Retrieval of Glass Fiber Post Using Er:YAG Laser and Conventional Endodontic Ultrasonic Method: An In Vitro Study

Effect of Er:YAG laser on debonding zirconia and lithium disilicate crowns bonded with 2- and 1-bottle adhesive resin cements

INTRODUCTION

Erbium-doped yttrium-aluminum-garnet (Er:YAG) laser debonding of zirconia and lithium disilicate restorations is increasingly used for a range of clinical applications. Using rotary instruments to remove such restorations for any purpose has proven to be challenging. Erbium laser has been reported to be a conservative method for removing ceramic restorations. There is little data in the literature about the effect of adhesive resin cement type on the debonding time of the ceramic restoration using the Er:YAG laser.

OBJECTIVES

To evaluate and compare the time required for the Er:YAG laser to debond zirconia and lithium disilicate crowns bonded with a 2- and 1-bottle adhesive resin cement systems.

MATERIALS AND METHODS

Forty extracted premolar teeth were prepared and scanned for milled 40 CAD/CAM crowns. Teeth were randomly assigned into groups (n = 10 per group): 3 mol% yttria-partially stabilized zirconia crowns 3Y-PSZ (G1a) bonded with Panavia™ V5 (2-bottle adhesive resin cement), Zirconia 3Y-PSZ crowns (G1b) bonded with RelyX™ Ultimate (1-bottle adhesive resin cement), and for the lithium disilicate crowns bonded with the two types of cements (G2a, G2b). Each specimen was irradiated with an Er:YAG laser at 335 mJ, 15 Hz, 5.0 W, and 50-ms pulse duration (super short pulse mode). The irradiation time required for crowns to be successfully debonded was recorded for each specimen. Data were statistically analyzed using ANOVA and Tukey HSD post-hoc test (p < 0.05), at the 95 percent level of confidence. The intaglio surface of the debonded crown was analyzed using scanning electron microscopy (SEM).

RESULTS

The mean ± standard deviation times needed for crown debonding were 5.75 ± 2.00 min for the G1a group, 4.79 ± 1.20 min for group G1b, 1.69 ± 0.49 min for group G2a, and 1.12 ± 0.17 for group G2b. There was no statistically significant difference in debonding time between the 2- and 1- bottle adhesive resin cement within the groups G1a and b (p = 0.2914), or between groups G2a b (p = 0.7116). A statistically significant difference (p < 0.05) was found between groups G1a and G2a and b and between groups G1b and G2a and b were SEM analysis showed no changes in the microstructure of the ceramic surface after Er:YAG laser irradiation.

CONCLUSION

Zirconia and lithium disilicate restorations can be debonded using Er:YAG lasers in a safe and efficient manner. There is no significant difference in the debonding time between the 2- and 1- bottle adhesive resin cement systems used in this study.

CLINICAL SIGNIFICANCE

Retrieving zirconia and lithium disilicate ceramics can be a challenging process when using diamond rotary instruments. ER:YAG lasers may efficiently debond these ceramics from the tooth structure, independent of the bonding process used for bonding them.

Accuracy comparison of single- and double-sleeve endodontic guides for fiber post removal

BACKGROUND

This study aimed to assess the accuracy of two different endodontic guides for fiber post removal.

METHODS

In this in vitro study, 54 maxillary canine fiber posts were mounted on 36 maxillary stone casts; 18 teeth were mounted unilaterally, and 36 teeth were mounted bilaterally. Static endodontic guides were fabricated according to baseline cone-beam computed tomography (CBCT) and intraoral optical scans using Blue Sky software. In the single-sleeve endodontic guides group (SSG), two anterior and two posterior teeth were included in a 5-unit guide. In the double-sleeve endodontic guides group (DSG) group, the guide was passed through the midline to include both canine teeth and extended by 2 teeth posterior to the canine teeth bilaterally (a 10-unit guide). After drilling, postoperative CBCT scans were taken and superimposed on the virtually designed path, and the maximum coronal deviation (MCD) at the marginal entry point of the tooth, maximum apical deviation (MAD) at 10 mm apical to the tooth margin, and maximum angular deflection (MAnD) of the drill were calculated.

