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

Comparative evaluation of three methods of adhesive remnant removal after orthodontic bracket debonding

OBJECTIVE

This study aimed to assess the effects of three methods of adhesive remnant removal (carbide bur and low speed handpiece, carbide bur and high speed handpiece, and zircon-rich glass fiber reinforced composite bur), after orthodontic bracket debonding, on tooth color and enamel surface roughness.

METHODS

Ninety sound premolar teeth were selected. The baseline tooth color was assessed using Vita spectrophotometer. The teeth were subjected to bracket bonding processes and then randomly divided into three equal groups. In each group, composite remnant was removed by one of the three methods of adhesive removal, and the teeth were then subjected to color assessment again. To measure the surface roughness, a scanning electron microscope (SEM) with x400 magnification was used.

RESULTS

ANOVA showed that the effect of the three methods of adhesive remnant removal on ∆L, ∆b and ∆E was statistically significant (p=0.01), but without significant effect on ∆a. Comparison of the means showed that composite bur and high speed carbide bur yielded the highest ∆E (p=0.05), and had a significant difference when compared to carbide bur and low speed handpiece. The highest ∆L and ∆b values belonged to samples approached with composite bur and carbide bur with high speed handpiece, respectively. SEM analysis showed that the composite bur created a very smooth surface, compared to the other two methods.

CONCLUSION

Zircon-rich glass fiber reinforced composite created the smoothest enamel surface and highest color change, when compared to the other two methods.

Er,Cr:YSGG Laser as a Means of Orthodontic Adhesive Removal: Myth or Reality?

Objective: This study aimed to compare the effect of Er,Cr:YSGG laser with a tungsten carbide bur in orthodontic finishing on the enamel surface roughness and the heat generated in the pulp chamber. Methods: Before bonding, of 125 intact extracted premolar teeth, 15 teeth were randomly assigned to the control group. Of the remaining 110 bonded teeth, 50 were used to determine the laser parameters, and 60 were included in the main in vitro study. After debonding, the teeth were randomly distributed among four study groups (n = 15) for finishing with laser beams (Er,Cr:YSGG, Waterlase) with and without polishing with Sof-Lex discs, and finishing with a bur (tungsten carbide, Reliance) with and without polishing with Sof-Lex discs. The thermal changes were measured during finishing using a thermo-controller-coupled thermocouple placed in the pulp chamber. Enamel surface roughness was evaluated qualitatively under a scanning electron microscope (SEM) and quantitatively under an atomic force microscope (AFM). Results: The thermal changes of the bur group were significantly higher than those in the laser group (p = 0.0001). Quantitatively, the surface roughness values of all the study groups were significantly higher than those of the control group (p < 0.05), with no significant difference between the study groups (p > 0.05). SEM analysis confirmed the AFM measurements. Conclusions: Er,Cr:YSGG can be recommended as an alternative for a carbide bur for adhesive agent removal after orthodontic debonding, considering its mild thermal effect on the pulp. Polishing with Sof-Lex discs did not significantly reduce the surface roughness, regardless of the finishing procedure.

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.

Image-Guided Ablation of Dental Calculus From Root Surfaces Using a DPSS Er:YAG Laser

BACKGROUND AND OBJECTIVES

Recent studies have demonstrated that near-infrared (IR) imaging can be used to acquire high-contrast images of root caries and calculus on the root surfaces of extracted teeth at wavelengths longer than 1450 nm. The purpose of this study was to determine if image-guided laser ablation can be used to selectively remove calculus from tooth surfaces with minimal damage to the underlying sound cementum and dentin.

MATERIALS AND METHODS

In this study, sequential near-IR images at 1500-1700 nm were used to guide a diode-pumped (DPSS) Er:YAG laser for the removal of calculus from the root surfaces of 10 extracted teeth. The selectivity of removal was assessed using digital microscopy, optical coherence tomography, and surface profilometry.

RESULTS

Calculus was removed rapidly with minimal damage to the underlying sound cementum and dentin. Image-guided ablation achieved high-selectivity, the mean volume of calculus removal was more than 27 times higher than the mean loss of cementum.

CONCLUSIONS

We have demonstrated that near-IR image-guided laser ablation can be used for the selective removal of calculus from root surfaces ex vivo. Additionally, we have demonstrated that a diode-pumped solid-state Er:YAG laser is well suited for selective removal. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Composite removal by means of erbium, chromium:yttrium-scandium-gallium-garnet laser compared with rotary instruments

BACKGROUND

Complete removal of existing composite restorations without unnecessary removal of tooth structure is challenging. The authors compared the amount of tooth structure removed and composite remaining in Class III preparations when using an erbium laser or a rotary instrument.

