Prognostic outcome of cervical laser ablation using a holmium yttrium-aluminum-garnet (Ho:YAG) laser for the treatment of cervical intraepithelial neoplasia: A single-center retrospective study

Objective

Although cervical conization is considered a standard treatment for cervical intraepithelial neoplasia (CIN) 2/3, laser ablation can compensate for the disadvantages of the former. CO2, semiconductor, and holmium yttrium-aluminum-garnet (Ho:YAG) lasers are applied in ablation, but no previous studies have shown the effectiveness of any of these techniques. Here, we retrospectively analyzed the application of the Ho:YAG laser in our hospital to verify its efficacy, and discussed the methods for optimal recurrence detection.

Methods

We evaluated the recurrence rates of the pathological condition in patients who underwent laser ablation with a Ho:YAG laser for CIN2/3 at our institution from June 2012 to November 2021. We defined the recurrence as histologically confirmed CIN2 or more advanced stage. Age, preoperative diagnosis, human papillomavirus (HPV) genotype, and postoperative high-risk HPV status were recorded to establish their association with recurrence rates.

Results

We performed surgery in 607 patients and the 2-year recurrence rate after interventions was 5.6%. Five patients were diagnosed with invasive cancer at the time of recurrence. Older age significantly correlated with higher risk of recurrence, but preoperative CIN grade and preoperative HPV 16/18 status did not significantly affect it. The postoperative high-risk HPV test was 100% sensitive for detecting recurrence.

Conclusions

Laser ablation with the Ho:YAG laser yields promising results. Together with postinterventional management, high-risk HPV test after laser ablation should be conducted after diagnostic conization.This study received the approval from the Ethics Committee of the NHO Tokyo Medical Center (Ethics Committee approval number: R22-067).

Effects of Two Remineralizing Agents in Combination with Er:YAG and CO2 Laser Irradiation on Microhardness of Demineralized Enamel: A Preliminary In Vitro Study

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.

Preliminary results of a new surgical technique: bladder mucosal graft harvested with holmium:YAG (HO:YAG) laser. A new option in bulbar replacement urethroplasty?

OBJECTIVE

To describe the technique of transurethral harvesting of bladder mucosal graft using the Holmium:YAG (Ho-YAG) laser and describe the preliminary results from 7 cases where this graft was used for urethroplasty.

MATERIALS AND METHODS

We performed a single-stage dorsal onlay urethroplasty using bladder mucosal graft in 7 patients with anterior urethral stricture. Transurethral harvesting was performed with the Ho-YAG laser. We performed a prospective and descriptive analysis with uroflowmetry performed at 30, 90 and 180 days after surgery and applied the PROM translated into Portuguese before and 6 months after urethroplasty.

RESULTS

Seven patients were included, 2 (28.5%) with penile urethral stricture, and 5 (71.5%) with bulbar urethral stricture. Mean stricture length was 50mm (range 35-60mm). Stricture etiology was trauma in 3 (42.9%) patients, iatrogenic in 1 (14.3%) patient, and idiopathic in 3 (42.9%) patients. Two patients (28.6%) had previously undergone ventral buccal mucosa urethroplasty. Mean bladder mucosal graft length was 52.86mm (± 13.801), and mean harvest time was 46.43min (± 14.639). Dorsal onlay urethroplasty using bladder mucosa was successfully completed in 5 patients (71.4%). Two patients (28.6%) couldn't have the procedure completed using bladder mucosa, one due to thermal damage of the graft during harvesting, and one due to insufficient graft length. In both cases the procedure was completed using buccal mucosa. Two patients (28.6%) experienced minor hematuria between the twelfth and eighteenth postoperative day, but neither required hospitalization and/or additional procedures. All patients achieved normalization of peak flow, and this was maintained throughout the follow-up period. Mean peak flow was 17.8 ml/s (± 3.271) at 30 days, 20.6 ml/s (± 5.413) at 90 days, and 19.6 ml/s (± 8.019) 180 days. Mean IPSS score decreased from 19.3 to 5.4. Similar improvements were also seen in the ICIQ-MLUTS Score (a mean drop from 3.8 to 2.0) and Peeling's Voiding Picture Score (a mean drop from 4.0 to 2.2). Quality of Life improved post urethroplasty, with increases in EQ-5D (from 0.6371 to 0.7285) and EQ-VAS (from 58.0 to 84.0).

CONCLUSION

Transurethral harvesting of bladder mucosa using the Holmium laser (Ho-YAG) is feasible and reproducible. Our preliminary experience suggests that bladder mucosa grafts achieve comparable results to other grafts when used for dorsal onlay urethroplasty. Further research is needed to confirm these results.

Transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts: A retrospective study

Background:

We aimed to investigate the clinical efficacy and safety of transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts.

Materials and Methods:

Between October 2017 and April 2021, the clinical data of 65 patients with parapelvic renal cysts were evaluated retrospectively. Thirty-one patients with parapelvic cysts (Group 1) underwent a transurethral flexible ureteroscopic incision and drainage with a holmium laser, whereas the other 34 patients (Group 2) underwent retroperitoneal laparoscopic unroofing. The patients' clinical features were documented. The surgery time, intraoperative blood loss, hospitalization time, complications and cyst size were recorded and statistically assessed one year following the procedure.

