Chemical changes associated with increased acid resistance of Er:YAG laser irradiated enamel

Effect of Er:YAG Laser Irradiation on Preventing Enamel Caries: A Systematic Review and Meta-Analysis

Caries is a global health problem, and its prevention has become a main goal of modern dentistry. Laser irradiation is believed to have potential in preventing dental caries. The purpose of this systematic review and meta-analysis was to evaluate whether Er:YAG laser irradiation has the potential to prevent enamel caries. Based on inclusion and exclusion criteria, PubMed, Web of Science, and EMBASE databases were searched; 2 reviewers independently used these search strategies to review titles and abstracts, with no language or date restrictions, up to June 2023. For the quantitative analysis, continuous variables were analysed by standard mean difference (SMD) with a 95% confidence interval (CI). The statistical analyses were conducted using Review Manager and Cochrane Collaboration (2020). A total of 51 potentially eligible studies were identified, of which 16 in vitro studies were eventually included in the quantitative meta-analysis. Three studies showed a low risk of bias, and 13 studies a medium risk of bias. In general, there was no significant difference between the calcium ions released under acidic conditions after laser irradiation. The final results indicated that after Er:YAG laser irradiation, enamel could maintain higher surface microhardness in acidic environments, as well as smaller lesion depth and less mineral loss, revealing its potential in preventing enamel caries. However, the effect of laser irradiation on the release of calcium ions in acidic solutions and the surface microhardness of demineralised enamel was not significant. Therefore, more in vitro and clinical trials are needed in to evaluate whether Er:YAG laser irradiation can effectively prevent enamel caries in clinical settings.

Study on the effect of crystal changes on acid resistance of erbium laser etched enamel surface

To investigate the mechanism underlying high acid resistance of enamel after erbium laser etching. Forty-five premolars were collected and assigned to three groups. A 4×4×1 mm enamel sample was prepared, the left side was the control side, the right side was the treated side, which was treated with different surface treatments, including 35% phosphoric acid etching, Er:YAG laser etching, and Er,Cr:YSGG laser etching. The hydroxyapatite crystal size on the enamel surface of the samples was observed. The contents of Ca, P, O, F, Cl, C, Mg were detected. The crystallinity of the hydroxyapatite crystal was analyzed. After erbium laser etching, the enamel surface had high hydroxyapatite crystal size, beneficial content of chemical elements and crystallinity. The morphological and composition changes of crystals in the enamel surface after erbium laser etching may be one of the crucial mechanisms underlying the enhancement of acid resistance of enamel after erbium laser etching.

Comparative Evaluation of Influence of Nd:YAG Laser (1064 nm) and 980 nm Diode Laser on Enamel around Orthodontic Brackets: An In Vitro Study

(1) Background: The prevention of demineralizing lesions at the enamel structure level continues to represent a challenge in daily dental practice. When bacteria influence the pH level, this will decrease below the threshold for remineralization and the dissociation of hydroxyapatite will occur with a high percentage of phosphate and calcium loss. These elements continue to be studied by many authors in order to obtain a working protocol that will lead to their stabilization at the level of the enamel structure, thus preventing the demineralization process. The aim of this study is to evaluate and compare the influence of two types of laser wavelengths on the surface morphology and mineral components of the enamel through an examination with scanning electron microscopy (SEM) and energy-dispersive X-ray spectrometry (EDX). (2) Methods: Thirty permanent human incisors extracted for periodontal reasons from patients aged 25−40 years old were selected for this study. Metallic brackets (SS Standard 022 Slot, OC Orthodontics, McMinnville, OR, 97128, USA) were bonded onto each tooth. The buccal surface was randomly assigned three sections: Section A—negative control (no treatment), section B—treated with 980 nm Gallium−Aluminum−Arsenide diode laser (a 300 µm optic fiber was used with 0.8 W output power, energy density of 5.33 J/mm2, in continuous mode, for 30 s, oriented perpendicularly to the enamel surface in contact mode) (KaVo GENTLEray 980 Diode Laser, Kaltenbach & Voigt GmbH, Biberach, Germany), and section C—treated with Nd:YAG laser (a 300 µm fiber was carried out at a 1 mm distance from the enamel surface with 0.75 W power, 75 mJ pulse energy, pulse repetition rate of 10 Hz, 5 J/mm2 fluency, average exposure time of 30 s, and water cooling assisted) (LIGHTWALKER AT S, M021-5AF/1 S, Fotona d.o.o, Ljubljana, Slovenia). The elements evaluated in this study were calcium (Ca), phosphate (P), oxygen (O), and carbon (C). A one-way analysis of variance, paired t-tests, and independent t-tests were carried out to evaluate the results using the SPSS 19 IBM Statistical package software for Microsoft. (3) Results: The evaluation of the data indicated that both wavelengths produced an increase in Ca wt% (for diode laser the mean of Ca wt% before irradiation was 21.06, while that after treatment reached 28.24; and for Nd:YAG laser, the mean of Ca wt% before irradiation was 21.31, while that after treatment reached 33.88); as well, the 980 nm diode laser decreased P wt% (from 17.20 before irradiation to 16.92 after irradiation) and the Nd:YAG laser increased P wt% (from 17.46 before irradiation to 18.28 after irradiation). These results showed a statistically significant difference at the p < 0.05 level. (4) Conclusions: It can be concluded that the best improvement of enamel chemical composition was obtained with Nd:YAG irradiation.

