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

Comparative study of debris and smear layer removal with EDTA and Er,Cr:YSGG laser

Background

To evaluate in vitro, the ability in removing debris and Smear Layer of 17% EDTA and Er,Cr:YSGG laser.

Material and Methods

58 unirradicular teeth were instrumented with MTwo® and divided into 3 groups according to irrigation protocol: 17%EDTA, laser and a combination of 17%EDTA and laser. All samples were analyzed in the apical and middle third with Scanning Electron Microscope. The Chi-cuadrado and McNemar tests were used to determine the statistical analysis and data processing and analysis was performed with the statistical package StatGraphics Centurion XVI.

Results

Debris analysis showed statistical significant differences when compared EDTA vs laser and EDTA vs EDTA+laser in the middle third. The Smear Layer removal showed statistical significant differences in the middle third when compared EDTA vs laser and EDTA vs EDTA+laser.

Conclusions

Laser showed a greater cleaning capacity than EDTA in the middle third; the cleanliness was even better when combined laser with EDTA, so the effect is accumulative.

Key words:Root canal treatment, Smear Layer, Er,Cr:YSGG laser, debridement.

Erbium Laser Technology vs Traditional Drilling for Caries Removal: A Systematic Review with Meta-Analysis

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.

Comparative evaluation of surface topography of tooth prepared using erbium, chromium: Yttrium, scandium, gallium, garnet laser and bur and its clinical implications

Background:

Erbium, chromium: Yttrium, scandium, gallium, garnet (Er, Cr: YSGG) laser has been successfully used in the ablation of dental hard and soft tissues. It has been reported that this system is also useful for preparing tooth surfaces and etching, but no consensus exist in the literature regarding the advantage of lasers over conventional tooth preparation technique.

Materials and Methods:

Labial surfaces of 25 extracted human maxillary central incisors were divided into two halves. Right half was prepared with diamond bur and left half with Er, Cr; YSGG laser and a reduction of 0.3–0.5 mm was carried out. Topography of prepared surfaces of five teeth were examined under scanning electron microscope (SEM). The remaining samples were divided into 4 groups of 10 specimens each based on the surface treatment received: One group was acid etched and other was nonetched. Composite resin cylinders were bonded on prepared surfaces and shear bond strength was assessed using a universal testing machine.

Results:

The SEM observation revealed that the laser prepared surfaces were clean, highly irregular and devoid of a smear layer. Bur prepared surfaces were relatively smooth but covered with smear layer.

Highest bond strength was shown by laser prepared acid etched group, followed by bur prepared the acid etched group. The bur prepared nonacid etched group showed least bond strength.

Conclusions:

Er, Cr: YSGG laser can be used for preparing tooth and bond strength value achieved by laser preparation alone without surface treatment procedure lies in the range of clinical acceptability.

Efficacy of Erbium, Chromium-doped:Yttrium, Scandium, Gallium, and Garnet Laser Irradiation Combined with Resin-based Tricalcium Silicate and Calcium Hydroxide on Direct Pulp Capping: A Randomized Clinical Trial

INTRODUCTION

The purpose of this randomized clinical study was to evaluate the efficiency of erbium, chromium-doped:yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser irradiation combined with a resin-based tricalcium silicate material and calcium hydroxide in direct pulp capping for a 6-month follow-up period.

METHODS

A total of 60 teeth of 60 patients between the ages of 18 and 41 years were recruited for this study. Sixty permanent vital teeth without symptoms and radiographic changes were randomly assigned to the following 4 groups (n = 15): Gr CH, the exposed area was sealed with calcium hydroxide (CH) paste; Gr laser CH, the treated area was sealed with CH paste after Er,Cr:YSGG laser irradiation at an energy level of 0.5 W without water and with 45% air; Gr TheraCal, TheraCal LC (Bisco, Schaumburg, IL) was applied directly to the exposed pulp; and Gr Laser TheraCal, TheraCal LC was applied after irradiation with an Er,Cr:YSGG laser. At the 1-week and 1-, 3-, and 6-month recall examinations, the loss of vitality, spontaneous pain, reactions to thermal stimuli and percussion, and radiographic changes were considered as failure.

RESULTS

The success rates in the CH and TheraCal groups were 73.3% and 66.6%, respectively. These rates did not reveal any significant difference. In both laser groups, success rates were 100%. The Er,Cr:YSGG laser-irradiated TheraCal and Er,Cr:YSGG laser-irradiated CH groups showed statistically higher success rates than the TheraCal and CH groups, respectively.

CONCLUSIONS

Er,Cr:YSGG laser irradiation at 0.5 W without water combined with pulp capping agents can be recommended for direct pulp therapy.

Effect of Er,Cr:YSGG Laser at Different Output Powers on the Micromorphology and the Bond Property of Non-Carious Sclerotic Dentin to Resin Composites

BACKGROUND

The objective of this study was to investigate the influence of Er,Cr:YSGG laser irradiated at different powers on the micromorphology and the bonding property of non-carious sclerotic dentin to resin composites.

