In vitro comparison of an Er:YAG laser-activated bleaching system with different light-activated bleaching systems for color change, surface roughness, and enamel bond strength

Evaluation of tooth color change after a bleaching process with different lasers

The aim of this in vitro study was to evaluate the efficiency of diode laser-activated bleaching systems for color change of teeth. 75 extracted teeth were studied in five different bleaching protocols. Group 1: diode laser 445 nm, 320 µm fiber, 0.5W, continuous wave mode, dose 53 J/cm2. Group 2: diode laser 970 nm, 320 µm fiber, 1W, continuous wave mode, dose 106.10 J/cm2. Group 3: diode laser 940 nm, bleaching handpiece, 7W, continuous wave mode, dose 105 J/cm2. Group 4: diode laser 940 nm, 300 µm fiber, 2W, continuous wave mode, dose 47.16 J/cm2. Group 5: bleaching process without laser activation. In groups 1, 2 and 5, teeth were bleached with Perfect Bleach Office + and in groups 3 and 4, LaserWhite20 bleaching gel was used. Tooth color was determined immediately after the bleaching process using a spectrophotometer. Color change data on the CIE L * a * b* system was analyzed statistically by the one-way ANOVA and Tukey's HSD test. All bleaching procedures resulted in a change of color. All laser groups (∆E * ab > 3) have statistically larger ∆E * ab values than the control group (∆E * ab = 0.73) (p < 0.05). The diode laser 445 nm has the largest ∆E * ab value (∆E * ab = 4.65) and results in a significantly higher color difference than all other groups. In terms of color score difference in VITA Shades, all laser-activated groups lead to a lightening effect while the control group leads to only a slight lightening effect. The diode laser 445 nm produced the greatest color difference. Laser-activated bleaching is more effective than conventional bleaching without light activation. The diode laser 445 nm performs best in this in vitro study.

The Effect of Two Different Wavelengths of Diode Laser on the Shear Bond Strength of Composite to Dental Enamel after Bleaching Process: An In Vitro Study

INTRODUCTION

In recent years, tooth whitening has become one of the most popular ways of achieving the original tooth color. The effect of whitening gel can be improved through heat, light or laser. The bond strength between the enamel and the composite can be reduced through bleaching and laser radiation. The purpose of this study is to assess the shear bond strength of resin composite to enamel after a bleaching process using hydrogen peroxide, with and without a laser (970 nm and 445 nm lasers).

METHOD

This study used 51 extracted anterior teeth without caries that were divided into three groups. A 40% hydrogen peroxide gel was used on the enamel of all teeth. The control group received bleaching without a laser. Both the second and third treatment groups received bleaching with a laser, one with 970 nm and the other with 445 nm. After the bleaching process, all groups had etching, bonding and curing of the composite performed. Lastly, the shear bond strength between the enamel and the composite was measured and the failure modes were recorded. The data were compared using a one-way ANOVA test.

RESULTS

The mean shear bond strength between the enamel and the composite in the 445 nm group three (445 nanometer) was significantly lower than the other groups (p < 0.05). There was no significant difference between the control and the 970 nm groups (p = 0.2).

CONCLUSION

According to the laser wavelengths and parameters that were used in this study and the results of this study, office bleaching with a 445 nm laser weakened the shear bond strength between the enamel and the composite.

Thermal Effects on Dental Pulp during Laser-Assisted Bleaching Procedures with Diode Lasers in a Clinical Study

Background In the current cosmetics industry, bleaching is often associated with lasers. However, such treatment also harbors risks. Tooth death is observed at pulpal temperature increases ≥5.6 °C. Therefore, it seems important to investigate the effects of using different lasers. The aim of this study was to determine pulpal temperature increases at different laser parameters during bleaching by modeling a realistic environment and to compare the temperature recording using a thermocouple and thermal camera. The authors assumed that there are laser settings for the lasers used at which the pulpal temperature increases are <5.6 °C and that the temperature recordings with thermocouples and thermal cameras differ only minimally. Methods Human teeth were used, which were extracted for dental reasons. During experiment, teeth were bleached conventionally and by laser activation at 940 nm, 445 nm, and 970 nm. The temperature in the pulp was recorded using thermocouples. In a second setup, longitudinally halved teeth were bleached, while the temperature in the pulp was recorded with a thermocouple and thermal camera. Descriptive statistics were used. The significance level is 0.05. Results In addition to conventional bleaching, temperature increases <5.6 °C were observed for bleaching at 940 nm 1.5 W, at 445 nm 0.3 W, and at 970 nm 0.5 W. For bleaching procedures using 940 nm 7 W, 940 nm 2 W, 445 nm 0.5 W, and 970 nm 1 W, the temperature increase was ≥5.6 °C. Significant differences (p < 0.05) were found in the maximum temperature increases (°C) between all groups. Temperature recordings using a thermocouple and thermal camera differed by about 2.3 °C. The working hypotheses were confirmed. Conclusion With laser bleaching, attention must be paid to the type of laser, its power, and the time in order to avoid excessive overheating of the dental pulp.

