Lasers in dentistry

Degree of conversion of composite resin: a Raman study

OBJECTIVE

Near infrared Raman spectroscopy (RS) was used to monitor, in vitro, the degree of conversion (DC) of composite resins (Z100, 3M), photoactivated by both the halogen lamp and the argon laser beam.

BACKGROUND DATA

Several methods were used to study the alterations of composite resins. Vibration methods such as RS allow a precise assessment of the depth of polymerization and the degree of conversion of composite resins.

MATERIALS AND METHODS

Sixty circular blocks of resin (7 mm x 2.5 mm) were cured using a halogen light source (n=30, lambda=400-500 nm, power density=478 mW/cm2) or an argon laser beam (n=30, lambda=488 nm, power density=625 mW/cm2) using the same irradiation time (5, 10, 20, 30, 40, and 60 sec). The directly irradiated (top) and the non-irradiated (bottom) surfaces were analyzed immediately after curing by Raman spectroscopy.

RESULTS

The Raman results show systematic changes of the relative intensities between the peaks at 1610 (aromatic C=C stretching mode) and the 1640 cm(-1) (methacrylate C=C stretching mode), as a function of irradiation time. After 60 sec of irradiation time, the maximum degree of conversion reached for the samples cured either by the argon laser or halogen lamp was 66.4% and 62.2%, respectively.

CONCLUSION

The argon laser was more effective and showed better biocompatibility, with less residual monomer in the bottom (2.5 mm). These results show that RS can be used as an effective method to study the degree of conversion of composite resins.

Thermal effects of the Er:YAG laser on a simulated dental pulp: a quantitative evaluation of the effects of a water spray

OBJECTIVES

To quantify the temperature increments in a simulated dental pulp following irradiation with an Er:YAG laser, and to compare those increments when the laser is applied with and without water spray.

METHODS

Two cavities were prepared on either the buccal or lingual aspect of sound extracted teeth using the laser. One cavity was prepared with water spray, the other without and the order of preparation randomised. Identical preparation parameters were used for both cavities. Temperature increments were measured in the pulp chamber using a calibrated thermocouple and a novel pulp simulant.

RESULTS

Maximum increments were 4.0 degrees C (water) and 24.7 degrees C (no water). Water was shown to be highly significant in reducing the overall temperature increments in all cases (p<0.001; paired t-test). None of the samples prepared up to a maximum of 135 J cumulative energy prepared with water spray exceeded that threshold at which pulpal damage can be considered to occur. Only 25% of those prepared without water spray remained below this threshold.

DISCUSSION

Extrapolation of the figures suggests probably tolerable limits of continuous laser irradiation with water in excess to 160 J. With the incorporation of small breaks in the continuity of laser irradiation that occur in the in vivo situation, the cumulative energy dose tolerated by the pulp should far exceed these figures.

CONCLUSIONS

The Er:YAG laser must be used in conjunction with water during cavity preparation. As such it should be considered as an effective tool for clinical use based on predicted pulpal responses to thermal stimuli.

Wavelength and average power density dependency of the surface modification of root dentin using an MIR-FEL

BACKGROUND AND OBJECTIVES

Surface modification of root dentin by mid-infrared (MIR) pulsed-laser irradiation is one of the candidates for a novel, non-invasive treatment to prevent root surface caries. To modify root dentin effectively and non-invasively it is essential to estimate quantitatively and qualitatively the laser parameters, such as the wavelength and power density, required for surface modification. The key aspect is to bring about effective surface modification of the root dentin while minimizing the unwanted removal of the underlying dentin.

STUDY DESIGN/MATERIALS AND METHODS

Using a tunable, MIR Free Electron Laser with lambda = 8.8-10.6 microm, we have investigated macroscopically the extent of the surface modification (morphological and chemical changes) of root dentin. We have obtained experimental results related to the ablation depth, the MIR absorption spectrum, and the elemental chemical composition.

RESULTS

The observations showed that the surface modification of root dentin was inclined toward well-recrystallized HAp-like material, leading to an increase in the acid resistance and dentinal tubule sealing. The laser parameters, at which efficient surface modification without enhanced ablation occurred, were estimated to be approximately in the wavelength region around lambda = approximately 9.0 or approximately 9.7 microm and in the average power density region of approximately 10-20 W/cm2 (resulting in total energy density and peak power density regions of approximately 1-2 kJ/cm2 and approximately 0.67-1.2 kW/cm2).

CONCLUSIONS

The surface modification of root dentin strongly depends on the laser parameters applied. We conclude that the optimum wavelengths for laser treatment of root surface caries are lambda = approximately 9.0 or approximately 9.7 microm, corresponding to the absorption peak due to P-O stretching.

Histopathological Changes in Dental Pulp Irradiated by Er:YAG Laser: A Preliminary Report on Laser Pulpotomy

OBJECTIVE

The effects of Er:YAG laser irradiation on the pulp tissue during a pulpotomy procedure were evaluated histopathologically.

BACKGROUND DATA

The effects on pulp tissue during laser pulpotomy using Er:YAG laser irradiation are not clear.

MATERIALS AND METHODS

Sixty mesial root canals of mandibular first molars in rats were divided into four groups. In three of these groups, root canals were irradiated using an Er:YAG laser at 2 Hz and 34, 68, and 102 mJ/pulse for 15 sec. Non-irradiated canals served as controls. The effects of laser irradiation on the remaining pulp tissue and periodontal tissues were evaluated at 0 days, 2 days, and 1 week after irradiation under light microscopy.

RESULTS

At 1 week after treatment, no inflammation or resorption was observed in any cases in the control or 34 mJ/pulse-irradiated groups. However, moderate to severe inflammation was observed in 9 of 10 cases (90%) in the 68 and 102 mJ/pulse-irradiated groups.

CONCLUSION

These results suggest that effects on pulp tissues during a pulpotomy procedure by Er:YAG laser irradiation are minimal, if appropriate parameters are selected, and this is a potential therapy for pulpotomy of human teeth.

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.

