The effect of chemical and/or mechanical conditioning on the Er:YAG laser-treated root cementum: analysis of surface morphology and periodontal ligament fibroblast attachment

Current status of Er:YAG laser in periodontal surgery

Lasers have numerous advantageous tissue interactions such as ablation or vaporization, hemostasis, bacterial killing, as well as biological effects, which induce various beneficial therapeutic effects and biological responses in the tissues. Thus, lasers are considered an effective and suitable device for treating a variety of inflammatory and infectious conditions of periodontal disease. Among various laser systems, the Er:YAG laser, which can be effectively and safely used in both soft and hard tissues with minimal thermal side effects, has been attracting much attention in periodontal therapy. This laser can effectively and precisely debride the diseased root surface including calculus removal, ablate diseased connective tissues within the bone defects, and stimulate the irradiated surrounding periodontal tissues during surgery, resulting in favorable wound healing as well as regeneration of periodontal tissues. The safe and effective performance of Er:YAG laser-assisted periodontal surgery has been reported with comparable and occasionally superior clinical outcomes compared to conventional surgery. This article explains the characteristics of the Er:YAG laser and introduces its applications in periodontal surgery including conventional flap surgery, regenerative surgery, and flapless surgery, based on scientific evidence from currently available basic and clinical studies as well as cases reports.

Dentin Collagen versus Er:YAG Laser as Surface Biomodifiers for Intact Root Slices Simulating Delayed Replanted Roots

Objective: To evaluate effects of dentin collagen versus Er:YAG laser application through enhancing human periodontal ligament fibroblast (PDLF) cells to attach to intact root surfaces imitating delayed replanted roots. Background Data: Accidental traumatic injuries with teeth avulsion are managed by replantation. Root resorption, poor conditioning, and non-viable fibroblasts are factors responsible for failure. Methods: Thirty six human healthy single-rooted premolars were collected. Six teeth were used for PDLF, six teeth used for dentin collagen, whereas the remaining 24 teeth (48 root slices) were used for PDLF cell density and morphology. Each root was soaked in 5.25% NaOCl. Three groups (n = 16 slices/each) were planned as follows: I: Control (untreated); II: dentin collagen application; III: Er:YAG laser irradiation (4 mm distance, 40 mJ/pulse, under coolant). Following incubation, cell density and morphology of PDLF were investigated under SEM. Statistical analysis was performed using analysis of variance with Scheffé's test, and p < 0.05 was considered significant. Results: All groups showed increased cultured PDLF following incubation. Regarding cell density, attached PDLFs were significantly lower in untreated controls (36.5 ± 6.36) (p < 0.00001 i.e., <0.05) in negative empty and/or light cellular areas, compared with dentin collagen (65 ± 6) and laser-irradiated (66.75 ± 5.77) groups that did not show significant differences (p = 0.940 i.e., >0.05) and showed intermediate and/or heavy cellular areas. Regarding cell morphology, controls showed round and/or oval appearance with less lamellipodia, whereas dentin collagen and laser groups showed flat morphology with cytoplasmic processes. Conclusions: Both dentin collagen and Er:YAG laser showed comparable effectiveness as biomodification tools with good biocompatibility for human PDLF cell attachment on intact root slices imitating delayed replantation. Dentin collagen as a natural bioactive material is considered an alternative to Er:YAG laser to enhance the regenerative effects.

Assessment of the Periodontal Cementum Ablation Depth during Root Planing by an Er:YAG Laser at Different Energy Densities: An Ex Vivo Study

INTRODUCTION

An important and non-adapted delivered energy of Er:YAG laser can eliminate the total thickness of root cementum during root planing. Conversely, the preservation of a partial layer of cementum covering the roots is vital for any periodontal ligament regeneration. Thus, the assessment of the cementum ablation depth produced by each energy density of Er:YAG laser is essential before considering its use for the periodontal planing and treatment of the cementum and root surfaces.

AIM OF THE STUDY

Assessment of the cementum ablation depth at different energy densities of the Er:YAG laser is the aim of this study.

MATERIALS AND METHODS

A total of 48 human caries free molars were collected and used in this study. Areas to be irradiated were delimited by two longitudinal grooves (0.5 mm depth). Roots were divided randomly into four groups (4 × n = 12). An Er:YAG laser (2.94 µm) was used with a side-firing tip (R600T) with a 600 µm diameter and a frequency of 20 Hz combined with a cooling system of air 6 mL/min and water 4 mL/min. We used a super short pulse mode (SSP: pulse duration: 50 μs). We used a single irradiation passage backward from apex to cervical parts at 1 mm/s with a slight contact and at an angle of 15° to 30° between the tip and the root surface. Different energies were selected: 30 mJ, 40 mJ, 50 mJ, and 60 mJ.

