Prevention of toothbrushing abrasion of acid-softened enamel by CO(2) laser irradiation

Clinical and ex-vivo effect of LASERs on prevention of early-enamel caries: systematic review & meta-analyses

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.

Design and Development of a Novel Oral Care Simulator for the Training of Nurses

OBJECTIVE

A Novel Oral Care Simulator was designed and developed to measure and visualise the facial and lingual forces exerted on teeth by the action of tooth brushing, considering the irregular geometry and structural composition of human dentition and the emulation of the realistic biomechanical deflection of the teeth.

METHOD

FEA simulations were carried out on a central incisor under facial loading and an appropriate force sensing mechanism was designed. An anatomically accurate mandibular jaw and 16 teeth were 3D printed, on which 16 force sensing structures were embedded. The signals from the sensors were amplified using a multichannel signal amplifier built using instrumentation amplifiers which were then visualised through a GUI.

RESULTS

The developed simulator is capable of indicating the magnitude of a force upto 15 N exerted on to the facial and lingual surfaces of teeth at a frequency of 60 Hz and above and it is capable of alerting the user if the force exceeds a pre-specified threshold.

CONCLUSION

The designed force sensing mechanism considers the irregular geometry and structural composition of human dentition in measuring the facial and lingual forces. It provides a reliable feedback by indicating the force and emulating the realistic biomechanical deflection of teeth.

SIGNIFICANCE

Nurses who care for the disabled, elderly and sick have explicitly stated the requirement for a simulator to train themselves on brushing the teeth of their subjects as their incorrect technique can cause longterm dental damage, for which a device has not been developed to date.

Effect of CPP-ACP paste with and without CO2 laser irradiation on demineralized enamel microhardness and bracket shear bond strength

Introduction:

Many patients seeking orthodontic treatment already have incipient enamel lesions and should be placed under preventive treatments. The aim of this in vitro study was to evaluate the effect of CPP-ACP paste and CO₂ laser irradiation on demineralized enamel microhardness and shear bond strength of orthodontic brackets.

Methods:

Eighty caries-free human premolars were subjected to a demineralization challenge using Streptococcus mutans. After demineralization, the samples were randomly divided into five equal experimental groups: Group 1 (control), the brackets were bonded without any surface treatment; Group 2, the enamel surfaces were treated with CPP-ACP paste for 4 minutes before bonding; Group 3, the teeth were irradiated with CO₂ laser beams at a wavelength of 10.6 µm for 20 seconds. The samples in Groups 4 and 5 were treated with CO₂ laser either before or through CPP-ACP application. SEM photomicrographs of a tooth from each group were taken to observe the enamel surface. The brackets were bonded to the buccal enamel using a conventional method. Shear bond strength of brackets and ARI scores were measured. Vickers microhardness was measured on the non-bonded enamel surface. Data were analyzed with ANOVA and Tukey test at the p< 0.05 level.

Results:

The mean shear bond strength and microhardness of the laser group were higher than those in the control group and this difference was statistically significant (p< 0.05). All groups showed a higher percentage of ARI score 4.

Conclusion:

CO₂ laser at a wavelength of 10.6 µm significantly increased demineralized enamel microhardness and enhanced bonding to demineralized enamel.

