Effectiveness of Low-Level Laser Therapy with a 915 Nm Wavelength Diode Laser on the Healing of Intraoral Mucosal Wound: An Animal Study and a Double-Blind Randomized Clinical Trial.

Background and objectives: Diode laser has been the most popular low-level laser therapy (LLLT) technique in dentistry due to its good tissue penetration, lower financial costs, small size for portable application, and convenience to use. A series of recent studies with 940 nm or 980 nm lasers demonstrated that LLLT showed positive effects after third molar extraction or periodontal flap surgery. However, the effects of LLLT on intraoral mucosal wound healing after surgical incision have not yet been determined in human clinical study. Materials and Methods: The present study was performed to determine the efficacy and safety of 915 nm wavelength low-level laser therapy (LLLT) in mucosal wound healing. A total of 108 Sprague-Dawley rats were used. They were divided into three groups: Abrasive wound group, immediate LLLT once group, and daily LLLT group. As a clinical study, a total of 16 patients with split-mouth design subjected to bilateral mandibular third molar extraction were allocated into the LLLT group and placebo group. The process of LLLT was performed on postoperative days 0, 1, and 7, and parameters related to wound healing were analyzed on days 1, 7, and 14. Results: Repeated laser irradiation promoted mucosal wound healing of the rats. In the clinical study, although there were no significant statistical differences between the LLLT and placebo groups in all inflammatory parameters, the early stage mucosal healing tendency of wound dehiscence was higher in the LLLT group than in the placebo group clinically on postoperative day 1. Conclusions: The present results showed that 915 nm LLLT could be applied safely as an auxiliary therapy for mucosal wound healing.

UVA-activated riboflavin improves the strength of human dentin.

The aim of this study was to evaluate the effects of UVA-activated riboflavin (UVA-RF) on the mechanical properties of non-demineralized human dentin. Dentin specimens obtained from 20 teeth were randomly divided into the following four groups: group 1 (control): no treatment, group 2 (low UVA-RF): specimens were exposed to UVA-RF for 10 min, group 3 (medium UVA-RF): specimens were exposed to UVA-RF for 30 min, and group 4 (high UVA-RF): specimens were exposed to UVA-RF for 60 min. Three-point flexural test and Raman spectroscopic analyses were performed. The mean flexural strengths (MPa) were 129.96, 128.96, 144.21, and 147.54, and the mean elastic modulus (GPa) were 8.59, 8.38, 10.21, and 9.87 for groups 1 to 4, respectively. Raman spectra showed chemical modifications of dental collagen under medium and high UVA-RF treatment. We conclude that medium and high UVA-RF increases the strength of non-demineralized human dentin by collagen crosslinking.

Comparison of photopolymerization temperature increases in internal and external positions of composite and tooth cavities in real time: Incremental fillings of microhybrid composite vs. bulk filling of bulk fill composite.

OBJECTIVES: This study evaluated temperature increases in the composite and pulpal side of dentin from incremental and bulk fillings in composite restorations. METHODS: Class-1 cavities (5 mm × 4 mm × 3 mm) were prepared in ten extracted third molars, filled with composite, and restored with two separate horizontal layers of Filtek Z250 (3M ESPE) in the incremental group or a single layer of SureFil SDR Flow (Dentsply) in the bulk-fill group (n=5). After placing the specimens in a 36.5°C water bath, temperatures were measured with eight thermocouples at the bottom center (BC), middle center (MC), top center (TC), bottom corner (BE), middle corner (ME), and top corner (TE) of the cavity, at the pulpal side of the dentin within the pulp chamber (PD), and in the curing light (CL) tip during light curing at 750 mW/cm(2) for 20s and then analyzed with one-way analysis of variance and Tukey's HSD tests (α=0.01). RESULTS: Maximum temperatures ranged from 39.0°C (PD 1st increment) to 60.0°C (MC 1st increment) in the incremental group and from 42.0°C (PD) to 74.9°C (TC) in the bulk-fill group. In the incremental group, temperatures were similar between the 1st and 2nd increments, except at MC and BC. CONCLUSIONS: Bulk-fill group exhibited a greater increase in temperature during composite restoration. Regardless of the filling technique, more heat was generated at the center than at the corner and at the top than at the bottom of the composite. PD temperatures increased by 3.1°C and 5.5°C in the incremental group and bulk-fill group, respectively. CLINICAL SIGNIFICANCE: Although bulk fillings save clinical chair time, clinicians should be aware of the greater heat that is generated with increasing amounts of composites during polymerization, which can jeopardize the pulpal health, especially when a large and deep cavity is being restored.