METHODS

Two hundred bovine incisors characterized by non-carious sclerotic dentin were selected, and the seventy-two teeth of which for surface morphological analysis were divided into nine groups according to various treatments (A: the control group, B: only treated with the adhesive Adper Easy One, C: diamond bur polishing followed by Adper Easy One, D-I: Er,Cr:YSGG laser irradiating at 1W, 2W, 3W, 4W, 5W, 6W output power, respectively, followed by Adper Easy One). The surface roughness values were measured by the non-contact three-dimensional morphology scanner, then the surface micromorphologies of surfaces in all groups were assessed by scanning electron microscopy (SEM); meanwhile, Image Pro-Plus 6.0 software was used to measure the relative percentage of open tubules on SEM images. The rest, one hundred twenty-eight teeth for bond strength test, were divided into eight groups according to the different treatments (A: only treated with the adhesive Adper Easy One, B: diamond bur polishing followed by the above adhesive, C-H: Er,Cr:YSGG laser irradiating at 1 W, 2 W, 3 W, 4 W, 5 W, 6 W output power, respectively, followed by the above adhesive), and each group was subsequently divided into two subgroups according to whether aging is performed (immediately tested and after thermocycling). Micro-shear bond strength test was used to evaluate the bond strength.

RESULTS

The 4W laser group showed the highest roughness value (30.84±1.93μm), which was statistically higher than the control group and the diamond bur groups (p<0.05). The mean percentages ((27.8±1.8)%, (28.0±2.2)%, (30.0±1.9)%) of open tubules area in the 4W, 5W, 6W group were higher than other groups (p<0.05). The 4W laser group showed the highest micro-shear bond strength not only in immediately tested (17.60±2.55 PMa) but after thermocycling (14.35±2.08MPa).

CONCLUSION

The Er,Cr:YSGG laser at 4W power can effectively improve the bonding property between non-carious sclerotic dentin and resin composites by increasing the roughness and mean percentage area of open tubules.

Effects of Er,Cr:YSGG laser parameters on dentin bond strength and interface morphology

Previous studies have shown the effects of Er,Cr:YSGG laser irradiation on the dentin bond strength; but there are few reports that show the significance of the irradiation with different laser parameters on dentin bond strength and interface morphology. This in-vitro study attempted to evaluate the microtensile bond strength (μTBS) and interface morphology of resin-dentin interfaces, either followed by treatment with Er,Cr:YSGG laser irradiation with different parameters or not. The flattened dentin samples of 35 bovine teeth were embedded into acrylic blocks and randomly divided into seven groups according to surface treatments using Er,Cr:YSGG lasers with different parameters: 3 W/20 Hz, 3 W/35 Hz, 3 W/50 Hz, 1.5 W/20 Hz, 1.5 W/35 Hz, 1.5 W/50 Hz, or no laser treatment (n = 5). Composite buildups were done over bonded surfaces and stored in water (24 hours at 37°C). Specimens were sectioned into sticks that were subjected to μTBS testing and observed under FE-SEM. Control groups (27.70 ± 7.0) showed statistically higher values than laser-irradiated groups. There were no significant differences among laser groups. Despite that, increasing the pulse frequency yielded slightly higher bond strength. Depending on laser settings, Er,Cr:YSGG laser irradiation caused interfacial gaps and resin tags with wings morphology. With the parameters used in this study, Er,Cr:YSGG laser irradiation promoted morphological changes within resin-dentin interfaces and negatively influenced the bond strength of adhesive systems.

Morphological analysis of the resin-dentin interface in cavities prepared with Er,Cr:YSGG laser or bur in primary teeth

OBJECTIVE

The purpose of this study was to analyze the resin-dentin interface in cavities prepared with laser or bur in primary teeth.

BACKGROUND DATA

Erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser was expected to be an alternative cavity preparation method, enhancing surface alterations and producing morphological changes.

METHODS

Twenty extracted primary molar teeth were divided to four groups according to one of four cavity preparation and pretreatment regimens: Er,Cr:YSGG laser (G1), Er,Cr:YSGG laser+acid-etching (G2), bur (G3), and bur+acid-etching (G4). After applying composite resin to the cavities, the teeth were sectioned. The resin-dentin interface was analyzed under scanning electron microscopy (SEM) and ion analysis was performed with SEM-energy-dispersive X-ray spectroscopy (EDX) after immersion in ammoniacal silver nitrate solution.

RESULTS

In G1 and 2, the surfaces were wavy, and in G3 and 4, the surfaces were smooth. Microcracks were seen in some of the lased cavities. In G1 and 2, dentin tubules were exposed and there was lack of a smear layer. In G3, there were gaps and a smear layer in the resin-dentin interface, but no gaps or smear layer were observed in G4. In G2, the resin tags were increased, and some resin tags were broken in cavities, which were prepared with laser (G1 and 2).

CONCLUSIONS

According to the results of this study, acid-etching was recommended after laser preparations, to have a better adhesion.

Shear bond strength of resin cement to an acid etched and a laser irradiated ceramic surface

PURPOSE

To evaluate the effects of hydrofluoric acid etching and Er,Cr:YSGG laser irradiation on the shear bond strength of resin cement to lithium disilicate ceramic.

