High temperature behaviour of hydroxy- and fluorapatite. Crystalchemical implications of laser effects on dental enamel

Real-Time Monitoring of Thermal Phenomena during Femtosecond Ablation of Bone Tissue for Process Control

Femtosecond (fs) laser technology is currently being considered in innovative fields such as osteotomy and treatment of hard tissue thanks to the achievable high resolution and ability to prevent tissue damage. In a previous study, suitable process parameters were obtained to achieve competitive ablation rates on pork femur processing. Nevertheless, a better control of thermal accumulation in the tissue during laser ablation could further improve the postoperative regeneration of the treated bone compared with conventional procedures and push forward the exploitation of such technology. This study presents methods for real time analyses of bone tissue temperature and composition during fs laser ablation and highlights the importance of implementing an efficient cooling method of bone tissue in order to achieve optimized results. Results show that it is possible to achieve a larger process window for bone tissue ablation where bone tissue temperature remains within the protein denaturation temperature in water-based processing environment. This is a key outcome towards a clinical exploitation of the presented technology, where higher process throughputs are necessary. The effects of process parameters and environments on bone tissue were confirmed by LIBS technique, which proved to be an efficient method by which to record real-time variation of bone tissue composition during laser irradiation.

Er:YAG laser osteotomy for removal of impacted teeth: Clinical comparison of two techniques

BACKGROUND AND OBJECTIVES

In contrast to many techniques currently employed for osteotomy, like saws, drills or modulated ultrasound, lasers offer non-contact and low-vibration bone cutting. Therefore, this report examines the benefits to laser osteotomy in oral surgery using two different short-pulsed Er:YAG laser systems.

MATERIALS AND METHODS

Er:YAG lasers, using either a fiber-optic delivery system and an articulated arm delivery system, were used to remove impacted teeth in 30 patients. In 15 patients an Er:YAG laser utilizing a fiber-optic delivery system was applied for cutting bone, with a pulse energy of 500 mJ, a pulse duration of 250 microseconds and frequency of 12 Hz (energy density 177 J/cm(2)). The other 15 patients were treated with an Er:YAG laser utilizing an articulated arm delivery system, with a pulse energy of 1,000 mJ, a pulse duration of 300 microseconds and a frequency of 12 Hz (energy density 157 J/cm(2)).

RESULTS

In all cases the lasers allowed precise bone ablation without any visible, negative, thermal side-effects. Since the laser tip was used in a non-contact mode and could be positioned freely, unrestricted cut geometries were feasible. Adjacent soft tissue structures could be preserved and were not harmed by the laser beam. However, osteotomies were time consuming, especially if teeth had to be separated. The level of water irrigation limited the use of the laser. In 20% of the cases in which the articulated arm delivery laser was used to section teeth, it was necessary to use a conventional dental drill to finish the procedure.

CONCLUSION

This bone ablation technique, using short Er:YAG laser pulses and water spray, produced good clinical results without any impairment to wound healing. However, for now, the lack of depth control and the time required to perform the necessary osteotomy limit routine clinical application.

Physico-chemical changes of human enamel irradiated with ArF excimer laser

BACKGROUND AND OBJECTIVES

Irradiation of tooth enamel by lasers can alter its structure and chemical composition. The purpose of this work was to determine the compositional changes and to elucidate the mechanisms of laser-enamel interaction using ArF excimer laser.

STUDY DESIGN/MATERIALS AND METHODS

Human enamel irradiated with ArF excimer laser (wavelength, 193 nm) at different fluences, was examined using X-ray diffraction, infrared (IR) spectroscopy and microprobe analysis.

RESULTS

Ablation without significant compositional changes in irradiated enamel was evident when low fluences (approximately 200-380 mJ/cm2) were used. However, fluences between 640 and 2,300 mJ/cm2 resulted in an increased Ca/P ratio, decreased amount of carbonate and protein, and the formation of tricalcium phosphate and tetracalcium phosphate, suggesting the involvement of a photothermal mechanism.

