In vitro study of the Nd:YAG laser effect on human dental enamel: optical and scanning electron microscope analysis

Is It Necessary to Prepare the Enamel before Dental Bleaching?

The aim of this in vitro study was to assess the influence of distinct surface treatments on the microhardness and color of enamel that will be bleached. Surface treatments are tested, accordingly: G1, no treatment; G2, 2% sodium fluoride; G3, casein phosphopeptide paste; G4, 2% fluoride+Nd:YAG laser. Forty blocks from bovine teeth composed the sample that were tested in Knoop microhardness (n = 10) and in color change (n = 10). After 24 h, bleaching with 35% hydrogen peroxide was performed for 45 min. Microhardness and color changes (using parameters ΔE, ΔL, Δa, and Δb) were assessed before and after bleaching. The data were analyzed by two-way ANOVA and Tukey's test (p < 0.05). Despite all surface treatments, a reduction of enamel microhardness occurred immediately after bleaching in all groups, being greater in G1. Enamel color changed in all groups. Immediately after bleaching, there was a decrease on enamel microhardness. However, after 7 days, some of those specimens previously treated before bleaching significantly recovered their initial microhardness without influencing the esthetic results of bleaching.

Chemical and Morphological Changes of Primary Teeth Irradiated with Nd:YAG Laser: An Ex Vivo Long-Term Analysis

OBJECTIVE

The aim of this study was to assess any long-term chemical and morphological Nd:YAG laser modifications on irradiated primary enamel.

BACKGROUND DATA

Previous studies on irradiated primary human enamel employed methodologies that evaluated the short-term effects only.

METHODS

One hundred and eighty-six irradiated (with and/or without fluoride) primary enamel teeth from high-caries-risk children, which were exfoliated over a 1-year period, were collected, and the sample surface area was submitted for scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, and X-ray energy-dispersive spectrometry (EDS). The subsurface was analyzed by Knoop microhardness and light microscopy (LM). Data were analyzed by one way ANOVA and Tukey tests (α=0.05) and Kruskall-Wallis and Tukey tests (α=0.05).

RESULTS

FTIR analysis revealed a higher concentration of phosphate and carbonate in the irradiated (0.987±0.064) and lower concentration in the control groups (1.477±0.310). SEM analysis showed that the control samples exhibited a slightly smoother surface than the irradiated groups. The EDS analysis did not show any differences in the amount of calcium, phosphorus, or fluoride among the groups. The microhardness analysis revealed that sealant (249.86±7.15) and laser irradiation (262.44±22.69) led to higher hardness values than the negative control group (128.35±25.19). LM indicated significantly reduced caries formation in the laser (5.35±5.38%) and the laser plus acidulated phosphate fluoride (APF) groups (10.35±0.88%) compared with the negative control group (72.56±12.86%).

CONCLUSIONS

Even with the limitations of the present study, these results suggest that Nd:YAG irradiation clinically modified the chemical composition of the enamel surface regardless of fluoride concentration, which successfully inhibited demineralization of primary tooth enamel over a 1-year period without significant morphological changes.

Comparative evaluation of microhardness and morphology of permanent tooth enamel surface after laser irradiation and fluoride treatment - An in vitro study

Background and aims: The aim of the study was to evaluate and compare the surface microhardness and surface morphology of permanent tooth enamel after Er,Cr:YSGG laser irradiation and Fluoride application. Materials and methods: One hundred and twenty premolars extracted for orthodontic purpose were used in the study and randomly divided into 6 groups. Group A was not subjected to any treatment. Group B was subjected to Er,Cr:YSGG laser irradiation. Group C was subjected to Er,Cr:YSGG laser irradiation followed by application of 2% NaF gel for 4 minutes. Group D was subjected to laser irradiation and 1.23% APF gel for 4 minutes. Group E was subjected to 2% NaF gel pretreatment technique followed by laser irradiation. Group F was subjected to 1.23% APF gel pretreatment technique followed by laser irradiation. All the test groups were subjected to microhardness testing and scanning electron microscope evaluation at 500 X and 1500 X. Results: All the treated groups showed an increase in microhardness value in comparison to the control group. The highest increase in microhardness was seen in Group F. Increase in microhardness values of Group B and Group D was not statistically significant as compared to Group A. Scanning Electron Micrographs showed few craters and fine porosities for Group A. These craters and porosities increased in size and often showed glass like appearance after laser irradiation. Conclusions: It can be suggested by means of present study that Er,Cr:YSGG laser irradiation alone or in combination with fluoride gel is an effective tool to provide resistance against the caries. Significantly higher resistance (p< 0.05) was seen when APF gel was used prior to Er,Cr:YSGG laser irradiation and this combination can act as an efficient tool for prevention against dental caries.

