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Santos RMC, Scatolin RS, de Souza Salvador SL, Souza-Gabriel AE, Corona SAM. Er:YAG laser in selective caries removal and dentin treatment with chitosan: a randomized clinical trial in primary molars. Lasers Med Sci 2023; 38:208. [PMID: 37697177 DOI: 10.1007/s10103-023-03869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
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.
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Affiliation(s)
- Rai Matheus Carvalho Santos
- Department of Pediatric Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Renata Siqueira Scatolin
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Avenida do Café, Ribeirão Preto, São Paulo, S/N, 14040-904, Brazil
| | - Sérgio Luiz de Souza Salvador
- Department of Clinical Toxicology and Bromatology of the School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Aline Evangelista Souza-Gabriel
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Avenida do Café, Ribeirão Preto, São Paulo, S/N, 14040-904, Brazil
| | - Silmara Aparecida Milori Corona
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Avenida do Café, Ribeirão Preto, São Paulo, S/N, 14040-904, Brazil.
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Curylofo-Zotti FA, Tedesco AC, Lizarelli GTC, Takahashi LAU, Corona SAM. Effect of green tea-loaded chitosan nanoparticles on leathery dentin microhardness. Odontology 2021; 109:860-867. [PMID: 33963944 DOI: 10.1007/s10266-021-00611-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/28/2021] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Fabiana Almeida Curylofo-Zotti
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Cafe Avenue, s/n, Ribeirão Preto, São Paulo, 14040-904, Brazil.
| | - Antonio Claudio Tedesco
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering -Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Gustavo Teodoro Costa Lizarelli
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Cafe Avenue, s/n, Ribeirão Preto, São Paulo, 14040-904, Brazil
| | - Luandra Aparecida Unten Takahashi
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering -Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Silmara Aparecida Milori Corona
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Cafe Avenue, s/n, Ribeirão Preto, São Paulo, 14040-904, Brazil
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Sarmadi R, Andersson EV, Lingström P, Gabre P. A Randomized Controlled Trial Comparing Er:YAG Laser and Rotary Bur in the Excavation of Caries - Patients' Experiences and the Quality of Composite Restoration. Open Dent J 2018; 12:443-454. [PMID: 29988202 PMCID: PMC5997848 DOI: 10.2174/1874210601812010443] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/23/2018] [Accepted: 05/14/2018] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to evaluate patients´ experiences of two excavation methods, Er:YAG laser and rotary bur and time required by the methods as well as objective assessments of quality and durability of restorations over a two-year period. Methods A prospective, single-blind, randomized and controlled investigation was performed. Patients aged 15 to 40 years with at least two primary caries lesions, which had been radiographically assessed as of the same size, were recruited. In each patient, one cavity was excavated using rotary bur and one using Er:YAG laser technique. The time required for excavations and, where applicable, local anaesthesia, was measured during the treatments. Patient experiences were measured using questionnaires. The quality and durability of restorations were assessed over a two-year period in accordance with modified Ryges criteria and radiographs. Twenty-five patients (mean age 22.6 years) participated in the study. In total, 56 cavities were included of which 28 were treated with Er:YAG laser and 28 were treated with a rotary bur. Results The patients associated the laser method with less discomfort. The mean time for excavation by laser was three times longer than by rotary bur (13.2 min vs. 4.3 min, P<0.0001). Over a two-year period, no statistically significant differences with regard to quality or durability could be seen between the restorations associated with the methods. Conclusion The Er:YAG laser technique was more time-consuming than the rotary bur. Despite this, the laser technique caused less discomfort and was preferred as an excavation method by patients.