MATERIALS AND METHODS

Fifty-five ceramic blocks (5 mm × 5 mm × 2 mm) were fabricated and embedded in acrylic resin. Their surfaces were finished with 1000-grit silicon carbide paper. The blocks were assigned to five groups: 1) 9.5% hydrofluoric-acid etching for 60 s; 2-4), 1.5-, 2.5-, and 6-W Er,Cr:YSGG laser applications for 60 seconds, respectively; and 5) no treatment (control). One specimen from each group was examined using scanning electron microscopy. Ceramic primer (Rely X ceramic primer) and adhesive (Adper Single Bond) were applied to the ceramic surfaces, followed by resin cement to bond the composite cylinders, and light curing. Bonded specimens were stored in distilled water at 37℃ for 24 hours. Shear bond strengths were determined by a universal testing machine at 1 mm/min crosshead speed. Data were analyzed using Kruskal-Wallis and Mann-Whitney U-tests (α=0.05).

RESULTS

Adhesion was significantly stronger in Group 2 (3.88 ± 1.94 MPa) and Group 3 (3.65 ± 1.87 MPa) than in Control group (1.95 ± 1.06 MPa), in which bonding values were lowest (P<.01). No significant difference was observed between Group 4 (3.59 ± 1.19 MPa) and Control group. Shear bond strength was highest in Group 1 (8.42 ± 1.86 MPa; P<.01).

CONCLUSION

Er,Cr:YSGG laser irradiation at 1.5 and 2.5 W increased shear bond strengths between ceramic and resin cement compared with untreated ceramic surfaces. Irradiation at 6 W may not be an efficient ceramic surface treatment technique.

Er,Cr:YSGG laser influence on microleakage of class V composite resin restorations

One of the most challenging issues following restoration is microleakage. The aim of this study was to investigate the effects of Er,Cr:YSGG laser with and without acid etching on microleakage of class V composite restorations. A total of 68 human intact premolars were selected, disinfected, and randomly allocated to four experimental groups (n = 16) as well as positive and negative controls (n = 2 each). Dimensionally, similar class V cavities were prepared on buccal surface of each tooth under the following conditions: group 1, bur cavity preparation and chemical etching (BE); group 2, bur cavity preparation and Er,Cr:YSGG laser conditioning (BLc); group 3, Er,Cr:YSGG laser cavity preparation and chemical etching (LE); and group 4, Er,Cr:YSGG laser cavity preparation and Er,Cr:YSGG laser conditioning (LLc). All samples were restored with composite. The teeth were sealed and immersed in 1 % methylene blue for 48 h before being sectioned. The microleakage evaluation was done under a stereomicroscope (×20). The leakage scores were recorded and Kruskal-Wallis and Mann-Whitney tests were used for statistical evaluations. The highest microleakage score was seen in gingival margins of group 4 (LLc) and the lowest in occlusal margins of group 3 (LE). The overall difference in leakage scores among the groups was statistically significant (p < 0.001) with gingival margins showing a significantly higher score than its occlusal counterparts (p < 0.001). It was noted that less microleakage could be achieved when cavities were prepared by laser compared to bur. In addition, less microleakage was seen in acid-etched cavities than laser-conditioned counterparts.

Minimally Invasive Periodontal Treatment Using the Er,Cr: YSGG Laser. A 2-year Retrospective Preliminary Clinical Study

Minimally invasive surgery (MIS) using the erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser (Waterlase MD, Biolase, Irvine, CA) to treat moderate to advanced periodontal disease is presented as an alternative to conventional therapies. To date, there are few short- or long-term studies to demonstrate the effects of this laser in treating and maintaining periodontal health. Electronic clinical records from 16 patients – total of 126 teeth, with pocket depths ranging from 4 mm to 9 mm – were treated with the same protocol using the Er,Cr:YSGG laser. The mean baseline probing depths (PD) were 5 mm and clinical attachment levels (CAL) were 5 mm in the 4 - 6 mm pretreated laser group. The mean baseline probing depths were 7.5 and 7.6 mm for PD and CAL respectfully in the 7 – 9 mm pretreatment laser group. At the 2 year mark, the average PD was 3.2 ± 1.1 mm for the 4-6 mm pocket group and the 7-9 mm pocket group had a mean PD of 3.7 ± 1.2 mm. mean CAL was 3.1 ± 1.1 mm for the 4-6 mm group and 3.6 ± 1.2 for the 7-9 mm group with an overall reduction of 1.9 mm and 4.0 mm respectively. At one and two years, both groups remained stable with PD comparable to the three-month gains. The CAL measurements at one and two years were also comparable to the three-month gains.

The effect of Nd:YAG and Er,Cr:YSGG lasers on the microhardness of human dentin

The current investigation determined the microhardness of dentin tissue irradiated with erbium, chromium-doped yttrium scandium gallium garnet (Er,Cr:YSGG) and neodymium-doped yttrium-aluminum garnet (Nd:YAG) lasers. Thirty non-carious human molars were used in this study. Dentin disks were prepared by horizontal sectioning of one third of the occlusal surface. Halves of dentin specimens were irradiated with 3.5- and 4.5-W Er,Cr:YSGG lasers and with a 2-W Nd:YAG laser. The remaining halves served as controls. The microhardness measurements were recorded with a Vickers surface microhardness tester. The results were statistically evaluated by paired t test and one-way ANOVA (p = 0.05). Laser irradiation has significantly reduced the microhardness of dentin within each group compared to its control. Moreover, statistically significant differences were observed among the different groups (p < 0.05). The 3.5-W Er,Cr:YSGG laser produced the greatest reduction in microhardness of dentin followed by 4.5 W and Nd:YAG laser. The differences between all the groups were statistically significant. It was concluded that both laser devices used in this study have resulted in significant thermal damage and subsequent reduction in dentin microhardness values.