RESULTS

The mean MCD, MAD, and MAnD were 0.34 mm, 0.6 mm, and 2.32 degrees, respectively, in the SSG and 0.31 mm, 0.7 mm, and 2.37 degrees, respectively, in the DSG. The two groups were not significantly different from each other in terms of MCD (P = 0.573), MAD (P = 0.290), or MAnD (P = 0.896).

CONCLUSIONS

The accuracies of the two techniques, the extended double sleeve guide and the single sleeve guide, were comparable and thus DSG may be used for removal of fiber posts in adjacent or distant teeth.

Er:YAG laser debonding of zirconia and lithium disilicate restorations

STATEMENT OF PROBLEM

Yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) restorations of different formulations are being used increasingly in monolithic form for a range of clinical applications. Using rotary instruments to remove such restorations for any purpose is challenging, but they can be removed conservatively with erbium lasers. However, studies on how a laser penetrates different zirconias to break the cement bond between the tooth surface and the zirconia are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate and compare the time required for an erbium-doped yttrium-aluminum-garnet (Er:YAG) laser to remove different types of zirconia and lithium disilicate crowns.

MATERIAL AND METHODS

Forty extracted premolar teeth were prepared, scanned, designed, and milled to fabricate 40 computer-aided design and computer-aided manufacturing (CAD-CAM) crowns, which were assigned to 4 groups (n=10): 3 mol% Y-TZP, 4 mol% Y-TZP, 5 mol% Y-TZP, and lithium disilicate as a control. All crowns were bonded to the teeth with a self-adhesive resin cement (Panavia SA Cement Universal). Each specimen was irradiated with an Er:YAG laser with the following parameters: 300 mJ, 15 Hz, 5.0 W, and a 50-microsecond pulse duration (supershort pulse mode). The irradiation time required for crowns to be retrieved successfully was recorded for each specimen. Data were statistically analyzed using analysis of variance and the Tukey honestly significant difference post hoc test (α=.05). The intaglio surfaces of the restorations were analyzed using scanning electron microscopy (SEM).

RESULTS

The mean ±standard deviation times in minutes needed for crown debonding were 12.46 ±4.17 for the 3 mol% Y-TZP group, 10.30 ±3.33 for the 4 mol% Y-TZP group, 4.03 ±1.62 for the 5 mol% Y-TZP group, and 2.08 ±0.92 for the lithium disilicate group. A statistically significant difference (P<.05) in the debonding time was found for all investigated groups, expect between the 3 mol% and 4 mol% Y-TZP groups and between the 5 mol% Y-TZP and lithium disilicate groups. SEM analysis of the ceramic surfaces showed no visual damage associated with Er:YAG laser irradiation.

CONCLUSIONS

Zirconia crown retrieval time with the Er:YAG laser was influenced by the yttria content of the zirconia, with decreasing retrieval time with increasing yttria content. Er:YAG laser debonding of zirconia crowns is a noninvasive, efficient, and rapid approach to the removal of crowns and could be applied in clinical practice.

Chemical and morphological analysis of dentin irradiated by different high-power lasers: a systematic review

PURPOSE

This systematic review provides an overview of the main chemical and morphological alterations generated on dentin by different high-power lasers' irradiation.

METHODS

The review was registered in PROSPERO (CRD42023394164) and PRISMA guidelines were followed. The search strategy was conducted on MEDLINE (PubMed), Embase (Elsevier), and Web of Science (Clarivate) databases. The eligibility criteria were established according to the PICOS strategy, focusing on in vitro and ex vivo studies that assessed the chemical and morphological changes in dentin using five high-power lasers: Nd:YAG (1064 nm), Er:YAG (2940 nm), Er, Cr:YSGG (2780 nm), diode (980 nm), and CO2 (10,600 nm). Publication range was from 2010 to 2022. Data was summarized in tables and risk of bias was assessed by QUIN tool.