RESULTS

Microscopic observations showed that the average of the ablation depth increased with the increase of the delivered energy from 30 mJ to 60 mJ. Mean values of the ablation depths were respectively as follows: 43.75 ± 4.89 µm for the energy of 30 mJ, 50.05 ± 3.72 µm for 40 mJ, 65.56 ± 10.35 µm for 50 mJ, and 74.80 ± 15.23 µm for 60 mJ. A statistically significant difference existed between the ablation depth of all groups.

CONCLUSION

Based on our results, the depth of cementum debridement is related to the level of the delivered energy. The lowest energy levels (30 mJ and 40 mJ) can ablate the root cementum surface for a variable depth from 43.75 ± 4.89 μm to 50.05 ± 3.72 μm.

The effect of intracanal medication variations on microhardness of simulated immature root dentin

The effect of different medicaments and irrigation solutions on root dentin microhardness (MH) was evaluated depending on time. After initial measurements, MH of 60 maxillary incisors (n = 15 per group) was measured after 3 steps: irrigation with 2.5% sodium hypochlorite, exposure to medicaments [triple antibiotic (TAP) or calcium hydroxide (CH) pastes, 1 week or 1 month)] and final irrigation [20 mL of 17% EDTA or 20 mL 1% phytic acid (PA)]. The percentage of MH reduction was calculated. Data were analysed statistically at P < 0.05. Treatments caused a significant decrease in MH values compared to baseline and pre-measurements (P < 0.05). TAP significantly reduced the MH values of the samples over time (P < 0.05). Removal of TAP after 1 month with PA resulted in a significant reduction in MH compared to removing TAP after 1 week and CH removing after 1 month (P < 0.05). Considering the chemical preparation steps, the most hazardous effect on MH was observed after the first irrigation.

Adjunctive Use of Lasers in Peri-Implant Mucositis and Peri-Implantitis Treatment: A Systematic Review

BACKGROUND

The aim of this systematic review is to compare the effectiveness of lasers in the treatment of implant mucositis and peri-implantitis compared to conventional treatment (non-surgical or surgical: resective or regenerative).

METHODS

Sources of PubMed, Cochrane and Google Scholar search engines were used on articles published from 1997 to 2020 in English, with selected keyword criteria applied. Nine randomized controlled trials (RCTs) were selected.

RESULTS

All included studies were considered of "high quality" according to the quality assessment scale. The comparative assessment of the RCTs was done twice for each RCT based on the type of treatment and according to wavelength. There is strong scientific evidence that, regarding non-surgical treatment, adjunct laser application can provide better results only in the short term (three months). Regarding the surgical approach, the method of decontamination plays a subordinate role. All wavelengths/applications presented similar results.

CONCLUSION

Within the limitations of this study, the adjunctive use of lasers in the treatment of peri-implant inflammation is effective for up to three months; there is no strong evidence regarding the long term benefit compared to conventional treatment.

Calculus Removal and Root Surface Roughness When Using the Er:YAG or Er,Cr:YSGG Laser Compared with Conventional Instrumentation Method: A Literature Review

Objective: The purpose of this literature review was to evaluate the effectiveness of using Er:YAG (erbium-doped yttrium/aluminum/garnet) laser or Er,Cr:YSGG (erbium, chromium-doped yttrium/scandium/gallium/garnet) laser on calculus removal and their effect on the topography and roughness of root surface in comparison with the conventional instruments in the nonsurgical periodontal therapy. Background data: One of the most challenging problems in treatment of periodontal disease is the elimination of plaque and calculus, leaving a clean and smooth root surface to decrease plaque and calculus retention, and for good gingival reattachment. Materials and methods: PubMed and Google Scholar were searched for available literature. The electronic search was limited to articles published in the period between January 2007 and April 2017, in the English language. Results: A total of 47 publications fulfilled the inclusion criteria of this systematic review and screened according to the research questions. Calculus removal using the ultrasonic instrument showed remaining calculus compared with the hand instrument, whereas, on the contrary, erbium lasers revealed no remaining calculus or smaller amounts compared with the conventional instruments when used in appropriate settings. The results of this review showed that ultrasonic instrumentation produced effects on the root surface almost similar to that of hand instrumentation. Er:YAG laser and Er,Cr:YSGG laser clarify a little more surface roughness when compared with conventional instruments. Conclusions: The present systematic review indicates that a combination of scaling and root planing (SRP) using the erbium lasers as an adjunctive therapy at certain parameters can be appropriate to remove residual debris from the root surface and at the same time have little or no negative thermal effect on the root surface. The Er:YAG laser also seems to be the most suitable for nonsurgical periodontal therapy. Additional new good-designed studies are needed to evaluate the effectiveness of erbium lasers with SRP in nonsurgical periodontal therapy.

