Evaluation of micromorphological changes in tooth enamel after mechanical and ultrafast laser preparation of surface cavities

Investigation of laser wavelength effect on the ablation of enamel and dentin using femtosecond laser pulses

We investigated the effect of femtosecond (fs) laser ablation of enamel and dentin for different pulse wavelengths: infrared (1030 nm), green (515 nm), and ultra-violet (343 nm) and for different pulse separations to determine the optimal irradiation conditions for the precise removal of dental hard tissues with the absence of structural and compositional damage. The ablation rates and efficiencies were established for all three laser wavelengths for both enamel and dentin at room temperature without using any irrigation or cooling system, and the surfaces were assessed with optical and scanning electron microscopy, optical profilometry, and Raman spectroscopy. We demonstrated that 515 nm fs irradiation provides the highest rate and efficiency for ablation, followed by infrared. Finally, we explored the temperature variations inside the dental pulp during the laser procedures for all three wavelengths and showed that the maximum increase at the optimum conditions for both infrared and green irradiations was 5.5 °C, within the acceptable limit of temperature increase during conventional dental treatments. Ultra-violet irradiation significantly increased the internal temperature of the teeth, well above the acceptable limit, and caused severe damage to tooth structures. Thus, ultra-violet is not a compatible laser wavelength for femtosecond teeth ablation.

Effect of Optical Wedge Rotary on Ablation Efficiency of Femtosecond Laser on Dental Hard Tissue and Restorative Materials

Objective: Femtosecond laser (fs-laser) is a novel tooth preparation tool but its ablation efficiency is insufficient. The purpose is to establish a new fs-laser tooth ablation method based on a dual-wedges path ablation system, and explore the efficiency of tooth hard tissue and dental restorative materials ablation. Materials and methods: Extracted third molars, pure titanium, cobalt-chromium alloy, gold alloy, and 3Y-zirconia were prepared into samples. These samples were rotary ablated by an fs-laser with dual-wedges. The wavelength was 1030 nm and the pulse duration was 250 fsec. Laser parameters were set as a repetition frequency of 25 kHz, the power percentages as 50% for dental tissues, and 60% for restorative materials. The optical wedge angle was set as 0°, 20°, 40°, 60°, and 80° for restorative materials, 0°, 20°, 30°, 40°, and 60° for enamel, and 0°, 10°, 20°, 30°, and 40°for dentin. Three times of ablation was processed at each parameter to obtain total 90 ablation microcavities of 6 kinds of materials. The diameter, depth, and volume of microcavities were measured by confocal laser microscopy and plotted against optical-wedge-angle in curves of different materials. One-way analysis of variance (ANOVA) was used to test whether the ablation efficiency between different angles was statistically significant. Results: The ablation efficiency of each material at different optical-wedge-angle was statistically significant (p < 0.05) and tends to be correlated. For dental hard tissue, the enamel ablation efficiency was 208.1 times and dentin ablation efficiency were 65.2 times than before when the wedge angle was 40°. For pure titanium, zirconia, cobalt-chromium, and gold alloys, the ablation efficiencies were 3.1, 10.7, 81.5, and 128.8 times than before when the rotation angle was 80°. Conclusions: The ablation efficiency of dental hard tissues and restorative materials was significantly increased with the increase of laser oblique incidence angle. Clinical Trial Registration number: PKUSSIRB-201949124.

Femtosecond laser dentistry for precise and efficient cavity preparation in teeth

High fluence focused femtosecond laser pulses were used to perform fast, high precision and minimally damaging cavity cutting of teeth at room temperature without using any irrigation or cooling system. The optimal ablation rates were established for both enamel and dentin, and the surfaces were assessed with optical and scanning electron microscopy, Raman spectroscopy and optical profilometry. No chemical change in the composition of enamel and dentin was observed. We explored temperature variations inside the dental pulp during the laser procedure and showed the maximum increase was 5.5°C, within the acceptable limit of temperature increase during conventional dental treatments.

Orthopedics-Related Applications of Ultrafast Laser and Its Recent Advances

The potential of ultrafast lasers (pico- to femtosecond) in orthopedics-related procedures has been studied extensively for clinical adoption. As compared to conventional laser systems with continuous wave or longer wave pulse, ultrafast lasers provide advantages such as higher precision and minimal collateral thermal damages. Translation to surgical applications in the clinic has been restrained by limitations of material removal rate and pulse average power, whereas the use in surface texturing of implants has become more refined to greatly improve bioactivation and osteointegration within bone matrices. With recent advances, we review the advantages and limitations of ultrafast lasers, specifically in orthopedic bone ablation as well as bone implant laser texturing, and consider the difficulties encountered within orthopedic surgical applications where ultrafast lasers could provide a benefit. We conclude by proposing our perspectives on applications where ultrafast lasers could be of advantage, specifically due to the non-thermal nature of ablation and control of cutting.

