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Abd El-Aal NH, Hussein AMHMM, Banerjee A, Hammama HH. Clinical and ex-vivo effect of LASERs on prevention of early-enamel caries: systematic review & meta-analyses. Lasers Med Sci 2024; 39:107. [PMID: 38635085 PMCID: PMC11026291 DOI: 10.1007/s10103-024-04049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
To investigate the in vivo and in situ effect of different types of lasers in prevention of enamel demineralization in high caries risk cases (around orthodontic brackets, around restoration and in caries susceptible pits and fissures). PubMed was searched using the following keyword sequence; (Laser therapy OR laser irradiation OR laser application) AND (enamel caries prevention OR enamel demineralization OR enamel remineralization OR early enamel caries OR early-enamel caries OR enamel resistance OR enamel decalcification OR white spot lesions WSLs OR incipient lesion OR enamel decay OR enamel Dissolution OR enamel microhardness) AND (clinical trial OR Randomized clinical trial OR In situ study). The latest literature search was ended by "30 January 2023". PubMed was used as a primary data base for study selection. Scopus, EBSCO, and Google scholar are checked in our study after results of systematic search on PubMed. Only duplicates were found. Two meta-analyses were carried out. The first, clinical meta-analysis on incidence of white spot lesions (WSLs) following CO2 laser irradiation of enamel. The second meta-analysis on ex-vivo/in situ effect of CO2 laser on microhardness of enamel. In each meta-analysis three studies were included. Risk of bias was assessed. The search identified eight studies (four ex-vivo and four clinical trials). Regarding the clinical meta-analysis, the overall standardized mean difference was 0.21 [ 95% confidence interval (CI): 0.15-0.30, p < 0.00001]. This indicates that the incidence of new WSLs in patients who received low power CO2 laser treatment was highly significantly lower than placebo groups. The heterogeneity was considerable (I2 = 71%). In the second meta-analysis, the overall standardized mean difference was 49.55 [ 95% confidence interval (CI): 37.74, 61.37, p < 0.00001]. This indicates that microhardness of enamel receiving low power (0.4-5 W) CO2 laser irradiation is highly significantly lower than control untreated enamel. The heterogeneity was substantial (I2 = 48%). Within the limitations of this study, Low level laser therapy concept with CO2 laser seems to be effective in preventing enamel caries.Prospero registration number: CRD42023437379.
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Affiliation(s)
| | | | - Avijit Banerjee
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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2
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Patano A, Malcangi G, Sardano R, Mastrodonato A, Garofoli G, Mancini A, Inchingolo AD, Di Venere D, Inchingolo F, Dipalma G, Inchingolo AM. White Spots: Prevention in Orthodontics-Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085608. [PMID: 37107890 PMCID: PMC10138765 DOI: 10.3390/ijerph20085608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
Early-stage dental demineralization, called white spots (WS), get their name from the characteristic colour that enamel takes on due to the acid attack of salivary cariogenic bacteria. They are often associated with fixed orthodontic therapy (FOT) and, if left untreated, evolve into caries with repercussions on oral health and dental aesthetics. This review aims to identify the most effective prophylaxis strategies to prevent WS during FOT. The search for the reviewed studies was conducted on the Pubmed, Scopus, and Web of Science databases, selecting English-only articles published in the 5 years from January 2018 to January 2023. The keywords used were "WS" and "fixed orthodontic*", using "AND" as the Boolean operator. A total of 16 studies were included for qualitative analysis. Prevention begins with maintaining proper oral hygiene; fluoride in toothpaste, mouthwashes, gels, varnishes, and sealants can be added to prophylaxis and used regularly. Using a laser in combination with fluoride helps prevent the occurrence of WS and assists in the repair processes of initial lesions. Further studies are needed to establish international guidelines for preventing WS in orthodontically treated patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Francesco Inchingolo
- Correspondence: (F.I.); (G.D.); (A.M.I.); Tel.: +39-3312111104 (F.I.); +39-3348010580 (A.M.I.)
| | - Gianna Dipalma
- Correspondence: (F.I.); (G.D.); (A.M.I.); Tel.: +39-3312111104 (F.I.); +39-3348010580 (A.M.I.)
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Belcheva AB, Shindova MP. Caries inhibition with CO2-laser during orthodontic treatment: a study protocol for a randomized split-mouth controlled clinical trial. Trials 2022; 23:208. [PMID: 35279220 PMCID: PMC8917669 DOI: 10.1186/s13063-022-06117-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 02/15/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction White spot lesions associated with orthodontic treatment are a common problem. Recent studies reported increased resistance to acid demineralization of enamel after sub-ablative CO2-laser irradiation in a combination with fluoride application. The aim of the study is to assess the efficacy of CO2-laser in combination with a fluoride varnish in the prevention, severity, and extent of white spot lesions during orthodontic treatment with fixed appliances. Methods and analysis This is a protocol for a randomized, split-mouth controlled, clinical trial. The participants will be children aged 12–18 years at high caries risk, requiring fixed orthodontic treatment. The vestibular surfaces of maxillary anterior teeth of eligible patients will be exposed to CO2-laser irradiation in combination with fluoride therapy and fluoride therapy alone followed by bonding of orthodontic brackets. The patients will be recalled 6 and 12 months post-irradiation. Outcome measures will be visual examination with International Caries Detection and Assessment System criteria and SoproLife fluorescence. Data will be analyzed by Student’s t test for paired samples and proportional odds logistic regression model, p<0.05. Ethics and dissemination The study protocol has been approved by the Committee for Scientific Research Ethics, Medical University-Plovdiv, Bulgaria (Reference number P-605/27.03.2020, Protocol of approval No. 2/01.04.2021) and registered on a publicly accessible database. This research received institutional funding from the Medical University–Plovdiv, Bulgaria. The results will be presented through peer-reviewed publications and conference presentations. Trial registration ClinicalTrials.gov NCT04903275. Registered on June 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06117-y.
