Pulpal effects of enamel ablation with a microsecond pulsed lambda = 9.3-microm CO2 laser

Nanosecond infrared laser (NIRL) for cutting roots of human teeth: thermal effects and quality of cutting edges

A nanosecond infrared laser (NIRL) was investigated in cutting dental roots. The focus of the investigation was defining the preparation accuracy and registration of thermal effects during laser application. Ten teeth were processed in the root area using a NIRL in several horizontal, parallel incisions to achieve tooth root ablation as in an apicoectomy. Temperature change was monitored during ablation and the quality of the cutting edges in the roots were studied by means of micro-CT, optical coherence tomography, and histology of decalcified and undecalcified specimens. NIRL produced clearly defined cut surfaces in dental hard tissues. The automated guidance of the laser beam created regular, narrow dentin defects that tapered in a V-shape towards the ablation plane. A biologically significant increase in the temperature of the object and its surroundings did not occur during the laser application. Thermal dentin damage was not detected in histological preparations of treated teeth. Defined areas of the tooth root may be ablated using a NIRL. For clinical translation of NIRL in apicoectomy, it would be necessary to increase energy delivered to hard tissue and develop beam application facilitating beam steering for oral treatment.

Ablation Precision and Thermal Effects of a Picosecond Infrared Laser (PIRL) on Roots of Human Teeth: A Pilot Study Ex Vivo

BACKGROUND/AIM

Picosecond infrared laser (PIRL) was investigated regarding its possible therapeutic application in cutting dental roots.

MATERIALS AND METHODS

Extracted human teeth were processed in the root area by laser ablations followed by histological evaluation. Dentin adjacent to the cutting surface was evaluated morphometrically.

RESULTS

PIRL produced clearly defined cutting boundaries in dental roots. At the bottom of the cavity, the ablation surface became slightly concave. Heat development in this scantly hydrated tissue was considerable. We attributed the excess heating effects to heat accumulation due to multiple pulse overlap across a limited scan range imposed by tooth geometries.

CONCLUSION

Defined areas of the tooth root may be treated using the PIRL. For clinical translation, it would be necessary to improve beam delivery to facilitate beam steering for the intended oral application (e.g. by using a fiber) and identify optimal repetition rates/scan speeds combined with cooling techniques to minimize accumulated heat within ablation cavities.

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.

In vivo spectral guided removal of composite from tooth surfaces with a CO2 laser

Dental composites are used as restorative materials to replace tooth structure after the removal of caries, shaping, covering teeth for esthetic purposes and as adhesives. Dentists spend more time replacing existing restorations that fail than they do placing new restorations. Tooth colored restorations are difficult to differentiate from the surrounding tooth structure making them challenging to remove completely without incidental removal of healthy tooth structure. Previous studies have demonstrated that CO₂ lasers in conjunction with spectral feedback can be used to selectively remove composite from tooth surfaces. In addition, we assembled a system feasible for clinical use that incorporates a spectral feedback system, scanning system, articulating arm and a clinical handpiece and subsequently evaluated the performance of that system on extracted teeth. The purpose of this study was to test this system in vivo to demonstrate its efficacy relative to dental clinicians. Eight test subjects with premolar teeth scheduled for extraction for orthodontic reasons had bilateral premolars prepared with small occlusal cavity preparations and filled with dental composite. The laser scanning system was used to remove the composite from one of the preparations and a dental handpiece was used to remove the composite from the other. Cross polarization optical coherence tomography was used to measure the volume of the preparation before and after composite placement and removal. There was no significant difference in the loss of enamel and residual composite between the laser and the handpiece. This study demonstrated that a computer controlled spectral guided CO₂ laser scanning system can be used in vivo to selectively remove composite from tooth surfaces.

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.

Automated ablation of dental composite using an IR pulsed laser coupled to a plume emission spectral feedback system

OBJECTIVE

The purpose of this study is to assemble a laser system for the selective removal of dental composite from tooth surfaces, that is feasible for clinical use incorporating a spectral feedback system, a scanning system, articulating arm and a clinical hand-piece, and evaluate the performance of that system on extracted teeth.

