Mechanical properties and molecular structure analysis of subsurface dentin after Er:YAG laser irradiation

Biomimetic dentin remineralization using eggshell derived nanohydroxyapatite with and without carboxymethyl chitosan - An in vitro study

The objective of this study was to evaluate the synergistic effect of eggshell-derived nanohydroxyapatite (EnHA) and carboxymethyl chitosan (CMC) in remineralizing artificially induced dentinal lesions. EnHA and CMC were synthesized using simple chemical processes and characterized using FTIR, XRD, HRSEM-EDX, TEM, DLS and TGA/DTA analyses. A total of 64 pre-demineralized coronal dentin specimens were randomly subjected to following treatments (n = 16):artificial saliva (AS), EnHA, CMC, and EnHA-CMC, followed by pH cycling for 7 days. HRSEM-EDX, Vickers-indenter, and micro-Raman analyses were used to assess surface-topography, microhardness, and chemical analysis, respectively. All tested materials demonstrated non-cytotoxicity when assessed on hDPSCs using MTT assay. FTIR, XRD and thermal analyses confirmed the characteristics of both EnHA and CMC. EnHA showed irregular rod-shaped nanoparticles (30-70 nm) with the presence of Ca,P,Na, and Mg ions. Dentin treated with EnHA-CMC exhibited complete tubular occlusion and highest microhardness whereas the AS group revealed the least mineral deposits (p < 0.05). No significant differences were observed between EnHA and CMC groups (p > 0.05). In addition, molecular conformation analysis revealed peak intensities in collagen's polypeptide chains in dentin treated with CMC and EnHA-CMC, whereas other groups showed poor collagen stability. The results highlighted that EnHA-CMC aided in rapid and effective biomineralization, suggesting its potential as a therapeutic solution for treating dentin caries.

Effect of chitosan and CMCS on dentin after Er:YAG laser irradiation: shear bond strength and surface morphology analysis

OBJECTIVES

The aim of the present study was to evaluate the effect of chitosan and carboxymethyl chitosan (CMCS) on dentin surface morphology and bonding strength after irradiation of Er:YAG laser.

METHODS

Eighty-four laser-irradiated dentin samples were randomly distributed into three groups (n = 28/group) according to different surface conditioning process: deionized water for 60s; 1wt% chitosan for 60s; or 1wt% CMCS for 60s. Two specimens from each group were subjected to TEM analysis to confirm the presence of extrafibrillar demineralization on dentin fibrils. Two specimens from each group were subjected to morphological analysis by SEM. Seventy-two specimens (n = 24/group) were prepared, with a composite resin cone adhered to the dentin surface, and were then randomly assigned to one of two aging processes: storage in deionized water for 24 h or a thermocycling stimulation. The shear bond strength of laser-irradiated dentin to the resin composite was determined by a universal testing machine. Data acquired in the shear bond strength test was analyzed by one-way ANOVA with the Tukey honestly significant difference post hoc test and Independent Samples t-test (α = 0.05).

RESULTS

CMCS group presented demineralized zone and a relatively smooth dentin surface morphology. CMCS group had significantly higher SBS value (6.08 ± 2.12) without aging (p < 0.05). After thermal cycling, both chitosan (5.26 ± 2.30) and CMCS group (5.82 ± 1.90) presented higher bonding strength compared to control group (3.19 ± 1.32) (p < 0.05). Chitosan and CMCS group preserved the bonding strength after aging process (p > 0.05).

CONCLUSIONS

CMCS has the potential to be applied in conjunction with Er:YAG laser in cavity preparation and resin restoration.

Chemical and morphological analysis of dentin irradiated by different high-power lasers: a systematic review

PURPOSE

This systematic review provides an overview of the main chemical and morphological alterations generated on dentin by different high-power lasers' irradiation.

METHODS

The review was registered in PROSPERO (CRD42023394164) and PRISMA guidelines were followed. The search strategy was conducted on MEDLINE (PubMed), Embase (Elsevier), and Web of Science (Clarivate) databases. The eligibility criteria were established according to the PICOS strategy, focusing on in vitro and ex vivo studies that assessed the chemical and morphological changes in dentin using five high-power lasers: Nd:YAG (1064 nm), Er:YAG (2940 nm), Er, Cr:YSGG (2780 nm), diode (980 nm), and CO2 (10,600 nm). Publication range was from 2010 to 2022. Data was summarized in tables and risk of bias was assessed by QUIN tool.

RESULTS

The search resulted in 2255 matches and 57 studies composed the sample. The methods most used to assess the outcomes were scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), and Raman. The studies presented "medium" and "low" risk of bias. The laser prevalently identified was the Er:YAG laser, associated with dentin ablation, absence of smear layer, and exposed tubules. The Nd:YAG laser generated vitreous surface and thermal damage, such as carbonization and cracks. The other lasers caused an irregular surface and no adverse thermal effects. Regarding the chemical structure, only the Er,Cr:YSGG laser caused collagen matrix reduction. The effects found were more intense with higher dosimetry.