Comparison of Er:YAG Laser and Hand Instrumentation on the Attachment of Cultured Human Gingival Fibroblasts to Periodontally Involved Root Surfaces

Introduction: The present study compared the effects of erbium-doped yttrium aluminium garnet (Er:YAG) laser and hand instrumentation on the attachment of human gingival fibroblast (HGF) cells to periodontally involved root surfaces. Methods: A total of 40 tooth specimens were collected and treated in four distinct groups: scaled and root planed with hand instruments, scaled with Er:YAG laser, treated with a combination of hand instruments and Er:YAG laser and non-treated control group. The attachment and proliferation rate of HGF were assessed using MTT assay and scanning electron microscope (SEM) examination was used for cell morphological evaluation. Results: The MTT (3-[4, 5-dimethylthiazol-2-yl]-2, 5 diphenyl tetrazolium bromide) assay showed significant decrease in HGF cell viability in both hand instruments only and combination treated teeth specimens compared to control specimens (P<0.05), 24 hours after cell seeding. However, at time 48, the cell viability of attached cells in these 2 treated groups was almost similar to control. In contrast, at 24 and 48 hours after cell seeding, viability of attached cells was higher than control in Er:YAG laser treated only specimens (P<0.05). According to SEM study, the laser treated specimens showed more surface roughness. Conclusion: Er:YAG laser increased attachment and proliferation of HGF cells in comparison to the hand instruments method.

Comparing fibroblast attachment in root surface scaling with Er, Cr:YSGG laser versus ultrasonic scaler: A SEM study

BACKGROUND AND OBJECTIVES

The regeneration of periodontal support is the main concern in periodontal therapy. The aim of this in vitro study was to investigate the fibroblasts attachment on root surfaces after scaling with Er, Cr:YSGG laser and ultrasonic instruments using scanning electron microscopy (SEM).

METHODS

72 root plates of ∼6 × 4 × 1 mm³ in dimension were prepared from 27 single-rooted human mature teeth and were then divided into four groups. One group irradiated with a G6 tip of Er, Cr:YSGG laser (2.78 µm, 0.75 W, pulse duration of 140 µs, repetition rate of 20 Hz) for 5 to 7 s, and the other groups were scaled with ultrasonic alone or laser-ultrasonic. The control group was subjected to neither laser nor ultrasonic scaling. Subsequently, Viability and proliferation rates were done using MTT assay on days 3 and 5. Finally the cell attachment was observed using SEM.

RESULTS

The data derived from MTT and cell-attachment analysis indicated that laser-ultrasonic scaling tended to increase cell-viability by the lapse of time (within 3-5 days), with significantly better cell-attachment compared with other groups on days 3 and 5 (p < .05). The comparison of the difference in fibroblast cell attachment rate on both the third and the fifth day with independent T-Test indicated a significant rise on the fifth day compared to the third day of study (p < .05).

CONCLUSION

Indeed, both Er, Cr:YSGG laser and ultrasonic scaling may promote fibroblast attachment on dentinal root surfaces more than laser or ultrasonic scaling alone.

Effects of Root Debridement With Hand Curettes and Er:YAG Laser on Chemical Properties and Ultrastructure of Periodontally-Diseased Root Surfaces Using Spectroscopy and Scanning Electron Microscopy

Introduction: The efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser for root debridement in comparison with curettes has been the subject of many recent investigations. Considering the possibility of chemical and ultra-structural changes in root surfaces following laser irradiation, this study sought to assess the effects of scaling and root planing (SRP) with curettes and Er:YAG laser on chemical properties and ultrastructure of root surfaces using spectroscopy and scanning electron microscopy (SEM). Methods: In this in vitro experimental study, extracted sound human single-rooted teeth (n = 50) were randomly scaled using manual curettes alone or in conjunction with Er:YAG laser at 100 and 150 mJ/pulse output energies. The weight percentages of carbon, oxygen, phosphorous and calcium remaining on the root surfaces were calculated using spectroscopy and the surface morphology of specimens was assessed under SEM. Data were analyzed using one-way analysis of variance (ANOVA). Results: No significant differences (P > 0.05) were noted in the mean carbon, oxygen, phosphorous and calcium weight percentages on root surfaces following SRP using manual curettes with and without laser irradiation at both output energies. Laser irradiation after SRP with curettes yielded rougher surfaces compared to the use of curettes alone. Conclusion: Although laser irradiation yielded rougher surfaces, root surfaces were not significantly different in terms of chemical composition following SRP using manual curettes with and without Er:YAG laser irradiation. Er:YAG laser can be safely used as an adjunct to curettes for SRP.

Periodontal and peri-implant wound healing following laser therapy

Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO2 , neodymium-doped yttrium-aluminium-garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft-tissue management. With development of the erbium-doped yttrium-aluminium-garnet (Er:YAG) and erbium, chromium-doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft-tissue management to hard-tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri-implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti-inflammatory agents, phototherapy using lasers and light-emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low- and high-level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri-implant diseases. This article discusses the outcomes of laser therapy in soft-tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri-implant treatment, focusing on postoperative wound healing of periodontal and peri-implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.