Effect of surface treatment with sandblasting and Er,Cr:YSGG laser on bonding of stainless steel orthodontic brackets to silver amalgam

Objectives: Satisfactory bonding of orthodontic attachments to amalgam is a challenge for orthodontists. The aim of this in vitro study was to compare the shear bond strength of stainless steel orthodontic brackets to silver amalgam treated with sandblasting and Er,Cr:YSGG laser. Study Design: Fifty-four amalgam discs were prepared, polished and divided into three groups: In group 1 (the control group) the premolar brackets were bonded using Panavia F resin cement without any surface treatment; in groups 2 and 3, the specimens were subjected to sandblasting and Er,Cr:YSGG laser respectively, before bracket bonding. After immersing in distilled water at 37°C for 24 hours, all the specimens were tested for shear bond strength. Bond failure sites were evaluated under a stereomicroscope. Data was analyzed using one-way ANOVA and a post hoc Tukey test. Results: The highest and lowest shear bond strength values were recorded in the laser and control groups, respectively. There were significant differences in mean shear bond strength values between the laser and the other two groups (p<0.05). However, there were no significant differences between the sandblast and control groups (p=0.5). Conclusions: Amalgam surface treatment with Er,Cr:YSGG laser increased shear bond strength of stainless steel orthodontic brackets.

Key words: Amalgam, surface treatment, shear bond strength, sandblasting, Er,Cr:YSGG laser.

Laser modulation of heat and capsaicin receptor TRPV1 leads to thermal antinociception

Er,Cr:YSGG lasers are used clinically in dentistry. The advantages of laser therapy include minimal thermal damage and the alleviation of pain. This study examined whether the Er,Cr:YSGG laser has in vivo and in vitro antinociceptive effects in itself. In capsaicin-evoked acute licking/shaking tests and Hargreaves tests, laser irradiation with an aerated water spray suppressed nociceptive behavior in mice. Laser irradiation attenuated TRPV1 activation by capsaicin in Ca(2+) imaging experiments with TRPV1-overexpressing cells and cultured trigeminal neurons. Therefore, the laser-induced behavioral changes are probably due to the loss of TRPV1 activity. TRPV4 activity was also attenuated, but limited mechanical antinociception by the laser was observed. The laser failed to alter the other receptor functions, which indicates that the antinociceptive effect of the laser is dependent on TRPV1. These results suggest that the Er,Cr:YSGG laser has analgesic effects via TRPV1 inhibition. Such mechanistic approaches may help define the laser-sensitive pain modality and increase its beneficial uses.

Comparison of microleakage of three adhesive systems in class V composite restorations prepared with Er,Cr:YSGG laser

OBJECTIVE

This study compared microleakage of three adhesives in class V (CI V) composite restorations prepared with Er,Cr:YSGG laser.

BACKGROUND DATA

Changes produced on enamel and dentin surfaces subsequent to laser irradiation influence microleakage of composite restorations.

MATERIALS AND METHODS

CI V cavities were prepared in 80 sound extracted human premolars with Er,Cr:YSGG laser. The teeth were randomly divided into 4 groups (n = 20). In group 1, a total-etch adhesive was used, and two-step and one-step self-etch adhesives were used in groups 2 and 3, respectively. Group 4 was the control group with no adhesives. Following restoration and thermocycling, microleakage was evaluated. To compare microleakage in occlusal and gingival margins in each group, the Wilcoxon test was used. Kruskal-Wallis analysis was used for comparison of occlusal and gingival microleakage, and two-by-two comparisons were made using the Mann-Whitney U test.

RESULTS

There were significant differences in microleakage between occlusal and gingival margins in each group except for the control group. Significant differences were observed in occlusal and gingival microleakage among all the groups. Two-by-two comparisons revealed significant differences in occlusal microleakage between the control group and the other groups. There were significant differences in gingival microleakage between groups 1 and 2 and groups 1 and 3; however, differences in gingival microleakage between groups 2 and 3 were not significant.

CONCLUSION

With all the adhesives, microleakage was significantly higher in gingival margins compared with occlusal margins. In occlusal margins, there were no significant differences in microleakage among the three adhesives. In gingival margins, self-etch adhesives revealed less microleakage than the total-etch adhesive.

Influence of etching time on bond strength in dentin irradiated with erbium lasers

The purpose of this in vitro study was to evaluate the effect of etching time on the tensile bond strength (TBS) of a conventional adhesive bonded to dentin previously irradiated with erbium:yttrium-aluminum-garnet (Er:YAG) and erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers. Buccal and lingual surfaces of 45 third molars were flattened until the dentin was exposed and randomly assigned to three groups (n = 30) according to the dentin treatment: control (not irradiated), irradiated with Er:YAG (1 W; 250 mJ; 4 Hz; 80.6 J/cm(2)) laser or Er,Cr:YSGG (4 W; 200 mJ; 20 Hz; 71.4 J/cm(2)) laser, and into three subgroups (n = 10) according to acid etching time (15 s, 30 s or 60 s) for each experimental group. After acid etching, the adhesive was applied, followed by the construction of an inverted cone of composite resin. The samples were immersed in distilled water (37 degrees C for 24 h) and subjected to TBS test [50 kilogram-force (kgf), 0.5 mm/min]. Data were analyzed by analysis of variance (ANOVA) and Tukey statistical tests (P < or = 0.05). Control group samples presented significant higher TBS values than those of all lased groups. Both irradiated groups exhibited similar TBS values. Samples subjected to the different etching times in each experimental group presented similar TBS. Based on the conditions of this in vitro study we concluded that Er:YAG and Er,Cr:YSGG laser irradiation of the dentin weakens the bond strength of the adhesive. Moreover, increased etching time is not able to modify the bonding strength of the adhesive to irradiated dentin.

