A Comparative Histological Study of Gingival Depigmentation by 808 and 445 nm Diode Lasers.

Introduction: Using lasers in melanin depigmentation is one of the main fields of interest for dental practitioners and patients. However, it is important to know what would happen inside the tissue and how the cells would interact inside the tissue with a laser. Methods: In this study, we used both wavelengths of 445 nm and 808 nm on sheep gingiva to find out the effects and side effects of these diode lasers while using them for gingival depigmentation. Results: After microscopic evaluation, we concluded that 808 nm and 445 nm lasers with a power of 1 W are safe enough to use in the depigmentation of gingiva, and both lasers are highly effective in melanin pigments which are located in basal membrane. Conclusion: The 445 nm blue laser produced a less thermal effect, which means it is safer to be used in gingival hyperpigmentation than a diode laser.

Comparison of the Diode Laser Wavelengths 445 nm and 810 nm in Gingival Depigmentation - A Clinical Evaluation.

Introduction: Nowadays, esthetic appearance plays an important role in the field of dentistry. Discolorations and pigmentations of the gingiva reduce the appearance of a healthy-looking smile. On this occasion, the use of lasers shows a promising approach for a fast and non-aggressive treatment in this field. Different laser wavelengths are being used for gingival depigmentation this clinical study aimed to investigate the effect of the novel laser wavelength (445 nm) in this field and compare it with an 810 nm diode laser. Methods: Two diode laser wavelengths (445 nm and 810 nm) were used for depigmentation. The laser output power chosen was 1 W. An optical fiber with a diameter of 400 µm was used. 21 patients with pigmented gingiva were selected. Depigmentation was carried out in a split-mouth design for a direct comparison of the clinical effect. Outcomes were documented by photograph after one month and six months of follow-up. Results: For each wavelength, 21 volunteers evaluated 21 clinical cases of depigmentation, which means that 441 comparisons were carried out in total regarding the color change from brownish to pinkish. A 100% clarification was achieved for 445 nm. In the 810 nm group, the color change in 44 of 441 cases (10%) could not be clearly identified. No statistically significant difference in pain experience was reported for both laser treatments. Conclusion: The clinical evaluation showed that within the limitations of this study, most of the clinical outcome parameters were highly acceptable by the patients due to mild pain and discomfort for both laser systems.

Transmission of 940 nm diode laser to the radicular area during its application as root canal disinfectant.

To measure the transmitted laser power in the coronal, middle and apical root thirds during vertical and horizontal irradiation of laser. 14 mm length whole roots and longitudinal root sections were irradiated using a 940 nm diode laser with 0.5 W in continuous mode for 5 s. A power detector was placed in front of the root apex for the vertical transmitted power measurement and placed laterally to root surface for the horizontal transmission experiment. The transmitted power from the root apex vertically was 53% of the irradiated power, while for the horizontal transmission experiment for the coronal, middle and apical root thirds were 25.6%, 40.4% and 41.3%, respectively. Irradiation of root canals with 940 nm laser power can be transmitted during vertical irradiation in more than 50% of the samples, whereas less transmission happens with horizontal irradiation at apical and middle root third than coronal.

Novel method to obtain human non-separated histological samples for the assessment of peri-implant soft tissue response: A feasibility study.

OBJECTIVES: To introduce a standardized and less invasive clinical model that provides histological information on the abutment-mucosa interface in humans. MATERIALS AND METHODS: New experimental healing abutments were left in an open healing position on bone-level implants in the interforaminal region of the mandibles in six edentulous patients. The one-piece abutments were hollow cylinder-shaped with two lateral openings that allow for ingrowth of the peri-implant mucosa into the central abutment cavity. After three months of healing, abutments and ingrown mucosa were sampled and processed for histological analysis in a non-separated resin-embedding technique. To test the validity of the new model, the ingrown tissue was compared to the peri-implant mucosa around the same samples. RESULTS: None of the experimental abutments exhibited signs of failure, and all samples showed mucosal ingrowth to the inner-abutment cavity. Comparison of ingrown tissue and peri-implant mucosa revealed no significant differences regarding the traits: tissue morphology, quality of collagen fibers, and adherence to the abutment. Ingrown mucosa exhibited a tendency for higher leukocyte infiltration. CONCLUSIONS: The presented model is a promising approach to reduce invasiveness during the sampling process for human non-separated abutment biopsies.