Retreatment of failed regenerative endodontic of orthodontically treated immature permanent maxillary central incisor: a case report

A revascularization procedure was shown to be the best alternative therapy for immature teeth with necrotic pulp and apical infection. A 12 year old female with a history of trauma to her upper central incisor and a sinus tract was referred for endodontic treatment. She was an active orthodontic patient and had undergone regenerative endodontic treatment for the past 2 years. Clinical examination revealed no response to sensibility, percussion, and palpation tests. The preoperative radiograph showed an open apex and apical rarefaction. The case was diagnosed as previously treated tooth with asymptomatic apical periodontitis. Regenerative endodontic retreatment was performed, and the case was followed for 3 years. Clinical, radiographic, and cone-beam computed tomography follow-up examination revealed an asymptomatic tooth, with evidence of periapical healing and root maturation.

Laser assisted periodontics: A review of the literature

Over the years, the use of the laser within health field and more particularly dentistry has been increasing and improving. The application of laser in the periodontal treatment takes part of a non-surgical and surgical approaches, is used for the decontamination of periodontal pockets due to its bactericidal effect, and the removal of granulation tissues, inflamed and diseased epithelium lining, bacterial deposits and subgingival calculus. However in spite of all the marketing surrounding, the use of laser highlighting its beneficial effect, the capacity of laser to replace the conventional treatment for chronic periodontitis is still debatable. In fact there is no evidence that any laser system adds substantial clinical value above conventional treatments of chronic periodontitis. Some studies showed a significant positive effect on clinical attachment level gain and probing depth reduction. In the other hand, several articles demonstrated no evidence of the superior effectiveness of laser therapy compared to root planing and scaling. Our aims is to review the literature on the capacity of erbium:Yttrium-aluminum-garnet and neodymium:Yttrium-aluminium-garnet laser to either replace or complete conventional mechanical/surgical periodontal treatments.

Effects of endodontic tri-antibiotic paste on bond strengths of dentin adhesives to coronal dentin

Objectives

The aim of this study was to evaluate the effects of tri-antibiotic paste (TAP) on microtensile bond strengths (MTBS) of dental adhesives to dentin.

Materials and Methods

Sixty extracted molars had their occlusal surfaces flattened to expose dentin. They were divided into two groups, i.e., control group with no dentin treatment and experimental group with dentin treatment with TAP. After 10 days, specimens were bonded using self-etch (Filtek P90 adhesive) or etch-and-rinse (Adper Single Bond Plus) adhesives and restored with composite resin. Teeth were sectioned into beams, and the specimens were subjected to MTBS test. Data were analyzed using two-way ANOVA and post hoc Tukey tests.

Results

There was a statistically significant interaction between dentin treatment and adhesive on MTBS to coronal dentin (p = 0.003). Despite a trend towards worse MTBS being noticed in the experimental groups, TAP application showed no significant effect on MTBS (p = 0.064).

Conclusions

The etch-and-rinse adhesive Adper Single Bond Plus presented higher mean bond strengths than the self-etch adhesive Filtek P90, irrespective of the group. The superior bond performance for Adper Single Bond when compared to Filtek P90 adhesive was confirmed by a fewer number of adhesive failures. The influence of TAP in bond strength is insignificant.

A microscopic analysis of the effects of root surface scaling with different power parameters of Er,Cr:YSGG laser

The aim of this study was to evaluate the effects of different power parameters of an Erbium, Cromium: Yttrium, Scandium, Gallium, Garnet laser (Er,Cr:YSGG laser) on the morphology, attachment of blood components (ABC), roughness, and wear on irradiated root surfaces. Sixty-five incisive bovine teeth were used in this study, 35 of which were used for the analysis of root surface morphology and ABC. The remaining 30 teeth were used for roughness and root wear analysis. The samples were randomly allocated into seven groups: G1: Er,Cr:YSGG laser, 0.5 W; G2: Er,Cr:YSGG laser, 1.0 W; G3: Er,Cr:YSGG laser, 1.5 W; G4: Er,Cr:YSGG laser, 2.0 W; G5: Er,Cr:YSGG laser, 2.5 W; G6: Er,Cr:YSGG laser, 3.0 W; G7: scaling and root planning (SRP) with manual curettes. The root surfaces irradiated by Er,Cr:YSGG at 1.0 W and scaling with manual curettes presented the highest degrees of ABC. The samples irradiated by the Er,Cr:YSGG laser were rougher than the samples treated by the manual curette, and increasing the laser power parameters caused more root wear and greater roughness on the root surface. The Er,Cr:YSGG laser is safe to use for periodontal treatment, but it is not appropriate to use irradiation greater than 1.0 W for this purpose.

Root Surface Bio-modification with Erbium Lasers- A Myth or a Reality??

The objective of this literature review was to critically review the evidence available in the literature regarding the expediency of erbium family of lasers for root bio modification as a part of periodontal therapy. The literature search was performed on the Pubmed using MeSH words such as "lasers/therapeutic use, scaling, dental calculus, tooth root/anatomy and histology, ultrasonic therapy". The studies were screened and were grouped as follows: those evaluating a) efficacy for calculus removal with the Erbium family of laser b) root surface changes following Er YAG and Er Cr YSGG application c) comparative studies of the Er YAG, Er Cr YSGG lasers versus conventional methods of root surface modification d) Bio compatibility of root surface following Erbium laser treatment e) Studies on the combined efficacy of laser root modification with conventional methods towards root surface bio-modification f) Studies on effectiveness of root surface bio-modification prior to root coverage procedures. In conclusion, the erbium family has a proven anti-bacterial action, predictable calculus removal, minimal root substance removal, and appears to favor cell attachment. The Erbium family of lasers appears to be a useful adjunct for the management of periodontal disease.

