Effects of Er:YAG and Er,Cr:YSGG lasers on dentine hypersensitivity. Short-term clinical evaluation

Dentine hypersensitivity (DH) is a painful condition and is a clinical challenge due to the different treatment strategies available. High-intensity lasers have been studied as a possible option. The aim of this randomized, controlled, double-blind clinical study was to evaluate the effects of Er:YAG and Er,Cr:YSGG lasers on DH. The study group comprised 28 subjects who met the inclusion criteria. A visual analogue scale was used to quantify sensitivity before treatment as baseline, immediately before and immediately after treatment, and 1 week and 1 month after treatment. Teeth were assigned to four groups: group 1 control (no treatment), group 2 Er:YAG laser treatment (2 Hz/32.4 mJ/5.9 J/cm(2)), group 3 Er,Cr:YSGG laser treatment (0.25 W/4.4 J/cm(2)), and group 4 Er,Cr:YSGG laser treatment (0.50 W/ 8.9 J/cm(2)). Data were collected and submitted to statistical analysis for both evaporative (air) and mechanical (probe) stimulation. For both the air and probe stimulation no differences were observed between the pretreatment sensitivities. With the evaporative stimulus, the pain level immediately after treatment was reduced; however, after this the values remained stable. Irradiation with the Er:YAG laser was associated with the lowest level of pain. With the mechanical stimulus, group 4 showed the most pronounced decrease in pain immediately after treatment; however, by the end of the study, pain levels had increased. Groups 1, 2 and 3 showed a reduction in pain that was significantly different from that in group 4 after the 4 weeks of clinical follow up. Based on the results and within the limits of this study, it can be concluded that none of the laser treatments studied was capable of completely eliminating pain, but the Er:YAG and Er,Cr:YSGG lasers are suitable for the treatment of DH.

Shear strength of the bond to primary dentin: influence of Er:YAG laser irradiation distance

The aim of this study was to assess in vitro the influence of Er:YAG laser irradiation distance on the shear strength of the bond between an adhesive restorative system and primary dentin. A total of 60 crowns of primary molars were embedded in acrylic resin and mechanically ground to expose a flat dentin surface and were randomly assigned to six groups (n = 10). The control group was etched with 37% phosphoric acid. The remaining five groups were irradiated (80 mJ, 2 Hz) at different irradiation distances (11, 12, 16, 17 and 20 mm), followed by acid etching. An adhesive agent (Single Bond) was applied to the bonding sites, and resin cylinders (Filtek Z250) were prepared. The shear bond strength tests were performed in a universal testing machine (0.5 mm/min). Data were submitted to statistical analysis using one-way ANOVA and the Kruskal-Wallis test (p < 0.05). The mean shear bond strengths were: 7.32 +/- 3.83, 5.07 +/- 2.62, 6.49 +/- 1.64, 7.71 +/- 0.66, 7.33 +/- 0.02, and 9.65 +/- 2.41 MPa in the control group and the groups irradiated at 11, 12, 16, 17, and 20 mm, respectively. The differences between the bond strengths in groups II and IV and between the bond strengths in groups II and VI were statistically significant (p < 0.05). Increasing the laser irradiation distance resulted in increasing shear strength of the bond to primary dentin.

Effect of Er : YAG and diode laser irradiation on the root surface: Morphological and thermal analysis

Background: the aim of the present study was to compare the effects of Er:YAG and diode laser treatments of the root surface on intrapulpal temperature after scaling and root planing with hand instruments.Methods: Fifteen extracted single-rooted teeth were scaled and root planed with hand instruments. The teeth were divided into 3 groups of 5 each and irradiated on their buccal and lingual surfaces: group A: Er:YAG laser, 2.94 mum/100 mJ/10 Hz/ 30 seconds; group B: diode laser, 810 nm/1.0 W/0.05 ms/30 seconds; group C: diode laser, 810 nm/1.4 W/0.05 ms/30 seconds. The temperature was monitored by means of a type T thermocouple (copper-constantan) positioned in the pulp chamber to assess pulpal temperature during and before irradiation. Afterwards, the specimens were longitudinally sectioned, and the buccal and lingual surfaces of each root were analyzed by scanning electron microscopy.Results: In the Er:YAG laser group, the thermal analysis revealed an average temperature of -2.2 +/- 1.5degreesC, while in the diode laser groups, temperatures were 1.6 +/- 0.8degreesC at 1.0 W and 3.3 +/- 1.0degreesC at 1.4 W. Electronic micrographs revealed that there were no significant morphological changes, such as charring, melting, or fusion, in any group, although the specimens were found to be more irregular in the Er:YAG laser group.Conclusions: the application of Er:YAG and diode lasers at the utilized parameters did not induce high pulpal temperatures. Root surface irregularities were more pronounced after irradiation with an Er:YAG laser than with a diode laser.