Inhibition of enamel demineralisation using "Nd-YAG and diode laser assisted fluoride therapy"

AIM

This in vitro study was to evaluate the irradiation efficacy of the Diode laser and the Nd-YAG laser either un-assisted or assisted by acidulated phosphate fluoride (APF) treatment on enamel's acid resistance.

METHODS

Seventy-two enamel samples, obtained from 12 extracted human molars, were randomly assigned to 6 groups as follows: (1) Control (C); (2) Exposed to APF gel (F); (3) Diode laser (DL); (4) Irradiated with Diode laser through APF gel (DL/F); (5) Nd-YAG laser (NL) and (6) Irradiated with Nd-YAG laser through APF gel (NL/F). The specimens were individually demineralised in an acidified hydroxyethylcellulose system, and the acid resistance was evaluated by determining the calcium ion dissolution using atomic absorption spectrometry.

RESULTS

The average concentration of the calcium ion determined in groups 1 to 6 was 901, 757, 736, 592, 497 and 416 parts per million micrograms/gram, respectively. The results showed that demineralisation in the NL/F group was significantly less than the other groups and the control group was significantly greater than the other groups (P < 0.001).

CONCLUSION

The effect of Nd-YAG laser irradiation, used alone or in combination with APF, in decreasing the enamel demineralisation was greater than all the other groups.

Human dental enamel and dentin structural effects after Er:YAG laser irradiation

Ideally projected to be applied on soft tissues, infrared lasers were improved by restorative dentistry to be used in hard dental tissues cavity preparations--namely enamel and dentin. This paper evidentiates the relevant aspects of infrared Erbium laser's action mechanism and its effects, and characterizes the different effects deriving from the laser's beams emission. The criteria for use and selection of optimal parameters for the correct application of laser systems and influence of supporting factors on the process, such as water amount and its presence in the ablation process, protection exerted by the plasma shielding and structural factors, which are indispensable in dental tissues cavity preparation related to restorative technique, are subordinated to optical modifications caused by the interaction of the energy dissipated by these laser light emission systems in the targeted tissue substrate.

CLINICAL RELEVANCE

Differences in the action of infrared Erbium laser system in regard to the nature of the ablation process and variations on the morphological aspects observed in the superficial structure of the target tissue irradiated, may be correlated to the structural optical modifications of the substrate produced by an interaction of the energy propagated by laser systems.

Effect of pretreatment with an Er:YAG laser and fluoride on the prevention of dental enamel erosion

The aim of this study was to evaluate the effect of the Er:YAG laser and its association with fluoride (1.23% acidulate phosphate fluoride gel) on the prevention of enamel erosion. Sixty specimens were obtained from bovine enamel (4 × 4 mm), which were ground flat, polished, and randomly divided into five groups according to the preventive treatments: control-fluoride application; L--Er:YAG laser; L+F--laser + fluoride; F+L--fluoride + laser; L/F--laser/fluoride simultaneously. Half of the enamel surface was covered with nail varnish (control area), and the other half was pretreated with one of the preventive strategies to subsequently be submitted to erosive challenge. When the laser was applied, it was irradiated for 10 s with a focal length of 4 mm and 60 mJ/2 Hz. Fluoride gel was applied for 4 min. Each specimen was individually exposed to regular Coca-Cola® for 1 min, four times/day, for 5 days. Wear analysis was performed with a profilometer, and demineralization was assessed with an optical microscope. Data were analyzed using the Kruskal-Wallis test (wear)/Dunn test and ANOVA/Fisher's exact tests. The group L/F was similar to control group. The other groups showed higher wear, which did not present differences among them. In the demineralization assessment, the groups F+L and L/F showed lower demineralization in relation to the other groups. It can be concluded that none preventive method was able to inhibit dental wear. The treatments L/F and F+L showed lower enamel demineralization.

