Laser photopolymerization of dental materials with potential endodontic applications

Photo-Crosslinked Hyaluronic Acid/Carboxymethyl Cellulose Composite Hydrogel as a Dural Substitute to Prevent Post-Surgical Adhesion

A dural substitute is frequently used to repair dura mater during neurosurgical procedures. Although autologous or commercially available dural substitutes matched most of the requirements; difficulties during dural repair, including insufficient space for suturing, insufficient mechanical strength, easy tear and cerebrospinal fluid leakage, represent major challenges. To meet this need, a photo-crosslinked hydrogel was developed as a dural substitute/anti-adhesion barrier in this study, which can show sol-to-gel phase transition in situ upon short-time exposure to visible light. For this purpose, hyaluronic acid (HA) and carboxymethyl cellulose (CMC), materials used in abdominal surgery for anti-adhesion purposes, were reacted separately with glycidyl methacrylate to form hyaluronic acid methacrylate (HAMA) and carboxymethyl cellulose methacrylate (CMCMA). The HA/CMC (HC) hydrogels with different HA compositions could be prepared by photo-crosslinking HAMA and CMCMA with a 400 nm light source using lithium phenyl-2,4,6-trimethylbenzoylphosphinate as a photo-initiator. From studies of physico-chemical and biological properties of HC composite hydrogels, they are bio-compatible, bio-degradable and mechanically robust, to be suitable as a dural substitute. By drastically reducing attachment and penetration of adhesion-forming fibroblasts in vitro, the HC hydrogel can also act as an anti-adhesion barrier to prevent adhesion formation after dural repair. From in vivo study in rabbits, the HC hydrogel can repair dural defects as well as protect the dura from post-operative adhesion, endorsing the possible application of this hydrogel as a novel dural substitute.

Effectiveness of photopolymerization in composite resins using a novel 445-nm diode laser in comparison to LED and halogen bulb technology

Challenges especially in the minimal invasive restorative treatment of teeth require further developments of composite polymerization techniques. These include, among others, the securing of a complete polymerization with moderate thermal stress for the pulp. The aim of this study is to compare current light curing sources with a blue diode laser regarding curing depth and heat generation during the polymerization process. A diode laser (445 nm), a LED, and a halogen lamp were used for polymerizing composite resins. The curing depth was determined according to the norm ISO 4049. Laser output powers of 0.1, 0.5, 1, and 2 W were chosen. The laser beam diameter was adapted to the glass rod of the LED and the halogen lamp (8 mm). The irradiation time was fixed at 40 s. To ascertain ΔT values, the surface and ground area temperatures of the cavities were simultaneously determined during the curing via a thermography camera and a thermocouple. The curing depths for the LED (3.3 mm), halogen lamp (3.1 mm) and laser_{(0.5/1 W)} (3/3.3 mm) showed no significant differences (p < 0.05). The values of ΔT_surface as well as ΔT_ground also showed no significant differences among LED, halogen lamp, and laser_{(1 W)}. The ΔT_surface values were 4.1_LED, 4.3_{halogen lamp}, and 4.5 °C for the laser while the ΔT_ground values were 2.7_LED, 2.6_{halogen lamp}, and 2.9 °C for the laser. The results indicate that the blue diode laser (445 nm) is a feasible alternative for photopolymerization of complex composite resin restorations in dentistry by the use of selected laser parameters.

Root apex sealing with different filling materials photopolymerized with fiber optic-delivered argon laser light

The present study evaluates the seal quality in the apex delta of uniradicular teeth filled with light-cured materials (calcium hydroxide, glass ionomer, and Flow-Fill Magic composite). A total of 45 roots prepared by the endo PTC/Dakin technique were used. All sample restorations were light-cured with 488-nm argon laser light. A 200-microm optical fiber introduced into the root canal delivered 100 mW of light power to the filler material. The fiber tip was positioned 5 mm away from the apex. Light was applied for 20 s. After curing, the samples were immersed in a methylene blue solution for 24 h. Then the samples were cut longitudinally and analyzed under a stereoscopic microscope for dye infiltration. For the sake of comparison, an additional group of ten samples submitted to conventional treatment with EndoREZ root canal sealer was also analyzed. The samples sealed with calcium hydroxide or with the glass ionomer presented less dye infiltration, as compared to those sealed with the Flow-Fill Magic composite. All products activated by fiber optic-delivered light showed superior sealing quality when compared with the self-activated EndoREZ sealer.