CONCLUSION

Evidence available indicates that the irradiation of dentin with high-power lasers are related to morphological outcomes favorable to adhesive restorative procedures, with minimal changes in collagen matrix and mineral content. However, those observations should be carried carefully by clinicians and more clinical trials regarding the association of high-power laser irradiation and restorative procedure longevity are needed.

Er:YAG laser in selective caries removal and dentin treatment with chitosan: a randomized clinical trial in primary molars

This study evaluated the effect of chitosan on dentin treatment after selective removal of caries lesions with Er:YAG laser in reducing Streptococcus mutans, as well as its effect on the performed restorations. The sample consisted of children (aged 7 to 9 years) with active carious lesions and dentin cavitation located on the occlusal surface of deciduous molars. Eighty teeth were randomly distributed into 4 groups according to the caries removal method: Er:YAG laser (250 mJ/4 Hz) or bur and dentin surface treatment: 2.5% chitosan solution or distilled water. The bacterial load of caries-affected dentin was quantified by counting CFU/mg (n = 10). The teeth were restored and evaluated at 7 days, 6 months, and 12 months using modified USPHS criteria (n = 20). Microbiological data was analyzed by Mann-Whitney and clinical analyses were done using Kruskal-Wallis and Dunn test (α = 0.05). The results showed that the Er:YAG laser significantly reduced the amount of Streptococcus mutans (p = 0.0068). After dentin treatment with chitosan, there was a significant reduction in the amount of Streptococcus mutans for both removal methods (p = 0.0424). For the retention and secondary caries criteria, no significant differences were observed along the evaluated time (p > 0.05). The laser-treated group was rated "bravo" for discoloration (p = 0.0089) and marginal adaptation (p = 0.0003) after 6 and 12 months compared to baseline. The Er:YAG laser reduced the amount of Streptococcus mutans and the chitosan showed an additional antibacterial effect. After 1 year, the Er:YAG laser-prepared teeth, regardless of the dentin treatment, showed greater discoloration and marginal adaptation of the restorations.

Er:YAG Laser Physical Etching and Ultra-High-Molecular-Weight Cross-Linked Sodium Polyacrylate Chemical Etching for a Reliable Dentin Dry Bonding

Dentin bond interface stability is the key issue of dental adhesion in present clinical dentistry. The concept of selective extrafibrillar demineralization has opened a new way to maintain intrafibrillar minerals to prevent interface degradation. Here, using ultra-high-molecular-weight sodium polyacrylate [Carbopol (Carbo) > 40 kDa] as a calcium chelator, we challenge this concept and propose a protocol for reliable dentin dry bonding. The results of high-resolution transmission electron microscopy revealed periodic bands of 67 nm dentin collagen fibrils after Carbo etching, and the hydroxyproline concentration increasing with prolonged chelating time denied the concept of extrafibrillar demineralization. The results that wet and dry bonding with Carbo-based demineralization produced a weaker bond strength than the traditional phosphoric acid wet adhesion suggested that the Carbo-based demineralization is an unreliable adhesion strategy. A novel protocol of Er:YAG laser physical etching followed by Carbo chemical etching for dentin adhesion revealed that a micro-/nano-level rough, rigid, and non-collagen exposed dentin surface was produced, the micro-tensile bond strength was maintained after aging under dry and wet bonding modes, and in situ zymography and nanoleakage within the hybrid layers presented lower signals after aging. Cell culture in vitro and a rabbit deep dentin adhesion model in vivo proved that this protocol is safe and biocompatible. Taken together, the concept of extrafibrillar demineralization is limited and insufficient to use in the clinic. The strategy of Er:YAG laser physical etching followed by Carbo chemical etching for dentin adhesion produces a bonding effect with reliability, durability, and safety.

Effect of Er: YAG laser irradiation with additional low energy on resin-dentin bonding and morphology of bonded interface

OBJECTIVES

To examine the micro tensile bond strength (μTBS) and the resin-dentin interface on a laser-irradiated dentin surface using two different irradiation methods, with or without additional low-energy irradiation.

METHODS

The flat bovine dentin surface was divided into three groups: i). control group (C group, no irradiation), ii) 80 mJ/pulse Er: YAG laser group (80 group), iii) 80 + 30 mJ/pulse Er: YAG laser group (80 + 30 group, with an additional 30 mJ/pulse). After the roughness of the dentin surface was recorded, Clearfil SE Bond 2 or Clearfil Universal Bond Quick (Kuraray Noritake Dental Inc., Tokyo, Japan) was applied. After the μTBS testing, the failure mode was observed. The bonded interface was assessed using Rhodamine-dye incorporated adhesives and observed by optical coherence tomography.