Quantitative determination of cut efficiency during soft tissue surgery using diode lasers in the wavelength range between 400 and 1500 nm.

Within the scope of this ex vivo study, the cut efficiency was investigated with eight diode laser wavelengths in the range from 400 to 1500 nm. Incisions on porcine gingiva samples were generated in CW-mode at a power range of 0.5-4 W using a bare fiber (∅ = 320 µm) in contact and non-contact mode at a cut speed of 2 mm/s. Cut depths, cut widths, and thermal damages were recorded based on histological sections and were evaluated via measurement masks. Moreover, with respect to the controllability of a therapeutic measure, an efficiency factor was defined. At powers above 2 W, for 445 nm, the maximum cut depth was 820 µm and 344 µm for 810 nm, respectively. At all wavelength and power ranges, the cut width averaged 125 µm. At minimum output power (0.5 W), the spatial expansion of the thermal damage in the tissue surface layer corresponds in the blue/green wavelength range from the very beginning of the laser impact to the fiber core diameter. It could be shown that increases in the diode laser power output do not correlate to the same extent with the incision depth nor with thermal damage to tissue.

A promising approach in laser vitrectomy executed by plasma-mediated removal of vitreous body via a diode-pumped Q-switched Nd:YAG laser.

To examine the applicability of plasma-mediated vitreous body removal, a diode-pumped Q-switched Neodymium:YAG laser was used for a possible application in eye surgery/vitrectomy. On a total of 1500 porcine vitreous bodies, removal rates were evaluated by comparing different LaserVit-tip designs (Mark I/II Gauge 19 and Mark III Gauge 22). The Nd:YAG laser, operating at a wavelength of 1064 nm and a pulse duration of 4 ns, was utilized for vitreous body removal with respective settings of 2, 3 and 4 mJ and pulse repetition rates (cut rates) from 5 to 25 Hz (300-1500 /min) in 5 Hz-steps as well as for 100 Hz (6000 cuts/min). The exposure times were selected at 10, 20, 40 and 60 s, respectively. Comparative measurements were carried out with mechanical cutters (Gauge 20 and Gauge 23), applying a fixed cut rate of 800 /min (13.33 Hz) at identical exposure times. The LaserVit-tips showed successful vitreous body removal for all laser settings and exposure times (Mark I: 6.2 g/min, Mark II: 8.2 g/min at 1500 cuts/min and 3 mJ, Mark II: 10.1 g/min, Mark III: 3.6 g/min at 6000 cuts/min at 3 mJ). Similar tip-dimensions (Gauge 22laser and Gauge 23cutter) showed comparable removal rates of 3.6 g/minlaser and 1.3 g/mincutter with settings of 6000 cuts/min at 3 mJ (laser) and 800 cuts/min for the mechanical cutter. A diode-pumped Q-switched Nd:YAG laser can successfully and gently remove vitreous body. The efficiency of the laser was comparable to that of mechanical cutters in terms of quantity of material removed per time unit.

Combined effects of a topical fluoride treatment and 445 nm laser irradiation of enamel against a demineralization challenge: A light and electron microscopic ex vivo study.

This study investigated the caries-preventive effect of 445 nm laser radiation in combination with fluoride on the prevention of white spot lesions. Previously, several studies have indicated the ability of 488 nm argon ion laser irradiation to reduce early enamel demineralization. A diode laser (445 nm) could be an alternative technology for possible caries-preventive potential. Each sample of a group of seventeen caries-free bovine teeth was treated in four different ways on four different zones of the labial surface: control/no treatment (C), laser irradiation only (L) (0.3 W, 60 s and applied dose of 90 J/cm2), amine fluoride application only (10,000 ppm and pH 3.9) (F), and amine fluoride application followed by laser irradiation (FL). After treatment, the teeth were subjected to a demineralization solution (pH 4.3 for 48 h at 37 °C) to induce subsurface lesions. After sectioning, the teeth were examined by light microscopy. Three teeth were analyzed by scanning electron microscopy (SEM). The depths of the subsurface lesions in the C, L, F, and FL groups were 103.01 (± 13.04), 96.99 (± 14.51), 42.59 (± 17.13), and 24.35 (± 11.38) µm, respectively. The pairwise group comparison showed the following results: p < 0.001 for FL versus C, FL versus L, F versus C, and F versus L, p = 0.019 for FL versus F and p = 0.930 for L versus C. The SEM micrographs support the light-microscopic examination. The results of the current study have shown that using relatively low irradiation settings of 445 nm laser on fluoridated enamel may be effective for prevention of white spot lesions.