Radiotherapy effect on nano-mechanical properties and chemical composition of enamel and dentine.

OBJECTIVE: To understand radiotherapy-induced dental lesions characterized by enamel loss or delamination near the dentine-enamel junction (DEJ), this study evaluated enamel and dentine nano-mechanical properties and chemical composition before and after simulated oral cancer radiotherapy. DESIGN: Sections from seven non-carious third molars were exposed to 2 Gy fractions, 5 days/week for 7 weeks for a total of 70 Gy. Nanoindentation was used to evaluate Young's modulus, while Raman microspectroscopy was used to measure protein/mineral ratios, carbonate/phosphate ratios, and phosphate peak width. All measures were completed prior to and following radiation at the same four buccal and lingual sites 500 and 30 µm from the DEJ in enamel and dentine (E-500, E-30, D-30 and D-500). RESULTS: The elastic modulus of enamel and dentine was significantly increased (P ≤ 0.05) following radiation. Based on Raman spectroscopic analysis, there was a significant decrease in the protein to mineral ratio (2931/430 cm(-1)) following radiation at all sites tested except at D-500, while the carbonate to phosphate ratio (1070/960 cm(-1)) increased at E-30 and decreased at D-500. Finally, phosphate peak width as measured by FWHM at 960 cm(-1) significantly decreased at both D-30 and D-500 following radiation. CONCLUSIONS: Simulated radiotherapy produced an increase in the stiffness of enamel and dentine near the DEJ. Increased stiffness is speculated to be the result of the radiation-induced decrease in the protein content, with the percent reduction much greater in the enamel sites. Such changes in mechanical properties and chemical composition could potentially contribute to DEJ biomechanical failure leading to enamel delamination that occurs post-radiotherapy. However, other analyses are required for a better understanding of radiotherapy-induced effects on tooth structure to improve preventive and restorative treatments for oral cancer patients.

Extracts of irradiated mature human tooth crowns contain MMP-20 protein and activity.

OBJECTIVES: We recently demonstrated a significant correlation between enamel delamination and tooth-level radiation dose in oral cancer patients. Since radiation can induce the synthesis and activation of matrix metalloproteinases, we hypothesized that irradiated teeth may contain active matrix metalloproteinases. MATERIALS AND METHODS: Extracted teeth from oral cancer patients treated with radiotherapy and from healthy subjects were compared. Extracted mature third molars from healthy subjects were irradiated in vitro and/or incubated for 0-6 months at 37°C. All teeth were then pulverized, extracted, and extracts subjected to proteomic and enzymatic analyses. RESULTS: Screening of irradiated crown extracts using mass spectrometry identified MMP-20 (enamelysin) which is expressed developmentally in dentine and enamel but believed to be removed prior to tooth eruption. MMP-20 was composed of catalytically active forms at Mr=43, 41, 24 and 22kDa and was immunolocalized predominantly to the morphological dentine enamel junction. The proportion of different sized MMP-20 forms changed with incubation and irradiation. While the pattern was not altered directly by irradiation of healthy teeth with 70Gy, subsequent incubation at 37°C for 3-6 months with or without prior irradiation caused the proportion of Mr=24-22kDa MMP-20 bands to increase dramatically. Extracts of teeth from oral cancer patients who received >70Gy radiation also contained relatively more 24 and 22kDa MMP-20 than those of healthy age-related teeth. CONCLUSION: MMP-20 is a radiation-resistant component of mature tooth crowns enriched in the dentine-enamel. We speculate that MMP-20 catalyzed degradation of organic matrix at this site could lead to enamel delamination associated with oral cancer radiotherapy.

Microtensile bond strength analysis of adhesive systems to Er:YAG and Er,Cr:YSGG laser-treated dentin.