RESULTS

The search resulted in 2255 matches and 57 studies composed the sample. The methods most used to assess the outcomes were scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), and Raman. The studies presented "medium" and "low" risk of bias. The laser prevalently identified was the Er:YAG laser, associated with dentin ablation, absence of smear layer, and exposed tubules. The Nd:YAG laser generated vitreous surface and thermal damage, such as carbonization and cracks. The other lasers caused an irregular surface and no adverse thermal effects. Regarding the chemical structure, only the Er,Cr:YSGG laser caused collagen matrix reduction. The effects found were more intense with higher dosimetry.

CONCLUSION

Evidence available indicates that the irradiation of dentin with high-power lasers are related to morphological outcomes favorable to adhesive restorative procedures, with minimal changes in collagen matrix and mineral content. However, those observations should be carried carefully by clinicians and more clinical trials regarding the association of high-power laser irradiation and restorative procedure longevity are needed.

Current Applications and Future Directions of Lasers in Endodontics: A Narrative Review

The utilization of lasers has been regarded as a novel technique for the purposes of clinical use in the dental field. Recently, numerous studies have been conducted on the potential applications of laser therapy in endodontics. Moreover, due to their ablation, penetrability, and disinfection capabilities, lasers have performed well with respect to endodontic treatments, including root canal treatment, vital pulp therapy (pulp capping and pulpotomy), dentinal hypersensitivity treatment, and management of dental pain related to pulp and periradicular disease. In particular, the superiorities of laser-aided pulp therapy are emphasized through condensed clinical controlled trials, and histological studies, in this review. Moreover, the ingenious use of laser applications with respect to aiding in the acceleration of root development and the extraction of foreign matters (i.e., broken files and fiber posts) in canals has quickly become the cutting-edge trend of current research. This review offers a summary and discussion of the current literature on all the aforementioned laser applications. Moreover, the characteristics of laser devices, including erbium lasers, neodymium-doped lasers, CO2 lasers, and diode lasers, are detailed and discussed here, providing useful references for laser application in endodontics. We also focus on the different wavelengths with respect to the lasers that are applied in endodontics. High-power lasers perform well as operative instruments; in addition, low-level lasers lead to the regulation of pulp inflammation, and the promotion of pulp healing. This narrative review provides a summary of the advanced applications of lasers in conjunction with various devices in the practice of endodontics, and aims to inspire innovative perspectives on lasers in the context of the treatment of dental diseases, especially pulp diseases, in the future.

Erbium laser-assisted ceramic debonding: a scoping review

PURPOSE

Removal of ceramic restorations and appliances can be time consuming, invasive, and inconvenient. Erbium lasers offer an alternative noninvasive method for debonding of ceramic appliances. This paper aims to provide a comprehensive review of current literature on the effectiveness of erbium lasers for removal of ceramic restorations and appliances from natural teeth and dental implants.

METHODS

A comprehensive search of 7 databases, including Medline (Ovid), Embase, Dentistry and Oral Sciences Source (DOSS), Web of Science, Cochrane Library, and ProQuest Dissertations and Theses was performed. The inclusion and exclusion criteria were agreed prior to the literature search. Two reviewers independently screened the title and abstract. A third reviewer then broke the tie, if any. The selected articles then underwent full text review and the data was extracted.

RESULTS

The search identified 4117 unique articles published through June 10, 2021. Studies were assessed and categorized based on the type of restoration/appliance, type of abutment, type of laser, laser settings, efficacy of debonding, and pulpal temperature rise. Thirty-eight full-text articles were reviewed for inclusion. Time for ceramic debonding varies depending on the type of restorations and materials. Removal of zirconia crowns from teeth and implant abutments requires a longer period of time compared to lithium disilicate crowns. Temperature increases were reported as 5.5 degrees or less. Laser setting and laser type affect the debonding time and the increase in temperature. Examinations of debonded ceramics demonstrated no known structural damages resulting from laser applications.

CONCLUSIONS

Erbium lasers are effective noninvasive tools to remove all ceramic restorations/appliances from natural teeth and implant abutments without causing harm to abutments. Laser-assisted debonding should be considered as a viable alternative to rotary instrumentation for ceramic crowns; however, clinical studies of erbium-assisted ceramic retrieval are needed.