RESULTS

The dentin surface showed opened dentinal tubules without a smear layer after irradiation. For both adhesives, the μTBS was significantly higher in 80 + 30 group than in the 80 group (p < 0.05). In the 80 group, the thickness of the adhesive layer was not uniform, and the dentin surface was occasionally in direct contact with the composite resin. The failure mode images showed that most of the fractures in the 80 group were at the sub-surface of irradiated dentin. The adhesive layers of the 80 + 30 groups were homogeneous.

CONCLUSIONS

The dentin surface was rough and irregular by 80 mJ irradiation, which might result in an inadequate resin-dentin interface and the weak μTBS. The bonded integrity was mitigated by additional irradiation.

Micro-Raman spectroscopy analysis of dentin remineralization using eggshell derived nanohydroxyapatite combined with phytosphingosine

The aim of this study was to assess the remineralization efficacy of chicken eggshell-derived nano-hydroxyapatite (CEnHAp) combined with phytosphingosine (PHS) on artificially induced dentinal lesions. PHS was commercially procured whereas CEnHAp was synthesized using microwave-irradiation method and characterized using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), high-resolution scanning electron microscopy-energy-dispersive X-ray spectroscopy (HRSEM-EDX), and transmission electron microscopy (TEM). A total of 75 pre-demineralized coronal dentin specimens were randomly treated with one of the following test agents (n = 15 each): artificial saliva (AS), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), CEnHAp, PHS, and CEnHAp-PHS under pH cycling for 7, 14, and 28 days. Vickers microhardness indenter, HRSEM-EDX, and micro-Raman spectroscopy methods were used to assess the mineral changes in the treated dentin samples. Data were submitted to Kruskal-Wallis and Friedman's two-way analyses of variance (p < 0.05). HRSEM and TEM analysis depicted irregular spherical structure of the prepared CEnHAp with a particle size of 20-50 nm. The EDX analysis confirmed the presence of Ca, P, Na and Mg ions. The XRD pattern showed the characteristic crystalline peaks for hydroxyapatite and calcium carbonate that are present in the prepared CEnHAp. Dentin treated with CEnHAp-PHS revealed highest microhardness values along with complete tubular occlusion compared to other groups at all test time intervals (p < 0.05). Specimens treated with CEnHAp showed increased remineralization than those treated with CPP-ACP followed by PHS and AS groups. The intensity of mineral peaks, as observed in the EDX and micro-Raman spectra, confirmed these findings. Further, the molecular conformation of the collagen's polypeptide chains, and amide-I and CH₂ peaks attained peak intensities in dentin treated with CEnHAp-PHS and PHS whereas other groups revealed poor stability of collagen bands. Microhardness, surface topography, and micro-Raman spectroscopy analyses revealed that dentin treated with CEnHAp-PHS have an improved collagen structure and stability as well as highest mineralization and crystallinity.

Bond strength of bulk fill composite to teeth prepared with Er

Aim: The present in vitro study aimed to evaluate the bond strength of a bulk fill composite on dentin surfaces prepared with the Er: YAG laser. Methods: Twenty-four permanent third molars were selected and divided into 2 groups: CP - Conventional preparation with high-speed handpiece (control) and LA (laser) - Preparation with Er: YAG laser. The occlusal surface was removed to expose coronal dentin, which was subsequently prepared with a high-speed handpiece or Er: YAG laser (350mJ, 4Hz, 1.5 ml/min water flow). Both groups were restored with Filtek One Bulk Fill (3M ESPE) composite resin. After 24 hours, the samples were evaluated for microtensile bond strength (μTBS), fracture pattern, and scanning electron microscopy (SEM). Results: The data obtained in the μTBS test were submitted to t-test (α=0.05). The results showed no difference in μTBS when the different types of cavity preparation were compared (ρ=0.091). Fracture patterns revealed the prevalence of cohesive fracture in composite resin in CP (83.3%) and adhesive fracture in LA (92.1%). In the SEM analysis, the LA group demonstrated the presence of gaps between the composite resin and the irradiated dentin surface. The hybrid layer exhibited more regularity with the presence of longer and uniform resin tags in the CP group. Conclusion: The type of cavity preparation did not influence the values of bulk fill composite resin μTBS to dentin. Fracture patterns and scanning electron microscopy analyses suggested less interference at the adhesive interface in preparations performed using CP.