The aim of this in vitro study was to evaluate the effect of different surface treatments (control, diamond bur, erbium-doped yttrium aluminum garnet (Er:YAG) laser, and erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser) on sound dentin surface morphology and on microtensile bond strength (µTBS). Sixteen dentin fragments were randomly divided into four groups (n = 4), and different surface treatments were analyzed by scanning electron microscopy. Ninety-six third molars were randomly divided into eight groups (n = 12) according to type of surface treatment and adhesive system: G1 = Control + Clearfil SE Bond (SE); G2 = Control + Single Bond (SB); G3 = diamond bur (DB) + SE; G4 = DB + SB, G5 = Er:YAG laser (2.94 µm, 60 mJ, 2 Hz, 0.12 W, 19.3 J/cm(2)) + SE; G6 = Er:YAG + SB, G7 = Er,Cr:YSGG laser (2.78 µm, 50 mJ, 30 Hz, 1.5 W, 4.5 J/cm(2)) + SE; and G8 = Er,Cr:YSGG + SB. Composite blocks were bonded to the samples, and after 24-h storage in distilled/deionized water (37 °C), stick-shaped samples were obtained and submitted to µTBS test. Bond strength values (in megapascal) were analyzed by two-way ANOVA and Tukey tests (α = 0.05). G1 (54.69 ± 7.8 MPa) showed the highest mean, which was statistically significantly higher than all the other groups (p < 0.05). For all treatments, SE showed higher bond strength than SB, except only for Er,Cr:YSGG treatment, in which the systems did not differ statistically from each other. Based on the irradiation parameters considered in this study, it can be concluded that Er:YAG and Er,Cr:YSGG irradiation presented lower values than the control group; however, their association with self-etching adhesive does not have a significantly negative effect on sound dentin (µTBS values of >20 MPa).

Long-term chlorhexidine effect on bond strength to Er:YAG laser irradiated-dentin.

This study evaluates the bond strength of dentin prepared with Er:YAG laser or bur, after rewetting with chlorhexidine on long-term artificial saliva storage and thermocycling. One hundred and twenty human third molars were sectioned in order to expose the dentin surface (n = 10). The specimens were randomly divided in 12 groups according to treatment and aging: Er:YAG laser rewetting with deionized water (LW) and 24 h storage in artificial saliva (WC); LW and 6 months of artificial saliva storage + 12.000 thermocycling (6M), LW and 12 months of artificial saliva storage + 24.000 thermocycling (12M), Er:YAG laser rewetting with 2% chlorhexidine (LC) and WC, LC and 6M, LC and 12M, bur on high-speed turbine rewetting with deionized water (TW) and WC, TW6M, TW12M, bur on high-speed turbine + 2% chlorhexidine (TC) and WC, TC and 6M, TC and 12M. The specimens were etched with 35% phosphoric acid, washed, and dried with air. Single Bond 2 adhesive was applied and the samples were restored with a composite. Each tooth was sectioned in order to obtain 4 sticks, which were submitted to microtensile bond strength test (µTBS). The two-way ANOVA, showed no significant differences for the interaction between the factors and for the aging factor. Tukey 5% showed that the LC group had the lowest µTBS. The rewetting with chlorhexidine negatively influenced the bond strength of the preparation with the Er:YAG laser. The artificial saliva aging and thermocycling did not interfere with dentin bond strength.

Relationship between the chemical and morphological characteristics of human dentin after Er:YAG laser irradiation.

The effects of laser etching on dentin are studied by microenergy-dispersive x-ray fluorescence spectrometry (µ-EDXRF) and scanning electron microscopy (SEM) to establish the correlation of data obtained. Fifteen human third molars are prepared, baseline µ-EDXRF mappings are performed, and ten specimens are selected. Each specimen received four treatments: acid etching (control-CG) or erbium:yttrium-aluminum-garnet (Er:YAG) laser irradiation (I-100 mJ, II-160 mJ, and III-220 mJ), and maps are done again. The Ca and P content are significantly reduced after acid etching (p<0.0001) and increased after laser irradiation with 220 mJ (Ca: p<0.0153 and P: p=0.0005). The Ca/P ratio increased and decreased after CG (p=0.0052) and GI (p=0.0003) treatments, respectively. CG treatment resulted in lower inorganic content (GI: p<0.05, GII: p<0.01, and GIII: p<0.01) and higher Ca/P ratios than laser etching (GI: p<0.001, GII: p<0.01, and GIII: p<0.01). The SEM photomicrographies revealed open (CG) and partially open dentin tubules (GI, GII, and GIII). µ-EDXRF mappings illustrated that acid etching created homogeneous distribution of inorganic content over dentin. Er:YAG laser etching (220 mJ) produced irregular elemental distribution and changed the stoichiometric proportions of hydroxyapatite, as showed by an increase of mineral content. Decreases and increases of mineral content in the µ-EDXRF images are correlated to holes and mounds, respectively, as found in SEM images.

