPa; G5-55.64 +/- 8.50 MPa; G6-56.45 +/- 12.05 MPa.

CONCLUSIONS

(1) Er:YAG laser and diamond burs are able to create distinct smear layers; however the resistance of dentin/adhesive interface is similar. In this way, we can use both instruments clinically without diminishing bond strength; (2) the #600-grit sandpaper disc least affects resistance and is highly recommended for in vitro studies to achieve standard preparation of dentinal surface; (3) active primer application is the method most recommended, despite the type of dentin preparation instrument used.

Shear bond strength and SEM evaluation of composite bonded to Er:YAG laser-prepared dentin and enamel

OBJECTIVES

The purpose of this study was to evaluate dentin and enamel bond strength to resin composite following high-speed rotary or Er:YAG laser preparation using a total etch adhesive system. The microstructure of resin-tooth interfaces was also investigated.

METHODS

Human dentin and enamel specimens were prepared with a high-speed handpiece (KaVo) or Er:YAG laser (DELight) at manufacturer's recommended settings and etched with either 37% H(3)PO(4), laser etched, or not etched. Composite rods (Z-250, 3M/ESPE) were bonded to specimens with an adhesive (Adper Scotchbond Multi-Purpose, 3M/ESPE). After thermocycling, specimens were tested in shear to failure.

RESULTS

Two-factor ANOVA detected significant differences in the main effects of preparation and etch type, and interaction (p<0.001). Post hoc analyses showed that in both dentin and enamel, only the acid-etched specimens had significantly higher mean bond strengths, with rotary-prepared specimens having significantly higher mean bond strengths versus laser prepared specimens. Within each preparation type, in both dentin and enamel, acid etch was better than laser etch, and laser etch was better than no etch. Scanning electron microscopy of laser-ablated specimens demonstrated significant surface scaling and subsurface fissuring beyond normal resin penetration depth.

SIGNIFICANCE

Adhesion to laser-ablated or laser-etched dentin and enamel was inferior to that of conventional rotary preparation and acid etching.

Morphological comparative study on ablation of dental hard tissues at cavity preparation by Er:YAG and Er,Cr:YSGG lasers

OBJECTIVE

The purpose of this study was to evaluate morphologically the dental hard tissue ablation at the class V cavity preparation by two types of laser devices: Er:YAG and Er,Cr:YSGG lasers in vitro.

BACKGROUND DATA

There have been no reports on the comparative study of dental tissue ablation at cavity preparation by Er:YAG and Er,Cr:YSGG lasers.

METHODS

Twenty-two extracted human mature molar teeth were used in this study and divided into two groups of 11 teeth each. The teeth of the Er:YAG laser-irradiated group were irradiated at the parameters of 250 mJ/pulse and 15 Hz with water spray, and those of the Er,Cr:YSGG laserirradiated group were irradiated at the parameters of 5 Wand 20 Hz with water spray. After cavity preparation, the teeth were dehydrated, coated with platinum, and examined by scanning electron microscopy.

RESULTS

Both of the laser devices were capable of ablating dental hard tissues, but similar, irregular, and rugged surface aspects with different depths were observed. Open dentinal tubules at the cavities prepared by Er,Cr:YSGG laser were more clearly visible than those prepared by Er:YAG laser. Smaller width and stripped surfaces were observed on the cavities prepared by Er,Cr:YSGG laser.

CONCLUSION

The results suggested that there is little difference between the two types of lasers-Er:YAG and Er,Cr:YSGG lasers-morphologically for class V cavity preparation, because both lasers were capable of preparing class V cavities, and the morphological features of the irradiated surfaces were very similar.

Microtensile Bond Strength Analysis of Different Adhesive Systems and Dentin Prepared with High-Speed and Er:YAG Laser: A Comparative Study

OBJECTIVE

The aim of this study was to evaluate the bond strength of two adhesive systems (Single Bond and Clearfil SE Bond) subjected or not to a thermocycling procedure and applied to cavities prepared either with high-speed diamond bur or Er:YAG laser.

BACKGROUND DATA

One of the possible applications of dental lasers includes increasing the quality of bond strength.

METHODS

This in vitro study was carried out using a microtensile test on 16 bovine teeth, divided into eight groups. Cavities were prepared on superficial dentin of the medium portion of the buccal surface. After application of adhesive systems, composite restorations were performed at 5-mm height. After 24 h, four groups of teeth were immersed in water, and the other four were thermocycled. Bonded specimens were sectioned into serial 1x1-mm beams, which were subjected to a microtensile test. Final values of bond strength were measured, expressed in MPa, and statistically analyzed.

RESULTS

Results were as follows: G1 (26.281 +/- 5.454 MPa); G2 (10.965 +/- 3.714 MPa); G3 (18.549 +/- 6.113 MPa); G4 (14.295 +/- 3.806 MPa); G5 (18.225 +/- 5.701 MPa); G6 (5.588 +/- 2.211 MPa); G7 (18.256 +/- 3.819 MPa); and G8 (15.423 +/- 4.714 MPa).

CONCLUSIONS

Self-etching adhesive system (SE) produced more stable bond strength results than the system that indicates total etching (SB). For dentin prepared at high speed, the total etching adhesive system was more indicated, whereas Er:YAG laser-preparation dentin was not influenced by the adhesive system. The thermocycling procedure could negatively affect microtensile bond strength of both adhesive systems, being more deleterious to SB than to SE.

Efficacy of Root Canal Preparation by Er,Cr:YSGG Laser Irradiation with Crown-Down Techniquein Vitro

OBJECTIVE

The purpose of this study was to compare the efficacy of Er,Cr:YSGG laser in root canal preparation and its effectiveness in removing debris and smear layer with the efficacy of the conventional hand instrument, in vitro.

BACKGROUND DATA

Recently, the use of the Er,Cr:YSGG laser device in root canal preparation has been excepted in the dental clinic. However, there have been no published reports on root canal preparation by using the Er,Cr:YSGG laser irradiation.

MATERIALS AND METHODS

A total of 40 straight root canals were prepared by an Er,Cr:YSGG laser at a output power of 2 W, and 40 canals were shaped by using the K file under irrigation with NaOCl and H2O2 by using the crown-down technique (control). The achievement degree of root canal preparation and debris score was morphologically investigated.

RESULTS

The results showed that great improvement in the cleanliness of the walls was found using the laser technique as compared with the control technique; a significant decrease in smear layer or debris was also recognized in laser-prepared canals (p < 0.01). But canal preparations with the laser device sometime result in ledge, zipped, perforation, or over-instrumentation.

CONCLUSION

The results demonstrated that root canal preparations with the laser device were significantly worse than in the control group. Further development in laser device and technique are required to ensure its success in root canal preparation.

