Dentin ablation by Ho: YAG laser: correlation of energy versus volume using stereophotogrammetry

Effect of CO2, Nd:YAG, and ArF excimer lasers on dentin morphology and pulp chamber temperature: an in vitro study

This study compared the effect of three laser systems: CO2 (10.600 nm), Nd:YAG (1.064 nm), and ArF excimer (193 nm) lasers on dentin hard tissue and on temperature increases of the pulp chamber. Sixty-six third molar teeth were used and randomly divided into three groups. A class I cavity was made to expose the dentin, and the pulp in the pulp chamber was removed via a hole bored in the cervical area. The pulp chamber was subsequently refilled with silicon grease, and a NiCr/NiSi thermocouple was inserted through the hole into the pulp chamber. The dentin surface was then lased for 30 s at the same settings (3 W, 2 mm spot size, 20 pps) with each laser. The average internal temperature increases were as follows: CO2, 37 degrees C; Nd: YAG, 28 degrees C; and ArF excimer, 1 degrees C. Scanning electron microscopy of the dentin in the occlusal cavity revealed extensive carbonization, isolated balls of recrystallized material, and the presence of smear layer at some dentinal tubule orifices for the CO2 and Nd:YAG lased teeth. Smear layer was also observed for the ArF excimer samples; however, they exhibited far less surface cavities than the others and seemed to undergo little morphological change on the dentin.

Lasers in endodontics: a review

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of papers on potential applications for lasers in endodontics have been published. The purpose of this paper is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilization of root canals, root canal shaping and obturation and apicectomy. The effects of laser on root canal walls and periodontal tissues are also reviewed. The essential question is whether a laser can provide equal or improved treatment over conventional care. Secondary issues include treatment duration and cost/benefit ratio. This article reviews the role of lasers in endodontics since the early 1970s, summarizes many research reports from the last decade, and surmises what the future may hold for lasers in endodontics. With the potential availability of many new laser wavelengths and modes, much interest is developing in this promising field.

Effect of power settings versus temperature change at the root surface when using multiple fiber sizes with a Holmium YAG laser while enlarging a root canal

The aim of this study was to determine if there is an increase in temperature at the root surface as the canal is enlarged when using a Holmium:YAG laser. An increase might be expected because, as the canal is enlarged, there is less dentin between the canal walls and the outer cementum surface of the root to absorb the heat. Sixty single-rooted human teeth were randomly assigned to 1 of 3 groups according to laser power settings: 0.50, 0.75, and 1.00 W. Each tooth in each power group was subjected to lasing using fiber sizes of 140, 245, 355, and 410 microns. The dependent variables in these analyses included: (a) change in temperature, measured with T-type thermocouples placed 2 mm from the coronal and apical ends of the root; (b) depth of laser in the tooth; (c) depth that a conventional fiber could be inserted after lasing; and (d) tooth physical dimensions. ANOVA for coronal temperature showed no interaction between fibers and power settings. Repeated-measures ANOVA for apical temperature showed a significant difference between fibers, but not between power settings. No interaction between fibers and power settings was observed. For the depth of tooth during lasing (how far the fiberoptic guide penetrated into the tooth), no interaction between fibers and power settings was observed. Pairwise contrasts revealed that all fibers were different from one another, with depth decreasing as fiber size increased. Depth files could be inserted that showed the depth significantly decreased as file size increased from 50 through 70. ANOVAs illustrated that there were no significant differences between power settings for any of the five tooth physical dimensions. All temperature differences observed apically and coronally were between 0 degree to 10 degrees C, with the majority (> 98%) being between 0 degree to 5 degrees C. After lasing with the 410-micron fiber, the root canals were widened to at least 45 or 50 K-files (450 or 500 microns). However, by using a 410-micron fiber, the laser did not seem to widen the canal beyond a 500-micron diameter.

Holmium:YAG lithotripsy efficiency varies with energy density

PURPOSE

We test the hypothesis that holmium:YAG lithotripsy efficiency varies with optical fiber size and energy settings (energy density).

MATERIALS AND METHODS

The 272, 365, 550 and 940 microm. optical fibers delivered 1 kJ. total holmium:YAG energy to calcium oxalate monohydrate calculi at energy output/pulse of 0.2 to 1.5 J. Stone mass loss was measured for each fiber energy setting. Stone crater width was characterized for single energy pulses. Fiber energy outputs were compared before and after lithotripsy.