Effect of Er:YAG Laser and Association of Protocols on the Demineralized Enamel Microhardness

Objective: The aim of this study was to analyze the microhardness of demineralized enamel following different treatments (fluoride varnish, Er:YAG laser, and Er:YAG laser associated with fluoride varnish). Methods: Forty-eight enamel blocks (4 × 4 × 7 mm) were divided into six groups (n = 8): (S) Sound; (DE) Demineralized; (DED) DE + Duraphat^® 5% (fluoride varnish); (DEL20) DE + Er:YAG laser (20 mJ pulse mode; 0.20 W; 10 Hz; 60 sec; 1.18 J/cm²; 11.83 W/cm²); (DEL50) DE + Er:YAG laser (50 mJ pulse mode; 0.50 W; 10 Hz; 60 sec; 2.95 J/cm²; 29.58 W/cm²); (DEL20D) DE + Er:YAG laser (20 mJ) + Duraphat 5%. The irradiation was performed at 1 mm distance from the surface using a tip (AS7066X, L-14 mm, D-1.3 mm in diameter) in water/air spray refrigeration (level 6). The enamel blocks were submitted to pH cycling (4 h into DES solution +20 h into RE solution for 8 days and the solutions were changed every day). Knoop microhardness was measured (50 g/15 sec, six readings per sample) and data were analyzed by Kruskal-Wallis test at 5% significance. Results: After treatments, DF group showed higher microhardness values than all the groups. Also, DEL20D group showed similar results with H group according to the microhardness analysis (p < 0.05). Conclusions: It could be concluded that Duraphat 5% treatment showed better results when compared with all tested groups, however, the association of Er:YAG Laser 20 with Duraphat 5% also showed promising results.

Lasers to prevent dental caries: a systematic review

OBJECTIVE

To assess the effectiveness of lasers (at sub-ablative parameters) in reducing caries incidence compared with traditional prophylactic interventions (TPIs) when used alone or together with other TPIs such as pits and fissures sealant or fluoride gels or varnishes.

DESIGN

A systematic review. Data sources include Medline (via PubMed), Embase, Web of Science and the Cochrane Library (December 2019).

ELIGIBILITY CRITERIA

Only randomised trials (RCTs) and controlled clinical trials (CCTs) dealing with prophylactic lasers use (vs TPI or untreated teeth) were considered as eligible. We excluded in vitro and ex vivo studies.

DATA EXTRACTION

Eligible studies were selected and data extracted independently by two reviewers. Risk of bias was assessed adopting the Cochrane Risk of Bias tool. Data on caries incidence, sealant retention, fluoride uptake, adverse events, treatment duration, patients' discomfort and cost-effectiveness ratio was extracted.

DATA ANALYSIS

Extracted data were presented narratively due to the heterogeneity of included studies.