Argon and Nd:YAG lasers for caries prevention in enamel

OBJECTIVE

The aim of this study was to investigate the effect of Nd:YAG and argon laser irradiations on enamel demineralization after two different models to induce artificial caries.

BACKGROUND DATA

It is believed that the use of the high-intensity laser on the dental structure can lead to a more acid-resistant surface.

MATERIALS AND METHODS

Twenty-one extracted human third molars were sectioned into tooth quarters. The quarters were distributed in three groups: Group I (control), untreated; Group II, Nd:YAG laser (60 mJ, 15 pps, 47.77 J/cm(2), 30 sec); and Group III, argon laser (250 mW, 12 J/cm(2), 48 sec). Tooth quarters from each group were subjected to two different demineralization models: cycle 1, a 14 day demineralization (pH 4.5; 6 h) and remineralization (pH 7.0; 18 h) solutions, 37 °C and cycle 2, 48 h in demineralization solution (pH 4.5). Samples were prepared in slices (60-100 μm thick) to be evaluated under polarized light microscopy. Demineralization areas were measured (mm(2)) (n=11). Data were analyzed by ANOVA and Tukey's test (p<0.05).

RESULTS

Means followed by different letters are significantly different: 0.25 A (control, cycle 48 h); 0.18 AB (control, cycle 14 days); 0.17 AB (Nd:YAG, cycle 14 days); 0.14 BC (argon, cycle 48 h); 0.09 BC (Nd:YAG, cycle 48 h), and 0.06 C (argon, cycle 14 days).

CONCLUSIONS

The argon laser was more effective for caries preventive treatment than Nd:YAG laser, showing a smaller demineralization area in enamel.

Nanoscratch resistance of human tooth enamel treated by Nd: YAG laser irradiation

The purpose of this study was to investigate the friction behaviour of human tooth enamel irradiated by Nd:YAG laser. Forty specimens were randomly divided into four groups, and received the Nd:YAG laser irradiation with different energy densities (without irradiation; 20, 40, and 80 J/cm2). Subsequently, nano-scratch tests were conducted on the treated enamel surfaces, with progressive loads from 0.1 to 80 mN. The morphologies of the treated enamel surfaces and the scratch scars were observed via a field emission scanning electron microscope and an AMBIOS XP-2 stylus profilometer. The results indicated that the Nd:YAG laser promoted slight morphological alterations under a lower energy density (20 J/cm2), but different morphologies occurred under a higher energy density (40 and 80 J/cm2). The irradiated enamel surfaces had inferior nano-scratch resistance, and the nano-scratch resistance decreased as the energy density increased. Nd:YAG laser irradiation decreased the nano-scratch resistance of the enamel. The main damage mechanisms of the irradiated enamel under nano-scratch consisted of brittle delaminations and formation of cracks.

Effects of Nd:YAG Laser on Enamel Microhardness and Dental Plaque Composition: Anin SituStudy

OBJECTIVE

This study evaluated Knoop microhardness (KHN) and dental plaque composition of human enamel irradiated with Nd:YAG laser and subjected to in situ cariogenic challenge.

BACKGROUND DATA

Although in vitro studies have shown that Nd:YAG laser irradiation results in a reduction of enamel mineral loss after acid challenge, this hypothesis has not been tested using an in situ caries model.

METHODS

Acrylic devices containing lased and non-lased human enamel slabs were used for 28 days by eight subjects highly colonized by S. mutans. Devices were immersed in a sucrose solution (20%) eight times daily in order to better simulate the cariogenic challenge.

