Bactericidal effects of diode laser onStreptococcus mutans after irradiation through different thickness of dentin

Efficacy of diode laser application versus silver diamine fluoride (SDF) as a modification of Hall technique in primary teeth

Background

The Hall technique is a new technique aimed at depriving bacteria of any substrate, thereby limiting the progression of caries. Silver diamine fluoride (SDF) and diode laser are documented to have an antibacterial effect on carious enamel and dentin by eradicating bacteria such as Streptococcus mutans.

Aim

The current study aimed to increase the success rate of the Hall technique in carious primary molars by eradicating bacteria present in carious lesions using SDF or diode laser in combination with the Hall technique.

Materials and methods

A total of 159 children aged 4-8 years were randomly divided into three equal groups: Group I, application of the Hall technique; Group II, SDF with Hall technique; Group III, diode laser with Hall technique. Children were recalled at regular intervals over a year. Results: At the end of the follow-up period, Group III showed the highest clinical success rate (94.3 %), followed by Group II (96.2 %), while Group I showed the lowest clinical and radiographic success rates (88.7 % and 86.8 %, respectively); however, these differences were statistically non-significant.

Conclusion

Treatment of carious lesions using SDF or Diode Laser increased the success rate of the Hall technique in primary teeth.

Comparison of the Effect of Diode Laser Irradiation and Fluoride Varnish on Salivary Streptococcus mutans Bacterial Colonies Counts: A Randomized Controlled Clinical Trial

Aim

The aim of this study was to assess antibacterial effects of diode laser irradiation and fluoride varnish on Streptococcus (S) mutans bacterial colonies counts in saliva.

Materials and Methods

This was a randomized controlled clinical trial research, in which 36 healthy caries-free schoolchildren aged 7-10 years referred to Birjand University dental school were selected randomly. None of the subjects had used any fluoride products before sampling. They divided into three groups: Group A: Diode laser irradiation, Group B: Fluoride varnish (FV) + diode laser irradiation, and Group C: FV. From each child, the baseline unstimulated saliva samples were obtained, transferred to the mitis salivarius agar (MSA) culture media and assessed for S. mutans colonies counts. The follow-up unstimulated saliva samples were collected one day after the treatments. Then the number of colony-forming units per milliliter were counted and analyzed statistically using Wilcoxon, Mann Whitney U and Kruskal-Wallis tests (p ≤ 0.05).

Results

No adverse events were reported. Salivary count of S. mutans significantly decreased in all groups. The highest and lowest number of the colonies of S. mutans in treated groups was observed in group I and group II, respectively. S. mutans was not completely eliminated by any of the treatments.

Conclusion

Considering the limitations of this study, antimicrobial efficacy of fluoride varnish + diode laser was higher than that of FV or diode laser alone. So this laser in combination with fluoride varnish may be useful in prevention of dental caries and antimicrobial treatment protocols.

Clinical trial registry

IRCTID: IRCT 201,706 181,7756N20

How to cite this article

Darmiani S, Yousefi M, Rad MS. Comparison of the Effect of Diode Laser Irradiation and Fluoride Varnish on Salivary Streptococcus mutans Bacterial Colonies Counts: A Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2022;15(S-2):S239-S241.

The Photobiomodulation Effect of 940nm Laser Irradiation on Enterococcus faecalis in Human Root Dentin Slices of Varying Thicknesses