Preparation of root canal orifices by Er:YAG laser irradiation: in vitro and clinical observations

OBJECTIVE

The purpose of the present study was to evaluate the effectiveness of Er:YAG laser irradiation for preparation of root canal orifices in extracted human teeth and several clinical cases.

BACKGROUND DATA

Few studies with sufficient data have been conducted in this area.

MATERIALS AND METHODS

Orifices of 42 extracted human teeth were prepared by conventional methods using a Peeso reamer or Er:YAG laser device at 250 mJ/pulse and 8 Hz. In the clinical study, the orifices of 11 teeth from 11 patients with irreversible pulpitis were prepared by Er:YAG laser irradiation at 160 mJ/pulse and 8 Hz. Teeth were carefully irradiated using non-contact methods. Evaluation was performed by visual inspection, stereoscopy, radiography, and scanning electron microscopy (SEM). In addition, the efficiency of using the Er:YAG laser was evaluated.

RESULTS

In the in vitro study, canal orifices were clearly exposed by laser irradiation in all specimens. In 31 of 36 teeth (86%), orifices were successfully prepared without ledge formation or perforation. SEM observations revealed that irradiated surfaces were slightly rough and scaly, but essentially free from debris and smear layer. In the clinical study, orifices were successfully prepared in 10 of 11 teeth (91%), and no ledge formation or perforation was observed.

CONCLUSION

These results suggest that the preparation of root canal orifices by Er:YAG laser irradiation may be useful in most cases, if appropriate parameters are selected.

Adhesion of a glass-ionomer root canal sealer to human dentine

This in vitro study evaluated the effect of smear layer removal on adhesion to human dentine of Ketac-Endo, Grossman, and Sealer 26 root canal sealers. A total of 60 extracted human maxillary and mandibular molars with their crowns ground flat were used. The teeth were divided into two groups: Group 1, the dentine surface received no treatment; Group 2, EDTA-C was applied to the dentine surface for 5 min. Ten samples were tested for each sealer and each group. Adhesion was measured with a Universal Testing Machine. Sealer 26 showed greater adhesion both with and without smear layer (p < 0.01). Ketac-Endo and Grossman sealers were statistically equal, having the lowest values of adhesion. Application of EDTA-C did not alter the adhesion of Ketac-Endo and Grossman sealers. However, the use of EDTA-C increased the adhesion of Sealer 26. The epoxy resin-based root canal sealer (Sealer 26) adhered better to dentine prepared with and without EDTA-C than glass-ionomer-based sealers and the zinc oxide eugenol-based (Ketac-Endo and Grossman) sealers.

Effect of Er:YAG laser on adhesion of root canal sealers

This in vitro study evaluated the effect of Er:YAG laser on adhesion to human dentin of Grossman, Endomethasone, N-Rickert, and Sealer 26 root canal sealers. The crowns of 40 human molars were cut on the occlusal side until a flat dentin surface was obtained. The teeth were divided into two groups: group 1, no laser application; and group 2, irradiation with Er:YAG laser (KaVo Key Laser 2; 11 mm focal distance, perpendicular to the dentin surface, 4 Hz frequency, 200 mJ energy, 62 J total energy and 313 pulses, 1-min application time, and 2.25 W power). Five samples were tested for each sealer and each group. An Instron universal testing machine was used for the adhesion test. Sealer 26 showed the best adhesion both with and without laser application (p < 0.01). Grossman and N-Rickert sealers had intermediate values, and Endomethasone had the worst adhesion. Application of Er:YAG laser did not alter the adhesion of Grossman, N-Rickert, or Endomethasone sealers. However, laser application increased the adhesion of Sealer 26. The epoxy resin-based root canal sealer (Sealer 26) adhered better to dentin prepared with and without Er:YAG laser than the zinc oxide/eugenol-based sealers (Endomethasone, N-Rickert, and Grossman).