Effect of Erbium, Chromium-doped: Yttrium, Scandium, Gallium and Garnet Laser Tooth Preparation on Gap Formation of Universal Adhesive Bonded to Enamel and Dentin: A Micro-CT and SEM Study

Introduction: The presence of gaps at the bonding interface of resin composite restorations is known to have an impact on restoration longevity. This study aimed to evaluate the effect of erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er, Cr:YSGG) laser irradiation on gap formation at the tooth–resin interface and to compare the reliability of micro-computed tomography (µCT) and scanning electron microscopy (SEM) scans for gap formation assessment. Methods: Thirty standardized non-retentive class V cavities were prepared on sound human premolars using either an Er,Cr:YSGG laser or a round carbide bur (n=15 for each). A universal adhesive and A nano-filled resin composite were applied in accordance with the manufacturer’s recommendations. After water storage for 24 hours at 37°C, the teeth were subjected to thermocycling. Gap formation assessments were performed by µCT (Skyscan 1173 µCT, Brucker, Belgium) and SEM (JEOL JSM-6610LV, Japan), and SPSS version 24.0 (IBM Inc., Chicago, USA) was used to analyze the data at P value<0.05. Descriptive statistics were used to describe the gap formation percentages. To compare the impact of both preparation and assessment methods, a non-parametric Mann–Whitney U test was used. Results: In enamel, similar gap formation values were detected for the two preparation methods (bur and laser). However, the laser-prepared group showed higher gap formation values in dentin. Additionally, higher gap formation values were reported for both preparation methods when µCT was used for assessment. Conclusion: Cavity preparation using a Waterlase laser led to higher gap formation percentages at the dentin–resin interface. In addition, SEM assessment is more reliable for assessing the tooth–resin interface.

Effect of 9.3 μm CO2 and 2.94 μm Er:YAG Laser vs. Bur Preparations on Marginal Adaptation in Enamel and Dentin of Mixed Class V Cavities Restored With Different Restorative Systems

This study aimed to compare marginal adaptation in enamel and dentin before and after aging of laser vs. bur-prepared mixed class V cavities restored by different restorative systems. Seventy two caries-free human molars were distributed to nine experimental groups; cavities were prepared using two different lasers: a handpiece -integrated 2.94 μm Er:YAG laser at 4.5 W, 300 mJ, and 0.75 W, 50 mJ with 15 Hz (LiteTouch, Light Instruments, Israel) and a novel CO2 laser at 12.95 W, 19.3 mJ, and 4.1 W, 6.11 mJ with 671 Hz (Solea 9.3 μm, Convergent Dental, USA). Cavities prepared with conventional diamond burs (Intensiv, Switzerland) in a red contra angle at high speed under maximal water cooling served as control. Cavities were prepared under simulation of dentinal fluid and restored using three different self-etching universal adhesives in combination with three nanohybrid composites, applied in two layers: Scotchbond Universal with Filtek Supreme XTE (3M, USA), G-Premio BOND with Essentia Universal (GC, Japan), and OptiBond Universal with Harmonize Universal (Kerr, USA). After restorations' polishing and simultaneous thermal (5–50°C, 2 min each) and mechanical loading (max. 49 N; 200,000 cycles), replicas of restoration margins were examined under SEM at × 200 magnification. Percentages of continuous margins (CMs) were quantified before and after the fatigue test and statistically compared (two-way ANOVA with Fisher's least significant difference [LSD] post hoc test). Significant differences were found in almost all groups between the results before and after the fatigue test, as well as between the different preparation tools and restorative materials (p &lt; 0.05). Traditional bur preparations are confirmed as gold standard in enamel and dentin, as all three tested restorative systems provide results of marginal adaptation of more than 80% CM after loading. Er:YAG laser preparations can be equally effective in combination with SBU/Filtek Supreme XTE. CO2 laser ablation could not provide convincing results with the tested self-etching restorative systems. Marginal adaptation has been highly dependent on the substrate and showed impaired adhesion, especially in enamel. Scotchbond Universal/Filtek Supreme XTE showed the highest and most stable values of CM. The other two restorative systems were highly dependent on the preparation device of the substrate.

Nanoscopic wear behavior of dentinogenesis imperfecta type II tooth dentin

OBJECTIVES

The aim of this study was to investigate the wear behavior of Dentinogenesis imperfecta type II (DGI-II) dentin and elucidate the correlation between its tribological properties and components.

METHODS

The mid-coronal dentin of normal and DGI-II teeth were divided into two groups: perpendicular and parallel to the dentin tubules. The microstructure of dentin was detected using atomic force microscopy (AFM). The wear behavior of dentin was evaluated by nanoscratch tests and scanning electron microscopy (SEM). Meanwhile, changes in molecular groups and chemical composition were analyzed by Raman and Energy-Dispersive X-ray (EDX) tests, respectively. Nanohardness was also evaluated.

