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Mapar M, Gholizadeh S, Moalemnia M. Effects of Two Remineralizing Agents in Combination with Er:YAG and CO 2 Laser Irradiation on Microhardness of Demineralized Enamel: A Preliminary In Vitro Study. Front Dent 2024; 21:11. [PMID: 38742220 PMCID: PMC11089429 DOI: 10.18502/fid.v21i11.15223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/20/2023] [Indexed: 05/16/2024] Open
Abstract
Objectives: This study assessed the effects of two remineralizing agents namely MI Paste Plus containing casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACFP) and Remin Pro containing hydroxyapatite, fluoride and xylitol (HFX) with/without erbium-doped yttrium aluminium garnet (Er:YAG) and CO2 laser irradiation on demineralized enamel microhardness. Materials and Methods: In this in vitro study, 70 sound human premolars were mesiodistally sectioned, demineralized at a pH of 4.6 for 8 hours, and randomly divided into 7 remineralization groups (n=10): of (I) MI Paste Plus (CPP-ACFP), (II) Remin Pro (HFX), (III) MI Paste Plus+CO2 laser (0.7 W power, 50 Hz), (IV) Remin Pro+CO2 laser, (V) MI Paste Plus+Er:YAG laser (1 W power, 10 Hz), (VI) Remin Pro+Er:YAG laser, and (VII) negative control. The Vickers hardness number of specimens was then measured. The groups were compared by one-way ANOVA and Tukey's test (α=0.05). Results: The mean microhardness was 319.8±49.9, 325.3±44.6, 359.4±35.7, 296.4±33.7, 319.9±58.1, 358.9±28.4, and 240.0±41.6 kg/mm2 in groups 1 to 7, respectively. The difference in microhardness was significant among the groups (P<0.0001). Pairwise comparisons revealed significant differences in microhardness between all groups (P≤0.03) except between groups 1 and 2, 1 and 5, 2 and 5, and 3 and 6 (P>0.05). Conclusion: Both Remin Pro (containing HFX) and MI Paste Plus (containing CPP-ACFP) can cause enamel remineralization. MI Paste Plus+CO2 laser irradiation and Remin Pro+Er:YAG laser irradiation were significantly more effective than the application of each remineralizing agent alone.
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Affiliation(s)
- Mehran Mapar
- Department of Restorative Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sara Gholizadeh
- Department of Restorative Dentistry, Khorasgan Islamic Azad Dental School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mina Moalemnia
- Department of Restorative Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Serdar Eymirli P, İleri T, Ergin E, Turgut MD. Evaluation of ER;CR:YSGG Laser and Remineralization Agents on Mineral Density and Ion Levels of Primary and Permanent Enamel. Photobiomodul Photomed Laser Surg 2024; 42:81-89. [PMID: 38252494 DOI: 10.1089/photob.2023.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Objective: The aim of this study is to evaluate the efficacy of two different fluoride varnishes used alone or in combination with laser treatment on permanent and primary tooth enamel. Methods: Ninety-six primary and 96 permanent molar samples were divided into six groups. The levels of calcium, phosphorus, fluoride, and silver ions of each sample were analyzed using energy-dispersive X-ray spectroscopy (EDS). Six different treatments were applied to 12 different groups (n = 15) as control (g1/G1), fluoride varnish (g2/G2), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-fluoride varnish (g3/G3), laser (g4/G4), laser+fluoride varnish (g5/G5), and laser+CPP-ACP-fluoride varnish (g6/G6). After the procedures, ion levels were reanalyzed with EDS. The teeth were subjected to the artificial caries-forming procedure and ion levels were again evaluated by EDS. One sample from each group was prepared separately for the focused ion beam-scanning electron microscope measurement; initial and final images were recorded. The obtained data were statistically analyzed with the SPSS 23.0 program. Results: Compared with the initial measurement, phosphorus percentages increased in most of the groups in the last measurement. Calcium percentages of primary teeth increased in the last measurement, except for the g1 group, but in permanent teeth, there was an increase only in the G6 group. There was a statistically significant difference between g1/G1 and g6/G6 groups in the last measurement of phosphorus and calcium percentages. Conclusions: The combined use of laser with CPP-ACP-fluoride varnish enhanced remineralization in the primary and permanent teeth. However, in permanent teeth, the use of laser alone was not as effective as in primary teeth. Therefore, combined usage with CPP-ACP-fluoride varnish can enhance its efficacy. This in vitro study was approved by the local ethics committee of Hacettepe University (Project No.: GO 20/441).
