Comparison between laser-induced photoemissions and phototransmission of hard tissues using fibre-coupled Nd:YAG and Er3+-doped fibre lasers

During pulsed laser irradiation of dental enamel, laser-induced photoemissions result from the laser-tissue interaction through mechanisms including fluorescence and plasma formation. Fluorescence induced by non-ablative laser light interaction has been used in tissue diagnosis, but the photoemission signal accompanying higher power ablative processes may also be used to provide real-time monitoring of the laser-tissue interaction. The spectral characteristics of the photoemission signals from normal and carious tooth enamel induced by two different pulsed lasers were examined. The radiation sources compared were a high-power extra-long Q-switched Nd:YAG laser operating at a wavelength of 1,066 nm giving pulses (with pulse durations in the range 200-250 μs) in the near infrared and a free-running Er(3+)-doped ZBLAN fibre laser operating at a wavelength near 3 μm with similar pulse durations in the mid-infrared region. The photoemission spectra produced during pulsed laser irradiation of enamel samples were recorded using a high-resolution spectrometer with a CCD array detector that enabled an optical resolution as high as 0.02 nm (FWHM). The spectral and time-dependence of the laser-induced photoemission due to thermal emission and plasma formation were detected during pulsed laser irradiation of hard tissues and were used to distinguish between normal and carious teeth. The use of these effects to distinguish between hard and soft biological tissues during photothermal ablation with a pulsed Nd:YAG laser or an Er fibre laser appears feasible. The real-time spectrally resolved phototransmission spectrum produced during pulsed Nd:YAG laser irradiation of human tooth enamel samples was recorded, with a (normalized) relative transmission coefficient of 1 (100%) for normal teeth and 0.6 (60%) for the carious teeth. The photoemission signal accompanying ablative events may also be used to provide real-time monitoring of the laser-tissue interaction.     

Early differentiation between caries and tooth demineralization using laser-induced autofluorescence spectroscopy

BACKGROUND AND OBJECTIVES: The intrinsic fluorescence of carious human teeth, of different stages of teeth demineralization, and the correspondence of such fluorescence to the mineral and organic distribution within the lesions were investigated. STUDY DESIGN/MATERIALS AND METHODS: Fluorescence spectra of teeth excited with 337 nm nitrogen laser were recorded. Spectra were obtained from healthy enamel, dentine, demineralized areas, and different carious stages of the teeth investigated. RESULTS: Spectra obtained from sound enamel consisted of one intensive peak at 480-500 nm and one secondary peak at 430-450 nm. In dentine, this secondary component had much higher intensity. Fluorescence spectra of normal teeth were similar to those of enamel layer. A significant decrease of the intensity of the fluorescence signal was observed in both cases-in demineralized teeth and in carious lesion. The appearance of a fluorescence peak in the red spectral region was observed in the spectra of the initial carious lesions. In the teeth demineralization process, we observed an increase of the relative fluorescence peak intensity at 430-450 nm related to thinned out of enamel. CONCLUSIONS: A differentiation between initial tooth demineralization and early stages of caries could be made by the laser-induced fluorescence spectroscopy method.     

Effects of ArF: Excimer laser irradiation on human enamel and dentin

Round enamel and dentin surfaces of sound and carious extracted human teeth were irradiated by an ArF:excimer laser for up to 180 sec. Thermographic measurements indicated that the temperature rise due to heat accumulation caused by laser irradiation on these enamel and dentin surfaces was up to 19°C (10 HZ with 540 J/cm²), and the temperature returned to the preirradiation value within 10 sec after the irradiation was stopped. Under light microscopy, no carbonization was evident on these surfaces, and a simple recess was formed by abrasion or vaporization in the irradiated regions. In the secondary SEM, uniformly distributed fine pores and prism structures appeared slightly on the enamel surfaces. Between the peritubular and the intertubular dentin, there appeared a distinct difference in the dissolved area. The laser almost completely removed carious regions of the enamel and the dentin, and penetration extended beyond the carious regions. In the backscattered electron SEM, highly mineralized layers were observed on the enamel and dentin surfaces dissolved by the laser. © 1993 Wiley-Liss, Inc.     