CONCLUSIONS

The results show that ArF excimer laser can alter the chemical composition and morphology of the highly mineralized (96%) dental enamel, depending on the fluence used.

In vivo animal trials with a scanning CO2 laser osteotome

BACKGROUND AND OBJECTIVES

We report first results of animal trials using an improved laser osteotomy technique. This technique allows effective bone cutting without the usual thermal tissue damage.

STUDY DESIGN/MATERIALS AND METHODS

A comparative in vivo study on mandibles of seven canines was done with a mechanical saw and a CO(2) laser based osteotome with a pulse duration of 80 microseconds. The laser incisions were performed in a multipass mode using a PC-controlled galvanic beam scanner and an assisting water spray.

RESULTS

A complete healing through a whole bony rearrangement of the osteotomy gap with newly build lamellar Haversian bone was observed 22 days after the laser operations under optimal irradiation conditions.

CONCLUSIONS

An effective CO(2) laser osteotomy without aggravating thermal side effects and healing delay is possible using the described irradiation technique. It allows an arbitrary cut geometry and may result in new advantageous bone surgery procedures.

Sintered hydroxyfluorapatites. Part I: Sintering ability of precipitated solid solution powders

The presence of fluoride within apatites occurring naturally within the body provides the basis for investigating the sintering ability of fluoride containing hydroxyapatites for use as biomaterials. Hydroxyfluorapatites were synthesized and then calcined to produce a 0%, 20%, 40%, 60%, 80% and 100% replacement of the hydroxyl ions with fluoride in the hydroxyapatite structure. Fluoride ion occupancy within the apatites was found to be about 90% of the anticipated value. Pycnometry results revealed a constant true density for powders of low to medium fluoride content followed by a rapid increase to the fluorapatite composition. Powders were uniaxially pressed, cold-isostatically pressed and sintered at 1150 degrees C, 1200 degrees C and 1250 degrees C. All hydroxyfluorapatite powders displayed a comparable ability for densification except when hydroxyl groups and fluoride ions were present at a comparable concentration. The grain size revealed that this composition also exhibited the smallest grain size and displayed the highest activation energy for grain growth. The lower diffusion created by similar amounts of fluoride and hydroxide within the lattice decreases grain growth and densification.

Ultrastructural analysis of bone tissue irradiated by Er:YAG Laser

BACKGROUND AND OBJECTIVES

The use of erbium:yttrium aluminum garnet (Er:YAG) laser has been suggested for bone ablation, however, little is known about the nature of the tissue after irradiation. This study was aimed to analyze the ultrastructure of bone tissue treated with Er:YAG laser, as compared to those treated with CO(2) laser and bur drilling.

STUDY DESIGN/MATERIALS AND METHODS

Parietal bones of Wistar rats were treated and analyzed by light microscopy, transmission electron microscopy (TEM), electron diffraction analysis and energy dispersive X-ray spectroscopy (SEM-EDX).

RESULTS

This study demonstrated that Er:YAG laser irradiation resulted in a very thin changed layer of approximately 30 microm thickness, which consisted of two distinct sub-layers: a superficial, greatly altered layer and a deep, less affected layer.

CONCLUSIONS

The major changes found on bone surface after Er:YAG laser irradiation consisted of micro-cracking, disorganization, and slight recrystallization of the original apatites and reduction of surrounding organic matrix.

Sintering mechanism of the CaF2 on hydroxyapatite by a 10.6-l microm CO2 laser

BACKGROUND AND OBJECTIVES

Laser has been reported as a heat source for melting and re-crystallization. Occurring at about 1100 degrees C, the melting of surface dental enamel along with re-crystallization might have an assistant role in the therapy of hypersensitive tooth, apical sealing of endodontic surgery in dentistry, preventive dentistry for pit and fissure sealing, and fluoridation. For laser to be accepted in clinical applications, it is desired that, studies must show the incorporation of CaF(2) into hydroxyapatite could reduce the sintering temperature for the sake of safety.