Procurement of Autogenous Bone from the Mandibular Ramus with Simultaneous Third-Molar Removal for Bone Grafting Using the Er, Cr:YSGG Laser: A Preliminary Report

Autogenous bone grafting and third-molar removal are surgical procedures routinely performed in dentistry on a daily basis. The purpose of this preliminary report is to describe our clinical experience with the Er, Cr:YSGG laser in the procurement of bone harvested from the ramus and removal of third molars simultaneously from the mandible.

Effect of Low-Level Er:YAG Laser Irradiation on Cultured Human Gingival Fibroblasts

BACKGROUND

Low-level laser irradiation has been reported to enhance wound healing. Activation of gingival fibroblasts (GF) has a potential for early wound healing in periodontal treatment. The present study aimed to investigate the direct effect of low-level Er:YAG laser irradiation on gingival fibroblasts proliferation in order to clarify the laser effect on healing.

METHODS

Cultured human gingival fibroblasts (hGF) were exposed to low-power, pulsed Er:YAG laser irradiation with different energy densities ranging from 1.68 to 5.0 J/cm(2). The cultures were analyzed by means of trypan blue staining and counted under a light microscope. The effect of Er:YAG laser on hGF was also evaluated using a transmission electron microscope (TEM).

RESULTS

Cultures irradiated with Er:YAG laser presented faster cell growth when compared with untreated controls. This difference was statistically significant. Transmission electron microscopy revealed rough endoplasmic reticulum, prominent Golgi complexes, and mitochondria after laser irradiation.

CONCLUSIONS

Our results showed that the low-level Er:YAG laser irradiation stimulates the proliferation of cultured gingival fibroblasts. The optimal stimulative energy density was found to be 3.37 J/cm(2). This result suggests that Er:YAG laser irradiation may be of therapeutic benefit for wound healing.

Observations on pulpal response to carbon dioxide laser drilling of dentine in healthy human third molars

Preservation of pulpal health is the primary prerequisite for successful application of laser systems in the hard tissue management of vital teeth. The purpose of this study was to investigate the short and long-term pulpal effects to cavity preparations in healthy human teeth using carbon dioxide (CO2) laser. A total of seven, healthy, third molars that were scheduled to be removed due to space problems were used. After the laser drilling, the occlusal cavities were closed temporarily, and the teeth were extracted 7 days (n=5) and 3 months (n=2) after the operation. The specimens were fixed, decalcified, subdivided and processed for light and transmission electron microscopy. Seven days postoperatively all the five teeth that had been irradiated with the CO2 laser did not reveal any pathological changes in the pulpo-dentine complex. Three months postoperatively the two teeth that were prepared with the laser showed subtle but distinct apposition of tertiary dentine that was lined with intact odontoblasts. One of the specimens at 3 months revealed the presence of a mild, but very circumscribed, pulpal infiltration of chronic inflammatory cells subjacent to the cavity preparation. The latter is unlikely to be due to a direct effect of the laser irradiation but a possible consequence of microleakage of oral antigens and/or other tissue-irritating molecules through the temporary restoration and the remaining dentine thickness (RDT). Although these preliminary histological results suggest that the CO2 laser under investigation induced only minimal response of the dentine-pulp complex when used as a hard-tissue drilling tool, with specific energy settings, pulse duration within thermal relaxation time and emitting radiations at 9.6 microm of wavelength, larger clinical trials involving various types of teeth are necessary to reach definite conclusions for large-scale clinical application of the laser device.

Erbium lasers in dentistry

Erbium hard tissue lasers have the capability to prepare enamel, dentin, caries, cementum, and bone in addition to cutting soft tissue. The ability of hard tissue lasers to reduce or eliminate vibrations, the audible whine of drills, microfractures, and some of the discomfort that many patients fear and commonly associate with high-speed handpieces is impressive. In addition, these lasers can be used with a reduced amount of local anesthetic for many procedures. Today, these instruments have evolved from their initial use for all classes of cavity preparations to their ability for removing soft tissue, their usefulness in the disinfection of bacteria within endodontic canals, and most recently, as an alternative to the high speed handpiece for the removal of bone in oral and maxillofacial surgery. In addition, recent research has centered on the value of the erbium family of laser wavelengths in periodontics, including the removal of calculus.

Morpho-structural aspects of Er:YAG-prepared class V cavities

OBJECTIVE

The aim of this study was to evaluate the ability of an Er:YAG laser (2960nm) to prepare class V cavities as compared with rotary instruments.

MATERIALS AND METHODS

Twenty-six freshly extracted human molars were selected and randomly distributed in two groups. Non standardized class V cavities were prepared using (group 1) a diamond bur for enamel, plus a tungsten bur for dentin with water irrigation and (group 2) an Er:YAG laser (output parameters, enamel: 1000 mJ, 12Hz, dentin: 500 mJ, 20Hz) with a continuous flow of water.

RESULTS

The SEM examination revealed characteristic micro-irregularities of the lased samples as compared with the conventional prepared cavities: group 1, the walls of the cavities were slightly curved and a smear layer plus muds covered peripheric walls as well as the depth of the cavity; rare dentinal tubules were opened; linear and circular surface irregularities were observed on the dentin; and group 2, the walls of the cavities were irregular, jagged; photo-ablation creates a real cleavage of hydroxyapatite prisms with respect to the enamel prism pathway; an homogeneous dentin with opened dentinal tubules covered the depth of the cavities; intertubular dentin is selectively more ablated than Er-YAG the peritubular dentin.

CONCLUSIONS

Jagged outline as well as opened dentinal tubules are the main characteristics of the Er-YAG prepared class V cavities. Further investigations (ulstrastructural, histochemical properties of the lased dentin, resistance to traction of bonded resins) should be conducted.

Thermal Effect and Morphological Changes Induced by Er:YAG Laser with Two Kinds of Fiber Tips to Enlarge the Root Canals

OBJECTIVE

The aim of this study was to assess the application of Er:YAG laser root canal preparation using two fiber tip systems.

BACKGROUND DATA

Previous studies have not shown the thermal effect of Er:YAG laser using cone-shaped fiber tip.

MATERIALS AND METHODS

The ability of Er:YAG laser to enlarge root canals at a pulse energy set at 30 or 20 mJ and constant pulse rate of 10 pps (pulses per second) was tested. A cone-shaped (84 degrees top angle) or a flat fiber tip of Er:YAG laser was used for comparison. Four groups of 15 artificial root canals with fixed dimension were prepared from bovine teeth. Irradiation was accompanied by sterilized distilled water spray (2 mL/min). The temperature changes on the root surface were recorded with an infrared apparatus, and the thermal images were captured with a thermocamera. The morphological changes of irradiated root canals were examined by a scanning electron microscope (SEM).

RESULTS

The mean temperature rises were 9.4 degrees C and 7.1 degrees C with the cone-shaped fiber tip at a pulse energy of 30 and 20 mJ, respectively, and were 11.0 degrees C and 6.5 degrees C with flat fiber tip at a pulse energy of 30 and 20 mJ, respectively. Marked difference in temperature change between the cone-shaped and flat fiber tips was noted at pulse energy of 30 mJ, but not at 20 mJ. The thermal distribution using the cone-shaped fiber tip (in contrast to the flat tip) had an elliptical shape around the fiber tip and was limited to the apical end of the root canals. SEM observation found that irradiation with cone-shaped fiber tip (in comparison to the flat tip) produced a cleaner surface.