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Affiliation(s)
- Roxana Sarmadi
- Department of Paediatric Dentistry, Public Dental Health, Uppsala County Council, Uppsala, Sweden.,Department of Cariology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elin Viktoria Andersson
- Department of Paediatric Dentistry, Public Dental Health, Uppsala County Council, Uppsala, Sweden
| | - Peter Lingström
- Department of Cariology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pia Gabre
- Department of Preventive Dentistry, Public Dental Health, Uppsala County Council, Uppsala, Sweden.,Department of Cariology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kellesarian SV, Ros Malignaggi V, Aldosary KM, Javed F. Laser-assisted removal of all ceramic fixed dental prostheses: A comprehensive review. J ESTHET RESTOR DENT 2017; 30:216-222. [DOI: 10.1111/jerd.12360] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/06/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Sergio Varela Kellesarian
- Department of General Dentistry; Eastman Institute for Oral Health, University of Rochester; New York
| | - Vanessa Ros Malignaggi
- Department of General Dentistry; Dental School, Santa Maria University; Caracas Venezuela
| | - Khaled M. Aldosary
- King Khaled University Hospital; King Saud University; Riyadh Saudi Arabia
| | - Fawad Javed
- Department of General Dentistry; Eastman Institute for Oral Health, University of Rochester; New York
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Tao S, Li L, Yuan H, Tao S, Cheng Y, He L, Li J. Erbium Laser Technology vs Traditional Drilling for Caries Removal: A Systematic Review with Meta-Analysis. J Evid Based Dent Pract 2017; 17:324-334. [PMID: 29197434 DOI: 10.1016/j.jebdp.2017.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The study aimed to assess the efficacy of erbium laser technology compared with traditional drilling for caries removal. METHODS A systematic search was conducted through Medline via PubMed, Embase, Cochrane databases, CNKI till December 2016. Randomised controlled trials, quasi-randomized controlled trials, or controlled clinical trials with data comparing the efficacy of erbium laser technology versus traditional drilling for caries removal were included. RESULTS Fourteen studies were selected in our meta-analysis. Erbium laser technology showed an increased time when removing caries compared with drilling (mean difference: 3.48, 95% confidence interval: 1.90-5.06, P < .0001). However, erbium laser technology reduced the requirement for local anesthesia (risk ratio: 0.28, 95% confidence interval: 0.13-0.62, P = .002). Erbium laser technology was also not significantly different to traditional drilling with regard to restoration loss, pulpal vitality, and postoperative sensitivity. CONCLUSIONS Erbium laser technology showed an increased time for cavity preparation compared with traditional drilling. However, erbium laser technology reduced the requirement for local anesthesia. There was no significant difference between erbium laser technology and traditional drilling regarding restoration loss, pulpal vitality, and postoperative sensitivity.
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Affiliation(s)
- Siying Tao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lan Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - He Yuan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sibei Tao
- Renal Division, Department of Internal Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yiming Cheng
- Renal Division, Department of Internal Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Libang He
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Korkut E, Gezgin O, Özer H, Şener Y. Evaluation of Er:YAG lasers on pain perception in pediatric patients during caries removal: a split-mouth study. ACTA ODONTOLOGICA TURCICA 2017. [DOI: 10.17214/gaziaot.296473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Curylofo-Zotti FA, Tanta GS, Zucoloto ML, Souza-Gabriel AE, Corona SAM. Selective removal of carious lesion with Er:YAG laser followed by dentin biomodification with chitosan. Lasers Med Sci 2017; 32:1595-1603. [PMID: 28762194 DOI: 10.1007/s10103-017-2287-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to evaluate the effect of Er:YAG laser for selective removal of carious lesion, followed by biomodification with chitosan gel where the subsurface microhardness, chemical composition, and morphological changes of the residual caries-affected dentin were examined. Artificial dentinal lesions were created by pH-cycling method (14 days) in 104 bovine specimens (5 × 5 mm). Specimens were randomly divided according to the carious removal method: bur (low-speed handpiece) or Er:YAG laser (250 mJ/4 Hz). Specimens were treated with 35% phosphoric acid and were subdivided into two groups according to dentin biomodification: without chitosan (control) and 2.5% chitosan. Forty specimens were restored with an adhesive system and composite resin. Subsurface microhardness tests were performed in sound dentin, caries-affected dentin, residual caries-affected dentin, and after the restoration. The other 64 specimens were subjected to SEM-EDS atomic analysis. Data were statistically analyzed (p < 0.05). After the Er:YAG laser excavation, the microhardness value of residual caries-affected dentin was higher (p < 0.05) than bur-treated dentin. A significant decrease in the amount of Ca, P, and Ca/P ratio was found after the removal of carious lesions with Er:YAG laser (p < 0.05). The biomodification with chitosan did not influence the microhardness and atomic percentage of Ca, P, and Ca/P ratio of residual caries-affected dentin (p > 0.05). SEM analysis showed morphological changes on residual caries-affected dentin (p > 0.05). The selective removal of carious dentin with Er:YAG laser increased microhardness of residual caries-affected dentin, changing its surface morphology and chemical composition. The biomodification with chitosan did not influence the structural and chemical composition of residual caries-affected dentin.
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Affiliation(s)
- Fabiana A Curylofo-Zotti
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-904, Brazil.