Introduction: An increase in dentine thickness could result in an inadequate depth of laser energy penetration. This study aimed to evaluate the effect of a 940 nm laser on Enterococcus faecalis through varying thicknesses of human root dentin slices. Methods: Thirty-five dentin slices of root dentin with thicknesses ranging between 500 and 3000 µm were produced. Six experimental groups (500, 1000, 1500, 2000, 2500, and 3000 µm (n=5 each) were lased and the seventh, non-lased group served as the positive control with a dentine thickness of 2000 µm. The slices were inoculated with 2 µL of E. faecalis suspension of 1.5 × 10⁸ E. faecalis cells/mL. All the lased slices were lased from the opposing side of the inoculation. A non-initiated 200 μm bare end fibre at the power of 1 W, in a continuous wave was used. Four doses of laser irradiation of 5 seconds with a side to side movement with the tip held at a 5º angle to the dentine slice were performed. The colony-forming units of E. faecalis were determined and the bacterial photobiomodulation effect analysed using one-way ANOVA with a Bonferroni and Holm post hoc test at a significance level of P > 0.05. Results: There were statistical differences between the dentin slices of 500, 1000, and 1500 μm treated with the laser compared to the positive control (P < 0.01). However, there were no statistical differences between the lased 2000 and 2500 μm slices compared to the positive control. There was significantly more photobiomodulation of the E. faecalis for the dentine slices of 3000 μm than the positive control (P < 0.01). Conclusion: Laser treatment through dentine slices of 2000 μm and thinner significantly reduced bacterial growth. The photobiomodulation effects started to occur in dentine slices thicker than 2500 μm compared to the positive control.

Cavity Disinfection With a 445 nm Diode Laser Within the Scope of Restorative Therapy - A Pilot Study

Introduction: Cavity disinfection is necessary to prevent a progressive infection of the crown dentin and pulp. Increasing intolerance and resistance to antiseptics and antibiotics as well as the controversy over the effects of those on the dental hard tissue and composite have prompted the investigation of alternative treatment options. The objective of this pilot study is to evaluate the antibacterial potential of a diode laser with a wavelength of 445 nm in the cavity preparation using the bacterium Streptococcus salivarius associated with caries in conjunction with the characteristics and influences of dentin on light transmission. Methods: The bactericidal effect of the laser irradiation was determined in culture experiments by using caries-free human dentin samples on bacteria-inoculated agar. For this, dentin discs (horizontally cut coronal dentin) of 500 µm and 1000 µm thicknesses were produced and irradiated with the laser with irradiation parameters of 0.7-1 W in a cw-mode and exposure times of between 5-30 s. Based on the different sample thicknesses, the penetration depth effect of the irradiation was ascertained after the subsequent incubation of the bacteria-inoculated agar. Additional influential parameters on the irradiation transmission were investigated, including surface moisture, tooth color as well as the presence of a smear layer on the dentin surface. Results: The optical transmission values of the laser radiation for dentin were significantly dependent on the sample thickness (P = 0.006) as well as its moisture content (P = 0.013) and were independent of the presence of a smear layer. There was a 40% reduction in bacteria after the radiography of the 500-µm-thick dentin samples, which was shown as the lowest laser dose (443 J/cm²). Conclusion: These findings indicate that the diode laser with light emission at a wavelength of 445 nm is interesting for the supportive cavity disinfection within the scope of caries therapy and show potential for clinical applications.

Effects of Different Disinfection Methods on Microleakage of Giomer Restorations

Objectives  The purpose of this in vitro study was to investigate the effects of different disinfection methods on microleakage of Class V Giomer restorations.

Materials and Methods  Class V cavity preparation was performed on 40 sound permanent central incisors. Class V cavities (3 x 2 x 2 mm) were prepared on the buccal surfaces of the selected teeth. The teeth were randomly divided into four groups, each to be disinfected with a different method: Group 1—Disinfection with 2% chlorhexidine, Group 2—Disinfection with 6% sodium hypochlorite, Group 3—Disinfection with erbium, chromium: yttrium-scandium-gallium-garnet laser, Group 4—Control (distilled water). BeautiBond adhesive and Beautifil II Giomer restoration materials were applied to all surfaces of the cavities after the disinfection of all groups. The teeth were thermocycled 5,000 times (5–55°C), and then were immersed in 0.5% methylene blue for 24 hours. After rinsing, the teeth were longitudinally sectioned and dye penetration was assessed under a stereomicroscope (40x) to evaluate microleakage.

Statistical Analysis  The results were statistically evaluated by using the Kruskal–Wallis and Mann–Whitney U tests.

Results  Statistically, no significant difference was found between all four groups ( p > 0.05). There was no statistically significant difference in microleakage scores of study groups ( p > 0.05). Also, the microleakage scores of the gingival margins were significantly higher than the incisal margins ( p < 0.0001).

Conclusions  Application of the different cavity disinfectants has no effect on the microleakage of Class V Giomer restorations.

