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

Effects of 9,300 nm Carbon Dioxide Laser on Dental Hard Tissue: A Concise Review

A carbon dioxide laser at 9,300 nm has a high absorption affinity for water and a shallow depth of penetration. It can be used for soft tissue surgery and hemostasis. Besides, it matches well with the absorption characteristic of hydroxyapatite in enamel and dentine. Therefore, the laser possesses a great ability for energy transfer to dental hard tissues. It has a low risk of thermo-damage to the dentine-pulp complex because it has a shallow depth of heat absorption. Hence, the laser is safe for dental hard tissue preparation. A carbon dioxide laser at 9,300 nm can effectively alter the chemical structure of teeth. It increases the ratio of calcium to phosphorus and converts the carbonated hydroxyapatite to the purer hydroxyapatite of enamel and dentine. It can alter the surface morphology of a tooth through surface melting, fusion, and ablation of dentine and enamel. At higher power, it removes caries lesions. It can enhance the success of restoration by increasing the bond strength of dental adhesives to the dentine and enamel. A carbon dioxide laser at 9,300 nm can also be used with fluoride for caries prevention. The advancement of technology allows the laser to be delivered in very short pulse durations and high repetition rates (frequency). Consequently, the laser can now be used with high peak power. The objective of this review is to discuss the effects and potential use of a 9,300 nm carbon dioxide laser on dental hard tissue.

Assessment of Structural Changes in Translucency and Opacity of Tooth Enamel against a Direct Demineralization Process: An In Vitro Study

Objective:

The objective of this study was to assess in vitro the structural changes in translucency and opacity of tooth enamel following a direct demineralization process.

Materials and Methods:

This experimental in vitro study evaluated 45 thirds (cervical, middle, and occlusal) of the tooth enamel surface of premolar teeth extracted from young adults divided into three groups of 15 specimens each: Group 1 (solution based on calcium, phosphorus, and fluorine), Group 2 (orthophosphoric acid 37%), and control group (distilled water). All underwent optical macroscopic examination with ×3 magnification to determine the initial translucency according to the variation of the medium in their intercrystalline spaces, and Thylstrup and Fejerskov Index was used. The experimental groups were then subjected to an artificial caries process during which the specimens were placed in an inorganic and organic solution of calcium, phosphorus, and fluorine at 37°C for 90 days with the acidic solution at pH 5 and the neutral solution at pH 7. The control specimens were placed in distilled water. Finally, all the specimens were assessed by polarization microscopy.

Results:

In relation to the occlusal third, the highest proportion in Groups 1 and 2 was in Grades 2 and 3 (80%). A significant association was only observed between the experimental groups in the degree of translucency in the occlusal third (P = 0.002), whereas no association was found in relation to the degree of opacity in the middle and cervical thirds in either study group (P > 0.05).

Conclusion:

The resistance of enamel hydroxyapatite crystals increases from occlusal to cervical due to the greater presence of aprismatic enamel in the cervical horizontal third.

The Impact of CO2 Laser Treatment and Acidulated Phosphate Fluoride on Enamel Demineralization and Biofilm Formation

Introduction: This study evaluated the impact of CO₂ laser treatment and acidulated phosphate fluoride (APF) on enamel demineralization and biofilm formation, using in vitro and in situ designs. Methods: Demineralized enamel slabs were distributed among 8 groups: placebo, placebo + continuous CO₂ laser, placebo + repeated CO₂ laser, placebo + ultrapulsed CO₂ laser, 1.23% APF, APF + continuous CO₂ laser, APF + repeated CO₂ laser and APF + ultrapulsed CO₂ laser. In the in vitro study, 15 enamel slabs from each group were subjected to a pH-cycling regimen for 14 days. In the cross over in situ design, 11 volunteers wore palatal appliances with demineralized enamel slabs for 2 periods of 14 days each. Drops of sucrose solution were dripped onto enamel slabs 8×/day. Biofilms formed on slabs were collected and the colony-forming units (CFU) of Streptococcus mutans and Lactobacillus were determined. Results: For both in vitro and in situ studies, there was no significant difference between treatments (P>0.05). However, all treatments increased microhardness of demineralized enamel (P<0.05). After a further in situ cariogenic challenge, with the exception of the placebo, all treatments maintained microhardness values (P<0.05). Microbiological analysis showed no difference in Streptococcus mutans (P>0.05) or Lactobacillus (P>0.05) counts between groups. Conclusion: The results suggest that APF gel combined with the CO₂ laser, regardless of the pulse emission mode used, was effective in controlling enamel demineralization, but none of the tested treatments was able to prevent bacterial colonization.