STUDY DESIGN/MATERIALS AND METHODS

In this study, the Sharplan 20XJ CO(2) laser with 10.6- microm wavelength was set under the following parameters: power, 5 W; repetitive mode, 0.1 second; beam, focused. Fluorite was added to hydroxyapatite as a synthetic compound to lower the sintering temperature. Human dental enamel without caries was used for in vitro sintering test. Scanning electron microscopy (SEM), X-ray diffractometer (XRD), Fourier transforming infrared spectroscopy (FTIR), and differential thermal analysis/thermogravimetric analysis (DAT/TGA) were used for the investigation of sintering mechanism of CaF(2).

RESULTS

Fusion between hexagonal shape crystals and cubic shape crystals (CaF(2)) were observed under SEM study. Hexagonal shape crystals indicated the formation of fluorapatite under XRD analysis. Under FTIR study, we examined reductions of water (3445 cm(-1)) and hydroxyl bands (3567 and 627 cm(-1)) in irradiated compounds. From the DTA pattern of synthetic compound, it showed the endothermic reaction reaching its peak point around 1180 +/- 20 degrees C. It was attributed to the phase transformation and/or initial melting.

CONCLUSIONS

In this study, we proposed the interrelationship of the eutectics between initiator (CaF(2)) and the reaction product (calcium hydroxide) that reduced the sintering temperature. It appeared that the co-eutectics interacted to reduce the sintering temperature of hydroxyapatite below 800 degrees C and that the key eutectic was calcium hydroxide. The clinical feasibility of the melting and re-crystallization of hydroxyapatite under 10.6-microm CO(2) laser would be therefore enhanced.

Development of a new calcium phosphate cement that contains sodium calcium phosphate

A cement powder consisting of sodium calcium phosphate, Na3Ca6(PO4)5, in addition to tetracalcium phosphate and beta-tricalcium phosphate was prepared by pulverizing blocks of 4 wt% sodium-, 11 wt% carbonate-containing apatite samples that were heated at 1700 degrees C for 5 h. When mixed with 30 wt% malic acid or citric acid at a powder liquid ratio of 3:1, the cement set in 3 or 7 min at room temperature with compressive strength being around 52 or 27 MPa. In HeLa-cell cultures, the cement mixed with malic acid was less cytotoxic than the cement mixed with citric acid, which was far less cytotoxic than a commercial carboxylate cement used as a negative control, suggesting malic acid to be superior to citric acid as a liquid in this regard. Similar findings were also obtained with osteoclasts, of which culture experiments clearly suggested that the number of osteoclasts on the cement mixed with malic acid was significantly greater than that on the cement mixed with citric acid. Since osteoclastic response to substrates could be used as a maker in evaluating their bioresorbability associated with osteoclasts, the above finding may suggest that the cement that is to be mixed with malic acid would be more useful as bone substitutes.

Ultrastructural properties of laser-irradiated and heat-treated dentin

Previous studies using scanning electron microscopy and infrared absorption spectroscopy reported that laser irradiation causes compositional changes in enamel. The purpose of this study was to evaluate the ultrastructural and compositional changes in dentin caused by irradiation with a short-pulse laser (Q-switched Nd:YAG). The irradiated and non-irradiated areas of the lased dentin samples were investigated by scanning (SEM) and transmission electron microscopy (TEM), micro-micro electron diffraction, and electron microprobe analysis of dispersive energy (EDX). Heat-treated dentin was similarly investigated. This study demonstrated that laser irradiation resulted in the recrystallization of dentin apatite and in the formation of additional calcium phosphate phases consisting of magnesium-substituted beta-tricalcium phosphate, beta-TCMP, beta-(Ca,Mg)3(PO4)2, and tetracalcium phosphate, TetCP, Ca4(PO4)O. TEM analyses of the modified and unmodified zones of the irradiated areas showed two types of crystal populations: much larger crystals from the modified zone and crystals with size and morphology similar to those of dentin apatite in the unmodified zone. The morphology of crystals in the modified zones in the irradiated dentin resembled those of dentin sintered at 800 or 950 degrees C. In the irradiated areas (modified and unmodified zones), the Ca/P ratio was lower compared with that in the non-irradiated dentin. The Mg/Ca ratio in the modified zones was higher than that in the unmodified zones and in the non-irradiated dentin. In sintered dentin, the Mg/Ca ratio increased as a function of sintering temperature. The ultrastructural and compositional changes observed in laser-irradiated dentin may be attributed to high temperature and high pressure induced by microplasma during laser irradiation. These changes may alter the solubility of the irradiated dentin, making it less susceptible to acid dissolution or to the caries process.