METHODS

Mesiolingual and distolingual preparations were prepared in 14 extracted anterior teeth, restored with shade-matched composite, finished, and polished. One restoration was removed with an erbium, chromium:yttrium-scandium-gallium-garnet laser and the other with a rotary instrument (handpiece and carbide burs). Gypsum models made from vinyl polysiloxane impressions of the preparation and removal stages were scanned. The 2 scans were precisely aligned to calculate the amount of tooth structure removed and residual composite, which were statistically compared (t test) between the bur and laser groups.

RESULTS

Rotary instruments removed significantly more tooth structure than the laser in terms of mean depth (P = .0017) but not maximum depth (P = .0762). Although mean depth of tooth loss was smaller in the laser group, the area of tooth loss was significantly larger (P = .0004) because the rotary instrumentation left significantly more composite than the laser in terms of volume (P = .0104), mean depth (P = .0375), maximum depth (P = .0318), and area (P = .0056).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The erbium, chromium:yttrium-scandium-gallium-garnet laser was more selective in removing existing composite restorations than a rotary instrument because it removed less tooth structure and left behind less composite. Unintentional loss of tooth structure and unnoticeable residual composite are inevitable when removing existing composites. Erbium lasers are alternative means of composite removal that may be more selective than a rotary instrument.

Use of a DPSS Er:YAG laser for the selective removal of composite from tooth surfaces

New diode-pumped solid state (DPSS) Er:YAG lasers have become available operating at high pulse repetition rates. These lasers are ideally suited for integration with laser scanning systems for the selective removal of dental decay and composite restorative materials from tooth surfaces. The purpose of this study was to determine if a DPSS Er:YAG laser system is suitable for the selective removal of composite from tooth surfaces. Relative ablation rates of composite and enamel were determined and composite was removed from tooth surfaces using a DPSS Er:YAG laser. Composite was removed very rapidly with ablation rates approaching 50-µm per pulse. A fluence of ~50 J/cm² appeared optimal for the removal of composite and damage to the enamel was limited to less than 100-µm after the removal of composite as thick as 700-800-µm; however, dentin is removed at similar rates to composite. The DPSS Er:YAG laser appears to be better suited for the removal of composite than conventional flash-lamp pumped Er:YAG lasers since composite is ablated at higher rates than dental enamel and the high pulse repetition rates enable greater selectivity while maintaining high removal rates.

Effect of Various Laser Surface Treatments on Repair Shear Bond Strength of Aged Silorane-Based Composite

Introduction: Successful repair of composite restorations depends on a strong bond between the old composite and the repair composite. This study sought to assess the repair shear bond strength of aged silorane-based composite following surface treatment with Nd:YAG, Er,Cr:YSGG and CO2 lasers. Methods: Seventy-six Filtek silorane composite cylinders were fabricated and aged by 2 months of water storage at 37°C. The samples were randomly divided into 4 groups (n=19) of no surface treatment (group 1) and surface treatment with Er,Cr:YSGG (group 2), Nd:YAG (group 3) and CO2 (group 4) lasers. The repair composite was applied and the shear bond strength was measured. The data were analyzed using one-way analysis of variance (ANOVA) and Tukey posthoc test. Prior to the application of the repair composite, 2 samples were randomly selected from each group and topographic changes on their surfaces following laser irradiation were studied using a scanning electron microscope (SEM). Seventeen other samples were also fabricated for assessment of cohesive strength of composite. Results: The highest and the lowest mean bond strength values were 8.99 MPa and 6.69 MPa for Er,Cr:YSGG and control groups, respectively. The difference in the repair bond strength was statistically significant between the Er,Cr:YSGG and other groups. Bond strength of the control, Nd:YAG and CO2 groups was not significantly different. The SEM micrographs revealed variable degrees of ablation and surface roughness in laser-treated groups. Conclusion: Surface treatment with Er,Cr:YSGG laser significantly increase the repair bond strength of aged silorane-based composite resin.

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.

Lasers for caries removal in deciduous and permanent teeth

BACKGROUND

Despite considerable improvements in oral health, dental caries continue to be a public health issue. The most frequently used, and universally accepted technique, to remove caries is through mechanical ablation of decayed tissues by means of rotating drills (diamond or tungsten carbide, or both). In the past few decades, the introduction of adhesive filling materials (resin composites) has affected cavity filling procedures by reducing its retention needs, with advantages for dental tissue conservation. Consequently, new minimally invasive strategies were introduced into dental practice, such as the use of lasers to perform highly controlled tissue ablation. Laser use has also raised expectations of limiting pain and discomfort compared to using drills, as well as overcoming drill phobia.

OBJECTIVES

The main objective of the review was to compare the effects of laser-based methods to conventional mechanical methods for removing dental caries in deciduous and permanent teeth.

