Bactericidal effect of Er,Cr:YSGG laser irradiation on endodontic biofilm: An ex vivo study.

AIM: This ex vivo study aimed to evaluate the of Er,Cr:YSGG laser effectiveness in the decontamination of an endodontic biofilm. MATERIALS AND METHODS: Seventy-three single rooted human teeth, freshly were chosen. Each tooth was exposed to four associated species in an endodontic biofilm (Enterococcus faecalis, Streptococcus salivarius, Porphyromonas gingivalis, and Prevotella intermedia) and randomly allocated to one of the seven experimental groups. The group 1 (7 teeth) was used to finalize the reliable biofilm-forming technique. The groups 2 and 3 (15 teeth each group) were irradiated with two different Er;Cr:YSGG laser settings (0,75 W - 40 Hz and 4 W - 40 Hz, respectively). The groups 4 and 5 (15 teeth each group) were irrigated with two different solutions and laser irradiated with the same settings (1,5 W - 15 Hz). The group 6 (6 teeth) was the control group treated only with 4 ml 2,5% NaOCl irrigation during 60 s. RESULTS: The observations of group 2 and 3 specimens showed the ripeness of the biofilm with the presence of Enterococcus faecalis and Streptococcus salivarius in chains but in group 3 thermal edge effects produced by the optic fiber in the canal walls were present. The group 4 specimens observation showed an average cleaning of the root canal walls while on the canal walls of group 5 samples the apical third presented several debris and smear layer and in the centre cracks and melting dentin of the radicular wall were observed. CONCLUSION: In those experimental conditions, this study, demonstrated that Er,Cr:YSGG laser has a canals decontamination ability when associated to NaOCl irrigation.

Impact of Warm Vertical Compaction on the Sealing Ability of Calcium Silicate-Based Sealers: A Confocal Microscopic Evaluation.

The aim of this in vitro study was to evaluate the dentinal tubule penetration of two calcium silicate-based sealers used in warm vertical compaction (WVC) obturation technique in comparison with the single cone (SC) technique by confocal laser scanning microscopy (CLSM). The null hypothesis was that both obturation techniques produced similar sealer penetration depths at 1 and 5 mm from the apex. Forty-four mandibular single-rooted premolars were randomly divided into four equally experimental groups (n = 10) and two control groups (n = 2) according to the type of sealer (Bio-C Angelus, Londrína, PR, Brazil or HiFlow Brasseler, Savannah, GA, USA) with either SC or WVC. The sealers were mixed with a fluorescent dye Rhodamine B (0.1%) to enable the assessment under the CLSM. All the specimens were sectioned horizontally at 1 and 5 mm from the apex. The maximum penetration depth was calculated using the ImageJ Software (ImageJ, NIH). Data were analyzed by Mann-Whitney U and Kruskal-Wallis tests (p < 0.05). A significant difference was shown between the four groups at 1 mm (p = 0.0116), whereas similar results were observed at 5 mm (p = 0.20). WVC allowed better diffusion for both sealers at 1 mm (p = 0.01) and 5 mm (p = 0.034). The maximum penetration of the Bio-C and HiFlow sealers was more important at 5 mm with the two obturation techniques. Within the limitations of this study, WVC enhanced the penetration of calcium silicate-based sealers into the dentinal tubules in comparison with the SC technique at both levels.

Nd:YAP laser in the treatment of dentinal hypersensitivity: An ex vivo study.