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Tavares JDP, da Silva CV, Engel Y, de Freitas PM, Rechmann P. In situ effect of CO2 laser (9.3 μm) irradiation, combined with AmF/NaF/SnCl2 solution in prevention and control of erosive tooth wear in human enamel. Caries Res 2021; 55:617-628. [PMID: 34689142 DOI: 10.1159/000520215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This single-blind, controlled cross-over in situ study aimed to evaluate the effect of CO2 laser (9.3µm) irradiation, combined with AmF/NaF/SnCl2 solution on prevention and control of Erosive Tooth Wear (ETW) in human enamel. MATERIALS AND METHODS Two trial conditions were analyzed, Condition-1 as ETW-prevention (sound tooth surface) and Condition-2 as ETW-control (in vitro initial erosive lesion). The experiment was conducted in two phases, one with one without exposure to AmF/NaF/SnCl2 solution. A hundred and ninety-two samples of human enamel (3x3x1mm) were randomly divided into 4 experimental groups for each condition: (C) without treatment (negative control); (F) AmF/NaF/SnCl2 solution (positive control); (L) CO2 laser irradiation; (L+F) CO2 laser+AmF/NaF/SnCl2 solution. Twelve volunteers used a removable device each containing 8 samples per phase. Ex-vivo erosive challenges (4×5min/day) and rinsing protocol (1×30s/day) were performed. The surface loss was determined using optical profilometer (n=12 per group), and the surface morphology was observed with Scanning Electron Microscopy (n=3). RESULTS Condition-1 data were analyzed by one-way ANOVA and Condition-2 by two-way repeated measures ANOVA, both with Tukey post-hoc tests (α=5%). Condition-1: groups L (4.59 ±2.95µm) and L+F (1.58 ±1.24µm) showed significantly less surface loss in preventing ETW than groups C and F. Condition-2: in controlling the progression of ETW, L+F was the only group with no significant surface loss between initial erosive lesion (3.65 ±0.16µm) and after erosive challenge (4.99 ±1.17µm). CONCLUSIONS CO2 9.3µm laser application prevented and controlled ETW progression in human enamel, with greater efficiency when combined with AmF/NaF/SnCl2 solution application.
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Affiliation(s)
- Juliane de Paula Tavares
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil,
| | - Camila Vieira da Silva
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Yael Engel
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Peter Rechmann
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, California, USA
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Xue VW, Zhao IS, Yin IX, Niu JY, Lo ECM, Chu CH. Effects of 9,300 nm Carbon Dioxide Laser on Dental Hard Tissue: A Concise Review. Clin Cosmet Investig Dent 2021; 13:155-161. [PMID: 33958895 PMCID: PMC8096333 DOI: 10.2147/ccide.s304273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Vicky Wenqing Xue
- School of Dentistry, Shenzhen University Health Science Center, Shenzhen, People's Republic of China.,Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Irene Shuping Zhao
- School of Dentistry, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | | | - John Yun Niu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | | | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong
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Badreddine AH, Couitt S, Donovan J, Cantor-Balan R, Kerbage C, Rechmann P. Demineralization Inhibition by High-Speed Scanning of 9.3 µm CO 2 Single Laser Pulses Over Enamel. Lasers Surg Med 2020; 53:703-712. [PMID: 33161599 DOI: 10.1002/lsm.23340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE In vitro studies were conducted to evaluate the use of an automated system for high-speed scanning of single 9.3 µm CO2 laser pulses in the inhibition of caries-like lesion formation in the enamel of extracted human molars. The effect of the laser in generating an acid-resistant layer and the effect of the layer on inhibiting surface mineral loss during pH cycling was explored. STUDY DESIGN/MATERIALS AND METHODS Laser irradiation was performed with fluences of 0.6, 0.8, and 1.0 J/cm2 for single pulses of 1 mm diameter (1/e2 ), with pulse durations of 17, 22, and 27 microseconds, respectively. The laser was scanned at a 750 Hz pulse repetition rate in an automated pattern covering an area of 7 mm2 in 0.3 sec. Six treatment groups were investigated: three groups for each fluence for laser-only and three for laser irradiation with additional fluoride from a toothpaste slurry (sodium fluoride at 1100 ppm). Each group used non-irradiated areas, which included untreated controls for the laser-only groups and a fluoride-only treatment for the groups with additional fluoride. pH cycling was performed on both groups, followed by microhardness testing to determine the relative mineral loss (∆Z) from a caries-like formation and surface mineral loss (∆S). RESULTS Laser irradiation with the 9.3 µm CO2 laser generated an acid-resistant layer of about 15 µm in depth. For the laser-irradiated samples with additional fluoride application, the relative mineral loss (∆Z) was 113 ± 63 vol%-µm, while for those with only fluoride application ∆Z was 572 ± 172 vol%-µm. At the highest fluence (1.0 J/cm2 ) used, an 80.2% inhibition of caries-like lesion was measured by ∆Z. Using only laser irradiation at the highest fluence resulted in an inhibition of caries-like lesion of 79.5% for the irradiated samples (∆Z = 374 ± 149 vol%-µm) relative to the control (∆Z = 1826 ± 325 vol%-µm). Surface microhardness tests resulted in an inhibition of surface softening, as measured by the Knoop Hardness Value (KHN) (108 ± 33 KHN for laser irradiated with additional fluoride, for non-irradiated controls with fluoride only 52 ± 16 KHN). Inhibition of surface loss was observed for all laser fluences, but the maximum surface loss for the untreated control group was only 2.2 ± 0.49 µm. CONCLUSIONS The results demonstrate a significant benefit of the 9.3 µm CO2 laser at fluences of 0.6, 0.8, and 1.0 J/cm2 in caries-like lesion inhibition as measured by the relative mineral loss in depth and surface mineral loss, without significant damage to the enamel. Additionally, inhibition of surface softening and surface loss during pH cycling was observed. The surface loss was small compared with the overall lesion depth and thickness of the generated acid-resistant layer. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Ali H Badreddine
- Convergent Dental, Inc., 140 Kendrick St Bldg C3, Needham, Massachusetts, 02494
| | - Stephen Couitt
- Convergent Dental, Inc., 140 Kendrick St Bldg C3, Needham, Massachusetts, 02494