Atomic analysis and hardness measurement of the cavity prepared by laser

The purpose of this study was to compare the compositional changes and microhardness of the cavity floor prepared by erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser irradiation with those of the conventional bur-prepared cavity. A total of 16 extracted human molar teeth (with no carious lesions or repairs) were selected for this study. On the buccal and lingual (palatal) surfaces of each tooth, cavities (diameter 3 mm, depth 2 mm) were prepared with an Er,Cr:YSGG laser system (Waterlase MD(TM), USA) and high-speed turbine. The cavities were cross-sectioned and subjected to atomic analysis by scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDX) and Vickers hardness test. Statistical analyses were performed with t-tests. Surface characteristics of the prepared cavities were also investigated by SEM. No significant differences were found between the calcium/phosphorus (Ca/P) ratio and Vickers hardness of laser- and bur-prepared cavities. The SEM observation revealed that the lased cavity surface was irregular, and there was also an absence of smear layer; the orifices of dentinal tubules were exposed. Microhardness measurement of the cavity floor confirmed that the Er,Cr:YSGG laser produced a clean-cut surface of the cavity.

Acid-etch interval and shear bond strength of Er,Cr:YSGG laser-prepared enamel and dentin

The formation of a superficial layer of tiny flakes has been observed on teeth prepared by Erbium lasers. It has been suggested that removing this layer (mechanically or chemically) may increase the bond strength of the resin composite. The purpose of this study is to evaluate the effect of various etching times on bond strength of resin composite to enamel and dentin prepared by Er,Cr:YSGG laser. Sixty previously flattened human molars were irradiated for 10 s by an Er,Cr:YSGG laser. Enamel (E) specimens were etched with 37% H(3)PO(4) for 20, 40 or 60 s and dentin (D) specimens were etched for 15 or 30 s. All specimens were prepared for a standard shear bond strength (SBS) test (1 mm/min). Data were analyzed [ANOVA, Tukey post-hoc, a < 0.05)] and the failure mode was studied under SEM. Mean SBS+/-sd (MPa) for each group was 16.97 +/- 7.77 (E20s), 21.34 +/- 3.55 (E40s), 14.08 +/- 4.77 (E60s), 13.62 +/- 7.28 (D15s) and 13.15 +/- 6.25 (D30s). SBS for E40s was significantly higher than E60s (p = 0.023). No difference was noted between the dentin groups. SEM evaluation showed predominantly cohesive failure. Within the limits of this study, etching time significantly influenced the SBS of composite resin to laser-prepared enamel. SEM showed subsurface cracks, fissures, and deformities leading to predominantly cohesive failure in both enamel and dentin.

Evaluation of mineral content of enamel prepared by erbium, chromium:yttrium-scandium-gallium-garnet laser

The aim of this study was to evaluate the mineral content of enamel etched at two different power settings with an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser. Buccal, lingual and mesial or distal surfaces of five premolar teeth were cut, and three enamel slabs were obtained from each tooth. Fifteen enamel specimens were divided into three groups (1 W, 2 W and control) of five specimens each and subjected to Er,Cr:YSGG laser. The mean percentage weights of the five elements [calcium (Ca), potassium (K), magnesium (Mg), sodium (Na) and phosphorus (P)] in each slab were measured by inductively coupled plasma-atomic emission spectrometry (ICP-AES). One way analysis of variance (ANOVA) was used to analyze differences among the groups (1 W, 2 W and control). There were no significant differences among the groups (1 W, 2 W and control) for Ca, K, Mg, Na, or P, or for the Ca/P ratio (P > 0.05). Scanning electron microscopy (SEM) photographs indicated that the surface irregularities increased with increased power setting. Laser treatment did not affect the mean percentage weights of Ca, K, Mg, Na, and P, or the Ca/P ratio, in any group.

Intrapupal temperature variation during Er,Cr: YSGG enamel irradiation on carries prevention

Studies have shown the cariostatic effect of Er,Cr:YSGG (2.78 mm) laser irradiation on human enamel and have suggested its use on caries prevention. However there are still no reports on the intrapulpal temperature increase during enamel irradiation using parameters for caries prevention. The aim of this in vitro study was to evaluate the temperature variation in the pulp chamber during human enamel irradiation with Er,Cr:YSGG laser at different energy densities. Fifteen enamel blocks obtained from third molars (3 x 3 x 3 mm) were randomly assigned to 3 groups (n=5): G1--Er,Cr:YSGG laser 0.25 W, 20 Hz, 2.84 J/cm(2), G2--Er,Cr:YSGG laser 0.50 W, 20 Hz, 5.68 J/cm(2), G3--Er,Cr:YSGG laser 0.75 W, 20 Hz, 8.52 J/cm(2). During enamel irradiation, two thermocouples were fixed in the inner surface of the specimens and a thermal conducting paste was used. One-way ANOVA did not show statistically significant difference among the experimental groups (alpha=0.05). There was intrapulpal temperature variation < or = 0.1 degrees C for all irradiation parameters. In conclusion, under the tested conditions, the use of Er,Cr:YSGG laser with parameters set for caries prevention lead to an acceptable temperature increase in the pulp chamber.