Argon and Nd:YAG lasers for caries prevention in enamel.

OBJECTIVE: The aim of this study was to investigate the effect of Nd:YAG and argon laser irradiations on enamel demineralization after two different models to induce artificial caries. BACKGROUND DATA: It is believed that the use of the high-intensity laser on the dental structure can lead to a more acid-resistant surface. MATERIALS AND METHODS: Twenty-one extracted human third molars were sectioned into tooth quarters. The quarters were distributed in three groups: Group I (control), untreated; Group II, Nd:YAG laser (60 mJ, 15 pps, 47.77 J/cm(2), 30 sec); and Group III, argon laser (250 mW, 12 J/cm(2), 48 sec). Tooth quarters from each group were subjected to two different demineralization models: cycle 1, a 14 day demineralization (pH 4.5; 6 h) and remineralization (pH 7.0; 18 h) solutions, 37 °C and cycle 2, 48 h in demineralization solution (pH 4.5). Samples were prepared in slices (60-100 µm thick) to be evaluated under polarized light microscopy. Demineralization areas were measured (mm(2)) (n=11). Data were analyzed by ANOVA and Tukey's test (p<0.05). RESULTS: Means followed by different letters are significantly different: 0.25 A (control, cycle 48 h); 0.18 AB (control, cycle 14 days); 0.17 AB (Nd:YAG, cycle 14 days); 0.14 BC (argon, cycle 48 h); 0.09 BC (Nd:YAG, cycle 48 h), and 0.06 C (argon, cycle 14 days). CONCLUSIONS: The argon laser was more effective for caries preventive treatment than Nd:YAG laser, showing a smaller demineralization area in enamel.

Tensile bond strength of sealants following Er:YAG laser etching compared to acid etching in permanent teeth.

The aim of this in vitro study was to assess the effect of Er:YAG laser surface treatment on the tensile bond strength of a sealant in permanent teeth. A total of 30 sound third molars were selected and embedded in cold-cure acrylic resin. The enamel surfaces were flattened by a grinding. The teeth were randomly divided into three groups and pretreated as follows: (1) 37% phosphoric acid; (2) Er:YAG laser (1.5 ml/min water spray, 100 mJ energy output, 10 Hz frequency, focal distance 17 mm); (3) Er:YAG laser + 37% phosphoric acid. The treated surfaces were isolated by double adhesive Sellotape and after insertion of a split Teflon matrix at an isolated site, sealant was applied. The specimens were thermocycled and stored at 37°C in distilled water for 72 h, then subjected to a tensile bond strength test (50 kgf at 0.5 mm/min). The mean tensile bond strengths (± SD, in megapascals) were: 18.51 ± 5.68 in group 1, 8.06 ± 2.69 in group 2, and 17.33 ± 5.04 in group 3. Data were submitted to analysis of variance and the Tukey test. No significant difference were found between groups 1 (37% phosphoric acid) and group 3 (Er:YAG laser + 37% phosphoric acid) but treatment with the Er:YAG laser alone (group 2) resulted in significantly lower tensile bond strength than seen in the other groups. In this setting, the Er:YAG laser prepared the enamel surface for sealing but did not eliminate the need for acid etching before sealant application.

Morphological alterations in dentine after mechanical treatment and ultrashort pulse laser irradiation.

The aim of this study was to evaluate and compare the morphological changes that occur in dentine after femtosecond laser irradiation and after mechanical treatment. The duration of the laser pulse is an important parameter, because within the time frame of the pulse heat diffusion plays a very important role in the mechanism of interaction between the light and the tissue. Six totally impacted human third molars were sectioned into sheets approximately 1 mm thick with an Accutom-50 precision cutting machine. The samples were randomly divided into two groups according to their cavity preparation: mechanical cavity preparation and laser cavity preparation. The samples were then examined by light microscopy and scanning electron microscopy. There were clear differences in the results obtained with the two techniques. Cavities prepared with the laser with pulses of <1 ps showed no microcracks, and the treated surface displayed a rough and irregular aspect with no smear layer and exhibited open dentinal tubules. On the contrary, cavities made with a rotatory instrument had a smooth surface and microcracks, a broad area of carbonization and merging, occluded dentinal tubules and a smear layer. This study showed that human dentine can be successfully ablated with the ultrashort pulse laser.