PURPOSE: The aims of this ex vivo study were to evaluate the effectiveness of the Nd:YAP laser in the treatment of dentin hypersensitivity, to compare the temperature rise during laser irradiation at three different dentine thicknesses, and to analyse the composition of the dentine-lased surface. METHODS: A total of 33 teeth were used in this study. For scanning electron microscopy (SEM) observation, 24 teeth were transversely sectioned and divided into 4 groups: group A was irrigated with EDTA; group B was irradiated by Nd:YAP laser with 180 mJ energy/per pulse, 0.9 W average power, and 5 Hz frequency (power density [PD] = 229 W/cm2); group C was irradiated by Nd:YAP laser with 280 mJ energy/pulse, 1.4 W average power, and 5 Hz frequency (PD = 356 W/cm2); and group D was irradiated by Nd:YAP with 360 mJ energy/pulse, 1.8 W average power, and 5 Hz frequency (PD = 458 W/cm2). Energy-dispersive spectroscopy (EDS) analysis was performed on the same teeth evaluated for SEM observations. For temperature increase evaluation performed with thermocouples, 9 teeth were transversely sectioned at 3 different thicknesses (3 for each group) of 1, 2, and 3 mm. RESULTS: Statistical analysis showed significant changes in the diameter of the dentinal tubule orifices among all groups; EDS did not show modification of the Ca/P ratio. Temperature increase under irradiation exceeded 5.5 °C only in the group D samples. CONCLUSIONS: This ex vivo study, based on temperature recording, SEM observation, and EDS analysis, demonstrated that Nd:YAP laser at a PD of 356 W/cm2, corresponding to an average power of 1.4 W, defines the best treatment for dentine hypersensitivity in terms of compromise between efficacy of the treatment and safety of the pulp.

Finishing and polishing effects of multiblade burs on the surface texture of 5 resin composites: microhardness and roughness testing.

OBJECTIVES: The aim of this in vitro study was to test the effect of 2 finishing-polishing sequences (QB, combining a 12/15-fluted finishing bur and an EVO-Light polisher; QWB, adding a 30-fluted polishing bur after the 12/15-fluted finishing bur used in the QB sequence) on 5 nanotech-based resin composites (Filtek Z500, Ceram X Mono, Ceram X Duo, Tetric Evoceram, and Tetric Evoceram Bulk Fill) by comparing their final surface roughness and hardness values to those of a Mylar strip control group (MS). MATERIALS AND METHODS: Twelve specimens of each nanocomposite were prepared in Teflon moulds. The surface of each resin composite was finished with QB (5 samples), QWB (5 samples), or MS (2 samples), and then evaluated (60 samples). Roughness was analysed with an optical profilometer, microhardness was tested with a Vickers indenter, and the surfaces were examined by optical and scanning electron microscopy. Data were analysed using the Kruskal-Wallis test (p < 0.05) followed by the Dunn test. RESULTS: For the hardness and roughness of nanocomposite resin, the QWB sequence was significantly more effective than QB (p < 0.05). The Filtek Z500 showed significantly harder surfaces regardless of the finishing-polishing sequence (p < 0.05). CONCLUSIONS: QWB yielded the best values of surface roughness and hardness. The hardness and roughness of the 5 nanocomposites presented less significant differences when QWB was used.

CO2 laser dentin surface treatment most effectively increased ceramic shear bond strength.

BACKGROUND AND AIMS: The purpose of this study is to determine the effect of CO2 laser irradiation in comparison with sandblasting (Sb), hydrofluoric acid (Hf) and silane coupling agent (Si) on shear bond strength (SBS) of resin cement to CAD/CAM ceramics bonded to dentin. MATERIAL AND METHODS: Forty-eight (CAD/CAM) ceramic discs were prepared and grouped by material, i.e. lithium disilicate (Emax CAD) and zirconia ceramic (Emax ZirCAD), distributed into four different groups: group A, lithium disilicate (Li) CO2/HF/Si; group B, Li: HF/Si; group C, zirconia (Zr) CO2/Sb/Si; group D, Zr: Sb/Si. RESULTS: It was shown significant difference between irradiated and non-irradiated groups in terms of shear bond strength for zirconia ceramics (p value = 0.039). CONCLUSION: CO2 laser irradiation increases shear bond strength for both CAD/CAM ceramics bonded to dentin.

Microhardness evaluations of CAD/CAM ceramics irradiated with CO2 or Nd:YAP laser.