Effect of different laser devices on the composition and microhardness of dentin

This study determined the compositional changes and microhardness of the cavity floor prepared by Er,Cr:YSGG and Er:YAG lasers and compared the results with the conventional method of bur preparation. Fifteen non-carious human molars were used in this study. On the buccal and lingual surfaces of each tooth, two cavities (mesio-distal 3 mm, inciso-gingival 3 mm, depth 2 mm) were prepared with two different laser devices (Er,Cr:YSGG laser; Waterlase MD and Er:YAG laser; KaVo Key Laser 3) and a high-speed turbine. The teeth were embedded into polyester resin and cross-sectioned. The microhardness measurements from the floor of each half cavity were recorded with the Vickers surface hardness tester. The remaining halves of the cavities were subjected to SEM-EDS atomic analysis. The results were statistically evaluated by one-way ANOVA and Kruskal Wallis tests (p = 0.05). No significant differences were observed among the microhardness values, quantities of Ca (Ca weight %), P (P weight %) and Ca/P ratio of the lased and conventionally prepared cavities (p > 0.05). The cavity preparation techniques and differences in laser devices did not significantly alter the composition and microhardness of dentin tissue. Both laser devices used in this study were observed to lead to minimal thermal damage in the dentin tissue and minimal thermally-induced changes in dentinal compositions.

Impact of Er,Cr:YSGG laser therapy on the cleanliness of the root canal walls of primary teeth

Root canal therapy might be required for primary teeth displaying signs of pulpal inflammation or necrosis. Cleaning and shaping followed by obturation of the canal space with a resorbable paste have been widely performed with remarkable clinical success. However, lengthy endodontic procedures might be contraindicated when treating certain pediatric patients. The aim of this study was to compare the cleanliness of the root canal walls of primary teeth and the time required for the completion of the cleaning and shaping procedures performed by the Er,Cr:YSGG laser, manual or rotary instrumentation techniques. Thirty-five extracted, single-rooted, primary teeth were divided into 4 groups: I, canals were instrumented with Profile .04 rotary instruments to a master apical file size #35; II, the laser was used (parameters: 1.50 W, 20 pps, 30% water and 50% air) with a Z3 laser tip (0.32-mm diameter); III, canals were instrumented with stainless steel K-files; and IV, no instrumentation was performed (control). The teeth were split in 2 halves and prepared for scanning electron microscopy analysis. Images from the coronal, middle, and apical thirds of the roots were analyzed independently by 2 calibrated, blinded evaluators. Statistical analysis revealed significant differences among the groups (Kruskal-Wallis, P = .0001). The techniques were not capable of providing completely clean canals. Treatment with Er,Cr:YSGG laser provided similar cleanliness when compared with rotary instrumentation technique and was superior to manual instrumentation. The laser technique required less time for completion of the cleaning and shaping procedures when compared with both rotary or hand instrumentation.

Changes in intrapulpal temperature after Er:YAG laser irradiation

OBJECTIVE

This study was performed to investigate the changes in temperature induced by an Er:YAG laser irradiation and to find the means to minimize potential thermal damage due to temperature rise after irradiation.

BACKGROUND DATA

Intrapulpal temperature rise was found to last after irradiation at times, although the addition of appropriate water spray during tooth ablation by Er:YAG laser produced efficient ablation with little thermal damage.

METHODS

To investigate intrapulpal temperature change, each extracted tooth specimen was embedded into a resin block and temperature-measuring probes were placed on the irradiated and the opposite pulpal walls. An Er:YAG laser irradiation was performed at 300 mJ/pulse and 20 Hz, with a water flow rate of 1.6 mL/min for 3 sec. Each lasing was followed by (1) no application of post-irradiation water spray, (2) post-irradiation water spray for 1 sec and (3) for 2 sec.

RESULTS

No significant temperature change was found on the irradiated pulpal wall during Er:YAG laser, while there existed significant temperature rise on the irradiated pulpal wall after irradiation. However, the addition of water spray for 1 or 2 sec after irradiation significantly decreased intrapulpal temperature compared to no application of post-irradiation water spray. There were no significant differences between the 1- and 2-sec groups.

CONCLUSION

It is suggested that the addition of water spray for 1 or more seconds after irradiation reduces post-irradiation temperature rise, possibly leading to thermal damage on the dental pulp tissue.

