Temperature elevation on the root surface during Nd:YAG laser irradiation in the root canal

Effective control of biofilms by photothermal therapy using a gold nanorod hydrogel

Biofilms are matrices synthesized by bacteria containing polysaccharides, DNA, and proteins. The development of biofilms in infectious processes can induce a chronic inflammatory response that may progress to the destruction of tissues. The treatment of biofilms is difficult because they serve as a bacterial mechanism of defense and high doses of antibiotics are necessary to treat these infections with limited positive results. It has been demonstrated that photothermal therapy using gold nanorods (AuNRs) is an attractive treatment because of its anti-biofilm activity. The purpose of this work was to generate a novel chitosan-based hydrogel embedded with AuNRs to evaluate its anti-biofilm activity. AuNRs were synthesized by the seed-mediated growth method and mixed with the chitosan-based hydrogel. Hydrogels were characterized and tested against two bacterial strains by irradiating the produced biofilm in the presence of the nanoformulation with a laser adjusted at the near infrared spectrum. In addition, the safety of the nanoformulation was assessed with normal human gingival fibroblasts. Results showed that a significant bacterial killing was measured when biofilms were exposed to an increase of 10°C for a short time of 2 min. Moreover, no cytotoxicity was measured when normal gingival fibroblasts were exposed to the nanoformulation using the bactericidal conditions. The development of the reported formulation can be used as a direct application to treat periodontal diseases or biofilm-produced bacteria that colonize the oral cavity.

Determining the optimal dose of 1940-nm thulium fiber laser for assisting the endodontic treatment

Insufficient cleaning, the complex anatomy of the root canal system, inaccessible accessory canals, and inadequate penetration of irrigants through dentinal tubules minimizes the success of the conventional endodontic treatment. Laser-assisted endodontic treatment enhances the quality of conventional treatment, but each laser wavelength has its own its own limitations. The optimal parameters for the antibacterial efficiency of a new wavelength, 1940-nm Thulium Fiber Laser, were firstly investigated in this study. This paper comprises of two preliminary analyses and one main experimental study, presents data about thermal effects of 1940-nm laser application on root canal tissue, effective sterilization parameters for bacteria, Enterococcus faecalis, and finally the antibacterial effectiveness of this 1940-nm Thulium Fiber Laser irradiation in single root canal. Based on these results, the optimal parameter range for safe laser-assisted root canal treatment was investigated in the main experiments. Comparing the antibacterial effects of four laser powers on an E. faecalis bacteria culture in vitro in 96-well plates showed that the most effective group was the one irradiated with 1 W of laser power (antibacterial effect corresponding to a log kill of 3). After the optimal laser power was determined, varying irradiation durations (15, 30, and 60 s) were compared in disinfecting E. faecalis. Laser application caused significant reduction in colony-forming unit values (CFU) compared with control samples in the 17% ethylenediaminetetraacetic acid (EDTA) group. The results of bacteria counts showed that 1 W with 30 s of irradiation with a 1940-nm thulium fiber laser was the optimal dose for safely achieving maximal bactericidal effect.

Evaluation of temperature rises during the application of different power levels of potassium titanyl phosphate and neodymium-doped:yttrium aluminum garnet lasers to external primary root canals

Background/purpose

Nowadays, laser systems play crucial roles in endodontic treatments. Therefore, these systems should be investigated in terms of parameters that may prevent periodontal tissues damages during laser irradiation. In this context, the purpose of this study was to evaluate temperature rises during the application of different power levels of potassium titanyl phosphate (KTP) and neodymium-doped:yttrium aluminum garnet (Nd:YAG) lasers to external primary root canals.

Materials and methods

Sixty primary mandibular molars were selected and chemomechanical preparation was performed. KTP laser treatment was applied to 30 of these 60 samples and the remaining 30 received Nd:YAG laser treatment. The teeth samples received laser application (KTP or Nd:YAG) at three different power levels (1 W, 1.5 W, and 2 W, respectively, applied to 10 samples from each group). Nine holes were drilled (1 mm in diameter) through the level of the coronal, middle, and apical third of each tooth canal to provide entry for a Type L thermocouple wire, which was used to measure temperature changes. Data were assessed with two-way analysis of variance and the Tukey test.

