Root surface roughness evaluation following application of different periodontal instruments and Er:YAG laser: A profilometry and SEM study

AIM

The aim of the present study was to evaluate the efficacy of 30°-angled Er:YAG laser tip and different periodontal instruments on root surface roughness and morphology in vitro.

METHODS

Eighteen bovine teeth root without carious lesion were decoronated from the cementoenamel junction and seperated longitidunally. A total of 36 obtained blocks were mounted in resin blocks and polished with silicon carbide papers under water irrigation. These blocks were randomly assigned into 3 treatment groups. In Group 1, 30°-angled Er:YAG laser (2.94 μm) tip was applied onto the blocks with a 20 Hz, 120 mJ energy output under water irrigation for 20 s. In Groups 2 and 3, the same treatment was applied to the blocks with new generation ultrasonic tip and conventional curette apico-coronally for 20 s with a sweeping motion. Surface roughness and morphology were evaluated before and after instrumentation with a profilometer and SEM, respectively.

RESULTS

After instrumentation, profilometric analysis revealed significantly higher roughness values compared to baseline in all treatment groups(p < 0.05). Laser group revealed the roughest surface morphology followed by conventional curette and new generation ultrasonic tip treatment groups (p < 0.05). In SEM analysis, irregular surfaces and crater defects were seen more frequently in the laser group.

CONCLUSION

Results of the study showed that the use of new generation ultrasonic tip was associated with smoother surface morphology compared to 30°-angled Er-YAG laser tip and conventional curette. Further in vitro and in vivo studies with an increased sample size are necessary to support the present study findings.

Use of Phototherapy and Er-YAG Laser in the Management of Mandible Osteoradionecrosis: A Case Report

Introduction: Osteoradionecrosis (ORN) is a secondary complication from radiotherapy, which is difficult to manage and significantly reduces the life quality of the affected patients. Case Report: A 59-year-old female patient, diagnosed with infiltration by squamous cell carcinoma in the left cervical region, underwent adjuvant cervical-facial radiotherapy with a total dose of 66.6 Gy of radiation. Eight years after the diagnosis, the patient underwent multiple extractions and, subsequently, the installation of osseointegrated implants, evolving to extensive intraoral bone exposure associated with oral cutaneous fistula. The patient was initially exposed to photobiomodulation therapy (PBMT), with a low-power laser at wavelengths of 660 nm and 808 nm, and thereafter to antimicrobial photodynamic therapy (aPDT). After an improvement in the clinical condition and resolution of the oral cutaneous fistula, a surgical procedure with the Er: YAG laser was performed to remove the remaining necrotic bone. Once the ORN condition was completely treated, the patient's oral rehabilitation was implemented by the installation of an upper mucous-supported total prosthesis and a lower implant-supported prosthesis. Conclusion: The patient is in a clinical follow-up and has no signs of bone necrosis recurrence, suggesting that low and high-power laser treatment can be an effective therapeutic alternative to resolve this condition.

Er:YAG laser in selective caries removal and dentin treatment with chitosan: a randomized clinical trial in primary molars

This study evaluated the effect of chitosan on dentin treatment after selective removal of caries lesions with Er:YAG laser in reducing Streptococcus mutans, as well as its effect on the performed restorations. The sample consisted of children (aged 7 to 9 years) with active carious lesions and dentin cavitation located on the occlusal surface of deciduous molars. Eighty teeth were randomly distributed into 4 groups according to the caries removal method: Er:YAG laser (250 mJ/4 Hz) or bur and dentin surface treatment: 2.5% chitosan solution or distilled water. The bacterial load of caries-affected dentin was quantified by counting CFU/mg (n = 10). The teeth were restored and evaluated at 7 days, 6 months, and 12 months using modified USPHS criteria (n = 20). Microbiological data was analyzed by Mann-Whitney and clinical analyses were done using Kruskal-Wallis and Dunn test (α = 0.05). The results showed that the Er:YAG laser significantly reduced the amount of Streptococcus mutans (p = 0.0068). After dentin treatment with chitosan, there was a significant reduction in the amount of Streptococcus mutans for both removal methods (p = 0.0424). For the retention and secondary caries criteria, no significant differences were observed along the evaluated time (p > 0.05). The laser-treated group was rated "bravo" for discoloration (p = 0.0089) and marginal adaptation (p = 0.0003) after 6 and 12 months compared to baseline. The Er:YAG laser reduced the amount of Streptococcus mutans and the chitosan showed an additional antibacterial effect. After 1 year, the Er:YAG laser-prepared teeth, regardless of the dentin treatment, showed greater discoloration and marginal adaptation of the restorations.

