Types of Lasers and Their Applications in Pediatric Dentistry

Surgical Correction of Ankyloglossia Using Diode Laser-Assisted Frenectomy in a Pediatric Patient: A Case Report

Tongue-tie is a continuation of the lingual frenum that is attached to the tip of the tongue. It is a congenital oral anomaly that could restrict tongue movements, caused by a lingual frenum a membrane that originates from the floor of the mouth to the bottom of the tongue that is too thick and short, which limits the natural ability of the tongue to move and function. The tongue is an auxiliary organ that facilitates speaking, mastication, and deglutition. This condition may result in several difficulties including chewing, breastfeeding, speech, and pronunciation of particular words, as well as possessing social and mechanical consequences. Ankyloglossia can be seen in young age groups. The use of lasers has increased in dentistry in recent years. However, in oral and maxillofacial surgery, the use of lasers has been largely restricted to soft tissues, and less focus is placed on the use of hard tissues. Carbon dioxide (CO2) lasers, erbium-doped yttrium aluminum garnet (Er: YAG) lasers, and Er, the erbium, chromium: yttrium: scandium gallium-garnet (Cr: YSGG) lasers are among the several types of lasers that have been utilized in dentistry for correction of soft tissues as well as for hard tissues.

Artificial Intelligence in Adult and Pediatric Dentistry: A Narrative Review

Artificial intelligence (AI) has been recently introduced into clinical dentistry, and it has assisted professionals in analyzing medical data with unprecedented speed and an accuracy level comparable to humans. With the help of AI, meaningful information can be extracted from dental databases, especially dental radiographs, to devise machine learning (a subset of AI) models. This study focuses on models that can diagnose and assist with clinical conditions such as oral cancers, early childhood caries, deciduous teeth numbering, periodontal bone loss, cysts, peri-implantitis, osteoporosis, locating minor apical foramen, orthodontic landmark identification, temporomandibular joint disorders, and more. The aim of the authors was to outline by means of a review the state-of-the-art applications of AI technologies in several dental subfields and to discuss the efficacy of machine learning algorithms, especially convolutional neural networks (CNNs), among different types of patients, such as pediatric cases, that were neglected by previous reviews. They performed an electronic search in PubMed, Google Scholar, Scopus, and Medline to locate relevant articles. They concluded that even though clinicians encounter challenges in implementing AI technologies, such as data management, limited processing capabilities, and biased outcomes, they have observed positive results, such as decreased diagnosis costs and time, as well as early cancer detection. Thus, further research and development should be considered to address the existing complications.

Micro-Morphological Features of the Er:YAG-Lased Interface in Primary Teeth: 12 Months Randomized Split-Mouth Trial

Despite considerable improvements in oral health, dental caries remains a public health issue. The most frequently used technique to remove caries is through rotating drills. New minimally invasive strategies were introduced into dental practice, such as the use of lasers to perform highly controlled tissue ablation while limiting pain and discomfort, as well as overcoming drill phobia. The objective was to assess and compare treatment with Er:YAG laser versus a conventional rotary treatment during cavity preparation in children with regard to bond interface quality. In a randomized trial using a split-mouth design, 40 (9-12 year-old) children with 80 carious primary molars were included. The cavity in one quadrant was treated conventionally using a bur, while the cavity in the other quadrant was prepared using an Er:YAG laser. Twenty restored teeth were extracted after one year. The SEM histological evaluation of bond interface results demonstrated no statistically significant differences between restorations placed following bur preparation and those placed following the Er:YAG laser preparation, and both treatments demonstrated promising results. Over a one-year period, no statistically significant differences in the bond interface quality were observed following class I cavity preparation in primary teeth with either Er:YAG laser or a conventional rotary bur.

Histologic Evaluation of Effect of Three Wavelengths of Diode Laser on Human Gingival Margins

Introduction: Available evidence suggests that the response of the intervened tissue is directly linked to the effects generated by the cutting instrument used. To determine the histological findings in gingival tissue margins excised through gingivectomies performed using 450 nm, 940 nm, and 980 nm diode lasers. The present study aimed to determine the histological findings in gingival tissue margins excised through gingivectomies performed using 450 nm, 940 nm, and 980 nm diode lasers. Methods: Gingival tissue samples were collected from 30 patients who had undergone gingivectomy procedures. Each study group comprised 10 patients who willingly provided their samples after providing informed consent. The visualization of histological findings was facilitated through Hematoxylin-Eosin staining. Additionally, variables related to pain and hemostasis were assessed during the intraoperative period. Results: The incision quality was categorized as irregular across all three wavelengths. Histological examination of the epithelial tissue revealed the absence of carbonization and the preservation of cell morphology in over 50% of the resection margin in samples obtained with the 450 nm and 940 nm wavelengths. In the connective tissue, observations included carbonization, collagen coagulation, and basophilia, with the 980 nm wavelength demonstrating the highest percentage of samples displaying collagen coagulation in more than 50% of the resection margin. Conversely, the 450 nm wavelength exhibited the highest degree of preservation of the fibroblast structure. Conclusion: Based on a comprehensive analysis of the study results, it can be inferred that the 450nm and 940nm wavelength lasers tend to produce less thermal damage and better cell preservation when compared to the 980nm wavelength.