Cavity Disinfection With a 445 nm Diode Laser Within the Scope of Restorative Therapy - A Pilot Study.

Introduction: Cavity disinfection is necessary to prevent a progressive infection of the crown dentin and pulp. Increasing intolerance and resistance to antiseptics and antibiotics as well as the controversy over the effects of those on the dental hard tissue and composite have prompted the investigation of alternative treatment options. The objective of this pilot study is to evaluate the antibacterial potential of a diode laser with a wavelength of 445 nm in the cavity preparation using the bacterium Streptococcus salivarius associated with caries in conjunction with the characteristics and influences of dentin on light transmission. Methods: The bactericidal effect of the laser irradiation was determined in culture experiments by using caries-free human dentin samples on bacteria-inoculated agar. For this, dentin discs (horizontally cut coronal dentin) of 500 µm and 1000 µm thicknesses were produced and irradiated with the laser with irradiation parameters of 0.7-1 W in a cw-mode and exposure times of between 5-30 s. Based on the different sample thicknesses, the penetration depth effect of the irradiation was ascertained after the subsequent incubation of the bacteria-inoculated agar. Additional influential parameters on the irradiation transmission were investigated, including surface moisture, tooth color as well as the presence of a smear layer on the dentin surface. Results: The optical transmission values of the laser radiation for dentin were significantly dependent on the sample thickness (P = 0.006) as well as its moisture content (P = 0.013) and were independent of the presence of a smear layer. There was a 40% reduction in bacteria after the radiography of the 500-µm-thick dentin samples, which was shown as the lowest laser dose (443 J/cm2). Conclusion: These findings indicate that the diode laser with light emission at a wavelength of 445 nm is interesting for the supportive cavity disinfection within the scope of caries therapy and show potential for clinical applications.

Laser-assisted prevention of enamel caries: a 10-year review of the literature.

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.

Artificial Caries Resistance in Enamel after Topical Fluoride Treatment and 445 nm Laser Irradiation.

OBJECTIVE: This in vitro study is aimed at investigating the caries preventive effectiveness of 445 nm diode laser in combination with topical fluoridation. MATERIALS AND METHODS: A total of 30 caries-free bovine teeth were used in this study. Eighteen teeth were covered with nail varnish except four windows on the labial surface. The windows were assigned to no treatment/control (C), laser (L) (0.3 W, 60 s, and 90 J/cm2), fluoride (F), and fluoride followed by laser (FL) treatment groups. Artificial caries lesions were created, and the teeth were sectioned and investigated under polarized light microscopy for quantitative measurement of the resulted lesion depth. Ten teeth were used for surface temperature measurement and two teeth for scanning electron microscopy (SEM). Extra twelve human molars were used for the intrapulpal temperature measurement. The absorbance of fluoride at 445 nm was measured. RESULTS: The means of lesion depth for the C, L, F, and FL groups were 123.48 (±21.93), 112.33 (±20.42), 99.58 (±30.68), and 89.03 (±30.38) µm, respectively. The pairwise differences of the L, F, and FL groups compared with the C group were significant (p < 0.05). The differences between groups were tested: FL versus L p=0.02, F versus L p=0.16, and FL versus F p=0.91, and the difference of the F versus FL was not significant (p=0.91). Temperature increment at the enamel surface and pulp roof were ∆T = 16.67 (±4.11) and 2.12 (±0.66)°C, respectively. The topical fluoride absorbance at 445 nm is five orders higher than that at 810 nm. SEM shows that after laser irradiation the enamel surface was intact and without thermal damage. CONCLUSIONS: The 445 nm laser irradiation may be useful for caries prevention, and its effectiveness is lower than those previously achieved using the argon ion laser.

Indocyanine green-based adjunctive antimicrobial photodynamic therapy for treating chronic periodontitis: A randomized clinical trial.

