Laser-induced thermal events in empty and pulp-filled dental pulp chambers

Evaluation of the Pulp Chamber Temperature during Tooth Veneer Preparation Using Burs with Different Degrees of Wear-A Preliminary In Vitro Study

The heat produced during tooth preparation could be a source of damage for dental pulp, and many variables are involved in this process. The aim of this in vitro study was to evaluate whether the different degrees of wear of the diamond burs significantly influenced the temperature changes in the pulp chamber during tangential veneer preparation. The sample comprised 30 intact permanent monoradicular teeth, randomly assigned to three study groups of 10 teeth each, of which 5 had the pulp tissue preserved and 5 had thermoconductive paste in the pulp chamber. For prosthetic preparation, we used new burs in the first group, burs at their fifth use in the second group, and burs at their eighth use for the third group. The pulp chamber temperature was evaluated at the start, after one minute, and after three minutes of preparation, using a k-type thermocouple. The results of the three-way ANOVA and Tukey post hoc comparisons showed a highly significant effect of the time of measurement, while the pulp condition and the degree of wear of the burs had no effect. In conclusion, the different degrees of wear of conventional diamond burs do not produce statistically significant different changes in the pulp chamber temperature.

Effect of simulated pulpal blood flow rate on the rise in pulp chamber temperature during direct fabrication of exothermic provisional restorations

AIM

To evaluate ex vivo the effect of several simulated pulpal blood flow rates on the change in pulp chamber temperature during direct fabrication of a provisional restoration using a polymethylmethacrylate (PMMA) resin.

METHODOLOGY

Fifteen noncarious human premolars were prepared for complete coverage restorations. A curved needle connected to a peristaltic pump simulated the pulp blood flow. Two K-type thermocouples connected to a digital thermometer were placed in the pulp chamber, and the assembly was placed in an incubator at 37 °C. Three provisional crowns were made for each specimen using no water flow (group 1), a 1-mL min^-1 flow rate (group 2) and a 0.5-mL/min^-1 flow rate (group 3). The pulp chamber temperature was recorded continuously during polymerization until the temperature increase peaked and started to decrease and reached the baseline temperature (37 °C). The temperature increase was measured for the three water flow conditions. Data were analysed statistically using descriptive statistics, repeated measures one-way analysis of variance (anova) with Greenhouse-Geisser correction and Bonferroni tests. The level of significance was set at P < 0.05.

RESULTS

All of the groups were associated with an increased pulp chamber temperature. Groups with flow rates at 1 and 0.5 mL min^-1 had a significantly lower temperature rise when compared to the group without water flow (P < 0.001).

CONCLUSIONS

Direct fabrication of provisional restorations can cause a critical increase in pulp chamber temperature. However, in the presence of simulated pulpal blood flow rates of 1 or 0.5 mL min^-1 , the increase in pulp chamber temperature did not exceed the critical threshold (5.6 °C).

Enamel alteration following tooth bleaching and remineralization

The purpose of this study was to compare the effects of professional tooth whitening agents containing highly concentrated hydrogen peroxide (with and without laser activation), on the enamel surface; and the potential of four different toothpastes to remineralize any alterations. The study was performed on 50 human molars, divided in two groups: treated with Opalescence(®) Boost and Mirawhite(®) Laser Bleaching. Furthermore, each group was divided into five subgroups, a control one and 4 subgroups remineralized with: Mirasensitive(®) hap+, Mirawhite(®) Gelleѐ, GC Tooth Mousse™ and Mirafluor(®) C. The samples were analysed by SEM/3D-SEM-micrographs, SEM/EDX-qualitative analysis and SEM/EDX-semiquantitative analysis. The microphotographs show that both types of bleaching cause alterations: emphasized perikymata, erosions, loss of interprizmatic substance; the laser treatment is more aggressive and loss of integrity of the enamel is determined by shearing off the enamel rods. In all samples undergoing remineralization deposits were observed, those of toothpastes based on calcium phosphate technologies seem to merge with each other and cover almost the entire surface of the enamel. Loss of integrity and minerals were detected only in the line-scans of the sample remineralized with GC Tooth Mousse™. The semiquantitative EDX analysis of individual elements in the surface layer of the enamel indicates that during tooth-bleaching with HP statistically significant loss of Na and Mg occurs, whereas the bleaching in combination with a laser leads to statistically significant loss of Ca and P. The results undoubtedly confirm that teeth whitening procedures lead to enamel alterations. In this context, it must be noted that laser bleaching is more aggressive for dental substances. However, these changes are reversible and can be repaired by application of remineralization toothpastes.