Ultrastructural analysis of bone tissue irradiated by Er:YAG Laser

BACKGROUND AND OBJECTIVES

The use of erbium:yttrium aluminum garnet (Er:YAG) laser has been suggested for bone ablation, however, little is known about the nature of the tissue after irradiation. This study was aimed to analyze the ultrastructure of bone tissue treated with Er:YAG laser, as compared to those treated with CO(2) laser and bur drilling.

STUDY DESIGN/MATERIALS AND METHODS

Parietal bones of Wistar rats were treated and analyzed by light microscopy, transmission electron microscopy (TEM), electron diffraction analysis and energy dispersive X-ray spectroscopy (SEM-EDX).

RESULTS

This study demonstrated that Er:YAG laser irradiation resulted in a very thin changed layer of approximately 30 microm thickness, which consisted of two distinct sub-layers: a superficial, greatly altered layer and a deep, less affected layer.

CONCLUSIONS

The major changes found on bone surface after Er:YAG laser irradiation consisted of micro-cracking, disorganization, and slight recrystallization of the original apatites and reduction of surrounding organic matrix.

Preparation of root canal orifices by Er:YAG laser irradiation: in vitro and clinical observations

OBJECTIVE

The purpose of the present study was to evaluate the effectiveness of Er:YAG laser irradiation for preparation of root canal orifices in extracted human teeth and several clinical cases.

BACKGROUND DATA

Few studies with sufficient data have been conducted in this area.

MATERIALS AND METHODS

Orifices of 42 extracted human teeth were prepared by conventional methods using a Peeso reamer or Er:YAG laser device at 250 mJ/pulse and 8 Hz. In the clinical study, the orifices of 11 teeth from 11 patients with irreversible pulpitis were prepared by Er:YAG laser irradiation at 160 mJ/pulse and 8 Hz. Teeth were carefully irradiated using non-contact methods. Evaluation was performed by visual inspection, stereoscopy, radiography, and scanning electron microscopy (SEM). In addition, the efficiency of using the Er:YAG laser was evaluated.

RESULTS

In the in vitro study, canal orifices were clearly exposed by laser irradiation in all specimens. In 31 of 36 teeth (86%), orifices were successfully prepared without ledge formation or perforation. SEM observations revealed that irradiated surfaces were slightly rough and scaly, but essentially free from debris and smear layer. In the clinical study, orifices were successfully prepared in 10 of 11 teeth (91%), and no ledge formation or perforation was observed.

CONCLUSION

These results suggest that the preparation of root canal orifices by Er:YAG laser irradiation may be useful in most cases, if appropriate parameters are selected.

Influence of the frequency of Er:YAG laser on the bond strength of dental enamel

OBJECTIVE

The present study had the aim of evaluating the influence of different frequencies of the Er:YAG laser on adhesive resistance of enamel and one restorative system.

BACKGROUND DATA

There have been no reports of studies assessing the influence of the pulse frequency variation of the Er:YAG laser on adhesive resistance of the enamel/resin interface.

MATERIALS AND METHODS

Fifty surfaces of enamel from extracted human third molars were planed and divided into five groups at random. Enamel surface treatment was realized by the Er:YAG laser at 80-mJ power and 1-, 2-, 3-, and 4-Hz pulse frequencies, followed by etching. For the control group, only acid conditioning with 37% phosphoric acid for 15 sec was used. The Single Bond/Filtek Z250 system was chosen for the fabrication of the specimens, which were stored in 100% relative humidity for 24 h, at 37 degrees C. The specimens were submitted to tensile resistance tests using a Universal Testing Machine (50 Kgf and 0.5 mm/min).

RESULTS

The mean values in MPa were 1 Hz, 25.58 (+/-6.16); 2 Hz, 25.58 (+/-3.79); 3 Hz, 21.34 (+/-3.78); 4 Hz, 21.17 (+/-3.13); and phosphoric acid only, 22.44 (+/-7.0). Data were submitted to statistical analysis using ANOVA, and there was no significant difference in tensile resistance between the studied groups.

CONCLUSION

The results suggest that the Er:YAG laser, with 80-mJ power associated with acid conditioning at 1-, 2-, 3-, and 4-Hz frequencies, did not present significant improvement in tensile bonding of enamel, as compared to acid conditioning only.

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.

Effects of the Er:YAG laser irradiation on titanium implant materials and contaminated implant abutment surfaces

OBJECTIVE

The purpose of this study was to examine the morphological changes and temperature increases of the titanium after Er:YAG laser irradiation, and also to investigate the effect of this laser on debridement of contaminated healing abutments.

BACKGROUND DATA

Mechanical instruments have been used for the cleaning of implant abutment surfaces, however, most of them are not appropriate for the application to titanium surface. Recently, the Er:YAG laser has been expected to have a promising ability for the debridement of implant surface.

MATERIALS AND METHODS

Experiments were composed of three parts. At first, ten titanium round plates were exposed to the Er:YAG laser irradiation at 30-200 mJ/pulse and the surface changes were observed by stereomicroscope and scanning electron microscope. Secondly, the surface temperature changes of 60 titanium plates during and after Er:YAG laser irradiation at 30 and 50 mJ/pulse were measured by thermographic equipment. At last, calculus on the surface of six contaminated healing abutments was removed by Er:YAG laser or ultrasonic scaler, and the treated surfaces were examined by stereomicroscope.

RESULTS

Under 50 mJ/pulse, distinct morphological changes were not observed and the elevation of surface temperature was minimal, especially in the use of water-cooling. The Er:YAG laser at 30 mJ/pulse and 30 Hz with water spray was capable of effectively removing plaque and calculus on the implant abutments without injuring their surfaces.

CONCLUSION

This study indicates that the Er:YAG laser can be a novel technical modality for the debridement of implant abutment surface.

Effect of Er:YAG laser on bond strength to dentin of a self-etching primer and two single-bottle adhesive systems

BACKGROUND AND OBJECTIVES

To assess the effect of erbium:yttrium aluminium garnet (Er:YAG) laser on bond strength to dentin of a self-etching primer (Clearfil Liner Bond 2V, CL2V) and two single-bottle agents (Excite, EX; Gluma One Bond, GB).