A New Laser-Processing Strategy for Improving Enamel Erosion Resistance

In the present study, a new automatic laser-processing strategy allowing standardized irradiation of natural tooth areas was investigated. The objective was to find a combination of laser parameters that could cause over a 600°C temperature increase at the enamel surface while not damaging enamel, avoiding temperature change above 5.5°C in the pulp and increasing enamel erosion resistance. Seventy-seven bovine enamel samples were randomly divided into 6 laser groups and 1 negative control (C/no treatment/ n = 11). A scanning strategy (7 × 3 mm) was used for the CO₂ laser treatment (λ = 10.6 µm, 0.1-18 J/cm²) with different pulse durations-namely, 20 µs (G20), 30 µs (G30), 55 µs (G55), and 490 µs (G490), as well as 2 modified pulse distances (G33d, G40d). Measurements of temperature change were performed at the surface (thermal camera/50 Hz), at the underside (thermocouples), and at the pulp chamber using a thermobath and human molars ( n = 10). In addition, histology and X-ray diffraction (XRD/ n = 10) were performed. Erosion was tested using an erosive cycling over 6 d, including immersion in citric acid (2 min/0.05 M/pH = 2.3) 6 times daily. Surface loss was measured using a profilometer and statistical analysis with a 2-way repeated-measures analysis of variance (α = 0.05). Only G20 fulfilled the temperature requirements at the surface (619 ± 21.8°C), at the underside (5.3 ± 1.4°C), and at the pulp (2.0 ± 1.0°C), and it caused no mineral phase change and significant reduction of enamel surface loss (-13.2 ± 4.0 µm) compared to C (-37.0 ± 10.1 µm, P < 0.05). A laser-scanning strategy (20 µs/2 kHz/1.25 J/cm², 3.4 mm/s) has been established that fulfilled the criteria for biological safety and significantly increased enamel erosion resistance (64%) in vitro.

Application of Laser Irradiation for Restorative Treatments

Nowadays, lasers are widely used in many fields of medicine. Also, they can be applied at many branches of dental practice such as diagnosis, preventive procedures, restorative treatments, and endodontic therapies. Procedures like caries removal, re-mineralization, and vital pulp therapy are the most noticeable effects of laser irradiation which has gained much attention among clinicians. With controlled and appropriate wavelength, they can help stimulating dentinogenesis, controlling pulpal hemorrhage, sterilization, healing of collagenic proteins, formation of a fibrous matrix, and inducing hard tissue barrier. Nevertheless, there are many controversies in literatures regarding their effects on the quality of bonded restorations. It hampered a wide application of lasers in some aspects of restorative dentistry and requirements to identify the best way to use this technology. The aim of this mini review is to explain special characteristics of laser therapy and to introduce the possible applications of laser devices for dental purposes.

Caries-preventive effect of anti-erosive and nano-hydroxyapatite-containing toothpastes in vitro

OBJECTIVES

The aim of the study was to investigate the caries-preventive effect of newly developed fluoride and fluoride-free toothpastes specially designed for erosion prevention. The hypothesis was that these products might also show superior caries-inhibiting effect than regular fluoride toothpastes, since they were designed for stronger erosive acid challenges.

MATERIALS AND METHODS

Enamel specimens were obtained from bovine teeth and pre-demineralized (pH = 4.95/21 days) to create artificial caries lesions. Baseline mineral loss (ΔZ_B) and lesion depth (LD_B) were determined using transversal microradiography (TMR). Ninety specimens with a median ΔZ_B (SD) of 6027 ± 1546 vol% × μm were selected and randomly allocated to five groups (n = 18). Treatments during pH-cycling (14 days, 4 × 60 min demineralization/day) were brushing 2×/day with AmF (1400 ppm F^-, anti-caries [AC]); AmF/NaF/SnCl₂/Chitosan (700 ppm F^-/700 ppm F^-/3500 ppm Sn²⁺, anti-erosion [AE1]); NaF/KNO₃ (1400 ppm F^-, anti-erosion [AE2]); nano-hydroxyapatite-containing (0 ppm F^-, [nHA]); and fluoride-free toothpastes (0 ppm F^-, negative control [NC]). Toothpaste slurries were prepared with mineral salt solution (1:3 wt/wt). After pH-cycling specimens presenting lesion, surface loss (mainly by NC and nHA) were discarded. For the remaining 77 specimens, new TMR analyses (ΔZ_E/LD_E) were performed. Changes in mineral loss (ΔΔZ = ΔZ_B - ΔZ_E) and lesion depth (ΔLD = LD_B - LD_E) were calculated.

RESULTS

All toothpastes caused significantly less demineralization (lower ΔΔZ) than NC (p < 0.05, ANOVA) except for nHA. The fluoride toothpastes did not differ significantly regarding ΔΔZ and ΔLD (p > 0.05, ANOVA).

CONCLUSION/CLINICAL RELEVANCE

While both anti-erosive and anti-caries toothpastes reduced mineral loss to a similar extent, the fluoride-free nano-hydroxyapatite-containing toothpaste seemed not to be suitable for inhibition of caries demineralization in vitro.

