SEM comparison of acid-etched, CO2 laser-irradiated, and combined treatment on dentin surfaces

Effect of Surface Conditioning on Adhesion of Glass Ionomer Cement to Er,Cr:YSGG Laser-Irradiated Human Dentin

OBJECTIVE

This study aimed to show the effect of dentin conditioner on the bond strength of glass ionomer cement to Er,Cr:YSGG-laser-irradiated dentin compared to conventional bur-prepared dentin.

BACKGROUND DATA

Glass ionomer cement bonds to tooth structure via direct chemical bonding without using any adhesive system. To improve the adhesion of this material, pretreating the dentin surface with a conditioner is recommended. Recently, lasers for tooth drilling have been used for cavity preparation, especially the Er,Cr:YSGG laser. However, there is a lack of research on the bond strength of glass ionomer cement to conditioned Er,Cr:YSGG-laser-irradiated dentin.

METHODS

Extracted human teeth were divided into eight experimental groups and prepared by using either Er,Cr:YSGG laser or a conventional bur. In half of these two groups, the relevant conditioner was applied on the dentin before building up with glass-ionomer cement. After 24 h, all teeth were sectioned, and the microtensile bond strength was determined. The mode of failure was observed, and the fractured surfaces were examined by scanning electron microscopy (SEM).

RESULTS

The use of conditioner was found to significantly affect bond strength for laser-prepared samples (analysis of variance [ANOVA], p < 0.05). Failure analysis showed no adhesive failures in the laser-prepared teeth, and this suggests an effective bond between glass ionomer cement and Er,Cr:YSGG laser-cut dentin.

CONCLUSION

To obtain the maximum retention of a glass ionomer restoration to Er,Cr:YSGG laser-irradiated dentin, the results of this study confirm that pretreatment of the laser-prepared dentin with dentin conditioner is advantageous.

Erbium lasers in dentistry

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

The effects of argon laser irradiation on enamel decalcification: An in vivo study

Enamel decalcification is a significant problem in orthodontic patients. The argon laser has been shown to reduce decalcification during an acidic challenge in vitro. The purpose of this study was to investigate the in vivo effects of argon laser irradiation on enamel decalcification during orthodontic treatment. Nine volunteers whose treatment plans included 4 first premolar extractions were enrolled in the study. The 36 extracted premolars were assigned to 1 of the following 4 groups: group 1, control group with no treatment; group 2 (pumice-laser), teeth were pumiced for 3 seconds and treated with a 325 mW, 5-mm diameter laser beam for 60 seconds; group 3 (pumice-etch-laser), teeth were pumiced for 3 seconds, acid-etched with 30% phosphoric acid for 30 seconds, and treated for 60 seconds with laser; and group 4 (laser only), teeth were treated for 60 seconds with laser. A specially designed (oversized) orthodontic band was fitted on each of the premolars to create a pocket for decalcification. The bands were cemented in place for 5 weeks. After extraction, the teeth were sectioned and examined under polarized light microscopy. Images of lesions were digitally analyzed and measured. Average lesion depths were calculated from 3 depth measurements recorded 10 microm apart. Average lesion area was calculated with the aid of imaging analysis software. Data were analyzed with analysis of variance (P <.05) and Student t tests. Significant differences were found in lesion depth (P <.001) and lesion area (P <.01) among the 4 test groups. The average lesion depths were 15.93 +/- 9.31 microm (control), 6.45 +/- 8.70 microm (pumice-laser), 1.71 +/- 4.82 microm (pumice-etch-laser), and 1.34 +/- 3.80 microm (laser only). The average lesion areas were 1028.67 +/- 725.68 microm (2) (control), 555.49 +/- 948.20 microm (2) (pumice-laser), 79.91 +/- 226.03 microm (2) (pumice-etch-laser), and 55.71 +/- 157.59 microm (2) (laser only). The average lesion depth in the laser-only group was reduced by 94.1% and the average lesion area was reduced by 94.4% when compared with the control group. In the pumice-etch-laser group, the average lesion depth was reduced by 89.1% and the average lesion area was reduced by 92.2% when compared with the control group. There were no significant differences in lesion depth and lesion area between maxillary and mandibular teeth (P <.06 and P <.08, respectively) and between the teeth on the right and left sides (P <.68 and P <.55, respectively). These results show that argon laser irradiation is effective in reducing enamel decalcification during orthodontic treatment. Pumicing and etching do not appear to reduce the effect of laser on enamel solubility.

A laser-powered hydrokinetic system for caries removal and cavity preparation

BACKGROUND

Laser systems have been developed for the cutting of dental hard tissues. The erbium, chromium:yttrium-scandium-gallium-garnet, or Er,Cr:YSGG, laser system used in conjunction with an air-water spray has been shown to be efficacious in vitro for cavity preparation.

METHODS

The authors randomly selected subjects for cavity preparation with conventional air turbine/bur dental surgery or an Er,Cr:YSGG laser-powered system using a split-mouth design. They prepared Class I, III and V cavities, placed resin restorations and evaluated subjects on the day of the procedure and 30 days and six months postoperatively for pulp vitality, recurrent caries, pain and discomfort, and restoration retention. Sixty-seven subjects completed the study.