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Affiliation(s)
- Pınar Serdar Eymirli
- Department of Pediatric Dentistry and School of Dentistry, Hacettepe University, Ankara, Turkey
| | - Tülin İleri
- Department of Pediatric Dentistry and School of Dentistry, Hacettepe University, Ankara, Turkey
| | - Esra Ergin
- Department of Restorative Dentistry, School of Dentistry, Hacettepe University, Ankara, Turkey
- Hacettepe University Dental Laser Application and Research Center, Ankara, Turkey
| | - Melek Dilek Turgut
- Department of Pediatric Dentistry and School of Dentistry, Hacettepe University, Ankara, Turkey
- Hacettepe University Dental Laser Application and Research Center, Ankara, Turkey
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Cheng L, Yuan R, Fan H, Si M, Hao Z, Feng Z. The effect of the Er,Cr:YSGG laser combined casein phosphopeptide amorphous calcium phosphate for enamel remineralisation: a systematic review and meta-analysis of in vitro studies. Lasers Med Sci 2023; 38:201. [PMID: 37667086 PMCID: PMC10477104 DOI: 10.1007/s10103-023-03864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
The purpose of this systematic review and meta-analysis of in vitro studies was to evaluate the effect of the 2780 nm Er,Cr:YSGG laser combined with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) for enamel remineralisation. The electronic PubMed, Cochrane Library, Web of Science, and EMBASE databases were searched, with no language or date restrictions, up to January 2023. Two reviewers independently performed research information extraction and quality assessment. Continuous variables were analysed by standard mean difference (SMD) with a 95% confidence interval (CI). The statistical analyses were conducted using Review Manager (Version 5.4; Rev Man) and Cochrane Collaboration (2020). Finally, four trials were included for meta-analysis. According to the comprehensive results, the effect of the Er,Cr:YSGG laser combined with CPP-ACP on enamel remineralisation was significantly better than that of CPP-ACP alone: surface microhardness (SMD = - 1.83, 95% CI: [- 2.98, - 0.69], P = 0.002); lesion depth (SMD = 6.63, 95% CI: [4.98, 8.28], P < 0.001). Under the limitations of this meta-analysis, the results show that the Er,Cr:YSGG laser combined with CPP-ACP has a better effect on enamel remineralisation than CPP-ACP alone. The combination of the Er,Cr:YSGG laser and CPP-ACP may be a feasible method to prevent and treat enamel demineralisation.
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Affiliation(s)
- Lin Cheng
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Yuan
- School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Shanxi Medical University, Taiyuan, China
| | - Hao Fan
- School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Shanxi Medical University, Taiyuan, China
| | - Minmin Si
- School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Shanxi Medical University, Taiyuan, China
| | - Zhaonan Hao
- School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Shanxi Medical University, Taiyuan, China
| | - Zhiyuan Feng
- School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Shanxi Medical University, Taiyuan, China.
- Department of Orthodontics, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China.
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Kasraei S, Kasraei P, Valizadeh S, Azarsina M. Rehardening of Eroded Enamel with CPP-ACFP Paste and CO 2 Laser Treatment. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3304553. [PMID: 34337003 PMCID: PMC8298158 DOI: 10.1155/2021/3304553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diet and lifestyle can destroy tooth structure due to the dissolution of enamel by acidic beverages. The present study evaluated the effect of CO2 laser irradiation and CPP-ACFP (casein phosphopeptide and amorphous calcium phosphate with fluoride) paste on the remineralization of enamel eroded by carbonated soft drinks. METHODS In the present in vitro study, 46 human sound premolar teeth were sectioned mesiodistally to achieve 84 samples. Fourteen samples were assigned to the positive control group (G1), and the remaining samples were immersed in 500 mL of cola drink for 2 minutes, followed by rinsing with distilled water for 10 seconds. This procedure was carried out three times to create erosive lesions. Then, the 60 eroded samples were randomly assigned to five groups of G2 to G6 in terms of the treatment as follows: negative control (G2), CO2 laser irradiation (G3), CPP-ACFP paste (G4), CO2 laser irradiation followed by CPP-ACFP paste application (G5), and CPP-ACFP paste application followed by CO2 laser irradiation (G6). The mean surface microhardness of the enamel surface was evaluated and determined at three points for each sample. Data were analyzed with one-way ANOVA and Tukey HSD tests (α = 0.05). RESULTS The highest and the lowest hardness values were recorded in the G1 (314 ± 12 kg/mm2) and G2 (213.7 ± 12 kg/mm2) groups, respectively. ANOVA revealed significant differences between the study groups (P < 0.001). Two-by-two comparisons showed significant differences between the G2 group and the other groups, indicating the efficacy of all the treatment modalities in tooth remineralization and rehardening procedures (P < 0.05). Only in group G6, the enamel microhardness was not significantly different from the G1 positive control group (P > 0.05). CONCLUSION Considering the parameters used in the present study, CO2 laser irradiation or CPP-ACFP paste application alone increased eroded enamel's surface hardness; however, their sequential application was more effective in rehardening the eroded enamel's surface to near-normal levels.