CONCLUSION

Our results suggest that the cone-shaped fiber tip of Er:YAG laser produced fewer thermal effects and morphological changes as compared to the other type of fiber tip.

Short-term histomorphological effects of Er:YAG laser irradiation to rat coronal dentin-pulp complex

OBJECTIVE

The objective of the study was to examine the morphological changes of neural elements in dentin-pulp complex ultrastructurally after Er:YAG laser irradiation and elucidate the mechanism of pain reduction in cavity ablation.

STUDY DESIGN

The Er:YAG laser was applied at occlusal surfaces of upper and lower first molar cusps of 6 rats, and shallow cavities were ablated. The dentin and pulps were examined with light and electron microscopes at 6 hours after the irradiation. Teeth, without laser irradiation, from three rats were used as controls.

RESULTS

Disruption of nerve terminals in the dentinal tubules, degeneration of nerve terminals between odontoblasts, and disruption of the myelin sheath in the pulp core were demonstrated with electron microscope.

CONCLUSION

Some Er:YAG laser beams could penetrate to deeper areas than ablated area, and damage of nerve fibers and terminals might be a mechanism of pain reduction in cavity ablation with Er:YAG laser.

In vitro study of a neodynium:yttrium aluminum perovskite laser on human nonexposed pulp after cavity preparation

PURPOSE

The aim of this study was to investigate dental pulp reactions after a neodynium:yttrium aluminum perovskite laser pulse on the dentinal floor of occlusal cavities in an in vitro model.

METHODS

A Lokki dt laser was used at 30 Hz, 5 W, and 160 mJ for 0.5 s. The pulp reactions were analyzed in a previously described human tooth slice cultured model. The following markers were identified by immunohistochemistry: collagens I, III, and IV and HLA-DR-positive cells.

RESULTS

After 4 days of culture, under laser pulse, a concentration of type III collagen beneath the odontoblast layer, a higher level of vessels and an accumulation of HLA-DR-positive cells were routinely observed subjacent to the cavity.

CONCLUSION

This laser treatment leads to the first step of rapid pulp repair under culture conditions.

Influence of the EDTA, Nd:YAG laser and association of both on the filling of artificial lateral root canals

This study aimed at evaluating the influence of EDTA, Nd:YAG laser and the combination of both for filling of artificial lateral root canals. Forty-five human mandibular premolars were employed, on which three artificial lateral root canals were prepared by means of a reamer with a similar diameter to a K file #15. The teeth were instrumented through the stepback technique employing Gates Glidden burs at the middle and cervical thirds and manual files at the apical portion, and irrigation with 1% sodium hypochloride. The teeth were divided in three groups: Group 1 -EDTA for 5 minutes; Group 2 -application of Nd:YAG laser at 15 Hz, 100 mJ and 1.5 Watts; and Group 3 - association of both. Roots were filled through the Tagger's hybrid technique, radiographed and the radiographs were digitized. Scores were assigned to the filling of the lateral root canals. Statistical analysis revealed no significant differences between the entire groups and also on the analysis of each third.

Three-dimensional topographic scanning electron microscope and Raman spectroscopic analyses of the irradiation effect on teeth by Nd:YAG, Er: YAG, and CO2 lasers

A three-dimensional analyzer installed in a scanning electron microscope was used to evaluate the morphology and surface roughness using noncontact profilometry. Observations were carried out on the enamel and dentin surface irradiated by three different lasers: Nd:YAG (wavelength 1.06 microm), Er:YAG (2.94 microm), and CO(2) (10.6 microm). Spectroscopic analysis was done by Raman spectroscopy for nonirradiated and laser-irradiated surfaces. The lasers were applied perpendicularly to vertically sectioned and polished human extracted caries-free molars. The tooth was sectioned at each cavity for cross-section analysis after laser irradiation. Irradiation by Nd:YAG and CO(2) lasers of the enamel surface showed an opaque white color, different from dentin where the surface turned black. The Er:YAG laser induced no changes in color of the dentin. Numerous cracks associated with thermal stress were observed in the CO(2) laser-irradiated dentin. Noncontact surface profile analysis of Er:YAG laser-irradiated enamel and dentin showed the deepest cavities, and direct cross-sectional observations of them showed similar cavity outlines. The CO(2) laser-irradiated dentin had the least surface roughness. Raman spectroscopic analysis showed that fluorescence from the laser-irradiated tooth was generally greater than from nonirradiated teeth. Bands in dentin attributed to organic collagen matrix were lost after Nd:YAG and CO(2) laser irradiation, and a broad peak due to amorphous carbon appeared. The Er:YAG laser-irradiated dentin showed no sign of a carbon band and had more suitable results for dental ablation. Noncontact surface profile analysis was effective to evaluate the structural change in the tooth in the microarea of study after laser irradiation.

Pulpal response to Er:YAG laser drilling of dentine in healthy human third molars

BACKGROUND AND OBJECTIVES

Maintenance of pulpal health is a critical prerequisite for successful application of light amplification by stimulated emission of radiations (lasers) in the hard tissue management of vital teeth. The purpose of this study was to investigate the short- and long-term pulpal effects to cavity-preparations in healthy human teeth using erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser.

MATERIALS AND METHODS

A total of seven healthy third molars that were to be removed due to space-problem were used. Following the laser excavation, the cavities in dentine were closed temporarily and the teeth were extracted after 7 days (n = 5) and 3 months (n = 2) post-operation. The specimens were fixed, decalcified, subdivided, and processed for light and transmission electron microscopy.

RESULTS

In the short-term group, four of the five laser-drilled teeth did not reveal any pathological changes in the pulp-dentine complex. One tooth showed mild disruption of odontoblasts (OB) and vascular dilatation subjacent to the deepest point of the cavity-preparation with a remaining dentine thickness (RDT) of less than 80 microm. The two teeth under long-term observation revealed distinct apposition of tertiary dentine (TD), lined predominantly with cuboidal cells on its pulpal aspect.

CONCLUSIONS

These results would allow a conclusion to be drawn that the Er:YAG laser under investigation is a pulp preserving hard-tissue drilling tool when used with the specific energy settings and emitting radiation at a wavelength of 2.94 microm.

Clinical application of Er:YAG laser for cavity preparation in children

OBJECTIVE

The purpose of this study was to determine the clinical usefulness of Er:YAG laser for cavity preparation in children.

BACKGROUND DATA

The conventional methods for cavity preparation instill fear and discomfort in pediatric patients. The Er:YAG laser is a new tool developed for cavity preparation; however, there are few reports of its clinical application.