Photobiomodulation Therapy in the Treatment of Oral Mucositis—A Case Report

In 2021, our group published a laboratory study on the impact of PBM on human gingival fibroblasts. The in vitro results confirmed the fact that the appropriately selected wavelength and properly selected parameters of the laser settings can increase cell proliferation, modulate inflammatory markers, and decrease the susceptibility of human gingival fibroblasts to apoptosis. Therefore, this case report was aimed at the clinical evaluation of the proposed settings and treatment regimen in a very difficult situation of an immunocompromised patient with extensive changes and stagnation of symptoms for many weeks. A 65-year-old man, during his oncological treatment, was diagnosed with oral mucositis grade 3 according to the World Health Organization and National Cancer Institute scales. Due to pain sensation, long-lasting and not healing oral lesions, and problems with solid food intake, he was qualified for laser photobiomodulation therapy. For the management of oral lesions, a diode laser 635 nm (Smart^MPro, Lasotronix, Poland) was intraorally applied at an energy density of 4 J/cm², the 20 s of irradiation, the output power of 100 mW, and in continuous wave mode. Seven treatment procedures were performed two times a week using the spot technique in contact and non-contact mode. Within 21 days of monotherapy, all ailments disappeared. The patient was also able to reuse dental dentures and return to a solid diet. The obtained results confirm the efficiency of at least 3 PBM protocols. Our case shows that the use of PMB therapy contributes to faster healing of painful oral lesions in oncological patients, and thus the treatment time and return to the appropriate quality of life is shorter.

Fibroblasts Adhesion to Laser-Modified Titanium Surfaces-A Systematic Review

OBJECTIVE

Laser treatment has been recently introduced in many fields of implant dentistry. The systematic review tried to address the question: "How does laser modification of titanium surface influence fibroblast adhesion?".

METHODS

An electronic search of the PubMed and Scopus databases was performed. The following keywords were used: (laser) AND (fibroblast) AND (titanium) AND (implant OR disc) AND (proliferation OR adhesion). Initially, 136 studies were found. Ten studies met the inclusion criteria and were included in the review. All studies chosen to be included in the review were considered to have a low risk of bias.

RESULTS

Studies included in the review varied with laser parameters or ways of observing fibroblast behavior. Studies showed that fibroblasts tend to take different shapes and create extensions on modified surfaces and that their metabolic activity is more intense. One study concentrated on laser application and showed that three-directional laser application is the most successful in terms of fibroblast adhesion. Studies which concentrated more on laser parameters showed that too low energy density (lower or equal to 0.75 J/cm2) does not influence fibroblast adhesion. Increasing the energy density over 0.75 J/cm2 causes better cell adhesion of fibroblasts to the laser-modified sample. One included study focused on increasing titanium surface wettability, which also positively influenced cell adhesion.

CONCLUSION

The studies included in the review proved a positive effect of laser-modified titanium surfaces on fibroblast adhesion. However, the application of an appropriate laser energy dose is crucial.

Comparison of Post Space Volume Changes Following Fiber Post Removal Using Er,Cr:YSGG Laser Versus Ultrasonic Instrument

PURPOSE

The purpose of this in vitro study was to compare the post space volume changes following removal of glass fiber posts in endodontically treated teeth by using erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser to the conventional ultrasonic method.

MATERIALS AND METHODS

Twelve single-root human extracted teeth were cut into 13 mm near cementoenamel junction (CEJ), and then underwent endodontic treatment. The post spaces were prepared to 8 mm in length. Glass fiber posts were inserted with self-curing resin cement. Specimens were randomly assigned to laser or ultrasonic methods for their post removal. Post space volumes were measured using microcomputed tomography (micro-CT) before post cementation and after post removal. Dentin thickness was measured after post removal at coronal, middle, and apical third of the root canal space. Paired t-test and t-test were used to compare space volumes between before post cementation and after post removal, and between laser and ultrasonic groups, respectively.