A Novel Method for Adjusting the Taper and Adaption of Automatic Tooth Preparations with a High-Power Femtosecond Laser

This study explored the effect of the light-off delay setting in a robotically controlled femtosecond laser on the taper and adaption of resin tooth preparations. Thirty resin teeth (divided into six equal groups) were studied under different light-off delay conditions. Tapers from six vertical sections of the teeth were measured and compared among the light-off delay groups. The mean taper decreased from 39.268° ± 4.530° to 25.393° ± 5.496° as the light-off delay increased (p < 0.05). The average distance between the occlusal surfaces of the scanned data and the predesigned preparation data decreased from 0.089 ± 0.005 to 0.013 ± 0.030 μm as the light-off delay increased (p < 0.05). The light-off delay of the femtosecond laser is correlated with the taper and adaption of automatic tooth preparations; this setting needs to be considered during automatic tooth preparation.

Ultrafast dynamics of hard tissue ablation using femtosecond-lasers

Several studies on hard tissue laser ablation demonstrated that ultrafast lasers enable precise material removal without thermal side effects. Although the principle ablation mechanisms have been thoroughly investigated, there are still open questions regarding the influence of material properties on transient dynamics. In this investigation, we applied pump-probe microscopy to record ablation dynamics of biomaterials with different tensile strengths (dentin, chicken bone, gallstone and kidney stones) at delay times between 1 picosecond and 10 microseconds. Transient reflectivity changes, pressure and shock wave velocities and elastic constants were determined. The result revealed that absorption and excitation show the typical well-known transient behavior of dielectric materials. We observed for all samples a photomechanical laser ablation process, where ultrafast expansion of the excited volume generates pressure waves leading to fragmentation around the excited region. In addition, we identified tensile-strength-related differences in the size of ablated craters and ejected particles. The elastic constants derived were in agreement with literature values. In conclusion, pressure-wave-assisted material removal seems to be a general mechanism for hard tissue ablation with ultrafast lasers. This photomechanical process increases ablation efficiency and removes heated material, thus ultrafast laser ablation is of interest for clinical application where heating of the tissue must be avoided.

Regulation and Measurement of the Heat Generated by Automatic Tooth Preparation in a Confined Space

OBJECTIVE

The aim of this study was to assess and regulate heat generation in the dental pulp cavity and circumambient temperature around a tooth during laser ablation with a femtosecond laser in a confined space.

BACKGROUND DATA

The automatic tooth preparing technique is one of the traditional oral clinical technology innovations. In this technique, a robot controlled an ultrashort pulse laser to automatically complete the three-dimensional teeth preparing in a confined space. The temperature control is the main measure for protecting the tooth nerve.

METHODS

Ten tooth specimens were irradiated with a femtosecond laser controlled by a robot in a confined space to generate 10 teeth preparation. During the process, four thermocouple sensors were used to record the pulp cavity and circumambient environment temperatures with or without air cooling. A statistical analysis of the temperatures was performed between the conditions with and without air cooling (p < 0.05).

RESULTS

The recordings showed that the temperature with air cooling was lower than that without air cooling and that the heat generated in the pulp cavity was lower than the threshold for dental pulp damage.

CONCLUSIONS

These results indicate that femtosecond laser ablation with air cooling might be an appropriate method for automatic tooth preparing.

Behavior of human periodontal ligament cells on dentin surfaces ablated with an ultra-short pulsed laser

This study aimed to evaluate the effects of an ultrashort pulsed laser (USPL) (1064 nm, 20 ps, 100 kHz) with different laser fluences (F, 4, 6, 8 J/cm²) and pulse overlaps (PO, 0, 50%) on human periodontal ligament cells (hPDLs) behavior. Dentin samples were ablated with USPL with different combinations of fluences and pulse overlaps; some samples were ablated with an Er:YAG laser (2940 nm, 150 µs, 100 mJ/pulse, 5 J/cm²) and some samples were ground with a carbide bur. Then hPDLs were grown on the samples after different treatments. Dentin morphology and cell adhesion were observed with SEM and gene expressions were measured by RT-PCR. The results showed dentin surfaces ablated with USPL when F = 4 J/cm², PO = 0, and F = 6 J/cm², PO = 0 were partially intact with obvious ridges and valleys and cells on these surfaces grew mostly along the valleys. USPL ablated surfaces in other groups were entirely ablated and cell cluster formation was observed. The RT-PCR results showed an upregulation of osteocalcin of cells grown on the dentin after some laser treatment. It can be concluded that USPL could improve the attachment and differentiation of hPDLs and thus potentially promote periodontal tissue regeneration.