METHODS

Ten extracted teeth were collected and small fillings were placed on the occlusal surface of each tooth. A clinical system featuring a CO₂ laser operating at 50 Hz and spectral optical feedback was used to remove the composite. Removal was confirmed using a cross polarized optical coherence tomography (CP-OCT) system designed for clinical use.

RESULTS

The system was capable of rapidly removing composite from small preparations on tooth occlusal surfaces with a mean loss of enamel of less than 20 μm.

CONCLUSION

We have demonstrated that spectral feedback can be successfully employed in an automated system for composite removal by incorporating dual photodiodes and a galvanometer controlled CO₂ laser. Additionally, the use of registered OCT images presents as a viable method for volumetric benchmarking. Overall, this study represents the first implementation of spectral feedback into a clinical hand-piece and serves as a benchmark for a future clinical study. Lasers Surg. Med. 49:658-665, 2017. © 2017 Wiley Periodicals, Inc.

Automated ablation of dental composite using an IR pulsed laser coupled to a plume emission spectral feedback system

Dental composites are used as restorative materials for filling cavities, shaping, and covering teeth for esthetic purposes, and as adhesives. Dentists spend more time replacing existing restorations that fail than they do placing new restorations. Tooth colored restorations are difficult to differentiate from the surrounding tooth structure making them challenging to remove without damaging healthy tooth structure. Previous studies have demonstrated that CO₂ lasers in conjunction with spectral feedback can be used to selectively remove composite from tooth surfaces. The purpose of this study is to assemble a system that is feasible for clinical use incorporating a spectral feedback system, a scanning system, articulating arm and a clinical handpiece and then evaluate the performance of that system on extracted teeth. In addition, the selectivity of composite removal was analyzed using a high-speed optical coherence tomography system that is suitable for clinical use. The system was capable of rapidly removing composite from small preparations on tooth occlusal surfaces with a mean loss of enamel of less than 20-μm.

A new sealed RF-excited CO2 laser for enamel ablation operating at 9.4-μm with a pulse duration of 26-μs

Several studies over the past 20 years have shown that carbon dioxide lasers operating at wavelengths between 9.3 and 9.6-μm with pulse durations near 20-μs are ideal for hard tissue ablation. Those wavelengths are coincident with the peak absorption of the mineral phase. The pulse duration is close to the thermal relaxation time of the deposited energy of a few microseconds which is short enough to minimize peripheral thermal damage and long enough to minimize plasma shielding effects to allow efficient ablation at practical rates. The desired pulse duration near 20-μs has been difficult to achieve since it is too long for transverse excited atmospheric pressure (TEA) lasers and too short for radio-frequency (RF) excited lasers for efficient operation. Recently, Coherent Inc. (Santa Clara, CA) developed the Diamond J5-V laser for microvia drilling which can produce laser pulses greater than 100-mJ in energy at 9.4-μm with a pulse duration of 26-μs and it can achieve pulse repetition rates of 3 KHz. We report the first results using this laser to ablate dental enamel. Efficient ablation of dental enamel is possible at rates exceeding 50-μm per pulse. This laser is ideally suited for the selective ablation of carious lesions.