| | - Julia Donovan
- Convergent Dental, Inc., 140 Kendrick St Bldg C3, Needham, Massachusetts, 02494
| | - Roni Cantor-Balan
- Convergent Dental, Inc., 140 Kendrick St Bldg C3, Needham, Massachusetts, 02494
| | - Charles Kerbage
- Convergent Dental, Inc., 140 Kendrick St Bldg C3, Needham, Massachusetts, 02494
| | - Peter Rechmann
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus Avenue, San Francisco, California, 94143
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Fissure caries inhibition with a CO 2 9.3-μm short-pulsed laser-a randomized, single-blind, split-mouth controlled, 1-year clinical trial. Clin Oral Investig 2020; 25:2055-2068. [PMID: 32803438 DOI: 10.1007/s00784-020-03515-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of this randomized, single-blind, split-mouth controlled, clinical trial was to evaluate whether the use of a short-pulsed 9.3-μm CO2 laser increases the caries resistance of occlusal pit and fissures in addition to fluoride therapy over 12 months. MATERIALS AND METHODS A total of 60 participants, average age 13.1 years, were enrolled. At baseline, second molars were randomized into test and control, and assessed by ICDAS, SOPROLIFE, and DIAGNOdent. An independent investigator irradiated test molars with a CO2 laser (wavelength 9.3 μm, pulse duration 4 μs, pulse repetition rate 43 Hz, beam diameter 250 μm, average fluence 3.9 J/cm2, 20 laser pulses per spot). Test molars received laser and fluoride treatment, control teeth fluoride alone. Fluoride varnish was applied at baseline and at 6 months. After 6 and 12 months, teeth were again assessed. RESULTS A total of 57 participants completed the 6-month and 51 the 12-month recall. Laser-treated surfaces showed very slight ICDAS improvements over time with ICDAS change - 1 in 11% and 8%, no changes (ICDAS change 0) in 68% and 67%, and slightly worsened (ICDAS change 1) in 19% and 24% at 6- and 12-month recalls, respectively, and worsened by two scores in 2% at both recall time points. Control teeth showed significantly higher ICDAS increases, with 47% and 25% showing ICDAS change 0, ICDAS change 1 in 49% and 55%, and ICDAS change 2 in 4% and 20% at 6- and 12-month recalls, respectively. Differences in ICDAS changes between the groups were statistically significant (P = 0.0002 and P < 0.0001; Wilcoxon's signed-rank test, exact). A total of 22% of the participants developed ICDAS 3 scores on the control teeth. CONCLUSIONS Microsecond short-pulsed 9.3-μm CO2 laser irradiation markedly inhibits caries progression in pits and fissures in comparison with fluoride varnish alone. CLINICAL RELEVANCE The 9.3-μm CO2 laser irradiation of pits and fissures enhances caries resistance. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02357979.
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Silva CV, Mantilla TF, Engel Y, Tavares JP, Freitas PM, Rechmann P. The effect of CO 2 9.3 μm short-pulsed laser irradiation in enamel erosion reduction with and without fluoride applications-a randomized, controlled in vitro study. Lasers Med Sci 2020; 35:1213-1222. [PMID: 32030555 DOI: 10.1007/s10103-020-02979-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
The aim of this in vitro study was to evaluate the protective effect of short-pulsed CO2 9.3 μm laser irradiation against erosion in human enamel without and combined with TiF4 and AmF/NaF/SnCl2 applications, respectively, as well as compared to the protective effect of these fluoride treatments alone. After polishing, ninety enamel samples (3 × 3mm) were used for 9 different treatment groups: 4% TiF4 gel (pH 1.5, 24,533 ppm F-); AmF/NaF/SnCl2 rinse (pH 4.5; 500 ppm F-, 800 ppm Sn2); CO2 laser (average power 0.58 W); CO2 laser (0.58 W) + TiF4; CO2 laser (0.58 W) + AmF/NaF/SnCl2; CO2 laser (0.69 W); CO2 laser (0.69 W) + TiF4; CO2 laser (0.69 W) + AmF/NaF/SnCl2; negative control (deionized water). TiF4 gel was brushed on only once before the first erosive cycling, while samples treated with AmF/NaF/SnCl2 were daily immersed in 5 ml of the solution before cycling. Laser treatment occurred with a CO2 laser (wavelength 9.3 μm, pulse repetition rate 100 Hz, pulse duration 14.6 μs/18 μs, average power 0.58 W/0.69 W, fluence 1.9 J/cm2/2.2 J/cm2, beam diameter 0.63 mm, irradiation time 10 s, air cooling). TiF4 was applied only once, while AmF/NaF/SnCl2 was applied once daily before the erosive challenge. Surface loss (in μm) was measured with optical profilometry immediately after treatment, and after 5 and 10 days of erosive cycling (0.5% citric acid, pH 2.3, 6 × 2 min/day). Additionally, scanning electron microscopy investigations were performed. All application measures resulted in loss of surface height immediately after treatment. After 5 days, significantly reduced surface loss was observed after applying laser irradiation (both power settings) followed by applications of TiF4 or AmF/NaF/SnCl2 solution (p < 0.05; 2-way ANOVA and Tukey test) compared to fluoride application alone. After 10 days, compared to after 5 days, a reduced tissue loss was observed in all groups treated with AmF/NaF/SnCl2 solution. This tissue gain occurred with the AmF/NaF/SnCl2 application alone and was significantly higher when the application was combined with the laser use (p < 0.05). Short-pulsed CO2 9.3 μm laser irradiation followed by additional application of AmF/NaF/SnCl2 solution significantly reduces the progression of dental enamel erosion in vitro.
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Affiliation(s)
- C V Silva
- Department of Restorative Dentistry, Faculdade de Odontologia, Universidade de São Paulo (USP), Av Prof. Lineu Prestes, 2227 - Cidade Universitária, São Paulo, SP, 05508-000, Brazil
| | - T F Mantilla
- Department of Restorative Dentistry, Faculdade de Odontologia, Universidade de São Paulo (USP), Av Prof. Lineu Prestes, 2227 - Cidade Universitária, São Paulo, SP, 05508-000, Brazil
| | - Y Engel
- Department of Restorative Dentistry, Faculdade de Odontologia, Universidade de São Paulo (USP), Av Prof. Lineu Prestes, 2227 - Cidade Universitária, São Paulo, SP, 05508-000, Brazil
| | - J P Tavares
- Department of Restorative Dentistry, Faculdade de Odontologia, Universidade de São Paulo (USP), Av Prof. Lineu Prestes, 2227 - Cidade Universitária, São Paulo, SP, 05508-000, Brazil
| | - P M Freitas
- Department of Restorative Dentistry, Faculdade de Odontologia, Universidade de São Paulo (USP), Av Prof. Lineu Prestes, 2227 - Cidade Universitária, São Paulo, SP, 05508-000, Brazil
| | - P Rechmann
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus Avenue, San Francisco, CA, 94143, USA.