Results:

All of the patients were successfully treated with flexible ureteroscopic incision and drainage or retroperitoneal laparoscopic unroofing. In terms of clinical parameters, such as age, gender, BMI, location, cyst size, and Bosniak classification of renal cysts, no statistically significant difference was detected between Groups 1 and 2. Compared to the control group (Group 2), Group 1 demonstrated a shorter surgery duration, less intraoperative blood loss, and a shorter hospital stay (p < 0.001). However, no significant differences in complications and cyst size were observed between the two groups one year after the surgery (p > 0.05).

Conclusions:

Transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts has obvious advantages over traditional surgery, and is worthy of advancement and application, but its long-term effect needs further follow-up studies.

Thermal Changes of Root Surface of Anterior Primary Teeth in Pulpectomy with Er:YAG Laser

OBJECTIVES

Successful root treatment depends on elimination of microorganisms from the root canal. Considering incomplete removal of bacteria from the canal by usual methods, lasers have been suggested as a new modality. Despite their anti-bacterial properties, lasers can cause thermal changes. This study assessed the thermal changes of root surface in pulpectomy of primary teeth following the use of Er:YAG laser.

MATERIALS AND METHODS

Sixty primary anterior teeth were collected and prepared by K-file up to number 50. Then, they were randomly divided into two groups and were irradiated with Er:YAG laser. The first group was irradiated with 1 W laser and the second group with 1.5 W laser. The laser irradiation time was two 10-second cycles with a 2-second interval in both groups. Thermal changes were measured by a thermometer in the apical and coronal areas per second. The results were analyzed by repeated measures ANOVA considering the laser power as between-subject variable.

RESULTS

There was a temperature increase in the coronal and apical areas in use of 1 W power. There was a temperature rise in the coronal and apical areas in use of 1.5 W power. The temperature rise in the apical third was more than that in the coronal third; also, the average temperature rise was more in use of 1.5 W power than 1 W power.

CONCLUSIONS

As the average temperature increase was not more than 7°C in any group, this type of laser seems to be suitable for root treatment of primary anterior teeth.

Root Surface Roughness After Scaling and Root Planing with Er:YAG Laser Compared to Hand and Ultrasonic Instruments by Profilometry

OBJECTIVES

Scaling and root planing (SRP) is one of the most commonly used procedures during periodontal treatment. The aim of this study was to evaluate the root surface roughness after SRP with erbium: yttrium aluminum garnet (Er:YAG) laser compared to ultrasonic and hand instruments.

MATERIALS AND METHODS

In this experimental study, 56 extracted sound single-rooted teeth with moderate level of calculus were selected and randomly divided into four groups: SRP was performed with Er:YAG laser (100 mJ pulse, 1W, 10Hz, VSP and contact mode, with 50% water and air) in group one, hand instrument in group two and ultrasonic tool in group three. Group four was considered as the control group. After SRP, all samples were cut by Servocut cutting machine into pieces with 3×3×2mm dimensions. The samples were mounted in acrylic resin. The surface roughness of the samples was evaluated with profilometry, and the data were analyzed using one-way ANOVA and Tukey's test in SPSS software.

RESULTS

Surface roughness was higher in laser and lower in ultrasonic group compared to other groups. There was a significant difference in surface roughness between laser and ultrasonic groups (P=0.043), but there was no significant difference in surface roughness among other groups (P>0.05).

CONCLUSION

The results of this study showed that surface roughness after SRP with Er:YAG laser was not higher than that after manual SRP, but the former value was higher than that after SRP with ultrasonic instrument.

Effect of CO2 and Nd:YAG Lasers on Shear Bond Strength of Resin Cement to Zirconia Ceramic

OBJECTIVES

Because of poor bond between resin cement and zirconia ceramics, laser surface treatments have been suggested to improve adhesion. The present study evaluated the effect of CO2 and Nd:YAG lasers on the shear bond strength (SBS) of resin cement to zirconia ceramic.

MATERIALS AND METHODS

Ninety zirconia disks (6×2 mm) were randomly divided into six groups of 15. In the control group, no surface treatment was used. In the test groups, laser surface treatment was accomplished using CO2 and Nd:YAG lasers, respectively (groups two and three). Composite resin disks (3×2 mm) were fabricated and cemented to zirconia disks with self-etch resin cement and stored in distilled water for 24 hours. In the test groups four-six, the samples were prepared as in groups one-three and then thermocycled and stored in distilled water for six months. The SBS tests were performed (strain rate of 0.5 mm/min). The fracture modes were observed via stereomicroscopy. Data were analyzed with one and two-way ANOVA, independent t and Tukey's tests.