A systematic review of the comparison between needling (RF-needling, meso-needling, and micro-needling) and ablative fractional lasers (CO2, erbium YAG) in the treatment of atrophic and hypertrophic scars

The aim of this study is to compare needling (RF-needling, meso-needling, micro-needling) and ablative fractional lasers (CO2, erbium-YAG) in the treatment of atrophic and hypertrophic scars in a systematic review. The database was searched, and 10 articles were selected that were relevant in terms of content, topic, and purpose and met the inclusion criteria. Of all the articles reviewed in this study, there were 2 randomized split-face trials (20%), 1 controlled nonrandomized trial (10%), 1 controlled randomized phase III clinical trial (10%), 1 prospective trial (10%), 1 prospective nonrandomized open-label trial (10%), and 1 randomized comparative trial (10%), with the type of study not reported in 3 articles. We used Endnote X8 to review the articles and extract data. After review, the studies were analyzed and categorized. No statistically significant difference was found between the two methods, laser and micro-needling, in the treatment of atrophic and hypertrophic scars in 60% of the articles studied, and both showed significant improvement (70% or more improvement to complete response). Significant improvement was noted in 20% of the studies reviewed for the laser and micro-needling treatment methods. The results of this study show that needling and ablative fractional lasers are tolerable and safe procedures with no significant difference in the treatment of skin scars in sixty percent of the studies.

Surface roughness and characteristics of CAD/CAM zirconia and glass ceramics after combined treatment procedures

BACKGROUND

The roughening of the inner surface of a fixed ceramic restoration is an important factor for the bonding process. The aim of this study is to investigate the effect of combined surface treatments (acid etching, air-abrasion and Er: YAG Laser) on surface roughness of CAD/CAM fabricated zirconia (ZrO₂) and lithium-disilicate glass ceramics (LDS).

METHODS

Sixty ZrO₂ (Ceramill Zi) and LDS (IPS e.max CAD) specimens, (5 mm in width, 5 mm in length and 1.5 mm in height) were fabricated using CAD/CAM and sintered according to the manufacturer's instructions. All specimens subjected to three surface treatment combinations; etching with 4% hydrofluoric acide (HF), airborne-particle abrasion with 110-μm alumina (Al₂O₃) (AP) and Er:YAG laser (Er:YAG) (Group A-HF + AP; Group B-Er:YAG + AP, and Group C-Er:YAG + HF). Perthometer was used to measure the surface roughness of the specimens before and after the tretments.

RESULTS

Group A presented the highest Ra (LDS 0.81 ± 0.27 and ZrO₂ 0.67 ± 0.21 after treatment) and Group C the lowest (LDS 0.45 ± 0.13 and ZrO₂ 0.26 ± 0.07, after treatment). Compared with before treatment, the Ra were significantly different only in Group A both ZrO₂ and LDS after treatment (p < 0.05). Qualitative SEM images suggested the surface topography of the ZrO₂ was smoother than the LDS. Less surface changes were observed in the Er:YAG combined procedures than HF + AP.

CONCLUSIONS

HF + AP was significantly succesful in modifying the ceramic surface. Er:YAG did not sufficiently promote the surface topography, even if combined with any other treatments. Overall, surface tretments on ZrO₂ not easier than LDS.