BACKGROUND AND AIMS: The aim of this study was to measure the microhardness values of irradiated computer-aided design/computer-aided manufacturing (CAD/CAM) ceramics surfaces before and after thermal treatment. MATERIALS AND METHODS: Sixty CAD/CAM ceramic discs were prepared and grouped by material, i.e. lithium disilicate ceramic (Emax CAD) and zirconia ceramic (Emax ZirCAD). Laser irradiation at the material surface was performed with a carbon dioxide laser at 5 Watt (W) or 10 W power in continuous mode (CW mode), or with a neodymium:yttrium aluminum perovskite (Nd:YAP) laser at 10 W on graphite and non-graphite surfaces. Vickers hardness was tested at 0.3 kgf for lithium disilicate and 1 kgf for zirconia. RESULTS: Emax CAD irradiated with CO2 at 5 W increased microhardness by 6.32 GPa whereas Emax ZirCAD irradiated with Nd:YAP decreased microhardness by 17.46 GPa. CONCLUSION: CO2 laser effectively increases the microhardness of lithium disilicate ceramics (Emax CAD).

Shear bond, wettability and AFM evaluations on CO2 laser-irradiated CAD/CAM ceramic surfaces.

The purpose of this study is to determine the CO2 laser irradiation in comparison with sandblasting (Sb), hydrofluoric acid (Hf) and silane coupling agent (Si) on shear bond strength (SBS), roughness (Rg) and wettability (Wt) of resin cement to CAD/CAM ceramics. Sixty (CAD/CAM) ceramic discs were prepared and distributed into six different groups: group A, control lithium disilicate (Li); group B, control zirconia (Zr); group C, Li: CO2/HF/Si; group D, Li: HF/Si; group E, Zr: CO2/Sb/Si; group F, Zr: Sb/Si. Result showed significant difference between irradiated and non-irradiated in terms of shear bond strength for zirconia ceramics (p value = 0.014). Moreover, partial surface wettability for irradiated and non-irradiated ceramics. Irradiated surface demonstrated more rough surface in lithium disilicate than zirconia ceramics. CO2 irradiation could increase shear bond strength, surface roughness and wettability for both CAD/CAM ceramics.

Histological evaluation of three techniques for caries removal.

A number of concepts and devices have been proposed for caries removal. Among these, the Er:YAG laser is a potential alternative to conventional mechanical treatment. This study compared the effectiveness of the Er:YAG laser with that of low-speed rotary instruments for removal of carious tissue in 26 extracted human molars and premolars with severe decay (i.e., large occlusal or proximal decay but no pulpal contact). The teeth were divided into three groups of eight teeth, and two teeth were used as controls. After sectioning all the teeth through the center of the carious lesion before excavation, each group was randomly assigned to three groups-Er:YAG laser versus tungsten bur, Er:YAG laser versus polymer bur, and polymer bur versus tungsten bur-to evaluate the efficacy of the three techniques. The time required for carious treatment of each half was recorded, and samples were then histologically examined. Mean duration of caries removal did not significantly differ in relation to the technique used. Histological analysis of tooth halves treated with the Er:YAG laser revealed a regular 5-µm-thick stained layer that appeared to be denatured collagen. A smear layer was often detectable in halves treated with carbide burs. A superficial disorganized layer, which was found to be affected dentin, was observed in halves treated with polymer burs. The present findings indicate that the three techniques were clinically and histologically effective in removing the infected dentin layer.(J Oral Sci 58, 583-589, 2016).

The effect of CO2 and Nd:YAP lasers on CAD/CAM Ceramics: SEM, EDS and thermal studies.

BACKGROUND AND AIMS: The objective of this study was to investigate the interaction of infrared laser light on Computer Aided Design and Computer Aided Manufacturing (CAD/CAM) ceramic surfaces. MATERIAL AND METHODS: Sixty CAD/CAM ceramic discs were prepared and divided into two different groups: lithiumdisilicate ceramic (IPSe.maxCADs) and Zirconia ceramic (IPSe.maxZirCADs). The laser irradiation was performed on graphite and non-graphite surfaces with a Carbon Dioxide laser at 5W and 10W power in continuous mode (CW mode) and with Neodymium Yttrium Aluminum Perovskite (Nd:YAP) laser at 10W. Surface textures and compositions were examined using Scanning Electron Microscopy (SEM), and Energy Dispersive Spectroscopy (EDS). Thermal elevation was measured by thermocouple during laser irradiation. RESULTS: The SEM observation showed a rough surface plus cracks and fissures on CO2 10W samples and melting areas in Nd:YAP samples; moreover, with CO2 5W smooth and shallow surfaces were observed. EDS analysis revealed that laser irradiation does not result in modifications of the chemical composition even if minor changes in the atomic mass percentage of the components were registered. Thermocouple showed several thermal changes during laser irradiation. CONCLUSION: CO2 and Nd:YAP lasers modify CAD/CAM ceramic surface without chemical composition modifications.