Healing of large (2 mm) gaps around calcium phosphate-coated bone implants: a study in goats with a follow-up of 6 months

Plasma-sprayed hydroxylapatite (HA) coatings are known for their ability to demonstrate osseointegration with bone. Recently it was found that the amount of bone apposition was strongly reduced 6 weeks after implantation in a goat model if gaps of two millimeters between bone and apatite coating existed. Stability of the apatite coatings examined did not influence the gap-healing ability. This study investigated whether a longer follow-up period of 24 weeks would be sufficient for the restoration of bone apposition on apatite coatings in an identical surgical model with 2 mm gaps, and whether bone apposition on the apatite coatings is influenced by the coating stability. Three coatings were investigated: 25-30% crystalline HA (aHA), 60-63% crystalline HA (cHA), and 85-90% crystalline fluorapatite (FA). Uncoated Ti-6A1-4V implants were used as controls. Implants were inserted in the femoral condyles of both femora of eight goats. Each goat received four implants. Histology revealed that bone formation on each of the apatite coatings remained low and did not increase with an extended follow-up period of 24 weeks. The coatings showed significantly (P < 0.01) more bone contact than the uncoated control implants. The three different coatings did not show significant differences in bone apposition. The aHA coating in most cases had disappeared completely after 24 weeks. Despite the disappearance of the aHA coating, bone contact was seen on the substrate surface without fibrous tissue interposition. The cHA coating showed minor signs of degradation while the FA coatings showed no visible degradation. It is concluded that non-press-fit implantation of apatite-coated implants leads to more bone apposition as compared to uncoated Ti-6A1-4V implants. However, it is suggested by these results that the upper limit of gaps around apatite implants is 2 millimeters in a non-weight-bearing model in goats. Bone apposition will not increase by extending the follow-up period more than six weeks, nor will it be altering the stability of the apatite coatings used.

Healing of gaps around calcium phosphate-coated implants in trabecular bone of the goat

Hydroxylapatite coatings are under clinical investigation in orthopaedics and dentistry. Bone formation on apatite coatings in the presence of gaps is important for clinical applications. The importance of the stability of the coating is not known at present. By varying the plasma-spray parameters, and by the addition of fluoride, the crystallinity and stability of calcium phosphates can be changed. It is suggested that bone formation is enhanced by dissolution of the apatite coating. We studied apatite coatings of varying stability with regard to their gap-healing characteristics, and we examined what the maximum gap would be that can be bridged if a coating is applied. Ti-6A1-4V implants coated with 62% crystalline hydroxylapatite, 30% crystalline hydroxylapatite or fluorapatite, or noncoated Ti-6A1-4V were implanted in 16 goats. The implants were surrounded by gaps of 1 or 2 mm, and the follow-up period was 6 weeks. Histological examination and histometry revealed that gaps of 1 mm can be bridged by bone if an apatite coating is applied. However, only a minimal amount of bone contact was seen on the apatite coatings with 2 mm gaps. Uncoated implants demonstrated no bone contact at all. Among the three different coatings there were no differences in gap healing. It can be concluded that in the goat, gaps of 2 or more mm between coated implants and host bone tissue inhibit bone deposition on the coating (p < 0.05), but the stability of the coating does not influence gap-healing characteristics.