Effects of Erbium:Yttrium-Aluminum-Garnet Laser Irradiation on Bovine Dentin Contaminated by Cariogenic Bacteria

Objective: This study was performed to determine the bactericidal effects of erbium:yttrium-aluminum-garnet (Er:YAG) laser irradiation and the morphological and chemical composition changes in bovine dentin. Methods: Dentin slabs were prepared from bovine incisors, and then cultured with Streptococcus mutans to produce bacteria-infected dentin samples. The samples were randomly divided into five groups with Er:YAG laser irradiation energy densities of 0, 6.37, 12.73, 19.11, and 25.47 J/cm². After irradiation, samples were stained and observed by confocal laser scanning microscopy. The bactericidal abilities were measured using live/dead staining. The morphology and chemical components were investigated by scanning electron microscopy and energy-dispersive spectrometry. Results: After irradiation, the elimination of bacteria and the smear layer were significantly better in the high energy density groups (19.11, 25.47 J/cm²) than in the low energy density groups (6.37, 12.73 J/cm²; p < 0.001). On morphological examination, the group with minimum energy density (6.37 J/cm²) showed superficial melting. In the high energy density groups (12.73, 19.11, and 25.47 J/cm²), laser-irradiated dentin showed a clean surface with open orifices. Significant increases were observed in the weight percentages of calcium (from 19.75 ± 0.69 to 34.47 ± 2.91, p < 0.001) and phosphate (from 8.58 ± 0.43 to 15.10 ± 1.81, p < 0.001), whereas significant decreases were observed for oxygen (from 49.84 ± 0.69 to 36.39 ± 2.86, p < 0.001) and carbon (from 26.06 ± 3.58 to 12.80 ± 2.26, p < 0.01) with increasing energy density. Conclusions: This study confirmed that Er:YAG laser irradiation has bactericidal and dentin conditioning effects.

Assessment of Photodynamic Therapy and Nanoparticles Effects on Caries Models

AIM:

To assess the antibacterial competence of 650 nm diode laser, Methylene Blue (MB) and Silver Nano-Particles (Ag NPs) on Streptococcus mutans in biofilm-induced caries models.

MATERIAL AND METHODS:

One hundred eighty specimens were prepared and equally divided into 6 groups. One group was untreated (control), and the others were subjected to either MB, laser, Ag NPs, the combination of MB and Laser or MB, laser and Ag NPs.

RESULTS:

Comparison of the log10 mean Colony Forming Units per millilitre (CFU/ml) values of each of the treated 5 groups and the control group was found statistically significant (P-value < 0.05). The combination of MB, laser and Ag NPs recorded the greatest reduction (95.28%). MB alone represented the least capable (74.09%). The efficiency differences among the Ag NPs treated group; the Laser treated group and the combined MB/Laser treated group were found statistically insignificant.

CONCLUSION:

The combination of MB, 650 nm diode laser and Ag NPs may be among the highly effective modern antimicrobial therapeutics in dentistry.

Effect of various dentin disinfection protocols on the bond strength of resin modified glass ionomer restorative material

Background

Disinfection of dentin surface prior to any restorative therapy is important for the longevity of the treatment rendered. However, these dentin disinfection methods should itself not interfere with the adhesion of the restorative material. Therefore the aim of this study was to determine the effect of various dentin disinfection protocols on the shear bond strength (SBS) of resin modified glass ionomer cement (RMGIC).

Material and Methods

The occlusal surface of 40 extracted premolars were trimmed to obtain a flat dentinal surface and was randomly divided into four groups. CTRL was the control group; NaOCl was 1% sodium hypochlorite disinfection group; CHX was 2% chlorhexidine disinfection group; and PAD was the photo-activated disinfection group. Then a predetermined dimension of RMGIC was bonded to the pre-treated dentin surfaces. Following this, each sample was tested for SBS using universal testing machine at a crosshead speed of 0.5mm/min.

Results

Among the test groups, CHX showed the least reduction in SBS and NaOCl the highest reduction in SBS as compared to the control group. PAD on the other hand showed significantly lower SBS than CTRL and CHX groups, but the values were higher than the NaOCl group.