MATERIALS AND METHODS

A clinical evaluation using an Er:YAG laser was carried out using 32 subjects (with 16 deciduous and 19 permanent teeth) with ages ranging from 2 to 12 years. All cavities were restored with light-cured composite resin following the application of bonding agent, but without acid etching or primer conditioning.

RESULTS

During laser treatment, the pediatric patients were very cooperative and hardly complained of any pain, and no tooth showed undesirable effects during the 3-year period of observation.

CONCLUSION

It can be concluded from the results of this study that an Er:YAG laser would be a useful alternative method for cavity preparation for composite resin restoration in children.

Efficacy of subgingival calculus removal with Er:YAG laser compared to mechanical debridement: an in situ study

OBJECTIVES

The aim of the present study was to compare the effectiveness of subgingival calculus removal from periodontally involved root surfaces with an Er:YAG laser compared to hand instrumentation in situ.

METHODS

The mesial and distal surfaces of 30 single-rooted teeth with untreated periodontitis were treated either by hand instrumentation (scaling and root planing (SRP)) or by Er:YAG laser irradiation with the aim of achieving a calculus-free root surface. Subgingival plaque samples were obtained before and immediately after treatment for microbiological evaluation by culture and DNA probe analysis. The teeth were extracted and the residual calculus was measured by means of digitized planimetry. The morphology of the root surface was evaluated by scanning electron microscopy, and undecalcified sections were analyzed to determine residual calculus and the extent of cementum removal following both treatments.

RESULTS

Following laser irradiation, 68.4+/-14.4% of the root surface was calculus free in contrast to 93.9+/-3.7% after SRP when both treatments were performed for the same time (2:15+/-1:00 min). If laser irradiation was allowed twice the time used for hand instrumentation, 83.3+/-5.7% of the root surface was devoid of calculus. The effectiveness of both treatments was not related to initial probing depth. The histologic evaluation showed that after SRP 73.2% of root dentin was completely denuded from cementum, while only a minimal cementum reduction was apparent after laser irradiation. Both treatment modalities resulted in a similar reduction of periodontopathogens.

DISCUSSION

The present investigation could demonstrate the in vivo capability of the Er:YAG laser to remove calculus from periodontally involved root surfaces, although the effectiveness did not reach that achieved by hand instrumentation. The lack of cementum removal in contrast to SRP may qualify the laser as an alternative approach during supportive periodontal therapy.

Atomic analysis and knoop hardness measurement of the cavity floor prepared by Er,Cr:YSGG laser irradiation in vitro

In the present study, the compositional changes and knoop hardness of the cavity floor prepared by Er,Cr:YSGG laser irradiation was compared with that of the conventional bur cavity. Fifteen laser and 15 bur cavities were cross-sectioned, and subjected to atomic analysis by SEM-EDX and knoop hardness test. Statistical analyses were performed using the Mann-Whitney U-test; a value of P < 0.01 was considered significant. Surface characteristics of the prepared cavities were also investigated by light microscopy and scanning electron microscopy (SEM). The results showed that the quantities of Ca (Ca weight %) and P (P weight %) were increased significantly in the laser cavity floor but no significant differences were found between the Ca/P ratio and knoop hardness number of laser and bur cavities. The SEM observation revealed that the lased cavity surface was irregular and there was also the absence of a smear layer; the orifice of dentinal tubules was exposed. Er,Cr:YSGG laser device is considered as one of the most effective and safe devices for cavity preparation because of its many advantages. This includes easy delivery system, minimal thermal damage to the surrounding tissues, minimal thermal-induced changes of dental hard tissue compositions, and favourable surface characteristic.

A comparative study on compositional changes and Knoop hardness measurement of the cavity floor prepared by Er:YAG laser irradiation and mechanical bur cavity

OBJECTIVE

This present study was performed to compare the compositional changes of human dentin and, Knoop hardness of the cavity floor prepared by Er:YAG laser irradiation with that of the conventional bur cavity.

BACKGROUND DATA

There are still no reports on the compositional changes of dental hard tissues and microhardness of the cavity floor prepared by Er:YAG laser irradiation.

MATERIALS AND METHODS

Fifteen laser and 15 bur cavities were cross-sectioned, and subjected to atomic analysis by SEM-EDX and Knoop hardness testing. Statistical analyses were performed using the Mann-Whitney U test; a value of p < 0.01 was considered significant. Cross sections of the remaining five laser and five bur cavities were examined by light microscopy and then by SEM.

RESULTS

The results showed that the quantities of Ca (Ca weight %) and P (P weight %) were increased significantly in the laser cavities, but no significant differences were found between the Ca/P ratio and Knoop hardness number of laser and bur cavities. The results of SEM observation revealed that the lased cavity surface was irregular, and there was also the absence of a smear layer; the orifice of dentinal tubules was exposed.

CONCLUSION

Er:YAG laser device produces minimal thermal induced changes of dental hard tissue compositions; Ca/P ratio and Knoop hardness of the lased cavity floor was almost similar to the bur cavities.

Effect of Nd:YAG laser irradiation on the hardness and elastic modulus of human dentin

OBJECTIVE

The purpose of this study was to investigate the changes of hardness and elastic modulus of human dentin after Nd:YAG laser irradiation.

BACKGROUND DATA

The application of Nd:YAG laser in dental hard tissues has been widely studied. However, little information is available about the mechanical properties of teeth after Nd:YAG laser irradiation.

METHODS

The human dentin was irradiated by Nd:YAG laser through a 400-microm optic bare fiber. The parameters in laser delivery were 100 mJ/pulse--10 pps--4 sec and 150 mJ/pulse--10 pps--4 sec. Both the hardness and elastic modulus were obtained using an Instron microhardness tester and Vickers indenter. The indentations were then examined under a scanning electron microscope.

RESULTS

The hardness and elastic modulus of irradiated human dentin in the energy of 100 mJ/pulse--10 pps--4 sec and 150 mJ/pulse--10 pps--4 sec were 44.7 kg/mm(2) and 22.8 GPa, and 46.9 kg/mm(2) and 21.4 GPa, respectively. These values were significantly lower than that of non-irradiated dentin by the Student's t test.

CONCLUSION

Our study demonstrated that Nd:YAG laser irradiation would reduce the hardness and elastic modulus of human dentin.

Morphological study of dentin irradiated by solid-state ultraviolet lasers: a comparison of wavelength and repetition rate

OBJECTIVE

In this study, we examined the surface morphology of dentin after being ablated by the third, fourth, and fifth harmonics of the Nd:YAG laser. The influences of the repetition rate with respect to the wavelength were also investigated.

BACKGROUND DATA

Typically, excimer lasers have been used as the primary sources of ultraviolet (UV) laser wavelengths to investigate laser ablation of dentin. In the past decade, developments in nonlinear optical technology have given rise to higher conversion efficiencies of the fourth and fifth harmonics of the Nd:YAG laser. To this end, sufficient energy densities of the fourth and fifth harmonics of the Nd:YAG laser have been generated to ablate dentin.