Effect of Er,Cr:YSGG and Er:YAG laser irradiation on the adhesion of blood components on the root surface and on root morphology

The aim of this study was to conduct an in vitro evaluation, by scanning electron microscopy (SEM), of the adhesion of blood components on root surfaces irradiated with Er,Cr:YSGG (2.78 mu m) or Er:YAG (2.94 mu m) laser, and of the irradiation effects on root surface morphology. Sixty samples of human teeth were previously scaled with manual instruments and divided into three groups of 20 samples each: G1 (control group) - no treatment; G2 - Er,Cr:YSGG laser irradiation; G3 - Er:YAG laser irradiation. After performing these treatments, blood tissue was applied to 10 samples of each group, whereas 10 samples received no blood tissue application. After performing the laboratory treatments, the samples were observed under SEM, and the resulting photomicrographs were classified according to a blood component adhesion scoring system and root morphology. The results were analyzed statistically (Kruskall-Wallis and Mann Whitney tests, alpha = 5%). The root surfaces irradiated with Er:YAG and Er,Cr:YSGG lasers presented greater roughness than those in the control group. Regarding blood component adhesion, the results showed a lower degree of adhesion in G2 than in G1 and G3 (G1 x G2: p = 0.002; G3 x G2: p = 0.017). The Er:YAG and Er,Cr:YSGG laser treatments caused more extensive root surface changes. The Er:YAG laser treatment promoted a greater degree of blood component adhesion to root surfaces, compared to the Er,Cr:YSGG treatment.

Short-term clinical and immunologic effects of scaling and root planing with Er : YAG laser in chronic periodontitis

Background: Recently, the erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser has been used for periodontal therapy. This study compared Er:YAG laser irradiation (100 mJ/pulse, 10 Hz, 12.9 J/cm(2)) with or without conventional scaling and root planing (SRP) to SRP only for the treatment of periodontal pockets affected with chronic periodontitis.Methods: Twenty-one subjects with pockets from 5 to 9 mm in non-adjacent sites were studied. In a split-mouth design, each site was randomly allocated to a treatment group: SRP and laser (SRPL), laser only (L), SRP only (SRP), or no treatment (C). The plaque index (PI), gingival index (GI), bleeding on probing (BOP), and interleukin (IL)-1 beta levels in crevicular fluid were evaluated at baseline and at 12 and 30 days postoperatively, whereas probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were evaluated at baseline and 30 days after treatment. A statistical analysis was conducted (P<0.05).Results: Twelve days postoperatively, the PI decreased for SRPL and SRP groups (P<0.05); the GI increased for L, SRP, and C groups but decreased for the SRPL group (P<0.05); and BOP decreased for SRPL, L, and SRP groups (P<0.01). Thirty days postoperatively, BOP decreased for treated groups and was lower than the C group (P<0.05). PD decreased in treated groups (P<0.001), and differences were found between SRPL and C groups (P<0.05). CAL gain was significant only for the SRP group (P<0.01). GR increased for SRPL and L groups (P<0.05). No difference in IL-1 beta was detected among groups and periods.Conclusion: Er:YAG laser irradiation may be used as an adjunctive aid for the treatment of periodontal pockets, although a significant CAL gain was observed with SRP alone and not with laser treatment.

Apical Sealing Quality of In Vitro Apicectomy Procedures After Using Both Er:YAG and Nd:YAG

The aim of this study was to evaluate the apical sealing of dentinal tubules after root-end surface cutting by using Er:YAG and Nd:YAG lasers. After root-canal instrumentation and filling, apices of 50 extracted maxillary canine human teeth were resected by Er: YAG with 400 mJ, 10 Hz, for 30 sec. The samples were randomly assigned to five groups (n = 10): (GI) treated without root-end cavity, but with Nd: YAG (1.0W, 10 Hz, 20 sec) for dentinal tubules sealing; (GII) treated with root-end cavity without the use of Nd: YAG; (GIII) treated with root-end cavity and Nd: YAG application; (GIV) treated with root-end cavity made by Er: YAG with no focus and without Nd: YAG application; and (GV) treated without root-end cavity and without Nd: YAG application. The root-end cavities were performed by using Er: YAG at 300 mJ, 10 Hz, for 20 sec. Subsequently, all teeth were waterproofed and immersed in 2% methylene blue for 48 h in a vacuum environment. The samples were longitudinally sectioned, and microleakage was measured. ANOVA and the Fisher LSD test showed that GIV was less susceptible to microleakage than were the other groups (p < 0.05). Interestingly, the use of the Er: YAG with no focus showed superior dentinal tubule sealing in comparison with the other groups, even with or without root-end cavity and Nd: YAG application.