The use of traditional and novel techniques to determine the hardness and indentation properties of immature radicular dentin treated with antibiotic medicaments followed by ethylenediaminetetraacetic acid

Objective:

The objective was to investigate the effect of intracanal antibiotic medicaments followed by ethylenediaminetetraacetic acid (EDTA) on the indentation properties and hardness of radicular dentin using a BioDent reference point indenter and a traditional microhardness technique, respectively.

Materials and Methods:

Specimens with intact root canal dentin surfaces and polished radicular dentin specimens were obtained from immature human premolars. Each type of specimen was randomly assigned (n = 10 per group) and treated with either double antibiotic paste (DAP) for 4-week followed by EDTA for 5 min, triple antibiotic paste (TAP) for 4-week followed by EDTA for 5 min, EDTA for 5 min or Hank's balanced salt solution (control). The BioDent reference point indentor and Vickers microhardness tester were used to measure the indentation properties of root canal surfaces and the hardness of polished dentin specimens, respectively. One-way ANOVA followed by Fisher's protected least significant differences were used for statistical analyses.

Results:

Both types of radicular dentin treated with antibiotic pastes and/or EDTA had a significant increase in the majority of indentation properties and a significant reduction in hardness compared to the untreated dentin. Furthermore, treatment of dentin with antibiotic pastes and EDTA caused significant increases in indentation properties and a significant reduction in hardness compared to EDTA-treated dentin. However, the RPI technique was not able to significantly differentiate between DAP + EDTA and TAP + EDTA-treated dentin.

Conclusion:

Dentin treated with antibiotic medicaments followed by EDTA had a significant increase the indentation properties and significantly reduction in hardness of radicular dentin.

Comparison of the effect of hand instruments, an ultrasonic scaler, and an erbium-doped yttrium aluminium garnet laser on root surface roughness of teeth with periodontitis: a profilometer study

PURPOSE

The present study aimed to measure root surface roughness in teeth with periodontitis by a profilometer following root planning with ultrasonic and hand instruments with and without erbium-doped yttrium aluminium garnet (Er:YAG) laser irradiation.

METHODS

Sixty single-rooted maxillary and mandibular teeth, extracted because of periodontal disease, were collected. The crowns and apices of the roots were cut off using a diamond bur and water coolant. The specimens were mounted in an acrylic resin block such that a plain root surface was accessible. After primary evaluation and setting a baseline, the samples were divided into 4 groups. In group 1, the samples were root planned using a manual curette. The group 2 samples were prepared with an ultrasonic scaler. In group 3, after scaling with hand instrumentation, the roots were treated with a Smart 1240D plus Er:YAG laser and in group 4, the roots were prepared with ultrasonic scaler and subsequently treated with an Er:YAG laser. Root surface roughness was then measured by a profilometer (MahrSurf M300+RD18C system) under controlled laboratory conditions at a temperature of 25℃ and 41% humidity. The data were analyzed statistically using analysis of variance and a t-test (P<0.05).

RESULTS

Significant differences were detected in terms of surface roughness and surface distortion before and after treatment. The average reduction of the surface roughness after treatment in groups 1, 2, 3, and 4 was 1.89, 1.88, 1.40, and 1.52, respectively. These findings revealed no significant differences among the four groups.

CONCLUSIONS

An Er:YAG laser as an adjunct to traditional scaling and root planning reduces root surface roughness. However, the surface ultrastructure is more irregular than when using conventional methods.

Effect of Er,Cr:YSGG and Er:YAG laser irradiation on the adhesion of blood components on the root surface and on root morphology

The aim of this study was to conduct an in vitro evaluation, by scanning electron microscopy (SEM), of the adhesion of blood components on root surfaces irradiated with Er,Cr:YSGG (2.78 µm) or Er:YAG (2.94 µm) laser, and of the irradiation effects on root surface morphology. Sixty samples of human teeth were previously scaled with manual instruments and divided into three groups of 20 samples each: G1 (control group) - no treatment; G2 - Er,Cr:YSGG laser irradiation; G3 - Er:YAG laser irradiation. After performing these treatments, blood tissue was applied to 10 samples of each group, whereas 10 samples received no blood tissue application. After performing the laboratory treatments, the samples were observed under SEM, and the resulting photomicrographs were classified according to a blood component adhesion scoring system and root morphology. The results were analyzed statistically (Kruskall-Wallis and Mann Whitney tests, α= 5%). The root surfaces irradiated with Er:YAG and Er,Cr:YSGG lasers presented greater roughness than those in the control group. Regarding blood component adhesion, the results showed a lower degree of adhesion in G2 than in G1 and G3 (G1 × G2: p = 0.002; G3 × G2: p = 0.017). The Er:YAG and Er,Cr:YSGG laser treatments caused more extensive root surface changes. The Er:YAG laser treatment promoted a greater degree of blood component adhesion to root surfaces, compared to the Er,Cr:YSGG treatment.

