Thermal effects and morphological aspects of human dentin surface irradiated with different frequencies of Er:YAG laser

This study reports the effects on micromorphology and temperature rise in human dentin using different frequencies of Er:YAG laser. Sixty human dentin fragments were randomly assigned into two groups (n = 30): carious or sound dentin. Both groups were divided into three subgroups (n = 10), according to the Er:YAG laser frequency used: 4, 6, or 10 Hz (energy: 200 mJ; irradiation distance: 12 mm; and irradiation time: 20 s). A thermocouple adapted to the tooth fragment recorded the initial temperature value (°C); then, the temperature was measured after the end of the irradiation (20 s). Morphological analysis was performed using images obtained with scanning electron microscope. There was no difference between the temperatures obtained with 4 and 6 Hz; the highest temperatures were achieved with 10 Hz. No difference was observed between carious and sound dentin. Morphological analyses revealed that all frequencies promoted irregular surface in sound dentin, being observed more selectively ablation especially in intertubular dentin with tubule protrusion. The caries dentin presented flat surface for all frequencies used. Both substrates revealed absence of any signs of thermal damage. It may be concluded that the parameters used in this study are capable to remove caries lesion, having acceptable limits of temperature rise and no significant morphological alterations on dentin surface. Microsc. Res. Tech. 2012. © 2012 Wiley Periodicals, Inc.     

Morphological and chemical changes in human deciduous dentin after phosphoric acid,self‐etching adhesive and Er: YAG laser conditioning

The morphological and chemical changes in deciduous dentin produced by different conditioning protocols were evaluated in this in vitro study. Eighty primary dentin samples were divided into eight groups (n = 10): G1, acid etching; G2, self‐etching adhesive; G3, G4, Er: YAG laser irradiation at 25.5 and 38.2 J cm^?2, respectively; 10 Hz and spray irrigation. Groups 5, 6, 7, and 8 were irradiated at previous densities, and then phosphoric acid or self‐etching adhesive conditioning was applied. Scanning electron microscopy (SEM) and energy dispersive X‐ray spectroscopy (EDS) were used to evaluate chemical and morphological changes. Paired t‐test and One‐way ANOVA were used for statistical analysis (p ≤ 0.05). All samples showed different morphology with specific characteristics according to the conditioning protocol. Changing element concentration values are expressed in atomic percent (at %). After conditioning, there were statistically significant differences (p ≤ 0.05) for p at% and Ca/P in all groups; highlighting the following additional findings by group: G1, G7, and G8 showed changes in all elements studied, G2 presented a decrease in C at% and increased Ca at%, G3 and G4 exhibited at% changes in C, trace elements and Ca. Furthermore, G5 showed at% changes in O and trace elements; while G6 changes were observed on C at%, O at% and trace elements at%. Dentin morphology and chemical composition varied in accordance with the conditioning protocol, with characteristics specific for each one that could have clinical implications for the retention and bond strength performance of adhesive materials.     

Morphological changes produced by acid dissolution in Er:YAG laser irradiated dental enamel

Several scientific reports have shown the effects of Er:YAG laser irradiation on enamel morphology. However, there is lack of information regarding the morphological alterations produced by the acid attack on the irradiated surfaces. The aim of this study was to evaluate the morphological changes produced by acid dissolution in Er:YAG laser irradiated dental enamel. Forty‐eight enamel samples were divided into four groups (n = 12). GI (control); Groups II, III, and IV were irradiated with Er:YAG at 100 mJ (12.7 J/cm²), 200 mJ (25.5 J/cm²), and 300 mJ (38.2 J/cm²), respectively, at 10 Hz without water irrigation. Enamel morphology was evaluated before‐irradiation, after‐irradiation, and after‐acid dissolution, by scanning electron microscopy (SEM). Sample coating was avoided and SEM analysis was performed in a low‐vacuum mode. To facilitate the location of the assessment area, a reference point was marked. Morphological changes produced by acid dissolution of irradiated enamel were observed, specifically on laser‐induced undesired effects. These morphological changes were from mild to severe, depending on the presence of after‐irradiation undesired effects. Microsc. Res. Tech. 77:410–414, 2014. © 2014 Wiley Periodicals, Inc.     

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^TM and the Axion Vision^TM software. Qualitative analysis was performed by Scanning electron microscope (SEM) and light microscope (LM). Data were analyzed by ANOVA and Fishers' tests. The DIAGNOdent^TM 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^TM 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. Microsc. Res. Tech., 2010. © 2010 Wiley‐Liss, Inc.     

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.     

