Effect of laser irradiation on the dissolution kinetics of hydroxyapatite preparations

Caries inhibition of simulated active caries lesions with CO2 laser irradiation and fluoride

It has been well established that CO₂ laser irradiation can be used to transform the mineral phase of dental enamel to make it more resistant to acid dissolution. The purpose of this study was to investigate if carbon dioxide laser irradiation and topical fluoride can be used to treat incipient caries lesions to inhibit further progression, i.e. treat active lesion surfaces as opposed to sound surfaces prior to subjecting them to an acid challenge. Simulated active caries lesions were produced on twenty eight bovine enamel samples using a pH cycling model and those surfaces were irradiated by a 9.4 μm CO₂ laser and treated with topical fluoride. Changes in the surface morphology, acid resistance, and permeability were measured using digital microscopy, optical coherence tomography (OCT), and SWIR reflectance surface dehydration rate measurements at 1950 nm after exposure to a further acid challenge. There was a significant reduction (P < 0.05) of further lesion progression for lesion windows treated with CO₂ laser irradiation followed by the application of an acidulated phosphate fluoride gel compared to the untreated lesion windows on each sample. Treatment by laser irradiation alone was not effective. The degree of lesion inhibition was not as high as has been previously observed for laser irradiated sound enamel surfaces exposed to an acid challenge.

Dissolution studies of bovine dental enamel surfaces modified by high-speed scanning ablation with a lambda = 9.3-microm TEA CO(2) laser

BACKGROUND AND OBJECTIVES

Previous studies have demonstrated that lasers can be used to modify the chemical composition of dental enamel to render the mineral phase more resistant to acid dissolution with minimal peripheral thermal damage. Transverse excited atmospheric (TEA) CO(2) lasers tuned to the strong mineral absorption of hydroxyapatite (HAP) near lambda = 9 microm are well-suited for the efficient ablation of dental hard tissues if the laser-pulse is stretched to greater than 5-10 microseconds to avoid plasma shielding phenomena. Moreover, TEA CO(2) lasers can be operated at very high repetition rates and are inherently less expensive and more versatile than Er:YAG and Er:YSGG solid-state lasers. In this study a lambda = 9.3-microm TEA CO(2) with a pulse duration of 8 microseconds and a repetition rate of 300 Hz was used to uniformly treat bovine enamel surfaces at ablative irradiation intensities. We hypothesized that a uniform surface layer of modified enamel of improved crystallinity and CaP phase composition would be formed with an enhanced resistance to acid-dissolution in the ablated areas at higher scanning rates used with the water spray. Such a modified layer of enamel formed at the base and walls of a cavity preparation under the irradiation conditions employed in this study have the potential to inhibit secondary caries under sealants and restorations.

STUDY DESIGN/MATERIALS AND METHODS

The surfaces of bovine enamel blocks (3 x 3 mm(2)) were rapidly scanned across the laser beam at rates of 2, 3, and 6 mm/second with and without a water-spray at an incident fluence of 30 J/cm(2). The resistance to acid dissolution was evaluated using controlled surface dissolution experiments on laser-irradiated and control samples.

RESULTS

The groups irradiated at a fluence of 30 J/cm(2) with a repetition rate of 300 Hz and a high scan rate of 6 mm/second with and without water-cooling significantly reduced the overall surface dissolution rates (P < 0.001). At low scan rates (2-3 mm/second) excessive heat deposition resulted in the formation of an outer layer of asperities containing non-apatitic CaP phases that were more susceptible to acid-dissolution. At a scanning rate of 6 mm/second even without the water spray a layer of purer phase HAP was formed without thermal damage, indicating that a high scanning rate can be used to avoid excessive thermal damage during ablation. The best results (80% inhibition) were attained for the higher scanning speed 6-mm/second combined with a water spray.

CONCLUSION

This study demonstrates that an enamel surface with enhanced resistance to acid dissolution is produced after ablation with lambda = 9.3-microm TEA CO(2) laser pulses delivered at high-repetition rates if sufficiently high scanning rates are used with or without a water-spray.