Results

All power levels indicated statistically significant differences between Nd:YAG and KTP laser systems (P < 0.05). Moreover, the same regional (apical, middle, and coronal) comparisons performed between Nd:YAG and KTP laser systems showed statistically significant differences (P < 0.05).

Conclusion

All parameters of KTP laser indicated lower temperature rises than Nd:YAG laser. Therefore, KTP laser may be preferable to protect the periodontal tissues from harmful thermal effects during the endodontic treatment of primary root canals.

Laser Application in Dentistry: Irradiation Effects of Nd:YAG 1064 nm and Diode 810 nm and 980 nm in Infected Root Canals-A Literature Overview

Objective. In endodontics, Nd:YAG laser (1064 nm) and diode laser (810 nm and 980 nm) devices are used to remove bacteria in infected teeth. A literature review was elaborated to compare and evaluate the advantages and disadvantages of using these lasers. Methods. Using combined search terms, eligible articles were retrieved from PubMed and printed journals. The initial search yielded 40 titles and 27 articles were assigned to full-text analysis. The studies were classified based upon laser source, laser energy level, duration/similarity of application, and initial and final bacterial count at a minimum of 20 prepared root canals. Part of the analysis was only reduced microorganisms and mechanically treated root canals upon preparation size of ISO 30. All studies were compared to evaluate the most favorable laser device for best results in endodontic therapy. Results. A total of 22 eligible studies were found regarding Nd:YAG laser 1064 nm. Four studies fulfilled all demanded criteria. Seven studies referring to the diode laser 980 nm were examined, although only one fulfilled all criteria. Eleven studies were found regarding the diode laser 810 nm, although only one study fulfilled all necessary criteria. Conclusions. Laser therapy is effective in endodontics, although a comparison of efficiency between the laser devices is not possible at present due to different study designs, materials, and equipment.

Bactericidal effect of Nd:YAG and Er:YAG lasers in experimentally infected curved root canals

OBJECTIVE

The purpose of this study was to evaluate the bactericidal efficacy of Nd:YAG and Er:YAG laser in the experimentally infected curved root canals.

BACKGROUND DATA

Previous studies revealed that laser systems have a significant bactericidal effect in both human and bovine infected straight root canals.

MATERIALS AND METHODS

Sixty extracted single-rooted teeth with single root canals were selected and then instrumented with endodontic files to a size 60 (K-type file). The degree of root curvature was determined according to modified Schneider's method. Each of the specimens was incubated in a sterile centrifuge tube with 1 mL of the Enterococcus faecalis suspension at 37°C for 2 weeks under aerobic conditions. After laser irradiation at each of the two settings, 50 mJ, 10 pps (0.5 W) or 100 mJ, 10 pps (1.0 W), the number of E. faecalis in each root canal was examined.

RESULTS

In the straight root canals, the Er:YAG laser showed higher bactericidal effects by 6.4-10.8% than did the Nd:YAG laser. Conversely, the bactericidal effect of Er:YAG laser in the curved root canals was higher by 1.5-3.1% than was that with the Nd:YAG laser. The bactericidal effect of the Er:YAG laser in the curved root canal is significantly lower than that in the straight root canal (p < 0.05).

CONCLUSION

These results suggest that further development in the endodontic laser tip and technique is required to ensure its success in curved root canals sterilization.

Temperature rise during photo-activated disinfection of root canals

The aim of this study was to determine whether it is safe to use photo-activated disinfection (PAD) during root canal treatment without heating the periodontal tissues. Root canals of 30 freshly extracted single-rooted teeth were prepared using ProFiles up to size ISO 40 and then filled with photo-sensitiser: tolonium blue (1.2 mg/l). The 635 nm diode laser was used with the manufacturer's endo-tip. Samples were irradiated for 150 s (output power 100 mW, approximate energy density 106.16 J/cm(2)). Temperatures were recorded at working length on the external root surface. After 150 s of PAD irradiation, the average temperature rise was 0.16 +/- 0.08 degrees C. All values were lower than the 7 degrees C safety level for periodontal injury. It was concluded that, regarding the temperature increase, the use of PAD in root canals could be considered harmless for periodontal tissues.