| | - Gabriela Solano Tanta
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-904, Brazil
| | - Miriane Lucindo Zucoloto
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, 14049-900, Brazil
| | - Aline E Souza-Gabriel
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-904, Brazil
| | - Silmara A M Corona
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-904, Brazil
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He Z, Chen L, Hu X, Shimada Y, Otsuki M, Tagami J, Ruan S. Mechanical properties and molecular structure analysis of subsurface dentin after Er:YAG laser irradiation. J Mech Behav Biomed Mater 2017. [PMID: 28646753 DOI: 10.1016/j.jmbbm.2017.05.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to evaluate the chemical and mechanical modifications in subsurface dentin layer after Er: YAG (Erbium-Yttrium Aluminium Garnet) laser irradiation, as the guidance of new dental restorative materials specific for laser irradiated dentin. MATERIALS AND METHODS Dentin disks obtained from extracted human molars were prepared and exposed to a single pulse Er:YAG laser irradiation at 80mJ/pulse. After laser irradiation the mechanical and chemical characteristics of intertubular dentin in subsurface layer were studied using nanoindentation tester and micro-Raman spectromy (μ-RS). The dentin 5-50µm depth beneath the lased surface was determined as testing area. Two-way analysis of variance (ANOVA) were used to compare the mechanical values between lased and untreated subsurface dentin (P = 0.05). RESULTS A laser affected subsurface dentin layer after Er:YAG laser treatment is present. The laser irradiation is considered to decrease the mechanical properties in the superficial subsurface layer (<15µm deep). There was no significant difference in nanohardness and Young's modulus between lased subsurface dentin and untreated dentin (p > 0.05) under the depth of 15µm. However, the dentin at 5µm and 10µm depth beneath the lased surface exhibited significantly lower (~ 47.8% and ~ 33.6% respectively) hardness (p < 0.05). Er:YAG laser irradiation affected both mineral and organic components in subsurface dentin layer, a higher degree of crystallinity and reduced organic compounds occurred in the lased subsurface dentin. CONCLUSION Under the tested laser parameters, Er:YAG laser irradiation causes lower mechanical values and reduction of organic components in subsurface dentin, which has deleterious effects on resin adhesion to this area.
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Affiliation(s)
- Zhengdi He
- Shenzhen Key Laboratory of Laser Engineering, College of Optoelectronic Engineering, Shenzhen University, Nanhai Road 3688, Shenzhen, Guangdong 518060, China.
| | - Lingling Chen
- Shenzhen Key Laboratory of Laser Engineering, College of Optoelectronic Engineering, Shenzhen University, Nanhai Road 3688, Shenzhen, Guangdong 518060, China.
| | - Xuejuan Hu
- Shenzhen Key Laboratory of Laser Engineering, College of Optoelectronic Engineering, Shenzhen University, Nanhai Road 3688, Shenzhen, Guangdong 518060, China.
| | - Yasushi Shimada
- Cariology and Operative Dentistry, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
| | - Masayuki Otsuki
- Cariology and Operative Dentistry, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
| | - Junji Tagami
- Cariology and Operative Dentistry, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
| | - Shuangchen Ruan
- Shenzhen Key Laboratory of Laser Engineering, College of Optoelectronic Engineering, Shenzhen University, Nanhai Road 3688, Shenzhen, Guangdong 518060, China.
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Effect of Er:Yag laser on dentin demineralization around restorations. Lasers Med Sci 2017; 32:413-418. [PMID: 28054260 DOI: 10.1007/s10103-016-2136-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
Abstract
The aim of this study was to evaluate the effect of cavity preparation with Er:YAG laser on dentin adjacent to restorations submitted to cariogenic challenge in situ, by subsuperficial microhardness analysis. Bovine incisors were sectioned, flattened, and polished, resulting in 40 dentin slabs. The slabs were randomly assigned to four groups (n = 10), according to the cavity preparation method: I-high-speed handpiece (control); II-Er:YAG laser (160 mJ; 3 Hz); III-Er:YAG laser (260 mJ; 3 Hz); IV-Er:YAG laser (300 mJ; 3Hz). Cavities were restored with composite resin, and the specimens were fixed in intra-oral appliances, which were worn by 10 volunteers for 14 days for simulating cariogenic challenge in situ. During the experimental period, 20% sucrose solution was dripped over each specimen 6 times a day. Samples were removed, sectioned, and examined for subsuperficial Knoop microhardness at 100, 200, and 300 μm from the restoration and at 30 μm from dentin surface. Split-plot analysis of variance showed no significant difference among the cavity preparation techniques (p = 0.1129), among distances (p = 0.9030), as well as no difference in the interaction between the main factors (p = 0.7338). It was concluded that the cavity preparation with Er:YAG laser did not influence on dentin microhardness submitted to cariogenic challenge in situ.