Laser-assisted prevention of enamel caries: a 10-year review of the literature

Since the invention of lasers in dentistry, investigations in caries prevention by the use of laser radiation have been proposed. There are several mechanisms stated for this purpose such as photothermal and/or photochemical interaction processes with the enamel. Alone or in conjugation with topical fluoride application, this treatment modality may improve enamel acid resistance in high-caries-risk populations. Data collection was done by searching the keywords caries, prevention, and laser in PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar. Lasing protocols of the collected literature and their effectiveness as well as examination methods used to verify treatment outcomes have been evaluated. One hundred eighteen publications were found for the last 10 years. The wavelengths investigated for caries prevention are mainly located in the near and the mid-infrared spectral range. In the evaluated period of time, investigations using CO₂; Er:YAG; Er,Cr:YSGG; Er:YLF; fundamental, second, and third harmonic generations of Nd:YAG; diodes; and argon ion lasers were found in the databases. Accounting for 39% of the literature, CO₂ laser was the most examined system for this purpose. Reviewing the literature in this narrative review showed that all laser systems presented a positive effect in varying degrees. Laser irradiation could be an alternative or synergistic to topical fluoridation for enamel caries prevention with longer lasting effect. Further research should be focused on selecting proper laser settings to avoid damage to enamel and developing effective evidence-based clinical protocols.

Influence of external cooling on the femtosecond laser ablation of dentin

In the present work, the influence of external cooling on the temperature rise in the tooth pulpal chamber during femtosecond laser ablation was investigated. The influence of the cooling method on the morphology and constitution of the laser-treated surfaces was studied as well. The ablation experiments were performed on dentin specimens using an Yb:KYW chirped-pulse-regenerative amplification laser system (560 fs, 1030 nm). Cavities were created by scanning the specimens at a velocity of 5 mm/s while pulsing the stationary laser beam at 1 kHz and with fluences in the range of 2-14 J/cm². The experiments were performed in air and with surface cooling by a lateral air jet and by a combination of an air jet and water irrigation. The temperature in the pulpal chamber of the tooth was measured during the laser experiments. The ablation surfaces were characterized by scanning electron microscopy (SEM) and Fourier transform infrared (FTIR) spectroscopy. The temperature rise reached 17.5 °C for the treatments performed with 14 J/cm² and without cooling, which was reduced to 10.8 ± 1.0 and 6.6 ± 2.3 °C with forced air cooling and water cooling, respectively, without significant reduction of the ablation rate. The ablation surfaces were covered by ablation debris and resolidified droplets containing mainly amorphous calcium phosphate, but the amount of redeposited debris was much lower for the water-cooled specimens. The redeposited debris could be removed by ultrasonication, revealing that the structure and constitution of the tissue remained essentially unaltered. The present results show that water cooling is mandatory for the femtosecond laser treatment of dentin, in particular, when high fluences and high pulse repetition rates are used to achieve high material removal rates.