Temperature increase during orthodontic bonding with different curing units using an infrared camera

AIM

To evaluate the effects of different curing units and light-tip tooth surface distances on the temperature increase generated during orthodontic bonding, using an infrared camera (IR) and artificial neural networks (ANN).

MATERIALS AND METHODS

Fifty-two freshly extracted human premolar teeth were used. Metallic orthodontic brackets were bonded to the buccal surfaces of the teeth and thermal records were taken using an IR camera and ANN. Brackets were cured with a light-emitting diode (LED) and high intensity halogen (HQTH). Teeth were divided into four groups according to the curing units (LED and HQTH) and curing distances (from tooth surface and 10 mm away from tooth surface). The results were analyzed with analysis of variance (ANOVA) and the Tukey HSD test.

RESULTS

The ANOVA and Tukey HSD tests revealed that temperature changes were influenced by the type of light source and exposure times. All groups revealed significant differences between each other (p < 0.001). The highest surface temperature increase was gained from curing with a LED unit from the tooth surface (11.35°C ± 0.91°C). The lowest surface temperature increase was gained from curing with a HQTH unit 10 mm away from the tooth surface (2.57°C ± 0.6°C).

CONCLUSION

The LED unit induced significantly higher temperature changes than did the HQTH. The temperature increase during orthodontic bonding was increased with long exposure time. A shorter light-tip tooth surface distance leads to greater increases in temperature.

Temperature rise in cavities prepared by high and low torque handpieces and Er:YAG laser

OBJECTIVE

The aim of this study was to compare intrapulpal temperature increases produced by a high-speed high-torque (speed-increasing) handpiece, a high-speed low-torque handpiece (air-turbine) and an Er:YAG (Erbium: Yttrium-Aluminum-Garnet) laser.

SUBJECT AND METHODS

Thirty bovine incisors were reduced to a dentine thickness of 2.0 mm. Class V preparations were prepared to a depth of 1.5 mm, measured with a caliper or by a mark on the burs. A thermocouple was placed inside the pulp chamber to determine temperature increases ( degrees C). Analysis was performed on the following groups (n = 10) treated with: G1, low-torque handpiece; G2, high-torque handpiece; and G3, Er:YAG laser (2.94 microm at 250 mJ/4 Hz), all with water cooling. The temperature increases were recorded with a computer linked to the thermocouples.

RESULTS

The data were submitted to ANOVA and Tukey statistical test. The average temperature rises were: 1.92+/-0.80 degrees C for G1, 1.34+/-0.86 degrees C for G2, and 0.75+/-0.39 degrees C for G3. There were significant statistical differences among the groups (p = 0.095). All the groups tested did not have a change of temperature that exceeds the threshold of 5.5 degrees C.

CONCLUSION

Temperature response to the low and high torque handpieces seemed to be similar, however the Er:YAG laser generated a lower temperature rise.

Precision ablation of dental enamel using a subpicosecond pulsed laser

In this study we report the use of ultra-short-pulsed near-infrared lasers for precision laser ablation of freshly extracted human teeth. The laser wavelength was approximately 800nm, with pulsewidths of 95 and 150fs, and pulse repetition rates of 1kHz. The laser beam was focused to an approximate diameter of 50microm and was scanned over the tooth surface. The rise in the intrapulpal temperature was monitored by embedded thermocouples, and was shown to remain below 5 degrees C when the tooth was air-cooled during laser treatment. The surface preparation of the ablated teeth, observed by optical and electron microscopy, showed no apparent cracking or heat effects, and the hardness and Raman spectra of the laser-treated enamel were not distinguishable from those of native enamel. This study indicates the potential for ultra-short-pulsed lasers to effect precision ablation of dental enamel.