Combined Tin-Containing Fluoride Solution and CO2 Laser Treatment Reduces Enamel Erosion in vitro

The aim of this in vitro study was to evaluate the effect of combined CO2 laser and tin-containing fluoride treatment on the formation and progression of enamel erosive lesions. Ninety-six human enamel samples were obtained, stored in thymol solution and, after surface polishing, randomly divided into 6 different surface treatment groups (n = 16 in each group) as follows: no treatment, control (C); one CO2 laser irradiation (L1); two CO2 laser irradiations (L2); daily application of fluoride solution (F); combined daily fluoride solution + one CO2 laser irradiation (L1F), and combined daily fluoride solution + two CO2 laser irradiations (L2F). Laser irradiation was performed at 0.3 J/cm2 (5 µs/226 Hz/10.6 µm) on day 1 (L1) and day 6 (L2). The fluoride solution contained AmF/NaF (500 ppm F), and SnCl2 (800 ppm Sn) at pH 4.5. After surface treatment the samples were submitted to an erosive cycling over 10 days, including immersion in citric acid (2 min/0.05 M/pH = 2.3) 6 times daily and storage in remineralization solution (≥1 h) between erosive attacks. At the end of each cycling day, the enamel surface loss (micrometers) was measured using a 3D laser profilometer. Data were statistically analyzed by means of a 2-level mixed effects model and linear contrasts (α = 0.05). Group F (-3.3 ± 2.0 µm) showed significantly lower enamel surface loss than groups C (-27.22 ± 4.1 µm), L1 (-18.3 ± 4.4 µm) and L2 (-16.3 ± 5.3 µm) but higher than L1F (-1.0 ± 4.4 µm) and L2F (1.4 ± 3.2 µm, p < 0.05). Under the conditions of this in vitro study, the tin-containing fluoride solution caused 88% reduction of enamel surface loss, while its combination with CO2 laser irradiation at 0.3 J/cm2 hampered erosive loss almost completely.

Effect of neodymium:yttrium-aluminum-garnet laser and fluoride on the acid demineralization of enamel

AIM

The aim of the present study was to evaluate the protective effect of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser and acidic phosphate fluoride (APF) on enamel erosion caused by hydrochloric acid.

METHODS

Fifty human enamel specimens were distributed according to the following treatments (n = 10): untreated (control), APF (1.23%) 4 min, Nd:YAG laser (100 mJ, 1 W, 10 Hz, 141.5 J/cm² ), APF + Nd:YAG laser, and Nd:YAG laser + APF. For 14 days the specimens were submitted to erosive challenge: 5 min in 3 mL hydrochloric acid (0.01 M, pH 2.2), rinsed with distilled water, and stored in artificial saliva for 3 h. This cycle was repeated four times per day. The calcium (Ca) loss was determined in demineralizing solution by atomic emission spectroscopy, and superficial roughness (Ra) was measured before and after the erosive challenge.

RESULTS

The mean Ca loss was (mg/L, ± standard deviation): control 12.74 ± 3.33, APF 1.71 ± 0.11, laser 1.64 ± 0.08, APF + laser 1.38 ± 0.08, and laser + APF 1.48 ± 0.07. Kruskal-Wallis test showed a significant difference between the control and other groups. APF + laser showed minor loss of Ca. After the erosive challenge, the APF + laser group showed Ra alteration.

CONCLUSION

A significant reduction in tooth dissolution was observed after fluoride application combined with Nd:YAG irradiation.

Effect of carbon dioxide laser irradiation on enamel surface microhardness around orthodontic brackets

INTRODUCTION

In this study, we aimed to determine the effect of carbon dioxide laser irradiation on enamel surface microhardness.

METHODS

In this single-blind interventional clinical trial, 16 patients needing at least 2 premolars extracted for orthodontic purposes participated. In each subject, 1 premolar was treated with the carbon dioxide laser (beam diameter, 0.2 mm; power, 0.7 W); the other was exposed to a visible guiding light as the control. A t-loop was ligated to the bonded brackets to increase caries risk. After at least 2 months, the teeth were extracted, and the surface microhardness was measured. Scanning electron microscope evaluation was performed on 1 sample from each group. Normal distribution of the data was assessed by the Kolmogorov-Smirnov and Shapiro-Wilks tests. Mean microhardness values of the 2 groups were compared using paired t tests.