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Montedori A, Abraha I, Orso M, D'Errico PG, Pagano S, Lombardo G. Lasers for caries removal in deciduous and permanent teeth. Cochrane Database Syst Rev 2016; 9:CD010229. [PMID: 27666123 PMCID: PMC6457657 DOI: 10.1002/14651858.cd010229.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite considerable improvements in oral health, dental caries continue to be a public health issue. The most frequently used, and universally accepted technique, to remove caries is through mechanical ablation of decayed tissues by means of rotating drills (diamond or tungsten carbide, or both). In the past few decades, the introduction of adhesive filling materials (resin composites) has affected cavity filling procedures by reducing its retention needs, with advantages for dental tissue conservation. Consequently, new minimally invasive strategies were introduced into dental practice, such as the use of lasers to perform highly controlled tissue ablation. Laser use has also raised expectations of limiting pain and discomfort compared to using drills, as well as overcoming drill phobia. OBJECTIVES The main objective of the review was to compare the effects of laser-based methods to conventional mechanical methods for removing dental caries in deciduous and permanent teeth. SEARCH METHODS We searched the following electronic databases: Cochrane Oral Health's Trials Register (searched 22 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 5) in the Cochrane Library (searched 22 June 2016), MEDLINE Ovid (1946 to 22 June 2016), Embase Ovid (1980 to 22 June 2016), ProQuest Dissertations and Theses (1980 to 22 June 2016), Zetoc (limited to conference proceedings) (1993 to 22 June 2016), and ISI Web of Knowledge (limited to conference proceedings) (1990 to 22 June 2016). We checked the reference lists of relevant articles to identify additional studies. We searched the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. SELECTION CRITERIA We included randomised controlled trials, split-mouth trials and cluster-randomised trials (irrespective of their language) comparing laser therapy to drill ablation of caries. We included participants of any age (children, adolescents and adults). DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts of citations identified by the review search strategy. Two review authors independently evaluated the full text of relevant primary studies, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included nine randomised trials, published between 1998 and 2014, involving 662 participants. The population consisted of both children and adolescents in four trials, only adults in four trials, and both children/adolescents and adults in one trial. Four studies examined only permanent teeth, and five studies evaluated both deciduous and permanent teeth. Six trials used Er:YAG (erbium-doped yttrium aluminium garnet) lasers, two trials employed Er,Cr:YSGG (erbium, chromium: yttrium-scandium-gallium-garnet) lasers, and one trial used Nd:YAG (neodymium-doped yttrium aluminium garnet) laser.Overall, the trials had small sample sizes, and the majority were at unclear or high risk of bias. The primary outcomes were evaluated in a limited number of trials (removal of caries (four trials (but only two reported quantitative data)); episodes of pain (five studies)). There was insufficient evidence to suggest that either lasers or drill were better at caries removal (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.99 to 1.01; 2 studies; 256 treated caries; P = 0.75; I2 = 0%; low-quality evidence).The incidence of moderate or high pain was greater in the drill group compared to the laser group (RR 0.40, 95% CI 0.28 to 0.57; 2 studies; 143 participants; P < 0.001; I2 = 50%). Similarly, the need for anaesthesia was significantly higher in the drill group than in the laser group (RR 0.25, 95% CI 0.10 to 0.65; 3 studies; 217 children/adolescents; P = 0.004; I2 = 0%).In terms of marginal integrity of restoration, there was no evidence of a difference between laser and drill comparisons evaluated at 6 months (RR 1.00, 95% CI 0.21 to 4.78; 3 studies), 1 year (RR 1.59, 95% CI 0.34 to 7.38; 2 studies), or 2 years (RR 1.00, 95% CI 0.21 to 4.74; 1 study).There was no evidence of a difference for durability of restoration between laser therapy or drill at 6 months' follow-up (RR 2.40, 95% CI 0.65 to 8.77; 4 studies), at 1 year (RR 1.40, 95% CI 0.29 to 6.78; 2 studies) or at 2 years' follow-up (RR 0.50, 95% CI 0.02 to 14.60; 1 study).Only two trials investigated the recurrence of caries, but no events occurred during 6 months' follow-up.There was insufficient evidence of a difference between laser or drill in terms of pulpal inflammation or necrosis at 1 week (RR 1.51, 95% CI 0.26 to 8.75; 3 studies) and at 6 months (RR 0.99, 95% CI 0.10 to 9.41; 2 studies). AUTHORS' CONCLUSIONS Given the low quality of the body of evidence, we concluded that evidence was insufficient to support the use of laser as an alternative to traditional drill therapy for caries removal. We found some evidence in favour of laser therapy for pain control, need of anaesthesia and patient discomfort, but, again, the body of evidence was of low quality. Additional well-designed, randomised trials investigating the most relevant outcomes are needed.