RESULTS

There were no statistical differences between the two treatment groups for the parameters measured with one exception; there was a statistically significant decrease in discomfort levels for the laser system at the time of cavity preparation for subjects who declined to receive local anesthetic.

CONCLUSIONS

The Er,Cr:YSGG laser system is effective for preparation of Class I, III and V cavities and resin restorations are retained by lased tooth surfaces.

CLINICAL IMPLICATIONS

Hard-tissue cutting lasers are being introduced for use in operative dentistry. In this study, an Er,Cr:YSGG laser has been shown to be effective for cavity preparation and restoration replacement.

Lasers in endodontics: a review

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

An analysis of surface roughness, surface morphology and composite/dentin bond strength of human dentin following the application of the Nd:YAG laser

OBJECTIVES

This study was conducted to investigate the surface effects to dentin following laser "etching" with an Nd:YAG laser, and to determine the shear bond strengths of composite to untreated and laser-treated dentin.

METHODS

Dentin surfaces from freshly extracted permanent molar teeth were subjected to laser treatment with an Nd:YAG laser using different laser pulse rates and power settings. The effect of application of a laser enhancing gel was also investigated. Surface profile analysis of the dentin surfaces was undertaken with a perthometer. The results were analysed by SPSS/PC multiple range test. Specimens were examined using a scanning electron microscope (SEM). The shear bond strengths of laser-treated dentin/composite and untreated dentin/composite by conventional dentin bonding (Gold Standard, Chameleon Dental Products) were also determined. These results were also compared by SPSS/PC multiple range test.

RESULTS

The laser-treated dentin specimens exhibited a qualitatively different surface morphology when compared with untreated dentin. Laser treatment at higher exposures resulted in the formation of microcracks and fissures. Bonding of resin composite to the laser-treated dentin was not significantly different from untreated dentin despite the fact that the surface roughness of laser-treated dentin was significantly higher than untreated dentin (p < 0.05).

SIGNIFICANCE

It was concluded from this study that the etched dentin surfaces produced by the Nd:YAG laser operated under the conditions described were not superior to those obtained with conventional dentin bonding.

Susceptibility of Nd:YAG laser-irradiated root surfaces in replanted teeth to external inflammatory resorption

Nd:YAG laser-induced modification of the root surface may inhibit development of external inflammatory resorption in replanted teeth. This study tested this hypothesis in vivo. The pulp chambers of six mandibular premolars in each of two dogs were accessed, inoculated with plaque, and sealed (Groups 1, 2). Two additional premolars in each dog were endodontically treated without inoculation (Groups 3, 4). After 2 weeks, teeth were hemisected and extracted. Each root had a 2 x 3 mm surface area denuded of cementum on the buccal and lingual surface. In Groups 1 (n = 12 roots) and 3 (n = 4), the denuded surfaces were wiped with 15% EDTA, coated with black ink, and irradiated with Nd:YAG laser (0.75 W, 15 pps, 300 microns tip, 20 s). In Groups 2 (n = 12) and 4 (n = 4), the surfaces were wiped with 15% EDTA, and rinsed with sterile saline for 20 s. Roots were replanted within 5 min. The dogs were perfusion-euthanised 10 weeks after replantation. Block specimens were removed, decalcified, embedded and horizontally sectioned (6 microns) at 180-microns intervals, resulting in 10 to 14 cross-sections of each root. From these, the middle five consecutive sections were stained with hematoxylin and eosin, and observed by light microscopy for occurrence of surface, inflammatory and replacement resorption on the denuded surfaces. No obvious differences were noted between the laser-irradiated and non-irradiated surfaces. Inflammatory resorption was frequent in Groups 1 and 2, and absent in Groups 3 and 4. Replacement resorption was minimal in Groups 1 and 2, and frequent in Groups 3 and 4. Differences between Groups 1 and 2, and between Groups 3 and 4 were not significant, whereas the differences between the two pairs of groups were statistically significant (chi-square and two-way ANOVA, P < 0.006). These results did not support the hypothesis, and questioned the clinical validity of the surface modification in Nd:YAG laser-irradiated dentin. Therefore, the clinical application of Nd:YAG laser to the root surfaces of replanted teeth is not warranted.

Effect of bonding agents on adhesion of composite resin following CO2 laser etching of dental enamel

Etching of dental enamel using pulsed carbon dioxide (CO2) laser radiation has been shown to give acceptable bond strengths when hydrophobic enamel bonding resins are used between the lased surface and composite resin. There have been dramatic changes in the composition of bonding agents in recent years. The present laboratory study examined the influence of the bonding agent on the shear bond strength to laser- and acid-etched enamel. Two current generation bonding systems were used (Scotchbond Multipurpose and Optibond). Shear bond strengths in the order of 10 MPa were consistently obtained using laser etching at "optimal" parameters, in the absence of any other preparation of the natural enamel surface. Although there was a consistent trend for shear bond strengths to be greater with Optibond than for Scotchbond MP in both human and porcine test systems, this difference was only statistically significant with acid etching of nonpolished human enamel, and suboptimal laser etching of polished human enamel. Prior surface polishing increased the shear bond strength obtained with maleic acid etching and Scotchbond MP by more than 2-fold, and increased bond strength when Optibond was used following optimal laser etching. These results indicate that both the type of surface preparation and the choice of bonding agent can influence bond strengths to laser-etched and acid-etched enamel.