Antimicrobial efficacy of photodynamic therapy, Nd:YAG laser and QMiX solution against Enterococcus faecalis biofilm.

BACKGROUND: Lasers have been recommended in final root canal disinfection protocol, however, there is no clear evidence about their efficacy against bacteria in biofilms. The aim of the study was to evaluate and compare the disinfection effect of antimicrobial photodynamic therapy (aPDT), Nd:YAG laser and QMiX solution against Enterococcus faecalis biofilm. METHODS: The study sample consisted of 65 dentine slices, which were inoculated with E. faecalis and incubated anaerobically for three weeks. The dentine discs were randomly allocated to one of the following experimental groups: aPDT (100 mW, 10 mg/ml phenothiazinium chloride, 1 min), Nd:YAG laser (2 W, 15 Hz, 4×5 s), QMiX solution (1 min). Positive controls did not receive any treatment and negative controls were treated with 5.25% NaOCl. To harvest surviving adherent cells, each dentine sample was transffered to a test tube containing of TSB, serial ten-fold dilutions were made and aliquot of 1 ml was plated onto blood agar plates and incubated for 48 h. Colony forming units grown were counted and transformed into actual counts based on the dilution factor. The remaining viable cells after each protocol were analysed by FISH. RESULTS: The aPDT and the QMiX solution were equally effective, with the reduction rate of E. faecalis CFUs of 98.8% and 99.3% respectively (p=1.107). The Nd:YAG laser caused 96% reduction of E. faecalis (P<0.001). CONCLUSION: The aPDT and the QMiX solution showed similar antibacterial efficacy against old E. faecalis biofilm, followed by Nd:YAG irradiation.

Evolution of the role of phototherapy during endodontic decontamination.

A microbe free root canal space before obturation leads to higher success rate and conventional chemo-mechanical debridement might not achieve this goal completely. First trials of laser in dentistry started from surgical intervention on caries and bones of oral cavity and extended to prepare cavities and even shaping root canals. Afterward lasers were implicated soon into direct debridement of root canal space. Anyhow failure of laser to remove debris totally from root canal space is demonstrated recently, additionally it might lead to damages to surrounding tissues or inorganic material of root canal if be used without precaution. Nowadays the theory of light assisted protocols became another start point for laser in endodontics. Laser has been introduced as an adjuvant to conventional debridement of root canals. We used Medline search engine to collect scientific publications to edit this review article in purpose of revealing the evolution of laser position from an ultimate cleaning methodology to an adjuvant to conventional root canal disinfection protocols.

Photodynamic therapy versus ultrasonic irrigation: interaction with endodontic microbial biofilm, an ex vivo study.

INTRODUCTION: Photodynamic therapy was introduced as an adjuvant to conventional chemo-mechanical debridement during endodontic treatment to overcome the persistence of biofilms. The aim of this study was to evaluate the ability of photodynamic therapy (PDT) to disrupt an experimental microbial biofilm inside the root canal in a clinically applicable working time. MATERIALS AND METHODS: Thirty extracted teeth were prepared and then divided in three groups. All samples were infected with an artificially formed biofilm made of Enterococcus faecalis, Streptococcus salivarius, Porphyromonas gingivalis and Prevotella intermedia bacteria. First group was treated with Aseptim Plus® photo-activated (LED) disinfection system, second group by a 650 nm Diode Laser and Toluidine blue as photosensitizer, and the third group, as control group, by ultrasonic irrigation (PUI) using EDTA 17% and NaOCl 2.6% solutions. The working time for all three groups was fixed at 3 min. Presence or absence of biofilm was assessed by aerobic and anaerobic cultures. RESULTS: There was no statistically significant difference between results obtained from groups treated by Aseptim Plus® and Diode Laser (P<0.6267). In cultures of both groups there was a maximal bacterial growth. The group that was treated by ultrasonic irrigation and NaOCl and EDTA solutions had the best results (P<0.0001): there was a statistically significant reduction of bacterial load and destruction of microbial biofilm. CONCLUSION: Under the condition of this study, Photodynamic therapy could not disrupt endodontic artificial microbial biofilm and could not inhibit bacterial growth in a clinically favorable working time.