RESULTS

Six specimens were tested for each group. The average volume change was 6.499 mm³ in laser and 7.418 mm³ in ultrasonic method. There was not a significant difference between laser and ultrasonic group in respect of post space volume changes (p = 0.71). Both methods showed significant volume increase following post removal (p < 0.05). Significantly less dentin was lost when laser was used for post removal in the coronal portion of the post space (p = 0.002).

CONCLUSIONS

Er,Cr:YSGG laser can be used as effective option, comparable to the conventional ultrasonic method when removing posts in endodontically treated teeth. Laser has the potential to provide conservative post removal.

Efficiency of Erbium-Doped Yttrium Aluminum Garnet Laser in Debonding Cemented Glass Fiber Posts: an in vitro Study

Statement of the Problem:

The efficacy of erbium-doped yttrium aluminum garnet (Er; YAG) laser on the debonding properties of certain post materials has remained largely unexplored.

Purpose:

This study aimed to investigate the effect of Er; YAG laser irradiation on debonding of cemented glass fiber posts in root canal treated teeth.

Materials and Method:

In this in vitro study, forty root canal treated mandibular premolar teeth were used in this study. Glass fiber posts were bonded using Panavia F 2.0 cement in the root canal space, and samples were divided into two groups. In the test group, samples were exposed to laser radiation of 7W, 350mJ, frequency of 20Hz and discontinued washing spray. In the control group, samples were left untouched. In each group, samples were sectioned into 1.5mm thick slices from the coronal, middle, and apical thirds of the root (N=120). Tensile bond strengths were evaluated using the push-out test and the failure patterns were evaluated using scanning electron microscopy (SEM). To compare the laser and non-laser groups at each location, independent sample t test was applied, and to compare bond strength between the locations in each group, one-way ANOVA and Tukey’s HSD post hoc was applied.

Results:

A significant difference in tensile strength was observed between the laser-irradiated group and control group; tensile bond strength was much higher in the control group (p<0.001). The highest frequency of fractures was observed at the cement-dentin interface. Given the used parameters, complete debonding was not achieved in the laser-irradiated group.

Conclusion:

Laser radiation reduced the bond strength of glass fiber posts to resin cement without complete debonding.

Retrieval of Prefabricated Zirconia Crowns with Er,Cr:YSGG Laser from Primary and Permanent Molars

(1) Background: Prefabricated zirconia crowns are used to restore teeth in children. The purpose of this study was to evaluate the removal of these crowns with the erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser; (2) Methods: A total of 12 primary and 12 permanent teeth were prepared and prefabricated zirconia crowns were passively fitted and cemented with two resin modified glass-ionomer (RMGI) cements. Surface areas of prepared teeth and crowns were calculated. Crowns were removed using two laser settings: 4.5 Watts, 15 Hertz, 20 water/20 air, and 5 Watts, 15 Hertz, 50 water/50 air. The retrieval time and temperature changes were tested recorded. Data were analyzed using ANOVA with Tukey’s adjusted post hoc pairwise comparison t-test; (3) Results: The average time for crown removal was: 3 min, 47.7 s for permanent; and 2 min 5 s for primary teeth. The mean temperature changes were 2.48 °C (SD = 1.43) for permanent; and 3.14 °C (SD = 1.88) for primary teeth. The time to debond was significantly positively correlated with tooth inner surface area and volume, outer crown volume, and the cement volume; (4) Conclusions: Use of the Er,Cr:YSGG laser is an effective, safe and non-invasive method to remove prefabricated zirconia crowns cemented with RMGI cements from permanent and primary teeth.

Laser Treatment of Fiber Post and Final Push-Out Bond Strength: A Systematic Review and Meta-Analysis

Purpose: This review article tries to answer this question: "What are the effects of laser surface treatment of fiber posts (FPs), compared with other surface roughening methods, on bond strength of cemented FPs?" Methods: Search was carried out in six electronic databases by focusing on defined key words. Related titles and abstracts, up to March 2019, were collected, read, and selected for quality assessments. A total of 2408 articles were included in the study at the initial stage of the searching phase. Results: Finally, seven studies were recognized to be reliable to be reviewed and meta data analysis in the study. All the studies were in vitro with a total of 340 samples. None of the Er:YAG (-0.27, 95% CI: -2.29 to 1.76; p = 0.79) and Er,Cr:YSGG (-0.04, 95% CI: -1.43 to 1.35; p = 0.95) treated samples showed any significant overall mean differences in final push-out bond strength (PBS) compared with the control groups. Conclusions: Laser pretreatment of FP surfaces might not be effective in providing high PBS. FP surface are susceptible to damage of high-level laser irradiation and might show decreased bond strength.