A New Laser-Processing Strategy for Improving Enamel Erosion Resistance

In the present study, a new automatic laser-processing strategy allowing standardized irradiation of natural tooth areas was investigated. The objective was to find a combination of laser parameters that could cause over a 600°C temperature increase at the enamel surface while not damaging enamel, avoiding temperature change above 5.5°C in the pulp and increasing enamel erosion resistance. Seventy-seven bovine enamel samples were randomly divided into 6 laser groups and 1 negative control (C/no treatment/ n = 11). A scanning strategy (7 × 3 mm) was used for the CO₂ laser treatment (λ = 10.6 µm, 0.1-18 J/cm²) with different pulse durations-namely, 20 µs (G20), 30 µs (G30), 55 µs (G55), and 490 µs (G490), as well as 2 modified pulse distances (G33d, G40d). Measurements of temperature change were performed at the surface (thermal camera/50 Hz), at the underside (thermocouples), and at the pulp chamber using a thermobath and human molars ( n = 10). In addition, histology and X-ray diffraction (XRD/ n = 10) were performed. Erosion was tested using an erosive cycling over 6 d, including immersion in citric acid (2 min/0.05 M/pH = 2.3) 6 times daily. Surface loss was measured using a profilometer and statistical analysis with a 2-way repeated-measures analysis of variance (α = 0.05). Only G20 fulfilled the temperature requirements at the surface (619 ± 21.8°C), at the underside (5.3 ± 1.4°C), and at the pulp (2.0 ± 1.0°C), and it caused no mineral phase change and significant reduction of enamel surface loss (-13.2 ± 4.0 µm) compared to C (-37.0 ± 10.1 µm, P < 0.05). A laser-scanning strategy (20 µs/2 kHz/1.25 J/cm², 3.4 mm/s) has been established that fulfilled the criteria for biological safety and significantly increased enamel erosion resistance (64%) in vitro.

Influence of cavity preparation with Er,Cr:YSGG laser and restorative materials on in situ secondary caries development

OBJECTIVE

The aim of this study was to evaluate the influence of cavity preparation and restorative materials containing fluorides in the prevention of secondary caries lesion development in situ.

METHODS

A total of 120 blocks obtained from human teeth were divided into two groups and standardized cavities were prepared using diamond burs (DB) or Er,Cr:YSGG-laser [20 Hz, 4.0W, 55% water, 65% air (LA)]. They were divided into three subgroups according to the restorative material (n=20): glass-ionomer cement (GI), resin modified glass-ionomer (RM) or composite resin (CR). Blocks were fixed in palatal intra-oral appliances worn in situ by 20 human volunteers, who dropped 20% sucrose solution eight times daily. After 21 days, blocks were removed and restorations were cross-sectioned to evaluate microhardness [Knoop hardness number (KHN)] underneath enamel surface from 30 to 200 μm. Factors "cavity preparation," "restorative materials," and "depth" were evaluated by three way ANOVA, followed by Tukey test (p<0.05).

RESULTS

The results showed lower microhardness in cavities prepared with DB than in cavities prepared with LA. At 30 μm, there were no statistical significant differences with regard to "cavity preparation" or "restorative materials" factors. In depth evaluation, the enamel microhardness progressively increased as a function of depth for the GI groups. In the groups prepared with LA at 60 μm/90 μm, there were no significant differences between GI and RM materials, whose microhardnesses were significantly higher than that of CR.

CONCLUSIONS

Cavity preparation using Er,Cr:YSGG laser increases caries resistance of enamel walls, and reduce caries lesion depth development regardless of fluoride presence in the restorative material. CR showed higher caries lesion development than GI, and RM showed intermediate results.

A method for monitoring enamel erosion using laser irradiated surfaces and optical coherence tomography

INTRODUCTION

Since optical coherence tomography (OCT) is well suited for measuring small dimensional changes on tooth surfaces, OCT has great potential for monitoring tooth erosion. Previous studies have shown that enamel areas ablated by a carbon dioxide laser manifested lower rates of erosion compared to the non-ablated areas. The purpose of this study was to develop a model to monitor erosion in vitro that could potentially be used in vivo.

METHODS

Thirteen bovine enamel blocks were used in this in vitro study. Each 10 mm × 2 mm block was partitioned into five regions, the central region was unprotected, the adjacent windows were irradiated by a CO2 laser operating at 9.3 µm with a fluence of 2.4 J/cm(2) , and the outermost windows were coated with acid resistant varnish. The samples were exposed to a pH cycling regimen that caused both erosion and subsurface demineralization for 2, 4 and 6 days. The surfaces were scanned using a time-domain polarization sensitive optical coherence tomography (PS-OCT) system and the degree of surface loss (erosion) and the integrated reflectivity with lesion depth was calculated for each window.