RESULTS

After the experimental period, no differences in dental plaque composition were observed between lased and non-lased enamel slabs indicating that all slabs were exposed to equivalent cariogenic challenges. Cross sections of enamel slabs were then measured for Knoop microhardness at 10, 20, 40, 60, 80, 120, and 180 microm in depth from the outer exposed surface. Un-lased enamel slabs not subjected to the in situ cariogenic challenge were also used as control. Enamel slabs from the two in situ groups exhibited lower hardness when compared to control. Lased enamel showed higher hardness values up to 60 microm in depth than the un-lased enamel exposed to in situ cariogenic challenge.

CONCLUSION

The results suggest that the irradiation of Nd:YAG laser of human enamel appears to be effective for increasing enamel hardness and thus decreasing the effect of acid attack.

Qualitative microanalysis of ions and ultrastructural changes in dentin exposed to laser irradiation and to metal salts solution

BACKGROUND AND OBJECTIVES

This study evaluated the ultrastructural changes in dentin after treatment with the Nd:YAG laser and/or metal salt solutions and verified the presence of Sn++, Sr++, and F- in dentin structure.

STUDY DESIGNS/MATERIALS AND METHODS

Sixty dentin disks were randomly divided into groups (n = 10): (I) control (no treatment), (II) Nd:YAG (1.5 W, 100 mJ, 15 Hz, 125 J/cm2), (III) 10% SnF2 aqueous solution for 30 minutes, (IV) Nd:YAG+10% SnF2 aqueous solution for 30 minutes, (V) 10% SrCl2 toothpaste for 30 minutes, (VI) Nd:YAG+10% SrCl2 toothpaste for 30 minutes. Then, all samples were prepared for scanning electron microscopy (SEM) and the samples from Groups I to IV for the energy dispersive X-ray microanalysis (EDX).

RESULTS

SEM evaluation revealed occluded dentinal tubules and a dentin surface altered by the laser irradiation. The EDX microanalysis revealed Sn++ at a depth of 250 microm in Group IV and not deeper than 100 microm in Group III. In Group V, Sr++ was not deeper than 50 microm, but it could be detected at a depth of 500 microm in Group VI. F- was found only in Group IV.

CONCLUSIONS

Ultrastructural changes caused by laser irradiation can increase dentin uptake of Sn++, Sr++, and F-.

Pulpal safety of 9.6 microm TEA CO2 laser used for caries prevention

BACKGROUND AND OBJECTIVES

Lasers are used for several procedures involving hard and soft tissues of the oral cavity. A potential future application is the use of the CO2 laser to alter the surface structure of tooth enamel to render it more resistant to caries. A new 9.6 microm wavelength transverse excited atmospheric pressure (TEA) CO2 laser (Argus Photonics, Jupiter, FL) has been investigated as a device that can be used for this purpose without harming the dental pulp.

STUDY DESIGN/MATERIALS AND METHODS

Erupted caries- and restoration-free third molars (n = 24 participants; 74 teeth) were used in the study. Teeth were irradiated at an incident fluence of 1.5 J/cm2, a repetition rate of 10 Hz and a spot size 1 mm in diameter. At the low and high settings, 200-400 pulses at 5-8 microseconds pulse duration were delivered at 12 mJ per pulse for a total energy of 2.4 or 4.8 J delivered for 20 or 40 seconds, respectively. Other teeth were subjected to a sham dental procedure (positive control) or no procedure (negative control). Prior to testing, radiographs were taken of all teeth, and they were assessed pulpally using heat, cold, and electricity to determine vitality. The teeth were removed either immediately or at 1 week or 1 month after testing.

RESULTS

Teeth were bioprepared and examined histologically for signs of inflammation. Only one tooth developed symptoms of sensitivity to cold for 10 days following exposure to the high power level. The sensitivity was of fleeting duration and was judged to be reversible pulpitis. All teeth tested responded normally at pre-testing and pre-extraction time periods. Histological examination of all teeth disclosed no indication of an inflammatory response in the pulp tissue at any time point. All sections appeared normal with no changes seen in the normal pulpal morphology.

CONCLUSIONS

We conclude that the 9.6 microm wavelength laser causes no permanent/serious pulpal damage at the energy levels used and can be used safely for caries prevention treatments in humans.