The Antibacterial and Remineralization Effect of Silver-Containing Mesoporous Bioactive Glass Sealing and Er-YAG Laser on Dentinal Tubules Treated in a Streptococcus mutans Cultivated Environment

The aim of this study was to evaluate the remineralization and antibacterial effect of silver-containing mesoporous bioactive glass (MBG-Ag) sealing combined with Er:YAG laser irradiation on human demineralized dentin specimens in a Streptococcus mutans cultivated environment. A total of 48 human dentin specimens were randomly divided into four groups. The characteristics of MBG-Ag and the occlusion efficiency of the dentinal tubules were analyzed using X-ray diffraction patterns, Fourier-transform infrared spectroscopy, scanning electron microscope images and energy dispersive X-ray spectroscopy. Moreover, the antibacterial activity against Streptococcus mutans was evaluated by colony formation assay. The results showed that the dentin specimens with Er:YAG laser irradiation can form a melted occlusion with a size of 3–4 µm. MBG-Ag promoted the deposition of numerous crystal particles on the dentinal surface, reaching the deepest penetration depth of 70 μm. The results suggested that both MBG-Ag and laser have the ability to enhance the remineralization and precipitation of hydroxyapatite crystals. While the results showed that MBG-Ag sealing combined with the thermomechanical subablation mode of Er:YAG laser irradiation-induced dense crystalline deposition, reaching a penetration depth of more than 300 µm, silver nanoparticles without good absorption of the Er:YAG laser resulted in a heterogeneous radiated surface. Er:YAG laser irradiation with a low energy and pulse rate cannot completely inhibit the growth of S. mutans, but MBG-Ag sealing reached the bactericidal concentration. It was concluded that the simultaneous application of MBG-Ag sealing and Er:YAG laser treatment can prevent the drawbacks of their independent uses, resulting in a superior form of treatment for dentin hypersensitivity.

Feasibility Assessment of Optical Coherence Tomography-Guided Laser Labeling in Middle Cranial Fossa Approach

INTRODUCTION

Different approaches have been developed to find the position of the internal auditory canal (IAC) in middle cranial fossa approach. A feasibility study was performed to investigate the combination of cone beam computed tomography (CBCT), optical coherence tomography (OCT), and laser ablation to assist a surgeon in a middle cranial fossa approach by outlining the internal auditory canal (IAC).

MATERIALS AND METHODS

A combined OCT laser setup was used to outline the position of IAC on the surface of the petrous bone in cadaveric semi-heads. The position of the hidden structures, such as IAC, was determined in MATLAB software using an intraoperative CBCT scan. Four titanium spheres attached to the edge of the craniotomy served as reference markers visible in both CBCT and OCT images in order to transfer the plan to the patient. The integrated erbium-doped yttrium aluminum garnet laser was used to mark the surface of the bone by shallow ablation under OCT-based navigation before the surgeon continued the operation.

RESULT

The technical setup was feasible, and the laser marking of the border of the IAC was performed with an overall accuracy of 300 μm. The depth of each ablation phase was 300 μm. The marks indicating a safe path supported the surgeon in the surgery.

CONCLUSION

The technique investigated in the present study could decrease the surgical risks for the mentioned structures and improve the pace and precision of operation.

Effect of surface treatment on enamel surface roughness

Purpose:

To compare the effects of different methods of surface treatment on enamel roughness.

Materials and Methods:

Ninety human maxillary first premolars were randomly divided into three groups (n=30) according to type of enamel surface treatment: I, acid etching; II, Er:YAG laser; III, Nd:YAG laser. The surface roughness of enamel was measured with a noncontact optical profilometer. For each enamel sample, two readings were taken across the sample—before enamel surface treatment (T1) and after enamel surface treatment (T2). The roughness parameter analyzed was the average roughness (Ra). Statistical analysis was performed using a Paired sample t test and the post-hoc Mann- Whitney U test, with the significance level set at 0.05.

Results:

The highest Ra (average roughness) values were observed for Group II, with a significant difference with Groups I and III (P<0.001). Ra values for the acid etching group (Group I) were significantly lower than other groups (P<0.001).

Conclusion:

Surface treatment of enamel with Er:YAG laser and Nd:YAG laser results in significantly higher Ra than acid-etching. Both Er:YAG laser or Nd:YAG laser can be recommended as viable treatment alternatives to acid etching.

Evaluation of the bond strength between aged composite cores and luting agent

PURPOSE

The aim of this study was to evaluate effect of different surface treatment methods on the bond strength between aged composite-resin core and luting agent.