Erbium, chromium:yttrium scandium gallium garnet laser for caries removal: influence on bonding of a self-etching adhesive system

This study evaluated the influence of the dental substrates obtained after the use of different caries removal techniques on bonding of a self-etching system. Forty, extracted, carious, human molars were ground to expose flat surfaces containing caries-infected dentine surrounded by sound dentine. The caries lesions of the specimens were removed or not (control--G1) either by round steel burs and water-cooled, low speed, handpiece (G2), or by irradiation with an erbium, chromium:yttrium scandium gallium garnet (Er,Cr:YSGG) laser (2W, 20 Hz, 35.38 J/cm(2), fiber G4 handpiece with 0.2826 mm(2), non-contact mode at a 2 mm distance, 70% air/20% water--G3) or using a chemo-mechanical method (Carisolv--G4). Caries-infected, caries-affected and sound dentines were submitted to a bonding system followed by construction of a resin-based composite crown. Hour-glass shaped samples were obtained and submitted to a micro-tensile bond test. The bond strength data were compared by analysis of variance (ANOVA), complemented by Tukey's test (P <or= 0.05). The samples of sound dentine presented higher bond strengths than did samples of caries-affected dentine, except for the groups treated with the Er,Cr:YSGG laser. The highest bond strengths were observed with the sound dentine treated with burs and Carisolv. The bond strengths to caries-affected dentine were similar in all groups. Additionally, bonding to caries-affected dentine of the Er,Cr:YSGG laser and Carisolv groups was similar to bonding to caries-infected dentine. Thus, caries-affected dentine is not an adequate substrate for adhesion. Moreover, amongst the caries removal methods tested, the Er,Cr:YSGG laser irradiation was the poorest in providing a substrate for bonding with the tested self-etching system.

An assessment following root canal preparation by Er,Cr:YSGG laser irradiation in straight and curved roots, in vitro

In the present study, the effectiveness of Er,Cr:YSGG laser in straight and curved root canal preparation was compared with that of the conventional canal preparation technique, in vitro. The degree of root curvature of 40 root canals was determined, and then 20 canals were prepared by an Er,Cr:YSGG laser of 2 W by using the crown-down technique, while the other 20 canals were shaped by K-file (control). The achievement degree of root canal preparation and debris score was investigated morphologically. The results indicated that straight root canals could be successfully prepared by Er,Cr:YSGG laser irradiation; a significant decrease of smear layer or debris was also recognized (P<0.01). However, canal preparation by laser device in curve root often leads to a ledge or zipped formation, perforation or over-instrumentation. The results demonstrated that further development in laser device and technique are required to ensure its success in root canal preparation, especially in curve root.

Effect of Er,Cr:YSGG laser irradiation on eruption of rat mandibular incisor after disturbance of the enamel organ in the pulp

To investigate the efficacy of Er,Cr:YSGG (erbium,chromium:yttrium scandium gallium garnet) laser irradiation in root canal preparation and to evaluate its effect on eruption of rat incisors after disturbance of the enamel organ in the pulp, 20 canals of lower left incisor teeth were prepared by K-files followed by Er,Cr:YSGG laser irradiation, and 20 canals of right incisors were subjected to K-files only (control). At 1 week after irradiation, both sides of incisors erupted at the same level from the gingival margin. Histological findings showed that laser irradiation produced a slightly larger damage in the pulp than that of control. Scanning electron microscope observation revealed that laser-treated surface revealed a rough, irregular, and very clean surface; there was almost no evidence of debris or smear layer, and dentinal tubules were opened. Adequate power of Er,Cr:YSGG laser irradiation is effective in root canal preparation without disturbance of the eruption.

Tensile bond strength of Er,Cr:YSGG laser-irradiated human dentin and analysis of dentin-resin interface

OBJECTIVES

As the bond strength of composite resin to Er,Cr:YSGG laser-irradiated dentin has not yet been evaluated, the objectives of this study were to investigate the tensile bond strength and to analyze the resin-dentin interface among bur-cut/acid-etched, Er,Cr:YSGG laser-ablated/acid-etched and Er,Cr:YSGG laser-ablated human dentin.

METHODS

Crown dentin disks prepared from extracted human third permanent molars were used for the observation of surface morphological changes by scanning electron microscope (SEM). The laser energy parameters were 3.5 W and 20 Hz with water spray (air pressure level, 80%; water pressure level, maximum level). Another group of crown dentin disks were prepared for composite resin restoration and observation of resin-dentin bond interface after demineralization in 6N hydrochloric acid (HCl) for 1 min and deproteinization in 1% sodium hypochlorite solution (NaOCl) for 10 min. The tensile bond strengths of the three groups were measured by a universal testing machine at a crosshead speed of 0.5 mm/min. Fracture types at the dentin-resin interface were analyzed using the digital stereoscopic microscope and fractured surfaces of the debonded specimens were examined by SEM.

RESULTS

All three groups showed that the treated surfaces were free of dentin debris and smear layer. The peritubular dentin protruded from the surrounding intertubular dentin after laser irradiation. The dentin-resin interface treated with Er,Cr:YSGG laser irradiation and acid etching demonstrated numerous resin tags converging into a bulge and then diverging again. The length of resin tags was greater than 100 microm. The tensile bond strengths of bur-cut/acid-etched, laser-ablated/acid-etched and laser-ablated human dentin were 5.37+/-1.51, 5.17+/-1.41 and 3.29+/-0.86 MPa, respectively. No statistical significance was found between the bur-cut/acid-etched and laser-ablated/acid-etched groups. The predominant fracture modes of bur-cut/acid-etched, laser-ablated/acid-etched and laser-ablated human dentin were Type 1 (50%), Type 2 (70%) and Type 1 (70%), respectively.

