Sub-ablative Er,Cr:YSGG laser irradiation under all-ceramic restorations: effects on demineralization and shear bond strength.

This study evaluated the caries resistant effects of sub-ablative Er,Cr:YSGG laser irradiation alone and combined with fluoride in comparison with fluoride application alone on enamel prepared for veneer restorations. And also, evaluated these treatments' effects on the shear bond strength of all-ceramic veneer restorations. One hundred and thirty-five human maxillary central teeth were assigned to groups of 1a-control, 1b-laser treated, 1c-fluoride treated, 1d-laser + fluoride treated for shear bond testing and to groups of 2a-positive control(non-demineralised), 2b-laser treated, 2c-fluoride treated, 2d-laser + fluoride treated, 2e-negative control (demineralised) for microhardness testing (n = 15, N = 135). Demineralisation solutions of microhardness measurements were used for the ICP-OES elemental analysis. The parameters for laser irradiation were as follows: power output, 0.25 W; total energy density, 62.5 J/cm2 and energy density per pulse, 4.48 J/cm2 with an irradiation time of 20 s and with no water cooling. Five percent NaF varnish was used as fluoride preparate. ANOVA and Tukey HSD tests were performed (α = 5%). Surface treatments showed no significant effects on shear bond strength values (p = 0.579). However, significant differences were found in microhardness measurements and in elemental analysis of Ca and P amounts (p < 0.01). Surface-treated groups showed significantly high VNH values and significantly low ICP-OES values when compared with non-treated (-control) group while there were no significance among surface-treated groups regarding VHN and ICP-OES values. Sub-ablative Er,Cr:YSGG treatment alone or combined with fluoride is as an effective method as at least fluoride alone for preventing the prepared enamel to demineralization with no negative effect on shear bond strength.

Near-IR image-guided laser ablation of demineralization on tooth occlusal surfaces.

INTRODUCTION: Studies have shown that reflectance images at near-IR wavelengths coincident with higher water absorption are well-suited for image-guided laser ablation of carious lesions since the contrast between sound and demineralized enamel is extremely high and interference from stains is minimized. The objective of this study was to demonstrate that near-IR reflectance images taken at a wavelength range of 1,500-1,700 nm can be used to guide a 9.3 µm CO(2) laser for the selective ablation of early demineralization on tooth occlusal surfaces. METHODS: The occlusal surfaces of ten sound human molars were used in this in vitro study. Shallow simulated caries lesions with random patterns and varying depth and position were produced on tooth occlusal surfaces. Sequential near-IR reflectance images at 1,500-1,700 nm were used to guide the laser for the selective removal of the demineralized enamel. Digital microscopy and polarization sensitive optical coherence tomography (PS-OCT) were used to assess selectivity. RESULTS: Images taken before and after lesion removal suggest that the demineralized areas were removed with high selectivity. Although the estimated volume of tissue ablated was typically higher than the initial lesion volume measured with PS-OCT, the volume of enamel removed by the laser correlated well with the initial lesion volume. CONCLUSION: Sequential near-IR reflectance images at 1,500-1,700 nm can be used to guide a 9.3 µm CO(2) laser for the selective ablation of early demineralization on tooth occlusal surfaces.

CO2 laser-irradiation through topically applied fluoride increases acid resistance of demineralised human enamel in vitro.

PURPOSE: To evaluate the effect of CO2 laser treatment through topically applied amine fluoride solution on demineralised enamel. MATERIALS AND METHODS: Sixty extracted human molar crowns were selected and cut longitudinally into half. One half was subjected to a 10-day pH-cycling procedure to create caries-like lesions, whereas the other was left non-demineralised. The following treatments were randomly assigned (one treatment per tooth, on respective non-demineralised and demineralised matched specimens): exposure to a 1% amine fluoride solution for 15 s without irradiation (group I), irradiation for 15 s with a continuous-wave CO2 laser (group II), or laser-treatment for 15 s through the amine fluoride solution applied immediately beforehand (group III). Fluoride uptake (n = 30) and acid resistance (n = 30) were determined after treatment. Enamel surface alterations after laser irradiation were monitored using scanning electron microscopy. RESULTS: In groups I and III, an increased fluoride uptake was detected (p < or = 0.05). Laser irradiation through topical fluoride resulted in an increased acid resistance of sound and demineralised enamel specimens in deeper layers (p < or = 0.05). In addition, less surface alterations were observed in SEM examination of specimens irradiated through the amine fluoride solution compared with counterparts treated with laser only. CONCLUSIONS: CO2 laser light application through an amine fluoride solution may be instrumental in enhancing acid resistance of sound and demineralised enamel.