Use of new minimum intervention dentistry technologies in caries management

Preservation of natural tooth structure requires early detection of the carious lesion and is associated with comprehensive patient dental care. Processes aiming to detect carious lesions in the initial stage with optimum efficiency employ a variety of technologies such as magnifying loupes, transillumination, light and laser fluorescence (QLF® and DIAGNOdent® ) and autofluorescence (Soprolife® and VistaCam®), electric current/impedance (CarieScan(®) ), tomographic imaging and image processing. Most fluorescent caries detection tools can discriminate between healthy and carious dental tissue, demonstrating different levels of sensitivity and specificity. Based on the fluorescence principle, an LED camera (Soprolife® ) was developed (Sopro-Acteon, La Ciotat, France) which combined magnification, fluorescence, picture acquisition and an innovative therapeutic concept called light-induced fluorescence evaluator for diagnosis and treatment (LIFEDT). This article is rounded off by a Soprolife® illustration about minimally or even non-invasive dental techniques, distinguishing those that preserve or reinforce the enamel and enamel-dentine structures without any preparation (MIT1- minimally invasive therapy 1) from those that require minimum preparation of the dental tissues (MIT2 - minimally invasive therapy 2) using several clinical cases as examples. MIT1 encompasses all the dental techniques aimed at disinfection, remineralizing, reversing and sealing the caries process and MIT2 involves a series of specific tools, including microburs, air abrasion devices, sonic and ultrasonic inserts and photo-activated disinfection to achieve minimal preparation of the tooth. With respect to minimally invasive treatment and prevention, the use of lasers is discussed. Furthermore, while most practices operate under a surgical model, Caries Management by Risk Assessment (CaMBRA) encourages a medical model of disease prevention and management to control the manifestation of the disease, or keep the oral environment in a state of balance between pathological and preventive factors. Early detection and diagnosis and prediction of lesion activity are of great interest and may change traditional operative procedures substantially. Fluorescence tools with high levels of magnification and observational capacity should guide clinicians towards a more preventive and minimally invasive treatment strategy.

Investigation of Acid-Etched CO2 Laser Ablated Enamel Surfaces Using Polarization Sensitive Optical Coherence Tomography

A carbon dioxide laser operating at the highly absorbed wavelength of 9.3μm with a pulse duration of 10-15μs is ideally suited for caries removal and caries prevention. The enamel thermally modified by the laser has enhanced resistance to acid dissolution. This is an obvious advantage for caries prevention; however, it is often necessary to etch the enamel surface to increase adhesion to composite restorative materials and such surfaces may be more resistant to etching. The purpose of the study was to non-destructively measure the susceptibility of laser-ablated enamel surfaces to acid dissolution before and after acid-etching using Polarization Sensitive Optical Coherence Tomography (PS-OCT). PS-OCT was used to acquire images of bovine enamel surfaces after exposure to laser irradiation at ablative fluence, acid-etching, and a surface softened dissolution model. The integrated reflectivity from lesion and the lesion depth were measured using PS-OCT. Samples were also sectioned for examination by Polarized Light Microscopy (PLM). PS-OCT images showed that acid-etching greatly accelerated the formation of subsurface lesions on both laser-irradiated and non-irradiated surfaces (P<0.05). A 37.5% phosphoric acid etch removed the laser modified enamel layer after 5-10 seconds.

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.

Microhardness and SEM after CO(2) laser irradiation or fluoride treatment in human and bovine enamel

BACKGROUND

It remains uncertain as to whether or not CO(2) laser is able to hinder demineralization of enamel. The possibility to use bovine instead of human teeth on anticariogenic studies with laser has not yet been determined.

PURPOSE

To compare the ability of CO(2) laser and fluoride to inhibit caries-like lesions in human enamel and to test whether a similar pattern of response would hold for bovine enamel.

STUDY DESIGN

Ninety-six enamel slabs (2 × 2 × 4 mm) (48 from bovine and 48 from human teeth) were randomly distributed according to surface treatment (n = 12): CO(2) laser, 5% sodium fluoride varnish (FV), 1.23% acidulated phosphate fluoride (APF) gel, or no treatment (control). Specimens were subjected to a 14-day in vitro cariogenic challenge. Microhardness (SMH) was measured at 30 μm from the surface. For ultrastructural analysis, additional 20 slabs of each substrate (n = 5) received the same treatment described earlier and were analyzed by SEM.

RESULTS

ANOVA and Tukey test ascertained that CO(2) laser promoted the least mineral loss (SMH = 252(a)). Treatment with FV resulted in the second highest values (207(b)), which was followed by APF (172(c)). Untreated specimens performed the worst (154(d)). SEM showed no qualitative difference between human and bovine teeth. APF and control groups exhibited surfaces covered by the smear layer. A granulate precipitate were verified on FV group and fusion of enamel crystals were observed on lased-specimens.

CONCLUSIONS

CO(2) laser may control caries progression more efficiently than fluoride sources and bovine teeth may be a suitable substitute for human teeth in studies of this nature.