RESULTS

There was a large and significant reduction in the depth of surface loss (erosion) and the severity of demineralization in the areas irradiated by the laser.

CONCLUSION

Irradiation of the enamel surface with a pulsed carbon dioxide laser at sub-ablative intensities results in significant inhibition of erosion and demineralization under the acid challenge employed in this study. In addition, these results suggest that it may be feasible to modify regions of the enamel surface using the laser to serve as reference marks to monitor the rate of erosion in vivo.

Analysis of enamel surface damage after selective laser ablation of composite from tooth surfaces

OBJECTIVE

Resin-based composites are used for many applications in dentistry. They are difficult to remove without damage to the underlying enamel since they adhere strongly and are color matched to the tooth. The objective of this study was to determine if an automated laser scanning system with spectral feedback could be used for selective removal of residual orthodontic composite from tooth surfaces with minimal damage to the underlying enamel.

MATERIALS AND METHODS

A CO₂ laser operating at a wavelength of 9.3 μm with a pulse duration of 10-15 μs and a pulse repetition rate of ~200 Hz was used to selectively remove composite from the buccal surfaces of extracted teeth. A spectral feedback system utilizing a miniature spectrometer was used to control the laser scanning system. Pulpal temperature measurements were performed during composite removal to determine if there was excessive heat accumulation. Conventional and digital microscopes were used to assess the amount of enamel lost during removal.

RESULTS

The amount of enamel lost averaged between 20 and 25 μm for irradiation intensities from 3.8 to 4.2 J/cm², respectively. An average maximum temperature rise of 1.9±1.5°C was recorded, with no teeth approaching the critical value of 5.5°C. The average time for composite removal from an area of 5 mm² was 19.3±4.1 s, fast enough for clinical feasibility.

CONCLUSION

Residual composite can be rapidly removed from tooth surfaces using a CO₂ laser with spectral feedback, with minimal temperature rise within the pulp and with minimal loss of sound enamel.

Methods for Monitoring Erosion Using Optical Coherence Tomography

Since optical coherence tomography is well suited for measuring small dimensional changes on tooth surfaces it has great potential for monitoring tooth erosion. The purpose of this study was to explore different approaches for monitoring the erosion of enamel. Application of an acid resistant varnish to protect the tooth surface from erosion has proven effective for providing a reference surface for in vitro studies but has limited potential for in vivo studies. Two approaches which can potentially be used in vivo were investigated. The first approach is to measure the remaining enamel thickness, namely the distance from the tooth surface to the dentinal-enamel junction (DEJ). The second more novel approach is to irradiate the surface with a carbon dioxide laser to create a reference layer which resists erosion. Measuring the remaining enamel thickness proved challenging since the surface roughening and subsurface demineralization that commonly occurs during the erosion process can prevent resolution of the underlying DEJ. The areas irradiated by the laser manifested lower rates of erosion compared to the non-irradiated areas and this method appears promising but it is highly dependent on the severity of the acid challenge.

Selective Removal of Demineralization Using Near Infrared Cross Polarization Reflectance and a Carbon Dioxide Laser

Lasers can ablate/remove tissue in a non-contact mode of operation and a pulsed laser beam does not interfere with the ability to image the tooth surface, therefore lasers are ideally suited for integration with imaging devices for image-guided ablation. Laser energy can be rapidly and efficiently delivered to tooth surfaces using a digitally controlled laser beam scanning system for precise and selective laser ablation with minimal loss of healthy tissues. Under the appropriate irradiation conditions such laser energy can induce beneficial chemical and morphological changes in the walls of the drilled cavity that can increase resistance to further dental decay and produce surfaces with enhanced adhesive properties to restorative materials. Previous studies have shown that images acquired using near-IR transillumination, optical coherence tomography and fluorescence can be used to guide the laser for selective removal of demineralized enamel. Recent studies have shown that NIR reflectance measurements at 1470-nm can be used to obtain images of enamel demineralization with very high contrast. The purpose of this study was to demonstrate that image guided ablation of occlusal lesions can be successfully carried out using a NIR reflectance imaging system coupled with a carbon dioxide laser operating at 9.3-μm with high pulse repetition rates.