Pulp ablation therapy by inductive heating: heat generation characteristics in the pulp cavity

OBJECTIVE AND METHODS

This study was performed to clarify the usefulness of inductive heating system for the new endodontic therapy. Dextran magnetite complex (DM) suspensions were injected into the root canal of a permanent tooth, and the tooth was heated up to about 55.0 degrees C by alternating-current magnetic field.

RESULTS AND CONCLUSION

The time until the temperature in the pulp cavity reached 55.0 degrees C was 328 +/- 26 s (mean +/- s.d., n = 8) in the 56 mg as Fe ml(-1) of DM concentration. The temperature in the pulp cavity could be maintained at 53.5-59.0 degrees C for 1200 s by changing the magnetic field intensity safely, while temperature elevations of the dental surface on the coronal and apical sides were 4.9 degrees and 3.7 degrees C, respectively. Thus, this inductive heating system, which has the possibility of selective heating, might be useful for eliminating residues of pulp as a new ablation therapy.

Comparison of Temperature Changes in the Pulp Chamber Induced by Various Light Curing Units, In Vitro

The thickness of the residual dentin is a critical factor in the reducing thermal transfer to pulp, and this transfer varies with the curing unit used.

Thermal risks from LED- and high-intensity QTH-curing units during polymerization of dental resins

The aim of this study was to test the ability of an infrared (IR) camera to assess temperature changes and distributions in teeth below restorations when quartz-tungsten-halogen (QTH) and light-emitting diode (LED) curing lights were used to photopolymerize the restorative material. Our hypothesis was that the higher power density and broader spectral distribution of the QTH source would cause greater increases in tooth temperature than the LED source, and that these differences would be best demonstrated with the IR camera. Cavities were prepared on human third molars and restored with a resin composite restorative material. The material was light-cured using three light-curing sources using several exposure times. The external (outside the tooth) and internal (inside the pulp chamber) temperature changes during polymerization of the composite material were recorded over 360 s with thermocouples and an IR camera. Using thermocouples the maximum increase in external temperature (+17.7 degrees C) was reported for the Swiss Master light after 20 s of curing time while the minimum temperature rise (+7.8 degrees C) was reported for the Freelight 2. Whereas a 2.6 degrees C increase in internal temperature was observed after curing 20 s with the Freelight 2, 7.1 degrees C was reported after 60 s of light exposure to Astralis 10. Infrared images showed similar trends in external-internal rises in temperature as the thermocouples, although temperatures measured by the IR were generally higher. These results indicate that the higher power density QTH sources caused greater increases in tooth temperatures than the LED source and that thermocouples may underestimate the heat applied to the tooth.

Temperature changes in dental pulp associated with use of power grinding equipment on equine teeth

OBJECTIVE

To quantify the temperature changes in the dental pulp associated with equine dental procedures using power grinding equipment.

DESIGN

A matrix experimental design with replication on the same sample was followed to allow the following independent variables to be assessed: horse age (young or old), tooth type (premolar or molar), powered grinding instrument (rotating disc or die grinder), grinding time (15 or 20 seconds) and the presence or absence of water coolant.

PROCEDURE

Sound premolar and molar teeth from a 6-year-old horse and a 15-year-old horse, which had been removed postmortem, were sectioned parallel to the occlusal plane to allow placement of a miniature thermocouple at the level of the dental pulp. The maximum temperature increase, the time taken to reach this maximum and the cooling time were measured (n=10 in each study). The teeth were placed in a vice and the instrument used on the tooth as per clinical situation.

RESULTS

Significant differences were recorded for horse age (P < 0.001), instrument type (P < 0.001), grinding time (P < 0.001) and presence or absence of coolant (P < 0.001). There was no significant difference for tooth type.

CONCLUSION

Thermal insult to the dental pulp from the use of power instruments poses a significant risk to the tooth. This risk can be reduced or eliminated by appropriate selection of treatment time and by the use of water irrigation as a coolant. The increased dentine thickness in older horses appears to mitigate against thermal injury from frictional heat.