Evaluation of the laser wavelength role on tooth bleaching in terms of color change, roughness, and microhardness with pulpal rapid temperature monitoring: an in vitro study

This in-vitro study evaluates the efficacy of the teeth bleaching approach using different laser wavelengths (405 nm blue diode, 940 nm infrared diode, and Er,Cr:YSGG 2780 nm lasers) in comparison to the conventional method using light-emitting diode (LED) sources (420-480) nm. Eighty caries-free sound human premolars were randomly divided into four groups (N=20). Each group received a different bleaching procedure. Then each group was further subdivided into two subgroups (N=10) stained with different solutions. The pulp chamber temperature rise was recorded using an optical fiber sensor with a novel design and fabrication. The color was analyzed using a digital spectrophotometer. Five samples of each subgroup were tested for surface roughness, while the others were tested for Vickers microhardness. The bleaching process with a short wavelength 405 nm blue diode laser showed the best results for the shade, with a minimum pulpal temperature increase indicating no possible necrosis and hence maintaining tooth vitality. Additionally, a remarkable reduction in bleaching time was achieved compared to the conventional approach. This process also yielded the highest color change (Δ E) and increased microhardness, with no noticeable change to the tooth roughness. The 405 nm blue diode laser applied for bleaching showed the best bleaching activity against tested stains and negligible pulpal temperature rise with a noticeable reduction in the bleaching time. The proposed novel method to measure temperature change could be used to develop a promising smart sensor for quick, effective, repeatable, and in-situ monitoring of human body temperature.

Efficacy of Nano Silver Fluoride and/or Diode Laser In Enhancing Enamel Anticariogenicity around orthodontic brackets

PURPOSE

This in vitro study aimed to compare the anticariogenic effect of using diode laser irradiation and/or nano silver fluoride varnish around orthodontic brackets.

MATERIALS AND METHODS

60 caries-free and intact premolars were randomly divided into 3 experimental groups as follow: (1) Group I (nano silver fluoride treated group, n = 20), (2) Group II (diode laser treated group, n = 20) and (3) Group III (combined nano silver fluoride and diode laser treated group, n = 20). Anticariogenicity was assessed using polarized light, scanning electron microscope, elemental and shear bond strength analyses.

RESULTS

PLM and SEM showed presence of few demineralized areas in group I. Group II revealed a dramatic increased demineralization. Group III disclosed almost typical homogenous surface enamel. elemental analysis showed a highly significant difference between Group III and II and a significant difference between Group III and I. Shear bond strength analysis revealed a significant difference between group I and II and between group III and II. The difference between group III and I was non-significant.

CONCLUSION

Both diode laser and nano silver fluoride positively affected dental enamel with the most superior enhancement in enamel criteria was achieved by surface pretreatment by combined nano silver fluoride varnish and diode laser irradiation.

Clinical comparison of diode laser- and LED-activated tooth bleaching: 9-month follow-up

This study aims to evaluate the effect of diode laser- or LED-activated tooth bleaching on color change, tooth sensitivity(TS), temperature variation, and gingival irritation (GI) for 9 months. Thirty-five subjects having anterior teeth with a color of A2 or darker were enrolled in the study. In a split-mouth design, one side of each arch was activated by a diode laser (Epic X, Biolase), and the other side was activated by an LED (Radii Plus, SDI) in conjunction with a bleaching agent (35%, Whiteness HP). The color change was evaluated by subjective (VitaClassic/Vita3D Master Bleachguide) and objective (spectrophotometer, Vita Easyshade) methods for up to 9 months. TS and GI were assessed by visual analogue scale (VAS) and gingival index, respectively, at the same recall periods. During the bleaching, the temperature variation was also recorded using a thermocouple. Statistical analyses were performed (p < 0.05). In the color evaluation, no statistically significant difference was found between diode laser and LED (p > 0.05), except for the 6-month spectrophotometric assessment (ΔE₀₀, ΔE_ab), where higher values were obtained with the laser (p < 0.05). The temperature difference and maximum temperature with diode were found to be significantly higher than LED (p < 0.05). Higher values were obtained with LED when the mean temperatures were compared (p < 0.05). There was no difference between the two activation methods in terms of TS and GI at any of the recalls (p > 0.05). The bleaching activated either with diode laser or LED performed similar clinical performance in terms of effective color change, tooth sensitivity, and gingival irritation with minimum temperature variations.