SEARCH METHODS

We searched the following electronic databases: Cochrane Oral Health's Trials Register (searched 22 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 5) in the Cochrane Library (searched 22 June 2016), MEDLINE Ovid (1946 to 22 June 2016), Embase Ovid (1980 to 22 June 2016), ProQuest Dissertations and Theses (1980 to 22 June 2016), Zetoc (limited to conference proceedings) (1993 to 22 June 2016), and ISI Web of Knowledge (limited to conference proceedings) (1990 to 22 June 2016). We checked the reference lists of relevant articles to identify additional studies. We searched the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials.

SELECTION CRITERIA

We included randomised controlled trials, split-mouth trials and cluster-randomised trials (irrespective of their language) comparing laser therapy to drill ablation of caries. We included participants of any age (children, adolescents and adults).

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles and abstracts of citations identified by the review search strategy. Two review authors independently evaluated the full text of relevant primary studies, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included nine randomised trials, published between 1998 and 2014, involving 662 participants. The population consisted of both children and adolescents in four trials, only adults in four trials, and both children/adolescents and adults in one trial. Four studies examined only permanent teeth, and five studies evaluated both deciduous and permanent teeth. Six trials used Er:YAG (erbium-doped yttrium aluminium garnet) lasers, two trials employed Er,Cr:YSGG (erbium, chromium: yttrium-scandium-gallium-garnet) lasers, and one trial used Nd:YAG (neodymium-doped yttrium aluminium garnet) laser.Overall, the trials had small sample sizes, and the majority were at unclear or high risk of bias. The primary outcomes were evaluated in a limited number of trials (removal of caries (four trials (but only two reported quantitative data)); episodes of pain (five studies)). There was insufficient evidence to suggest that either lasers or drill were better at caries removal (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.99 to 1.01; 2 studies; 256 treated caries; P = 0.75; I² = 0%; low-quality evidence).The incidence of moderate or high pain was greater in the drill group compared to the laser group (RR 0.40, 95% CI 0.28 to 0.57; 2 studies; 143 participants; P < 0.001; I² = 50%). Similarly, the need for anaesthesia was significantly higher in the drill group than in the laser group (RR 0.25, 95% CI 0.10 to 0.65; 3 studies; 217 children/adolescents; P = 0.004; I² = 0%).In terms of marginal integrity of restoration, there was no evidence of a difference between laser and drill comparisons evaluated at 6 months (RR 1.00, 95% CI 0.21 to 4.78; 3 studies), 1 year (RR 1.59, 95% CI 0.34 to 7.38; 2 studies), or 2 years (RR 1.00, 95% CI 0.21 to 4.74; 1 study).There was no evidence of a difference for durability of restoration between laser therapy or drill at 6 months' follow-up (RR 2.40, 95% CI 0.65 to 8.77; 4 studies), at 1 year (RR 1.40, 95% CI 0.29 to 6.78; 2 studies) or at 2 years' follow-up (RR 0.50, 95% CI 0.02 to 14.60; 1 study).Only two trials investigated the recurrence of caries, but no events occurred during 6 months' follow-up.There was insufficient evidence of a difference between laser or drill in terms of pulpal inflammation or necrosis at 1 week (RR 1.51, 95% CI 0.26 to 8.75; 3 studies) and at 6 months (RR 0.99, 95% CI 0.10 to 9.41; 2 studies).

AUTHORS' CONCLUSIONS

Given the low quality of the body of evidence, we concluded that evidence was insufficient to support the use of laser as an alternative to traditional drill therapy for caries removal. We found some evidence in favour of laser therapy for pain control, need of anaesthesia and patient discomfort, but, again, the body of evidence was of low quality. Additional well-designed, randomised trials investigating the most relevant outcomes are needed.

Selective removal of esthetic composite restorations with spectral guided laser ablation

Dental composites are used for a wide range of applications such as fillings for cavities, adhesives for orthodontic brackets, and closure of gaps (diastemas) between teeth by esthetic bonding. Anterior restorations are used to replace missing, diseased and unsightly tooth structure for both appearance and function. When these restorations must be replaced, they are difficult to remove mechanically without causing excessive removal or damage to enamel because dental composites are color matched to teeth. Previous studies have shown that CO₂ lasers have high ablation selectivity and are well suited for removal of composite on occlusal surfaces while minimizing healthy tissue loss. A spectral feedback guidance system may be used to discriminate between dental composite and dental hard tissue for selective ablation of composite material. The removal of composite restorations filling diastemas is more challenging due to the esthetic concern for anterior teeth. The objective of this study is to determine if composite spanning a diastema between anterior teeth can be removed by spectral guided laser ablation at clinically relevant rates with minimal damage to peripheral healthy tissue and with higher selectivity than a high speed dental hand-piece.

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.