Conclusions

Thus, it could be concluded from the present study that use of chlorhexidine based dentin disinfection does interfere with the adhesion of RMGIC. However, photo-activated disinfection should be done with caution. Moreover, sodium hypochlorite based disinfectants should be avoided prior to the use of RMGIC.

Key words:Chlorhexidine, Dentin disinfection, Photo-activated disinfection, Resin modified glass ionomer cement, Shear bond strength, Sodium hypochlorite.

Atomic force microscopy visualization of injuries in Enterococcus faecalis surface caused by Er,Cr:YSGG and diode lasers

Aim: To visualize by Atomic Force Microscopy the alterations induced on Enterococcus. faecalis surface after treatment with 2 types of laser: Erbium chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser and Diode laser. Material and Methods: Bacterial suspensions from overnight cultures of E. faecalis were irradiated during 30 seconds with the laser-lights at 1 W and 2 W of power, leaving one untreated sample as control. Surface alterations on treated E. faecalis were visualized by Atomic Force Microscopy (AFM) and its surface roughness determined. Results: AFM imaging showed that at high potency of laser both cell morphology and surface roughness resulted altered, and that several cell lysis signs were easily visualized. Surface roughness clearly increase after the treatment with Er,Cr:YSGG at 2W of power, while the other treatments gave similar values of surface roughness. The effect of lasers on bacterial surfaces visualized by AFM revealed drastic alterations. Conclusions: AFM is a good tool to evaluate surface injuries after laser treatment; and could constitute a measure of antimicrobial effect that can complete data obtained by determination of microbial viability.

Key words:Atomic force microscopy, Er,Cr:YSGG laser, diode laser, Enterococcus faecalis, surface roughness.

Comparison of the Effect of Nd:YAG and Diode Lasers and Photodynamic Therapy on Microleakage of Class V Composite Resin Restorations

Background and aims

Considering the importance of disinfecting dentin after cavity preparation and the possible effect of disinfection methods on induction of various reactions between the tooth structure and the adhesive restorative material, the aim of the present study was to evaluate microleakage of composite resin restorations after disinfecting the prepared dentin surface with Nd:YAG and Diode lasers and photodynamic therapy.

Materials and methods

Standard Class V cavities were prepared on buccal surfaces of 96 sound bovine teeth. The samples were randomly divided into 4 groups based on the disinfection method: Group 1: Nd:YAG laser; Group 2: Diode laser; Group 3: photodynamic therapy; and Group 4: the control. Self-etch bonding agent (Clearfil SE Bond) was applied and all the cavities were restored with composite resin (Z100). After thermocycling and immersing in 0.5% basic fuchsin, the samples were prepared for microleakage evaluation under a stereomicroscope. Data was analyzed with Kruskal-Wallis and Wilcoxon signed-rank tests at P<0.05.

Results

There were no significant differences in the microleakage of occlusal and gingival margins between the study groups (P>0.05). There were no significant differences in microleakage between the occlusal and gingival margins in the Nd:YAG laser group (P>0.05). In the other groups, microleakage at gingival margins was significantly higher than that at the occlusal margins (P<0.05).

Conclusion

Nd:YAG and Diode lasers and photodynamic therapy can be used to disinfect cavity preparations before composite resin restorations.

Mechanical and acid neutralizing properties and bacteria inhibition of amorphous calcium phosphate dental nanocomposite