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Brandão CB, Corona SAM, Torres CP, Côrrea-Marques AA, Saraiva MCP, Borsatto MC. Efficacy of CO lasers in preventing dental caries in partially erupted first permanent molars: a randomized 18-month clinical trial. Lasers Med Sci 2020; 35:1185-1191. [PMID: 31970563 DOI: 10.1007/s10103-020-02967-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
The aim of this controlled randomized double-blinded clinical trial was to evaluate the use of a CO2 laser with or without topical application of acidulated fluorides in the prevention of dental caries in partially erupted first permanent molars. We selected 61 healthy children at high risk of caries, all between 6 and 8 (7.1 ± 0.8) years of age and with 4 partially erupted first permanent molars. A CO2 laser device emitting at 10.6 μm was used (0.5 W, 0.05 mJ per pulse, 10 kHz). Each first molar in an individual was randomly assigned to one treatment: (L) CO2 laser (0.066 J/cm2); (FL) 1.23% acidulated fluoride gel and CO2 laser (0.066 J/cm2); (V) 5% fluoride varnish, or (S) sealant (control). Patients were followed-up at 3, 6, 12, and 18 months after treatment, through direct visual examination and by an operator blinded to the treatments (kappa ≥ 0.70). The International Caries Detection and Assessment System (ICDAS-II) index was used to assess the soundness of tooth structure or the presence of white spot lesions, cavitated enamel, and/or dentin lesions. The Yildiz Visual Index was used to evaluate sealant retention. Results were evaluated using Kaplan-Meier survival analysis, and the hazard ratio of the treatments was estimated using shared frailty models with a gamma distribution, which considered the patient as a cluster. There were no significant differences among treatments compared to sealants. After 18 months, the use of a CO2 laser with or without acidulated fluorides was shown to be effective in preventing caries on the occlusal surface of partially erupted permanent first molars in children at high risk for caries.
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Affiliation(s)
- Cristina Bueno Brandão
- Department of Pediatric Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Silmara Aparecida Milori Corona
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carolina Paes Torres
- Department of Pediatric Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alessandra Afonso Côrrea-Marques
- Department of Pediatric Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Conceição Pereira Saraiva
- Department of Pediatric Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Cristina Borsatto
- Department of Pediatric Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Rechmann P, Le CQ, Kinsel R, Kerbage C, Rechmann BMT. In vitro CO 2 9.3-μm short-pulsed laser caries prevention-effects of a newly developed laser irradiation pattern. Lasers Med Sci 2020; 35:979-989. [PMID: 31897815 DOI: 10.1007/s10103-019-02940-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/22/2019] [Indexed: 11/24/2022]
Abstract
Caries prevention with different lasers has been investigated in laboratory studies and clinical pilot trials. Objective of this in vitro study was to assess whether 9.3-μm microsecond short-pulsed CO2 laser irradiation enhances enamel caries resistance without melting, with and without additional fluoride application. Seven groups of enamel, totaling 105 human enamel samples, were irradiated with 2 different carbon dioxide lasers with 2 different energy application systems (original versus spread beam; 9.3 μm wavelength, pulse repetition rate 43 Hz vs 100 Hz, fluence ranges from 1.4 to 3.9 J/cm2, pulse duration 3 μs to 18 μs). The laboratory pH-cycling was performed with or without additional fluoride, followed by cross-sectional microhardness testing. To assess caries inhibition, the mean relative mineral loss delta Z (∆Z) was determined. To evaluate for melting, scanning electron microscopy (SEM) examinations were performed. For the non-laser control groups with additional fluoride use, the relative mineral loss (ΔZ, vol% × μm) ranged between 512 ± 292 and 809 ± 297 (mean ± SD). ΔZ for the laser-irradiated samples with fluoride use ranged between 186 ± 214 and 374 ± 191, averaging a 58% ± 6% mineral loss reduction (ANOVA, P < 0.01 to P < 0.0001). For the non-laser-treated controls without additional fluoride, the mineral loss increased (ΔZ 914 ± 422 to 1224 ± 736). In contrast, the ΔZ for the laser-treated groups without additional fluoride ranged between 463 ± 190 and 594 ± 272 (P < 0.01 to P < 0.001) indicative of 50% ± 2% average reduction in mineral loss. Enhanced caries resistance was achieved by all applied fluences. Using the spread beam resulted in enhanced resistance without enamel melting as seen by SEM. CO2 9.3-μm short-pulsed laser irradiation with both laser beam configurations resulted in highly significant reduction in enamel mineral loss. Modifying the beam to a more homogenous profile will allow enamel caries resistance even without apparent enamel melting.
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Affiliation(s)
- Peter Rechmann
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - C Q Le
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - R Kinsel
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - C Kerbage
- Convergent Dental, 140 Kendrick Street, Bldg C3, Needham, MA, 02494, USA
| | - B M T Rechmann
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus Avenue, San Francisco, CA, 94143, USA
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Mahmoudzadeh M, Alijani S, Soufi LR, Farhadian M, Namdar F, Karami S. Effect of CO2 Laser on the Prevention of White Spot Lesions During Fixed Orthodontic Treatment: A Randomized Clinical Trial. Turk J Orthod 2019; 32:165-171. [PMID: 31565692 DOI: 10.5152/turkjorthod.2019.18052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/20/2019] [Indexed: 11/22/2022]
Abstract
Objective This study aimed to assess the effect of carbon dioxide (CO2) laser on prevention of white spot lesions (WSLs) associated with fixed orthodontic treatment. Methods In this parallel controlled trial, 554 maxillary anterior teeth in 95 patients with age range of 12-30 years were included. The samples were randomly divided in two groups: 1) CO2 laser (n=278) and 2) control (n=276) groups. Following bracket attachment, the teeth in the laser group were exposed to CO2 laser (0.4 mw, 10.6 μm, 5 Hz) for 20 s, and the control group received placebo light. Incidence, severity, and extent of the lesions were assessed in four surface regions (gingival, incisal, mesial, and distal) at baseline and 6 months post-irradiation. The inter-group comparison was performed by the Mann-Whitney U test and McNemar analysis. Results A significant difference regarding WSLs incidence in all teeth was observed between the two study groups (p<0.001). The two study groups illustrated a significant difference in lesion extent and incidence in incisal, mesial, and distal regions (p<0.05). The WSLs were significantly different in terms of severity in the incisal and mesial sites (p<0.05). Conclusion The CO2 laser irradiation seemed to effectively prevent incidence of WSLs. In addition, its effectiveness varied depending on the surface region.