BACKGROUND: The objective was to evaluate the efficiency of indocyanine green (ICG)-based adjunctive antimicrobial photodynamic therapy (aPDT) in a prospective clinical study regarding non-surgical treatment of chronic periodontitis. METHODS: Affected teeth of twenty patients were treated with scaling and root planing (control group). Using a split-mouth design, two quadrants received additional ICG-based (perio green®, 0.1 mg/ml) aPDT (test group) with a diode laser at 808 nm (100 mW at 2 kHz). Clinical assessment of bleeding on probing (BOP), sulcus fluid flow rate (SFFR) and microbiological analysis were performed at baseline, two weeks, three and six months after treatment. Relative attachment level (RAL), probing depths (PD) and gingival recession (GR), were also analyzed. RESULTS: At baseline, none of the assessed parameters showed significant differences between the test and control groups. Median values for BOP, RAL, PD, decreased significantly in both groups after three months of treatment (p ≤ 0.05) without significant difference between the groups. Two weeks after treatment, the SFFR showed significantly lower mean values in the test group (aPDT). CONCLUSION: Within the study limits, the only significant difference between the control group and the aPDT group was a transient smaller amount of SFFR in the latter during the first follow-up. With the applied parameters, this study does not conclusively support ICG-based aPDT, though it is promising because no adverse effects occurred. The precise modes of action of ICG must be elucidated, and further clinical trials are needed.

Effectiveness of photopolymerization in composite resins using a novel 445-nm diode laser in comparison to LED and halogen bulb technology.

Challenges especially in the minimal invasive restorative treatment of teeth require further developments of composite polymerization techniques. These include, among others, the securing of a complete polymerization with moderate thermal stress for the pulp. The aim of this study is to compare current light curing sources with a blue diode laser regarding curing depth and heat generation during the polymerization process. A diode laser (445 nm), a LED, and a halogen lamp were used for polymerizing composite resins. The curing depth was determined according to the norm ISO 4049. Laser output powers of 0.1, 0.5, 1, and 2 W were chosen. The laser beam diameter was adapted to the glass rod of the LED and the halogen lamp (8 mm). The irradiation time was fixed at 40 s. To ascertain ΔT values, the surface and ground area temperatures of the cavities were simultaneously determined during the curing via a thermography camera and a thermocouple. The curing depths for the LED (3.3 mm), halogen lamp (3.1 mm) and laser(0.5/1 W) (3/3.3 mm) showed no significant differences (p < 0.05). The values of ΔTsurface as well as ΔTground also showed no significant differences among LED, halogen lamp, and laser(1 W). The ΔTsurface values were 4.1LED, 4.3halogen lamp, and 4.5 °C for the laser while the ΔTground values were 2.7LED, 2.6halogen lamp, and 2.9 °C for the laser. The results indicate that the blue diode laser (445 nm) is a feasible alternative for photopolymerization of complex composite resin restorations in dentistry by the use of selected laser parameters.

In-vitro cytocompatibility of dental resin monomers on osteoblast-like cells.

OBJECTIVES: Dental resin-based materials are widely used in modern dentistry. Especially, resin cements enjoy great popularity and are utilized in many applications. Nevertheless, monomers could be released from the resinous matrix, thus interact with surrounding tissues, cause adverse biological reactions and may lead in cases of implant retained restorations to peri-implant bone destruction. Hence, we performed an in-vitro study to determine cytotoxicity of resin monomers on osteoblast-like cells. METHODS: Three permanent osteoblast-like cell lines from tumor origin (MG-63 and Saos-2) as well as immortalized human fetal osteoblasts (hFOB 1.19) were used and treated with different concentrations of the main monomers: BisGMA, UDMA, TEGDMA and HEMA. The impact on cell viability was monitored using three different cytotoxicity tests: alamarBlue, XTT, and LDH assay. Mean±SEM were calculated and statistical analysis was performed with GraphPad Prism software. RESULTS: All monomers tested caused concentration dependent cytotoxic effects on the three investigated osteoblast-like cell lines. Although all three cell viability assays showed comparable results in cytotoxic ranking of the monomers (BisGMA > UDMA > TEGDMA > HEMA), higher differences in the absolute values were detected by the various test methods In addition, also a cell line dependent influence on cell viability could be identified with higher impact on the immortalized hFOB 1.19 cells compared to both osteosarcoma cell lines (MG-63, Saos-2). CONCLUSIONS: Monomer concentrations detected in elution studies caused toxic effects in osteoblast-like cells. Although the results from in-vitro studies cannot be directly transferred to a clinical situation our results indicate that released monomers from composite resin cements may cause adverse biological effects and thereby possibly lead to conditions favoring peri-implantitis and bone destruction. CLINICAL SIGNIFICANCE: The wide use of composite resin cements especially in implant-prosthetic treatments should be scrutinized to avoid possible clinical implications between eluted resin monomers and bone cells leading to conditions favoring peri-implantitis and bone destruction.