Evaluation of the Erbium-doped Yttrium Aluminum Garnet Laser and the Conventional Method on Pain Perception and Anxiety Level in Children during Caries Removal: A Randomized Split-mouth Study

Aim and objective

To assess and compare children's anxiety level and pain perception during cavity preparation using an erbium-doped yttrium aluminum garnet (Er:YAG) laser vs traditional rotational treatment.

Materials and methods

A randomized, controlled, split-mouth clinical trial was carried out in 35 healthy children with 70 carious primary molars. Teeth were divided equally into two groups according to the method of treatment. A bur was used to prepare the cavity in one quadrant, while an Er:YAG laser was used to prepare the cavity in the other quadrant. Anxiety was assessed using Venham's dental anxiety scale and a fingertip pulse oximeter. The pain was assessed using the Wong-Baker Face Pain Rating Scale, and the number of local anesthesia (LA) needed during both procedures was also considered.

Results

The mean age was 9.4 ± 1.29. Males accounted for 51.4% of the participants. There were no statistically significant variations in pulse rate at the baseline between Er:YAG laser and the conventional treatments. The mean pulse rate was higher during the conventional intervention than during the laser intervention; this difference was statistically significant vs the baseline pulse rate. The mean pulse rate with the conventional method was significantly higher during and after cavity formation than with the laser method. The Er:YAG laser and the conventional groups showed statistically significant differences in the Venham's and Wong-Baker scores. The scores of both scales were much higher in the conventional group. The number of participants who requested LA during the conventional technique was significantly higher than during the laser procedure.

Conclusion

Using Er:YAG lasers to remove caries produces minimal pain and anxiety and reduces the requirement for LA.

Clinical significance

During cavity preparation, the Er:YAG laser helps children stay calm.

How to cite this article

Abdrabuh RE, El Meligy OAES, Felemban OM, et al. Evaluation of the Erbium-doped Yttrium Aluminum Garnet Laser and the Conventional Method on Pain Perception and Anxiety Level in Children during Caries Removal: A Randomized Split-mouth Study. Int J Clin Pediatr Dent 2023;16(S-1):S39-S44.

Efficacy of Various Laser Wavelengths in the Surgical Treatment of Ankyloglossia: A Systematic Review

Ankyloglossia, commonly known as tongue-tie, is the most common disorder of tongue morphology characterized by aberrant attachment of the lingual frenum. This study aimed to provide a comprehensive literature review and evaluate the effectiveness of various laser wavelengths in the surgical treatment of patients with ankyloglossia. An electronic screening of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted on 8 November 2021. The following search terms were used to review the available data on the subject of interest: (ankyloglossia OR tongue tie OR short lingual frenulum OR lingual frenectomy OR lingual frenulectomy OR lingual frenotomy OR lingual frenulotomy) AND laser. The use of lasers in ankyloglossia treatment resulted in shorter procedure time, reduced indications for general anesthesia, reduced administration of postoperative analgesics, fewer sutures or none needed, reduced postoperative bleeding, and improved healing. Despite many advantages, this method has its clinical limitations: it requires the use of expensive equipment; well-trained personnel familiar with lasers; and personal protective equipment for the patient, caregiver, operator, and assistant. The laser procedure does not eliminate the need for myofunctional exercises and work with a speech therapist.

Computer-Controlled CO2 Laser Ablation System for Cone-beam Computed Tomography and Digital Image Guided Endodontic Access: A Pilot Study

Introduction:

Ideal endodontic access provides unobstructed entry to the pulp chamber and visualization of the canal orifices while preserving the maximum amount of tooth structure. The aim of this study was to implement the use of lasers to accurately and predictably access teeth to follow the principles of minimally invasive endodontics.

Methods:

Traditional, conservative, ultraconservative, bridge, truss, and orifice-directed accesses were performed. A computer-controlled 9.3-μm CO₂ laser ablation system was assembled and coupled with custom software capable of combining cone-beam computed tomographic (CBCT) volumetric data with spatially calibrated digital images of teeth to provide an augmented reality environment for designing and preparing endodontic accesses. Twenty (N = 20) sound posterior teeth with fully developed root canal systems were imaged with CBCT scans and accessed via laser ablation in vitro.