Modeling the modification depth of carbon dioxide laser-treated dental enamel

BACKGROUND AND OBJECTIVES

Many studies of laser-induced thermal decomposition of dental enamel have demonstrated a reduction in the rate of acid dissolution, size of artificial caries-like lesions, and acid reactivity. Additionally, studies have correlated the loss of carbonate from dental enamel with a reduction in acid dissolution. Dental mineral consists of hydroxyapatite with many substitutions, the major one being carbonate ( approximately 3-5% by weight), which markedly affects acid reactivity. The principle objective of the present work was to determine the precise depth of modification, i.e. , thermally induced decomposition of dental enamel (carbonate loss), at the predicted optimum laser irradiation parameters. STUDY DESIGN/ MATERIALS AND METHODS: Bovine enamel blocks were irradiated at lambda = 9.6 microm with 2-microsec and 100-microsec pulses and at lambda = 10.6 microm with 2-microsec pulses. Carbonate loss was calculated from infrared spectra as a function of depth and compared to numerical simulations of the maximum temperature rise.

RESULTS

Carbonate loss was initiated at temperatures greater than 400 degrees C, but was complete only after repeated irradiation of the surface above the melting threshold. Carbonate loss of dental enamel irradiated at 9.6 microm with a 100-microsec pulse and at 10.6 microm with a 2-microsec pulse was greater than that of enamel irradiated at 9.6 microm with a 2-microsec pulse. The depth of carbonate loss in dental enamel irradiated with a 2-microsec pulse was greater for lambda = 10.6 microm than for lambda = 9.6 microm.

CONCLUSION

The depth of modification is consistent with the presented model that incorporates the absorption depth and thermal relaxation time/pulse duration. However, repeated irradiation is required for complete removal of carbonate, depending on absorption depth and pulse duration.

Raman spectroscopic studies of CO2 laser-irradiated human dental enamel

While the effects of carbon dioxide (CO2) laser radiation on the physical properties of human dental enamel are well characterized, little is known regarding laser-induced chemical changes. In this study, enamel was exposed to CO2 laser radiation to induce fusion and recrystallization, and the Raman spectra recorded using both dispersive and Fourier-transformed (FT) Raman spectroscopy. Spectra were compared to a heart-treated specimen of hydroxyapatite (HAP) and enamel. Laser irradiation induced chemical changes which differed from those induced by heat treatment. Comparing the Raman spectra of lased enamel to HAP and tricalcium phosphate (TCP), it is evident that CO2 laser irradiation of enamel causes the partial conversion of HAP to TCP. The effect of laser irradiation is not merely a simple local heating effect as previously thought, since simple heating of enamel leads to the formation of both TCP and Ca(OH)2, while laser treatment of enamel results in the formation of TCP but not Ca(OH)2.

CO2 laser inhibitor of artificial caries-like lesion progression in dental enamel

Several studies during the last 30 years have demonstrated the potential of laser pre-treatment of enamel or tooth roots to inhibit subsequent acid-induced dissolution or artificial caries-like challenge in the laboratory. The overall objective of ongoing studies in our laboratories is to determine, systematically, the optimum sets of parameters for carbon dioxide laser irradiation that will potentially effectively inhibit dental caries in enamel and tooth roots. The aim of the present study was to examine the roles of wavelength and fluence in the prevention of caries progression in vitro in enamel by means of a pH-cycling model. The hypothesis to be tested was that the highly absorbed 9.3- and 9.6-microm wavelengths would be efficiently converted to heat, creating a temperature sufficiently high to reduce the acid-reactivity of the mineral and inhibit caries-like lesion progression in dental enamel. One hundred and sixty caries-free tooth crowns were cleaned and varnished with acid-resistant varnish, leaving one exposed window of enamel. Twelve groups of 10 enamel samples were irradiated in their individual windows by one of the four wavelengths (9.3, 9.6, 10.3, or 10.6 microm) of a tunable CO2 laser. Energy per pulse was 25, 50, 100, 200, or 250 mJ (25 pulses). Repetition rate was 10 Hz, and beam diameter was 1.6 mm. Fluence conditions of 1 to 12.5 J/cm2 per pulse were produced. All teeth, including 40 non-irradiated controls, were subjected to pH-cycling to produce artificial caries-like lesions. Results were assessed by cross-sectional microhardness testing. Inhibition of caries progression of from 40% to 85% was achieved over the range of laser conditions tested. At 9.3 and 9.6 microm, 25 pulses at absorbed fluences of 1 to 3 J/cm2 produced inhibition on the order of 70% with minimal subsurface temperature elevation (< 1 degree C at 2 mm depth), comparable with inhibition produced in this model with daily fluoride dentifrice treatments. Safety and efficacy studies will be required in animals and humans before these promising laboratory results can be applied in clinical practice.