Enamel surface roughness analysis after laser ablation and acid-etching

Laser-roughened enamel surfaces have been shown to provide for greater acid-resistance and enhanced restorative material/enamel bond strength. Extracted tooth enamel was irradiated with several lasers: CO2/Nd:YAG (CW), CO2 (RSP), Nd:YAG (CW), Nd:YAG (Q-switched), Argon (CW), and Ar:F excimer. Additional teeth were acid-etched. Energy densities were standardized at 25.47 J/cm2 for all mediums. Surface profile analyses were conducted with a profilometer to determine the amount of enamel surface roughness. The acid-etched samples exhibited both a greater amount of surface roughness and a qualitatively different type of enamel surface morphology than the laser-treated specimens. Independent use of the CO2 and Nd:YAG beams exhibited a moderate amount of roughness, while the coaxial CO2/Nd:YAG beam displayed surface roughness approaching that of the acid-etch samples. Different laser mediums produce enamel surface morphologies that are characteristic of a variety of inherent lasing parameters.

Effect of the ArF excimer laser on human enamel

Human enamel surface was irradiated with ArF excimer laser and examined under light microscopy and scanning electron microscopy (SEM). Enamel surface was irradiated at three different areas with different energy fluences. It is demonstrated that the ArF excimer laser causes ablation of the calcified hard enamel tissue. Ablation curves were measured. There was no significant difference found in the etch depth between the three different areas of enamel surface. The morphology of the irradiated areas seen under the SEM was found to be dependent on energy fluence. It changed with increase in energy fluence from being etched to forming a smooth, fused, glaze-like surface and then at very high energy fluences producing a rough surface. The influence of the laser irradiation was confined to the irradiated area only, with no visible heat damage to the surroundings. These results suggest that excimer laser could be applied in a controlled and defined manner for tooth enamel treatments in dentistry.

Experimental studies of the application of the Er:YAG laser on dental hard substances: I. Measurement of the ablation rate

Up to now lasers have not achieved any practical importance in dentistry for drilling teeth because of considerable damage to the surrounding tissue. We studied the application of pulsed 2.94 microns Er:YAG laser radiation in vitro on extracted teeth to remove enamel, dentin, and carious lesions. The depth and diameter of laser-drilled holes were measured as a function of pulse number and radiant exposure. The tissue removal is very effective both for dentin and enamel.

The ultrastructure of human dental enamel heat-treated in the temperature range 200 degrees C to 600 degrees C

Heating enamel in the temperature range 200 degrees C to 600 degrees C resulted in poor crystal packing due to void formation, permanent change in the sign of its birefringence (from negative to positive) in some areas, and an altered crystal morphology. Transmission electron microscopy of enamel heated in the temperature range 200 degrees C to 400 degrees C revealed that the distinction between the positively birefringent regions and the negatively birefringent regions (which were present up to 350 degrees C and occasionally up to 400 degrees C) at the tooth's surface was due to the greater volume of intra- and inter-crystalline voids within the positively birefringent regions. There was a significant increase in void volume at 400 degrees C, and above this all of the enamel was positively birefringent and opaque. Large remineralized crystals of beta-tricalcium phosphate (beta-TCP) phase (whitlockite) were initially formed at 400 degrees C, and their size and number increased at 500 degrees C and above. Both the greater solubility of beta-TCP crystals and the increased surface area due to the presence of voids would increase the rate of demineralization of heat-treated enamel.

Thermal effects of lasers on dental tissues

The thermal effects of Nd:YAG, argon, and CO2 laser beams are observed on enamel, dentin, and dental pulp by means of computerized infrared thermography and thermocouple. This study shows that the Nd:YAG laser beam deeply diffuses through the enamel and dentin to the pulp. The argon laser effects are inconsistent depending on whether the enamel surface is cleaned, but after cleaning, the superficial and deep temperatures are low. With the CO2 laser, the enamel and dentin surfaces reach very high temperatures, but only low temperatures are measured in the pulp chamber.