Microtensile bond strength of an etch-and-rinse adhesive to enamel and dentin after Er:YAG laser pretreatment with different pulse durations.

The purpose of this study is to evaluate microtensile bond strength (µTBS) of an etch-and-rinse adhesive to enamel and dentin after treatment with Er:YAG laser using different pulse durations. Extracted human molars were flattened to obtain enamel or dentin surfaces. The enamel specimens (E) were divided into nine groups and the dentin (D) specimens were divided into seven groups according to the surface treatments (n = 6). E-C: acid was applied according to the manufacturer's instructions and used as control, E-SSP: 120 mJ, 10 Hz, SSP (50 µs), E-SSP-A: 120 mJ,10 Hz, SSP+acid, E-VSP: 120 mJ, 10 Hz, VSP (100 µs), E-VSP-A: 120 mJ, 10 Hz, VSP+acid, E-SP: 120 mJ, 10 Hz, SP (150 µs), E-SP-A:120 mJ,10 Hz, SP+acid, E-LP:120 mJ,10 Hz, LP (300 µs), E-LP-A:120 mJ,10 Hz, LP+acid; D-C: acid was applied and used as control, D-SSP: 80 mJ, 10 Hz, SSP, D-SSP-A: 80 mJ, 10 Hz, SSP+acid, D-VSP: 80 mJ, 10 Hz, VSP, D-VSP-A: 80 mJ, 10 Hz, VSP+acid, D-SP: 80 mJ, 10 Hz, SP, D-SP-A: 80 mJ, 10 Hz, SP+acid. After application of etch-and-rinse adhesive, composite built-ups were created with a nanoceramic composite. Specimens were sectioned into serial 1-mm(2) sticks, and µTBS was measured in five sticks from each tooth randomly selected (n = 30). Failure modes were determined under a stereomicroscope. µTBS test data were analyzed by Welch-ANOVA followed by Dunnett's T3 tests and failure mode distributions were analyzed by Pearson Chi-square test (p = 0.05). µTBS was higher for enamel and dentin after additional acid etching than laser irradiation alone. E-SSP-A group exhibited the highest µTBS for enamel (p < 0.05). The D-SP-A group showed the highest value but the difference was not significant in comparison to D-C (p > 0.05). The µTBS of laser-irradiated but not acid-etched groups decreased when longer pulse durations were used. Laser treatment could enhance or impair the µTBS to enamel and dentin depending on the pulse duration used and additional acid application.

Characterization of the radioresponse of human apical papilla-derived cells.

BACKGROUND: The purpose of this study was to characterize the radiobiological properties of stem/progenitor cells derived from apical papilla-derived cells (APDCs) compared to bulk APDCs. METHODS: APDCs were isolated from freshly extracted human third molars with immature apices. Multipotent spheres, which are thought to contain an enriched population of stem/progenitor cells, were formed from the APDCs, using a neurosphere culture technique. After γ-irradiation, papillary sphere-forming cells (PSFCs) and bulk APDCs were subjected to radiosensitivity and hard tissue-forming assays. RESULTS: Compared to bulk APDCs, the PSFCs exhibited a radioresistant phenotype and a higher capacity for DNA double strand break repair. Irradiation induced a significant increase in a senescence-like phenotype in both cell types. Neither type of cells exhibited a significant induction of apoptotic changes after 8 Gy of irradiation. Ability to form hard tissue in vivo was significantly decreased in PSFCs, but not in APDCs following 4 Gy of irradiation. CONCLUSIONS: We demonstrated for the first time that stem/progenitor cells derived from APDCs exhibit a radioresistant phenotype; however, the hard tissue forming ability in vivo, but not bulk APDCs, was significantly reduced after irradiation.

Influence of Er:YAG laser frequency on dentin caries removal capacity.