Evaluation of spontaneous space closure and development of permanent dentition after extraction of hypomineralized permanent first molars.

AIM: The aim of this study was to evaluate spontaneous space closure, development of the permanent dentition, and need for orthodontic treatment after extraction of permanent first molars due to severe molar-incisor hypomineralization (MIH). SUBJECTS: Twenty-seven children aged 5.6-12.7 (median 8.2) years had one to four permanent first molars extracted due to severe MIH. Each case was followed up on individual indications 3.8-8.3 (median 5.7) years after extractions. The eruption of the permanent dentition, and space closure were documented by orthopantomograms, casts, photographs, and/or bitewings. RESULTS: Fifteen children were judged to have a favourable spontaneous development of their permanent dentition without any orthodontic intervention. Seven children were or should be subjected to orthodontic treatment for other reasons registered prior to the extraction. Five children were judged to have a treatment at least caused by the extractions, but three of them abstained because of no subjective treatment need. CONCLUSION: Extraction of permanent first molars severely affected by MIH is a good treatment alternative. Favourable spontaneous space reduction and development of the permanent dentition positioning can be expected without any intervention in the majority of cases extracted prior to the eruption of the second molar.

Extraction of first permanent molar teeth: results from three dental hospitals.

OBJECTIVE: To evaluate and compare the reasons for and pattern of extraction of first permanent molars (FPMs) in three UK dental hospitals. DESIGN: Prospective multicentre study. SETTING: Hospital. SUBJECTS: Three hundred children attending Manchester Dental Hospital, Liverpool Dental Hospital and Charles Clifford Dental Hospital (Sheffield) who required extraction of at least one FPM. RESULT: The mean age in months was 129 (SD 22.7), 139 (SD 29.4), and 133 (SD 26.8) for Manchester, Liverpool and Sheffield respectively. Forty-five percent and 48% of children had four FPMs extracted at Manchester and Sheffield respectively, compared to 25% in Liverpool. The main reason for extraction was caries with poor prognosis (70%); molar incisor hypomineralisation was the reason for extraction in 11% of cases. General anaesthesia was the main anaesthetic method used in 77%, 55%, and 47% of cases in Manchester, Liverpool and Sheffield respectively. Sixty-eight percent of cases had not received previous treatment for the FPMs and 5% had fissure sealants detected. Forty percent of children had had previous extractions. CONCLUSION: The children who are attending the hospitals for extraction of FPMs tend to be older than the recommended age for achieving spontaneous space closure. This study highlights the need for extensive prevention programs targeted at those children with high caries risk.

Effect of Er:YAG laser treatment on the microstructure of the dentin/adhesive interface after acid-base challenge.

PURPOSE: The aim of this study was to evaluate the effect of Er:YAG laser ablation on the microstructure of the dentin/adhesive interface after acid-base challenge in vitro. MATERIALS AND METHODS: Thirty-two extracted third molars were used. One pair of disk-shaped specimens was obtained from the midcoronal dentin of each tooth. One surface in each pair was subjected to Er:YAG laser irradiation, while the other was ground using 600-grit SiC abrasive paper. The specimens were assigned to 4 groups with 8 pairs in each group. A self-etching primer (Clearfil SE-Bond), a bonding adhesive (Clearfil SE-Bond), and a photocuring composite (Clearfil AP-X) were applied accordingto manufacturer's instructionsto create dentin-resin "sandwiches" of each pair, except in group IV, where no primer was applied. The specimens were stored in demineralizing solution for 20 min in groups I and IV, 60 min in group II, and 120 min in group III. After immersion in 5% NaOCl, all the specimens were polished and argon-ion etched. Finally, the interfaces between the dentin and bonding agent were observed under a scanning electron microscope. RESULTS: All specimens in groups I to III showed an acid-base resistant zone, except those of group IV, which debonded completely. A statistically significant difference was found in the thickness of the acid-base resistant zone between group I vs groups II and III for both abraded and Er:YAG-irradiated surfaces. There was no statistically significant difference in the thickness of the acid-base resistant zone between groups II and III for both conventionally prepared and Er:YAG-irradiated surfaces. CONCLUSION: The existence of an acid-base resistant zone followingthe application of the SE Bond system on both abraded and Er:YAG-lased human dentin, regardless of the acid-base challenge duration, was confirmed.