Er:YAG 2,940-nm laser fiber in endodontic treatment: a help in removing smear layer.

Cleaning and disinfection of the root canal system are some of the most important goals in endodontic therapy. The aim of this preliminary study is to assess the effectiveness of Er:YAG laser fiber in removing the smear layer produced during root canal walls instrumentation. Forty-eight single-rooted teeth were prepared with manual and rotary Ni-Ti instruments, in addition to 2.5% NaOCl irrigation. Samples were randomly subdivided into groups and treated with: three irradiations of 5 s each, with 300-µm Er:YAG endodontic fiber, 1 W and 2.5% NaOCl solution (A Group); two laser irradiations with 17% EDTA solution and 2.5% NaOCl solution (B Group); laser irradiation plus 17% EDTA solution and 2.5% NaOCl (C Group); only in the final wash of 17% EDTA (control group D). During laser treatment, temperature variations were analyzed by using thermocouple and thermal camera devices in order to test both deep and superficial temperatures. Each sample was finally observed by scanning electron microscope (SEM) at the coronal, medium, and apical thirds at ×500 magnification and blindly scored depending on the amount of smear layer. Statistical analysis of the results was conducted using the Kruskal-Wallis and Mann-Whitney test to determine the eventual significant differences between the quantity of smear layer in each group and between the groups at coronal, medium, and apical third: a p value <0.05 was considered significant. The thermal analysis realized by thermocouple with the used parameters demonstrated that laser endodontic fiber produces an average deep temperature increase of 3.5 ± 0.4 °C; analysis performed with a thermal camera showed an average superficial temperature increase of 1.3 ± 0.2 °C produced by laser endodontic fiber use. Deep and superficial temperatures fall immediately after irradiation possibly without causing structural damage or anatomical alteration inside the root canal and neither on periodontal tissues. SEM analysis showed that specimens of group B had the highest level of cleaning in every third, with a significant difference with groups D and A; group C samples showed a good percentage of cleaned tubules in apical and middle thirds, while group D teeth showed open dentinal tubules in coronal third, with a statistical difference with group A samples which were the worst cleaned. The Er:YAG fiber double irradiation with EDTA 17% and NaOCl 2.5% has been demonstrated to be effective in removing smear layer, even in the apical third which is described as the hardest area to clean during endodontic treatment.

The quality of Thermafil obturations with different final apical tapers: a three-dimensional microcomputed tomographic comparative study.

AIM: The aim of this study is to evaluate the influence of final canal taper on the sealing ability of Thermafil by using microcomputed tomography (micro-CT). MATERIALS AND METHODS: Fifty-four single-rooted teeth were instrumented to apical size 40 taper 4, 6 and 8%. Teeth were divided into three groups. All teeth were filled with Thermafil (Dentsply,Tulsa Dental Products). Using micro-CT, roots were scanned and volume measurements of voids at 1, 3 and 5 mm from the apex were calculated using specialized CT software. Measurements were analyzed statistically with ANOVA followed by Bonferroni multiple comparison correction. RESULTS: Data analysis showed that 0.08 preparations provided better results than 0.06 and 0.04% tapered samples especially at 1 mm from the apex. Mean percentage of voids were significantly higher with Thermafil taper 0.06% (p = 0.05). None of the root canals filled teeth were gap free. Root canal preparations with bigger taper exhibited less voids than smaller tapered preparations. CLINICAL SIGNIFICANCE: In our daily practice, enlarging the apical third (last 3 mm) of root canals to an 8% taper gives a better sealing ability and thus long-term success for our root canal obturations.

Inhibition of Candida albicans yeast-hyphal transition and biofilm formation by Solidago virgaurea water extracts.