RESULTS

AFM images of DGI-II dentin illustrated a decrease in the number of tubules and the tubule diameter. Nanoscratch test showed a higher friction coefficient and a greater depth-of-scratch in DGI-II dentin. The wear resistance of DGI-II dentin was reduced independent of tubule orientation. EDX results indicated that DGI-II dentin mineral content decreased and Raman spectra results showed DGI-II dentin had a decreased collagen matrix structure stability coupled with hypomineralization. Furthermore, a significant reduction in nanohardness and elastic modulus of DGI-II dentin was observed. Regression analysis revealed a close correlation between dentin components and inferior wear resistance.

CONCLUSIONS

All results indicated the wear behavior of DGI-II dentin was significantly deteriorated, presumably caused by the disorder in microstructures and the reduction of chemical composition.

Effect of green tea-loaded chitosan nanoparticles on leathery dentin microhardness

The purpose of this study was to assess the effect of a chitosan-based nanoformulation containing green tea on leathery (remaining) dentin subsurface microhardness. Size distribution, polydispersity index (PDI) and zeta potential (mV) of nanoformulations were previously determined by dynamic light scattering (DLS). Human dentin specimens were exposed to Streptococcus mutans for 14 d. Soft dentin were selectively removed by Er:YAG laser (n = 30) or bur (n = 30). Remaining dentin was biomodified with chitosan nanoparticles (Nchi, n = 10) or green tea-loaded chitosan nanoparticles (Gt + Nchi, n = 10) for 1 min. Control group (n = 10) did not receive any treatment. Subsurface microhardness (Knoop) was evaluated in hard (sound) and soft dentin, and then, in leathery dentin and after its biomodification, at depths of 30, 60 and 90 μm from the surface. Nchi reached an average size of ≤ 300 nm, PDI varied between 0.311 and 0.422, and zeta potential around + 30 mV. Gt + Nchi reached an average size of ≤ 350 nm, PDI < 0.45, and zeta potential around + 40 mV. Soft dentin showed significantly reduced microhardness at all depths (p > 0.05). The subsurface microhardness was independent of choice of excavation method (p > 0.05). At 30 µm from the surface, Gt + Nchi increased the leathery dentin microhardness compared to untreated group (p < 0.05). Nchi promoted intermediate values (p > 0.05). Both nanoformulations showed an average size less than 350 nm with nanoparticles of different sizes and stability along the 90-day period evaluated. Subsurface microhardness of bur-treated and laser-irradiated dentin was similar. At 30 µm, the biomodification with Gt + Nchi improved the microhardness of leathery dentin, independently of caries excavation method used.

Influence of Er,Cr:YSGG laser on root dentin submitted to erosive and/or abrasive challenges

This study evaluated how Er,Cr:YSGG laser, associated or not with 5% fluoride varnish, influences the surface roughness and volume loss of bovine root dentin submitted to erosive and/or abrasive wear. One hundred and twenty dentin specimens were divided into the groups: without preventive treatment (WPT), 5% fluoride varnish (FV); Er,Cr:YSGG laser irradiation (L), and varnish combined with laser (FV + L). The specimens (n = 10) were subdivided into: 1 = erosion (E); 2 = abrasion (A); and 3 = erosion followed by abrasion (E + A). The erosive solution used was a soft-drink (pH = 2.42 at 4ºC) applied in 5-min cycles twice a day for 10d. Abrasive wear involved brushing for 60s with an electric brush (1,600-oscillations/s) at a load of 2.0N. Surface roughness and volume loss were evaluated using a laser scanning confocal microscope. Roughness data were submitted to one-way ANOVA and Tukey post-hoc test. For volume loss, the Kruskal-Wallis and Dunn's post-hoc tests were used (α = 5%). The lowest values of roughness were found in the control areas of all subgroups (p > 0.05). In the experimental area, the [(WPT) + (E+A)] subgroup had a significantly higher roughness (5.712 ± 0.163 μm 2 ) than the other subgroups (p < 0.05). The L and (FV + L) groups had statistically similar roughness, regardless of the type of wear. The (FV + L) group had the lowest volume loss, regardless of the type of wear performed: [(FV + L) + (E)] = 7.5%, [(FV + L) + (A) = 7.3%, and [(FV + L) + (E + A)] = 8.1%. The subgroup [(WPT) + (E + A)] had the highest volume loss (52.3%). The proposed treatments were effective in controlling dentin roughness. Laser irradiation can be an effective method to increase root dentin resistance after challenges and limit problems related to non-carious lesions.