MATERIALS AND METHODS

Thin dentin samples (typically 1 mm) were irradiated by the third, fourth, and fifth harmonics of the Nd:YAG laser. Ablation occurred at repetition rates of 1, 5, 10, and 20 Hz, using similar energy densities for each laser wavelength. An environmental scanning electron microscope was used to assess the resultant surface morphology.

RESULTS

Dentine surfaces after 355-nm ablation exhibited plugging at each repetition rate. Similar surfaces were exhibited after 266-nm ablation. "Plugging" over dentine tubules was less obvious after 213-nm laser ablation. The results may highlight the impact of different absorption characteristics of each wavelength.

CONCLUSION

Solid-state UV laser ablation of dentin exhibits similar properties to excimer laser ablation. At similar energy densities, the deeper UV laser wavelengths exhibit less "plugging" of dentin tubules, suggesting a lower thermal impact.

Histological and scanning electron microscope examination of root canal after preparation with Er:YAG laser microprobe: a preliminary in vitro study

OBJECTIVE

Until now, there has been no study that demonstrates the effectiveness of Er:YAG laser microprobes to clean and shape the root canal without using any mechanical instrumentation.

MATERIALS AND METHODS

The study was conducted on 28 single-rooted extracted central incisors teeth with straight roots. Fourteen were mechanically prepared and served as the control group, and 14 were treated by Er:YAG laser only. From every group, half of the teeth were examined histiolgically and half by SEM. The instrument tested was an Er:YAG laser with microprobes 200-400 micro in diameter and 20 mm in length, coupled onto special handpieces, attached to the delivery fiber of an OPUS 20 Er:YAG laser. The Er:YAG laser was applied with the following parameters: wavelength 2.94 microm; pulse duration 400 msec; repetition rate 10 Hz; energy per pulse 140 mJ for the 400 micro microprobe and 90 mJ for the 200-micro microprobe.

RESULTS

For the control group, histologically, large amounts of residual pulp tissue were found in the root canal cavity, and open tubules were seen in all the specimens; SEM examination showed very uniform root canal, from apical to cervical portion, high number of open tubules, and different levels of canal debridment. For the study group, histologically, no residual pulp tissue was found in the root canal cavity and open tubules were seen in all the specimens; SEM examination showed the root canal free of debris, removed smear layer, open dentinal tubules, and different levels of enlargement.

CONCLUSION

Our results show that the Er:YAG laser special microprobes are effective in shaping, cleaning, and enlarging straight root canals faster and more efficiently then traditional methods.

Immunohistochemical study on pulpal response in rat molars after cavity preparation by Er:YAG laser

While Er:YAG laser systems are in extensive use for caries removal and cavity preparation, the effects of such treatment on pulp tissue remain unclear. This study evaluates these systems using immunohistochemical methods and compares the results with information gained from treatment using conventional burs. Cervical cavities were prepared in the upper first molars of rats, using either an Er:YAG laser or a conventional tungsten-carbide bur. At intervals of 5 min, 6 h, 12 h, 1 d, 3 d and 7 d after cavity preparation, the teeth were processed for immunohistochemical analyses of tissue non-specific alkaline phosphatase, OX6-positive major histocompatibility complex class II antigen-expressing cells and PGP 9.5-immunoreactive nerve fibers. DNA fragmentation was detected by the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method. Tissue non-specific alkaline phosphatase was observed mainly in the subodontoblastic layer under the cavity lesion, from 5 min, in both groups. The immunoreactivity was more pronounced in the laser group, but by 7 d no significant differences were recognizable. At 12 h, TUNEL-positive cells were detected around the odontoblastic layer in both groups. From 3 d to 7 d, a limited number of positive cells were still visible in the group that underwent standard treatment. Clear similarities in the distribution patterns of OX6-immunopositive cells and PGP 9.5-immunoreactive nerve fibers were also noted. From 12 h to 1 d, OX6-positive cells accumulated along the pulp-dentin border, extending their processes into the dentinal tubules. Numerous bead-like PGP 9.5-immunoreactive nerve fibers were observed under the odontoblastic layer at 7 d. These results demonstrated that there was no appreciable difference in the manner in which pulp tissue responded to treatment with either Er:YAG laser or a conventional drill. This would seem to indicate the usefulness of the Er:YAG laser system in the removal of caries and cavity preparation.

Morphological and microleakage studies of the cavities prepared by Er:YAG laser irradiation in primary teeth

OBJECTIVE

The purposes of this study were to investigate cavity surfaces morphologically, and compare microleakage at cavities prepared by Er:YAG laser after composite resin restoration versus conventional mechanical treatment in human primary teeth in vitro.

BACKGROUND DATA

There have been few reports on microleakage at cavities prepared by Er:YAG laser irradiation.

MATERIALS AND METHODS

A total of 30 cavities (class V) in human primary teeth were used. Half of the cavities were prepared by an Er:YAG laser system at 300 mJ pulse energy and 4 Hz, and the other half were prepared with a high-speed diamond bur. Five cavities from each group were investigated by scanning electron microscopy (SEM) and histopathological examination. Remaining cavities were filled with a composite resin without an acid-etching technique and then subjected to microleakage test in 0.6% rhodamine B solution under thermocycling.

RESULTS

Microleakage (score: 2.45 +/- 1.07) at cavities prepared by laser was significantly less than that by bur (score: 1.30 +/- 0.95; p < 0.05). SEM observation showed that, compared with the relatively flat appearance of cavities prepared by bur, cavity margins prepared by laser were irregular but there was almost no smear layer at the cavity walls.

CONCLUSION

It can be concluded that cavity surfaces prepared by Er:YAG laser are irregular, but microleakage at cavities prepared by the laser after filling with composite resin is better than that by mechanical bur using the dye penetration method.

Glass ionomer microleakage from preparations by an Er/YAG laser or a high-speed handpiece

OBJECTIVE

The purpose of this study was to compare microleakage of glass ionomer materials (GIC) using two different modes of cavity preparation: a high-speed hand piece and an erbium/yttrium-aluminum-garnet (Er/YAG) laser.

METHODS

Eighty caries free permanent molar teeth had class V preparations cut on both the buccal and lingual surfaces. The high-speed hand piece was used to prepare a class V cavity preparation on the buccal surface and an Er/YAG laser was used to prepare a class V cavity preparation on the lingual surface. GIC or resin modified GIC was used as the restorative material. The teeth were thermocycled for 7000 cycles, placed in 2% basic fushin for 24h, sectioned in the center of each restoration, and analyzed under a stereomicroscope.

RESULTS

There was no statistical difference in microleakage between the two modes of cavity preparations. The gingival margins had more microleakage than the occlusal margins for both GIC materials and the resin modified GIC showed significantly more leakage than the conventional GIC.

CONCLUSIONS

The Er/YAG laser provided an equivalent method of tooth removal when evaluated for microleakage of GIC materials compared to a high-speed hand piece.