STUDY DESIGN/MATERIALS AND METHODS

Thirty human molars were selected, roots were removed and crowns were bisected, providing 60 halves. Specimens were included and ground to expose dentin. Bonding site was limited and samples were assigned to three groups: I, CL2V; II, EX; III, GB. Dentin was either conventionally treated or submitted to laser conditioning + conventional treatment. The adhesive protocol was performed, samples were stored for 24 hours and bond strength was tested to failure (0.5 mm/min).

RESULTS

Statistical analysis showed a decrease in bond strength for lased subgroups and this drop was more evident for EX. CL2V provided the best overall results, regardless of the surface treatment.

CONCLUSIONS

Er:YAG laser may adversely affect bond strength in higher or lesser degree, depending on the adhesive system used.

Nonlinear scattering in hard tissue studied with ultrashort laser pulses

The back-scattered spectrum of ultrashort laser pulses (800 nm, 0.2 ps) was studied in human dental and other hard tissues in vitro below the ablation threshold. Frequency doubled radiation (SHG), frequency tripled radiation and two-photon fluorescence were detected. The relative yield for these processes was measured for various pulse energies. The dependence of the SHG signal on probe thickness was determined in forward and back scattering geometry. SHG is sensitive to linear polarization of the incident laser radiation. SHG in human teeth was studied in vitro showing larger signals in dentin than in cementum and enamel. In carious areas no SHG signal could be detected. Possible applications of higher harmonic radiation for diagnostics and microscopy are discussed.

Morphological analysis of cementum and root dentin after Er:YAG laser irradiation

BACKGROUND AND OBJECTIVES

To investigate the morphology of cementum and root dentin after Er:YAG laser irradiation with and without water coolant, compared to that after CO(2) laser irradiation and an untreated surface.

STUDY DESIGN/MATERIALS AND METHODS

Ten extracted healthy human teeth were used. Er:YAG and CO(2) lasers were applied with energy outputs of 0.4 W, with and without coolant and 0.5 W, without coolant, respectively. Scanning electron microscopy (SEM) analysis was performed at high and ultra-high magnifications.

RESULTS

The surface of cementum was micro-irregular with numerous projections while that of dentin appeared scaly after Er:YAG laser irradiation. Unlike after CO(2) laser treatment, no major melting or cracking was observed with Er:YAG laser treatment. The use of water spray produced fine micro-irregularities without attached debris. Ultra-high magnification revealed similar microparticles-composed aspects for both cementum and dentin. However, the more porous structure of the surface was observed after Er:YAG laser irradiation without water spray.

CONCLUSIONS

Cementum and root dentin presented distinct micro-roughness after Er:YAG laser irradiation, possibly due to structural differences in the original tissue. However, under ultra-high magnifications, both cementum and dentin presented similar characteristics of the irradiated surface. In addition, the use of water spray during laser irradiation minimized thermal effects and resulted in a cleaner and less porous surface.

Morphological changes of bovine mandibular bone irradiated by Er,Cr:YSGG laser: an in vitro study

OBJECTIVE

The purpose of this study was to investigate the morphological changes of bovine mandibular bone following Er,Cr:YSGG laser irradiation in different methods in vitro.

BACKGROUND DATA

Recently, an erbium, chromium/yttrium, scandium, garmet (Er,Cr:YSGG) laser device that emits a laser beam at the wavelength of 2.78 micro m was introduced. This type of infrared laser proved to ablate dental hard tissues effectively. However, the different effects of bone ablation by this laser in different irradiation methods were still unknown.

MATERIALS AND METHODS

Adult bovine mandibular bones were cut into 24 small pieces, 3-4 cm in length. The parameters of Er,Cr:YSGG laser irradiation were as follows: wavelength was 2.78 micro m, pulse duration was 140-200 micro sec, repetition rate was 20 pulse/sec, power was 4 W, spot size was 1.26 x 10(-3) mm(2), and energy density was 160 J/cm(2). Irradiation methods were different in four groups (six specimens in each group): group A, fixed position and contact mode; group B, fixed position and noncontact mode; group C, nonfixed position and contact mode; and group D, nonfixed position and noncontact mode.

RESULTS

Ablation depth in group A was significantly greater than in group B (p < 0.01). In group A, thermal damage was apparent. In group B, C, and D, thermal damage was minimal.

CONCLUSION

Er,Cr:YSGG laser allows for precise surgical bone cutting and ablation with minimal thermal damage to adjacent tissue. Irradiation in different methods may achieve different ablation rates and thermal damage.

Pulpal space pressure and temperature changes from Nd:YAG laser irradiation of dentin

OBJECTIVES

To investigate pulpal space pressure and temperature after application of Nd:YAG laser, and high-speed diamond bur on dentin surface.

METHODS

One and 3 W Nd:YAG laser and high-speed diamond bur were used to remove dentine from twenty extracted premolars. The pulp chambers were monitored for pressure and temperature changes with a pressure transducer and thermocouple, respectively.

RESULTS

Regardless of the remaining dentin thickness (RDT), laser irradiation and high-speed diamond bur use generated an increase in pulpal space pressure and temperature (ANOVA and Fisher's LSD tests, P < 0.001). Pressure and temperature increased with an increase in laser power. Three-Watt laser irradiation caused greater changes than 1 W (1.75 kPa and 1.31 degrees C, 0.53 kPa and 0.34 degrees C, respectively). Both pulpal space pressure (P < 0.001) and temperature (P < 0.005) increased as the RDT decreased.

CONCLUSIONS

Laser irradiation and the use of a high-speed diamond bur generated an increase in pulpal space pressure and temperature. Pulpal space pressure and temperature increased with an increase in energy density of laser and a decrease in RDT.

A comparative study of microleakage through enamel and cementum after laser Er:YAG instrumentation in class V cavity obturations, using scanning electron microscopy

OBJECTIVE

The purpose of this study was to use scanning electron microscopy (SEM) in order to compare the surfaces of cavities prepared using laser with those prepared conventionally, and to measure the degree of leakage through both enamel and cementum.

MATERIALS AND METHODS

We prepared 135 class V cavities and divided them randomly into three groups: laser-treated (group A), laser-treated, and acid-etched (group B) and rotary instrumented (group C).