Dental composites do not hinder bacteria colonization and plaque formation. Caries at the restoration margins is a frequent reason for replacement of existing restorations, which accounts for 50 to 70% of all restorations. The objectives of this study were to examine the filler level effect on nanocomposite containing nanoparticles of amorphous calcium phosphate (NACP) and investigate the load-bearing and acid-neutralizing properties and bacteria inhibition. NACP with 116-nm particle size were synthesized via a spray-drying technique and incorporated into a resin. Flexural strength of nanocomposite with 10 to 30% NACP fillers matched the strength of a commercial hybrid composite (p > 0.1). Nanocomposite with 40% NACP matched the strength of a microfill composite, which was 2-fold that of a resin-modified glass ionomer. Nanocomposite with 40% NACP neutralized a lactic acid solution of pH 4 by rapidly increasing the pH to 5.69 in 10 min. In contrast, the commercial controls had pH staying at near 4. Using Streptoccocus mutans, an agar disk-diffusion test showed no inhibition zone for commercial controls. In contrast, the inhibition zone was (2.5 ± 0.7) mm for nanocomposite with 40% NACP. Crystal violet staining showed that S. mutans coverage on nanocomposite was 1/4 that on commercial composite. In conclusion, novel calcium-phosphate nanocomposite matched the mechanical properties of commercial composite and rapidly neutralized lactic acid of pH 4. The nanocomposite appeared to moderately reduce the S. mutans growth, and further study is needed to obtain strong antimicrobial properties. The new nanocomposite may have potential to reduce secondary caries and restoration fracture, two main challenges facing tooth cavity restorations.

Bactericidal effects of 2.94 µm and 1.67 µm laser

The bactericidal effects of lasers with wavelengths of 1.67 and 2.94 µm on cariogenic Streptococcus mutans were investigated. Temperature during irradiation was also measured to determine the mechanism underlying the bactericidal effects of the lasers. An aliquot of 2 µl cell suspension of S. mutans JC-2 strain was placed on anhydrous quartz or dentin plate, covering an area of approximately 5.0 mm in diameter to a depth of approximately 0.1 mm. Cell suspension was then irradiated at a power of 0.8 W (3.1 J/cm²) at a rate of 40 pps for 30 sec. After irradiation, the plate was put into a bottle containing PBS and vigorously voltated. Solution was serially diluted and inoculated on MS agar. After incubation anaerobically for 72 hr, colony forming units on the agar were counted. The experimental group, the number of bacteria decreased significantly compared to the control group under all conditions. No significant differences were observed in effect of wavelength or plate on bactericidal activity. In conclusion, laser irradiation at a wavelength of 1.67 µm for 30 sec showed a bactericidal effect on S. mutans, suggesting that this wavelength is more useful than 2.94 µm due to greater tissue penetration.

Production of reactive oxygen species from photosensitizers activated with visible light sources available in dental offices

OBJECTIVES

The aim of this study was to assess the ability of commonly available red- or blue-light dental sources to generate reactive oxygen species (ROS) from photosensitive chemicals that might be useful for photodynamic antimicrobial chemotherapy (PACT).

BACKGROUND

Although the use of red diode lasers is well documented, there is limited information on how useful blue-light sources might be for PACT in dental contexts.

MATERIALS AND METHODS

A diode laser (Periowave; see Table 1 for material and equipment sources) emitting red light (660-675 nm) was used to activate toluidine blue; riboflavin and pheophorbide-a polylysine (pheophorbide-a-PLL) were photoactivated using an Optilux 501 curing unit emitting blue light (380-500 nm). Ozone gas (generated by OzoTop, Tip Top Tips, Rolle, Switzerland), sodium hypochlorite, and hydrogen peroxide were used for comparison. ROS production was estimated using an iodine-triiodide colorimetric assay, and ROS levels were plotted versus concentration of chemicals to determine each chemical's efficiency in ROS production. One-way ANOVA with Tukey post hoc analysis (alpha = 0.05) was used to compare the efficiencies of ROS production for the various chemicals.

RESULTS

Sodium hypochlorite, hydrogen peroxide, and ozone gas produced ROS spontaneously, whereas pheophorbide-a-PLL, riboflavin, and toluidine blue required light exposure. The efficiency of ROS production was higher for pheophorbide-a-PLL and toluidine blue than for ozone gas or riboflavin (p < 0.05). Hydrogen peroxide was the least efficient ROS producer.

CONCLUSIONS

The results of the current study support the use of blue- or red-light-absorbing photosensitizers as candidates to produce ROS for clinical applications. Blue-light photosensitizers were as efficient as red-light photosensitizers in producing ROS and more efficient than the oxidant chemicals currently used for dental disinfection.