RESULTS

Seven RCTs and two CCTs, all with an evident risk of bias, met inclusion criteria, pooling together 269 individuals and 1628 teeth. CO₂, neodymium-doped yttrium aluminium garnet, erbium-doped yttrium aluminum garnet (Er:YAG), erbium, chromium: yttrium scandium gallium garnet (Er,Cr:YSGG) and Argon lasers were used. In the permanent dentition, lasers only when used in combination with TPIs were effective in reducing caries when compared with untreated teeth (risk ratio (RR)=0.44 (0.20-0.97); Er:YAG laser) or with TPIs used alone (RR=0.39 (0.22-0.71); CO₂ laser). Moreover, Argon laser significantly improved the fluoride uptake into the enamel surfaces (ANalysis Of VAriance (ANOVA) tests: 95%, p<0.0001). Likewise, sealant retention improved when acid etching was performed on previously irradiated enamel fissures by CO₂ laser (RR=0.63 (0.38-1.04)) or Er:YAG laser (RR=0.54 (95% CI: 0.34 to 0.87)). In addition, laser resulted safe and well tolerated by patients.

CONCLUSION

Despite some positive indications, an inadequate level of evidence was found in the included studies concerning the lasers' effectiveness in preventing caries. Further studies with a higher methodological quality level are required.

Effects of Er:YAG Laser Treatment on the Mineral Content and Morphology of Primary Tooth Enamel

Objective: The aim of this study was to evaluate the mineral content and morphology of primary tooth enamel prepared using an Er:YAG laser at different power settings. Materials and methods: The buccal surfaces of 45 noncarious primary molars were assessed in this study. The surfaces were cleaned and the teeth were randomly divided into nine groups (n = 5 each) to evaluate the effects of Er:YAG laser treatment at different energy levels: 200 mJ, 2 Hz; 200 mJ, 3 Hz; 200 mJ, 10 Hz; 250 mJ, 2 Hz; 250 mJ, 3 Hz; 250 mJ, 10 Hz; 300 mJ, 2 Hz; 300 mJ, 3 Hz; and 300 mJ, 10 Hz. The mean percentage weight (wt%) of calcium (Ca), phosphorous (P), fluoride (F), magnesium (Mg), potassium (K), and sodium (Na) in the primary tooth enamel was calculated for each group using scanning electron microscopy (SEM) with energy dispersive X-ray spectroscopy before and after laser application. The enamel morphology was also evaluated using SEM. The obtained data were statistically analyzed by one-way analysis of variance and Tukey's honest significant difference test. Results: The mean wt% of Ca, P, and F in the enamel exhibited a significant change after laser treatment (p < 0.05); the wt% of Mg, K, and Na remained unchanged (p > 0.05). There was no association between the power setting of the laser and changes in the wt% of minerals in the enamel (p > 0.05). SEM showed that enamel irradiated at different energy levels exhibited a characteristic lava flow appearance, and more surface irregularities were observed with the 250-mJ setting than with the 200-mJ setting. Conclusions: Our findings suggest that the mineral content and morphology of the enamel of primary teeth are affected by Er:YAG laser irradiation.

Effect of Er:YAG laser irradiation on deciduous enamel roughness and bacterial adhesion: An in vitro study

Laser irradiation has been proposed as a preventive method against dental caries since it is capable to inhibit enamel demineralization by reducing carbonate and modifying organic matter, yet it can produce significant morphological changes. The purpose of this study was to evaluate the influence of Er:YAG laser irradiation on superficial roughness of deciduous dental enamel and bacterial adhesion. Fifty-four samples of deciduous enamel were divided into three groups (n = 18 each). G1_control (nonirradiated); G2_100 (7.5 J/cm² ) and G3_100 (12.7 J/cm² ) were irradiated with Er:YAG laser at 7.5 and 12.7 J/cm² , respectively, under water irrigation. Surface roughness was measured before and after irradiation using a profilometer. Afterwards, six samples per group were used to measure bacterial growth by XTT cell viability assay. Adhered bacteria were observed using confocal laser scanning microscopy (CLSM) and a scanning electron microscopy (SEM). Paired t-, one-way analysis of variance (ANOVA), Kruskal-Wallis and pairwise Mann-Whitney U tests were performed to analyze statistical differences (p < .05). Before treatment, samples showed homogenous surface roughness, and after Er:YAG laser irradiation, the surfaces showed a significant increase in roughness values (p < .05). G3_100 (12.7 J/cm² ) showed the highest amount of Streptococcus mutans adhered (p < .05). The increase in the roughness of the tooth enamel surfaces was proportional to the energy density used; the increase in surface roughness caused by laser irradiation did not augment the adhesion of Streptococcus sanguinis; only the use of the energy density of 12.7 J/cm² favored significantly the adhesion of S. mutans.