Bactericidal effects of two parameters of Er:YAG laser intracanal irradiation: ex-vivo study

The success of endodontic treatment depends on the complete elimination of microorganisms from the root canal system, thus the search for new procedures to eliminate them is justified. The aim of this study was to assess bacterial reduction after intracanal irradiation with the Er:YAG laser. The canals of 70 extracted human maxillary canines were prepared up to file #40 using 1% NaOCl, irrigated with 17% EDTA, and then washed with physiological solution activated by ultrasound. The roots were sterilized by autoclaving, inoculated with 10 mu l of a suspension containing 1.5 x 10(8) CFU/ml of Enterococcus faecalis ATCC 29212 and incubated at 37A degrees C for 72 h. The canals were irradiated with the Er:YAG laser using two energy settings: 60 mJ and 15 Hz, and 100 mJ and 10 Hz. The remaining bacteria were counted immediately and 48 h after laser irradiation. The results showed a high bacterial reduction at both time points. With 60 mJ and 15 Hz there was an immediate reduction of 99.73% and the reduction was 77.02% after 48 h, and with 100 mJ and 10 Hz there was an immediate reduction of 99.95% and the reduction was 84.52% after 48 h. Although the best results were observed with 100 mJ of energy, the difference between the two settings was not statistically significant. The count performed 48 h after irradiation showed that E. faecalis were able to survive, and can grow even from small numbers.

Fluoride uptake and acid resistance of enamel irradiated with Er : YAG laser

This study evaluated the resistance to demineralization and fluoride incorporation of enamel irradiated with Er:YAG. A total of 110 bovine teeth were selected and divided into eight groups: unlased, 37% phosphoric acid, and samples irradiated with the Er:YAG laser at several fluences (31.84 J/cm(2), 25.47 J/cm(2), 19.10 J/cm(2), 2.08 J/cm(2), 1.8 J/cm(2), and 0.9 J/cm(2)). The application of acidulated phosphate fluoride was performed after treatments. All samples were immersed in 2 ml of 2.0 M acetic-acetate acid solution at pH 4.5 for 8 h, and fluoride, calcium, and phosphorus ions dissolved were analyzed by atomic absorption spectrometry and spectrophotometry. The phosphoric acid and 31.84 J/cm(2) groups presented the lowest dissolution of calcium and phosphorus ions. Higher fluoride incorporation was observed on 1.8 J/cm(2) and 0.9 J/cm(2) groups. Based on these results, Er:YAG laser was able to decrease acid dissolution and increase fluoride uptake and can be a promissory alternative for preventive dentistry.

Pulpal temperature increases with Er : YAG laser and high-speed handpieces

Statement of problem. During tooth preparation, both high-speed handpieces and lasers generate heat, which, if not controlled, can cause pulpal necrosis.Purpose. The aim of this study was to compare temperature increases produced by a high-speed dental handpiece with those produced by a relatively new instrument, the Er:YAG (erbium: yttrium-aluminum-garnet) laser.Material and methods. Thirty bovine mandibular incisors were reduced to an enamel/dentin thickness of 2.5 mm. Class V preparations were completed to a depth of 2.0 mm, measured with a caliper or by a mark oil the burs. A thermocouple was placed inside the pulp chamber to determine temperature increases (degreesC). Analysis was performed on the following groups (n = 10): Group 1, high-speed handpiece without water cooling, Group 11, high-speed handpiece with water cooling (30 mL/min), and Group III, the noncontact Er:YAG laser (2.94 mum at 350 mJ/10 Hz) with water cooling (4.5 mL/min). The temperature increases were recorded by a computer linked to the thermocouples. The data were analyzed using the Kruskal-Wallis test. The Dunn multiple comparison test was used as post hoc test (alpha = .05).Results. The average temperature rises were: 11.64degreesC (+/-4.35) for Group 1, 0.96degreesC (+/-0.71) for Group 11, and 2.69degreesC (+/-1.12) for Group III. There were no statistical differences between Groups 11 and III, both 11 and III differed from Group I significantly (P = .000 and P = .002, respectively).Conclusion. The preparations made with the high-speed and the laser instrument generated similar heat increases under water cooling. Water cooling was essential to avoid destructive temperature increases when using both the high-speed handpiece and laser.