Controlling dental enamel-cavity ablation depth with optimized stepping parameters along the focal plane normal using a three axis, numerically controlled picosecond laser

OBJECTIVE

The purpose of this study was to establish a depth-control method in enamel-cavity ablation by optimizing the timing of the focal-plane-normal stepping and the single-step size of a three axis, numerically controlled picosecond laser.

BACKGROUND DATA

Although it has been proposed that picosecond lasers may be used to ablate dental hard tissue, the viability of such a depth-control method in enamel-cavity ablation remains uncertain.

METHODS

Forty-two enamel slices with approximately level surfaces were prepared and subjected to two-dimensional ablation by a picosecond laser. The additive-pulse layer, n, was set to 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70. A three-dimensional microscope was then used to measure the ablation depth, d, to obtain a quantitative function relating n and d. Six enamel slices were then subjected to three dimensional ablation to produce 10 cavities, respectively, with additive-pulse layer and single-step size set to corresponding values. The difference between the theoretical and measured values was calculated for both the cavity depth and the ablation depth of a single step. These were used to determine minimum-difference values for both the additive-pulse layer (n) and single-step size (d).

RESULTS

When the additive-pulse layer and the single-step size were set 5 and 45, respectively, the depth error had a minimum of 2.25 μm, and 450 μm deep enamel cavities were produced.

CONCLUSIONS

When performing three-dimensional ablating of enamel with a picosecond laser, adjusting the timing of the focal-plane-normal stepping and the single-step size allows for the control of ablation-depth error to the order of micrometers.

The Effect of Femtosecond Laser Treatment on the Effectiveness of Resin-Zirconia Adhesive: An In Vitro Study

Introduction: When aesthetics is compromised, dental ceramics are excellent materials for dental restorations; owing to their optical properties and biocompatibility, zirconia ceramics are particularly interesting. Self-adhesive resin cements are the most suitable for bonding to zirconia ceramics, but traditional adhesive chemistry is ineffective and surface treatments are required to improve the adhesive bonding between resin and zirconia. The aim of this study was to evaluate the effect of femtosecond laser treatment on the shear bond strength (SBS) of self-adhesive resin cement on zirconia surfaces and to contrast it with other different surface conditioning methods. Methods: Sixty square-shaped zirconia samples were divided randomly into four groups (n = 15) according to their surface conditioning method: the NT group - no surface treatment; the APA25 group - airborne abrasion with 25 μm alumina particles; the TSC group - tribochemical silica coating, and the FS group - femtosecond laser irradiation (800 nm, 4 mJ, 40 fs/pulse, 1 kHz). Self-adhesive resin cements were bonded at the centre of samples, and after 72 hours, they were tested for SBS with a universal testing machine at a crosshead speed of 0.5 mm/min, until fracture. Five zirconia surfaces for each group were subjected to a surface morphology analysis by scanning electron microscopy (SEM). The failure modes were noted and a third of the specimens were prepared to morphological analysis. Results: The NT group showed lower SBS values than the other groups. Femtosecond laser treatment demonstrated higher values than the control and APA25 groups and similar values to those of the TSC group. In the APA25 group, the surface conditioning method had values close to those of the TSC group, but lower than those obtained with femtosecond laser treatment. Conclusion: The treatment of zirconia with femtosecond laser irradiation created a consistent and profound surface roughness, improving the adhesive effectiveness of the zirconia-resin interface.

An automatic tooth preparation technique: A preliminary study

The aim of this study is to validate the feasibility and accuracy of a new automatic tooth preparation technique in dental healthcare. An automatic tooth preparation robotic device with three-dimensional motion planning software was developed, which controlled an ultra-short pulse laser (USPL) beam (wavelength 1,064 nm, pulse width 15 ps, output power 30 W, and repeat frequency rate 100 kHz) to complete the tooth preparation process. A total of 15 freshly extracted human intact first molars were collected and fixed into a phantom head, and the target preparation shapes of these molars were designed using customised computer-aided design (CAD) software. The accuracy of tooth preparation was evaluated using the Geomagic Studio and Imageware software, and the preparing time of each tooth was recorded. Compared with the target preparation shape, the average shape error of the 15 prepared molars was 0.05–0.17 mm, the preparation depth error of the occlusal surface was approximately 0.097 mm, and the error of the convergence angle was approximately 1.0°. The average preparation time was 17 minutes. These results validated the accuracy and feasibility of the automatic tooth preparation technique.