Nd:YAG Laser Influence on Microleakage of Class V Composite Restoration

OBJECTIVE

The purpose of this research was to evaluate the influence of the Nd:YAG laser on microleakage of class V composite restorations.

BACKGROUND DATA

There has been very little research that concerns microleakage resulting from the use of lasers and restorative materials.

MATERIALS AND METHODS

Thirty-six cavities were prepared and divided into three groups (n = 12) as follows: Group 1, control; Group 2, Nd:YAG laser irradiation before adhesive technique; Group 3, Nd:YAG laser irradiation after adhesive technique. Nd:YAG laser parameters were 320 micro m of fiberoptics; energy/pulse of 40 mJ of energy/pulse; repetition rate of 15 Hz; power of 0.6 W; pulsed and non-contact, 1 mm from the surface; 30 sec in scanning mode; energy density was 49,76 J/cm(2). Cavities were restored with microhybrid composite. After polishing, thermocycling and impermeabilization procedures were performed and specimens were submitted to a microleakage test, with complete immersion in aqueous solution of 50% silver nitrate for 8 h, in the total absence of light. After washing and drying, teeth were embedded to facilitate buccal-lingual vertical sectioning. Microleakage was revealed by light.

RESULTS

We used the Kruskal-Wallis test at a 5% level of confidence and observed no statistically significant difference among the tested groups.

CONCLUSION

It was possible to conclude that Nd:YAG laser does not influence marginal microleakage on composite restorations, independent of the moment the laser had been used.

Microleakage and nanoleakage: influence of laser in cavity preparation and dentin pretreatment

OBJECTIVE

The purpose of this study was to verify if the application of the Nd:YAG laser following pretreatment of dentin with adhesive systems that were not light cured in class V cavities and were prepared with Er:YAG laser would promote better sealing of the gingival margins when compared to cavities prepared the conventional way.

BACKGROUND DATA

Previous studies had shown that the pretreatment of dentin with laser irradiation after the application of an adhesive system is efficient in achieving higher shear bond and tensile bond strength.

MATERIALS AND METHODS

Er:YAG laser (Kavo-Key, Germany) with 350 mJ, 4 Hz, and 116.7 J/cm2 was used for cavity preparation. The conventional preparation was made with diamond bur mounted in high-speed turbine. Dentin treatment was accomplished using an Nd:YAG laser (Pulse Master 1000, ADT. USA) at 60 mJ, 10 Hz, and 74.65/cm2 following application of the adhesive system. The cavities were stored with Single Bond/Z100 and Prime & Bond NT/TPH. Eighty bovine incisors were used, and class V preparations were done at buccal and lingual surfaces divided into eight groups: (1) Er:YAG preparation + Prime & Bond NT + TPH; (2) Er:YAG preparation + Single Bond + Z100; (3) Er:YAG preparation + Single Bond + Nd:YAG + Z100; (4) Er:YAG preparation + Prime & Bond NT + Nd:YAG + TPH; (5) conventional preparation + Prime & Bond NT + TPH; (6) conventional preparation + Single Bond + Z100; (7) conventional preparation + Single Bond + Nd:YAG + Z100; (8) conventional preparation + Prime & Bond NT + Nd:YAG + TPH. All specimens were thermocycled for 300 full cycles between 5 degrees C+/-2 degrees C and 55 degrees C+/-2 degrees C (dwell time of 30 sec), and stored in 50% silver nitrate solution for 24 h soaked in photodeveloping solution and exposed to fluorescent light for 6 h. After this procedure, the specimens were sectioned longitudinally in 3 portions and the extension of microleakage at the gingival wall was determined following a criteria ranging from 0 to 4 using scanning electron microscopy (SEM). The medium portion sectioned of each specimen was polished and prepared for nanoleakage avaliation by SEM.

RESULTS

Kruskall-Wallis and Miller statistical tests determined that group 3 presented less microleakage and nanoleakage.

CONCLUSION

Application of the Nd:YAG laser following pretreatment of dentin with adhesive Single Bond non-photocured Single Bond adhesive in cavities prepared with Er:YAG promote better sealing of the gingival margins.