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Affiliation(s)
- Alessandro Montedori
- Regional Health Authority of UmbriaHealth Planning ServiceVia Mario Angeloni 61PerugiaUmbriaItaly06124
| | - Iosief Abraha
- Regional Health Authority of UmbriaHealth Planning ServiceVia Mario Angeloni 61PerugiaUmbriaItaly06124
| | - Massimiliano Orso
- Regional Health Authority of UmbriaHealth Planning ServiceVia Mario Angeloni 61PerugiaUmbriaItaly06124
| | - Potito Giuseppe D'Errico
- University of PerugiaDipartimento di Scienze Chirurgiche, Radiologiche e OdontostomatologicheOspedale S. Maria della Misericordia ‐ S. Andrea delle FrattePerugiaUmbriaItaly06156
| | - Stefano Pagano
- University of PerugiaDipartimento di Scienze Chirurgiche, Radiologiche e OdontostomatologicheOspedale S. Maria della Misericordia ‐ S. Andrea delle FrattePerugiaUmbriaItaly06156
| | - Guido Lombardo
- University of PerugiaDipartimento di Scienze Chirurgiche, Radiologiche e OdontostomatologicheOspedale S. Maria della Misericordia ‐ S. Andrea delle FrattePerugiaUmbriaItaly06156
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Najeeb S, Khurshid Z, Zafar MS, Ajlal S. Applications of Light Amplification by Stimulated Emission of Radiation (Lasers) for Restorative Dentistry. Med Princ Pract 2015; 25:201-11. [PMID: 26642047 PMCID: PMC5588377 DOI: 10.1159/000443144] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 12/06/2015] [Indexed: 01/24/2023] Open
Abstract
Light amplification by stimulated emission of radiation (laser) has been used widely in a range of biomedical and dental applications in recent years. In the field of restorative dentistry, various kinds of lasers have been developed for diagnostic (e.g. caries detection) and operative applications (e.g. tooth ablation, cavity preparation, restorations, bleaching). The main benefits for laser applications are patient comfort, pain relief and better results for specific applications. Major concerns for using dental lasers frequently are high cost, need for specialized training and sensitivity of the technique, thereby compromising its usefulness particularly in developing countries. The main aim of this paper is to evaluate and summarize the applications of lasers in restorative dentistry, including a comparison of the applications of lasers for major restorative dental procedures and conventional clinical approaches. A remarkable increase in the use of lasers for dental application is expected in the near future.
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Affiliation(s)
- Shariq Najeeb
- School of Clinical Dentistry, University of Sheffield, Riyadh, Saudi Arabia
- Department of Applied Sciences, Restorative Dental Sciences, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - Zohaib Khurshid
- School of Metallurgy and Materials, University of Birmingham, Birmingham, UK
| | - Muhammad Sohail Zafar
- Department of Restorative Dental Sciences, Taibah University College of Dentistry, Medina, Riyadh
| | - Syed Ajlal
- Department of Applied Sciences, King Saud University, Riyadh, Saudi Arabia
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Ding J, Ebihara A, Watanabe S, Iino Y, Kokuzawa C, Anjo T, Suda H, Sumi Y. Application of optical coherence tomography to identify pulp exposure during access cavity preparation using an Er:YAG laser. Photomed Laser Surg 2015; 32:356-9. [PMID: 24905930 DOI: 10.1089/pho.2013.3688] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The study aimed to evaluate the ability of optical coherence tomography (OCT) to guide and identify pulp exposure using an erbium: yttrium-aluminum-garnet (Er:YAG) laser. BACKGROUND DATA The Er:YAG laser has been proven to be effective in ablating dental hard tissue and offers advantages, as there is none of the vibration and noise you get with conventional methods, but it has limitations in relation to the tactile feedback that would aid in identification of entry into the pulp chamber. Based on depth-resolved optical reflectivity, OCT technology has been developed to provide high-resolution, cross-sectional images of the internal structure of biological tissues. MATERIALS AND METHODS The pulp chambers of 20 human mandibular incisors were examined, and the average thickness of hard tissue covering the pulp chamber was assessed using micro-computed tomography (micro-CT) images. An Er:YAG laser was used to gradually penetrate the hard tissue over the pulp chamber under microscopic guidance. The preparation was constantly imaged using a swept-source OCT at 10 sec intervals until a pulp chamber exposure was identified using the technology. The pulp exposure was re-examined under the microscope and compared with micro-CT images for verification. RESULTS The pulp exposures of 20 incisors were all verified microscopically and with micro-CT images. The thickness of hard tissue penetrated by the laser ranged from 0.44 to 1.69 mm. CONCLUSIONS Swept-source OCT is a useful tool for identifying pulp exposure during access opening with the Er: YAG laser.
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Affiliation(s)
- Jiangfeng Ding
- 1 Department of Stomatology, Nanshan Affiliated Hospital of Guangdong Medical College , Shenzhen, Guangdong, China
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Caries removal in deciduous teeth using an Er:YAG laser: a randomized split-mouth clinical trial. Clin Oral Investig 2015; 20:65-73. [PMID: 25877234 DOI: 10.1007/s00784-015-1470-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of the present clinical randomized split-mouth study was to evaluate the effectiveness and efficiency of an Er:YAG laser for caries removal in primary molars, microbiological dentin analysis, and clinical restorations after 1 year in 29 children. MATERIALS AND METHODS The children's teeth were randomized into two groups: (I) an Er:YAG laser group and (II) a bur preparation group. The efficiency of the treatments (the time necessary for the removal of carious tissue) was evaluated based on the time spent on caries removal in the deciduous molars. The effectiveness (caries removal capacity) of the caries removal was determined by means of a blind test in which the examiner performed a tactile and visual examination of the dentin. Microbiological analysis was performed by counting the Streptococcus mutans and Lactobacillus sp in the remaining dentin. Clinical analysis of restorations was performed using the USPHS method in combination with photographs of restored teeth, 7 days after the restorative procedure and again after 1 year. All cavities were restored with the Adper Single Bond 2/Filtek Z350 system. The obtained data were analyzed with a significance level of 5 %. RESULTS The Er:YAG laser was less effective and had the same efficacy as bur preparation during caries removal at the pulpal wall of deciduous molars. In the surrounding walls, bur preparation was the more effective method. Regardless of the method employed, the affected dentin in the pulpal wall had similar amounts of S. mutans and Lactobacillus sp. The restorations were clinically accepted by the USPHS method over a 1-year period. CONCLUSION It can be concluded that caries removal with an Er:YAG laser has no influence on the clinical behavior of restorations. CLINICAL RELEVANCE Irradiation with an Er:YAG laser is appropriate for caries removal in primary teeth.
