Surface alterations of zirconia and titanium substrates after Er,Cr:YSGG irradiation

Dental implant surface morphology, chemical composition, and topography following double wavelength (2780/940 nm) laser irradiation. An in vitro study

OBJECTIVE

The aim of this in vitro study was to evaluate morphology alterations, chemical composition, and topography of moderately rough dental implants following double-wavelength laser irradiation.

MATERIAL AND METHODS

Commercial-grade titanium dental implants representing different surface characteristics (Osseospeed [OS], TiUnite [TiU], and Roxolid SLActive [RS]) were used. Laser irradiation was performed using a computer-controlled robotic device with calibrated energy/power settings and deionized water spray. Micro-, nano-morphology surface alterations, chemical composition, and surface topography (S_a , S_ds , S_dr ) in the test group (laser plus water), control group A (water only), and control group B (no treatment) were analyzed using scanning electron microscopy (SEM), energy-dispersive X-ray analysis (EDX), and white light laser profilometer (Interferometry).

RESULTS

SEM-evaluation revealed minor between-group differences in micro- and nano-morphology within each implant system. Significant overall differences in surface element content were observed between the test and control group B for all implant systems (p < .05). For the test compared with control group B, statistically significantly higher oxygen content was detected for OS and RS (p < .05), a corresponding significant difference was detected for carbon for TiU (p < .05). For RS, a significantly lower content of titanium and zirconium was detected within the test group (p < .05). A significant difference in topography between test and control group B was observed for OS (S_a : p = .039 and S_dr : p = .041) with the highest roughness value for control group B.

CONCLUSIONS

Altered chemical composition and surface topography were observed for all implant surfaces compared with untreated control following double wavelength laser irradiation. A clinical evaluation of the impact of the altered surface composition following double wavelength laser irradiation on the ability to reosseointegrate appears warranted.

The effects of physical decontamination methods on zirconia implant surfaces: a systematic review

PURPOSE

Peri-implantitis therapy and implant maintenance are fundamental practices to enhance the longevity of zirconia implants. However, the use of physical decontamination methods, including hand instruments, polishing devices, ultrasonic scalers, and laser systems, might damage the implant surfaces. The aim of this systematic review was to evaluate the effects of physical decontamination methods on zirconia implant surfaces.

METHODS

A systematic search was conducted using 5 electronic databases: Ovid MEDLINE, PubMed, Scopus, Web of Science, and Cochrane. Hand searching of the OpenGrey database, reference lists, and 6 selected dental journals was also performed to identify relevant studies satisfying the eligibility criteria.

RESULTS

Overall, 1049 unique studies were identified, of which 11 studies were deemed suitable for final review. Air-abrasive devices with glycine powder, prophylaxis cups, and ultrasonic scalers with non-metal tips were found to cause minimal to no damage to implant-grade zirconia surfaces. However, hand instruments and ultrasonic scalers with metal tips have the potential to cause major damage to zirconia surfaces. In terms of laser systems, diode lasers appear to be the most promising, as no surface alterations were reported following their use.

CONCLUSION

Air-abrasive devices and prophylaxis cups are safe for zirconia implant decontamination due to preservation of the implant surface integrity. In contrast, hand instruments and ultrasonic scalers with metal tips should be used with caution. Recommendations for the use of laser systems could not be fully established due to significant heterogeneity among included studies, but diode lasers may be the best-suited system. Further research-specifically, randomised controlled trials-would further confirm the effects of physical decontamination methods in a clinical setting.

The effects of using erbium, chromium-doped:yttrium-scandium-gallium-garnet laser on the surface modification, bacterial decontamination, and cell adhesion on zirconia discs: an in vitro study