RESULTS

On analyzing the tooth enamel, the amount of leakage was found to be similar in groups A and B, whilst the samples in the group C were more prone to leakage. On analyzing the cementum, the group C samples appeared to display surfaces that were more conducive to the adhesion of the materials used in obturation (although this difference was not strictly significant), and this might have provoked the relatively low levels of leakage.

CONCLUSION

The use of acid etching in conjunction with both conventional and laser cavity preparation improves the adhesion of the materials used in obturation to enamel surfaces.

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.

Assessing microleakage on class V composite resin restorations after Er:YAG laser preparation varying the adhesive systems

OBJECTIVE

The aim of this study was to assess the performance of three bonding agents in preventing microleakage of class V cavities prepared and treated by Er:YAG laser associating with acid etching.

BACKGROUND DATA

There has been very little research comparing the efficiency of single-component and self-etching adhesive systems in preventing microleakage of cavities prepared and conditioned with Er:YAG laser.

MATERIALS AND METHODS

Thirty cavities - with occlusal margin in enamel and cervical in dentin/cementum - were prepared in sound human third molars using a short pulsed Er:YAG laser (500 mJ/5 Hz) The enamel and dentin surfaces were conditioned for 30 sec using lower dosimetries (120 mJ/4 Hz), and the samples were randomly assigned into three groups, according to the adhesive system: (I) Bond-1; (II) Prime & Bond NT; and (III) Etch & Prime 3.0. Groups I and II were acid-etched for 15 sec, and group III did not receive any acid treatment once a self-etching system was employed. Cavities were restored with a light-cured composite resin (JEK-Z250 Filtek-250), and after finishing, the samples were thermocycled, isolated with epoxy resin and nail varnish, immersed in a 0.2% Rhodamine B solution for 24 h, and sectioned longitudinally. The sections obtained were analyzed for leakage using an optical microscope connected to a computer and a video camera. We digitized the images using a special software program that allowed a quantitative evaluation of microleakage in millimeters.

RESULTS

Statistical analysis using the Kruskal-Wallis test showed statistically significant difference between both margins, and the occlusal region presented better marginal sealing. Comparing the three resin bonding systems, Prime & Bond NT entirely sealed both margins, while Etch & Prime 3.0 provided the poorest overall results, showing a statistically significant difference (p < 0.01).

CONCLUSION

It may be concluded that, for all the tested materials, microleakage values were higher in cervical (dentin/cementum) margins. Additionally, Prime & Bond NT provided a complete elimination of marginal infiltration at both margins, after treating the dental surface with laser irradiation associated with a sequent acid-etching.

Acquired acid resistance of enamel and dentin by CO2 laser irradiation with sodium fluoride solution

OBJECTIVE

The purpose of this study was to investigate the caries-preventive effect of CO2 laser irradiation with or without sodium fluoride (NaF) solution at human dental enamel and dentin in vitro.

BACKGROUND DATA

The capability of caries prevention with CO2 laser irradiation has been reported in many previous studies, but few studies have been performed with regard to the combined effect of fluoride and laser.

MATERIALS AND METHODS

Forty extracted human incisor teeth were used for the enamel study, and 40 molar teeth were used for the dentin study. Samples were then divided into four categories: control (no treatment); CO2 laser irradiation only; NaF treatment only; and NaF treatment followed by CO2 laser irradiation. Each sample was immersed in 2 mL of lactic acid (0.1 M, pH 4.8) solution for 24 h at 37 degrees C in 100% humidity. The parts per million (ppm) of calcium ion (Ca2+) dissolved in each solution was determined by atomic absorption spectrophotometry. The samples were also observed by stereoscopy and scanning electron microscopy (SEM).

RESULTS

The lowest mean Ca2+ ppm was recorded at the enamel or dentin samples treated with NaF and laser. Statistical analysis of the data was considered significant (p < 0.01). SEM observation showed that surfaces were changed to melted, smooth, and mirror-like appearances when CO2 laser irradiation was applied with NaF solution.

CONCLUSION

It can be concluded that CO2 laser irradiation with NaF solution has more caries-preventive effect than CO2 laser irradiation only at the enamel and dentin surfaces.

Er:YAG laser effects on enamel occlusal fissures: an in vitro study

This study evaluated by scanning electron microscopy (SEM) the morphological changes in occlusal fissure enamel, of permanent models, irradiated by Er:YAG laser using contact and noncontact fiberoptics in vitro. Previous studies have demonstrated the efficacy of Er:YAG laser for dental hard tissue removal and cavity preparation. The treatment of occlusal fissures in noncarious permanent human molars (n = 9) was carried out with Er:YAG laser (KEY Laser II) using handpiece no. 2051, noncontact, focused (12 mm), water spray-cooled, pulse energy 200 mJ, and frequency 2 Hz (group 1), and handpiece no. 2055 with a quartz fiberoptic 50/10, in contact, air cooled, pulse energy setting of 350 mJ and frequency 2 Hz (group 2) and 400 mJ/2 Hz (group 3). The specimens were sectioned, dehydrated in a graded series of aqueous ethanol, dried, and sputtering with gold. Morphological change analysis on occlusal fissures was performed by SEM. Group 1 showed removal of fissure debris and predominantly enamel etching-like patterns, and groups 2 and 3 showed irregular edges, melting, and recrystallization of fissure enamel, with a lava-like structure and bubble-like voids. The results of this in vitro study suggest that the irradiation of fissures by Er:YAG laser using a fiberoptics (contact and air cooled) produced melting and recrystallization of fissures enamel. Further studies are required with different energy parameters and water cooling to evaluate the thermal effects on teeth.

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.

Root surface temperature increase during Er:YAG laser irradiation of root canals

The authors measured the temperature of the root surface during root canal preparation using Er:YAG laser irradiation and evaluated the thermal effect on the periodontal region. Twenty extracted human teeth with single roots were divided into two groups of 10. These were irradiated using an Er: YAG laser at 2 Hz and 136 to 184 or 170 to 230 mJ/pulse for 1 min with a water spray. The temperature of the root surface was monitored using thermocouples throughout the procedure. The teeth were longitudinally bisected and observed by stereoscopy and scanning electron microscopy. The temperature on the root surface increased by less than 6 degrees C at the apical area and by less than 3 degrees C at the central area. A morphological evaluation revealed no carbonization or melting. These results suggest that the thermal effect on periodontal tissues during root canal preparation using an Er: YAG laser at less than 230 mJ/pulse for 1 min is minimal.