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Affiliation(s)
- Majid Mahmoudzadeh
- Department of Orthodontics, Hamadan University of Medical Sciences School of Dentistry, Hamadan, Iran
| | - Sara Alijani
- Department of Orthodontics, Hamadan University of Medical Sciences School of Dentistry, Hamadan, Iran
| | - Loghman Rezaei Soufi
- Department of Operative, Dental Research Center, Hamadan University of Medical Sciences School of Dentistry, Hamadan, Iran
| | - Maryam Farhadian
- Department of Biostatistics, Hamadan University of Medical Sciences School of Public Health and Research Center for Health Sciences, Hamadan, Iran
| | - Fatemeh Namdar
- Dental Materials Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Somayeh Karami
- Post Graduate Orthodontic Student of Hamadan School of Dentistry, Department of Orthodontics, Hamadan University of Medical Sciences School of Dentistry, Hamadan, Iran
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Al-Maliky MA, Frentzen M, Meister J. Laser-assisted prevention of enamel caries: a 10-year review of the literature. Lasers Med Sci 2019; 35:13-30. [PMID: 31399861 DOI: 10.1007/s10103-019-02859-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 08/01/2019] [Indexed: 01/13/2023]
Abstract
Since the invention of lasers in dentistry, investigations in caries prevention by the use of laser radiation have been proposed. There are several mechanisms stated for this purpose such as photothermal and/or photochemical interaction processes with the enamel. Alone or in conjugation with topical fluoride application, this treatment modality may improve enamel acid resistance in high-caries-risk populations. Data collection was done by searching the keywords caries, prevention, and laser in PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar. Lasing protocols of the collected literature and their effectiveness as well as examination methods used to verify treatment outcomes have been evaluated. One hundred eighteen publications were found for the last 10 years. The wavelengths investigated for caries prevention are mainly located in the near and the mid-infrared spectral range. In the evaluated period of time, investigations using CO2; Er:YAG; Er,Cr:YSGG; Er:YLF; fundamental, second, and third harmonic generations of Nd:YAG; diodes; and argon ion lasers were found in the databases. Accounting for 39% of the literature, CO2 laser was the most examined system for this purpose. Reviewing the literature in this narrative review showed that all laser systems presented a positive effect in varying degrees. Laser irradiation could be an alternative or synergistic to topical fluoridation for enamel caries prevention with longer lasting effect. Further research should be focused on selecting proper laser settings to avoid damage to enamel and developing effective evidence-based clinical protocols.
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Affiliation(s)
- Mohammed Abbood Al-Maliky
- Department of Periodontology, Operative and Preventive Dentistry, Dental Faculty, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany. .,Center of Applied Medical Laser Research and Biomedical Optics (AMLaReBO), University of Bonn, Bonn, Germany. .,Department of Biomedical Applications, Institute of Laser for Postgraduate Studies, University of Baghdad, Baghdad, Iraq.
| | - Matthias Frentzen
- Department of Periodontology, Operative and Preventive Dentistry, Dental Faculty, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany
| | - Jörg Meister
- Department of Periodontology, Operative and Preventive Dentistry, Dental Faculty, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany.,Center of Applied Medical Laser Research and Biomedical Optics (AMLaReBO), University of Bonn, Bonn, Germany
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Abufarwa M, Noureldin A, Azimaie T, Campbell PM, Buschang PH. Preventive effects of carbon dioxide laser and casein phosphopeptide amorphous calcium phosphate fluoride varnish on enamel demineralization: A comparative, in vitro study. JOURNAL OF INVESTIGATIVE AND CLINICAL DENTISTRY 2019; 10:e12400. [PMID: 30693660 DOI: 10.1111/jicd.12400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Abstract
AIM The aim of the present study was to compare the effects of carbon dioxide (CO2 ) laser and casein phosphopeptide amorphous calcium phosphate (CPP-ACP)fluoride varnish on enamel demineralization. METHODS Human teeth were randomly assigned to three groups. The enamel was treated with fluoride varnish, 10.6 μm CO2 laser, or no treatment (control), followed by 9 days of pH cycling. Baseline and final FluoreCam images were used to quantify the area, intensity, and impact of demineralization; cross-sectional microhardness was used to measure the mechanical properties of the enamel. RESULTS There were statistically-significant changes in the area, intensity and impact of demineralization in the control and laser groups (P < 0.05), but not in the fluoride group. The control group showed a significantly greater area and impact of enamel demineralization compared to the fluoride group. The area of demineralization in the laser group was significantly greater than that of the fluoride group. Enamel demineralization of the laser and control groups was comparable. The fluoride group showed statistically-significant harder enamel than the control at 20, 40, and 60 μm depths; the laser group enamel was significantly harder than the control at 20 and 40 μm depths. The fluoride group showed statistically-significant harder enamel than the laser group at 20 μm depth. CONCLUSIONS CPP-ACP fluoride varnish is more effective than CO2 in preventing enamel demineralization.