SIGNIFICANCE

Er,Cr:YSGG laser irradiation affects adversely adhesion of resin to dentin but acid etching following laser irradiation could increase the tensile bond strength as high as that of bur-cut/acid-etched human dentin.

Innovative wavelengths in endodontic treatment

BACKGROUND AND OBJECTIVES

The sanitation of the root canal system and the adjacent dentin has always been a key requirement for successful endodontics. In recent years, various laser systems have provided a major contribution to this aim, namely the Nd:YAG-, the 810 nm Diode-, the Er:YAG-, and the Er,Cr:YSGG laser. Numerous studies could prove their efficiency within the endodontic procedure. Recently, two new wavelengths have been introduced to the field of oral laser applications: The KTP laser emitting at 532 nm and the 980 nm diode laser. The present in vitro investigation was performed to evaluate the effects of these laser systems focusing on their antibacterial effect in deep layers of dentin and their impact on the root canal dentin.

STUDY DESIGN/MATERIALS AND METHODS

Two-hundred slices of root dentin with a thickness of 1 mm were obtained by longitudinal cuts of freshly extracted human premolars. The samples were steam sterilized and subsequently inoculated with a suspension of either Escherichia coli or Enterococcus faecalis. After the incubation, the samples were randomly assigned to the two different laser systems tested. Each laser group consisted of two different operational settings and a control. The dentinal samples underwent "indirect" laser irradiation through the dentin from the bacteria-free side and were then subjected to a classical quantitative microbiologic evaluation. To assess the temperature increase during the irradiation procedure, additional measurements were carried out using a thermocouple. To assess the impacts on the root canal walls, 20 additional samples underwent laser irradiation at two different settings and were subjected to scanning electron microscopy.

RESULTS

Microbiology indicated that both laser systems were capable of significant reductions in both test strains. At an effective output power of 1 W, E. coli was reduced by at least 3 log steps in most of the samples by the tested wavelengths, with the best results for the KTP laser showing complete eradication of E. coli in 75% of the samples. E. faecalis, a stubborn invader of the root canal, showed minor changes in bacterial count at 1 W. Using the higher setting of 1.5 W, significant reductions of E. coli were again observed with both laser systems, where the lasers were capable of complete eradication of E. faecalis to a significant extent. There was no significant relation between the temperature increase and the bactericidal effect.

CONCLUSIONS

The present study demonstrates that both wavelengths investigated could be suitable for the disinfection of even the deeper layers of dentin and equal the results achieved by established wavelengths in state-of-the-art endodontics.

Morphological Study of the Er,Cr:YSGG Laser for Root Canal Preparation in Mandibular Incisors with Curved Root Canals

OBJECTIVE

The objectives of this study were to observe morphological changes of root canal walls and to evaluate the capability of Er,Cr:YSGG laser for preparation of curved mandibular incisor root canals in vitro.

BACKGROUND DATA

There are no published reports on the use of Er,Cr:YSGG laser for curved root canal preparation.

METHODS

Twenty curved mandibular incisor root canals (10 and 15 degrees) were prepared sequentially by laser irradiation at 20 Hz, 2 Wusing two different sizes of fine fiber tips (200 and 320 microm in diameters). After laser irradiation, the teeth were bisected longitudinally, and the specimens were observed by stereoscope and scanning electron microscope (SEM).

RESULTS

Root canal walls of the irradiated areas showed step-like appearances and openings of dentinal tubules, and root canal preparation, having curvatures of less than 10 degrees, could be carried out by this laser irradiation.

CONCLUSIONS

Er,Cr:YSGG laser irradiation is capable of preparing root canals having curvatures of less than 10 degrees.

Morphological comparative study on ablation of dental hard tissues at cavity preparation by Er:YAG and Er,Cr:YSGG lasers

OBJECTIVE

The purpose of this study was to evaluate morphologically the dental hard tissue ablation at the class V cavity preparation by two types of laser devices: Er:YAG and Er,Cr:YSGG lasers in vitro.

BACKGROUND DATA

There have been no reports on the comparative study of dental tissue ablation at cavity preparation by Er:YAG and Er,Cr:YSGG lasers.

METHODS

Twenty-two extracted human mature molar teeth were used in this study and divided into two groups of 11 teeth each. The teeth of the Er:YAG laser-irradiated group were irradiated at the parameters of 250 mJ/pulse and 15 Hz with water spray, and those of the Er,Cr:YSGG laserirradiated group were irradiated at the parameters of 5 Wand 20 Hz with water spray. After cavity preparation, the teeth were dehydrated, coated with platinum, and examined by scanning electron microscopy.

RESULTS

Both of the laser devices were capable of ablating dental hard tissues, but similar, irregular, and rugged surface aspects with different depths were observed. Open dentinal tubules at the cavities prepared by Er,Cr:YSGG laser were more clearly visible than those prepared by Er:YAG laser. Smaller width and stripped surfaces were observed on the cavities prepared by Er,Cr:YSGG laser.

CONCLUSION

The results suggested that there is little difference between the two types of lasers-Er:YAG and Er,Cr:YSGG lasers-morphologically for class V cavity preparation, because both lasers were capable of preparing class V cavities, and the morphological features of the irradiated surfaces were very similar.