The purposes of this study were to evaluate in vitro the influence of different frequencies of Er:YAG laser on the human dentin caries removal capacity. Thirty fragments obtained from third molars were randomly assigned into three groups (n = 10) according to the laser frequency used: 4, 6, and 10 Hz. The caries lesion (±1 mm deep) was induced before the irradiation by S.mutans cultures for 6 weeks. The specimens of all groups were irradiated with 200 mJ of energy in noncontact and focused mode under constant refrigeration (water flow: 2.5 mL/min). Quantitative analysis of the caries removal was performed by DIAGNOdent™ and the Axion Vision™ software. Qualitative analysis was performed by Scanning electron microscope (SEM) and light microscope (LM). Data were analyzed by ANOVA and Fishers' tests. The DIAGNOdent™ revealed that the caries removal was similar with 4 and 6 Hz and was superior with 10 Hz (P < 0.05). The analysis with Axion Vision™ software revealed that the caries removal was similar with 6 and 10 Hz and the 4 Hz group promoted the lowest caries removal. Through SEM morphologic analysis, some specimens irradiated with 4 Hz presented, under the demineralized dentin, a disorganized collagenous matrix. The LM images revealed that all frequencies used promoted irregular caries removal, being observed over preparations with 6 and 10 Hz. It can be concluded that the increase of Er:YAG laser frequency provided a higher dentin caries removal without selectivity to the disorganized dentin.

Effect of erbium:yttrium-aluminum-garnet laser energies on superficial and deep dentin microhardness.

This study evaluated the microhardness of superficial and deep dentin irradiated with different erbium:yttrium-aluminum-garnet (Er:YAG) laser energies. Seventy-two molars were bisected and randomly assigned to two groups (superficial dentin or deep dentin) and into six subgroups (160 mJ, 200 mJ, 260 mJ, 300 mJ, 360 mJ, and control). After irradiation, the cavities were longitudinally bisected. Microhardness was measured at six points (20 microm, 40 microm, 60 microm, 80 microm, 100 microm, and 200 microm) under the cavity floor. Data were submitted to analysis of variance (ANOVA) and Fisher's tests (alpha = 0.05). Superficial dentin presented higher microhardness than deep dentin; energy of 160 mJ resulted in the highest microhardness and 360 mJ the lowest one. Values at all points were different, exhibiting increasing microhardness throughout; superficial dentin microhardness was the highest at 20 microm with 160 mJ energy; for deep dentin, microhardness after irradiation at 160 mJ and 200 mJ was similar to that of the control. The lowest energy increased superficial dentin microhardness at the closest extent under the cavity; deep dentin microhardness was not altered by energies of 160 mJ and 200 mJ.

Influence of etching with erbium, chromium:yttrium-scandium-gallium-garnet laser on microleakage of class V restoration.

The aim of this in vitro study was to evaluate some parameters of dental etching when irradiated with an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser. One-hundred sound human third molars were selected and randomly distributed into ten groups (n = 10). The class V cavities of group 1 (control) were prepared with a bur and etched with 37% phosphoric acid, while groups G2 to G10, were prepared with laser (5 W, 88.46 J/cm(2), 90/70% air/water) and etched with the following powers: G3 and G4, 0.25 W; G5 and G6, 0.5 W; G7 and G8, 0.75 W; G9 and G10, 1 W. Group G2 received no laser etching. Prior to restoration, G2, G4, G6, G8 and G10 received acid etching. After restoration, all samples were submitted to a microleakage test. According to statistical analysis (Kruskal-Wallis and Dunn's tests), G10 presented the lowest microleakage values (P<0.05). The other groups showed no differences between them. Etching with Er,Cr:YSGG laser (1 W) followed by phosphoric acid was effective in reducing the microleakage of class V restorations.

SEM analysis of enamel surface treated by Er:YAG laser: influence of irradiation distance.

BACKGROUND: Depending on the distance of laser tip to dental surface a specific morphological pattern should be expected. However, there have been limited reports that correlate the Er:YAG irradiation distance with dental morphology. PURPOSE: To assess the influence of Er:YAG laser irradiation distance on enamel morphology, by means of scanning electron microscopy (SEM). METHODS: Sixty human third molars were employed to obtain discs (approximately =1 mm thick) that were randomly assigned to six groups (n=10). Five groups received Er:YAG laser irradiation (80 mJ/2 Hz) for 20 s, according to the irradiation distance: 11, 12, 14, 16, or 17 mm and the control group was treated with 37% phosphoric acid for 15 s. The laser-irradiated discs were bisected. One hemi-disc was separated for superficial analysis without subsequent acid etching, and the other one, received the phosphoric acid for 15 s. Samples were prepared for SEM. RESULTS: Laser irradiation at 11 and 12 mm provided an evident ablation of enamel, with evident fissures and some fused areas. At 14, 16 and 17 mm the superficial topography was flatter than in the other distances. The subsequent acid etching on the lased-surface partially removed the disorganized tissue. CONCLUSIONS: Er:YAG laser in defocused mode promoted slight morphological alterations and seems more suitable for enamel conditioning than focused irradiation. The application of phosphoric acid on lased-enamel surface, regardless of the irradiation distance, decreased the superficial irregularities.