Effect of sodium bicarbonate amount on in vitro indomethacin release from self-setting carbonated-apatite cement

PURPOSE

In the present study, to develop a drug delivery system with higher bioactivity in hard tissues by using the self-setting bioactive carbonate apatite cement, we have investigated the effects of sodium bicarbonate content on the in vitro drug release from a self-setting bioactive carbonate apatite cement containing indomethacin (IMC).

METHODS

The cement powder systems constituted an equimolar mixture of tetracalcium phosphate (Ca4(PO4)2O) and dicalcium phosphate dihydrate (CaHPO4.2H2O), hydroxyapatite (HAP, Ca10(PO4)6(OH)2) seed crystals and sodium bicarbonate. Two types of 2% IMC loaded-cements were prepared as follows, one containing 0% HAP seed crystal and 0-10% sodium bicarbonate, and the other containing 40% HAP seed crystal and 0-10% sodium bicarbonate. The drug release profiles from 2% IMC loaded-cements were measured in simulated body fluid at pH 7.25 and 37.0 degrees C.

RESULTS

The drug release profiles from the cement matrix systems with or without seed crystals were estimated using a moment analysis computer program. The mean drug release time (MDT) and the time required for 50% drug release of the cement containing 0 and 40% seed crystal decreased with an increase of sodium bicarbonate. Furthermore, after the drug release the total pore volume of the cement matrix, as measured by mercury porosimetry, increased with an increase of sodium bicarbonate.

CONCLUSIONS

MDT and T50's were a function of adding the amount of sodium bicarbonate. The results of the relationship between the micropore distribution, total volume of pores after drug release and drug release supported the hypothesis that the variation in drug release from the cements resulting from the addition of sodium bicarbonate was mainly due to an increase in the diffusion of the drug in the micropores of the cement by dissolution or erosion of the cement matrix.

A novel skeletal drug delivery system using self-setting calcium phosphate cement. 9: Effects of the mixing solution volume on anticancer drug release from homogeneous drug-loaded cement

The effects of mixing solution volume (0.25-0.65 mL/g) on in vitro drug release from a self-setting bioactive calcium phosphate cement containing the anticancer agent 6-mercaptopurine (6-MP) as a model compound were investigated. The drug release profiles from isolated planar surfaces as well as the entire surfaces of cement systems containing 5% 6-MP were measured in simulated body fluid at pH 7.25 and 37.0 degrees C. The drug release rate from both cement system geometries increased with increasing mixing solution volume. Drug release profiles from the planar-release and entire-surface-release cement matrix systems were analyzed by and found to agree with the Higuchi and Cobby equations, and the kinetic parameters were estimated with a nonlinear least-squares computer program. Linear relationships were found between the mixing solution volume and the drug release rate constants or time required for 50% drug release for both cement release geometries. Furthermore, the total pore volume of the cements, as measured by mercury porosimetry, increased with increasing mixing solution volume.

Lasers in dentistry

Since the development of the ruby laser by Maiman in 1960, there has been great interest among dental practitioners, scientists, and patients to use this tool to make dental treatment more pleasant. Oral soft tissue uses are becoming more common in dental offices. The possible multiple uses of lasers in dentistry, beyond soft tissue surgery and dental composite curing, unfortunately, have not yet been realized clinically. These include replacement of the dental drill with a laser, laser dental decay prevention, and laser decay detection. The essential question is whether a laser can provide equal or improved treatment over conventional care. Safe use of lasers also must be the underlying goal of proposed or future laser therapy. With the availability and future development of different laser wavelengths and methods of pulsing, much interest is developing in this growing field. This article reviews the role of lasers in dentistry since the early 1960s, summarizes some research reports from the last few years, and proposes what the authors feel the future may hold for lasers in dentistry.

Heat-treatment-induced reduction in the apparent solubility of human dental enamel