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Affiliation(s)
- Moufida Abufarwa
- Department of Biomedical Science, Texas A&M University College of Dentistry, Dallas, Texas
| | - Amal Noureldin
- Department of Public Health Sciences, Texas A&M University College of Dentistry, Dallas, Texas
| | - Taha Azimaie
- Rutgers School of Dental Medicine, Newark, New Jersey
| | - Phillip M Campbell
- Department of Orthodontics, Texas A&M University College of Dentistry, Dallas, Texas
| | - Peter H Buschang
- Department of Orthodontics, Texas A&M University College of Dentistry, Dallas, Texas
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15
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Raghis T, Mahmoud G, Abdullah A, Hamadah O. Enamel resistance to demineralisation around orthodontic brackets after CO2 laser irradiation: a randomised clinical trial. J Orthod 2018; 45:234-242. [DOI: 10.1080/14653125.2018.1504410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Tuqa Raghis
- Department of Orthodontics, Faculty of Dental Medicine, Damascus, Syria
| | - Ghiath Mahmoud
- Department of Orthodontics, Faculty of Dental Medicine, Damascus, Syria
| | | | - Omar Hamadah
- Faculty of Dental Medicine, Damascus, Syria
- Higher Institute for Laser Research and Applications, Damascus, Syria
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Rechmann P, Bartolome N, Kinsel R, Vaderhobli R, Rechmann BMT. Bond strength of etch-and-rinse and self-etch adhesive systems to enamel and dentin irradiated with a novel CO 2 9.3 μm short-pulsed laser for dental restorative procedures. Lasers Med Sci 2017; 32:1981-1993. [PMID: 28812169 DOI: 10.1007/s10103-017-2302-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study was to evaluate the influence of CO2 9.3 μm short-pulsed laser irradiation on the shear bond strength of composite resin to enamel and dentin. Two hundred enamel and 210 dentin samples were irradiated with a 9.3 µm carbon dioxide laser (Solea, Convergent Dental, Inc., Natick, MA) with energies which either enhanced caries resistance or were effective for ablation. OptiBond Solo Plus [OptiBondTE] (Kerr Corporation, Orange, CA) and Peak Universal Bond light-cured adhesive [PeakTE] (Ultradent Products, South Jordan, UT) were used. In addition, Scotchbond Universal [ScotchbondSE] (3M ESPE, St. Paul, MN) and Peak SE self-etching primer with Peak Universal Bond light-cured adhesive [PeakSE] (Ultradent Products) were tested. Clearfil APX (Kuraray, New York, NY) was bonded to the samples. After 24 h, a single plane shear bond test was performed. Using the caries preventive setting on enamel resulted in increased shear bond strength for all bonding agents except for self-etch PeakSE. The highest overall bond strength was seen with PeakTE (41.29 ± 6.04 MPa). Etch-and-rinse systems achieved higher bond strength values to ablated enamel than the self-etch systems did. PeakTE showed the highest shear bond strength with 35.22 ± 4.40 MPa. OptiBondTE reached 93.8% of its control value. The self-etch system PeakSE presented significantly lower bond strength. The shear bond strength to dentin ranged between 19.15 ± 3.49 MPa for OptiBondTE and 43.94 ± 6.47 MPa for PeakSE. Etch-and-rinse systems had consistently higher bond strength to CO2 9.3 µm laser-ablated enamel. Using the maximum recommended energy for dentin ablation, the self-etch system PeakSE reached the highest bond strength (43.9 ± 6.5 MPa).
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Affiliation(s)
- Peter Rechmann
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - N Bartolome
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - R Kinsel
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - R Vaderhobli
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - B M T Rechmann
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus Avenue, San Francisco, CA, 94143, USA
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Influence of irradiation by a novel CO 2 9.3-μm short-pulsed laser on sealant bond strength. Lasers Med Sci 2017; 32:609-620. [PMID: 28132137 DOI: 10.1007/s10103-017-2155-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
The objective of this in vitro study was to evaluate whether irradiation of enamel with a novel CO2 9.3-μm short-pulsed laser using energies that enhance caries resistance influences the shear bond strength of composite resin sealants to the irradiated enamel. Seventy bovine and 240 human enamel samples were irradiated with a 9.3-μm carbon dioxide laser (Solea, Convergent Dental, Inc., Natick, MA) with four different laser energies known to enhance caries resistance or ablate enamel (pulse duration from 3 μs at 1.6 mJ/pulse to 43 μs at 14.9 mJ/pulse with fluences between 3.3 and 30.4 J/cm2, pulse repetition rate between 4.1 and 41.3 Hz, beam diameter of 0.25 mm and 1-mm spiral pattern, and focus distance of 4-15 mm). Irradiation was performed "freehand" or using a computerized, motor-driven stage. Enamel etching was achieved with 37% phosphoric acid (Scotchbond Universal etchant, 3M ESPE, St. Paul, MN). As bonding agent, Adper Single Bond Plus was used followed by placing Z250 Filtek Supreme flowable composite resin (both 3M ESPE). After 24 h water storage, a single-plane shear bond test was performed (UltraTester, Ultradent Products, Inc., South Jordan, UT). All laser-irradiated samples showed equal or higher bond strength than non-laser-treated controls. The highest shear bond strength values were observed with the 3-μs pulse duration/0.25-mm laser pattern (mean ± SD = 31.90 ± 2.50 MPa), representing a significant 27.4% bond strength increase over the controls (25.04 ± 2.80 MPa, P ≤ 0.0001). Two other caries-preventive irradiation (3 μs/1 mm and 7 μs/0.25 mm) and one ablative pattern (23 μs/0.25 mm) achieved significantly increased bond strength compared to the controls. Bovine enamel also showed in all test groups increased shear bond strength over the controls. Computerized motor-driven stage irradiation did not show superior bond strength values over the clinically more relevant freehand irradiation. Enamel that is made caries-resistant with CO2 9.3-μm short-pulsed laser irradiation showed at least equal or significantly higher shear bond strength to pit and fissure sealants than non-laser-irradiated enamel. The risk of a sealant failure due to CO2 9.3-μm short-pulsed laser irradiation appears reduced. If additional laser ablation is required before placing a sealant, the CO2 9.3-μm enamel laser-cut showed equivalent or superior bond strength to a flowable sealant.
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Kumar P, Goswami M, Dhillon JK, Rehman F, Thakkar D, Bharti K. Comparative evaluation of microhardness and morphology of permanent tooth enamel surface after laser irradiation and fluoride treatment - An in vitro study. Laser Ther 2016; 25:201-208. [PMID: 27853345 PMCID: PMC5108995 DOI: 10.5978/islsm.16-or-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/12/2016] [Indexed: 11/06/2022]
Abstract
Background and aims: The aim of the study was to evaluate and compare the surface microhardness and surface morphology of permanent tooth enamel after Er,Cr:YSGG laser irradiation and Fluoride application. Materials and methods: One hundred and twenty premolars extracted for orthodontic purpose were used in the study and randomly divided into 6 groups. Group A was not subjected to any treatment. Group B was subjected to Er,Cr:YSGG laser irradiation. Group C was subjected to Er,Cr:YSGG laser irradiation followed by application of 2% NaF gel for 4 minutes. Group D was subjected to laser irradiation and 1.23% APF gel for 4 minutes. Group E was subjected to 2% NaF gel pretreatment technique followed by laser irradiation. Group F was subjected to 1.23% APF gel pretreatment technique followed by laser irradiation. All the test groups were subjected to microhardness testing and scanning electron microscope evaluation at 500 X and 1500 X. Results: All the treated groups showed an increase in microhardness value in comparison to the control group. The highest increase in microhardness was seen in Group F. Increase in microhardness values of Group B and Group D was not statistically significant as compared to Group A. Scanning Electron Micrographs showed few craters and fine porosities for Group A. These craters and porosities increased in size and often showed glass like appearance after laser irradiation. Conclusions: It can be suggested by means of present study that Er,Cr:YSGG laser irradiation alone or in combination with fluoride gel is an effective tool to provide resistance against the caries. Significantly higher resistance (p< 0.05) was seen when APF gel was used prior to Er,Cr:YSGG laser irradiation and this combination can act as an efficient tool for prevention against dental caries.