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Schwendicke F, Paris S, Tu YK. Effects of using different criteria for caries removal: A systematic review and network meta-analysis. J Dent 2015; 43:1-15. [DOI: 10.1016/j.jdent.2014.10.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 11/15/2022] Open
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Er:YAG Laser Dental Treatment of Patients Affected by Epidermolysis Bullosa. Case Rep Dent 2014; 2014:421783. [PMID: 25431688 PMCID: PMC4238183 DOI: 10.1155/2014/421783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/09/2014] [Accepted: 10/10/2014] [Indexed: 11/18/2022] Open
Abstract
Aim. The purpose of this study was to evaluate the efficacy of Er:YAG laser used for treating hard dental tissue in patients with epidermolysis bullosa (EB). Methods. We report two cases of EB in which an Er:YAG laser was used for conservative treatments. In the first case, the Er:YAG laser (2,940 μm, 265 mJ, 25 Hz) was used to treat caries on a deciduous maxillary canine in an 8-year-old male patient affected by dystrophic EB. In the second case, we treated a 26-year-old female patient, affected by junctional EB, with generalized enamel hypoplasia, and an Er:YAG laser (2,940 μm, 265 mJ, 25 Hz) was used to remove the damaged enamel on maxillary incisors. Results. The use of the Er:YAG laser, with the appropriate energy, was effective in the selective removal of carious tissue and enamel hypoplasia. During dental treatment with the Er:YAG laser, patients required only a few interruptions due to the absence of pain, vibration, and noise. Conclusions. Laser treatment of hard dental tissues is a valuable choice for patients affected by EB since it is less invasive compared to conventional treatment, resulting in improved patient compliance.
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Okamoto KI, Aoki S, Tamura Y. Comparisons of discomfort among cutting instruments for removal of carious dentine in children. PEDIATRIC DENTAL JOURNAL 2014. [DOI: 10.1016/j.pdj.2014.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Victoria Torres Toro C, Dos Reis Derceli J, Jendiroba Faraoni-Romano J, Marchi P, Djalma Pécora J, Guenka Palma-Dibb R. The use of an Er:YAG laser to remove demineralized dentin and its influence on dentin permeability. Microsc Res Tech 2012; 76:225-30. [DOI: 10.1002/jemt.22156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 10/29/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Carmen Victoria Torres Toro
- Department of Restorative Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; CEP 14040-904; Ribeirão Preto; SP; Brazil
| | - Juliana Dos Reis Derceli
- Department of Restorative Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; CEP 14040-904; Ribeirão Preto; SP; Brazil
| | - Juliana Jendiroba Faraoni-Romano
- Department of Restorative Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; CEP 14040-904; Ribeirão Preto; SP; Brazil
| | - Patricia Marchi
- Department of Restorative Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; CEP 14040-904; Ribeirão Preto; SP; Brazil
| | - Jesus Djalma Pécora
- Department of Restorative Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; CEP 14040-904; Ribeirão Preto; SP; Brazil
| | - Regina Guenka Palma-Dibb
- Department of Restorative Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; CEP 14040-904; Ribeirão Preto; SP; Brazil
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Schwass DR, Leichter JW, Purton DG, Swain MV. Evaluating the efficiency of caries removal using an Er:YAG laser driven by fluorescence feedback control. Arch Oral Biol 2012; 58:603-10. [PMID: 23123070 DOI: 10.1016/j.archoralbio.2012.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/21/2012] [Accepted: 09/25/2012] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Caries lesions in dental hard tissues autofluoresce when exposed to light of certain wavelengths, whereas sound tissues do not, and this can be used as an in vitro histological marker for dental caries. Detection of autofluorescence is the basis of KaVo DIAGNOdent™ technology, and provides objective feedback control of laser-stimulated ablation of dental caries for the KaVo Key Laser 3™. This Er:YAG laser operates at 2940nm wavelength, and is effective at removal of infected dental hard tissues. Micro-computed tomography (micro-CT) allows the non-invasive investigation of three-dimensional structures and analysis of mineral density profiles of dentine following laser ablation. OBJECTIVE To evaluate removal of infected, demineralised dentine by Er:YAG irradiation with a laser feedback mechanism, using micro-CT. DESIGN 27 carious teeth (1 control) and 1 sound tooth, treated with the KaVo Key Laser 3™ using a KaVo™ non-contact 2060 handpiece at specific feedback settings, were examined using a Skyscan 1172 Micro-CT, to observe the efficiency of demineralised dentine removal. Grey scale images obtained were colour rendered to assist detection of demineralised tissue if present. RESULTS Complete removal of demineralised tissue occurred with laser-stimulated ablation under feedback control at values of 7 and 8 when measured by micro-CT. At greater values, removal of demineralised dentine was incomplete. CONCLUSION Examination of dental tissues by micro-CT allowed determination of the efficiency of Er:YAG laser-stimulated ablation. Feedback control of the KaVo Key Laser 3™ appeared to operate like a cut-off switch when infected dentine was eliminated, at a threshold of between 6 and 7.