MATERIALS AND METHODS

Seventy-five resin composites and also seventy-five zirconia ceramic discs were prepared. 60 composite samples were exposed to thermal aging (10,000 cycles, 5 to 55℃) and different surface treatment. All specimens were separated into 5 groups (n=15): 1) Intact specimens 2) Thermal aging-air polishing 3) Thermal aging- Er:YAG laser irradiation 4) Thermal aging- acid etching 5) Thermal-aging. All specimens were bonded to the zirconia discs with resin cement and fixed to universal testing machine and bond strength testing loaded to failure with a crosshead speed of 0.5 mm/min. The fractured surface was classified as adhesive failure, cohesive failure and adhesive-cohesive failure. The bond strength data was statistically compared by the Kruskal-Wallis method complemented by the Bonferroni correction Mann-Whitney U test. The probability level for statistical significance was set at α=.05.

RESULTS

Thermal aging and different surface treatment methods have significant effect on the bond strength between composite-resin cores and luting-agent (P<.05). The mean baseline bond strength values ranged between 7.07 ± 2.11 and 26.05 ± 6.53 N. The highest bond strength of 26.05 ± 6.53 N was obtained with Group 3. Group 5 showed the lowest value of bond strength.

CONCLUSION

Appropriate surface treatment method should be applied to aged composite resin cores or aged-composites restorations should be replaced for the optimal bond strength and the clinical success.

Scanning Electron Microscope (SEM) Evaluation of Composite Surface Irradiated by Different Powers of Er:YAG Laser

INTRODUCTION

The aim of this study was to evaluate the composite surface treated by different powers of Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) laser in comparison with bur preparation via scanning electron microscope.

METHODS

Fourteen composite resin blocks with 15× 10 × 10 mm dimensions were used in this study. The samples were divided to seven groups as follow: Group 1 (power: 1 W, Energy: 50 mJ); Group 2 (power: 2 W, Energy: 100 mJ); Group 3 (power: 3W, Energy: 150 mJ); Group 4 (power: 4 W, Energy: 200 mJ); Group 5 (power: 5W, Energy: 250 mJ); Group 6 (power: 6 W, Energy: 300 mJ); Group 7: Diamond bur. Then, the samples were prepared for SEM examination.

RESULTS

The surface treated by Er:YAG laser showed irregular and micro porous surface.

CONCLUSION

It seems that composite surface treatment by Er:YAG laser can be an alternative method for composite repair if suitable parameters are used.

Minimally invasive treatment of dental caries in primary teeth using an Er:YAG Laser

INTRODUCTION

Maintaining deciduous teeth as long as possible represents a goal in pediatric dentistry and avoids a plethora of health problems. Er:YAG carious decay treatment may help for prevention as well as during the curative processes.

MATERIALS AND METHODS

An Er:YAG laser was used to ablate 30 carious lesions on primary teeth. Diagnosis being conventionally dressed, treatment was conducted in respect of the following parameters: Er:YAG laser (Lite Touch, Syneron): output power from 300 mJ (enamel) to 200 mJ (dentine), frequency 20 Hz, sapphire tip (diameter 1.3 mm), air water spray ratio 8 (39 ml/min), pulse duration 50 µsec., theoretical fluence ranging from 15.08 J/cm(2) for dentin to 22.61 J/cm(2) for enamel. Then cavity depth was controlled (observation + probe). Glass-ionomer cement (GC Fuji Triage capsule) or flowable composite resin or compomer were used to fill the cavities. Children's acceptance to Er-YAG laser treatment was evaluated. According to predefined criteria, each case was followed up for one month after treatment and then with further monthly follow-ups for one year.

RESULTS

Clinical cases illustrate the validity of this clinical approach. The benefit of laser dental treatment has been shown to be the greatest in children. However, the lack of studies evaluating laser ablation capability in primary teeth restrains the adoption of this technology. The interaction between the Er:YAG laser and primary enamel and dentin depends on the composition of the tissues - a higher presence of water and lower presence of minerals- comparative to the permanent enamel and dentin. Thus, photoablation of primary enamel and dentin requires lower energy. This study shows that the laser parameters used (300 mJ/20 Hz for enamel and 200 mJ/20 Hz for dentin) are efficient enough for the ablation of tissues of deciduous teeth and moreover demonstrates to be well accepted by young patients.