Histological and SEM analysis of root cementum following irradiation with Er:YAG and CO2 lasers

Recently, the Er:YAG and CO(2) lasers have been applied in periodontal therapy. However, the characteristics of laser-irradiated root cementum have not been fully analyzed. The aim of this study was to precisely analyze the alterations of root cementum treated with the Er:YAG and the CO(2) lasers, using non-decalcified thin histological sections. Eleven cementum plates were prepared from extracted human teeth. Pulsed Er:YAG laser contact irradiation was performed in a line at 40 mJ/pulse (14.2 J/cm(2)/pulse) and 25 Hz (1.0 W) under water spray. Continuous CO(2) laser irradiation was performed in non-contact mode at 1.0 W, and ultrasonic instrumentation was performed as a control. The treated samples were subjected to stereomicroscopy, scanning electron microscopy (SEM), light microscopy and SEM energy dispersive X-ray spectroscopy (SEM-EDS). The Er:YAG laser-treated cementum showed minimal alteration with a whitish, slightly ablated surface, whereas CO(2) laser treatment resulted in distinct carbonization. SEM analysis revealed characteristic micro-irregularities of the Er:YAG-lased surface and the melted, resolidified appearance surrounded by major and microcracks of the CO(2)-lased surface. Histological analysis revealed minimal thermal alteration and structural degradation of the Er:YAG laser-irradiated cementum with an affected layer of approximately 20-μm thickness, which partially consisted of two distinct affected layers. The CO(2)-lased cementum revealed multiple affected layers showing different structures/staining with approximately 140 μm thickness. Er:YAG laser irradiation used with water cooling resulted in minimal cementum ablation and thermal changes with a characteristic microstructure of the superficial layer. In contrast, CO(2) laser irradiation produced severely affected distinct multiple layers accompanied by melting and carbonization.

Effects of dentin surface modifications treated with Er:YAG and Nd:YAG laser irradiation on fibroblast cell adhesion

OBJECTIVE

The purpose of this in vitro study was to evaluate the effect of surface modifications induced by erbium (Er):YAG and neodymium (Nd):YAG laser irradiation on cell adhesion by comparing it to that of conventional methods for surface preparation after root-end resection.

BACKGROUND DATA

Many studies have been seeking a favorable method to produce a resected root end with optimal conditions for cell response. However, little improvement has been achieved. This study evaluated the biocompatibilities of resected root surfaces after Er:YAG or Nd:YAG laser irradiation on initial cell adhesion.

MATERIALS AND METHODS

Dentin disks were divided into three groups. Group A was left untreated, Group B was treated with Er:YAG laser irradiation (60 mJ/pulse, 10 pps, 60 sec), and Group C with Nd:YAG laser irradiation (60 mJ/pulse, 10 pps, 60 sec). After laser irradiation, the dentin disks were incubated with NIH/3T3 fibroblasts cultured in Dulbecco's modified Eagle's medium. A morphological analysis of the dentin surface and cell adhesion was observed under a scanning electron microscope. Surface roughness was measured using a confocal laser scanning microscope. The statistical analysis was undertaken using ANOVA at a level of significance of 5% (p<0.05).

RESULTS

Morphological analysis and roughness measurement showed that dentin surfaces treated with Er:YAG laser irradiation were rougher than those in Groups A and C. Group B (Er:YAG) exhibited the greatest number of attached cells among all groups after 12 and 24 h.

CONCLUSIONS

Morphological alteration induced by Er:YAG laser irradiation showed a favorable effect on the attachment of fibroblasts to dentin surfaces.

Initial fibroblast attachment to Erbium:YAG laser-irradiated dentine

AIMS

To evaluate the effects of Erbium (Er):YAG laser irradiation on the morphology of resected dentine surfaces, and to investigate fibroblast attachment to laser-irradiated dentine surfaces.

METHODOLOGY

Dentine blocks obtained from single-rooted human teeth were divided into the following groups after sterilization in an autoclave: (i) Laser group treated with Er:YAG laser irradiation (30 mJ per pulse, 10 pps, 60 s); (ii) L-MTAD group treated with laser irradiation as in (i) plus a mixture of doxycycline, tetracycline isomer and citric acid; (iii) RC-Prep group treated with EDTA gel or cream (RC-Prep) and (iv) Control group left untreated. After each treatment, the dentine blocks were incubated with NIH/3T3 fibroblasts cultured to subconfluency in Dulbecco's modified Eagle's medium supplemented with 10% foetal bovine serum and antibiotics. The number of attached cells amongst the groups was analysed statistically at the 5% significance level. The dentine surface morphologies and cell attachments were evaluated by counting assays, histological observations and scanning electron microscopy (SEM).