RESULTS

The data had normal distributions. Means and standard deviations of the microhardness in the laser-treated and control groups were 301.81 ± 94.29 and 183.9 ± 72.08 Vickers hardness numbers, respectively; this was different significantly (P <0.001). Scanning electron microscopy showed the enamel surface melting in the laser-treated specimens.

CONCLUSIONS

Carbon dioxide laser treatment results in higher enamel surface microhardness around orthodontic brackets. Patients at high risk of caries might benefit from this intervention. Exact control of the laser irradiation parameters is recommended.

Screening of CO(2) laser (10.6 μm) parameters for prevention of enamel erosion

OBJECTIVE

The aim of this study was to screen CO(2) laser (10.6 μm) parameters to increase enamel resistance to a continuous-flow erosive challenge.

BACKGROUND DATA

A new clinical CO(2) laser providing pulses of hundreds of microseconds, a range known to increase tooth acid-resistance, has been introduced in the market.

METHODS

Different laser parameters were tested in 12 groups (n=20) with varying fluences from 0.1 to 0.9 J/cm(2), pulse durations from 80 to 400 μs and repetition rates from 180 to 700 Hz. Non-lased samples (n=30) served as controls. All samples were eroded by exposure to hydrochloric acid (pH 2.6) under continuous acid flow (60 μL/min). Calcium and phosphate release into acid was monitored colorimetrically at 30 sec intervals up to 5 min and at 1 min intervals up to a total erosion time of 15 min. Scanning electron microscopic (SEM) analysis was performed in lased samples (n=3). Data were statistically analysed by one-way ANOVA (p<0.05) and Dunnett's post-hoc tests.

RESULTS

Calcium and phosphate release were significantly reduced by a maximum of 20% over time in samples irradiated with 0.4 J/cm(2) (200μs) at 450 Hz. Short-time reduction of calcium loss (≤1.5 min) could be also achieved by irradiation with 0.7 J/cm(2) (300μs) at 200 and 300 Hz. Both parameters revealed surface modification.

CONCLUSIONS

A set of CO(2) laser parameters was found that could significantly reduce enamel mineral loss (20%) under in vitro erosive conditions. However, as all parameters also caused surface cracking, they are not recommended for clinical use.

Long-term protective effect of surface sealants against erosive wear by intrinsic and extrinsic acids

OBJECTIVE

To test sealants to prevent erosive tooth wear caused by extrinsic and intrinsic acids under long-term exposition.

METHODS

144 bovine enamel samples were randomly allocated to twelve groups (1-12). Samples of groups 1, 5 and 9 remained unsealed (positive controls), 2, 6 and 10 were sealed with Silicon Seal Nano Mix and 3, 7 and 11 with Seal&Protect. Groups 4, 8 and 12 were sealed with flowable composite (negative controls). Groups 1-4 were immersed in artificial saliva, 5-8 in hydrochloric acid and groups 9-12 in citric acid for 28 days, respectively. After 1, 2, 4, 7, 11, 14, 21 and 28 days, solutions were renewed and enamel wear was quantified by assignation of (32)P in the solutions.

RESULTS

In all immersion solutions, lowest mineral loss was observed for the negative controls whilst highest loss was observed for unsealed positive controls. In artificial saliva and citric acid, the loss from samples sealed with Seal&Protect was not significantly different compared with negative controls whilst loss in groups sealed with Silicon Seal Nano Mix was significantly higher. In hydrochloric acid, loss from samples sealed with Seal&Protect was not different compared with that of negative controls up to 4 days. Except day 1, the mineral loss in the Seal&Protect group was significantly lower compared with that of the Silicon Seal Nano Mix group.

CONCLUSION

The tested resin based surface sealant is able to significantly reduce the erosive demineralisation of enamel caused by hydrochloric and citric acid even under long-term exposition.