Selective ablation of surface enamel caries with a pulsed Nd:YAG dental laser

BACKGROUND AND OBJECTIVE: High intensity infrared light from the pulsed Nd:YAG dental laser is absorbed by carious enamel and not absorbed by healthy enamel. Consequently, this system has potential for selective removal of surface enamel caries. Safety and efficacy of the clinical procedure was evaluated in two sets of clinical trials at three dental schools. Selective ablation was evaluated with FTIR spectroscopy. STUDY DESIGN/MATERIALS AND METHODS: Carious lesions were randomized to drill or laser treatment. Pulp diagnosis, enamel surface condition, preparations, and restorations were evaluated by blinded evaluators. In Study I, surface caries were removed from 104 third molars scheduled for extraction. One-week post-treatment teeth were evaluated clinically, extracted, and the pulp was examined histologically. In Study II, 90 patients with 462 lesions on 374 teeth were randomized to laser or drill and followed for 6 months. RESULTS: Pulsed Nd:YAG laser removal of surface enamel caries was demonstrated to be both safe and effective. Caries were removed in all conditions. There were no adverse events and both clinical and histological evaluations of pulp vitality showed no abnormalities. A significantly greater number of preparations in the drill groups vs. laser groups entered dentin (drill = 11, laser = 1, P = 0.007). CONCLUSION: The more conservative laser treatment removed the caries but not the sound enamel below the lesion. The pulsed Nd:YAG dental laser was found to be both safe and effective for surface caries removal.     

Experimental studies of the application of the Er:YAG laser on dental hard substances: I. Measurement of the ablation rate

Up to now lasers have not achieved any practical importance in dentistry for drilling teeth because of considerable damage to the surrounding tissue. We studied the application of pulsed 2.94 microns Er:YAG laser radiation in vitro on extracted teeth to remove enamel, dentin, and carious lesions. The depth and diameter of laser-drilled holes were measured as a function of pulse number and radiant exposure. The tissue removal is very effective both for dentin and enamel.     

Characterization of dental caries by LIF spectroscopy with 404-nm excitation

The potential of laser-induced fluorescence (LIF) spectroscopy for the characterization of different stages of dental caries using 404-nm diode laser excitation was investigated. In vitro spectra from 16 sound, 10 noncavitated carious and 10 cavitated carious molar teeth were recorded on a miniature fibre-optic spectrometer. The areas under the receiver operating characteristics (ROC-AUC) were calculated and one-way analysis of variance (ANOVA) was performed. The LIF spectra of the carious teeth showed two peaks at 635 and 680 nm in addition to a broad band seen at 500 nm in sound teeth. The fluorescence intensity ratios, F500/F635 and F500/F680, in carious teeth were always lower than those in sound teeth. The ROC-AUC for discriminating between carious and sound teeth was 0.94, and for discriminating between noncavitated and cavitated carious teeth was 0.87. Statistically significant differences (p<0.001) were seen between sound, noncavitated carious and cavitated carious teeth. The results showed that LIF spectroscopy has the potential to be useful for characterizing different stages of caries in a clinical setting.     

Er:YAG laser ablation of enamel and dentin of human teeth: determination of ablation rates at various fluences and pulse repetition rates.

A pulsed Er:YAG laser (2.94 microns) was used to determine ablation depths per pulse of laser energy at 2 Hz and 5 Hz in human teeth cross sections of enamel and dentin. Ablation depths per pulse at 2 Hz in enamel of intact human teeth were measured and compared to ablation depths per pulse determined in enamel cross sections at 2 Hz. Close correlation was observed for ablation depths per pulse of laser energy between teeth cross sections and intact teeth for enamel. Photographs of lased holes at 2 Hz and 5 Hz indicated minimal thermal effects in enamel at fluences below 80 J/cm2. Minimal thermal effects in dentin were noted below 74 J/cm2. Scanning Electron Microscopy (SEM) pictures of lased dentin showed an irregular serrated surface. Results of this study suggest that the Er:YAG laser can effectively ablate enamel and dentin with minimal thermal effects at 2 Hz and 5 Hz.     