A novel blue light laser system for surgical applications in dentistry: evaluation of specific laser-tissue interactions in monolayer cultures.

OBJECTIVES: The objective of this study was to examine a new blue light diode laser system (445 nm) for dental soft tissue surgery on cellular level. MATERIALS AND METHODS: An in vitro cell culture model was established to evaluate the effects of the 445-nm diode laser in comparison to an established infrared diode laser (IR). Monolayer cell cultures were irradiated and wound healing was morphometrically measured. Fluorescence staining was used for proof of potential DNA double-strand breaks as well as cytoskeleton alterations. Cellular live/dead discrimination was performed and temperature development during laser irradiation was measured with a thermographic infrared camera. RESULTS: A characteristic zone formation was detected after irradiation with both wavelengths. Despite a larger wound area after irradiation with 445 nm, due to its higher temperature development, this laser system showed a faster wound healing in comparison to the IR laser. No increase of devitalized cells was documented with higher distances between laser tip and cell layer and thus without thermal interaction. Neither cytoskeleton alteration nor DNA double-strand breaks could be recorded after irradiation in non-contact mode. CONCLUSIONS: The blue diode laser system demonstrated an excellent direct thermal coupling to cells and tissues without side effects even by reduced power settings. CLINICAL RELEVANCE: The blue diode laser seems to be a promising technology for clinical application due to high absorption of blue light without major side effects in adjacent tissues even by reduced power settings.

Imaging of Dental Hard Tissue Surfaces Prepared by an Ultrashort Pulsed Laser System (USPL).

The aim of this study was to compare surface structures of laser-irradiated dental hard tissues using confocal (CFM), atomic force (AFM), and scanning electron microscopy (SEM). The general potential of the AFM in analyzing laser-irradiated surfaces was determined in this context. Specimens of human enamel and dentin were irradiated using an 8.6 W Nd:YVO4 laser with a pulse duration of 8 ps, λ Center=1,064 nm, and a pulse repetition rate of 500 kHz. Surface topology of irradiated areas (1 mm2) was investigated using AFM, CFM, and SEM. Surface roughness R z was measured only with the AFM and the CFM. For non-irradiated enamel and dentin surfaces, roughnesses for CFM and AFM are in the nanometer range. However, major differences in roughness were determined for laser-prepared surfaces. For enamel, R z (CFM)=2.33 µm is much higher compared with R z (AFM)=0.09 µm; in the case of dentin, R z (CFM)=5.35 µm is also much higher compared with R z (AFM)=0.093 µm. Information regarding structural properties of surfaces needs real dimensions, particularly for use in dentistry. In this respect, AFM technology provides no additional results that lead to a significant improvement.

In vitro biocompatibility of ICON(®) and TEGDMA on human dental pulp stem cells.

OBJECTIVES: Resin infiltrants have been successfully used in dental medicine preventing the progression of tooth decay in an early phase of caries development. ICON(®) is an infiltrant of low-viscosity which penetrates via dentinal tubules into the lesion in dependence of the demineralization depth. Hence, we performed an in vitro study to determine the effect of ICON(®) on human dental pulp stem cells (hDPSCs). METHODS: Using explant technique, primary hDPSCs were collected from extracted teeth. Characterization and isolation were performed with typical mesenchymal stem cell markers (Stro-1, CD73, CD90, CD105) and hDPSCs differentiation was validated by immunofluorescence and flow cytometry. HDPSCs were stimulated with light-cured ICON(®) (lc) and non-light-cured ICON(®) (nc) conditioned media as well as different TEGDMA concentrations followed by the analysis of cytotoxicity, pro- and anti-inflammatory responses and differentiation using XTT assay, RT-PCR and ELISAs, respectively. RESULTS: Initial analysis demonstrated that hDPSCs express characteristic mesenchymal stem cell markers and differentiate into adipocytes, chondrocytes and osteoblasts. Notably, ICON(®) nc dramatically reduced cell viability (up to 98.9% after 48h), whereas ICON(®) lc showed only a modest cytotoxicity (10%). Data were in line with cytokine expression demonstrating increased levels of IL-6 and IL-8 as well as decreased IL-10 after ICON(®) nc exposure compared to ICON(®) lc. ICON(®) lc caused almost no alterations of DSPP, whereas ICON(®) nc markedly elevated DSPP mRNA levels (130.3-times). A concentration-dependent effect was observed in TEGDMA challenged hDPSCs. SIGNIFICANCE: ICON(®) is a successful minimal invasive technique. However, clinicians should strictly follow manufacturer's instructions to prevent adverse effects.