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Affiliation(s)
- Donald R Schwass
- Department of Oral Rehabilitation, School of Dentistry, University of Otago, Dunedin, New Zealand.
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Levallois B, Terrer E, Panayotov Y, Salehi H, Tassery H, Tramini P, Cuisinier F. Molecular structural analysis of carious lesions using micro-Raman spectroscopy. Eur J Oral Sci 2012; 120:444-51. [DOI: 10.1111/j.1600-0722.2012.00988.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2012] [Indexed: 01/01/2023]
Affiliation(s)
- Bernard Levallois
- EA 4203, UFR Odontologie, Université Montpellier 1; Montpellier Cedex; France
| | | | - Yvan Panayotov
- EA 4203, UFR Odontologie, Université Montpellier 1; Montpellier Cedex; France
| | - Hamideh Salehi
- EA 4203, UFR Odontologie, Université Montpellier 1; Montpellier Cedex; France
| | | | - Paul Tramini
- EA 4203, UFR Odontologie, Université Montpellier 1; Montpellier Cedex; France
| | - Frédéric Cuisinier
- EA 4203, UFR Odontologie, Université Montpellier 1; Montpellier Cedex; France
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Raucci-Neto W, Pécora JD, Palma-Dibb RG. Thermal effects and morphological aspects of human dentin surface irradiated with different frequencies of Er:YAG laser. Microsc Res Tech 2012; 75:1370-5. [PMID: 22648790 DOI: 10.1002/jemt.22076] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 04/30/2012] [Indexed: 11/12/2022]
Abstract
This study reports the effects on micromorphology and temperature rise in human dentin using different frequencies of Er:YAG laser. Sixty human dentin fragments were randomly assigned into two groups (n = 30): carious or sound dentin. Both groups were divided into three subgroups (n = 10), according to the Er:YAG laser frequency used: 4, 6, or 10 Hz (energy: 200 mJ; irradiation distance: 12 mm; and irradiation time: 20 s). A thermocouple adapted to the tooth fragment recorded the initial temperature value (°C); then, the temperature was measured after the end of the irradiation (20 s). Morphological analysis was performed using images obtained with scanning electron microscope. There was no difference between the temperatures obtained with 4 and 6 Hz; the highest temperatures were achieved with 10 Hz. No difference was observed between carious and sound dentin. Morphological analyses revealed that all frequencies promoted irregular surface in sound dentin, being observed more selectively ablation especially in intertubular dentin with tubule protrusion. The caries dentin presented flat surface for all frequencies used. Both substrates revealed absence of any signs of thermal damage. It may be concluded that the parameters used in this study are capable to remove caries lesion, having acceptable limits of temperature rise and no significant morphological alterations on dentin surface.
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Affiliation(s)
- Walter Raucci-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Makhija SK, Anabtawi MF. There is Limited Evidence to Support the Effectiveness of Dental Lasers in the Removal of Caries Compared With Rotary Burs. J Evid Based Dent Pract 2012; 12:31-2. [DOI: 10.1016/j.jebdp.2011.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jacobsen T, Norlund A, Englund GS, Tranæus S. Application of laser technology for removal of caries: a systematic review of controlled clinical trials. Acta Odontol Scand 2011; 69:65-74. [PMID: 21319941 DOI: 10.3109/00016357.2010.536901] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the scientific evidence regarding laser technology for removal of carious tissue. MATERIAL AND METHODS A search for literature on the effect of treatment and on economic aspects of laser technology identified 23 papers. No relevant studies on economic aspects were found. Regarding the effect of treatment, 16 papers were selected for assessment according to established criteria. RESULTS Cavity preparation and caries excavation by erbium laser were evaluated in three studies of medium quality. The time required to remove carious tissue was evaluated in five studies assessed as being of medium quality for this outcome. In four studies the effect of laser treatment on the dental pulp was included as an outcome but, due to the short follow-up time, the quality was assessed as low. Two studies that included the longevity of the restoration as an outcome were also assessed as being of low quality because the follow-up time was inadequate. Patient response was evaluated in three studies, which were assessed as being of medium quality with respect to this outcome. CONCLUSIONS There is limited scientific evidence that laser treatment is as effective as a rotary bur for removing carious tissue. Treatment time is prolonged. There is limited scientific evidence that adults prefer laser treatment. No conclusions can be drawn regarding biological or technical complications, children's perception of laser treatment or the cost-effectiveness of the method.