Preliminary investigation of a novel carbon dioxide laser for applications in dentistry

BACKGROUND AND OBJECTIVE: A novel pulsed CO(2) laser was examined for its ability to ablate hard dental tissues. STUDY DESIGN/MATERIALS AND METHODS: Lased human enamel surfaces were viewed using light and scanning electron microscopy for evidence of adverse structural changes. In vitro shear bond strength tests were conducted on composite resin bonded to lased enamel surfaces and compared with conventionally prepared specimens. A thermal camera was used to monitor temperature changes during cavity preparation in tooth slabs to assess likely changes to the dental pulp. RESULTS: No charring or surface cracks were observed on lased enamel surfaces using both microscopic techniques. Bonding of the lased enamel surfaces to composite resin was not significantly different from the acid-etched control group. For cavities with a remaining dentine thickness of less than 1 mm, the temperature rise was less than 6 degrees C. CONCLUSION: A novel pulsed CO(2) laser shows promise for cutting cavities in teeth.     

Comparative In Vitro Study of the Bond Strength of Composite to Enamel and Dentine Obtained with Laser Irradiation or Acid-etch

. The shear bond strength of composite resin on enamel and dentine was compared after acid-etch or irradiation by Er:YAG and Nd:YAP lasers. Forty-eight extracted molars were selected. Dentine and enamel samples were prepared by buccal and lingual surface sectioning to expose a plane enamel or dentine surface. Samples (n=12) were randomly assigned to eight groups. In groups 1 and 5, enamel and dentine surfaces were etched with a 37% phosphoric acid solution. In groups 2 and 6, surfaces were irradiated by Er:YAG laser at an energy of 200 mJ and 4 Hz for enamel and 140 mJ and 4 Hz for dentine. In groups 3 and 7, irradiation was performed by Nd:YAP laser at 310 mJ and 10 Hz for enamel and 240 mJ and 10 Hz for dentine. Groups 4 and 8 served as controls. A cone of composite was bonded perpendicularly onto the prepared surfaces using the Scotch Bond Multipurpose adhesive system. Each sample was then stored in physiological serum at 37°C for one week and thermocycled. Shear bond strength was determined on a universal testing machine. Composite–enamel and composite–dentine interfaces were examined by scanning electron microscopy and microanalysis. Shear bond strength was greater on dentine and enamel after acid-etch than laser radiation. These treatments could be ranged in the following order: acid-etch, laser Er:YAG and laser Nd:YAP. Differences between groups were significant for enamel, whereas no significant differences were found for dentine between acid-etch and Er:YAG laser-irradiation (Kruskal–Wallis test). Thus, laser preparation did not improve bonding to enamel and dentine. Paper received 14 August 1998; accepted following revision 11 January 1999.     

Observations on pulpal response to carbon dioxide laser drilling of dentine in healthy human third molars

Preservation of pulpal health is the primary prerequisite for successful application of laser systems in the hard tissue management of vital teeth. The purpose of this study was to investigate the short and long-term pulpal effects to cavity preparations in healthy human teeth using carbon dioxide (CO₂) laser. A total of seven, healthy, third molars that were scheduled to be removed due to space problems were used. After the laser drilling, the occlusal cavities were closed temporarily, and the teeth were extracted 7 days (n=5) and 3 months (n=2) after the operation. The specimens were fixed, decalcified, subdivided and processed for light and transmission electron microscopy. Seven days postoperatively all the five teeth that had been irradiated with the CO₂ laser did not reveal any pathological changes in the pulpo-dentine complex. Three months postoperatively the two teeth that were prepared with the laser showed subtle but distinct apposition of tertiary dentine that was lined with intact odontoblasts. One of the specimens at 3 months revealed the presence of a mild, but very circumscribed, pulpal infiltration of chronic inflammatory cells subjacent to the cavity preparation. The latter is unlikely to be due to a direct effect of the laser irradiation but a possible consequence of microleakage of oral antigens and/or other tissue-irritating molecules through the temporary restoration and the remaining dentine thickness (RDT). Although these preliminary histological results suggest that the CO₂ laser under investigation induced only minimal response of the dentine-pulp complex when used as a hard-tissue drilling tool, with specific energy settings, pulse duration within thermal relaxation time and emitting radiations at 9.6 m of wavelength, larger clinical trials involving various types of teeth are necessary to reach definite conclusions for large-scale clinical application of the laser device.     