The use of zirconia for implants and abutments has become more prevalent in implant dentistry as an alternative to the commonly used titanium implants, and peri-implant disease can still affect them. The erbium, chromium-doped:yttrium-scandium-gallium-garnet (Er, Cr:YSGG) laser has emerged as a promising treatment modality. The purposes of this in vitro study were to (1) determine the effects of the laser on the surface roughness of zirconia discs; (2) determine the extent of removal of a single species biofilm, E. coli, on the zirconia discs after applying the laser; (3) determine the amount of cell adhesion and proliferation utilizing fibroblasts on zirconia discs after treatment with the laser. All treatments will be compared with the commonly used ultrasonic instrumentation and hand scalers. For the first aim, gross examination revealed noticeable surface damage on the discs when using ultrasonic and scalers but not for the laser group. For surface roughness, the mean roughness was Pa= 0.623±0.185 μm, 0.762±0.421 μm, 0.740±0.214 μm, and 0.724±0.168 μm for control discs, and discs treated with either the Er,Cr:YSGG laser, ultrasonic instrumentation, and hand scalers respectively. There was no statistical significance among the groups (p=0.628). For bacteria decontamination, there was a statistical significance among the groups (p< 0.0001). Statistical significance was seen between the control group and each of the three treatment groups, favoring the treatment groups (p< 0.0001). Statistical significance was seen when comparing ultrasonic instrumentation and hand scalers (p= 0.000) as well as when comparing the Er,Cr:YSGG laser to hand scalers (p= 0.007), favoring both the ultrasonic instrumentation and Er,Cr:YSGG laser. No significance between the Er,Cr:YSGG laser group and the ultrasonic instrumentation group was noted (p =0.374). When comparing the cell attachment following treatment in each of the three groups and also without treatment (control), there was a statistical significance among the groups (p<0.0001) in terms of total cell count, favoring the control and the laser groups. Further evaluations with SEM showed differences in cell morphology indicating more adherent cells on Er,Cr:YSGG laser-treated surfaces. In conclusion, gross examination of the discs show clear surface changes when using ultrasonic instrumentation and hand scalers compared to the Er,Cr:YSGG laser group. The Er,Cr:YSGG laser was able to effectively ablate bacteria from zirconia disc. Fibroblast attachment on the surfaces of the zirconia discs shows more adherence when treated with Er,Cr:YSGG laser.

Exploring the use of pulsed erbium lasers to retrieve a zirconia crown from a zirconia implant abutment

Background

Removal of cement-retained implant fixed restorations when needed, can be challenging. Conventional methods of crown removal are time consuming and costly for patients and practitioners. This research explored the use of two different types of pulsed erbium lasers as a non-invasive tool to retrieve cemented zirconia crowns from zirconia implant abutments.

Materials and methods

Twenty identical zirconia crowns were cemented onto 20 identical zirconia prefabricated abutments using self-adhesive resin cement. The specimens were divided into two groups for laser assisted crown removal; G1 for erbium-doped yttrium aluminum garnet laser (Er:YAG), and G2 for erbium, chromium-doped yttrium, scandium, gallium and garnet (Er,Cr:YSGG). For the G1, after the first crown removal, the specimens were re-cemented and removed again using the Er:YAG laser. Times needed to remove the crowns were recorded and analyzed using ANOVA (α = 0.05). The surfaces of the crown and the abutment were further examined using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) analyses.

Results

The average times of zirconia crown removal from zirconia abutments were 5 min 20 sec and 5 min 15 sec for the Er:YAG laser of first and second experiments (G1), and 5 min 55 sec for the Er,Cr:YSGG laser experiment (G2). No statistical differences were observed among the groups. SEM and EDS examinations of the materials showed no visual surface damaging or material alteration from the two pulsed erbium lasers.

Conclusions

Both types of pulsed erbium lasers can be viable alternatives for retrieving a zirconia crown from a zirconia implant abutment. Despite operating at different wavelengths, the Er:YAG and Er,Cr:YSGG lasers, perform similarly in removing a zirconia crown from a zirconia implant abutment with similar parameters. There are no visual and elemental composition damages as a result of irradiation with pulsed erbium lasers.