Changes in heated and in laser-irradiated human tooth enamel and their probable effects on solubility

Enamel of intact human teeth laser irradiated in vitro under certain conditions is known to have less subsurface demineralization than unirradiated enamel on exposure to acid; consequently, the potential use of laser irradiance to reduce caries is apparent. The laser-induced physical and/or chemical changes that cause this reduced subsurface demineralization are not known. A laser-irradiated tooth enamel surface will have a temperature gradient that decreases towards the dentin junction. Dependent on irradiant conditions, the temperature may range from greater than 1400 degrees C at the surface to near normal at the dentin-pulp junction. Along this steep temperature gradient, different compositional, structural, and phase changes in the tooth enamel are to be expected. Identification of changes occurring along this gradient has bearing on understanding the dissolution reduction mechanism and, in turn, optimizing its effect. Changes in laser-irradiated material from the highest temperature region have been characterized, but those occurring in sequential layers of decreasing temperatures have not. Since the laser-induced changes are expected to primarily arise from localized heating, previously reported thermally induced changes in tooth enamel on heating in conventional furnaces were utilized to infer corollary changes along the gradient in laser-irradiated tooth enamel. These thermally inferred changes which resulted in modifications in the tooth enamel apatite and/or newly formed phases were correlated with their probable effects on altering solubility. A temperature gradient range from 100-1600 degrees C was considered with subdivisions as follows: I, 100-650 degrees C; II, 650-1100 degrees C; and III, greater than 1100 degrees C. Two of the products formed in range III, alpha-Ca3(PO4)2 and Ca4(PO4)2O, and also identified in the fused-melted material from laser-irradiated tooth enamel, are expected to markedly increase solubility in those regions that contain considerable amounts of these compounds. Products and changes occurring in range II, separate phases of alpha- and/or beta-Ca3(PO4)2 and a modified phase of apatite, may increase or decrease the solubility depending on the Ca/P ratio and the resultant amounts of alpha-, beta-Ca3(PO4)2 formed. Modifications in tooth enamel apatite effected in range I are expected to decrease its solubility; the formation of pyrophosphate in this range may have a substantial effect on reducing the solubility rate.(ABSTRACT TRUNCATED AT 400 WORDS)

Compositional, structural, and phase changes in in vitro laser-irradiated human tooth enamel

Tooth enamel laser irradiated under certain conditions previously has been shown to have reduced subsurface demineralization rates. Identification of these laser-induced changes has bearing on understanding the dissolution rate reduction mechanism; some of these changes, ones that occur in high temperature regions, were studied in this report. X-ray diffraction and infrared spectroscopy were used to identify changes in enamel of extracted intact human teeth subjected to high energy density (approximately 10,000 J/cm2) 10.6 microns wavelength carbon dioxide laser irradiance. The laser irradiance melted the enamel apatite; this solidified melt was composed of minor phases of alpha-tricalcium phosphate, alpha-Ca3 (PO4)2, and tetracalcium phosphate, Ca4(PO4)2O, and a major phase of modified apatite. The apatite modifications, as compared with the original were (1) reductions in contents of water, protein, carbonate, and chloride (or chloride rearrangement); (2) essentially no change in apatite hydroxide content; (3) possible incorporation of oxide replacing some hydroxide ions; and (4) an uptake of traces of carbon dioxide and cyanate. An infrared band at 434 cm-1 that appears in spectra of hydroxyapatite partially dehydroxylated by thermal treatment was assigned to oxide translation. This band was utilized to search for oxide formation in the laser-irradiated tooth enamel.

Bioceramics consisting of calcium phosphate salts

After a discussion of the chemical considerations involved in the production of calcium phosphate ceramics, animal and clinical studies are reviewed. Specific conclusions are that although these ceramics have high compressive strengths, they are not suitable for joint replacements. Prevention of alveolar ridge resorption is a promising concept, and space-filling and use of aids for jaw-bone enlargement are proposed for routine clinical application.