Rapid and selective removal of composite from tooth surfaces with a 9.3 µm CO2 laser using spectral feedback

OBJECTIVE

Dental composite restorative materials are color matched to the tooth and are difficult to remove by mechanical means without excessive removal or damage to peripheral enamel and dentin. Lasers are ideally suited for selective ablation to minimize healthy tissue loss when replacing existing restorations, sealants, or removing composite adhesives such as residual composite left after debonding orthodontic brackets.

METHODS

In this study, a carbon dioxide laser operating at 9.3-µm with a pulse duration of 10-20-microsecond and a pulse repetition rate of ∼200 Hz was integrated with a galvanometer based scanner and used to selectively remove composite from tooth surfaces. Spectra of the plume emission were acquired after each laser pulse and used to differentiate between the ablation of dental enamel or composite. Microthermocouples were used to monitor the temperature rise in the pulp chamber during composite removal. The composite was placed on tooth buccal and occlusal surfaces and the carbon dioxide laser beam was scanned across the surface to selectively remove the composite without excessive damage to the underlying sound enamel. The residual composite and the damage to the underlying enamel was evaluated using optical microscopy.

RESULTS

The laser was able to rapidly remove composite from tooth buccal and occlusal surfaces with minimal damage to the underlying sound enamel and without excessive heat accumulation in the tooth.

CONCLUSION

This study demonstrated that composite can be selectively removed from tooth surfaces at clinically relevant rates using a CO(2) laser operating at 9.3-µm with high pulse repetition rates with minimal heat deposition and damage to the underlying enamel.

High-speed scanning ablation of dental hard tissues with a λ = 9.3 μm CO2 laser: adhesion, mechanical strength, heat accumulation, and peripheral thermal damage

CO(2) lasers can be operated at high laser pulse repetition rates for the rapid and precise removal of dental decay. Excessive heat accumulation and peripheral thermal damage is a concern when using high pulse repetition rates. Peripheral thermal damage can adversely impact the mechanical strength of the irradiated tissue, particularly for dentin, and reduce the adhesion characteristics of the modified surfaces. The interpulpal temperature rise was recorded using microthermocouples situated at the roof of the pulp chamber on teeth that were occlusally ablated using a rapidly-scanned CO(2) laser operating at 9.3 μm with a pulse duration of 10 to 15 μs and repetition rate of 300 Hz over a 2 min time course. The adhesion strength of laser treated enamel and dentin surfaces was measured for various laser scanning parameters with and without post-ablation acid etching using the single-plane shear test. The mechanical strength of laser-ablated dentin surfaces were determined via the four-point bend test and compared to control samples prepared with 320 grit wet sand paper to simulate conventional preparations. Thermocouple measurements indicated that the temperature remained below ambient temperature if water-cooling was used. There was no discoloration of either dentin or enamel laser treated surfaces, the surfaces were uniformly ablated, and there were no cracks visible. Four-point bend tests yielded mean mechanical strengths of 18.2 N (s.d. = 4.6) for ablated dentin and 18.1 N (s.d. = 2.7) for control (p > 0.05). Shear tests yielded mean bond strengths approaching 30 MPa for both enamel and dentin under certain irradiation conditions. These values were slightly lower than nonirradiated acid-etched control samples. Additional studies are needed to determine if the slightly lower bond strength than the acid-etched control samples is clinically significant. These measurements demonstrate that enamel and dentin surfaces can be rapidly ablated by CO(2) lasers with minimal peripheral thermal and mechanical damage and without excessive heat accumulation.