Cellular Distribution and Gene Expression Pattern of Metastasin (S100A4), Calgranulin A (S100A8), and Calgranulin B (S100A9) in Oral Lesions as Markers for Molecular Pathology.

The objective of this study was to analyze cellular localization and expression levels of oncologic relevant members of the S100 family in common oral lesions.Biopsies of various oral lesions were analyzed. S100A4 showed a higher expression rate in leukoplakias and oral squamous cell carcinomas. Transcript levels of S100A8 and S100A9 were significantly decreased in malignant OSCCs. A correlation could be drawn between the expression levels of these genes and the pathological characteristics of the investigated lesions. S100A4, A8, and A9 proteins represent promising marker genes to evaluate the risk potential of suspicious oral lesions in molecular pathology.

Thermotransduction and heat stress in dental structures during orthodontic debonding : Effectiveness of various cooling strategies.

OBJECTIVES: Recent studies have indicated possible thermal damage to pulpal tissue during orthodontic debonding. This study aimed to analyze the thermal loads acting upon dental structures and their transfer to the pulp during orthodontic debonding. Specific goals were to analyze temperature changes in local dental tissues, thermotransduction to the pulp cavity, and the effectiveness of common cooling strategies and of simulated intrapulpal circulation. MATERIALS AND METHODS: Metal brackets were bonded to five extracted human molars and subsequently removed. While a carbide bur was applied to debond the residual composite from the tooth surface, various cooling strategies (no/air/water cooling) were employed with or without simulated intrapulpal circulation, accompanied by temperature measurements with a thermographic infrared camera on the enamel surface and with measuring probes in the pulp cavity. Appropriate evaluation software was used to calculate the enamel-to-pulp temperature gradients and for statistical analysis. RESULTS: Significant differences in temperature rise and heat development over time, both on the enamel surfaces and in the pulp cavities were found. The mean temperature rises associated with no/air/water cooling were 90.7/46.6/9.2 °C on the enamel surface versus 9/8/4.6 °C inside the pulp. However, thermotransduction from enamel to pulp remained below 10 % of the surface measurements in all groups. Simulated intrapulpal microcirculation was found to significantly reduce intrapulpal temperature levels. CONCLUSION: During debonding of residual bracket adhesives, provided that a carbide bur is properly used, our data indicate a low risk of reaching critical intrapulpal temperatures even in the absence of dedicated cooling and no risk if the instrumentation is accompanied by air or water cooling.

Ghrelin promotes oral tumor cell proliferation by modifying GLUT1 expression.

In our study, ghrelin was investigated with respect to its capacity on proliferative effects and molecular correlations on oral tumor cells. The presence of all molecular components of the ghrelin system, i.e., ghrelin and its receptors, was analyzed and could be detected using real-time PCR and immunohistochemistry. To examine cellular effects caused by ghrelin and to clarify downstream-regulatory mechanisms, two different oral tumor cell lines (BHY and HN) were used in cell culture experiments. Stimulation of either cell line with ghrelin led to a significantly increased proliferation. Signal transduction occurred through phosphorylation of GSK-3ß and nuclear translocation of ß-catenin. This effect could be inhibited by blocking protein kinase A. Glucose transporter1 (GLUT1), as an important factor for delivering sufficient amounts of glucose to tumor cells having high requirements for this carbohydrate (Warburg effect) was up-regulated by exogenous and endogenous ghrelin. Silencing intracellular ghrelin concentrations using siRNA led to a significant decreased expression of GLUT1 and proliferation. In conclusion, our study describes the role for the appetite-stimulating peptide hormone ghrelin in oral cancer proliferation under the particular aspect of glucose uptake: (1) tumor cells are a source of ghrelin. (2) Ghrelin affects tumor cell proliferation through autocrine and/or paracrine activity. (3) Ghrelin modulates GLUT1 expression and thus indirectly enhances tumor cell proliferation. These findings are of major relevance, because glucose uptake is assumed to be a promising target for cancer treatment.