MDP-based universal adhesive system irradiated with Er,CR:YSGG: Analysis of its performance up to 6 months

This study aimed to analyze the interaction of a MDP-based universal dentin bonding system (DBS) with Er, Cr: YSGG laser irradiation, measuring the microtensile bond strength to dentin over a six-month period. The experimental design involved three factors: DBS (Adper Scotchbond Universal; Clearfil SE Bond, Adper Scotchbond Multipurpose and Adper Single Bond 2), laser (Control and Er, Cr: YSGG), and time (initial- 7 days and 6 months). Eighty dentin samples from molars were prepared (n=10) with laser irradiation after primer and DBS application. After 7 days, were subjected to micro tensile bond strength test. The data were analyzed by three-way ANOVA and Tukey tests (p<0.05). Both DBS and laser significantly affected the bonding performance and their interaction was statistically significant (p=0.0194). The self-etching mode of the MDP-based universal DBS maintained the bond strength on dentin irradiated with ER, Cr: YSGG after 6 months, while bonding with all other DBS deteriorated.

Optical coherence tomography characterizes the roughness and thickness of the heterogeneous layer on cortical bone surface induced by Er:YAG laser ablation at different moisture contents

Background

As an innovative bone ablation tool, pulsed erbium: yttrium-aluminum-garnet (Er:YAG) laser is being used in clinical practice. It faces the same problems as traditional tools: the water content of bone usually changes with the position, while the amount of water spray in the process of laser irradiation is also uncertain. Real-time monitoring of the effects of laser bone ablation is necessary, but effective tools are still lacking. In this study, we examined the feasibility of rapidly and non-destructively evaluating the surface properties of bone after Er:YAG laser irradiation at different moisture contents by optical coherence tomography (OCT).

Methods

Bone specimens (n=90) collected from pig cortical bone were used in this study. All bone specimens had similar volume and surface characteristics after machining. To display the baseline level before Er:YAG laser ablation, a control group (n=10) without dehydration or Er:YAG laser ablation was examined with OCT, scanning electron microscopy (SEM), and energy dispersive X-ray (EDX) spectroscopy. The remaining specimens were randomly divided into four groups (n=20/group) with different moisture content: dried (Group 2 and Group 4) or not dried (Group 1 and Group 3). Pulsed Er:YAG laser (120 mJ/pulse, 20 Hz, 100 µs) was used for perpendicular irradiation with (Group 1 and Group 2) or without (Group 3 and Group 4) water spray. The treated specimens were subjected to SEM, EDX spectroscopy, OCT, and then processed for histological evaluation.

Results

After Er:YAG laser ablation, the melting effect was obvious in the SEM results of the dry groups and non-sprayed groups (Groups 2-4). EDX spectroscopy showed that the content of calcium and phosphorus and their ratios remained unchanged in the undried and with water spray group (Group 1) were the closest to the control group. Three-dimensional (3D) OCT could evaluate the depth and shape of ablation grooves. The roughness of the laser-ablated surface could be visualized by extracting the surface lines from cross-sectional OCT images. The results illustrated that the laser ablation with water spray could achieve a smoother surface. Furthermore, OCT results demonstrated that a layer with high image intensity was generated on the bone surface after laser irradiation. The thickness of these layers showed a correlation with whether or not the laser irradiation was sprayed with water. Histology showed that thin eosin-stained layers were created in all experimental groups, which matched well with OCT results of the layers with high image intensity. No denatured layer was observed in the non-irradiated areas of bone tissues.

Conclusions

OCT could rapidly and non-destructively visualize the bone surface before and after Er:YAG laser ablation at four different moisture contents. The morphology of ablation grooves, as well as the roughness and thickness of the heterogeneous layer on the bone surface, could be characterized quantitatively with good correlation with SEM and histology. This study will promote the development of OCT as an efficient and accurate tool for evaluating laser ablation of bone.

Raman spectroscopy-multivariate analysis related to morphological surface features on nanomaterials applied for dentin coverage

Raman spectroscopy and scanning electron microscopy (SEM) were used to investigate the effect of coating materials and acidulated phosphate fluoride gel (APF) treatment on dentin before and after erosion-abrasion cycles. A multi-walled carbon nanotube/graphene oxide hybrid carbon-based material (MWCNTO-GO), nanohydroxyapatite (nHAp), or a combined composite (nHAp/MWCNTO-GO) were used as a coating. Seventy root dentin fragments obtained from 40 bovine teeth were prepared and divided into groups (n = 10): negative control, artificial saliva - C, positive control - APF; nHAp; MWCNTO-GO; APF_nHAp; APF_MWCNTO-GO and APF_nHAp/MWCNTO-GO. All samples were subjected to cycles of demineralization (orange juice, pH ~3.7, room temperature, 1 min) followed by remineralization (saliva, 37 °C, 1 h). The remineralization procedures were followed by tooth brushing (150 strokes). The above cycle was repeated 3×/day for 5 days. The previous APF treatment of dentin allowed a better affinity of nHAp and MWCNTO-GO with the inorganic and organic portion of dentin, respectively. This interaction indicates the formation of a protective layer for the dentin surface and for the collagen giving possible protection against erosion. SEM micrographs illustrated the formation of a protective layer after application of the biomaterials and that it was partially or totally removed after the erosion and abrasion. Raman spectroscopy combined with multivariate analysis could distinguish samples with respect to treatment efficacy. The APF_nHAP/MWCNT-GO composite has shown to be a promising material since it has binding characteristics both to the inorganic and organic portion of the dentin and reduced solubility. Mineral-to-matrix ratio (MMR) parameter analysis confirmed the binding capability of MWCNTO-GO-based materials to dentin.