Residual heat deposition in dental enamel during IR laser ablation at 2.79, 2.94, 9.6, and 10.6 microm

BACKGROUND AND OBJECTIVE

The principal factor limiting the rate of laser ablation of dental hard tissue is the risk of excessive heat accumulation in the tooth. Excessive heat deposition or accumulation may result in unacceptable damage to the pulp. The objective of this study was to measure the residual heat deposition during the laser ablation of dental enamel at those IR laser wavelengths well suited for the removal of dental caries. Optimal laser ablation systems minimize the residual heat deposition in the tooth by efficiently transferring the deposited laser energy to kinetic and internal energy of ejected tissue components.

STUDY DESIGN/MATERIALS AND METHODS

The residual heat deposition in dental enamel was measured at laser wavelengths of 2.79, 2.94, 9.6, and 10.6 microm and pulse widths of 150 nsec -150 microsec using bovine block "calorimeters." Water droplets were applied to the surface before ablation with 150 microsec Er:YAG laser pulses to determine the influence of an optically thick water layer on reducing heat deposition.

RESULTS

The residual heat was at a minimum for fluences well above the ablation threshold where measured values ranged from 25-70% depending on pulse duration and wavelength for the systems investigated. The lowest values of the residual heat were measured for short (< 20 micros) CO(2) laser pulses at 9.6 microm and for Q-switched erbium laser pulses at 2.79 and 2.94 microm. Droplets of water applied to the surface before ablation significantly reduced the residual heat deposition during ablation with 150 microsec Er:YAG laser pulses.

CONCLUSIONS

Residual heat deposition can be markedly reduced by using CO(2) laser pulses of less than 20 microsec duration and shorter Q-switched Er:YAG and Er:YSGG laser pulses for enamel ablation.

The growth of Nd: YAG single crystals

Y3Al5O12 doped with 0.8%wt.Nd (Nd:YAG) single crystals were grown by the Czochralski technique under an argon atmosphere. The conditions for growing the Nd:YAG single crystals were calculated by using a combination of Reynolds and Grashof numbers. The critical crystal diameter and the critical rate of rotation were calculated from the hydrodynamics of the melt. The crystal diameter Dc=1.5 cm remained constant during the crystal growth while the critical rate of rotation changed from ?c=38 rpm after necking to ?c=13 rpm at the end of the crystal. The value of the rate of crystal growth was experimentally found to be 0.8?1.0 mm/h. According to our previous experiments, it was confirmed that 20 min exposure to conc. H3PO4 at 603 K was suitable for chemical polishing. Also, one-hour exposure to conc. H3PO4 at 493 K was found to be suitable for etching. The lattice parameter a=1.201 (1) nm was determined by X-ray powder diffraction. The obtained results are discussed and compared with published data.

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.

Effects of erbium,chromium:YSGG laser irradiation on canine mandibular bone

BACKGROUND

Only relatively few reports have described the morphological effects on bone produced by erbium,chromium: yttrium,scandium,gallium,garnet (Er,Cr:YSGG) laser irradiation, and none has investigated the atomic changes or estimated the temperature increases involved. The objectives of this study were to investigate the morphological, atomic, and temperature changes in irradiated areas during and after laser irradiation, and to evaluate the cutting effect on canine mandibular bone in vitro.

METHODS

Two canine mandibular bones were cut into 3 to 5 cm pieces and irradiated by an Er,Cr:YSGG laser utilizing a water-air spray at 5 W and 8 Hz for 10 or 30 seconds. During and after laser irradiation, temperature increases in the irradiated areas were measured by thermography. The samples were then observed by stereoscopy and scanning electron microscopy to determine morphological changes and by energy dispersive x-ray spectroscopy to evaluate atomic alterations.

RESULTS

Regular holes or grooves having sharp edges and smooth walls were produced, but no melting or carbonization was observed. The maximum temperature increase was an average 12.6 degrees C for 30-second irradiation. The continuous time of a temperature increase of more than 10 degrees C was consistently less than 10 seconds. An atomic analytical examination revealed that the calcium:phosphorus ratio was not significantly changed between the lased and unlased areas (P>0.0 1).

CONCLUSION

These results showed that the Er,Cr:YSGG laser cuts canine mandibular bone effectively without burning, melting, or altering the calcium:phosphorus ratio of the irradiated bone.

Apical leakage of obturated canals prepared by Er:YAG laser

The present study evaluates the degree of apical leakage in vitro after root canal preparation using Er:YAG laser irradiation followed by obturation. Twenty-four single-rooted teeth were divided into 2 groups of 12. One group served as a control and these root canals were conventionally prepared up to a #50K file. The other group was prepared by Er:YAG laser irradiation at parameters of 2 Hz and 170 to 230 mJ/pulse. After obturation the teeth were immersed in a vacuum flask containing 0.6% rhodamine for 48 h, longitudinally bisected, and observed by stereoscopy and scanning electron microscopy. The degree of apical leakage from an apical stop was measured and statistical analysis was performed. The degree of apical leakage from the teeth prepared by laser was not significantly less than that from control teeth (p > 0.01). Morphological findings showed that contact between the root canal walls and obturated materials was hermetic in both groups, but canal walls prepared by laser were rough and irregular. These results show that root canal preparation by laser does not affect apical leakage after obturation compared with leakage in canals prepared using the conventional method.

Free-electron laser etching of dental enamel

OBJECTIVE

The purpose of this study was to evaluate the Mark-III free-electron laser as a means of etching enamel surfaces, with potential application to resin bonding.

METHODS

The FEL was tuned to wavelengths ranging from 3.0 to 9.2 microm. Specific wavelengths that are resonantly absorbed by phosphates, proteins, and water were used. First, bovine enamel was polished and exposed to static FEL exposures. Lased enamel was examined using scanning electron microscopy (SEM). Additional bovine enamel specimens were exposed to FEL at similar wavelengths, but with rastering to create treated rectangular areas on each specimen. Surface roughness was evaluated using profilometry and atomic force microscopy (AFM). Composite was bonded to the lased enamel, and shear bond strengths were determined using an Instron universal testing machine. As a control, the surface roughness of, and shear bond strengths to, acid-etched enamel were determined.