RESULTS

The SBS values of Nd:YAG group (18.95±3.46MPa) was significantly higher than that of the CO2 group (14.00±1.96MPa), but lower than that of controls (23.35±3.12MPa). After thermocycling and six months of water storage, the SBS of the untreated group (1.80±1.23 MPa) was significantly lower than that of the laser groups. In groups stored for 24 hours, 60% of the failures were adhesive; however, after thermocycling and six months of water storage, 100% of failures were adhesive.

CONCLUSION

Bonding durability of resin cement to zirconia improved with CO2 and Nd:YAG laser surface treatment of zirconia ceramic.

Comparison of Dentin Permeability After Tooth Cavity Preparation with Diamond Bur and Er:YAG Laser

OBJECTIVES

The aim of this study was to compare the permeability of dentin after using diamond bur and Er:YAG laser.

MATERIALS AND METHODS

Seventy-two recently extracted, intact, and restoration-free human permanent molars were used in this study. The samples were randomly divided into three groups of 24 each and class I cavities were prepared as follows. Group 1: High speed diamond bur with air and water spray. Group 2: Er:YAG laser. Group 3: Er:YAG laser followed by additional sub-ablative laser treatment. Each group consisted of two subgroups with different cavity depths of 2mm and 4mm. The entire cavity floor was in dentin. Two samples from each subgroup were observed under scanning electron microscope (SEM). The external surfaces of other samples were covered with nail varnish (except the prepared cavity) and immersed in 0.5% methylene blue solution for 48 hours. After irrigation of samples with water, they were sectioned in bucco-lingual direction. Then, the samples were evaluated under a stereomicroscope at ×160 magnification. The data were analyzed using two-way ANOVA and Tukey's HSD test.

RESULTS

Two-way ANOVA showed significant difference in permeability between groups 2 and 3 (laser groups with and without further treatment) and group 1 (bur group). The highest permeability was seen in the group 1. There was no significant difference in dentin permeability between groups 2 and 3 and no significant difference was observed between different depths (2mm and 4mm).

CONCLUSION

Cavities prepared by laser have less dentin permeability than cavities prepared by diamond bur.

Effect of Four Methods of Surface Treatment on Shear Bond Strength of Orthodontic Brackets to Zirconium

OBJECTIVES

Providing reliable attachment between bracket base and zirconia surface is a prerequisite for exertion of orthodontic force. The purpose of the present study was to evaluate the effect of four zirconium surface treatment methods on shear bond strength (SBS) of orthodontic brackets.

MATERIALS AND METHODS

One block of zirconium was trimmed into four zirconium surfaces, which served as our four study groups and each had 18 metal brackets bonded to them. Once the glazed layer was removed, the first group was etched with 9.6% hydrofluoric acid (HF), and the remaining three groups were prepared by means of sandblasting and 1W, and 2W Er: YAG laser, respectively. After application of silane, central incisor brackets were bonded to the zirconium surfaces. The SBS values were measured by a Dartec testing machine with a crosshead speed of 1 mm/min. Data were analyzed using one-way ANOVA and Tukey's HSD for multiple comparisons.

RESULTS

The highest SBS was achieved in the sandblasted group (7.81±1.02 MPa) followed in a descending order by 2W laser group (6.95±0.87 MPa), 1W laser group (6.87±0.92 MPa) and HF acid etched group (5.84±0.78 MPa). The differences between the study groups were statistically significant except between the laser groups (P<0.05).

CONCLUSION

In terms of higher bond strength and safety, sandblasting and Er: YAG laser irradiation with power output of 1W and 2W can be considered more appropriate alternatives to HF acid etching for zirconium surface treatment prior to bracket bonding.

Effects of KTP Laser Bleaching on Traumatized Tooth Enamel

BACKGROUND

Bleaching of traumatized discolored teeth is considered an important issue in esthetic dentistry. Various methods have been introduced for bleaching, some of which may have adverse effects on soft or hard tissues of the tooth.

OBJECTIVES

The objective of the study was to evaluate the effects of KTP laser bleaching on enamel of traumatized teeth.

MATERIALS AND METHODS

A square of 36 mm(2) was chosen on the labial surface of 32 extracted teeth. The corners were drilled in order to indicate the location precisely. The shade of each sample was recorded and the teeth were divided into four groups, each with eight teeth: group A (Smartbleach with KTP laser for 30 seconds), group B (Smartbleach with G-Light for 5 minutes), group C (only Smartbleach for 10 minutes) and group D (control group with no bleaching). After one session of bleaching, shade assessment was performed again. In another experiment on nine teeth, Smartbleach with KTP laser was used for 150 seconds to 1500 seconds. The samples were critically processed and observed by using scanning electron microscope (SEM) to assess enamel damage. Data was statistically analyzed using Kruskal-Wallis test (confidence interval level were set at 95%).

RESULTS

Smartbleach was highly effective when used with KTP laser (P = 0.0419). Enamel damage was observed after frequent KTP bleaching and 750 seconds of KTP bleaching was recognized as the limit by morphological evaluation via SEM, indicating a major difference between under and over 750 seconds of bleaching.

CONCLUSIONS

Application of KTP laser may increase the bleaching effect of Smartbleach, nevertheless it may cause some enamel damage.