Shear bond strength and SEM morphology evaluation of different dental adhesives to enamel prepared with ER:YAG laser

CONTEXT

Early observations of enamel surfaces prepared by erbium lasers motivated clinicians to use laser as an alternative to chemical etching.

AIMS

Evaluate shear bond strength (SBS) values of different dental adhesives on Erbium:Yttrium Aluminum Garnet (Er:YAG) laser prepared enamel and to evaluate possible etching patterns correlations between dental adhesives and SBS values.

SUBJECTS AND METHODS

One hundred bovine incisors were randomly assigned to SBS tests on enamel (n = 15) and to enamel morphology analysis (n = 5) after Er:YAG laser preparation as follows: Group I - 37% phosphoric acid (PA)+ ExciTE(®); Group II - ExciTE(®); Group III - AdheSE(®) self-etching; Group IV - FuturaBond(®) no-rinse. NR; Group V - Xeno(®) V. Teeth were treated with the adhesive systems and subjected to thermal cycling. SBS were performed in a universal testing machine at 5 mm/min.

STATISTICAL ANALYSIS USED

One-way ANOVA and post-hoc tests (P < 0.05). For the morphology evaluation, specimens were immersed in Ethylenediamine tetraacetic acid (EDTA) and the etching pattern analyzed under Scanning Electron Microscope (SEM).

RESULTS

Mean bond strengths were Group I - 47.17 ± 1.61 MPa (type I etching pattern); Group II - 32.56 ± 1.64 MPa, Group III - 29.10 ± 1.34 MPa, Group IV - 23.32 ± 1.53 MPa (type III etching pattern); Group V - 24.43 MPa ± 1.55 (type II etching pattern).

CONCLUSIONS

Different adhesive systems yielded significantly different SBSs. Acid etching significantly increased the adhesion in laser treated enamel. No differences in SBS values were obtained between AdheSE(®) and ExciTE(®) without condition with PA. FuturaBond(®) NR and Xeno(®) V showed similar SBS, which was lower in comparison to the others adhesives. No correlation between enamel surface morphology and SBS values was observed, except when PA was used.

Effect of Air Abrasion and Erbium-Doped Yttrium Aluminum Garnet (Er: YAG) laser preparation on Shear Bond Strength of Composite to Dentin

INTRODUCTION

The aim of this study was to assess shear bond strength of composite to dentin after air abrasion and laser treatment.

METHODS

40 human extracted molars divided into 4 groups (n=10) received the following treatments. Group 1: carbide bur, Group 2: air abrasion with aluminum oxide 50 μm, Group 3: irradiated with Erbium-Doped Yttrium Aluminum Garnet (Er: YAG) laser (150 mJ/20Hz), Group 4: irradiated with Er:YAG laser (150 mJ/20Hz)+ air. Specimens in all groups were chemically etched with phosphoric acid 37% and treated with bonding agent (single bond 3M). Then, composite build-up was performed by tygon tube. After storage in distilled water at 37°c for one week, all specimens were subjected to a shear bond strength test with universal testing machine. Data were analyzed with ANOVA and T-Test.

RESULTS

The mean and standard deviation of shear bond strength of the 4 groups were 20.8±6.76, 14.98±3.98, 11.43±4.36 and 14.95± 3.18 MPa, respectively.

CONCLUSION

Air abrasion after laser treatment improved the shear bond strength.

Comparison of Manual Tools, Ultrasonic and Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) Laser on the Debridement Effect of the Surface of the Root of Teeth Suffering from Periodontitis

INTRODUCTION

Periodontal diseases are considered as some of the most common reasons of teeth loss, which occur due to the aggregation of microbial plaque and other precipitations on the dental surfaces. In this study, the scaling effect using manual tools, ultrasonic machine and Erbium-Doped Yttrium Aluminum Garnet (Er:YAG)laser on the connection of the human gums connective tissue cells on the root surface of the teeth suffering from severe periodontitis will be compared.