Results:

All 20 (20/20) teeth were successfully accessed without iatrogenic errors. Volumetric renderings from post-access CBCT scans were used to verify the access and determine accuracy qualitatively. The volumetric measurements of hard tissue removed were as follows: traditional = 39.41 mm³, conservative = 9.76 mm³, ultraconservative = 7.1 mm³, bridge = 11.53 mm³, truss = 19.21 mm³, and orifice directed = 16.86 mm³.

Conclusions:

Digital image guidance based on feature recognition and registration with CBCT data is a viable method to address the challenge of dynamic navigation for accessing the pulp chamber. Modern lasers with high pulse repetition rates integrated with computer-controlled scanning systems are suitable for the efficient cutting of dental hard tissues.

The Efficacy of Lingual Laser Frenectomy in Pediatric OSAS: A Randomized Double-Blinded and Controlled Clinical Study

This randomized, double-blind and controlled clinical trial investigates how a diode laser lingual frenectomy can improve obstructive sleep apnea syndrome (OSAS) in pediatric patients. Background: Several authors have shown that a short lingual frenulum causes a reduction in incoming air flow and the relationship between OSAS and a short lingual frenulum. Methods: Thirty-two pediatric patients were equally randomly divided into a Study Group (SG) and a Control Group (CG). On each SG patient a polysomnography 1 (PSG1) and a lingual frenectomy were performed using a diode laser via Doctor Smile Wiser technology, power 7 W. After three months, a new polysomnography (PSG2) was performed to evaluate the lingual frenectomy efficacy in pediatric patients. The pain was assessed by a numerical rating scale (NRS) before and after surgery. The CG followed the same protocol without a lingual frenectomy but myofunctional and speech therapy were conducted to qualitatively and quantitatively improve the lingual functionality. In the SG, eight subjects (50%) had severe OSAS and eight had moderate (50%) while in the CG, three subjects had severe OSAS (18.8%) and thirteen had moderate (81.2%). Results: In the SG, 93.8% were classified as mild OSAS and 6.2% as moderate. In contrast, in the CG, 18.75% were classified as mild OSAS, 62.5% as moderate and 18.75% as severe. Conclusion: The study demonstrates how a lingual laser frenectomy can improve OSAS in pediatric patients.

Recurrent Oral Mucocele Management with Diode Laser

Background

Mucocele is the most common minor salivary glands disease. Its management may present a challenge for dental professionals. The aim of the present clinical case was to describe mucocele treatment with diode laser and its benefits. Case Report. A case of lower lip mucocele in a 10-year-old female patient is reported. A conventional excision surgery was performed. Two months later, the patient reported discomfort and swelling at the same operative site. The lesion had recurred. Thus, mucocele was removed using a diode laser with wavelength of 980 nm, an initiated fiberoptic tip of 300 μm, in continuous mode, and a power setting of 2 Watts. The procedure was rapidly completed with no bleeding. The patient was followed-up after 2 weeks and 6 months. The wound healed without complications: no postoperative discomfort or pain and no infection. There was no recurrence.

Conclusion

Diode laser is an effective, easy, bloodless, and well-accepted procedure to treat mucocele in pediatric patients.

Adhesive bond integrity of dentin conditioned by photobiomodulation and bonded to bioactive restorative material

AIM

The aim of this in-vitro study is to investigate the shear bond strength (SBS) of Bioactive bulk fill restorative material (BARM) (Activa) by surface pre-treatment using Er,Cr:YSGG (ECL) on dentin in comparison to conventional dentin conditioning techniques.

MATERIAL AND METHODS

Sixty extracted non-carious, non-fractured, restoration free human molars were collected and mounted vertically in acrylic resin. The buccal surface of all molars were ground and polished with abrasive paper. The specimens were randomly allocated into four groups (n = 15) according to the type of surface treatment. Group 1 ECL + BARM, Group 2 ECL + Ketac + BARM, Group 3 Conventional Etch and Rinse + BARM, Group 4 Self-etch + BARM. The specimens from each group were positioned in a universal testing machine for SBS testing. Ten samples from each group were assessed for modes of failure. Means and standard deviations were compared using analysis of variance (ANOVA) and Tukey's post hoc test at a significance level of p < 0.05.