Mechanism of high-power NIR laser bacteria inactivation

Lasers are used in dentistry for a variety of indications. One of these is the disinfection of root canals or the sterilization of residual caries. Many studies have demonstrated the capacity to kill bacteria for lasers but the fundamental mechanism of the laser effect remains quite unclear. With our experiments we wanted to determine whether high-power NIR laser bacterial killing is caused by the light itself (photochemical effect) or by a photothermal process. In order to differentiate between mechanisms we heated bacteria suspensions of a nonpathogenic strain of E. coli by a water bath and by a diode laser (940 nm) with the same temporal temperature course. Furthermore, bacteria suspensions were irradiated while the temperature was fixed by ice water. Killing of bacteria was measured via fluorescence labelling. Comparison of killing rates between laser and water-based heating shows no significant differences. The most important parameter is the maximum temperature. Laser irradiation of bacteria at low temperatures does not result in killing. Our experiments show that at least for E. coli bacteria inactivation by high-power laser irradiation is solely based on a thermal process.

Bond strength of a self-adhesive resinous cement to root dentin irradiated with a 980-nm diode laser

OBJECTIVE

To assess the bond strength of Rely-X Unicem (RX), in comparison with Cement-Post (CP), to the cervical, middle and apical thirds of root canal dentin irradiated with a 980-nm diode laser.

MATERIAL AND METHODS

Forty maxillary canines were separated into four equal groups according to the cement used and the laser surface treatment: RX/laser irradiation (LI) group; RX/no irradiation (NI) group; CP/LI group; and CP/NI group. Two slices (2-mm thick) of each root third were submitted to a push-out test to assess the bond strength of the cement to the root canal dentin. The data obtained were submitted to two-way ANOVA and fracture analysis was performed by scanning electron microscopy.

RESULTS

The type of cement as well as 980-nm LI at the different root canal thirds significantly affected the bond strength values (p < 0.05). LI promoted an increase in bond strength of RX in all root thirds (p < 0.05). For all groups, bond strength to the cervical third was highest, followed by the middle and apical thirds (p < 0.05). When the cements were compared, RX always presented the highest bond strength in comparison with CP, irrespective of the laser application (p < 0.05). Fracture analysis showed a predominance of mixed failures for RX and of adhesive failure between dentin and cement for CP, irrespective of the laser application.

CONCLUSION

The 980-nm LI promoted an increase in bond strength of the self-adhesive resinous cement to root dentin.

In vivo histological evaluation of a novel ablative fractional resurfacing device

BACKGROUND AND OBJECTIVES

A novel carbon dioxide (CO(2)) laser device employing ablative fractional resurfacing was tested on human skin in vivo for the first time.

STUDY DESIGN/MATERIALS AND METHODS

An investigational 30 W, 10.6 microm CO(2) laser system was focused to a 1/e(2) spot size of 120 microm to generate an array of microscopic treatment zones (MTZ) in human forearm skin. A range of pulse energies between 5 and 40 mJ was tested and lesion dimensions were assessed histologically using hematoxylin and eosin. Wound healing of the MTZ's was assessed immediately-, 2-day, 7-day, 1-month, and 3-month post treatment. The role of heat shock proteins was examined by immunohistochemistry.

RESULTS

The investigational CO(2) laser system created a microscopic pattern of ablative and thermal injury in human skin. The epidermis and part of the dermis demonstrated columns of thermal coagulation that surrounded tapering ablative zones lined by a thin eschar layer. Changing the pulse energy from 5 to 30 mJ resulted in a greater than threefold increase in lesion depth and twofold increase in width. Expression of heat shock protein (hsp)72 was detected as early as 2 days post-treatment and diminished significantly by 3 months. In contrast, increased expression of hsp47 was first detected at 7 days and persisted at 3 months post-treatment.

CONCLUSION

The thermal effects of a novel investigational ablative CO(2) laser system utilizing fractional resurfacing were characterized in human forearm skin. We confirmed our previous ex vivo findings and show for the first time in-vivo, that a controlled array of microscopic treatment zones of ablation and coagulation could be deposited in human skin by varying treatment pulse energy. Immunohistochemical studies of heat shock proteins revealed a persistent collagen remodeling response lasting at least 3 months. We successfully demonstrated the first in-vivo use of ablative fractional resurfacing (AFR) treatment on human skin.