Selective Removal of Dental Composite using a Rapidly Scanned Carbon Dioxide Laser

Dental restorative materials are color matched to the tooth and are difficult to remove by mechanical means without excessive removal or damage to peripheral enamel and dentin. Lasers are ideally suited for selective ablation to minimize healthy tissue loss when replacing existing restorations, sealants or removing composite adhesives such as residual composite left after debonding orthodontic brackets. In this study a carbon dioxide laser operating at high laser pulse repetition rates integrated with a galvanometer based scanner was used to selectively remove composite from tooth surfaces. A diode array spectrometer was used to measure the plume emission after each laser pulse and determine if the ablated material was tooth mineral or composite. The composite was placed on tooth buccal and occlusal surfaces and the carbon dioxide laser was scanned across the surface to selectively remove the composite without excessive damage to the underlying sound enamel. The residual composite and the damage to the underlying enamel was evaluated using optical microscopy. The laser was able to rapidly remove the composites rapidly from both surfaces with minimal damage to the underlying sound enamel.

Dentine caries inhibition through CO(2) laser (10.6μm) irradiation and fluoride application, in vitro

OBJECTIVE

The purpose of the study was to investigate whether dentine irradiation with a pulsed CO(2) laser (10.6μm) emitting pulses of 10 ms is capable of reducing dentine calcium and phosphorus losses in an artificial caries model.

DESIGN

The 90 dentine slabs obtained from bovine teeth were randomly divided into six groups (n=15): negative control group (GC); positive control group, treated with fluoride 1.23% (GF); and laser groups irradiated with 8 J/cm(2) (L8); irradiated as in L8+fluoride 1.23% (L8F); irradiated with 11 J/cm(2) (L11); irradiated as in L11+fluoride 1.23% (L11F). After laser irradiation the samples were submitted to a pH-cycling model for 9 days. The calcium and phosphorous contents in the de- and remineralization solutions were measured by means of inductively coupled plasma optical emission spectrometer--ICP-OES. Additionally intrapulpal temperature measurements were performed. The obtained data were analysed by means of ANOVA and Tukey's test (α=0.05).

RESULTS

In the demineralization solutions the groups L11F and GF presented significantly lower means of calcium and phosphorous losses than the control group; and in L11F means were significantly lower than in the fluoride group. Both irradiation parameters tested caused intrapulpal temperature increase below 2°C.

CONCLUSION

It can be concluded that under the conditions of this study, CO(2) laser irradiation (10.6 μm) with 11 J/cm(2) (540 mJ and 10 Hz) of fluoride treated dentine surfaces decreases the loss of calcium and phosphorous in the demineralization process and does not cause excessive temperature increase inside the pulp chamber.

Nondestructive Assessment of Early Tooth Demineralization Using Cross-Polarization Optical Coherence Tomography

New methods are needed for the nondestructive measurement of tooth demineralization and remineralization to monitor the progression of incipient caries lesions (tooth decay) for effective nonsurgical intervention and to evaluate the performance of anticaries treatments such as chemical treatments or laser irradiation. Studies have shown that optical coherence tomography (OCT) has great potential to fulfill this role since it can be used to measure the depth and severity of early lesions with an axial resolution exceeding 10 µm, it is easy to apply in vivo and it can be used to image the convoluted topography of tooth occlusal surfaces. In this paper, a review of the use of polarization-sensitive-OCT for the measurement of tooth demineralization is provided along with some recent results regarding improved methods for the detection of caries lesions in the earliest stages of development. Automated methods of analysis were used to measure the depth and severity of demineralized bovine enamel produced using simulated caries models that emulate demineralization in the mouth. Significant differences in the depth and integrated reflectivity from the lesions were detected after only a few hours of demineralization. These results demonstrate that cross-polarization-OCT is ideally suited for the nondestructive assessment of early demineralization.