Lasers in endodontics: a review

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of papers on potential applications for lasers in endodontics have been published. The purpose of this paper is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilization of root canals, root canal shaping and obturation and apicectomy. The effects of laser on root canal walls and periodontal tissues are also reviewed. The essential question is whether a laser can provide equal or improved treatment over conventional care. Secondary issues include treatment duration and cost/benefit ratio. This article reviews the role of lasers in endodontics since the early 1970s, summarizes many research reports from the last decade, and surmises what the future may hold for lasers in endodontics. With the potential availability of many new laser wavelengths and modes, much interest is developing in this promising field.

Permeability, morphologic and temperature changes of canal dentine walls induced by Nd: YAG, CO2 and argon lasers

The permeability, temperature and morphologic changes of the wall of the root canal induced by Nd:YAG, CO2 and argon lasers were studied. The changes were evaluated according to the presence or absence of a smear layer. Root canals of 140 human single-rooted teeth were enlarged using a step-back technique. Permeability was evaluated by the extent of methylene blue dye penetration into the tubules. Temperature changes were measured using a thermovision system, and morphological changes were evaluated by scanning electron microscopy. Laser energy was delivered into the canal by means of a flexible optical fibre or metal tip. There were statistically significant differences in permeability between lased groups with and without a smear layer in the cervical third of the root canal following lasing. In the middle third of the root canal, all three laser types induced permeability increases in groups with a smear layer. In the apical third, statistically significantly decreases in permeability were observed among CO2 laser and Nd:YAG compared with control group (P < 0.01). Rises in temperature ranged from a minimum of +10.1 degrees C (CO2 laser) to a maximum of +54.8 degrees C (argon laser). All three laser devices appeared capable of producing a glazed-like surface and craters.

Comparison of the sealing ability of laser-softened, laterally condensed and low-temperature thermoplasticized gutta-percha

This study compared the effectiveness of four different techniques used for obturation of single rooted-teeth: lateral condensation, low-temperature gutta-percha (Ultrafil), vertical condensation of gutta-percha softened by means of three different laser devices (argon, CO2, and Nd:YAG), or composite resin photopolymerized by argon laser. Seventy single-rooted teeth were instrumented using a step-back technique and obturated using one of the methods listed previously. To evaluate apical sealing effectiveness techniques, samples were subjected to 1% methylene blue dye at 37 degrees C for 7 days. The most extensive dye penetration (4.3 mm) was observed in teeth obturated with composite resin, followed by gutta-perch laser with CO2 (2.15 mm), and the Nd:YAG laser (3.54 mm). Gutta-percha softened with argon laser created an apical seal almost identical to that obtained with the lateral condensation and Ultrafil techniques (1.50, 1.45, and 1.48 mm of leakage, respectively). These results indicate that the argon laser can be used for gutta-percha softening to produce good apical sealing results.

Laser applications in dentistry: a review of the literature

While there are many applications of lasers in dentistry, few have advantages over existing technology. To date, lasers should be considered to be an adjunct to conventional techniques. There are also considerations of cost and rapid obsolescence of current laser equipment. The possible adverse effects of lasers on the tissues adjacent to those being irradiated, to users and to patients must also be considered.

Argon laser initiated resin photopolymerization for the filling of root canals in human teeth

This work was undertaken to determine if 488 nm light is transmitted through dentin in quantities adequate to polmerize resin located several milimeters from the light source (an optical fiber). The spread of polymerization in a camphorquinone activated resin due to 488 nm light emanating from an opaque plastic canal was compared with light emanating from a canal of the same diameter in tooth dentin. Results indicated that irradiation of a resin-filled chamber via an opaque canal generated a series of ellipsoidal forms, while irradiation via a root canal generated bullet-shaped forms of much larger volume and weight. The base of these bullet-shaped forms was flat against the dentin-resin interface and surrounded the canal. These results indicated that 488 nm argon laser light was transmitted through dentin and could act to polymerize resin at a distance of several millimeters from the canal. Further experiments verified that resin in lateral canals of tooth roots was readily polymerized by 488 nm light applied at low power levels (50 mW). These experiments demonstrate the effectiveness of the argon laser in polymerizing light activated dental resins located within or adjacent to tooth dentin at distances up to several milimeters from the fiberoptic terminus. The flexibility and control that these procedures make possible in the obturation of root canals may lead to substantial improvements in endodontic therapy.