Root surface morphological changes after focused versus defocused CO2 laser irradiation: a scanning electron microscopy analysis

BACKGROUND

Many studies have observed damages to root surfaces treated by CO2 laser in continuous mode with a focused beam. The morphologic changes observed were always associated with temperature increase induced by high energy release.

METHODS

The purpose of this study was to analyze by scanning electron microscopy (SEM) the effects of CO2 laser in 2 different modes on root surfaces. Study samples consisted of 30 extracted single-rooted periodontally compromised human teeth. Root specimens were randomly assigned to 3 groups: group A (12) treated with CO2 laser in continuous mode with a focused beam of 0.8 mm; group B (12) treated with CO2 laser in pulsed mode with defocused beam of 4 mm; and group C (6), untreated controls.

RESULTS

Group A (continuous mode) showed severe damages to dentin surfaces such as craters and fissures. Group B (defocused mode) did not result in any damages to the root surfaces, showing flat and smooth surfaces with apparent fusion of the smear layer and dentinal tubules almost completely sealed. The untreated control group was characterized by irregular and amorphous surfaces with several shallow depressions.

CONCLUSIONS

Although both laser modes resulted in changes to the treated root surface specimens, the changes resulting in a smooth surface from use of defocused pulsed beam may present an advantage in periodontal treatment.

Clinical assessment of Er,Cr:YSGG laser application for cavity preparation

In this study, an erbium,chromium:YSGG (Er,Cr:YSGG) laser emitting at a wavelength of 2.78 microm was clinically applied to remove caries and prepare cavities, and the clinical outcome was evaluated. Effective clinical application of Er,Cr:YSGG laser had been expected from previous studies. This study included 44 patients (26 females, 18 males; aged 23-58) with a total of 50 cavity preparations by the Er,Cr:YSGG laser irradiation at 3-6 W with water spray. Patient acceptance and prognosis were evaluated. Most cases (94%) were prepared without anesthesia, and no pain was felt in 34 cases (68%). No adverse reaction was observed in any of the cases, and patient acceptance for this system was favorable. All cases had a good prognosis. In 45 cases (90%), overall clinical evaluation was satisfactory. From the present study, it can be concluded that the Er,Cr:YSGG laser system is an efficient, effective, and safe device for caries removal and cavity preparation.

The effect of Nd:YAG radiation at nanosecond pulse duration on dentine crater depth

The effect of laser parameters on laser-dentine interaction is little known. The aim of this in vitro study was to determine the effect on dentine crater depth of Nd:YAG laser radiation in relation to pulse repetition rate, total delivered energy, dentine site and the presence or absence of a dye. One hundred and forty-four sound third molars were extracted and sectioned transversely to provide 288 upper and lower cut surfaces. The upper surfaces were painted with a layer of dye (IR5) suitable for absorption at 1064 nm. The specimens were divided into 12 sub-groups each containing 12 upper and 12 lower specimens. These were exposed to a Nd:YAG laser with a 30 nanosecond (ns) pulse duration. This laser operated in a non-contact mode (spot diameter 165 microm) with pulse repetition rates of 2.5, 5.4 and 10.5 Hz. Four total energies were delivered at each repetition rate; 2.3, 3.63, 3.96, 4.29 joule (J) at 2.5 Hz repetition rate; 2.3, 2.64, 3.63, 4.29 J at 5.4 and 10.5 Hz repetition rates. Five outer and three inner sites were irradiated on each specimen. Each dentine crater depth was measured five times using a Reflex Microscope and a three-dimensional centre of gravity derived. An upper and lower specimen were taken from each sub-group and viewed under a scanning electron microscope (SEM). ANOVA was applied: total delivered energy and dyed/undyed were found to have a statistically significant effect on crater depth (p<0.0001). In general increasing energy and the presence of dye produced deeper craters. Inner/outer dentine location and repetition rate were not found to be statistically significant. All craters were carbonised.

Analysis of surface roughness of enamel and dentin after Er,Cr:YSGG laser irradiation

OBJECTIVE

The purpose of this investigation was to compare the surface roughness of enamel and dentin following the Er,Cr:YSGG laser irradiation and acid etching.

BACKGROUND DATA

Laser-roughened enamel or dentin surfaces have been expected to enhance restorative materials bond strength.

MATERIALS AND METHODS

Er,Cr:YSGG laser irradiation was performed in one half of each polished enamel or dentin sample at 3 W (33.9 J/cm2, with air 70% and water 20%,) pulse energy for 6 sec. Then the other half was treated with 37% phosphoric acid for 30 sec. Surface roughness and morphological studies were performed.

RESULTS

It was found that surface roughness was significantly increased with the laser system. Scanning electron microscopy analysis showed that irradiated surface produces a rough surface that was completely lacking of a smear layer; there was also no cracking of enamel or dentin.

CONCLUSION

Er,Cr:YSGG laser irradiation could provide an effective and alternative method to the acid etch technique.

Comparison between the removal effect of mechanical, Nd:YAG, and Er:YAG laser systems in carious dentin

OBJECTIVE

The purpose of this study was to compare the effectiveness of carious dentin removal by using an Er:YAG laser irradiation and Nd:YAG laser under a continuous water spray with that of the conventional mechanical treatment in vitro.

BACKGROUND DATA

Lasers are being considered as a potential replacement of conventional mechanical systems to remove diseased and healthy dental hard tissues.

METHODS

First, one half of the 10 carious lesions were treated with the round steel bur and then removed. The other half were treated with the Er:YAG laser at 200-mJ pulse energy at 2 Hz. After that, one half of another set of 10 teeth was subjected to the round steel bur in which the other half was removed using the Nd:YAG laser at 6-W output power, 20 pps, and under a continuous water spray (120 mL/min). Thermal change during each treatment and the time required for carious dentin removal was determined, and the surface characteristic was observed using the scanning electron microscopic (SEM).

RESULTS

The Er:YAG or Nd:YAG laser irradiation time was almost two or three times longer than the bur treatment, respectively. From the SEM study, it was found that the lased cavity surface revealed various patterns of microirregularity, and there was also no smear layer.

CONCLUSIONS

It can be suggested that under adequate water spray and with a careful irradiation technique, cavities without sign of thermal damage to the surrounding tissues as well as dental pulp could be produced with the Er:YAG and Nd:YAG laser.