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.

Pulpal temperature increases with Er:YAG laser and high-speed handpieces

STATEMENT OF PROBLEM

During tooth preparation, both high-speed handpieces and lasers generate heat, which, if not controlled, can cause pulpal necrosis.

PURPOSE

The aim of this study was to compare temperature increases produced by a high-speed dental handpiece with those produced by a relatively new instrument, the Er:YAG (erbium: yttrium-aluminum-garnet) laser.

MATERIALS AND METHODS

Thirty bovine mandibular incisors were reduced to an enamel/dentin thickness of 2.5 mm. Class V preparations were completed to a depth of 2.0 mm, measured with a caliper or by a mark on the burs. A thermocouple was placed inside the pulp chamber to determine temperature increases (degrees C). Analysis was performed on the following groups (n=10): Group I, high-speed handpiece without water cooling, Group II, high-speed handpiece with water cooling (30 mL/min), and Group III, the noncontact Er:YAG laser (2.94 microm at 350 mJ/10 Hz) with water cooling (4.5 mL/min). The temperature increases were recorded by a computer linked to the thermocouples. The data were analyzed using the Kruskal-Wallis test. The Dunn multiple comparison test was used as post hoc test (alpha=.05).

RESULTS

The average temperature rises were: 11.64 degrees C (+/- 4.35) for Group I, 0.96 degrees C (+/- 0.71) for Group II, and 2.69 degrees C (+/- 1.12) for Group III. There were no statistical differences between Groups II and III; both II and III differed from Group I significantly (P=.000 and P=.002, respectively).

CONCLUSION

The preparations made with the high-speed and the laser instrument generated similar heat increases under water cooling. Water cooling was essential to avoid destructive temperature increases when using both the high-speed handpiece and laser.

Ultrasonic dental scaler: associated hazards

BACKGROUND

The ultrasonic dental scaler is a valuable tool in the prevention of periodontal disease; however, this equipment has a number of hazards with which it is associated. These include heating of the tooth during scaling, vibrational hazards causing cell disruption, possible platelet damage by cavitation, associated electromagnetic fields that can interrupt pacemakers, auditory damage to patient and clinician and the release of aerosols containing dangerous bacteria.

OBJECTIVE

To collate the research reported on the various hazards associated with the ultrasonic dental scaler and discuss possible future research areas.

DATA SOURCES

The scientific literature was searched using Web of Science, EMBASE and Medline, and the results of these were then hand-searched to eliminate nonrelevant papers.

CONCLUSIONS

This review outlines some of the research conducted into these areas of associated hazard in order to assess their significance in the clinical situation, and discusses ideas for future research. Suggestions of recommendations are given, which have been previously investigated for their aid in reducing possible hazards, to ensure the safe working of ultrasonic scalers in the dental practice.

Effect of HeNe and pulsed Nd:YAG laser irradiation on intradental nerve responses to mechanical stimulation of dentine

BACKGROUND AND OBJECTIVE

Our study aimed to determine how lasing affected intradental nerve responses to dentine stimulation. Study Design/Materials and Methods Intradental nerve activity was recorded from canine teeth of anaesthetised ferrets. Dentine exposed at the tip of the tooth was stimulated with a glass probe. After determining baseline responses to mechanical stimulation, dentine was lased using a pulsed Nd:YAG laser at 60-150mJ/pulse and 10-30 pulses/sec (total power = 0.3-3.0 W).

RESULTS

The HeNe aiming beam alone and Nd:YAG laser at 0.3 W (+ HeNe) had no effect on intradental nerve responses to dentine stimulation. Lasing at 0.6-1. 5 W could either enhance or suppress intradental nerve responses. Lasing at more than or equal to 2.0 W or repeated lasing at lower intensities depressed intradental nerve responses. Lasing often induced intradental nerve firing.

CONCLUSION

HeNe lasing had no effect on intradental nerve excitability. The Nd:YAG laser could depress intradental nerve responses to dentine stimulation.