Er,Cr:YSGG laser surface treatment of gamma titanium aluminide: Scanning electron microscopy-energy-dispersive X-ray spectrometer analysis, wettability and Eikenella corrodens and Aggregatibacter actinomycetemcomitans bacteria count-in vitro study

Dental implants play an important role in oral health. Titanium dental implants must endure the complex microflora environment of the oral cavity. Moreover, bacterial infections have been considered as one of the most important factors of implant failure. The issue of dental improvement through modification of chemical composition and surface treatment has received considerable critical attention. γ-TiAl as a novo biocompatible material revealed a slower corrosion rate in biological media rather Ti-6Al-4V. The objective of this study is to investigate the effect of Er,Cr:YSGG laser on γ-TiAl in comparison with sandblasted and acid-etched samples as the control groups and machined samples.Wettability, surface roughness, surface topography, scanning electron microscopy-energy dispersive X-ray spectrometer analysis of surface and subsurface of samples were investigated and bacteria counts of two periodontal bacterial strains (Aggregatibacter actinomycetemcomitans and Eikenella corrodens) were evaluated on the Er,Cr:YSGG laser surface-treated sandblasted and acid-etched and machined samples.The results of this investigation show that Er,Cr:YSGG laser surface treatment affects surface roughness, surface topography, wettability, chemical composition of the surface and bacteria count. Scanning electron microscopy-energy dispersive X-ray spectrometer analysis of the sample revealed the increment of titanium and oxygen content and reduction of aluminum content in the surface and subsurface layer. A. actinomycetemcomitans and E. corrodens count were found from the lowest level to highest in the sandblasted and acid-etched samples, laser samples and machined samples, respectively.Using controlled parameters of Er,Cr:YSGG laser ensured no significant adverse alteration. The findings to emerge from this study revealed the significant correlation between microbial count and wettability. Furthermore, the contact angle strongly correlated with surface roughness.

Er,Cr:YSGG Laser Performance Improves Biological Response on Titanium Surfaces

Porphyromonas gingivalis infection is one of the causes of implant failures, which can lead to peri-implantitis. Implant surface roughness is reportedly related strongly to P. gingivalis adhesion, which can lead to peri-implantitis and, later, cell adhesion. Our aim was to evaluate the effects of Er,Cr:YSGG laser on titanium (Ti) disc surfaces and its interaction with bacterial adhesion and fibroblast viability. Ti discs underwent two treatments: autoclaving (control) and erbium, chromium-doped yttrium scandium gallium garnet (Er,Cr:YSGG) laser treatment (test). Ti disc surfaces were examined with scanning electronic microscope (SEM), Energy-dispersive spectrometry (EDX), X-ray photoelectron spectroscopy (XPS). The surface roughness same as wettability were also investigated. Fibroblast viability was assessed with the water-soluble tetrazolium 1 (WST-1) test, and osteoblast differentiation was assessed with the alkaline phosphatase (ALP) assay. Bacterial structure and colony formation were detected with scanning electron microscopy and Gram stain. In comparison to control discs, the test discs showed smoother surfaces, with 0.25-µm decrease in surface roughness (p < 0.05); lower P. gingivalis adhesion (p < 0.01); less P. gingivalis colonization (p < 0.05); and increased fibroblast viability and osteoblast differentiation (p < 0.05). Er,Cr:YSGG laser treatment improved disc surfaces by making them slightly smoother, which reduced P. gingivalis adhesion and increased fibroblast viability and osteoblast differentiation. Er,Cr:YSGG laser treatment can be considered a good option for managing peri-implantitis. Further investigations of laser-assisted therapy are necessary for better guidelines in the treatment of peri-implantitis.

Lithium di silicate ceramic surface treated with Er,Cr:YSGG and other conditioning regimes bonded to orthodontic bracket

Aim

To assess bond integrity and modes of failure of metallic brackets to lithium disilicate ceramics (LDC) conditioned with Er,Cr:YSGG laser (ECL).

Material and methods

Sixty LDC were arbitrarily allocated into six groups (n = 15) according to the type of ceramic surface conditioning treatment. Group 1 surface treated with silane (S) only, group 2 surface etched with hydrofluoric acid (HF)+ S, group 3 surface conditioned with HF+ ultrasonic bath (UB)+ S, group 4 sand blasting (SB) of glass ceramic surface with 50 µm Al₂O₃, group 5 surface conditioned with self-etch ceramic primer (SECP) and in group 6 surface treated with ECL + S. After conditioning, the specimens were positioned in a universal testing device for shear bond strength (SBS) testing. Adhesive Remnant Index (ARI) was used to determine sites of bond failure. Among experimental groups analysis of variance (ANOVA) and Tukey multiple comparison test was used at a significance level of (p < 0.05).