Application of pulsed and continuous wave 1.32 and 1.06 microns wavelengths of the Nd:YAG laser in the canine tracheobronchial tree: a comparative study

Previous investigations have shown good clinical potential for the use of the 1.32 microns wavelength Nd:YAG laser because its soft tissue absorption is better than that of the 1.06 microns wavelength Nd:YAG laser. The 1.32 microns wavelength Nd:YAG laser has an absorption coefficient in water that is 10 times higher than the 1.06 microns wavelength Nd:YAG laser. A comparative in vivo study of laser soft tissue effects was performed by using the 1.32 microns wavelength and the 1.06 microns wavelength Nd:YAG lasers in a pulsed wave (PW) mode and continuous wave (CW) mode using a non-contact endoscopic delivery system. A standard 5 mm mucosal lesion was made in the canine tracheobronchial tree down to the level of the perichondrium. Soft tissue and cartilage effects were examined by light and scanning electron microscopy, acutely, 1 week and 2 weeks after operation, and a comparison was made between the different laser modalities. To create similar lesions, higher energy was required when using the 1.06 microns wavelength Nd:YAG laser. Soft tissue injury was greater with the 1.06 microns wavelength in CW mode, and no cartilage damage occurred in the PW mode. Soft tissue and cartilage repair after 1 and 2 weeks was better with the 1.32 microns wavelength laser. In comparison, the CO2 laser and the contact Nd:YAG laser proved to be more precise cutting tools than the 1.32 microns wavelength or the 1.06 microns wavelength Nd:YAG lasers. Both Nd:YAG laser wavelengths were useful for coagulation and vaporization of tissues and blood vessels. More studies are needed to determine the effect of the new 1.32 microns wavelengths on endotracheal tumors.     

Erbium,chromium:yttrium scandium gallium garnet laser for caries removal: influence on bonding of a self-etching adhesive system

This study evaluated the influence of the dental substrates obtained after the use of different caries removal techniques on bonding of a self-etching system. Forty, extracted, carious, human molars were ground to expose flat surfaces containing caries-infected dentine surrounded by sound dentine. The caries lesions of the specimens were removed or not (control—G1) either by round steel burs and water-cooled, low speed, handpiece (G2), or by irradiation with an erbium, chromium:yttrium scandium gallium garnet (Er,Cr:YSGG) laser (2W, 20 Hz, 35.38 J/cm², fiber G4 handpiece with 0.2826 mm², non-contact mode at a 2 mm distance, 70% air/20% water—G3) or using a chemo-mechanical method (Carisolv—G4). Caries-infected, caries-affected and sound dentines were submitted to a bonding system followed by construction of a resin-based composite crown. Hour-glass shaped samples were obtained and submitted to a micro-tensile bond test. The bond strength data were compared by analysis of variance (ANOVA), complemented by Tukey’s test (P ≤ 0.05). The samples of sound dentine presented higher bond strengths than did samples of caries-affected dentine, except for the groups treated with the Er,Cr:YSGG laser. The highest bond strengths were observed with the sound dentine treated with burs and Carisolv. The bond strengths to caries-affected dentine were similar in all groups. Additionally, bonding to caries-affected dentine of the Er,Cr:YSGG laser and Carisolv groups was similar to bonding to caries-infected dentine. Thus, caries-affected dentine is not an adequate substrate for adhesion. Moreover, amongst the caries removal methods tested, the Er,Cr:YSGG laser irradiation was the poorest in providing a substrate for bonding with the tested self-etching system.     

Excimer laser (248 nm) drilling of tooth tissue: Preliminary investigation

Removal of bulk dental hard tissue is carried out conventionally using burrs and turbine handpieces. This paper reports on the use of excimer laser radiation in the production of tunnel preparations to access deep caries. Using energy densities which were calculated to produce a clinically acceptable rate of tissue removal, extracted human teeth were irradiated. Both enamel and dentine were subjected to numbers of pulses ranging from 500 to 2500 with an energy per pulse of 15 J cm⁻². The cross-section and depth of the lesions produced were measured using the Reflex microscope. The results showed that the ablation for dentine appears to be relatively constant while there is a gradual reduction in ablation rate in enamel as the depth increases. This may be attributable to the interaction between the plume of debris and the laser beam.     

lead levels in deciduous teeth of children from selected urban areas in the Cape Peninsula

The lead levels in shed deciduous teeth of children from two selected urban regions in the Cape Peninsula were compared. The average levels in the teeth of children living in the vicinity of two large industrial plants were: whole teeth 20,419 ppm, enamel 10,952 ppm, and dentine 22,733 ppm. The lead levels in teeth from children living in the vicinity of light industries were: whole teeth 16,556 ppm, enamel 2,919 ppm, and dentine 19,926 ppm. These differences were significant at the 1% level (teeth and enamel) and 5% level (dentine).     