Dental Aerosol as a Hazard Risk for Dental Workers

Standard dental procedures, when using a water coolant and rotary instruments, generate aerosols with a significantly higher number of various dangerous pathogens (viruses, bacteria, and fungi). Reducing the amount of aerosols to a minimum is mandatory, especially during the new coronavirus disease, COVID-19. The study aimed to evaluate the amount of aerosol generated during standard dental procedures such as caries removal (using dental bur on a high and low-speed handpiece and Er:YAG laser), ultrasonic scaling, and tooth polishing (using silicon rubber on low-speed handpiece) combined with various suction systems. The airborne aerosols containing particles in a range of 0.3-10.0 μm were measured using the PC200 laser particle counter (Trotec GmbH, Schwerin, Germany) at three following sites, manikin, operator, and assistant mouth, respectively. The following suction systems were used to remove aerosols: saliva ejector, high volume evacuator, saliva ejector with extraoral vacuum, high volume evacuator with extraoral vacuum, Zirc® evacuator (Mr.Thirsty One-Step®), and two customized high volume evacuators (white and black). The study results showed that caries removal with a high-speed handpiece and saliva ejector generates the highest amount of spray particles at each measured site. The aerosol measurement at the manikin mouth showed the highest particle amount during caries removal with the low and high-speed handpiece. The results for the new high volume evacuator (black) and the Zirc® evacuator showed the lowest increase in aerosol level during caries removal with a high-speed handpiece. The Er:YAG laser used for caries removal produced the lowest aerosol amount at the manikin mouth level compared to conventional dental handpieces. Furthermore, ultrasonic scaling caused a minimal aerosol rise in terms of the caries removal with bur. The Er:YAG laser and the new wider high volume evacuators improved significantly suction efficiency during dental treatment. The use of new suction systems and the Er:YAG laser allows for the improvement of biological safety in the dental office, which is especially crucial during the COVID-19 pandemic.

Exploring the use of pulsed erbium lasers to retrieve a zirconia crown from a zirconia implant abutment

Background

Removal of cement-retained implant fixed restorations when needed, can be challenging. Conventional methods of crown removal are time consuming and costly for patients and practitioners. This research explored the use of two different types of pulsed erbium lasers as a non-invasive tool to retrieve cemented zirconia crowns from zirconia implant abutments.

Materials and methods

Twenty identical zirconia crowns were cemented onto 20 identical zirconia prefabricated abutments using self-adhesive resin cement. The specimens were divided into two groups for laser assisted crown removal; G1 for erbium-doped yttrium aluminum garnet laser (Er:YAG), and G2 for erbium, chromium-doped yttrium, scandium, gallium and garnet (Er,Cr:YSGG). For the G1, after the first crown removal, the specimens were re-cemented and removed again using the Er:YAG laser. Times needed to remove the crowns were recorded and analyzed using ANOVA (α = 0.05). The surfaces of the crown and the abutment were further examined using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) analyses.

Results

The average times of zirconia crown removal from zirconia abutments were 5 min 20 sec and 5 min 15 sec for the Er:YAG laser of first and second experiments (G1), and 5 min 55 sec for the Er,Cr:YSGG laser experiment (G2). No statistical differences were observed among the groups. SEM and EDS examinations of the materials showed no visual surface damaging or material alteration from the two pulsed erbium lasers.

Conclusions

Both types of pulsed erbium lasers can be viable alternatives for retrieving a zirconia crown from a zirconia implant abutment. Despite operating at different wavelengths, the Er:YAG and Er,Cr:YSGG lasers, perform similarly in removing a zirconia crown from a zirconia implant abutment with similar parameters. There are no visual and elemental composition damages as a result of irradiation with pulsed erbium lasers.