[Morphologic evaluation of the bonding between adhesive/composite resin and dentin irradiated with Er:YAG and Nd:YAG lasers: comparative study using scanning microscopy]

Since bonding systems were introduced in the restorative procedures carried out with esthetic materials, the treatment of dentin surfaces has been widely studied in order to establish the ideal technique. The application of 37% phosphoric acid on dentin is still the best known method. However, alternative methods for treating the dentin surface have been discussed in the literature, including the utilization of some kinds of laser irradiation. The purpose of this research was to morphologically evaluate the bond between adhesive materials and the dentin treated with Er:YAG and Nd:YAG lasers, in a comparative study by means of scanning electron microscopy (SEM). Irradiation either substituted acid etching, or was associated to it. Recently extracted bovine incisors were utilized. They received class V cavity preparations and were restored with a bonding system and a light-cured composite resin. Meanwhile, some of the teeth underwent irradiation with Er:YAG laser or Nd:YAG laser before the application of the bonding agent and the composite resin. The samples were selected, prepared for SEM and submitted to morphological analysis. Data were registered in photomicrographs. Based on the microscopic observations, we concluded that only in the dentin surfaces submitted to irradiation with Er:YAG laser and to acid conditioning there was penetration of resin into the dentine. With the Nd:YAG laser treatment, there was only visual superposition of resin over the dentin surface, which suggests that there was only occlusion of the tubules, with characteristics of fusion in the superficial dentine.

Microleakage of composite restorations after acid or Er-YAG laser cavity treatments

OBJECTIVES

The purpose of this study was to compare microleakage of Class V restorations following acid, laser or laser and acid treatment of cavity walls.

METHODS

Standardized lingual and buccal Class V preparations were made in 18 human extracted third molars. The preparations were randomly assigned to three equal groups (n=12). Group 1: cavities were treated with 35% phosphoric acid. Group 2: cavities were irradiated with an Er-YAG laser at 2Hz and 250mJ on dentin and 300mJ on enamel, with water cooling. Group 3: cavities were irradiated with the laser before acid etching. Scotchbond 1 Adhesive System and Z100 resin composite were used for restorations. The specimens were stored in water for 24h at 37 degrees C and thermally cycled (500x) between 6-60 degrees C. After 24h immersion in 0.5% basic fuchsin, dye penetration was recorded according to an ordinal scale. Data were analysed using non-parametric statistical tests (Kruskal-Wallis and Mann-Whitney).

RESULTS

On the occlusal walls, microleakage in acid etched cavities was significantly lower than that achieved after laser treatment (P<0.001) or after both treatments (P<0.05). On the gingival walls, no statistical differences were found.

SIGNIFICANCE

Laser irradiation of enamel is not a valid alternative to acid-etching pretreatment for resin composite materials adhesion. Acid etching alone gave the lowest microleakage at the occlusal margin. No differences were found for microleakage on gingival wall, although lased dentin surfaces presented several characteristics that appear to be advantageous for bonding.

A study on acquired acid resistance of enamel and dentin irradiated by Er,Cr:YSGG laser

OBJECTIVE

This investigation was performed to evaluate the acid resistance of lased enamel and dentin by Er,Cr:YSGG laser to artificial caries-like lesions by spectrophotometry, and the ultrastructure of lased areas was investigated by scanning electron microscopy (SEM) in vitro.

BACKGROUND DATA

In recent years, many studies have been performed to evaluate the effects of Er,Cr:YSGG laser on dental hard tissues. However, there have been only a few studies to determine if this laser is suitable for caries preventive treatments.

METHODS

An Er,Cr:YSGG laser was used to irradiate the enamel or dentin samples from 30 extracted human molars at 6 W (67.9 J/cm2) or 5 W (56.6 J/cm2) pulse energy, respectively, with or without water mist. Samples were subjected to 2 microl of 0.1 M lactic acid solution (pH 4.8) for 24 h at 36 degrees C. The parts per million (ppm) of calcium ion (Ca2+) dissolved in each solution was determined by atomic absorption spectrophotometery, and the morphological changes were investigated by SEM.

RESULTS

The lowest mean Ca2+ ppm was recorded in the lased samples. SEM observation showed that the lased areas were melted and seemed to be thermally degenerated. After acid demineralization, the thermally degenerated enamel or dentin surfaces were almost unchanged.

CONCLUSIONS

The results of this study suggested that Er,Cr:YSGG laser irradiation with and without water mist appears to be effective for increasing acid resistance.

Removal of carious dentin by Er:YAG laser irradiation with and without carisolv

OBJECTIVE

The purpose of this study was to investigate the effectiveness of caries removal by using an Er:YAG laser irradiation with and without Carisolv, in vitro.

BACKGROUND DATA

Effective ablation of dental hard tissues using Er:YAG laser has been reported and its application to caries removal has been expected.

METHODS

Five extracted human teeth were selected for Carisolv and burr treatment. One-half of the lesion was treated with the Carisolv and then removed. The other half was removed using burr treatment. Fifty teeth were subjected to Er:YAG laser treatment with and without Carisolv. First, Carisolv was applied on one-half of each carious lesions for 1 min and followed by the Er:YAG laser irradiation at 60-140 mJ, 2 Hz for another 1 min; the other half was treated with Er:YAG laser only. The cavity was carefully assessed by DIAGNOdent. Each lesion was photographed before and after treatment, and the treated cavity was observed by microscopy and with scanning electron microscope (SEM).

RESULTS

Our results revealed that application of Carisolv followed by Er:YAG laser irradiation at 100-140 mJ pulse energy effectively removed dentin caries. From the SEM study, it was found that the cavity surface treated with the laser revealed various patterns of microirregularity, often accompanied by microfissure propagation. There was also no smear layer.

CONCLUSIONS

It was revealed that Er:YAG laser and Carisolv could provide an alternative technique for caries removal for conventional mechanical drilling and cutting.

Effects of Er,Cr:YSGG laser irradiation in human enamel and dentin: ablation and morphological studies

OBJECTIVE

This investigation was performed to determine quantitatively the ranges of ablation and to evaluate the morphological changes in human enamel and dentin irradiated by Er,Cr:YSGG laser with or without water spray.

SUMMARY BACKGROUND DATA

Recently, Er,Cr:YSGG laser has been introduced in dental clinics to remove carious dental hard tissues in anticipation of replacing the high-speed dental drill.

METHODS

A total of 40 extracted human teeth were used in this study. An Er,Cr:YSGG laser was used to ablate human dental hard tissues with the output powers of 3 to 6 W. Ablation extent with or without water spray at different output powers was measured, and the morphological changes on enamel and dentin were also investigated by stereoscopy and scanning electron microscopy (SEM).

RESULTS

The irradiation with water spray significantly (p < 0.001) increased the ablation depths compared to those irradiated without water mist. Morphological findings by SEM indicated that when irradiated without water spray, carbonization with brown or dark color was recognized in enamel or dentin, respectively. In addition, cavities with a molten lava-like appearance were produced and an irregular structure with many microholes was observed in dentin.

CONCLUSIONS

These results suggest that during the Er,Cr:YSGG laser irradiation, water spray directed at the ablation sites increases the ablation depths and water plays an important role as an initiator of the ablation of dental hard tissues.

Nd:YAG laser influence on sound dentin bond strength

OBJECTIVE

In the present study, the authors evaluated tensile bond strength of composite resin to dentin treated with Nd:YAG laser before and after bonding procedures.