Electron probe microanalysis of secondary carious lesions adjacent to silicate fillings

Secondary caries associated with silicate fillings is characterized by lesions at the tooth surface and lesions of the cavity wall. The mineral content of the cavity wall lesions and the penetration of elements originating from the silicate fillings were studied in experimental in vitro and in vivo lesions as well as in natural carious lesions. Dentine wall lesions, where microradiographs had shown increased radiopacity relative to intact tissue, exhibited increased Ca and P values. Elements derived from the silicate fillings were regularly found in enamel and dentine. The concentrations of fluorine (F) and of zinc (Zn) amounted to 2–3% by weight close to the cavity wall and decreased gradually to <0.1% at depths of 600 μm and 400 μm, respectively, from the cavity. Aluminum (Al) most often occurred in a 20–40 μm-wide zone, showing a maximum concentration of 2–3% near the cavity. Sulfur (S) was often present in the dentinal cavity walls of natural secondary caries, but not in the in vitro specimens. The findings indicate that F released from the silicate filling significantly modifies the progress of a carious lesion in the adjacent enamel and dentine. Through its tendency to form complexes with F, Al may possibly enhance the cariostatic effect of F.     

Influence of Er,Cr:YSGG laser irradiation on enamel caries prevention

The objective of this study was to evaluate the effects of chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser irradiation on the acid resistance of dental enamel. Forty human enamel samples were divided into four groups. They were manually irradiated with an Er,Cr:YSGG laser device (λ?=?2.78 µm, 20 Hz, 20 s), in a scanning mode, with and without water cooling, according to the following parameters: Group 1: 0.25 W, 62.5 J/cm², no water cooling; group 2: 0.25 W, 62.5 J/cm², 5.0 ml/min; group 3: 0.5 W, 125 J/cm², no water cooling; group 4: 0.5 W, 125 J/cm², 5.0 ml/min. No airflow was used. Afterwards, the samples were submitted to an acid challenge and assessed by cross-sectional Knoop microhardness at different depths (20, 40, 60, 80, and 100 µm) from the outer enamel surface. Average values were obtained for both irradiated and control areas in each sample and they were compared to obtain a percentage of microhardness increase. Data were analyzed by analysis of variance and Fisher’s exact test (α?=?5%). The percentage of microhardness increase observed in group 1 (+23.58%) was similar to group 3 (+19.12%), but higher than groups 2 (+3.61%) and 4 (10.9%) (p?<?0.05). The comparison of the depths showed that the Er,Cr:YSGG laser acted in the superficial layers of the dental enamel. The findings of the present study suggest that the energy densities of 62.5 and 125 J/cm² were capable of increasing the acid resistance of human enamel. The presence of water during irradiation makes it difficult to obtain an enamel surface more resistant to acids.     

Pulpal response to Er:YAG laser drilling of dentine in healthy human third molars

BACKGROUND AND OBJECTIVES: Maintenance of pulpal health is a critical prerequisite for successful application of light amplification by stimulated emission of radiations (lasers) in the hard tissue management of vital teeth. The purpose of this study was to investigate the short- and long-term pulpal effects to cavity-preparations in healthy human teeth using erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser. MATERIALS AND METHODS: A total of seven healthy third molars that were to be removed due to space-problem were used. Following the laser excavation, the cavities in dentine were closed temporarily and the teeth were extracted after 7 days (n = 5) and 3 months (n = 2) post-operation. The specimens were fixed, decalcified, subdivided, and processed for light and transmission electron microscopy. RESULTS: In the short-term group, four of the five laser-drilled teeth did not reveal any pathological changes in the pulp-dentine complex. One tooth showed mild disruption of odontoblasts (OB) and vascular dilatation subjacent to the deepest point of the cavity-preparation with a remaining dentine thickness (RDT) of less than 80 microm. The two teeth under long-term observation revealed distinct apposition of tertiary dentine (TD), lined predominantly with cuboidal cells on its pulpal aspect. CONCLUSIONS: These results would allow a conclusion to be drawn that the Er:YAG laser under investigation is a pulp preserving hard-tissue drilling tool when used with the specific energy settings and emitting radiation at a wavelength of 2.94 microm.     