Results

The highest SBS values were observed in group 3 HF+ UB + S (18.21 ± 1.241) and the lowest SBS values were displayed group 1 surface treated with S only (5.21 ± 0.23). Specimens surface conditioned in group 2 with HF+ S (17.85 ± 1.25), group 3 HF+ UB + S (18.21 ± 1.241) and group 6 ECL + S (17.09 ± 1.114) unveiled comparable SBS values (p > 0.05).

Conclusion

LDC conditioned with ECL at (4.5 W and 30 Hz) has a potential to be used in clinical settings alternate to HF acid.

A Comparative Study of Laser Irradiation Versus Sandblasting in Improving the Bond Strength of Titanium Abutments

Objective: The purpose of this study was to evaluate the effects of Er,Cr:YSGG laser irradiation with different energy powers versus sandblasting for enhancing the tensile bond strength (TBS) between titanium implant abutments (IAs) and resin cements. Background data: Clinical decementation of prosthetic restorations often occurs, particularly on short IAs. Increasing the bonding area on the IA surface can enhance the function and longevity of the superstructure. Materials and methods: Fifty dental IAs were used in solid form and randomly assigned to five groups (n = 10 each) for the following different pretreatments: control group was left untreated, a laser operating at 2.78 μm wavelength with different energy powers (1, 2, and 3 W) was used for three laser groups, and 50 μm alumina particles were applied to the abutment surface for the sandblasting group. Fifty metal substructures that had an occlusal metal O-ring were cast and cemented to all abutments using dual-cure resin cement. Test specimens were then subjected to thermal cycling. TBS tests were performed with a universal testing machine. The specimens' surface topography and roughness were evaluated with scanning electron microscope, and energy dispersive spectroscopy (EDS) was used to measure the elemental profiles of each specimen. Data were analyzed using a one-way analysis of variance/Kruskal-Wallis test at a significance level of p < 0.05. Results: Surface treatments affected the surface roughness and TBS of the IA. The sandblasting group showed the highest bond strength values (510.77 ± 60.86 N) and followed by the 2 W group (279.07 ± 37.9 N). In EDS analysis, no elemental components other than titanium and oxygen were observed, except for in the sandblasting group. Conclusions: Sandblasting and 2 W laser treatment increased the surface roughness of the IA, which could contribute to the increased interfacial bond strength between the IA and resin cement.

Efficacy of phototherapy with different conventional surface treatments on adhesive quality of lithium disilicate ceramics

AIM

The aim of the present study was to evaluate shear bond strength (SBS) of LDC and resin composite in combination with phototherapy and different ceramic surface treatments.

MATERIALS AND METHOD

Forty Lithium Disilicate Glass Ceramic (LDC) disks measuring (4 × 4 x 9 mm) were fabricated. The specimens were randomly divided into four groups (n = 10 each) according to the surface treatment. Group 1 H F + Silane (Control); Group 2 HF + Ultrasonic bath + Silane; Group 3 SECP (Self etch ceramic primer) and Group 4 phototherapy (Er, Cr: YSGG) + Silane. On each ceramic disk a resin build-up was done. For SBS the specimens were subjected to increasing load with a transversal velocity of 1 ml/min on a universal testing machine on a ceramic resin interface. Failure mode was evaluated using digital microscope. The failure modes were divided into adhesive, cohesive and admixed interface. Data through bond strength testing was tabulated using statistical program for social science (SPSS). Means and standard deviations were compared using analysis of variance and Tukey's post hoc test (p < 0.05).

RESULTS

The maximum and minimum bond strength was observed in group 2 [19.58(1.011)] and group 1 [17.14(1.122)] respectively. The bond strength among experimental group 1 [17.14 (1.122)] and group 4 [17.48(1.145)] were found to be comparable. Specimens in Group 2 displayed significantly higher bond strength among all experimental groups. Commonly adhesive failure mode was observed in the present study, with an incidence of 60%, 100% and 70% in groups 1,2 and 3 correspondingly.

CONCLUSION

Phototherapy using laser at frequency 30 Hz and 4.5 W can be used as a surface conditioner for LDC alternate to HF acid. Conditioning of LDC using Self-etch ceramic primer showed better SBS outcomes as compared to phototherapy (Er, Cr: YSGG laser).