Selective removal of dental composite with a diode-pumped Er:YAG laser

Selective removal of dental composite with high precision is best accomplished using lasers operating at high pulse repetition rates focused to a small spot size. Conventional flash-lamp pumped Er:YAG lasers are poorly suited for this purpose, but new diode-pumped Er:YAG lasers have become available operating at high pulse repetition rates. The purpose of this study was to compare the ablation rates and selectivity of enamel and composite for a 30 W diode-pumped Er:YAG laser operating with a pulse duration of 30-50-μs and evaluate it's suitability for the selective removal of composite from tooth surfaces. The depth of ablation and changes in surface morphology were assessed using digital microscopy. The fluence range of 30-50 J/cm² appeared optimal for the removal of composite, and damage to sound enamel was limited to less than 100-μm after the removal of composite as thick as 700-800-μm. Future studies will focus on the use of methods of feedback to further increase selectivity.

Selective removal of carious human dentin using a nanosecond pulsed laser operating at a wavelength of 5.85 μm

Less invasive methods for treating dental caries are strongly desired. However, conventional dental lasers do not always selectively remove caries or ensure good bonding to the composite resin. According to our previous study, demineralized dentin might be removed by a nanosecond pulsed laser operating at wavelengths of around 5.8 μm . The present study investigated the irradiation effect of the light on carious human dentin classified into "remove," "not remove," and "unclear" categories. Under 5.85-μm laser pulses, at average power densities of 30 W/cm² and irradiation time of 2 s, the ablation depth of "remove" and "not remove," and also the ablation depth of "unclear" and "not remove," were significantly different (p<0.01 ). The ablation depth was correlated with both Vickers hardness and Ca content. Thus, a nanosecond pulsed laser operating at 5.85  μm proved an effective less-invasive caries treatment.

Effects of removing adhesive from tooth surfaces by Er:YAG laser and a composite bur on enamel surface roughnessand pulp chamber temperature

BACKGROUND

At the end of fixed orthodontic treatment, the remnant of adhesive should be eliminated from the tooth surface. The purpose of this study was to compare the effect of three methods of removing adhesive on enamel surface roughness, dental pulp temperature, and also on the time spent.

MATERIALS AND METHODS

The brackets on 90 extracted teeth were debonded using bracket removal pliers. A thermocouple sensor was fitted on the buccal wall of the pulp chamber through access cavity to measure thermal changes during adhesive removal. The residue of adhesive was eliminated from enamel surface of teeth by either tungsten carbide bur, erbium-doped yttrium aluminum garnet laser, or fiber reinforced composite bur. Scanning electron micrographs images were taken to assess the roughness of enamel surface. The time spent for adhesive removal was recorded as well. Chi-square test was used to evaluate the remnants of adhesive and enamel surface roughness; t-test and also repeated measurement analysis of variance were applied at P < 0.05 to compare the thermal changes of the pulp chamber and time spent between the methods of surface treatment.

RESULTS

The results of surface roughness were significantly different (P < 0.001). The pulp temperature changed significantly (P < 0.001). Tungsten carbide bur increased the temperature by 5.5°C significantly slower than reinforced composite bur (P = 0.004), however removed the adhesive residue faster than two other methods although not significantly (P = 0.069).

CONCLUSION

Within the limitations of this study, fiber reinforced composite bur created the smoothest enamel surface while Er:YAG laser the roughest. Tungsten carbide and composite burs generated more heat compared to Er:YAG laser. In addition, tungsten carbide bur was the fastest and Er:YAG laser the slowest devices to remove adhesive residue.

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.

Effect of Surface Treatment with Er;Cr:YSSG, Nd:YAG, and CO2 Lasers on Repair Shear Bond Strength of a Silorane-based Composite Resin

Background and aims. The aim of the present study was to compare the effect ofsurface treatment with Er; Cr:YSSG, Nd:YAG, and CO₂ lasers on repair shear bond strength of a silorane-based composite resin.

Materials and methods. Sixty eight cylindrical samples of a silorane-based composite resin (Filtek Silorane) were pre-pared and randomly divided into 4 groups as follows: group 1: without surface treatment; groups 2, 3 and 4 with surface treatments using Er; Cr:YSSG, Nd:YAG, and CO₂ lasers, respectively. A positive control group (group 5) was assigned in order to measure cohesive strength. Repair shear bond strength values were measured and data was analyzed using one-way ANOVA and a post hoc Tukey test at a significance level of α=0.05.

Results. There were statistically significant differences in repair shear bond strength values between group 2 and other groups (P < 0.05); and between group 1and groups 3and 4 (P < 0.001); however, there were no significant differences be-tween groups 3 and 4 (P = 0.91).

Conclusion. The repair shear bond strength of silorane-based composite resin was acceptable by surface treatment with lasers

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.