Femtosecond laser for cavity preparation in enamel and dentin: ablation efficiency related factors

To study the effects of laser fluence (laser energy density), scanning line spacing and ablation depth on the efficiency of a femtosecond laser for three-dimensional ablation of enamel and dentin. A diode-pumped, thin-disk femtosecond laser (wavelength 1025 nm, pulse width 400 fs) was used for the ablation of enamel and dentin. The laser spot was guided in a series of overlapping parallel lines on enamel and dentin surfaces to form a three-dimensional cavity. The depth and volume of the ablated cavity was then measured under a 3D measurement microscope to determine the ablation efficiency. Different values of fluence, scanning line spacing and ablation depth were used to assess the effects of each variable on ablation efficiency. Ablation efficiencies for enamel and dentin were maximized at different laser fluences and number of scanning lines and decreased with increases in laser fluence or with increases in scanning line spacing beyond spot diameter or with increases in ablation depth. Laser fluence, scanning line spacing and ablation depth all significantly affected femtosecond laser ablation efficiency. Use of a reasonable control for each of these parameters will improve future clinical application.

Fracture Forces of Dentin after Surface Treatment with High Speed Drill Compared to Er:YAG and Er,Cr:YSGG Laser Irradiation

Dental tooth restorative procedures may weaken the structural integrity of the tooth, with the possibility of leading to fracture. In this study we present findings of coronal dentin strength after different techniques of surface modification. The fracture strength of dentin beams after superficial material removal with a fine diamond bur high speed drill hand piece, Er:YAG (2.94 μm, 8 J/cm(2)), and Er,Cr:YSGG (2.78 μm, 7.8 J/cm(2)) laser irradiation slightly above the ablation threshold was measured by a four-point bending apparatus. Untreated dentin beams served as a control. A total of 58 dentin beams were manufactured from sterilized human extracted molars using the coronal part of the available dentin. Mean values of fracture strength were calculated as 82.0 ± 27.3 MPa for the control group (n = 10), 104.5 ± 26.3 MPa for high speed drill treatment (n = 10), 96.1 ± 28.1 MPa for Er,Cr:YSGG laser irradiation (n = 20), and 89.1 ± 36.3 MPa for Er:YAG laser irradiation (n = 18). Independent Student's t-tests showed no significant difference between each two groups (p > 0.05). Within the parameter settings and the limits of the experimental setup used in this study, both lasers systems as well as the high speed drill do not significantly weaken coronal dentin after surface treatment.

Time-resolved microscopy reveals the driving mechanism of particle formation during ultrashort pulse laser ablation of dentin-like ivory

In dental health care, the application of ultrashort laser pulses enables dental tissue ablation free from thermal side effects, such as melting and cracking. However, these laser types create undesired micro- and nanoparticles, which might cause a health risk for the patient or surgeon. The aim of this study was to investigate the driving mechanisms of micro- and nanoparticle formation during ultrashort pulse laser ablation of dental tissue. Time-resolved microscopy was chosen to observe the ablation dynamics of mammoth ivory after irradiation with 660 fs laser pulses. The results suggest that nanoparticles might arise in the excited region. The thermal expansion of the excited material induces high pressure in the surrounding bulk tissue, generating a pressure wave. The rarefaction wave behind this pressure wave causes spallation, leading to ejection of microparticles.

Femtosecond laser ablation of dentin and enamel: relationship between laser fluence and ablation efficiency

The objective was to study the relationship between laser fluence and ablation efficiency of a femtosecond laser with a Gaussian-shaped pulse used to ablate dentin and enamel for prosthodontic tooth preparation. A diode-pumped thin-disk femtosecond laser with wavelength of 1025 nm and pulse width of 400 fs was used for the ablation of dentin and enamel. The laser spot was guided in a line on the dentin and enamel surfaces to form a groove-shaped ablation zone under a series of laser pulse energies. The width and volume of the ablated line were measured under a three-dimensional confocal microscope to calculate the ablation efficiency. Ablation efficiency for dentin reached a maximum value of 0.020 mm3∕J when the laser fluence was set at 6.51 J∕cm2. For enamel, the maximum ablation efficiency was 0.009 mm3∕J at a fluence of 7.59 J∕cm2.Ablation efficiency of the femtosecond laser on dentin and enamel is closely related to the laser fluence and may reach a maximum when the laser fluence is set to an appropriate value.