Analysis of the interfacial micromorphology of adhesive systems in cavities prepared with Er,Cr:YSGG, Er:YAG laser and bur

The purpose of this in vitro study was to evaluate the interaction pattern of adhesive systems on laser and bur cavities. Cavities were prepared according to the following groups (n=9): (G1) conventional diamond bur (No. 1013); (G2) Er:YAG laser (250 mJ, 4 Hz, 80.6 J/cm2); (G3) Er,Cr:YSGG laser (3.5 W, 20 Hz, 61.7 J/cm2). After cavity preparation, specimens were divided into three subgroups differing the adhesive systems used (n=3): (GA) AdheSE; (GB) Clearfil standard error (SE) Bond; (GC) Single Bond. After insertion of a micro-hybrid composite resin, the specimens were sectioned across the bonded surface dividing the teeth into two halves, which were prepared for SEM analysis. Cavities prepared with laser appeared to be more irregular than the bur cavities. Different patterns of gap formation and resin tags could be observed, showing the differences, advantages, and disadvantages of both types of cavities. Under the settings of the present study, resin tags were more pronounced in lased dentin than bur prepared dentin independently of the bonding systems used. On the other hand gap formation between dentin and resin in laser prepared cavities was observed suggesting collagen alteration.     

Thermal alteration and morphological changes of sound and demineralized primary dentin after Er:YAG laser ablation

The purpose of this study was to assess the influence of Er:YAG laser pulse repetition rate on the thermal alterations occurring during laser ablation of sound and demineralized primary dentin. The morphological changes at the lased areas were examined by scanning electronic microscopy (SEM). To this end, 60 fragments of 30 sound primary molars were selected and randomly assigned to two groups (n = 30); namely A sound dentin (control) and B demineralized dentin. Each group was divided into three subgroups (n = 10) according to the employed laser frequencies: I-4 Hz; II-6 Hz, and III-10 Hz. Specimens in group B were submitted to a pH-cycling regimen for 21 consecutive days. The irradiation was performed with a 250 mJ pulse energy in the noncontact and focused mode, in the presence of a fine water mist at 1.5 mL/min, for 15 s. The measured temperature was recorded by type K thermocouples adapted to the dentin wall relative to the pulp chamber. Three samples of each group were analyzed by SEM. The data were submitted to the nonparametric Kruskal-Wallis test and to qualitative SEM analysis. The results revealed that the temperature increase did not promote any damage to the dental structure. Data analysis demonstrated that in group A, there was a statistically significant difference among all the subgroups and the temperature rise was directly proportional to the increase in frequency. In group B, there was no difference between subgroup I and II in terms of temperature. The superficial dentin observed by SEM displayed irregularities that augmented with rising frequency, both in sound and demineralized tissues. In conclusion, temperature rise and morphological alterations are directly related to frequency increment in both demineralized and sound dentin.     

Effects of Er:YAG laser on bond strength of self‐etching adhesives to caries‐affected dentin

The erbium:yttrium–aluminum–garnet (Er:YAG) laser may be effective the bond strength of adhesive systems on dentine surfaces, the chemical composition and aggressiveness of adhesive systems in clinical practice. The purpose of this study was to evaluate the effects of the Er:YAG laser system with the bonding ability of two different self‐etching adhesives to caries‐affected dentine in primary molars. Ninety mid‐coronal flat dentine surfaces obtained from sound and caries‐affected human primary dentine were treated with an Er:YAG laser or a bur. The prepared surfaces were restored with an adhesive system (Xeno V; Clearfil S³) and a compomer (Dyract Extra). The restored teeth were sectioned with a low‐speed saw and 162 samples were obtained. The bond strength of the adhesive systems was tested using the micro‐tensile test method. The data were statistically analyzed. A restored tooth in each group was processed for scanning electron microscopy evaluation. The values of the highest bond strength were obtained from the Clearfil S³‐Er:YAG laser‐sound dentine group in all groups. (24.57 ± 7.27 MPa) (P > 0.05). The values of the lowest bond strength were obtained from the Xeno V‐Er:YAG laser‐sound dentine group in all groups (11.01 ± 3.89 MPa). It was determined that the Clearfil S³ increased the bond strength on the surface applied with Er:YAG laser according to the Xeno V. Microsc. Res. Tech. 77:282–288, 2014. © 2014 Wiley Periodicals, Inc.     