Electron probe microanalysis of secondary carious lesions adjacent to silicate fillings

Secondary caries associated with silicate fillings is characterized by lesions at the tooth surface and lesions of the cavity wall. The mineral content of the cavity wall lesions and the penetration of elements originating from the silicate fillings were studied in experimental in vitro and in vivo lesions as well as in natural carious lesions. Dentine wall lesions, where microradiographs had shown increased radiopacity relative to intact tissue, exhibited increased Ca and P values. Elements derived from the silicate fillings were regularly found in enamel and dentine. The concentrations of fluorine (F) and of zinc (Zn) amounted to 2–3% by weight close to the cavity wall and decreased gradually to <0.1% at depths of 600 μm and 400 μm, respectively, from the cavity. Aluminum (Al) most often occurred in a 20–40 μm-wide zone, showing a maximum concentration of 2–3% near the cavity. Sulfur (S) was often present in the dentinal cavity walls of natural secondary caries, but not in the in vitro specimens. The findings indicate that F released from the silicate filling significantly modifies the progress of a carious lesion in the adjacent enamel and dentine. Through its tendency to form complexes with F, Al may possibly enhance the cariostatic effect of F.     

Ti:sapphire femtosecond laser ablation of dental enamel, dentine, and cementum

This paper reports an investigation into the characteristics of femtosecond laser (800-nm central wavelength) in the ablation of human dental enamel, dentine, and cementum at various laser fluences from 0.2 to 3.68 J/cm² with single and multiple pulses. The femtosecond laser interaction with cementum is reported for the first time. Ablation thresholds were determined to be 0.58, 0.44, and 0.51 J/cm² for enamel, dentine, and cementum, respectively. Under the average laser fluences of 1.13 to 3.68 J/cm², clean ablated surfaces without debris and microcracks were obtained. Laser fluence was found to influence the ablated diameter and depth, whereas under a certain fluence, pulse number only affects the depth, without affecting the diameter. The ablation mechanism is found to be based on multi-photon absorption, not previously known for femtosecond laser ablation of dental materials. The low thermal loads of 0.708, 1.44, and 0.404 J/cm³ required for ablating enamel, dentine, and cementum, determined for the first time, are beneficial for minimizing the heat-affected zones and micro-damage. The Raman spectroscopic analysis of phosphate shows that the chemical components of the tooth remain intact before and after the fs-laser ablation. It also shows that different dental tissues respond differently to the laser irradiation.     

Effects of 980-nm diode laser on the ultrastructure and fracture resistance of dentine

Few reports have addressed the effects of diode laser irradiation at 980 nm on the morphology and fracture resistance of dentine. The purpose of this study is to evaluate the effects of 980-nm diode laser on the ultrastructure and fracture resistance of root dentine. The roots of 90 extracted canine teeth were divided into three groups according to the type of irrigating solution (water, NaOCl, and NaOCl/EDTA) and subdivided into three subgroups (n?=?10) according to the amount of laser irradiation (without irradiation, 1.5 W/100 Hz and 3.0 W/100 Hz). The roots were filled with an epoxy resin-based sealer and gutta-percha and then subjected to a fracture resistance test. Data were analyzed by ANOVA and the Tukey test (p?<?0.05). Additionally, 18 canine teeth were prepared using the same irrigation/irradiation protocols and evaluated by scanning electron microscopy (SEM). The SEM showed greater changes when the laser power increased, and the changes also varied according to the irrigating solution. A modified smear layer was observed in specimens that were treated with water and then laser-irradiated. The laser treatment did not alter the fracture resistance of roots treated with 1.5 W/100 Hz (246.3?±?29.5 N) and 3.0 W/100 Hz (215.3?±?25.1 N) laser power. The roots treated with NaOCl were more susceptible to fracture (199.4?±?15.1 N) than those irrigated with water (254.2?±?23.0 N) (p?<?0.05). The 980-nm diode laser altered the morphology of the dentine but did not affect the fracture resistance of the roots.