RESULTS

Static FEL exposures caused changes in the enamel ranging from an etched appearance to pits, cracks, and frank cratering. The surface roughness of lased enamel was much greater than that of acid-etched enamel, and was qualitatively different as well. Shear bond strengths of resin to acid-etched enamel were significantly higher than bond strengths to lased enamel.

CONCLUSIONS

Under the conditions used in this study, the FEL did not offer a practical and effective method of etching enamel for resin bonding. However, the ability of the FEL to deliver many specific wavelengths makes it an interesting tool for further research of laser effects on tooth structure.

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.

Microleakage of a resin sealant after acid-etching, Er:YAG laser irradiation and air-abrasion of pits and fissures

OBJECTIVE

The aim of this in vitro study was to assess microleakage underneath a filled pit-and-fissure sealant bonded to occlusal surfaces treated by four enamel etching techniques.

SUMMARY BACKGROUND DATA

There has been no report of a study assessing microleakage of a pit-and-fissure sealant, comparing acid-etching, Er:YAG laser and air-abrasion for treating enamel surface.

METHODS

Forty extracted human third molars were selected and randomly assigned into four groups of ten teeth: group I, the occlusal surfaces were acid-etched; group II, a very short pulsed Er:YAG laser was used to treat the surfaces; group III, aluminum oxide air-abrasion was associated with acid-etching; group IV, Er:YAG laser was associated with acid-conditioning. The surfaces were sealed and the teeth were stored for 7 days in distilled water. Then, specimens were thermocycled, immersed in a 0.2% rhodamine solution, sectioned, and analyzed for leakage using an optical microscope connected to a video camera. The images were digitized and analyzed by software that allowed microleakage assessment in millimeters.

RESULTS

Statistical analysis showed that occlusal surfaces treated exclusively by the Er:YAG laser (group II) provided the poorest marginal sealing and that acid-etching (group I) was statistically similar to aluminum oxide air-abrasion + acid etching (group III) and to Er:YAG laser + acid-etching (group IV).

CONCLUSIONS

The results suggest that complementing either air-abrasion or Er:YAG laser irradiation with a subsequent acid-conditioning did not lessen microleakage at the enamel-sealant interface when compared with an acid-etched group. It was also observed that treating the enamel surface exclusively by Er:YAG laser resulted in the highest degree of leakage.

Effects of erbium, chromium:YSGG laser irradiation on root surface: morphological and atomic analytical studies

OBJECTIVE

The purpose of this study was to investigate the morphological and atomic changes on the root surface by stereoscopy, field emission-scanning electron microscopy (FE-SEM), and energy dispersive X-ray spectroscopy (SEM-EDX) after erbium, chromium:yttrium, scandium, gallium, garnet (Er,Cr:YSGG) laser irradiation in vitro.

SUMMARY BACKGROUND DATA

There have been few reports on morphological and atomic analytical study on root surface by Er,Cr:YSGG laser irradiation.

METHODS

Eighteen extracted human premolar and molar teeth were irradiated on root surfaces at a vertical position with water-air spray by an Er,Cr:YSGG laser at the parameter of 5.0 W and 20 Hz for 5 sec while moving. The samples were then morphologically observed by stereoscopy and FE-SEM and examined atomic-analytically by SEM-EDX.

RESULTS

Craters having rough but clean surfaces and no melting or carbonization were observed in the samples. An atomic analytical examination showed that the calcium ratio to phosphorus showed no significant changes between the control and irradiated areas (p > 0.01).

CONCLUSIONS

These results showed that the Er,Cr:YSGG laser has a good cutting effect on root surface and causes no burning or melting after laser irradiation.

Dental hard tissue modification and removal using sealed transverse excited atmospheric-pressure lasers operating at lambda=9.6 and 10.6 microm

Pulsed CO(2) lasers have been shown to be effective for both removal and modification of dental hard tissue for the treatment of dental caries. In this study, sealed transverse excited atmospheric pressure (TEA) laser systems optimally tuned to the highly absorbed 9.6 microm wavelength were investigated for application on dental hard tissue. Conventional TEA lasers produce an initial high energy spike at the beginning of the laser pulse of submicrosecond duration followed by a long tail of about 1-4 micros. The pulse duration is well matched to the 1-2 micros thermal relaxation time of the deposited laser energy at 9.6 microm and effectively heats the enamel to the temperatures required for surface modification at absorbed fluences of less than 0.5 J/cm(2). Thus, the heat deposition in the tooth and the corresponding risk of pulpal necrosis from excessive heat accumulation is minimized. At higher fluences, the high peak power of the laser pulse rapidly initiates a plasma that markedly reduces the ablation rate and efficiency, severely limiting applicability for hard tissue ablation. By lengthening the laser pulse to reduce the energy distributed in the initial high energy spike, the plasma threshold can be raised sufficiently to increase the ablation rate by an order of magnitude. This results in a practical and efficient CO(2) laser system for caries ablation and surface modification.

Effects of erbium,chromium:YSGG laser irradiation on root canal walls: a scanning electron microscopic and thermographic study

The present study evaluates the morphological changes in root canal walls and temperature changes at root surfaces as a result of intracanal irradiation by erbium,chromium:YSGG laser under various conditions in vitro. Sixty single-rooted human teeth were examined. Root canals were prepared, and laser irradiation was performed using an optic fiber at output powers ranging from 1 to 6 W with or without water spray cooling. Specimens were evaluated by stereoscopy, scanning electron microscopy, and thermography. Carbonization and cracks were observed in all samples irradiated without cooling, whereas little or no carbonization and no smear layer or debris were observed in samples irradiated with cooling. Maximum temperature rise at irradiation without cooling was above 37 degrees C, whereas that at irradiation with cooling was 8 degrees C. Results of the present study indicate that erbium,chromium:YSGG laser irradiation with water spray cooling is a useful method for removal of smear layer and debris from root canals.

