Numerical analysis of the thermochemical tooth damage induced by laser radiation

Topographical characteristics and shear bond strength of tooth surfaces cut with a laser-powered hydrokinetic system

STATEMENT OF PROBLEM

Erbium lasers, specifically Er;YAG and Er, Cr;YSGG that emit in the near red wavelengths, cut both enamel and dentine. Bonding to these cut surfaces with composites has not been assessed for all laser systems.

PURPOSE

This investigation assessed the shear bond strength of composite bonded to tooth structure treated with an Er,Cr;YSGG-powered hydrokinetic system (HKS, Millennium system) and then was compared with surfaces treated with a carbide bur.

MATERIAL AND METHODS

Extracted human molars were cut into enamel and dentin with both systems. Nonetched and acid-etched subgroups were evaluated. Shear bond strength was measured with an Instron test machine with a knife-edge loading head. In addition, SEMs were evaluated.

RESULTS

There were no significant differences in shear bond strength between etched bur cut (23.3 +/- 2.5 MPa), etched laser-cut enamel (23.7 +/- 4.5 MPa), and nonetched laser-cut enamel (20.5 +/- 2.8 MPa). For nonetched enamel, bond strength values for laser-cut surfaces were significantly higher than the bur-cut surfaces (8.7 +/- 4.3 MPa). Bond strength differences for dentin between bur (14.3 +/- 1.7 MPa) and laser cuts (11.5 +/- 4.3 MPa) were not significant (P =.03). SEM revealed that laser cutting of enamel did not cause formation of a smear layer.

CONCLUSION

There were no significant differences in shear bond strength between etched bur-cut, etched laser-cut, and nonetched laser-cut enamel. With nonetched enamel, bond strength values for nonetched laser-cut surfaces were significantly higher than for the bur-cut surfaces. No bond strength differences between bur and laser cutting existed for dentin. Similar topography was observed for bur and laser prepared surfaces of etched enamel and nonetched dentin.

Pulpal thermal responses to an erbium,chromium: YSGG pulsed laser hydrokinetic system

PROBLEM

Laser systems are known to raise pulpal temperatures when applied to tooth surfaces. Dental biocalcified tissues can be cut with an erbium,chromium:yttrium-scandium-gallium-garnet laser-powered hydrokinetic system. This device is effective for caries removal and cavity preparation in vitro. Pulpal monitoring of temperature changes during hard tissue cutting by a hydrokinetic system have not been reported.

OBJECTIVES

This study compared the effects of hydrokinetic system, dry bur, and wet bur tooth cutting on pulpal temperature.

STUDY DESIGN

In vivo thermocouple intrapulpal measurements were made on cuspid teeth in anesthetized beagle dogs. In vitro measurements were made on extracted human molar teeth preserved in high-salt solution and later rinsed in phosphate-buffered saline (pH 7.4) to simulate in vivo conditions. The hydrokinetic system was compared with conventional air-turbine-powered bur cutting. The hydrokinetic system cuts and bur preparations were randomly made on the buccal surfaces at the cervical one third of the crown and extended until exposure of the pulp was confirmed clinically.

RESULTS

Pulpal temperatures associated with the hydrokinetic system either showed no change or decreased by up to 2 degrees C. Wet bur preparations resulted in a 3 degrees to 4 degrees C rise. With dry bur preparations, a 14 degrees C rise in temperature was recorded.

CONCLUSIONS

Under the conditions of this study, the erbium,chromium:yttrium-scandium-gallium-garnet laser-powered hydrokinetic system, when used for cavity preparation, had no apparent adverse thermal effect as measured in the pulp space.

Pulpal response to cavity preparation by an erbium, chromium:YSGG laser-powered hydrokinetic system

The near red-pulsed erbium, chromium:yttrium-scandium-gallium-garnet laser hydrokinetic system, or Er,Cr:YSGG laser HKS, is effective in cutting dental hard tissues. In this longitudinal study, the authors studied the continuously erupting open-apex incisors of New Zealand albino rabbits and the constricted apex teeth of beagles to determine the effects of HKS-produced lesions at various energy levels and of preparations produced by a tapered fissure bur on dental pulp. No pulpal inflammatory responses could be identified either immediately or 30 days after surgery in HKS preparations that removed enamel and dentin without pulp exposure.

The effects of cooling systems on CO2-lased human enamel

The thermal effects on dentin during CO2 laser irradiation on human enamel were investigated. To simulate the clinical practice, two cooling methods (air and water spray) were applied immediately after laser exposure, whereas one group without cooling was served as control. Three hundred and sixty uniform tooth blocks were obtained from freshly extracted human third molars. Temperature change measurements were made via electrical thermocouple implanted within the tooth block 2 mm away from the enamel surface. Experimental treatments consisted of lasing without cooling, lasing with 0.5-ml/sec water cooling, and lasing with 15-psi air cooling. Our results indicated that (1) both air- and water-cooling groups could reduce temperature elevation significantly; (2) the larger power energy resulted in the higher temperature elevation. In conclusion, for CO2 laser irradiation on human enamel both water- and air-cooling methods may be effective on prevention of thermal damage of pulp.

Lasers in dentistry

Since the development of the ruby laser by Maiman in 1960, there has been great interest among dental practitioners, scientists, and patients to use this tool to make dental treatment more pleasant. Oral soft tissue uses are becoming more common in dental offices. The possible multiple uses of lasers in dentistry, beyond soft tissue surgery and dental composite curing, unfortunately, have not yet been realized clinically. These include replacement of the dental drill with a laser, laser dental decay prevention, and laser decay detection. The essential question is whether a laser can provide equal or improved treatment over conventional care. Safe use of lasers also must be the underlying goal of proposed or future laser therapy. With the availability and future development of different laser wavelengths and methods of pulsing, much interest is developing in this growing field. This article reviews the role of lasers in dentistry since the early 1960s, summarizes some research reports from the last few years, and proposes what the authors feel the future may hold for lasers in dentistry.

CO2 laser application to the mineralized dental tissues--the possibility of iatrogenic sequelae

From the many types of laser that are available commercially, the CO2 laser is presently thought to have the greatest potential for use in dentistry. An outline of the generation of emitted radiation from such a laser is given together with a review of work previously carried out and reported in the literature regarding application to the teeth. The main points of interest are the effects of radiation on the enamel and dentine, but concern is felt towards the possible iatrogenic damage of thermal origin that may occur within the pulp following irradiation of the dental tissues.

Dentinal temperature transients caused by exposure to CO2 laser irradiation and possible pulpal damage

An investigation is described that attempts to establish, in vitro, the characteristics of heat transference following laser irradiation of bovine dentinal tissue and the relationship with the periodicity of radiation. The results of this study appear to indicate that at depths of overlying dentine of up to 3 mm, laser-induced thermal injury to the pulp is a definite possibility. Fail-safe facilities to prevent build up of heat must be incorporated into the design of dental lasers to allow their beneficial effects to be utilized without the risk of iatrogenic damage.

The soft laser: therapeutic tool or popular placebo?

Because of the alleged effectiveness of soft laser therapy in the treatment of a wide range of medical and dental conditions, it is becoming increasingly popular with both patients and practitioners. It was the purpose of this study to assess soft laser treatment of hypersensitive dentin, gingivitis, pulp-capped teeth, herpes labialis, and nausea. Clinical trails demonstrated no advantage in augmenting or replacing conventional treatment of these conditions with soft laser therapy, despite its positive effect on patient attitude toward treatment.