RESULTS

The number of attached cells was significantly higher (P < 0.05) in the Laser group than in the RC-Prep and Control groups at 16 h. Dendritic cell extension of the fibroblasts was only observed in the Laser group at 8 h by SEM. In the histological analyses, significantly more attached cells were found on the dentine surfaces treated with laser irradiation.

CONCLUSIONS

Er:YAG laser irradiation induced morphological alterations in dentine surfaces, which may improve the attachment of fibroblasts to dentine.

Effect of human beta-defensin-3 on the proliferation of fibroblasts on periodontally involved root surfaces

Human beta-defensin-3 (HBD-3) has versatile antibacterial activity against oral bacteria and can promote the proliferation of fibroblasts. The goal of the present study was to investigate the effect of HBD-3 on attachment and proliferation of periodontal ligament cells (PDL) onto the periodontitis affected root surfaces. PDL cells were seeded onto healthy and diseased root specimens with scaling and root planing (SRP), SRP & HBD-3 (100 ng/ml), or SRP & HBD-3 (200 ng/ml) treatment for 1, 3, and 7 days incubation. The results showed that HBD-3, especially in the 200 ng/ml group, significantly promoted fibroblast attachment and proliferation onto the diseased root surfaces. The cell number in the HBD-3 group was much greater than in the group treated with SRP alone. On day 7, the cells in the HBD-3 were well-spread and formed a network similar to those on the surfaces of the healthy root specimens. These results suggest that HBD-3 could play an important role in antibacterial activity and fibroblast proliferation, thus promoting periodontal regeneration. Meanwhile, HBD-3 might act as a potent regeneration-promoter in infectious diseases.

Influence of the angle of irradiation of the Er,Cr:YSGG laser on the morphology, attachment of blood components, roughness, and root wear: in vitro study

BACKGROUND AND OBJECTIVES

To evaluate the influence of the working tip angulation of the Er,Cr:YSGG laser on the morphology, attachment of blood components, roughness, and wear on irradiated root surfaces compared to scaling and root planing (SRP).

STUDY DESIGN/MATERIALS AND METHODS

The present study used 45 teeth, of which 25 were used for the analysis of the morphology and the attachment of blood components and 20 were used for the analysis of the roughness and of the root wear. The teeth were randomly divided into five groups according to the treatment applied: (G1) Laser Er,Cr:YSGG-30°; (G2) Laser Er,Cr:YSGG-45°; (G3) Laser Er,Cr:YSGG-60°; (G4) Laser Er,Cr:YSGG-90°; and (G5) SRP.

RESULTS

The root surfaces irradiated with the Er,Cr:YSGG laser working angulation tip of 45° and 60°, and the samples scaled with manual instruments presented greater attachment of blood components than the group where the Er,Cr:YSGG laser irradiated at working tip angulation of 30° and 90° (P<0.05). The samples irradiated with the Er,Cr:YSGG laser were rougher than the samples scaled with manual instruments (P<0.05). The group that was irradiated with the Er,Cr:YSGG laser at an angle of 30° presented the least wear in comparison to all the other treatments (P<0.01).

CONCLUSIONS

The irradiated root surfaces proved to be rougher than those scaled with manual instruments; however, irradiation at working tip angulations of 45° and 60° produced results of attachment of blood components and root wear comparable with those obtained with manual instrumentation.

Root surface biomodification with an Er:YAG laser for the treatment of gingival recession with subepithelial connective tissue grafts

BACKGROUND/AIM

Root surface biomodification has been used to treat gingival recession and periodontitis. The principle for this procedure is that removing the smear layer from the root surfaces exposes collagen fibers, which leads to improved healing. Clinical studies generally have failed to find any improvement in clinical parameters when using such agents. The aim of this study was to evaluate and compare the outcome of gingival recession therapy using the subepithelial connective tissue graft (SCTG) with or without Er:YAG laser application for root surface biomodification.

MATERIALS AND METHODS

Twenty-four teeth in 12 patients with Miller class I and II recession were treated with SCTG with (test group) or without (control group) the application of an Er:YAG laser (2 Hz, 60 mJ/pulse, 40 s, with air spray). Clinical attachment level (CAL), recession depth (RD), recession width (RW), and probing depth (PD) were measured at baseline and 6 months postsurgery.

RESULTS

There were no significant differences between test and control groups (p > 0.05). Postoperatively, significant root coverage, gains in CAL, and highly significant increases in the RW were observed in both groups. For test and control groups, the average root coverage was 80% and 86%, respectively (p > 0.05), and complete root coverage was 75% and 67%, respectively.

CONCLUSIONS

The present study showed that root surface conditioning with an Er:YAG laser does not enhance the results achieved when SCTG was performed alone.