Effects of laser treatments on surface roughness of zirconium oxide ceramics

BACKGROUND

The aim of this study was to analyze the surface roughness of yttrium stabilized tetragonal polycrystalline zirconia (Y-TZP) ceramics after different laser treatments (CO_2, ER: YAG).

METHODS

5x5x2 mm rectangular prisms of forty eight Y-TZP (Zirkonzahn) ceramic specimens were prepared. In order to standardize surfaces, 600-, 1200- grid silicon carbide papers were used to gradually ground wet on 300 rpm grinding machine for 10 s. Eight groups (n = 6) were randomly formed from the specimens of each ceramic as control (GroupC), sandblasted (GroupS), two different CO₂ laser treatments (Group3W: 3 W and 382 w/cal, Group4W: 4 W and 509w/cal) and four different Er: YAG laser treatments (Group150SP: 150 mJ and 10-Hz with 100μS; Group150SSP: 150 mJ and 10-Hz with 300μS; Group300SP: 300 mJ and 10-Hz with 100μS; Group300SSP: 300 mJ and 10-Hz with 300μS). A profilometer was used to conduct surface roughness measurements (Ra). Surface morphologies of the specimens were evaluated under SEM after laser treatment.

RESULTS

To analyze the data one-way ANOVA and to compare the mean values Tukey HSD tests (α = .05) were used. One - way ANOVA results showed that Group S had the highest Ra value and Group150 SP had the lowest. After sandblasting group the highest value was seen in Group4W. There were no statistically significant differences among Group C, Group3W, Group150SSP, Group300SP, and Group300SSP.

CONCLUSIONS

The study showed that surface roughness of zirconium oxide ceramics was increased with CO2 laser.

Evaluation of Temperature and Roughness Alteration of Diode Laser Irradiation of Zirconia and Titanium for Peri-Implantitis Treatment

OBJECTIVE

This study investigated the effects of diode laser (gallium, aluminium, arsenide [GaAlAs]) irradiation with decontamination parameters on the temperature and roughness of yttrium-stabilized tetragonal zirconia polycrystal (Y-TZP), titanium (TI), and sandblasted large grit acid-etched titanium (SLA).

MATERIALS AND METHODS

Three groups (n = 10) of standardized disks with 5 mm diameter and 2 mm thickness were produced with Y-TZP obtained from computer-aided design and computer-aided manufacturing (CAD-CAM), machined TI and SLA. The diode laser single application (808 nm, 20 sec, 1 W, 50 Hz, t on = 100 ms, t off = 100 ms, energy density = 28.29 J/cm(2)) was performed in contact mode, on each disk. The temperature was measured by a thermosensor attached to a digital thermometer fixed to the opposite irradiated surface. The temperature gradient (ΔT) was calculated (ΔT = final temperature - initial temperature) for each group. The parameters Ra (in μm) and Sa (in μm(2)) were measured by white light confocal laser microscopy to express the surface roughness. Data of ΔT was statistically analyzed by one way ANOVA at the 95% confidence level and compared by Tukey post-hoc test (α = 0.05). Roughness data was analyzed by t test.

RESULTS

The diode laser irradiation presented the following results (ΔT value): Y-TZP = 10.3°C(B); TI = 38.6°C(A), and SLA = 26.7°C(A). The ΔT values ((°)C) of the titanium groups were higher than for the Y-TZP group. For both roughness parameters (Ra and Sa), data did not show statistical significant differences to "irradiation" factor (p > 0.05) to Y-TZP and SLA. The Ra results (in μm) were: Y-TZP (control) = 0.73 (0.55); Y-TZP (irradiated) = 0.45 (0.27); SLA (control) = 0.74 (0.23); and SLA (irradiated) = 0.99 (0.33). The Sa results (in μm(2)) were: Y-TZP (control) = 1.39 (1.05); Y-TZP (irradiated) = 0.73 (0.41); SLA (control) = 0.85 (0.08); and SLA (irradiated) = 1.27 (0.44).

CONCLUSIONS

Diode laser irradiation for peri-implantitis treatment increased both zirconia and TI temperature without surface roughness alterations.