Influence of energy and pulse repetition rate of Er:YAG laser on enamel ablation ability and morphological analysis of the laser-irradiated surface.

OBJECTIVE: To assess the influence of energy and pulse repetition rate of Er:YAG laser on the enamel ablation ability and substrate morphology. METHODS: Fifteen crowns of molars were sectioned in four fragments, providing 60 samples, which were ground to flatten the enamel surface. The initial mass was obtained by weighing the fragments. The specimens were hydrated for 1 h, fixed, and a 3-mm-diameter area was delimited. Twelve groups were randomly formed according to the combination of laser energies (200, 250, 300, or 350 mJ) and pulse repetition rates (2, 3, or 4 Hz). The final mass was obtained and mass loss was calculated by the difference between the initial and final mass. The specimens were prepared for SEM. Data were submitted to ANOVA and Scheffé test. RESULTS: The 4 Hz frequency resulted in higher mass loss and was statistically different from 2 and 3 Hz (p < 0.05). The increase of frequency produced more melted areas, cracks, and unselective and deeper ablation. The 350 mJ energy promoted greater mass loss, similar to 300 mJ. CONCLUSIONS: The pulse repetition rate influenced more intensively the mass loss and morphological alteration. Among the tested parameters, 350 mJ/3 Hz improved the ability of enamel ablation with less surface morphological alterations.

Combined FT-Raman and SEM studies of the effects of Er:YAG laser irradiation on dentin.

OBJECTIVE: This study evaluated the molecular and morphological changes on dentin elements after Er:YAG laser irradiation. BACKGROUND DATA: Spectroscopy studies reporting the effects of Er:YAG laser irradiation as an alternative to acid etching are needed to better understand the laser's effects. METHODS: The occlusal one-third of the crown of six human third molars was removed. The dentin surface was schematically divided into areas corresponding to four surface treatment groups: control (group C): 37% phosphoric acid etching; group I: Er:YAG laser 80 mJ; group II: Er:YAG laser 120 mJ; and group III: Er:YAG laser 180 mJ. The analysis was performed by scanning electron microscopy (SEM) and Fourier transform Raman spectroscopy (FT-Raman) before and after the treatments. Raman data were submitted to ANOVA and Bonferroni tests. RESULTS: The SEM photomicrographs revealed open dentin tubules in the control group. The molars from groups I, II, and III showed partially open dentin tubules. SEM images showed that the laser-irradiated dentin surface was not favorable to the diffusion of monomers. A significant reduction of the spectra relative intensity was observed in group III specimens. CONCLUSIONS: Er:YAG laser irradiation with 180 mJ could produce chemical changes in proteins, phosphate, and carbonate in dentin.

Prevention of third molar development in dog with long pulse diode laser: a preliminary report.

INTRODUCTION: Wisdom teeth continue to plague man with a high rate of frequency. It may be possible to prevent their development in children at an early age with a non- or minimally invasive technique, even before the tooth begins to form, by treating the soft tissue overlying the site of their development. A previous study that treated the intra-oral soft tissues of newborn rats with a 20 watt diode laser stopped third molar development up to 80% of the time with minimum observable side effects. This brief report describes a similar use of the diode laser in a limited number of young beagle pups. It is the first reported attempt at preventing third molar development in an animal model close in size to man. MATERIALS AND METHODS: Four 6-7 week old beagle pups were treated on one side of their mandibles with either a 20 or a 100 watt, 800 nm diode laser at a time third molar tooth buds are just beginning to form under the oral mucosa. Six months following treatment, the pups were examined intra-orally and radiographically for evidence of third molar formation. RESULTS: The two intra-oral sites that received the 20 watt diode laser treatment showed normal third molar development. The two intra-oral sites that received the 100 watt diode laser treatment did not develop third molars. CONCLUSIONS: The diode laser may be capable of selectively stopping third molar development and further studies are warranted.