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Affiliation(s)
- Shahin Kasraei
- Department of Restorative Dentistry, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sara Valizadeh
- Dental Research Center, Dentistry Research Institute, Restorative Dentistry Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Azarsina
- Department of Operative Dentistry, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ghadirian H, Geramy A, Shallal W, Heidari S, Noshiri N, Keshvad MA. The Effect of Remineralizing Agents With/Without CO 2 Laser Irradiation on Structural and Mechanical Properties of Enamel and its Shear Bond Strength to Orthodontic Brackets. J Lasers Med Sci 2020; 11:144-152. [PMID: 32273955 DOI: 10.34172/jlms.2020.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Remineralizing agents may be used for the treatment of white spot lesions (WSLs) prior to bracket bonding. However, some concerns exist regarding their possible interference with the etching and bonding process, negatively affecting the bond strength. This study aimed to assess the effect of two remineralizing agents with/without CO2 laser irradiation on the mechanical properties and shear bond strength (SBS) of demineralized enamel to the orthodontic bracket. Methods: This study evaluated 60 premolar teeth in 6 groups (n=10) as follows: (I) sound enamel, (II) demineralized enamel, (III) Nupro remineralizing agent (N), (IV) Nupro and CO2 laser (N/L), (V) Teethmate remineralizing agent (T), and (VI) Teethmate and CO2 laser (T/L). The remineralizing agents were applied to the enamel surfaces after their immersion in a demineralizing solution for 5 days. In groups IV and VI, the CO2 laser with a 10.6 μm wavelength, 10 ms pulse duration, a 50 Hz repetition rate, 0.3 mm beam diameter and 0.7 W power was irradiated after applying the remineralizing agents. Brackets were bonded to the enamel surfaces and SBS was measured by a universal testing machine. For the assessment of enamel microhardness, 20 sections of molar teeth were divided into 4 groups (n=5; N, N/L, T, T/L) and their microhardness was measured before demineralization, after demineralization and after remineralization. X-ray diffraction (XRD) analysis, field-emission scanning electron microscopy (FESEM) and energy-dispersive spectrometry (EDS) were carried out to assess the formation of hydroxyapatite. The atomic percentages of the C, O, P, Ca, Na, Si, F and Ca/P ratio were determined by EDS analysis. Results: The SBS significantly decreased in group II (P<0.001). There was no significant difference among the groups I, III, IV, V and VI (P<0.05). This finding was similar to the microhardness results, which showed an increase in microhardness after remineralization (P<0.05), with no difference among the remineralizing agents. The Ca/P ratio was the highest in the Nupro group and the lowest in the demineralized group. Conclusion: Remineralizing agents can significantly improve the microhardness and structural properties of demineralized enamel to a level similar to that of sound enamel with no adverse effect on SBS to orthodontic brackets.