Sealant bond strengths of CO(2) laser-etched versus acid-etched bovine enamel

BACKGROUND AND OBJECTIVE

The purpose of this study was to evaluate sealant shear bond strength on bovine enamel with standard acid etching compared with CO(2) laser etching.

STUDY DESIGN/MATERIALS AND METHODS

Bovine enamel was prepared either by acid or laser etching and divided into four experimental groups, either acid or laser-etched teeth with or without a primer. A gelatin capsule was used to place the sealant on the prepared enamel surface and the bond tested in shear. Also surface roughness was evaluated by using a surface analyzer and an atomic force microscope.

RESULTS

Shear bond strength results were the following: acid etch = 8.8 +/- 3.8 MPa, acid etch with primer = 10.3 +/- 5.5 MPa, laser etch = 4.0 +/- 1.1 MPa, and laser etch with primer = 6.2 +/- 2.3 MPa. Analysis of variance statistical analysis found no significant difference in bond strength between the acid-etched groups. However, the laser-etched groups had significantly lower bond strengths from the acid-etched teeth. In addition, a significant difference was observed between the laser-etched groups, where the use of the primer helped to increase the bond strength of the sealants. The surface roughness was significantly greater on the laser-etched teeth at the microm level (by using a surface analyzer) from the acid-etched and the control specimens. No difference in roughness (by using an atomic force microscope) was observed at the nanometer level between the laser and acid-etched teeth.

CONCLUSION

For these particular settings, the laser-etched teeth resulted in lower bond strengths to enamel and the use of a primer increased the bond strength for laser-etched teeth only.

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.

Differences in bonding to acid-etched or Er:YAG-laser-treated enamel and dentin surfaces

STATEMENT OF PROBLEM

Er:YAG (erbium-doped yttrium aluminium garnet) lasers have been effective in the removal of dental tissues. It has been suggested that they are also useful for preparing dental surfaces for adhesion, but results to date have been controversial.

PURPOSE

This study compared the tensile strength of bracket-tooth bonds obtained after preparation of the surface for adhesion (dentin or enamel) by conventional acid-etching or by Er:YAG laser etching and investigated microstructure of resin-tooth interfaces using the 2 procedures.

MATERIAL AND METHODS

Eighty healthy human premolars were used. Brackets were cemented to acid-etched enamel, laser-etched enamel, acid-etched dentin, or laser-etched dentin (20 teeth per group). Dentin was previously exposed using a high-speed handpiece. Acid-etching was with 37% orthophosphoric acid (15 seconds for enamel, 5 seconds for dentin). Laser etching was with Er:YAG laser (four 200 mJ pulses per second for enamel; four 160 mJ pulses per second for dentin). Brackets were bonded with autocuring resin paste, having first applied a primer (dentin only) and then light-cured bonding resin. Tensile strength was determined with a universal testing machine. Data were analyzed with 2-way ANOVA and subsequent t test with Bonferroni correction. Fracture patterns were compared by the Wilcoxon test with Bonferroni correction. For SEM studies of the resin-tooth interface, a total of 12 premolars were used (3 for each tissue per treatment combination).

RESULTS

Mean tensile bond strength for acid-etched enamel (14.05 +/- 5.03 MPa) was significantly higher (P<.05) than for laser-etched enamel (8.45 +/- 3.07 MPa), and significantly higher (P<.05) for acid-etched dentin (4.70 +/- 2.50 MPa) than laser-etched dentin (2.48 +/- 1.94 MPa). Bond failure after laser etching was due to microcohesive fracture of tooth tissue. SEM studies of both resin-enamel and resin-dentin interfaces indicated extensive subsurface fissuring after laser etching.

CONCLUSION

Adhesion to dental hard tissues after Er:YAG laser etching is inferior to that obtained after conventional acid etching. Enamel and dentin surfaces prepared by Er:YAG laser etching show extensive subsurface fissuring that is unfavorable to adhesion.

Laser-tissue interaction with a continuous wave 3-mcm fibre laser: preliminary studies with soft tissue

BACKGROUND AND OBJECTIVE

Lasers operating at wavelengths in the mid-infrared region have become increasingly popular for applications in areas of surgery and medicine. Advances in fibre laser technology have introduced a highly efficient, compact, diode-pumped source operating at around the 3-mcm wavelength. This study examines the effects of this recently developed laser on soft biological tissue.

STUDY DESIGN/MATERIALS AND METHODS

Chicken breast and liver tissue samples were exposed to 800 mW continuous wave laser power, at a wavelength of 2.71 mcm, with incident spot sizes of around 150 mcm. Samples were inspected grossly immediately after laser irradiation and also prepared for histologic processing.

RESULTS

After irradiation, visual assessment of changes at sample surfaces indicated a region of thermally affected tissue surrounding the ablation crater. This region was observed to grow in size to around 1.0 mm in diameter after 3 seconds of laser exposure at 800 mW. An ablation velocity of 0.80 mm.s(-1) was determined in chicken breast for the same incident laser parameters. Analysis of samples irradiated at 800 mW and processed for histology revealed minimal damage at hole boundaries and no signs of char formation, providing incident exposure times were restricted to below around 0. 5 seconds.

CONCLUSION

This fibre laser source has demonstrated its potential to fulfil medical applications, enabling accurate, precise tissue removal to proceed at a rapid ablation rate. The efficiency and small size of the laser are attractive features.

Morphological study of the effects of CO2 laser emitted at 9.3 microm on human dentin

OBJECTIVE

The purpose of this study was to investigate the effects of dentin ablation using a carbon dioxide (CO2) laser emitted at 9.3 microm by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM).

BACKGROUND DATA

There have been no reports on effects of CO2 laser irradiation emitted at 9.3 microm on dentin by SEM and CLSM.

METHODS

Thirty extracted human teeth showing no clinical signs of caries were used. All teeth were horizontally sectioned to approximately 200 microm thickness and sections were irradiated using a 9.3 microm CO2 laser at different parameters as follows: 26 mJ [energy density (ED) 53.0 J/cm2] and 30 mJ (ED 61.1 J/cm2). After laser irradiation, samples were treated with sodium hypochlorite, stained using rhodamine-123, and observed with CLSM followed by SEM procedures.