Method to control depth error when ablating human dentin with numerically controlled picosecond laser: a preliminary study

A three-axis numerically controlled picosecond laser was used to ablate dentin to investigate the quantitative relationships among the number of additive pulse layers in two-dimensional scans starting from the focal plane, step size along the normal of the focal plane (focal plane normal), and ablation depth error. A method to control the ablation depth error, suitable to control stepping along the focal plane normal, was preliminarily established. Twenty-four freshly removed mandibular first molars were cut transversely along the long axis of the crown and prepared as 48 tooth sample slices with approximately flat surfaces. Forty-two slices were used in the first section. The picosecond laser was 1,064 nm in wavelength, 3 W in power, and 10 kHz in repetition frequency. For a varying number (n = 5-70) of focal plane additive pulse layers (14 groups, three repetitions each), two-dimensional scanning and ablation were performed on the dentin regions of the tooth sample slices, which were fixed on the focal plane. The ablation depth, d, was measured, and the quantitative function between n and d was established. Six slices were used in the second section. The function was used to calculate and set the timing of stepwise increments, and the single-step size along the focal plane normal was d micrometer after ablation of n layers (n = 5-50; 10 groups, six repetitions each). Each sample underwent three-dimensional scanning and ablation to produce 2 × 2-mm square cavities. The difference, e, between the measured cavity depth and theoretical value was calculated, along with the difference, e 1, between the measured average ablation depth of a single-step along the focal plane normal and theoretical value. Values of n and d corresponding to the minimum values of e and e 1, respectively, were obtained. In two-dimensional ablation, d was largest (720.61 μm) when n = 65 and smallest when n = 5 (45.00 μm). Linear regression yielded the quantitative relationship: d = 10.547 × n - 7.5465 (R (2) = 0.9796). During three-dimensional ablation, e 1 was the smallest (0.02 μm) when n = 5 and d = 45.00 μm. The depth error was 1.91 μm when 450.00-μm depth cavities were produced. When ablating dentin with a three-axis picosecond laser scan-ablation device (450 μm, 3 W, 10 kHz), the number of focal plane additive pulse layers and step size along the focal plane normal was positively correlated with the single-layer and total ablation depth errors. By adjusting the timing of stepwise increments along the focal plane normal and single-step size when ablating dentin by using the numerically controlled picosecond laser, the single-step ablation depth error could be controlled at the micrometer level.

Influence of Er:YAG and Ti:sapphire laser irradiation on the microtensile bond strength of several adhesives to dentin

The aim of the present study was to evaluate the influence of erbium:yttrium-aluminum-garnet (Er:YAG) and Ti:sapphire laser irradiation on the microtensile bond strength (MTBS) of three different adhesive systems to dentin. Flat dentin surfaces from 27 molars were divided into three groups according to laser irradiation: control, Er:YAG (2,940 nm, 100 μs, 2.7 W, 9 Hz) and Ti:sapphire laser (795 nm, 120 fs, 1 W, 1 kHz). Each group was divided into three subgroups according to the adhesive system used: two-step total-etching adhesive (Adper Scotchbond 1 XT, from now on XT), two-step self-etching adhesive (Clearfil SE Bond, from now on CSE), and all-in-one self-etching adhesive (Optibond All-in-One, from now on OAO). After 24 h of water storage, beams of section at 1 mm(2) were longitudinally cut from the samples. Each beam underwent traction test in an Instron machine. Fifteen polished dentin specimens were used for the surface morphology analysis by scanning electron microscopy (SEM). Failure modes of representative debonded microbars were SEM-assessed. Data were analyzed by ANOVA, chi-square test, and multiple linear regression (p < 0.05). In the control group, XT obtained higher MTBS than that of laser groups that performed equally. CSE showed higher MTBS without laser than that with laser groups, where Er:YAG attained higher MTBS than ultrashort laser. When OAO was used, MTBS values were equal in the three treatments. CSE obtained the highest MTBS regardless of the surface treatment applied. The Er:YAG and ultrashort laser irradiation reduce the bonding effectiveness when a two-step total-etching adhesive or a two-step self-etching adhesive are used and do not affect their effectiveness when an all-in-one self-etching adhesive is applied.