Comparison of Er,Cr:YSGG laser and hand instrumentation on the attachment of periodontal ligament fibroblasts to periodontally diseased root surfaces: an in vitro study

BACKGROUND

This study investigates the effects of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser irradiation and hand instrumentation on the attachment of periodontal ligament (PDL) fibroblasts to periodontally involved root surfaces.

METHODS

Twenty-four single-rooted periodontally involved human teeth (test groups), and six healthy premolar teeth extracted for orthodontic reasons (control group) were included in this study. A total of 45 root slices were obtained from all selected teeth and assigned to the following five groups: 1) untreated healthy group (+control); 2) untreated periodontally diseased group (-control); 3) hand instrumentation group (scaled Gracey); 4) laser I, Er,Cr:YSGG laser irradiation setting-I (short pulse); and 5) laser II, Er,Cr:YSGG laser irradiation setting-II (long pulse). All of the root slices were autoclaved in phosphate buffered saline and slices were placed onto cell culture inserts. PDL fibroblasts were placed at the density of 80,000 cells on the root plate (5 x 6 mm) and incubated for 48 hours and transferred to 24-well plates. The attachment PDL fibroblasts on the root plates were observed using confocal microscopy (at 12 hours and on days 3 and 7) and scanning electron microscopy (at 12 hours and day 3). 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide assay was performed on day 5 for PDL fibroblast survival.

RESULTS

3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide assay shows that whereas laser-treated specimens showed a significantly higher cell density, the Gracey-treated group showed a lower cell density compared to the positive control group (P <0.05). Based on confocal microscopy, apparent reduction was observed in the attachment of PDL cells to the periodontally diseased root surfaces. In the laser and Gracey groups, cells looked well-oriented to the root surfaces. Laser-treated groups provided suitable environment for cell adhesion and growth. Laser I treatment was more favorable for the attachment of PDL compared to scaled Gracey, laser II, and even healthy root surfaces.

CONCLUSION

The results of the study indicate that short-pulse laser setup (laser I) looks more promising regarding the attachment, spreading, and orientation of PDL cells.

Comparison of microleakage of three adhesive systems in class V composite restorations prepared with Er,Cr:YSGG laser

OBJECTIVE

This study compared microleakage of three adhesives in class V (CI V) composite restorations prepared with Er,Cr:YSGG laser.

BACKGROUND DATA

Changes produced on enamel and dentin surfaces subsequent to laser irradiation influence microleakage of composite restorations.

MATERIALS AND METHODS

CI V cavities were prepared in 80 sound extracted human premolars with Er,Cr:YSGG laser. The teeth were randomly divided into 4 groups (n = 20). In group 1, a total-etch adhesive was used, and two-step and one-step self-etch adhesives were used in groups 2 and 3, respectively. Group 4 was the control group with no adhesives. Following restoration and thermocycling, microleakage was evaluated. To compare microleakage in occlusal and gingival margins in each group, the Wilcoxon test was used. Kruskal-Wallis analysis was used for comparison of occlusal and gingival microleakage, and two-by-two comparisons were made using the Mann-Whitney U test.

RESULTS

There were significant differences in microleakage between occlusal and gingival margins in each group except for the control group. Significant differences were observed in occlusal and gingival microleakage among all the groups. Two-by-two comparisons revealed significant differences in occlusal microleakage between the control group and the other groups. There were significant differences in gingival microleakage between groups 1 and 2 and groups 1 and 3; however, differences in gingival microleakage between groups 2 and 3 were not significant.

CONCLUSION

With all the adhesives, microleakage was significantly higher in gingival margins compared with occlusal margins. In occlusal margins, there were no significant differences in microleakage among the three adhesives. In gingival margins, self-etch adhesives revealed less microleakage than the total-etch adhesive.

Periodontal regeneration with multi-layered periodontal ligament-derived cell sheets in a canine model

Periodontal regeneration has been challenged with chemical reagents and/or biological approaches, however, there is still no sufficient technique that can regenerate complete periodontium, including alveolar bone, cementum, and well-oriented collagen fibers. The purpose of this study was to examine multi-layered sheets of periodontal ligament (PDL)-derived cells for periodontal regeneration. Canine PDL cells were isolated enzymatically and expanded in vitro. The cell population contained cells capable of making single cell-derived colonies at an approximately 20% frequency. Expression of mRNA of periodontal marker genes, S100 calcium binding protein A4 and periostin, was observed. Alkaline phosphatase activity and gene expression of both osteoblastic/cementoblastic and periodontal markers were upregulated by osteoinductive medium. Then, three-layered PDL cell sheets supported with woven polyglycolic acid were transplanted to dental root surfaces having three-wall periodontal defects in an autologous manner, and bone defects were filled with porous beta-tricalcium phosphate. Cell sheet transplantation regenerated both new bone and cementum connecting with well-oriented collagen fibers, while only limited bone regeneration was observed in control group where cell sheet transplantation was eliminated. These results suggest that PDL cells have multiple differentiation properties to regenerate periodontal tissues comprising hard and soft tissues. PDL cell sheet transplantation should prove useful for periodontal regeneration in clinical settings.