Effects of Bleaching Associated with Er:YAG and Nd:YAG Laser on Enamel Structure and Bacterial Biofilm Formation

OBJECTIVE

To compare the effects of bleaching associated with Er:YAG and Nd:YAG laser on enamel structure and mixed biofilm formation on teeth surfaces.

MATERIALS AND METHODS

Sixty-eight enamel samples were randomly divided into four groups (n = 17), control, Opalescence Boost only, Opalescence Boost plus Er: YAG laser, and Opalescence Boost plus Nd:YAG laser. The structure was observed using SEM after bleaching. Subsequently, the treated enamel samples were also cultured in suspensions of Streptococcus mutans, Streptococcus sanguis, Actinomyces viscosus, and Fusobacterium nucleatum (Fn) for 24 and 48 h. Biofilm formation was quantified by crystal violet staining, and the structure was visualized by confocal laser scanning microscopy. The data were analyzed using the Kruskal-Wallis method.

RESULTS

The enamel structure significantly changed after bleaching. There was no obvious difference in the biofilm formation after 24 h; however, after 48 hours, the amount of biofilm increased significantly. Remarkably, the amount was significantly higher on enamel bleached only, however, there was no significant difference between samples bleached with Er:YAG or Nd:YAG laser compared to the control.

CONCLUSIONS

Bleaching only appeared to markedly promote biofilm formation after 48 h, and the biofilms on samples bleached with Er:YAG or Nd:YAG laser did not change significantly, showing that bleaching with Er:YAG or Nd:YAG laser can be safely applied in clinical practice.

Evaluation of Monomer Elution and Surface Roughness of a Polymer-Infiltrated Ceramic Network CAD-CAM Material After Er,Cr:YSGG Laser-assisted Tooth Bleaching

PURPOSE

The aim of this in vitro study was to examine the effect of Er,Cr:YSGG laser-assisted tooth bleaching treatment on the elution of monomers and surface roughness of a hybrid computer-aided design-computer-aided manufacturing (CAD-CAM) material, and to compare it with a resin composite for direct restorations.

METHODS AND MATERIALS

Forty specimens of a hybrid CAD-CAM material (Enamic) and forty of a conventional resin composite (Tetric) were fabricated and randomly divided into four groups (n=10). Half of the specimens of each material were stored in distilled water and the other half in artificial saliva for 7 days. At the end of this period, the storage medium was analyzed by high-performance liquid chromatography (HPLC), and the surface roughness parameters of the specimens were evaluated by optical imaging noncontact interferometric profilometry. Afterwards, half of the specimens of each tested material received a conventional in-office tooth bleaching treatment and the other half an Er,Cr:YSGG laser-assisted bleaching treatment, and then they were again incubated in distilled water and artificial saliva for an additional 7-day time period. At the end of this period, the effect of the bleaching treatments on elution of monomers and surface roughness of the tested materials was evaluated.

RESULTS

Bisphenol A (BPA), urethane dimethacrylate (UDMA), triethylene glycol dimethacrylate (TEGDMA), and bisphenol A-glycidyl dimethacrylate (BisGMA) were eluted from the conventional resin composite into both the solutions tested. Only TEGDMA was eluted from the hybrid CAD-CAM material. However, no statistically significant differences were found among the surface roughness parameters of both materials. Both the conventional and Er,Cr:YSGG laser-assisted tooth bleaching treatments affected the monomer elution from the composite resin. However, there were no statistically significant differences (p<0.05) between the treatments.

CONCLUSIONS

According to the results of this study, tooth bleaching with Er,Cr:YSGG laser or conventional technique is safe, even if the bleaching agent comes in contact with hybrid CAD-CAM restorations.

Influence of light and laser activation of tooth bleaching systems on enamel microhardness and surface roughness

Objective

The objective of this study was to compare the effects of light and laser activation of in-office tooth bleaching systems on enamel microhardness and surface roughness.