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Affiliation(s)
- Puneet Kumar
- Pedodontics & Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi
| | - Mridula Goswami
- Pedodontics & Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi
| | - Jatinder Kaur Dhillon
- Pedodontics & Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi
| | - Ferah Rehman
- Pedodontics & Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi
| | - Deepti Thakkar
- Pedodontics & Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi
| | - Kusum Bharti
- Pedodontics & Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi
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Rechmann P, Rechmann BMT, Groves WH, Le CQ, Rapozo-Hilo ML, Kinsel R, Featherstone JDB. Caries inhibition with a CO2 9.3 μm laser: An in vitro study. Lasers Surg Med 2016; 48:546-54. [PMID: 27075245 DOI: 10.1002/lsm.22497] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES The caries preventive effects of different laser wavelengths have been studied in the laboratory as well as in pilot clinical trials. The objective of this in vitro study was to evaluate whether irradiation with a new 9.3 μm microsecond short-pulsed CO2 -laser could enhance enamel caries resistance with and without additional fluoride applications. STUDY DESIGN/MATERIALS AND METHODS One hundred and one human tooth enamel samples were divided into seven groups. Each group was treated with different laser parameters (CO2 -laser, wavelength 9.3 μm, 43 Hz pulse-repetition rate, pulse duration between 3 µs at 1.5 mJ/pulse to 7 µs at 2.9 mJ/pulse). A laboratory pH-cycling model followed by cross-sectional microhardness testing determined the mean relative mineral loss delta Z (ΔZ) for each group to assess caries inhibition in tooth enamel by the CO2 9.3 µm short-pulsed laser irradiation. The pH-cycling was performed with or without additional fluoride. RESULTS The non-laser control groups with additional fluoride had a relative mineral loss (ΔZ, vol% × µm) that ranged between 646 ± 215 and 773 ± 223 (mean ± SD). The laser irradiated and fluoride treated samples had a mean ΔZ ranging between 209 ± 133 and 403 ± 245 for an average 55% ± 9% reduction in mineral loss (ANOVA test, P < 0.0001). Increased mean mineral loss (ΔZ between 1166 ± 571 and 1339 ± 347) was found for the non-laser treated controls without additional fluoride. In contrast, the laser treated groups without additional fluoride showed a ΔZ between 470 ± 240 and 669 ± 209 (ANOVA test, P < 0.0001) representing an average 53% ± 11% reduction in mineral loss. Scanning electron microscopical assessment revealed that 3 µs pulses did not markedly change the enamel surface, while 7 µs pulses caused some enamel ablation. CONCLUSION The CO2 9.3 µm short-pulsed laser energy renders enamel caries resistant with and without additional fluoride use. The observed enhanced acid resistance occurred with the laser irradiation parameters used without obvious melting of the enamel surface as well as after irradiation with energies causing cutting of the enamel. Lasers Surg. Med. 48:546-554, 2016. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Peter Rechmann
- Department of Preventive and Restorative Dental Sciences, University of California at San Francisco, School of Dentistry, 707 Parnassus Avenue, San Francisco, California, 94143
| | - Beate M T Rechmann
- Department of Preventive and Restorative Dental Sciences, University of California at San Francisco, School of Dentistry, 707 Parnassus Avenue, San Francisco, California, 94143
| | - William H Groves
- Convergent Dental, Inc., 2 Vision Drive, Natick, Massachusetts, 01760
| | - Charles Q Le
- Department of Preventive and Restorative Dental Sciences, University of California at San Francisco, School of Dentistry, 707 Parnassus Avenue, San Francisco, California, 94143
| | - Marcia L Rapozo-Hilo
- Department of Preventive and Restorative Dental Sciences, University of California at San Francisco, School of Dentistry, 707 Parnassus Avenue, San Francisco, California, 94143
| | - Richard Kinsel
- Department of Preventive and Restorative Dental Sciences, University of California at San Francisco, School of Dentistry, 707 Parnassus Avenue, San Francisco, California, 94143
| | - John D B Featherstone
- Department of Preventive and Restorative Dental Sciences, University of California at San Francisco, School of Dentistry, 707 Parnassus Avenue, San Francisco, California, 94143
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CO2 laser and topical fluoride therapy in the control of caries lesions on demineralized primary enamel. ScientificWorldJournal 2015; 2015:547569. [PMID: 25874248 PMCID: PMC4385669 DOI: 10.1155/2015/547569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the effect of CO2 laser irradiation and topical fluoride therapy in the control of caries progression on primary teeth enamel. 30 fragments (3 × 3 × 2 mm) from primary canines were submitted to an initial cariogenic challenge that consisted of immersion on demineralizing solution for 3 hours and remineralizing solution for 21 hours for 5 days. Fragments were randomly assigned into three groups (n = 10): L: CO2 laser (λ = 10.6 μm), APF: 1.23% acidulated phosphate fluoride, and C: no treatment (control). CO2 laser was applied with 0.5 W power and 0.44 J/cm2 energy density. Fluoride application was performed with 0.1 g for 1 minute. Cariogenic challenge was conducted for 5 days following protocol previously described. Subsurface Knoop microhardness was measured at 30 μm from the edge. Obtained data were subjected to analysis the variance (ANOVA) and Duncan test with significance of 5%. It was found that the L group showed greater control of deciduous enamel demineralization and were similar to those of APF group, while being statistically different from C group (P ≤ 0.05) that showed the lowest microhardness values. It was concluded that CO2 laser can be an additional resource in caries control progression on primary teeth enamel.