Remineralization of Artificial Dentin Caries Using Dentin and Enamel Matrix Proteins

To assess the remineralizing potential of dentin matrix proteins and enamel matrix derivatives (DMPs and EMDs) after application on artificially induced dentin lesions, given the hypothesis that these materials increase the mineral uptake, binding, and mineralization. Forty-eight caries-free human premolars were used. Teeth were cut, polished, and embedded, leaving an open window on the root surface, of which one-third was covered with a flowable composite to preserve the healthy untreated dentin. Then, samples were demineralized in Buskes solution for 33 days. A micro-CT scan prior to treatment was performed. Next, the samples were randomly allocated into four groups: (A) An untreated negative control (CON), (B) application of porcine dentin matrix proteins (DMP), (C) treatment with enamel matrix derivatives (EMD, Emdogain, Straumann), and (D) amine fluoride application (AMF, Elmex fluid, GABA). All samples were placed in artificial saliva for 21 days. A second micro-CT scan was performed, after which the change in gray scaling within a defined region of interest (0.25 mm³) was analyzed. ANCOVA was applied to discover statistical differences between the different treatments. Both, treatment with AMF; (P = 0.011 versus CON) as well as with DMP (P = 0.043 versus CON) yielded a statistically significant difference compared to the control treatment. EMD treatment was not found to differ (P > 0.05). Mainly the top layer of the defects showed clear signs of remineralization, which was also evident in CON. This study was able to visually confirm the remineralization potential of demineralized dentin especially after DMP application, which, however, did not outperform AMF. Based on this, additional studies combining proteins and fluorides are now warranted and ongoing.

Influence of Er:YAG laser pulse duration on the long-term stability of organic matrix and resin-dentin interface

The purpose of this study was to explore the influence of Er:YAG laser irradiation with different pulse durations on the organic matrix, micromorphology of the hybrid layer (HL), and bond strength over time. Sixty caries-free human molars were cut to obtain flat dentin surfaces which were randomly divided into 4 groups: control (not irradiated-G1) and laser groups (80 mJ/2 Hz) with pulse duration ranging between 50 (G2), 300 (G3), and 600 μs (G4). A self-etch adhesive system (Universal 3M ESPE) was applied on pre-treated dentin surfaces and cylinders of resin composite were built up and stressed in a universal testing machine (μSBS) at 24 h and after12 months (n = 12). In addition, 3 other dentin-bonded specimens were prepared as previously described for each group with the adhesive doped with 0.1 wt% Rhodamine B to analyze hybrid layer morphology under Confocal Laser Microscope Scanning (CLMS). Organic matrix and collagen fibrils were analyzed by second harmonic generation (SGH). Two-way ANOVA and Tukey's test detected significantly higher μSBS values for the control group, whereas the lower values were observed in all laser groups at 24 h (p < 0.05). Storage in artificial saliva did not reduce μSBS in all groups. The low signal emitted by SHG images below the irradiated area demonstrated thermal damage of the collagen matrix. CLMS images of laser groups exhibited thicker and irregular resin-dentin interfaces than the control group. Regardless of the pulse duration, Er:YAG laser pre-treatment altered the organic matrix and HL formation which resulted in low μSBS values at 24 h. The alterations on dentin's organic structure did not jeopardize the μSBS after 1 year of saliva storage.

Effect of Er:YAG laser irradiation and chitosan biomodification on the stability of resin/demineralized bovine dentin bond

OBJECTIVE

The purpose of this study was to evaluate the effect of Er:YAG laser for selective removal of carious lesion, followed by biomodification with chitosan on the microtensile bond strength (µTBS), adhesive interface, dry mass loss and hydroxyproline release (HYP).

METHODS

Artificial lesions were created in 104 bovine dentin blocks. Blocks were divided according to caries removal method: bur or Er:YAG laser. Seventy-six blocks were acid etched and subdivided according to dentin biomodification: no chitosan and 2.5% chitosan. Composite resin restorations were performed. Blocks were sectioned into beams and stored in water. After 24 h, 6 and 12 months, beams were submitted to μTBS test (n = 10) and analysis of adhesive interface by SEM (n = 3). The other 28 blocks were sectioned into beams and initial dry mass (DM) was determined (n = 7). Beams were stored and after 7 days, DM was redetermined. HYP release (n = 7) was evaluated by ELISA. Data were analyzed by ANOVA and Bonferroni's tests (α = 0.05).