Effects of Er,Cr:YSGG laser parameters on dentin bond strength and interface morphology

Previous studies have shown the effects of Er,Cr:YSGG laser irradiation on the dentin bond strength; but there are few reports that show the significance of the irradiation with different laser parameters on dentin bond strength and interface morphology. This in‐vitro study attempted to evaluate the microtensile bond strength (μTBS) and interface morphology of resin‐dentin interfaces, either followed by treatment with Er,Cr:YSGG laser irradiation with different parameters or not. The flattened dentin samples of 35 bovine teeth were embedded into acrylic blocks and randomly divided into seven groups according to surface treatments using Er,Cr:YSGG lasers with different parameters: 3 W/20 Hz, 3 W/35 Hz, 3 W/50 Hz, 1.5 W/20 Hz, 1.5 W/35 Hz, 1.5 W/50 Hz, or no laser treatment (n = 5). Composite buildups were done over bonded surfaces and stored in water (24 hours at 37°C). Specimens were sectioned into sticks that were subjected to μTBS testing and observed under FE‐SEM. Control groups (27.70 ± 7.0) showed statistically higher values than laser‐irradiated groups. There were no significant differences among laser groups. Despite that, increasing the pulse frequency yielded slightly higher bond strength. Depending on laser settings, Er,Cr:YSGG laser irradiation caused interfacial gaps and resin tags with wings morphology. With the parameters used in this study, Er,Cr:YSGG laser irradiation promoted morphological changes within resin‐dentin interfaces and negatively influenced the bond strength of adhesive systems. Microsc. Res. Tech. 78:1104–1111, 2015. © 2015 Wiley Periodicals, Inc.     

Microtensile strength of resin cement bond to indirect composite treated by different output powers of Er:YAG laser

The study aimed to evaluate the effect of different output powers of Er:YAG laser on microtensile bonding strength of indirect composite to resin cements.36 indirect composite blocks (GC Gradia DA2, Japan) size 15 × 10 × 10 mm³ were constructed, and divided into 12 groups, as follows:G1: control group (no treatment); Groups G2 to G6: treated with Er:YAG laser (2,940 nm) in noncontact mode, frequency 20 Hz, pulse duration 470 µs, with output power ranging from 2W to 6W; Groups G7 sandblasting, Groups 8 to G12: as Groups G2 to G 6 with preparatory sandblasting. One specimen from each group was analyzed by SEM; each specimen was fixed to a specialized metal jig using cyanoacrylate (Mitreapel, Beta Kimya San. Ve TIC, Iran) and debonded under tension with a universal testing machine (Zwick, Germany) at a crosshead speed of 0.5 mm min^?1. Sandblasting and laser can improve bond strength above an energy level of 150 mJ. SEM evaluation of laser‐treated specimens showed irregularities and deep undercuts. T test analysis showed no significant difference between sandblasted and non‐sandblasted group, with laser output power of 0, 100, or 150 mJ (P = 0.666, P = 0.875, and P = 0.069); in the specimens irradiated with energy output of 200, 250, or 300 mJ, sandblasted specimens showed higher bond strength than non‐sandblasted ones. The results demonstrate that, in composite resin irradiated with laser at energy output of 200–300 mJ, sandblasting might be a suitable procedure to enhance bond strength of resin cement. Microsc. Res. Tech. 79:328–333, 2016. © 2016 Wiley Periodicals, Inc.     

The use of an Er:YAG laser to remove demineralized dentin and its influence on dentin permeability

The purpose of this study was to analyze, correlate, and compare the demineralization and permeability of dentin remaining after caries removal with either an Er:YAG laser, a bur, or a curette. Thirty human dentin fragments were immersed in a demineralizing solution for 20 days and were randomly divided into three groups (n = 10) for the removal of the demineralized lesion. The groups were G1—Er:YAG laser (200 mJ/6 Hz; noncontact at 12 mm; spot: 0.63 mm), G2—Bur, and G3—Curette. The specimens were then immersed in a 10% copper sulfate solution, then in a 1% dithiooxamide alcoholic solution for 30 min and kept in ammonia vapor for 7 days. Next, the specimens were examined with optical microscopy. The amount of demineralized dentin and the level of copper ion infiltration in the dentin were quantified in μm using Axion Vision software. Data were analyzed with the Kruskal‐Wallis test (p < 0.05) and Pearson's Correlation test. The analysis revealed no significant differences between the three caries removal methods in terms of their capacity to remove demineralized tissue (G1: 10.6 μm; G2: 8.4 μm; G3: 11 μm), although the laser removal generated more tissue permeability than the others methods (G1: 17.6 μm; G2: 6.6 μm; G3: 5.5 μm). The correlation between the remaining demineralized dentin and the dentin permeability was moderate for the conventional methods and higher for the Er:YAG laser. It can therefore be concluded that the laser produced an increase in permeability that was directly proportional to the amount of demineralized tissue removal. Microsc. Res. Tech. 76:225–230, 2013. © 2012 Wiley Periodicals, Inc.     