RESULTS

Stone mass loss correlated inversely with optical fiber diameter (p <0.05). Stone loss correlated with energy/pulse for the 365, 550 and 940 microm. fibers (p <0.001). The 272 and 365 microm. fibers yielded equivalent stone loss at 0.2 and 0.5 J. per pulse. At energies of 1.0 J. per pulse or greater the 272 microm. optical fiber was prone to damage, and yielded reduced energy output and stone loss compared to the 365 microm. fiber (p <0.01). Stone crater width for single pulse energies correlated with energy settings for all fibers (p <0.001).

CONCLUSIONS

Lithotripsy efficiency with the holmium:YAG laser depends on pulse energy output and diameter of the optical delivery fiber, implying that lithotripsy efficiency correlates with energy density. The 365 microm. fiber is indicated for most lithotripsy applications. The 272 microm. fiber is susceptible to damage and inefficient energy transmission at energies of 1.0 J. per pulse or greater. The 272 microm. fiber is indicated at energies of less than 1.0 J. per pulse for small caliber ureteroscopes or when maximal flexible ureteroscope deflection is required.

The efficiency of root canal disinfection using a holmium:yttrium-aluminum-garnet laser in vitro

The aim of the present study was to determine the bactericidal effect of a holmium:yttrium-aluminum-garnet (Ho:YAG) laser on root canals in vitro. The efficiency of different laser settings was compared. The in vitro examinations revealed extensive bacterial reduction in extracted, endodontically prepared teeth that had been incubated with Streptococcus faecalis with the most favorable results at a setting of 5 Hz and 2 W. In average, 99.98% of the bacteria injected in the root canal could be eliminated. Considering this bactericidal effect, the application of the Ho:YAG laser in root canal treatment appears to be very efficient.

In vitro study of a Nd:YAP laser in endodontic retreatment

Nd:YAP laser is a dental laser with a 1340 nm wavelength. The laser beam is carried by a 200 to 300 microns fiberoptic and is suitable for endodontic therapy. We used the Nd:YAP laser in an in vitro experiment to study its effectiveness in endodontic retreatment. Temperature measurements and irradiation parameters were first defined. Then Nd:YAP laser irradiation was used, alone or in combination with hand instruments, to remove various canal sealers and broken instruments. Clinical parameters were monitored and scanning electron microscopic observations were conducted. When used at 200 mJ--with a pulse duration of 150 ms, an exposure time of 1 s and a frequency of 10 Hz--Nd:YAP laser preserved the dentinal walls of the root canal and enabled root canal retreatment without thermic elevation harming periodontal tissue. It is concluded that, in combination with hand instruments, the Nd:YAP laser is an effective device for root canal preparation in endodontic retreatment.

Effect of power settings on temperature change at the root surface when using a Holmium YAG laser in enlarging the root canal

The aim of this study was to determine the maximum amount of power, in watts, that a Holmium YAG laser could deliver via a 245-micron fiberoptic to the canal surface and still not raise the temperature (delta T) of the cementum by > 5 degrees C. Sixty single-rooted teeth were divided into three groups according to power selection (0.50, 0.75, and 1.00 W). The three main outcome variables were: change in apical temperature, change in coronal temperature, and maximum size of an endodontic file that could fit into the canal after lasing. The group means for apical delta T were: 1.00 W = 2.2 degrees C, 0.75 W = 2.68 degrees C, and 0.50 W = 1.58 degrees C. The group means for coronal delta T were: 1.00 W = 1.15 degrees C, 0.75 W = 0.99 degree C, and 0.50 W = 0.56 degree C. The group means for file size were: 1.00 W = 41.25, 0.75 W = 38.75, and 0.50 W = 40.75. The canal size was increased from a size 25 file up to approximately a size 40 file with all power groups. There were no significant differences between the groups for change in apical temperature (p = 0.32), coronal temperature (p = 0.17), or maximum file size (p = 0.86) when adjustments were made for tooth dimensions. In all groups studied, the delta T was < 5 degrees C. This represents a safe and predictable laser procedure.