RESULTS

After 24 h, the highest µTBS was found for bur (p < 0.001). After 6 months, methods were similar (p = 0.432). After 12 months, laser-irradiated dentin showed the highest µTBS values (p = 0.025). Chitosan promoted higher µTBS values after 6 (p = 0.011) and 12 months (p < 0.001) preserving adhesive interface. Dry mass loss and HYP release were not influenced (p > 0.05) by caries removal method or by dentin biomodification.

CONCLUSION

The bond strength to demineralized dentin reduced over 50% in all groups after water storage. From 6 months of water storage, Er:YAG laser irradiation and biomodification with chitosan maintained the stability of the resin-dentin bonds, but did not influence dry mass loss and HYP release.

Effect of diode laser irradiation on the bond strength of polymerized non-simplified adhesive systems after 12 months of water storage

Objectives:

The aim of this in vitro study was to evaluate the bonding strength of non-simplified dentin bonding systems (DBS) to dentin irradiated with a diode laser (970 nm) immediately and after 12 months of water storage following either primer or bond application.

Material and methods:

The experimental design included three different factors: DBS type [Adper^TM Scotchbond Multipurpose (MP) and Clearfil™ SE Bond (CSE)], irradiation [without irradiation - control (C), irradiation after primer application (AP), and irradiation after bond application (AB)], and time [initial (I) and after 12 months of water storage (12 m)]. Sixty sound human third molars (n = 10) were obtained, and their flat occlusal dentin areas were prepared and standardized. Laser irradiation was performed in the contact mode perpendicular to the dental surface over an automatically selected scanning area at a pulse energy of 0.8 W, frequency of 10 Hz, and energy density of 66.67 J/cm². After 7 days of treatment, the specimens were cut, and half of them were subjected to microtensile testing (500 N/0.05 mm/min), whereas the remaining sticks were examined after 12 months of water storage. The obtained data were analyzed by three-way analysis of variance (ANOVA) followed by a Tukey test (p<0.05). The observed fracture modes were investigated using a portable digital microscope with a magnification of 40x.

Results:

Among the utilized DBS, MP generally exhibited higher bond strengths, but did not always differ from CSE under similar conditions. The irradiation factor was statistically significant only for the MP/AB groups. After 12 months of storage, all groups demonstrated a significant reduction in the bond strength, whereas the results of fracture analysis showed a predominance of the adhesive type.

Conclusions:

The laser treatment of non-simplified DBS was not able to stabilize their bonding characteristics after 12 months.

Effect of Er:YAG laser energy densities on thermally affected dentin layer: Morphological study

BACKGROUND AND AIMS

Physical and chemical composition of dentin is subject to modification when irradiated with Er:YAG laser. Temperature rise causes water evaporation and micro-mechanical ablation of dentin. The misuse of laser parameters could affect negatively dentin collagen fibers leading to failure in bonded composite restorations. The aim of this in vitro study was to evaluate the effect of Er:YAG laser radiation at different levels of energy on the morphology of thermally affected dentin layer.

MATERIALS AND METHODS

Forty-eight freshly extracted human third molars were randomly divided into six groups (n = 8). In all groups, except for the control groups, dentin was subject to irradiation with H02 handpiece Er:YAG laser in non-contact mode (SSP mode = 50 µs; 10 Hz; speed of 1 mm/second; air 6 mL/min; and water 4 mL/min) with the following levels of energy (40, 60, 80, 100, and 120 mJ) respectively. Teeth were sliced longitudinally. Photo-ablated cavities were observed. The cavity depth and dentin fiber collagen deterioration were measured.

RESULTS

Laser irradiation increased the depth of dentinal crater from 46.57 µm to 178.2 µm, when energy level increased from 40 mJ to 120 mJ. A superficial black layer, representing dentinal affected collagen fibers, was present in all groups except for control group. When comparing the thickness of the black layer, there was no significant difference between groups. It increased at 40 mJ to 28.17 µm then decreased to 15.19 µm at 60 mJ and then increased again for 80 mJ to 19.93 µm, 100 mJ to 22.87 µm and 120 mJ to 28.53 µm. Only one group (60 mJ) showed low values and significant difference as compared to the other irradiated groups, when multiple comparisons tests (ANOVA) were made using Newman-Keuls test.

CONCLUSION

Dentin organic matrix presented the minimum alteration when Er:YAG laser is used specifically at an appropriate level of energy (60 mJ).