Microhardness and SEM after CO2 laser irradiation or fluoride treatment in human and bovine enamel

Background: It remains uncertain as to whether or not CO₂ laser is able to hinder demineralization of enamel. The possibility to use bovine instead of human teeth on anticariogenic studies with laser has not yet been determined. Purpose: To compare the ability of CO₂ laser and fluoride to inhibit caries‐like lesions in human enamel and to test whether a similar pattern of response would hold for bovine enamel. Study Design: Ninety‐six enamel slabs (2 × 2 × 4 mm) (48 from bovine and 48 from human teeth) were randomly distributed according to surface treatment (n = 12): CO₂ laser, 5% sodium fluoride varnish (FV), 1.23% acidulated phosphate fluoride (APF) gel, or no treatment (control). Specimens were subjected to a 14‐day in vitro cariogenic challenge. Microhardness (SMH) was measured at 30 μm from the surface. For ultrastructural analysis, additional 20 slabs of each substrate (n = 5) received the same treatment described earlier and were analyzed by SEM. Results: ANOVA and Tukey test ascertained that CO₂ laser promoted the least mineral loss (SMH = 252^a). Treatment with FV resulted in the second highest values (207^b), which was followed by APF (172^c). Untreated specimens performed the worst (154^d). SEM showed no qualitative difference between human and bovine teeth. APF and control groups exhibited surfaces covered by the smear layer. A granulate precipitate were verified on FV group and fusion of enamel crystals were observed on lased‐specimens. Conclusions: CO₂ laser may control caries progression more efficiently than fluoride sources and bovine teeth may be a suitable substitute for human teeth in studies of this nature. Microsc. Res. Tech. 73:1030–1035, 2010. © 2010 Wiley‐Liss, Inc.     

Caries removal with Er:YAG laser followed by dentin biomodification with carbodiimide and chitosan: Wettability and surface morphology analysis

This study aimed to investigate dentin wettability and surface morphology after selective removal of carious lesion by erbium‐doped yttrium aluminum garnet (Er:YAG) laser, followed by dentin biomodification with carbodiimide (EDC) and chitosan (CHI). Seventy‐eight bovine dentin specimens were submitted to caries induction. Specimens were distributed according to methods of carious removal (n = 39): bur at low‐speed (40,000 rpm) or Er:YAG laser (noncontact mode, 250 mJ/pulse and 4Hz). All specimens were etched with 35% phosphoric acid, and subdivided according to dentin biomodification (n = 13): Control (no biomodification), EDC or CHI. The contact angle (n = 10) between adhesive system (3M ESPE) and dentin surface was measured by a goniometer. Eighteen specimens (n = 3) were analyzed by scanning electron microscopy. Data were analyzed by two‐way ANOVA and Tukey's test (α = .05). The method used to remove carious lesion did not influence the wettability of dentinal surface (p = .748). The angles produced on the remaining dentin after biomodification were influenced (p = .007). CHI promoted higher contact angles (p = .007) and EDC did not differ from the control group (p = .586). In the bur‐treated group, most tubules were open, regardless of which biomodifier was used. Laser modified the organic matrix layer. CHI promoted partially closed tubules in some areas while EDC exposed dentinal tubules. Regardless of which method was used for selective removal of carious lesion, biomodification with EDC did not affect the dentin wettability, whereas CHI changed the wettability of remaining dentin. Both biomodifiers promoted a slight change on dentin morphology.     

Evaluation of fibroblast attachment in root conditioning with Er,Cr:YSGG laser versus EDTA: A SEM study

The regeneration of periodontal support is a main concern in periodontal therapy. This study aims to investigate the efficacy of Er, Cr:YSGG laser and EDTA based conditioning in attachment of fibroblast on root surfaces. This in vitro study was conducted on 81 root plates (6 mm × 4 mm × 1 mm) prepared from 27 single‐rooted human mature teeth. The samples were divided into three groups: (1) Er, Cr: YSGG laser conditioning with a G6 tip (2.78 µm, 0.75 W, pulse duration of 140 µs, repetition rate of 20 Hz) for 5–7 s; (2) EDTA conditioning (17%, pH: 8) for 1 min; and (3) the control group which were exposed neither to EDTA nor laser. The viability and proliferation rates assessments were performed using MTT assay on days 3 and 5. In addition, the level of cell attachment was studied using scanning electron microscopy. The data indicated Er, Cr:YSGG conditioning increased cell viability by lapse of time (from days 3–5), with significantly better cell attachment compared to the other groups on days 3 and 5 (P < 0.05). In addition, increasing cell attachment in the EDTA conditioning group compared with the control group was statistically significant on day 5 but not on day 3 (P < 0.05). In conclusion, Er, Cr:YSGG laser conditioning can promote enhance fibroblast attachment on dentinal root surfaces more than EDTA. Microsc. Res. Tech. 78:317–322, 2015. © 2015 Wiley Periodicals, Inc.