METHODS

After removal of the big precipitations with manual tools, Er:YAG laser light emission of Photona machine is used with respect to the following characteristics: wavelength: 2940μm, each pulse: 100mJ, frequency: 10 pulse/sec, optic fiber with cross section 0.5x1.65mm, fiber tip angle with root surface: 15-20 degrees with non-contact mode, 1.5mm farther than the root surface and pulse duration 230 very short. The gingival fibroblast cellular was incubated as a sample of the human gums connective tissue cells under 37C. These cells were departed from the culture medium after the cellular reproduction in the third passage.On the 3rd day after incubation, the gingival fibroblast cells morphology was studied by Scanning Electron Microscopy (SEM).

RESULTS

The results of SEM images in the present study indicated the spread fibroblast cells with philopodia were found in all of 5 groups; untreated healthy group (control), untreated group suffering from periodontitis, the scaling effect using manual tools (Scaled Gracey), ultrasonic machine and Er:YAG laser. There is a meaningful difference among the three treatment groups (P<0.001) in the numbers of the fibroblast cells, while all the four treated groups had a meaningful difference with the positive control group (P < 0.001).

CONCLUSION

The present study indicated that although various dental surfaces cleaning methods may be different in other aspects, but are similar concerning the fibroblasts morphology. Also in addition to power, laser emission time may also be effective in the cells morphology results.

In vitro evaluation of the effect of different laser irradiations on the enamel surfaces of teeth treated with home bleach procedure

INTRODUCTION

The aim of this study was to evaluate the effect of dental surface treatment with Erbium-Doped Yttrium Aluminum Garnet(Er: YAG), Neodymium-Doped Yttrium Aluminium Garnet(Nd: YAG) and Carbon Dioxide Laser (CO2) lasers and sodium ascorbate to recently home bleached enamel by scanning electron microscope (SEM).

METHODS

Thirty extracted human third molars were selected for this in vitro study. The teeth were randomly divided in two groups including home bleached group and control group (non-bleached). In group 1, the samples were bleached by home bleach technique. No bleaching procedure was done in second the group which served as control group.Then , the samples of two groups were divided to five subgroups as follow: Subgroup 1: treated using Nd:YAG laser with output power of 1 W, Subgroup 2: treated using Er:YAG laser with output power of 0.5 W, Subgroup 3: treated using CO2 laser with output power of 0.5 W, Subgroup 4: sodium ascorbate 10%, Subgroup 5: no treatment. After treatments, the surfaces were evaluated using Scanning Electron Microscope (SEM) analysis.

RESULTS

The surfaces treated by Nd:YAG laser showed some melting and recrystallized areas and in some area droplet pattern was observed. But the surface treated by Er:YAG laser showed irregular and micro porous surface with flake pattern. CO2 laser treatment of home-bleached surfaces resulted in melting area and cracks. Sodium ascorbate did not change the home-bleached surface.

CONCLUSION

Among different surface treatments used in this study, it seems that Er:YAG laser can best interact with home-bleached teeth.

Evaluation of shear bond strength of orthodontic brackets bonded with Er-YAG laser etching

BACKGROUND

Based on contradictory findings concerning the use of lasers for enamel etching, the purpose of this study was to investigate the shear bond strength of teeth prepared for bonding with Er-YAG laser etching and compare them with phosphoric acid etching.

MATERIALS AND METHODS

In this in vitro study forty - eight premolars, extracted for orthodontic purposes were randomly divided in to three groups. Thirty-two teeth were exposed to laser energy for 25 s: 16 teeth at 100 mj setting and 16 teeth at 150 mj setting. Sixteen teeth were etched with 37% phosphoric acid. The shear bond strength of bonded brackets with the Transbond XT adhesive system was measured with the Zwick testing machine. Descriptive statistics, Kolmogorov-Smirnov test, of homogeneity of variances, one- way analysis of variances and Tukey's test and Kruskal Wallis were used to analyze the data.

RESULTS

The mean shear bond strength of the teeth lased with 150 mj was 12.26 ± 4.76 MPa, which was not significantly different from the group with acid etching (15.26 ± 4.16 MPa). Irradiation with 100 mj resulted in mean bond strengths of 9.05 ± 3.16 MPa, which was significantly different from that of acid etching (P < 0.001).

CONCLUSIONS

laser etching at 150 and 100 mj was adequate for bond strength but the failure pattern of brackets bonded with laser etching is dominantly at adhesive - enamel interface and is not safe for enamel during debonding.