Effects of Er:YAG laser and Nd:YAG laser treatment on the root canal dentin of human teeth: a SEM study

The objective of the study was to observe the morphological changes on root canal dentin after Er:YAG laser and Nd:YAG laser treatment. Twenty-one teeth biomechanically prepared were divided into three groups with seven teeth of each. Group A was unlased as a control. In group B, Er:YAG laser and in group C, Nd:YAG laser was applied to the root canal dentin. The roots were split longitudinally and examined using a scanning electron microscopy for the evaluation of debris, smear layer, and recrystallization. There was no statistically significant difference between the groups. This study indicates that laser beam is not effective in removing debris and smear layer.

Effects of the Nd:YAG laser, air-abrasion, and acid-etchant on filling materials

The purpose of this study was to determine any inadvertent effects of the neodymium: yttrium-aluminium-garnet (Nd:YAG) laser, air-abrasion, and ortho-phosphoric acid on some conventionally used dental filling materials [amalgam, composite resin, compomer, glass-ionomer cement (GIC), and ceromer], when they were used for purposes of margin etching and assessed according to standard enamel etching parameters using a total of five fillings. The surfaces of the filling materials were polished. One sample from each material group was exposed to laser (at 0.75 J, 15 pps) and air abrasion (with Al-oxide powder, 60 psi) for 2 s and to the 37% ortho-phosphoric acid for 60 s. The exposed materials were examined under Scanning Electron Microscopy (SEM). After laser treatment most specimens showed recrystallized areas, the GIC surface being the most affected. There were some pores and cavities on the amalgam surface following laser treatment. The abraded surfaces showed mechanical abrasions. The acid etchant showed the least effect. During the application of laser or air-abrasion, the adjacent tooth or filling surface must be protected or the dentist must be careful.

Removal of Two Types of Root Canal Filling Material Using Pulsed Nd:YAG Laser Irradiation

OBJECTIVE

The aim of this study was to examine the usefulness of a pulsed Nd:YAG laser in removing two types of endodontic obturation material from the root canal in vitro.

BACKGROUND DATA

Recently, a fine flexible glass fiber made of quartz has been developed to transmit the laser beam more effectively and permit its concentration in a specific area. This has increased the potential usefulness of the Nd:YAG laser in root canal treatment.

METHODS

The time required for removing the root canal obturation material (Gutta-percha cones and, Sealapex or AH26) by means of either Nd:YAG laser irradiation or a conventional method (Gates Glidden drills and K files) was measured. Contact microradiography was used to assess the radiopacity of the root canals before and after the removal of obturation material. The surfaces of the root canal after removal of the obturation materials were also observed by scanning electron microscopy.

RESULTS

Although none of the methods used in this study resulted in complete removal of debris from the root canal wall, the time required for the removal of any of the root canal obturation materials using laser ablation was significantly shorter than that required using the conventional method (p < 0.05). It appeared that some orifices of the dentinal tubules were blocked with melted dentin following laser irradiation.

CONCLUSIONS

Nd:YAG laser irradiation is an effective tool for the removal of root canal obturation materials, and may offer advantages over the conventional method.

External temperature during KTP-Nd:YAG laser irradiation in root canals: an in vitro study

To avoid the damage of periodontal tissues during laser irradiation of the root canal, the conditions of lasering must be carefully controlled. The aim of this study was to determine the safety parameters of the irradiation conditions during the use of a KTP-Nd:YAG laser in root canals. Root canals of 60 freshly extracted teeth were prepared (step-back technique) and filled with a photosensitiser (Acid Red 52). Different irradiation conditions [output power (P), pulse width (PW), pulse repetition rate (PRR, Hz)] were used. The laser beam was delivered by means of the KTP-Nd:YAG fibre tip with a beam spot-size diameter of 200 microm. The temperature increases were measured on the external apical third of the root surface using a thermocouple. The results showed that the temperature rise was always below 7 degrees C at the following laser settings: (1) single irradiation, P < or = 4 W, PW < or = 2.55 ms and PRR < or = 20 Hz; (2) repetitive irradiation series, five pulses of 1 s each, four resting times of 1 s each, P < or = 2.25 W, PW < or = 2.55 ms and PRR < or = 20 Hz. The use of resting times was necessary so as to avoid thermal cumulative effects. In these in vitro irradiation conditions, the use of the KTP-Nd:YAG laser in endodontics may be considered harmless for periodontal tissues.