Holcomb and Young (1980) have shown a significant increase in human dental enamel (HE) structural order resulting from heat treatment in the temperature range of from 275 to 400 degrees C. Also, previous work in our laboratory had shown dramatic decreases in the initial dissolution rates (IDRs) of both carbonated apatite (CAP) heated at similar temperatures (from 300 to 500 degrees C) and HE exposed to CO2 laser irradiation for which calculated surface temperatures were in this same range. We hypothesize that thermal treatment shifts the apparent solubility distribution profile of HE toward lower apparent solubilities, paralleling the observed increased in crystal structural order and the decrease in IDRs. Powdered HE was heated in a furnace at temperatures ranging from 150 to 500 degrees C for 24 hours. The apparent solubility distributions of both heated and unheated HE powders were measured by equilibration for 24 hours in a series of partially saturated solutions simulating various amounts of HE dissolved in a pH 4.5 dissolution medium. The apparent solubility distribution for the unheated HE showed a peak at KHAP [the ion activity product based on the Ca10(PO4)6(OH)2 stoichiometry] of 10(121.0). Heat treatment shifted the apparent solubility distribution to lower solubilities. The peak KHAP values were approximately 10(124.8) at 200 degrees C; approximately 10(127.8) at 300 degrees C; and approximately 10(-129.1) from 400 to 500 degrees C. This approximately 8 orders of magnitude decrease in KHAP for HE heated at from 400 to 500 degrees C correlates with the previously observed reduction in the IDR driving force for laser-treated HE experiencing a similar surface temperature.(ABSTRACT TRUNCATED AT 250 WORDS)

A novel skeletal drug delivery system using self-setting calcium phosphate cement. 7. Effect of biological factors on indomethacin release from the cement loaded on bovine bone

The use of self-setting bioactive calcium phosphate cement containing indomethacin as a model drug in bovine bone was investigated by means of an in vitro drug release test, mercury porosimetry, and scanning electron microscopy (SEM). Calcium phosphate cements containing 2 and 5% indomethacin after being mixed with dilute phosphoric acid were applied to defect sites and the medullary cavity of bovine bone and transformed into hydroxyapatite. The in vitro drug release from the cement loaded on the defect site into a simulated body fluid (SBF) containing 2.5 mM Ca2+ and 1.0 mM HPO4(2+) or 0.1 M phosphate buffer at pH 7.25 and 37 degrees C continued for more than 3 weeks. The release profiles of the drug-loaded cements in phosphate buffer were linear using the Higuchi plot; however, that was not the case for SBF. The drug release in SBF was much lower than that in phosphate buffer. The total pore volume of the cement after the drug release test in SBF was lower than its initial value. However, the pore size of 0.1-0.01 microns after drug release in phosphate buffer was higher than that seen in SBF. The micropore distribution results suggested that hydroxyapatite crystallized from SBF and the pore volume in the cement decreased after drug release. However, in phosphate buffer it appeared to dissolve. The SEM observations for cements loaded on the bone after drug release in phosphate buffer suggested that there was a boundary layer between the cement and natural bone, but this was not the case in SBF, where the cement bonded with the natural bone. The drug release rates from the cement-loaded bone were significantly higher than those from cement loaded on the dissolution holder. The results suggested that cement formation and drug release were affected by the presence of protein from natural bone. The drug release rates from the cement loaded on the defective bone were slower than those from the medullary cavity.

A novel skeletal drug delivery system using a self-setting calcium phosphate cement. 5. Drug release behavior from a heterogeneous drug-loaded cement containing an anticancer drug

A novel drug delivery device based on a self-setting bioactive calcium phosphate cement formed from tetracalcium phosphate and dicalcium phosphate has been developed and tested in vitro using the anticancer agent 6-mercaptopurine (6-MP) as a model compound. X-ray diffraction results suggest that equimolar mixtures of the calcium phosphate salts were transformed into hydroxyapatite after being mixed with a dilute phosphoric acid solution, even in the presence of various amounts of 6-MP powder. The inclusion of 6-MP in the reaction mixture resulted in the formation of a homogeneous drug-containing cement. Alternatively, the drug was loaded after cement formation to produce a heterogeneous drug-containing pellet. In vitro drug release from both the homogeneous and heterogeneous drug-loaded cement pellets into simulated body fluid (pH 7.25, 37.0 degrees C) was measured using the rotating-disk method. Release from the homogeneous 5% drug-loaded cements did not obey the Higuchi equation. The release rate from the heterogeneous drug-loaded cements of different thicknesses (1, 2, and 3 mm) was a function of thickness, indicating that release kinetics could be controlled by the design of the cement formulation.

A novel skeletal drug delivery system using self-setting calcium phosphate cement. 2. Physicochemical properties and drug release rate of the cement-containing indomethacin

A novel drug delivery device based on a self-setting bioactive cement formed from tetracalcium phosphate and dicalcium phosphate has been developed and tested in vitro with indomethacin as a model drug. Equimolar mixtures of the calcium phosphate powders containing 2 and 5% of indomethacin were transformed into a hydroxyapatite after being mixed with a dilute phosphoric acid solution. X-ray diffraction and differential scanning calorimetry results suggested that indomethacin transformed into an amorphous form in the pores of the cement matrix as it hardened. In vitro drug release from cement pellets into a 0.1 mol/L phosphate buffer at pH 7.40 and 37 degrees C continued for > 3 weeks. Release from 2 and 5% drug-loaded cements followed the Higuchi model equation. The drug release profiles of 5% drug-loaded cements with different thicknesses (0.5, 1.0, and 1.5 g) overlapped up to 90% drug release, indicating that the drug concentration gradient in the pore was independent of the thickness of the cement as expected from the model equation.