RESULTS

BARM bonded to dentin surface etched with conventional etch and rinse technique (group 3) exhibited SBS value of 18.45 ± 1.34. Similarly, the lowest bond strength was observed by group 4 (self-etch regime) bonded to BARM (16.09 ± 0.81). The bond strength among groups 1 (ECL + BARM), 2 (ECL + Ketac + BARM) and 3 (etch and rinse + BARM) were found to be comparable (p > 0.05).

CONCLUSION

Conditioning of dentin with photobiomodulation for the adhesive bonding of BARM showed comparable bond strength outcomes to conventional conditioning techniques.

Er:YAG laser application in caries removal and cavity preparation in children: a meta-analysis

The aim of this meta-analysis was to systematically evaluate the applications of Er:YAG lasers for the removal of caries and cavity preparation in children. The meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was conducted with data extracted from seven relevant randomized controlled trials (RCTs) published from 1997 to July 2017. The data heterogeneity of each study was assessed by a Q test. We used the heterogeneity results to calculate the standard mean difference (SMD) or relative risk (RR) and 95% confidence interval (95%CI) using STATA version 10.0. The publication bias was evaluated using Begger's test. There were seven randomized controlled trials included in this study. The analysis results indicate that compared to the conventional mechanical method, more time was needed for Er:YAG laser treatment (SMD 1.945, 95%CI 0.942 to 2.948). However, the pain reported by patients was reduced with Er:YAG laser treatment (SMD - 1.013, 95%CI - 1.892 to - 0.196). There were no significant differences between the groups in the complete retention rate (RR 1.021, 95%CI 0.963 to 1.114), the marginal discoloration (RR 1.638, 95% CI 0.240 to 11.986) and the marginal adaptation (RR 1.480, 95%CI 0.257 to 8.515). In conclusion, our data indicate that the time required for Er:YAG laser treatment was longer than that for the conventional mechanical method, but there was less pain associated with the Er:YAG laser treatment. There were no significant differences in the complete retention rate, marginal discoloration, and marginal adaptation between the two groups.

Clinical evaluation of near-infrared light transillumination in approximal dentin caries detection

The objective of this clinical study was to compare conventional caries detection techniques, pen-type laser fluorescence device, and near-infrared light transillumination method in approximal dentin caries lesions. The study included 157 patients, aged 12-18, without any cavity in the posterior teeth. Two calibrated examiners carried out the assessments of selected approximal caries sites independently. After the assessments, the unopened sites were excluded and a total of 161 approximal sites were included in the study. When both the examiners arrived at a consensus regarding the presence of dentin caries, the detected lesions were opened with a conical diamond burr, the cavity extent was examined and validated (gold standard). Sensitivity, specificity, negative predictive value, positive predictive value, accuracy, and area under the ROC curve (Az) values among the caries detection methods were calculated. Bitewing radiography and near-infrared (NIR) light transillumination methods showed the highest sensitivity (0.83-0.82) and accuracy (0.82-0.80) among the methods. Visual inspection showed the lowest sensitivity (0.54). Laser fluorescence device and visual inspection showed nearly equal performance. Near-infrared light transillumination can be used as an alternative method to approximal dentin caries detection. Visual inspection and laser fluorescence device alone should not be used for approximal dentin caries.

Pediatric patients tolerance: a comparative study about using of Er:YAG laser and self-adhesive flowable composite for treatment of primary decayed teeth

Aim

To verify the tolerance of children aged between 3 and 8 years, having class I caries and treated with Er:YAG Laser in association with a new self-adhesive flowable resin in comparison with a high-speed diamond bur and a conventional flowable resin treatment.

Methods

A group of 80 healthy children (43 male and 37 female) ranging in age from 3 to 8 years, who had been diagnosed with at least one active occlusal non-cavitated superficial carious lesions in first or second deciduous molars, were selected for the present study. They were divided in 4 groups: group A: Class I occlusal cavities prepared using an Er:YAG laser and a self-adhesive flowable resin; Group B: Class I occlusal cavities prepared using an Er:YAG laser and a conventional flowable resin; Group C: Class I occlusal cavities prepared using a high-speed diamond bur and a self-adhesive flowable resin; Group D: Class I occlusal cavities prepared using a high-speed diamond bur and a conventional flowable resin. Before and after the treatments the patient tolerance was tested with the modified Wong-Baker pain level scale.

Results

In the first group, the tolerance rate was 95% with 0 score (no hurt) for 19 patients; in Group D, the tolerance rate was 75%. Just one child of group D experienced hurting worst because of non cooperative patient.

Conclusion

From these results it emerged that, although the limits of the study, Er:Yag laser in association with self-adhering composite, is very effective in pediatric dentistry and is a good treatment option especially for non cooperative patients.