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Souza-Gabriel AE, Turssi CP, Colucci V, Tenuta LMA, Serra MC, Corona SAM. In situ study of the anticariogenic potential of fluoride varnish combined with CO2 laser on enamel. Arch Oral Biol 2015; 60:804-10. [PMID: 25791325 DOI: 10.1016/j.archoralbio.2015.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 12/12/2014] [Accepted: 01/31/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This in situ study evaluated the effect of fluoride varnish combined with CO2 laser in controlling enamel demineralization caused by cariogenic challenges. DESIGN In a crossover study conducted in 2 phases of 14 days each, 14 volunteers (n = 14) wore palatal appliances with bovine enamel slabs treated with fluoride varnish + CO2 laser (FV + CO2), fluoride varnish (FV), nonfluoride placebo varnish (PV) and nonfluoride placebo varnish + CO2 laser (PV + CO2). Drops of sucrose solution were dripped onto enamel slabs allowing the accumulation of biofilm. At the first phase, half of the volunteers received 4 enamel slabs treated with FV while the remainders received slabs exposed to the PV with and without CO2 laser. In the second phase, the vonlunteers were reversed treatments. The slabs were evaluated for cross-sectional microhardness (CSMH) and the concentration of loosely bound fluoride (CaF2) and firmly bound fluoride (FAp). The concentration of fluoride in biofilm were also determined. RESULTS Two-way ANOVA showed that the CSMH values were higher in laser-irradiated enamel, regardless of the fluoride varnish. Friedman test showed that FV group presented significantly larger amount of fluoride in biofilm (P < 0.05). In the enamel, the largest amount of fluoride was found in the groups FV + CO2, which was not different from FV (P > 0.05). CONCLUSION The synergistic effect of fluoride varnish and CO2 laser on enamel demineralization was not observed, however, CO2 laser reduces enamel demineralization. CLINICAL SIGNIFICANCE CO2 laser might reduce the demineralization of subsurface enamel, although its association with a high concentrated fluoride therapy may not result in a positive synergistic interaction.
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Affiliation(s)
- Aline Evangelista Souza-Gabriel
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | | | - Vivian Colucci
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lívia Maria Andaló Tenuta
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Mônica Campos Serra
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Silmara Aparecida Milori Corona
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Ramos-Oliveira TM, Ramos TM, Esteves-Oliveira M, Apel C, Fischer H, Eduardo CDP, Steagall W, Freitas PMD. Potential of CO2 lasers (10.6 µm) associated with fluorides in inhibiting human enamel erosion. Braz Oral Res 2014; 28:1-6. [PMID: 25337934 DOI: 10.1590/1807-3107bor-2014.vol28.0057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 07/03/2014] [Indexed: 11/22/2022] Open
Abstract
This in vitro study aimed to investigate the potential of CO2 lasers associated with different fluoride agents in inhibiting enamel erosion. Human enamel samples were randomly divided into 9 groups (n = 12): G1-eroded enamel; G2-APF gel; G3-AmF/NaF gel; G4-AmF/SnF2 solution; G5-CO2 laser (λ = 10.6 µm)+APF gel; G6-CO2 laser+AmF/NaF gel; G7-CO2laser+AmF/SnF2solution; G8-CO2 laser; and G9-sound enamel. The CO2 laser parameters were: 0.45 J/cm2; 6 μs; and 128 Hz. After surface treatment, the samples (except from G9) were immersed in 1% citric acid (pH 4.0, 3 min). Surface microhardness was measured at baseline and after surface softening. The data were statistically analyzed by one-way ANOVA and Tukey's tests (p < 0.05). G2 (407.6 ± 37.3) presented the highest mean SMH after softening, followed by G3 (407.5 ± 29.8) and G5 (399.7 ± 32.9). Within the fluoride-treated groups, G4 (309.0 ± 24.4) had a significantly lower mean SMH than G3 and G2, which were statistically similar to each other. AmF/NaF and APF application showed potential to protect and control erosion progression in dental enamel, and CO2 laser irradiation at 0.45J/cm2 did not influence its efficacy. CO2 laser irradiation alone under the same conditions could also significantly decrease enamel erosive mineral loss, although at lower levels.
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Affiliation(s)
| | - Thaysa Monteiro Ramos
- Department of Restorative Dentistry, School of Dentistry, Universidade de São Paulo - USP, São Paulo, SP, Brazil
| | - Marcela Esteves-Oliveira
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - Christian Apel
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - Horst Fischer
- Department of Dental Materials and Biomaterials Research, RWTH Aachen University, Aachen, Germany
| | - Carlos de Paula Eduardo
- Department of Restorative Dentistry, School of Dentistry, Universidade de São Paulo - USP, São Paulo, SP, Brazil
| | - Washington Steagall
- Department of Dentistry, School of Dentistry, Universidade Nove de Julho - UNINOVE, São Paulo, SP, Brazil
| | - Patricia Moreira de Freitas
- Department of Restorative Dentistry, School of Dentistry, Universidade de São Paulo - USP, São Paulo, SP, Brazil
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Liu J, Lü P, Sun Y, Wang Y. Wettability of dentin after Yb:KYW thin-disk femtosecond ablation. Lasers Med Sci 2014; 30:1689-93. [DOI: 10.1007/s10103-014-1655-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/02/2014] [Indexed: 11/28/2022]
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Cohen J, Featherstone JD, Le CQ, Steinberg D, Feuerstein O. Effects of CO2laser irradiation on tooth enamel coated with biofilm. Lasers Surg Med 2014; 46:216-23. [DOI: 10.1002/lsm.22218] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Julie Cohen
- Faculty of Dental Medicine; Institute of Dental Sciences; Hebrew University-Hadassah; Jerusalem Israel
- Faculty of Dental Medicine; Department of Prosthodontics; Hebrew University-Hadassah; Jerusalem Israel
| | | | - Charles Q. Le
- School of Dentistry; University of California San Francisco; San Francisco California
| | - Doron Steinberg
- Faculty of Dental Medicine; Institute of Dental Sciences; Hebrew University-Hadassah; Jerusalem Israel
| | - Osnat Feuerstein
- Faculty of Dental Medicine; Department of Prosthodontics; Hebrew University-Hadassah; Jerusalem Israel
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