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Affiliation(s)
- Thomas Jacobsen
- Public Dental Services, Västra Götaland District, Skövde, and Department of Cariology, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden
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Raucci-Neto W, Chinelatti MA, Ito IY, Pécora JD, Palma-Dibb RG. Influence of Er:YAG laser frequency on dentin caries removal capacity. Microsc Res Tech 2011; 74:281-6. [DOI: 10.1002/jemt.20902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 06/06/2010] [Indexed: 11/10/2022]
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Caries-removal effectiveness and minimal-invasiveness potential of caries-excavation techniques: a micro-CT investigation. J Dent 2010; 39:154-62. [PMID: 21111770 DOI: 10.1016/j.jdent.2010.11.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 11/16/2010] [Accepted: 11/17/2010] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To determine the caries-removal effectiveness (CRE) and minimal-invasiveness potential (MIP) of contemporary caries-removal techniques. METHODS Carious molars were scanned using micro-CT, after which dentine caries was removed by 9 contemporary caries-removal techniques. The micro-CT was repeated and CRE was determined on basis of the relative volume of residual caries and the mineral density (MD) at the cavity floor. MIP was determined by measuring the cavity size relative to the initial size of the caries lesion. RESULTS CRE and MIP varied most for the Er:YAG laser (Kavo) despite its laser-induced fluorescence (LIF) feedback system. Whilst some specimens revealed much residual caries, others showed over-excavation into sound dentine. With the highest Relative Cavity Size, the Er:YAG laser presented the lowest MIP. Rotary/oscillating instruments revealed a more favourable CRE with some tendency towards over-excavation, except for CeraBur (Komet-Brasseler) and Cariex (Kavo) that typically left caries at the cavity floor and cavity walls, respectively. Chemo-mechanical excavation aided by conventional metal excavators (Carisolv, MediTeam; exp. SFC-V and SFC-VIII, 3M-ESPE) combined best CRE with MIP. When however a plastic excavator was used along with exp. SFC-VIII, caries was less completely removed. SIGNIFICANCE Er:YAG-laser aided by LIF resulted in non-selective caries removal. Rotary/oscillating caries removal may lead to over-excavation, especially when burs are combined with Caries Detector (Kuraray). This risk for over-excavation is reduced when a tungsten-carbide bur is solely used. On the contrary, Cariex (Kavo) and CeraBur showed a tendency for under-preparation. Chemo-mechanical methods were most selective in removing caries, whilst preserving sound tissue.
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Ghaname ES, Ritter AV, Heymann HO, Vann WF, Shugars DA, Bader JD. Correlation between laser fluorescence readings and volume of tooth preparation in incipient occlusal caries in vitro. J ESTHET RESTOR DENT 2010; 22:31-9. [PMID: 20136944 DOI: 10.1111/j.1708-8240.2009.00309.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study evaluated the correlation between laser fluorescence readings and the extent of incipient occlusal caries as measured by the volume of tooth preparation in vitro. MATERIALS AND METHODS One hundred and three permanent molars and premolars containing incipient occlusal pit-and-fissure caries and sound occlusal surfaces (1/4 of the sample, control) were selected. DIAGNOdent (KaVo Dental Corporation, Lake Zurich, IL, USA) readings were obtained according to manufacturer instructions. Caries was removed with 1/4 round burs in high speed. The volume of tooth preparation was measured using a surrogate measure based on the amount of composite needed to fill the preparations. Sensitivity and specificity using different cutoff values were calculated for lesions/preparations extending into dentin. The results were analyzed statistically. RESULTS The Pearson correlation for preparation volume and DIAGNOdent reading measurements was low (r = 0.285). Sensitivity and specificity of DIAGNOdent for detection of dentinal lesions were 0.83 and 0.60, and 0.66 and 0.73 for the cutoff values of 20 and 30, respectively. CONCLUSIONS Within the limitations of this study, laser fluorescence measured with DIAGNOdent does not correlate well with extent of carious tooth structure in incipient occlusal caries. CLINICAL SIGNIFICANCE Clinicians should not rely only on DIAGNOdent readings to determine the extension of incipient occlusal caries.
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Affiliation(s)
- Eduardo S Ghaname
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan, Ann Arbor, MI, USA
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