Thermal Effect and Morphological Changes Induced by Er:YAG Laser with Two Kinds of Fiber Tips to Enlarge the Root Canals

OBJECTIVE

The aim of this study was to assess the application of Er:YAG laser root canal preparation using two fiber tip systems.

BACKGROUND DATA

Previous studies have not shown the thermal effect of Er:YAG laser using cone-shaped fiber tip.

MATERIALS AND METHODS

The ability of Er:YAG laser to enlarge root canals at a pulse energy set at 30 or 20 mJ and constant pulse rate of 10 pps (pulses per second) was tested. A cone-shaped (84 degrees top angle) or a flat fiber tip of Er:YAG laser was used for comparison. Four groups of 15 artificial root canals with fixed dimension were prepared from bovine teeth. Irradiation was accompanied by sterilized distilled water spray (2 mL/min). The temperature changes on the root surface were recorded with an infrared apparatus, and the thermal images were captured with a thermocamera. The morphological changes of irradiated root canals were examined by a scanning electron microscope (SEM).

RESULTS

The mean temperature rises were 9.4 degrees C and 7.1 degrees C with the cone-shaped fiber tip at a pulse energy of 30 and 20 mJ, respectively, and were 11.0 degrees C and 6.5 degrees C with flat fiber tip at a pulse energy of 30 and 20 mJ, respectively. Marked difference in temperature change between the cone-shaped and flat fiber tips was noted at pulse energy of 30 mJ, but not at 20 mJ. The thermal distribution using the cone-shaped fiber tip (in contrast to the flat tip) had an elliptical shape around the fiber tip and was limited to the apical end of the root canals. SEM observation found that irradiation with cone-shaped fiber tip (in comparison to the flat tip) produced a cleaner surface.

CONCLUSION

Our results suggest that the cone-shaped fiber tip of Er:YAG laser produced fewer thermal effects and morphological changes as compared to the other type of fiber tip.

Influence of the EDTA, Nd:YAG laser and association of both on the filling of artificial lateral root canals

This study aimed at evaluating the influence of EDTA, Nd:YAG laser and the combination of both for filling of artificial lateral root canals. Forty-five human mandibular premolars were employed, on which three artificial lateral root canals were prepared by means of a reamer with a similar diameter to a K file #15. The teeth were instrumented through the stepback technique employing Gates Glidden burs at the middle and cervical thirds and manual files at the apical portion, and irrigation with 1% sodium hypochloride. The teeth were divided in three groups: Group 1 -EDTA for 5 minutes; Group 2 -application of Nd:YAG laser at 15 Hz, 100 mJ and 1.5 Watts; and Group 3 - association of both. Roots were filled through the Tagger's hybrid technique, radiographed and the radiographs were digitized. Scores were assigned to the filling of the lateral root canals. Statistical analysis revealed no significant differences between the entire groups and also on the analysis of each third.

Root surface temperature increase during Er:YAG laser irradiation of root canals

The authors measured the temperature of the root surface during root canal preparation using Er:YAG laser irradiation and evaluated the thermal effect on the periodontal region. Twenty extracted human teeth with single roots were divided into two groups of 10. These were irradiated using an Er: YAG laser at 2 Hz and 136 to 184 or 170 to 230 mJ/pulse for 1 min with a water spray. The temperature of the root surface was monitored using thermocouples throughout the procedure. The teeth were longitudinally bisected and observed by stereoscopy and scanning electron microscopy. The temperature on the root surface increased by less than 6 degrees C at the apical area and by less than 3 degrees C at the central area. A morphological evaluation revealed no carbonization or melting. These results suggest that the thermal effect on periodontal tissues during root canal preparation using an Er: YAG laser at less than 230 mJ/pulse for 1 min is minimal.