Comparative ablation rate from a Er : YAG laser on enamel and dentin of primary and permanent teeth

This study was conducted to analyze the ablation rate and micromorphological aspects of microcavities in enamel and dentin of primary and permanent teeth using a Er:YAG laser system. Micromorphological evaluation has been performed in terms of permanent teeth; however, little information about Er: YAG laser interaction with primary teeth can be found in the literature. Because children have been the most beneficiary patients with laser therapy in our offices, it is extremely necessary to compare the effects of this kind of laser system on the enamel and dentin of permanent and primary teeth. In this study, we used eleven intact primary anterior exfoliated teeth and six extracted permanent molar teeth. We used a commercial laser system: a Er: YAG Twin Light laser system (Fotona Medical Lasers, Slovenia) at 2940 nm, changing average energy levels per pulse ( 100, 200, 300, and 400 mJ) producing 48 microcavities in enamel and dentin of primary and permanent teeth. Primary teeth are more easily ablated than are permanent teeth, when related to enamel or dentin. However, while this laser system is capable of slowly revealing the enamel's microstructure, in dentin only the lowest laser energies permit this kind of observation, more easily decomposing the original tissue aspect, when related to primary or permanent teeth. Statistically, the only different factor at the 5% level was an energy per pulse of 400 mJ, confirming the results found in SEM. Our results showed that dentin in both primary and permanent teeth is less resistant to Er: YAG laser ablation; this fact is easily observed under SEM observation and through the ablation rate evaluation.

Caries resistance of lased human enamel with Er : YAG laser - morphological and ratio Ca/P analysis

Objective: In vitro analysis of caries resistance of dental enamel under caries simulation after irradiation with Er:YAG laser. Background Data: More susceptible to caries development spots at adjacent hard tissues from cavity preparations of dental tissues using burrs or lasers are quite common. Methods: Thirteen caries-free third permanent human molars were distributed as follows: G1: sound control and caries control; G2: Er:YAG 100, 200, 300, or 400 mJ/ 10 Hz/ 3 sec.; G3: the same parameters of G2 followed by artificial caries simulation, through dynamic model of demineralization and remineralization (DE/RE). Caries resistance analysis was evaluated through scanning electron microscopy (SEM) and Ca/P rate (X-Rays spectroscopy - EDX). Results: Photomicrographs showed that the Er:YAG laser created craters with rough aspect which became more evident as the energy per pulse was increased, but without change of regular morphology of enamel prisms. Significant statistical changes among the irradiated and control groups was observed considering the Ca/P ratio. Conclusion: Irradiated groups showed higher caries resistance than control groups. However, it is not possible to affirm that the enamel surface accidental irradiation could be a benefit to caries resistance for other situations can be considered, as biofilm deposit, which could increase the caries susceptibility.

Influence of CVD diamond tips and Er:YAG laser irradiation on bonding of different adhesive systems to dentin

Aim: The aim of this study was to compare the microtensile bond strength of three adhesive systems, using different methods of dentin preparation. Materials and methods: A hundred and eight bovine teeth were used. The dentin from buccal face was exposed and prepared with three different methods, divided in 3 groups: Group 1 (DT)- diamond tip on a high-speed handpiece; Group 2 (CVD)-CVD tip on a ultrasonic handpiece; Group 3 (LA)-Er: YAG laser. The teeth were divided into 3 subgroups, according adhesive systems used: Subgroup 1-Adper Single Bond Plus/3M ESPE (SB) total-etch adhesive; Subgroup 2-Adper Scotchbond SE/3M ESPE (AS) selfetching adhesive; Subgroup 3-Clearfil SE Bond/Kuraray (CS) selfetching adhesive. Blocks of composite (Filtek Z250-3M ESPE) 4 mm high were built up and specimens were stored in deionized water for 24 hours at 37°C. Serial mesiodistal and buccolingual cuts were made and stick-like specimens were obtained, with transversal section of 1.0 mm2. The samples were submitted to microtensile test at 1 mm/min and load of 10 kg in a universal testing machine. Data (MPa) were subjected to ANOVA and Tukey's tests (p < 0.05). Results and conclusion: Surface treatment with Diamond or CVD tips associated with Clearfil SE Bond adhesive produced significantly lower bond strength values compared to other groups. Surface treatment with Er: YAG laser associated with Single Bond Plus or Clearfil SE Bond adhesives and surface treatment with CVD tip associated with Adper Scotchbond SE adhesive produced significantly lower bond strength values compared to surface treatment with diamond or CVD tips associated with Single Bond Plus or Adper Scotchbond SE adhesives. Clinical significance: Interactions between laser and the CVD tip technologies and the different adhesive systems can produce a satisfactory bonding strength result, so that these associations may be beneficial and enhance the clinical outcomes.

Resistência de união de um sistema adesivo irradiado com laser Nd:YAG em dentina tratada com laser de Er:YAG

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Resistência adesiva de reparos em resina composta: tratamento da superfície com ponta diamantada, jato de óxido de alumínio e laser de Er:YAG

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação in vitro da resistência de união em dentina irradiada com o laser de Er:Yag, mediante a aplicação de diferentes sistemas adesivos

Pós-graduação em Ciências Odontológicas - FOAR