SUMMARY BACKGROUND DATA

Lasers have been widely used in dentistry and have contributed to the development of new technologies. Adhesive systems have been indicated for most dental procedures and have produced good results. Studies concerned with the combined use of this adhesive system was the subject of this study.

METHODS

Thirty noncarious human anterior teeth, freshly extracted, for periodontal reasons, were used. After grinding the buccal dentinal surface until its exposition, specimens were separated into three groups and received the following treatments: (group 1) control--acid etching plus primer plus bond; (group 2) laser plus acid etching plus primer plus bond; (group 3) acid etching plus primer plus bond plus laser. Specimens of composite resin (Z100, 3M, Saint Paul, MN) were constructed on an inverted truncated 3-mm diameter cone mold. Tensile bond strength was performed using Inströn Universal machine, at 0.5 mm/min speed.

RESULTS

Analysis of variance (ANOVA) (p < 0.05) determined that the type of dentinal treatments used had an influence on tensile bond strength. Tukey's test, however, showed that group 1 (15.46) and 3 (15.67) had similar results both of which were higher than group 2 (4.57).

CONCLUSIONS

Based on the results obtained, one can conclude that group 1 (without laser) and group 3 (laser after bonding) had similar results, both higher than those observed for group 2 (laser before bonding). These results indicate that more research is needed about how a hybrid layer is formed when laser radiation is used.

Effect of Nd:YAG radiation at millisecond pulse duration on dentine crater depth

BACKGROUND AND OBJECTIVE

The effect of laser parameters on laser-dentine interaction has not been explored fully. This in vitro study investigated the effect on dentine crater depth of Nd:YAG laser radiation with varying repetition rates, total delivered energy, and dentine site either dyed or undyed.

STUDY DESIGN/MATERIALS AND METHODS

One hundred forty-four caries-free third molars were sectioned transversely to provide 288 upper and lower cut surfaces. The upper surfaces were dyed (IR5). These upper and lower cut surfaces were exposed to an Nd:YAG laser with a 7 millisecond (msec) pulse duration, pulse repetition rates (RR) of 2. 5, 5.4, and 10.5 Hz, and four total energies (2.28, 2.64, 3.6, 4.2 joules). Dentine crater depth was measured by using a Reflex microscope. Results were statistically analysed with analysis of variance.

RESULTS

Crater depth increased with increase in total delivered energy and in dyed and inner dentine sites (P<0.0001) but decreased with increasing repetition rate (P< 0.0001).

CONCLUSIONS

Increasing energy, dyed, and inner dentine sites produced deeper craters.

Response of feline intradental nerve fibers to tooth cutting by Er:YAG laser

BACKGROUND AND OBJECTIVE

The aim of this study was to investigate the response of intradental A- and C-fibers during tooth cutting by Er:YAG laser.

STUDY DESIGN/MATERIALS AND METHODS

Bipolar electrical stimulation was applied to the cat's canine to identify functional single nerve fibers of the inferior alveolar nerve. The tip of the canine tooth was cut in 0.5-mm steps until the pulp was exposed. Teeth were alternately cut by using Er:YAG laser (50 mJ, 5 pps) and micromotor under water cooling. The nerve response recorded from the single nerve fibers during laser cutting was compared with that during micromotor cutting.

RESULTS

All 26 A-fibers responded to laser cutting with high frequency of nerve firings. The nerve firing rate was significantly higher during laser cutting compared with that during micromotor cutting of superficial dentin (Chi(2) test, P < 0.05) but was not significantly different at deep dentin (P > or = 0. 05). Nine of 11 C-fibers responded to laser cutting when the deep dentin was cut. Among those nine nerve fibers, three also showed a low frequency response to laser cutting of the superficial dentin.

CONCLUSION

During the tooth cutting, Er:YAG laser was more effective in activating intradental A-fibers compared with micromotor and also caused the activation of intradental C-fibers.

Pulpal response to exposure with Er:YAG laser

OBJECTIVE

The purpose of this study was to evaluate the pulpal response to the Er:YAG laser after accidental exposure of the pulp.

STUDY DESIGN

Cavities were prepared, and pulps were exposed by either Er:YAG laser or mechanically by a slow-speed conventional handpiece (control group) in 76 maxillary first molars of male Wistar rats. Rats were killed immediately, at 3 days, 1 week, and 2 weeks. Histopathologic examinations of the pulp at the exposure site were performed and evaluated with the Mann-Whitney U test (P <.05).

RESULTS

The Er:YAG laser group showed no bleeding and no dentin chips at the exposure site immediately after pulp exposure. However, they displayed an area of blood extravasation near the exposure site. Subsequently, the Er:YAG laser group formed dentin bridges at the exposure site more frequently than the control group. The Er:YAG laser group demonstrated more reparative dentin formation near the exposure site than the control group, especially at 2 weeks, which was highly significant (P <.01).

CONCLUSION

According to the results of this study, Er:YAG laser-exposed pulp tissue demonstrated good healing capacity with the formation of a dentin bridge and reparative dentin. However, further investigations are suggested to study the effect of the blood extravasation, which appeared near the laser exposure sites.

Removal effects of the Nd:YAG laser and Carisolv on carious dentin

OBJECTIVE

The purpose of this study was to investigate the removal effect of the Nd:YAG laser irradiation and Carisolv on carious dentin.

BACKGROUND DATA

Many previous studies have reported several simple and alternative techniques, such as lasers and chemicals, for caries removal.

METHODS

Carisolv was applied on the surface of 20 extracted human anterior and molar teeth for 1 min and then the Nd:YAG laser was irradiated with a continuous water spray for another 1 min. The energy densities were varied from 2 to 6W with a repetition rate of 20 pps. As caries removal progressed, the cavity was carefully assessed by DIAGNOdent. Each lesion was photographed before and after treatment, and the treated cavity was observed microscopically using a stereoscope and with scanning electron microscope (SEM). Thermal change at the time of laser irradiation was measured by thermovision.

RESULTS

Our results revealed that application of Carisolv followed by Nd:YAG laser irradiation at 4-6W pulse energy effectively removed dentin caries. The total procedure was usually repeated once or twice for complete caries removal. From the SEM study, it was found that the cavity surface treated with the laser revealed various patterns of microirregularity, often accompanied by microfissure propagation. There was also no smear layer.

CONCLUSIONS

It was revealed that Nd:YAG laser and Carisolv could provide an alternative technique for caries removal instead of the conventional mechanical drilling and cutting.

Lasers in endodontics: a review

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of papers on potential applications for lasers in endodontics have been published. The purpose of this paper is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilization of root canals, root canal shaping and obturation and apicectomy. The effects of laser on root canal walls and periodontal tissues are also reviewed. The essential question is whether a laser can provide equal or improved treatment over conventional care. Secondary issues include treatment duration and cost/benefit ratio. This article reviews the role of lasers in endodontics since the early 1970s, summarizes many research reports from the last decade, and surmises what the future may hold for lasers in endodontics. With the potential availability of many new laser wavelengths and modes, much interest is developing in this promising field.