Adhesion of Streptococcus mutans and Streptococcus sanguinis on Er:YAG Laser-Irradiated Dental Enamel: Effect of Surface Roughness

Objective: To determine surface roughness caused by Er:YAG laser irradiation and its effect on the increase in bacterial adhesion. Background: Er:YAG laser was proposed as a strategic device to reduce caries by its ability to generate chemical and structural changes in tooth enamel; in turn, it produces undesirable effects on the tooth surface that could increase its roughness and allow a greater accumulation of microorganisms. Methods: Eighty-four samples of human enamel were divided into seven groups (n = 12): G1_control (no laser irradiation); G2_100/H₂O, G3_200/H₂O, and G4_300/H₂O were irradiated with Er:YAG laser (12.7, 25.5, and 38.2 J/cm², respectively) under water irrigation. In addition, G5_100, G6_200, and G7_300 were irradiated with the energy densities described above and no water irrigation. Surface roughness measurements were recorded before and after treatment using a profilometer. Afterward, three samples per group were incubated in a microorganism suspension for the tetrazolium salt (XTT) assay. Biofilm morphology was observed using scanning electron microscopy and confocal laser scanning microscope. One-way analysis of variance and t-tests were performed for statistical analysis (p < 0.05). Results: There were no statistically significant differences in roughness values in the G5_100 group before and after treatment, but there were statistically significant differences observed in the other groups evaluated (p < 0.05). No significant differences in adhesion of both strains were detected in irradiated groups compared with G1_control. Conclusions: The increase in roughness on dental enamel surfaces was proportional to the irradiation conditions. However, the increase in surface roughness caused by Er:YAG laser irradiation did not affect Streptococcus mutans and S. sanguinis adhesion.

Effect of 2.94 µm Er: YAG laser on the chemical composition of hard tissues

The aim was to investigate the effect of the Er-YAG laser radiation on morphology and chemical composition of enamel, dentin, and bone. The specimens of the three groups were irradiated with a very long pulse mode (VLP) of 2.94 µm Er-YAG laser with 100 mJ pulse energy and energy density of 8.42 J/ c m 2 for 30 s, at a repetition rate of 15 Hz. The organic and inorganic content of the samples were investigated by Fourier Transforms Infrared spectroscopy (FTIR). The morphological characteristics were investigated with scanning electron microscopy (SEM) and elemental analysis (calcium and phosphorus) with energy-dispersive X-ray spectroscopy (EDX). FTIR data were analyzed with a One-Way ANCOVA test and EDX data with the independent sample t-test. Following the laser radiation, FTIR showed a significant decrease in the organic content of all tissues. The weight percentage (wt %) calcium content of dentin and bone increased significantly following irradiation with a p-value of .002 for both tissues, but the wt % of phosphorus content was not influenced significantly. The morphological alterations expressed signs of fusion in all the samples.

Effect of Surface Treatment on Enamel Cracks After Orthodontic Bracket Debonding: Er,Cr:YSGG Laser-Etching Versus Acid-Etching

OBJECTIVES

This study sought to compare enamel cracks after orthodontic bracket debonding in the surfaces prepared with erbium, chromium: yttrium-scandium-galliumgarnet (Er,Cr:YSGG) laser and the conventional acid-etching technique.

MATERIALS AND METHODS

This in-vitro experimental study was conducted on 60 sound human premolars extracted for orthodontic purposes. The teeth were randomly divided into two groups (n=30). The teeth in group A were etched with 37% phosphoric acid gel, while the teeth in group B were subjected to Er,Cr:YSGG laser irradiation (gold handpiece, MZ8 tip, 50Hz, 4.5W, 60μs, 80% water and 60% air). Orthodontic brackets were bonded to the enamel surfaces and were then debonded in both groups. The samples were inspected under a stereomicroscope at ×38 magnification to assess the number and length of enamel cracks before bonding and after debonding. Independent-samples t-test was used to compare the frequency of enamel cracks in the two groups. Levene's test was applied to assess the equality of variances.

RESULTS

No significant difference was noted in the frequency or length of enamel cracks between the two groups after debonding (P>0.05).

CONCLUSIONS

Despite the same results of the frequency and length of enamel cracks in the two groups and by considering the side effects of acid-etching (demineralization and formation of white spot lesions), Er,Cr:YSGG laser may be used as an alternative to acid-etching for enamel surface preparation prior to bracket bonding.