RESULTS

No craters or cracks were observed, but many small molten and rehardened particles were documented on the sample surface using SEM. Some small cracks were seen in the subsurface layer, and some patent dentinal tubules were detected using CLSM.

CONCLUSION

These results suggest that laser irradiation at these parameters affected the sample surface only (less than 20 microm) and would be less harmful to thermal damage of dental pulp for dentin ablation.

Effects of Er:YAG laser in caries treatment: a clinical pilot study

BACKGROUND AND OBJECTIVE

Various lasers have been suggested for cavity preparation. Pain reduction is expected as a potential benefit of laser usage. Among the systems studied in vitro, the Er:YAG laser offers a distinct combination of high ablation efficiency and low thermal side effects. Animal studies demonstrated that pulp damage can be avoided when appropriate laser parameters are used.

STUDY DESIGN/MATERIAL AND METHODS

The present prospective clinical study was intended to test the practical applicability of the system and to investigate the patient's response. The study population consisted of 67 teeth on 33 subjects. Patient's reaction to pain was documented in four categories: no pain, little pain (like a brief pressure to the tooth), medium pain (like needle sticks), and strong pain (like a thermal shock test).

RESULTS

For superficial cavities 200 pulses (SD: 114) were needed. At a pulse repetition rate of 2 Hz, the preparation time was 1.6 min (SD: 2.1 min). Deeper cavities required 391 pulses (SD: 251), or approximately 3.3 min (SD: 2.1 min). No loss in pulp vitality was observed. In 36% of the laser-treated teeth, no pain was felt, and in 57%, little pain was reported. With one exception, no local anesthesia was needed.

CONCLUSION

On the basis of this study, we suggest that the Er:YAG: laser can provide caries removal and cavity preparation in an adequate preparation time with minimal patient discomfort.

Effects of Nd:YAG-laser irradiation on monolayer cell cultures

BACKGROUND AND OBJECTIVE

The clinical applications of Nd:YAG lasers on oral soft tissues include a wide field of surgical and periodontal procedures. This in vitro study focuses on the histological effects of Nd:YAG-laser irradiation on a fibroblast monolayer cell culture especially with regard to thermal damage and cell necrosis. The results of this basic research study provide us with clear power settings for a safe soft tissue laser treatment.

STUDY DESIGN/MATERIALS AND METHODS

Two hundred forty multiwell cell cultures and 24 micro-slide Leighton tubes were laser treated. Laser irradiation was performed with a commercial free-running pulse Nd:YAG laser and a quartz fiber with a diameter of 200 microns on L-929 fibroblast cell cultures. The variable parameters were pulse energy (30-120 mJ), pulse rate (20-100 Hz), power output (1.5-3.0 W), and time of irradiation (10-60 s). The cultures were analyzed with help of vital staining, autoradiography, and cytomorphology examination.

RESULTS

Depending on the different settings the laser irradiation caused inhibitions of the DNA metabolism rate and the cell division rate, a degeneratively changed cytomorphology up to cell pyknosis. An increasing pulse energy, pulse rate, or an increased time of irradiation created an extended diameter of the pyknotic cell zone.

CONCLUSIONS

The laser beam creates an exactly bordered damage between cells. The cells had a very good inherent mobility, but the border between eliminated and unloaded cell zone was sharp, even after an incubation of 24 h. These stable results prove that the laser can be applied up to a micrometer distance. With the help of cell clusters it was proved that the laser beam is also able to eliminate exactly one monolayer. Cells which had been covered by another cell layer (in a cluster) were not eliminated.

Effect of pulsed Nd:YAG laser radiation on action potential conduction in isolated mammalian spinal nerves

BACKGROUND AND OBJECTIVE

Dental lasers are claimed to produce analgesia, but the mechanisms and extent of any effects are uncertain. This study investigated the effects of lasing on nerve conduction in isolated nerves.

STUDY DESIGN/MATERIALS AND METHODS

Pulsed Nd:YAG laser energy was applied to spinal nerves in vitro and effects were measured as attenuation of the compound action potential (CAP) evoked by electrical stimulation.

RESULTS

Lasing for 1 minute at 0.3-3.0 W caused a dose-dependent attenuation of all components of the CAP (P < 0.03). With 0.3-1.0 W power, the CAP recovered to > 95% of the control levels 7 minutes after lasing; recovery was incomplete after lasing at > 2.0 W.

CONCLUSION

Isolated nerves were remarkably tolerant of lasing. The degree of nerve conduction block increased with laser power. The data indicate that lasing could diminish sensations, including pain, mediated by peripheral nerves in soft tissues.

Laser ablation as a function of the primary absorber in dentin

BACKGROUND AND OBJECTIVE

Infrared transmission spectra of dentin reveal a broad absorption band between 6.0 and 7.0 microns composed of absorption peaks of water, collagen and carbonated hydroxyapatite. The nearly constant absorption and the existence of absorption peaks of different tissue components were used to investigate ablation as a function of the primary absorber.

STUDY DESIGN/MATERIALS AND METHODS

Laser ablation of dentin as a function of fluence was studied in the wavelength range between 6.0 and 7.5 microns using the Vanderbilt Free-Electron Laser (FEL). Depth and volume of the ablation crater were determined with a silicon replica method and subsequent confocal laser topometry. SEM investigations were performed on the irradiated surfaces. For the description of the experimental data an ablation model is developed.

RESULTS

At all applied wavelengths we found a linear increase of ablation depth as a function of fluence above a threshold fluence. The lower absorption of dentin at 7.5 microns compared to the absorption at 6.0, 6.5 and 7.0 microns results in a greater ablation threshold. At 6.0, 6.5 and 7.0 microns wavelengths the ablation thresholds are comparable. The experimental data are in good agreement with an ablation model using a mean absorption coefficient of the target material. No thermal cracking is observed after ablation in dentin. The post ablative surface structure at 6.0 and 7.0 microns looks similar whereas at 7.5 microns the surface reveals a greater roughness.

CONCLUSION

The ablation efficiency and threshold depend on the mean absorption but do not depend upon the chemical identity of the primary absorber in dentin. Calculations show that heat conduction during the laser pulse leads to a thermal equalization between the heated microstructures and surrounding tissue resulting in an ablation with little dependence on the primary absorber.