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Affiliation(s)
- Hannaneh Ghadirian
- Department of Orthodontics, School of Dentistry, Tehran University of Medical sciences, Tehran, Iran
| | - Allahyar Geramy
- Department of Orthodontics, School of Dentistry, Tehran University of Medical sciences, Tehran, Iran
| | | | - Soolmaz Heidari
- Department of Operative Dentistry, Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Nooshin Noshiri
- Medical Image Processing Laboratory (MIPL), Department of Technology and Engineering, Alzahra University, Tehran, Iran
| | - Mohammad Ali Keshvad
- Department of Orthodontics, School of Dentistry, Tehran University of Medical sciences, Tehran, Iran
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Yassaei S, Motallaei MN. The Effect of the Er:YAG Laser and MI Paste Plus on the Treatment of White Spot Lesions. J Lasers Med Sci 2020; 11:50-55. [PMID: 32099627 DOI: 10.15171/jlms.2020.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: White spot lesions (WSLs) occurring after orthodontic treatment lead to patient dissatisfaction and aesthetic problems. The role of calcium-phosphate demineralization systems and the Er:YAG laser in the treatment of these lesions has recently been taken into account. This study aimed to investigate the effect of the Er:YAG laser and MI Paste Plus on the treatment of WSLs. Methods: A total of 65 premolars extracted due to orthodontic treatment were studied in this research. To create enamel lesions, the teeth were placed in a demineralizing solution. The teeth were then randomly divided into five groups (n=13) as follows: first group, control; second group, saliva; third group, MI Paste Plus; fourth group, Er:YAG laser; and fifth group, MI Paste Plus together with the Er:YAG laser. The teeth were kept in artificial saliva between treatment processes. Artificial saliva was replaced daily with fresh artificial saliva. The teeth were sectioned longitudinally by a disc from the middle of the exposed enamel and each section was mounted in polyester resin. The surface of the samples was serially polished and the microhardness of the teeth was measured at depths of 0, 50, 100, and 150 µm. Results: The microhardness was significantly higher in the fifth group than other groups at depths of 50 and 150 µm (P <0.005). Using the laser or MI Paste Plus alone did not significantly increase the microhardness. Conclusions: The combined application of the Er:YAG laser and MI Paste Plus is effective in the treatment of WSLs.
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Affiliation(s)
- Soghra Yassaei
- Department of Orthodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Nima Motallaei
- Research Center of Prevention and Epidemiology of Non-communicable Disease, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Al-Maliky MA, Frentzen M, Meister J. Laser-assisted prevention of enamel caries: a 10-year review of the literature. Lasers Med Sci 2019; 35:13-30. [PMID: 31399861 DOI: 10.1007/s10103-019-02859-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 08/01/2019] [Indexed: 01/13/2023]
Abstract
Since the invention of lasers in dentistry, investigations in caries prevention by the use of laser radiation have been proposed. There are several mechanisms stated for this purpose such as photothermal and/or photochemical interaction processes with the enamel. Alone or in conjugation with topical fluoride application, this treatment modality may improve enamel acid resistance in high-caries-risk populations. Data collection was done by searching the keywords caries, prevention, and laser in PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar. Lasing protocols of the collected literature and their effectiveness as well as examination methods used to verify treatment outcomes have been evaluated. One hundred eighteen publications were found for the last 10 years. The wavelengths investigated for caries prevention are mainly located in the near and the mid-infrared spectral range. In the evaluated period of time, investigations using CO2; Er:YAG; Er,Cr:YSGG; Er:YLF; fundamental, second, and third harmonic generations of Nd:YAG; diodes; and argon ion lasers were found in the databases. Accounting for 39% of the literature, CO2 laser was the most examined system for this purpose. Reviewing the literature in this narrative review showed that all laser systems presented a positive effect in varying degrees. Laser irradiation could be an alternative or synergistic to topical fluoridation for enamel caries prevention with longer lasting effect. Further research should be focused on selecting proper laser settings to avoid damage to enamel and developing effective evidence-based clinical protocols.
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Affiliation(s)
- Mohammed Abbood Al-Maliky
- Department of Periodontology, Operative and Preventive Dentistry, Dental Faculty, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany. .,Center of Applied Medical Laser Research and Biomedical Optics (AMLaReBO), University of Bonn, Bonn, Germany. .,Department of Biomedical Applications, Institute of Laser for Postgraduate Studies, University of Baghdad, Baghdad, Iraq.
| | - Matthias Frentzen
- Department of Periodontology, Operative and Preventive Dentistry, Dental Faculty, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany
| | - Jörg Meister
- Department of Periodontology, Operative and Preventive Dentistry, Dental Faculty, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany.,Center of Applied Medical Laser Research and Biomedical Optics (AMLaReBO), University of Bonn, Bonn, Germany
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