A novel skeletal drug-delivery system using self-setting calcium phosphate cement. 4. Effects of the mixing solution volume on the drug-release rate of heterogeneous aspirin-loaded cement

The effect of the mixing solution volume was investigated on the in vitro drug-release rate of a novel drug-delivery device based on a self-setting bioactive calcium phosphate cement containing aspirin as a model drug. Equimolar mixtures of metastable calcium phosphate powders containing various proportions (3-40 w/w %) of seed hydroxyapatite crystals transformed into hydroxyapatite after being mixed with dilute phosphoric acid. The drug release from cement pellets in vitro into a 0.1 mol/L phosphate buffer at pH 7.40 and 37 degrees C by the rotating disk method continued for more than 1 week. The drug-release rate from the cement increased with increasing volumes of mixing solution. The relationship between the liquid/powder ratio and the porosity of the cement was a straight line, indicating that the cement porosity depended on the amount of the mixing solution, but was independent of the amount of seed crystals. Drug release from the cement followed the modified Fick's law, with the rate increasing with the amount of mixing solution, since the porosity depended on the amount. The tortuosity of the cements was estimated from the modified Fick's equation, and the relationships between the drug release rate and the tortuosity of the pore in the drug-loaded cement in the plots were nonlinear. The results suggested that the drug-release rates from the cement were controlled by the drug diffusion in the pores.

Structural changes in dental enamel induced by high energy continuous wave carbon dioxide laser

The morphological changes in dental enamel exposed to a high energy continuous beam surgical carbon dioxide laser were studied with a wet-scanning electron microscope. Utilizing a 1 mm focused beam, energy levels of 5, 10, and 12.5 watts were applied to the external enamel surface of teeth for between 0.05 and 2 seconds. Subsequent examination showed melting and resolidification of the surface enamel. Examination in cross section revealed three different zones of change, which were consistent in thickness. The outer layer of melted and resolidified enamel approximates 100 microns in width, whereas the next zone of acid resistant amorphous enamel measures only 12 microns in width and the third zone of porous enamel measures approximately 110 microns in width. Though of no immediate practical value in dentistry, the exact physical chemical changes occurring in the enamel warrant further investigation.

Initial dissolution rate studies on dental enamel after CO2 laser irradiation

The influence of CO2 laser irradiation on the dissolution behavior of human dental enamel has been investigated. Human enamel was irradiated by a continuous-wave CO2 laser at 10.6 microns and initial dissolution rates (IDRs) were measured in 0.1 mol/L acetate buffer, pH = 4.5, both with and without calcium and/or phosphate common ion, by means of a rotating disk assembly. The effects of (1-hydroxyethylidene) bisphosphonic acid (EHDP), fluoride (F), and dodecylamine HCl (DAC) at various levels upon the IDR were also determined. All of the findings were consistent with the hypothesis that CO2 laser irradiation converts dental enamel to hydroxyapatite (HAP) possessing site #2 character (Yamamoto et al., 1986). The dissolution driving force function, KHAP = aCa10aPO4(6)aOH2, was found to have a value of 10(-129.9) after being lased, as compared with 10(-121.4) before being lased. The IDR values for EHDP (3 mmol/L) and DAC (3 mmol/L) were essentially zero as expected for site #2 HAP. For solution F, the deduced dissolution driving force function, KFAP = aCa10aPO4(6)aF2 was 10(-128.6) after being lased as compared with 10(-116.3) before being lased. These results all support the hypotheses (1) that laser irradiation may convert the surface of human dental enamel to an apatite of significantly lower effective solubility (i.e., site #2 HAP) than that of unlased enamel; and (2) that there is significant synergism between laser treatment and these chemical dissolution rate inhibitors (again consistent with site #2 HAP). Simple model calculations indicate that, in both the presence and absence of fluoride, these laser-induced changes in the driving force for dissolution should dramatically lessen the susceptibility of enamel to the types of acid challenge that might be encountered in the mouth.