Xerostomia is a decrease of saliva secretion, which can unbalance the oral microflora, mainly to the benefit of Candida albicans. The aim of the present study was to find a plant extract that could create an unfavourable environment for Candida, and would, therefore, be appropriate for use in a dry-mouth daily-care mouthwash. Water extract from the herbaceous plant Solidago virgaurea (Goldenrod) was selected due to its saponin content (plant detergents). Saponin concentrations reached 0.7 and 0.95 mg ml(-1) in S. virgaurea subsp. virgaurea and S. virgaurea subsp. alpestris extracts, respectively. C. albicans was grown in liquid medium and cells were counted by microscopic examination after 0, 4 and 24 h of incubation. Solidago extracts did not inhibit the growth of C. albicans (four strains), Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus mutans, Streptococcus salivarius or Enterococcus faecalis. When inocula were incubated with Solidago extract for 4 and 24 h, we observed a decrease in Candida yeast-hyphal transition. Candida biofilms were then prepared in microtitre plates and treated with plant extracts at 0 h, to estimate biofilm formation, or at 18 h to estimate the effect of the saponin on pre-formed biofilms. Biofilm formation and pre-formed biofilms were both strongly inhibited. In conclusion, the S. virgaurea extract was efficient against two key virulence factors of C. albicans: the yeast-hyphal transition phase and biofilm formation.

Influence of calcium hydroxide intracanal medication on the sealing ability of warm gutta-percha.

This in vitro study sought to evaluate the influence of calcium hydroxide on the sealing ability of vertically condensed warm gutta-percha filling. Sixty single-rooted teeth were instrumented with a rotary system and divided randomly into two groups of 26 teeth each; the remaining eight teeth were divided into two groups of four to serve as negative and positive controls. The canals in the first group were filled with calcium hydroxide paste while the canals in the second group received no medication. Seven days after incubation, root canal dressings were removed by irrigation, using 5.25% sodium hypochlorite associated with ultrasonics and 50% citric acid. All specimens were filled using the warm gutta-percha vertical compaction technique, placed in test tubes containing India ink, and centrifuged at 30 G for five minutes; at that point, the dye penetration level was scored. Under the conditions of this study, the calcium hydroxide group showed significantly greater dye penetration than the non-medicated group.

A scanning electron microscopic evaluation of root canal wall cleanliness after calcium hydroxide removal using three irrigation regimens.

AIMS: The aims of this in vitro study were to evaluate debris and smear layer elimination capability effectiveness of 5.25% sodium hypochlorite (NaOCl) after calcium hydroxide removal from the root canal and to determine if ethylenediaminetetraacetic acid (EDTA) and citric acid have any additional effects on debris and smear layer removal. METHODS AND MATERIALS: All irrigation regimens are associated with ultrasonics. Thirty-six pulpless single-rooted teeth were divided into three groups on the basis of the irrigation regimen, namely 5.25% NaOCl alone, 5.25% NaOCl with 17% EDTA pH 7 (NaOCl-EDTA), and 5.25% NaOCl with 50% citric acid (NaOCl-CA). All root canals were instrumented with the Protaper rotary system (Dentsply-Maillefer, Ballaigues, Switzerland) using a crown-down approach. The apical foramen of each tooth was enlarged to a size 30 with a 0.09 taper. After longitudinal sectioning, the dentin walls were microphotographed using scanning electron microscopy (SEM) at a 1500x magnification. Using a grid and a 5-step scale these microphotographs were scored by three investigators in order to evaluate debris and smear layer residuals. Data were statistically evaluated using Kruskal-Wallis and Mann-Whitney tests. RESULTS: In the coronal third the lowest score obtained with NaOCl-CA was similar to NaOCl-EDTA. When using NaOCl-EDTA, mean debris scores were similar to the control group (NaOCl) and lower than NaOCl-CA in the middle and apical thirds. Regarding the mean smear layer score, NaOCl-CA was the lowest in the coronal, middle, and apical thirds with a statistically significant difference (p < 0.001). CONCLUSION: When the total surface of the root was evaluated, NaOCl-EDTA was superior in removing debris, but the association of NaOCl-CA enabled the most effective removal of the smear layer.