Nondestructive assessment of dentin demineralization using polarization-sensitive optical coherence tomography after exposure to fluoride and laser irradiation

Previous studies have demonstrated that polarization-sensitive optical coherence tomography (PS-OCT) can be used to image natural and artificial caries in dentin. The purpose of this study was to measure nondestructively the severity of artificial caries lesions in dentin and determine the efficacy of intervention with anticaries agents including fluoride and lasers. Although several studies have assessed the utility of PS-OCT to image caries lesions in enamel and to quantify the lesion severity, only a few studies have focused on lesions in dentin. In this study, images of artificial dentin lesions on extracted human teeth were acquired with PS-OCT. Before exposure to an artificial demineralizing solution, three incisions were made on the sample surfaces using either Er:YAG, Nd:YAG (lambda = 355 nm), or TEA CO(2) lasers and selected areas were treated with topical fluoride to create six unique treatment areas for each of the three laser conditions investigated. The integrated reflectivity and depth of demineralization were calculated for each of the six areas on each sample using the PS-OCT images. Polarized light microscopy (PLM) and transverse microradiography (TMR) were used to measure lesion severity on histological thin sections for comparison. PS-OCT successfully measured the inhibition of demineralization by topical fluoride. Laser irradiation was not particularly effective in increasing or decreasing the rate of dentin demineralization. PLM and TMR corroborated those results. This study demonstrates that PS-OCT can be used to measure demineralization on dentin surfaces and determine the degree of inhibition of demineralization by anticaries agents.

Evaluation of mineral content of enamel prepared by erbium, chromium:yttrium-scandium-gallium-garnet laser

The aim of this study was to evaluate the mineral content of enamel etched at two different power settings with an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser. Buccal, lingual and mesial or distal surfaces of five premolar teeth were cut, and three enamel slabs were obtained from each tooth. Fifteen enamel specimens were divided into three groups (1 W, 2 W and control) of five specimens each and subjected to Er,Cr:YSGG laser. The mean percentage weights of the five elements [calcium (Ca), potassium (K), magnesium (Mg), sodium (Na) and phosphorus (P)] in each slab were measured by inductively coupled plasma-atomic emission spectrometry (ICP-AES). One way analysis of variance (ANOVA) was used to analyze differences among the groups (1 W, 2 W and control). There were no significant differences among the groups (1 W, 2 W and control) for Ca, K, Mg, Na, or P, or for the Ca/P ratio (P > 0.05). Scanning electron microscopy (SEM) photographs indicated that the surface irregularities increased with increased power setting. Laser treatment did not affect the mean percentage weights of Ca, K, Mg, Na, and P, or the Ca/P ratio, in any group.

Non-destructive assessment of inhibition of demineralization in dental enamel irradiated by a lambda=9.3-microm CO2 laser at ablative irradiation intensities with PS-OCT

BACKGROUND AND OBJECTIVE

Polarization sensitive optical coherence tomography (PS-OCT) has great promise for the non-destructive assessment of the efficacy of anti-caries agents such as fluoride and thermal laser treatments on enamel surfaces. The purpose of this study was to demonstrate that PS-OCT can be used to measure demineralization in craters/incisions prepared in enamel by a CO(2) laser operating at the high irradiation intensities required for cavity preparations.

MATERIALS AND METHODS

Incisions in bovine enamel surfaces were produced by a CO(2) laser used with a water spray. The laser was operated at lambda=9.3 microm with a pulse duration of 15 micros and an incident fluence of 20 J/cm(2). The laser treatments were also combined with topical fluoride treatments. A PS-OCT system operating at 1,310 nm was used to acquire polarization resolved images of six areas including sound and laser-ablated+topical fluoride treated zones on each sample. After imaging the teeth, they were sectioned and the thin sections were examined with polarized light microscopy (PLM) and transverse microradiography (TMR). The integrated reflectivity and lesion depth derived from the PS-OCT scans, the integrated mineral loss and depth measured using TMR and the lesion depth measured with PLM were acquired for each area on the fifteen samples for comparison.

RESULTS

The integrated reflectivity and depth in the areas treated by the laser and fluoride were significantly lower (P<0.05) than for the untreated enamel. Similar results were observed for TMR and PLM.

CONCLUSIONS

These results suggest that PS-OCT has great potential for the non-destructive "in vivo" assessment of the inhibition of demineralization by lasers at ablative irradiation intensities with and without topical fluoride application.