Materials and Methods

Twenty-five enamel slabs were divided into three treatment groups: light-activated bleaching, laser-activated bleaching, and control. The baseline data were recorded for enamel microhardness (Vickers microhardness [VMH]) and surface roughness (Roughness average, Ra). The specimens were cured for 10 min upon hydrogen peroxide application for the light-activated bleaching group and activated with a laser source, 8 cycles, 10 s per cycle for the laser-activated group. The changes in VMH and Ra at days 1, 7, and 28 were evaluated. Kruskal-Wallis, Friedman, Wilcoxon, and Mann-Whitney tests were used to analyze both VMH and Ra between the treatment groups at different time intervals.

Results

There were a significant reduction in VMH values and significant differences between days 1, 7, and 28 against the baseline in the light-activated bleaching group (P = 0.001). The Ra values revealed significant differences in both light- (P = 0.001) and laser-activated (P = 0.033) groups.

Conclusion

Light activation of a bleaching agent caused a reduction in enamel microhardness and an increase in surface roughness when compared to laser activation.

Photon-Induced Photoacoustic Streaming Activation of the Postbleaching Antioxidant Application Rapidly Improves Bonding to Pulp Chamber Dentin

Objective: This study explored whether the erbium/yttrium/aluminum/garnet (Er:YAG) laser irradiated through the photon-induced photoacoustic streaming (PIPS) method would impact on the resin bonding to pulp chamber dentin when used to activate bleaching and/or postbleaching antioxidant treatment. Materials and methods: One hundred five dentin samples prepared from freshly extracted human incisors were randomly assigned to seven groups (n = 15): control (no bleaching/antioxidant); CB (conventional bleaching only); MB (modified bleaching only); CB-NI (conventional bleaching+antioxidant with needle irrigation); MB-NI (modified bleaching+antioxidant with needle irrigation); CB-PIPSI (conventional bleaching+antioxidant with PIPS-activated irrigation); and MB-PIPSI (modified bleaching+antioxidant with PIPS-activated irrigation). Bleaching (40% hydrogen peroxide) lasted for 20 min. Modified bleaching groups were irradiated with Er:YAG laser using the PIPS tip (2940 nm, 0.90 W, 30 Hz, 30 mJ/pulse, 50-μsec pulse duration) during the first 60 sec of the procedure. The antioxidant treatment with 10% sodium ascorbate lasted for 60 sec. PIPS-activated antioxidant groups were irradiated with Er:YAG laser using the PIPS tip (2940 nm, 0.30 W, 15 Hz, 20 mJ per pulse, 50-μsec pulse duration) throughout the procedure. After completing the composite restorations, all samples were subjected to 5000 thermocycling and the shear bond strength (SBS) test at a crosshead speed of 1 mm/min. SBS data were analyzed using the Kruskal-Wallis test with Bonferroni correction (α& 0.05). Results: No significant difference was detected among the control, CB-PIPSI, and MB-PIPSI (p > 0.05), which presented a significantly higher SBS compared with the other groups (p < 0.05). Conclusions: Irrespective of the application mode of the initial bleaching, PIPS-activated irrigation of the antioxidant improved SBS to bleached dentin to the level of the control in 1 min. Postbleaching antioxidant treatment combined with the PIPS method might be a promising approach to enable immediate resin restoration of bleached dentin.

Effect of Three Wavelengths of Diode Laser on the Efficacy of Bleaching of Stained Teeth

Objectives:

Light irradiation and heat have been used to accelerate the process of tooth bleaching. This study aimed to assess the efficacy of conventional bleaching compared to laser-bleaching using three different wavelengths of diode lasers.

Materials and Methods:

In this in-vitro experimental study, 40 extracted human central incisors were immersed in a coloring solution made of tea, coffee, and cola for 21 days. The L*, a*, and b* color parameters were measured before and after the immersion using spectrophotometry. The teeth were then randomly divided into four groups (n=10) as follows: group 1: 810-nm diode laser + Biolase Laser White 20, group 2: 940-nm diode laser + Biolase Laser White 20, group 3: 980-nm diode laser + Biolase Laser White 20, and group 4: conventional bleaching with Opalescence Boost without laser irradiation. One-way analysis of variance (ANOVA) was used to assess the effect of laser type and bleaching technique on color parameters.

Results:

The 940-nm (ΔE=28.5896) and 810-nm laser groups (ΔE=21.2382) showed the highest and the lowest bleaching efficacy, respectively; however, the groups were not significantly different in terms of bleaching efficacy (P>0.05).

Conclusion:

Laser-bleaching with 810-, 940- and 980-nm wavelengths of diode laser has an efficacy similar to that of conventional bleaching but in a shorter period. No difference was noted between different laser wavelengths in terms of bleaching efficacy.