Study on acid resistance of human dental enamel and dentin irradiated by semiconductor laser with Ag(NH3)2F solution

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.

Silver diamine fluoride therapy for dental care

Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is used to control early childhood caries, arrest root caries, prevent fissure caries and secondary caries, desensitise hypersensitive teeth, remineralise hypomineralised teeth, prevent dental erosion, detect carious tissue during excavation and manage infected root canals. SDF is commonly available as a 38% solution containing 255,000 ppm silver and 44,800 ppm fluoride ions. Silver is an antimicrobial and inhibits cariogenic biofilm. Fluoride promotes remineralisation and inhibits the demineralisation of teeth. SDF also inactivates proteolytic peptidases and inhibits dentine collagen degradation. It arrests caries without affecting dental pulp or causing dental fluorosis. Indirect pulp capping with SDF causes no or mild inflammatory pulpal response. However, direct application of SDF to dental pulp causes pulp necrosis. Furthermore, SDF stains carious lesions black. Patients must be well informed before SDF treatment. SDF therapy is simple, painless, non-invasive, inexpensive, and requires a simple armamentarium and minimal support. Both clinicians and patients generally accept it well. In 2021, the World Health Organization included SDF as an essential medicine that is effective and safe for patients. Moreover, it can be used for caries control during the COVID-19 pandemic because it is non-aerosol-generating and has a low risk of cross-infection.

Combined Effects of Topical Fluorides and Semiconductor Lasers on Prevention of Enamel Caries: A Systematic Review and Meta-Analysis

Objective: To compare the effects of combined treatment of topical fluoride and semiconductor laser (F&L) with topically using fluoride (F) on remineralization and prevention of enamel caries. Background: There is no agreement on whether semiconductor lasers can promote the effect of topical fluoride on the remineralization and prevention of dental caries. This study is the first systematic review and meta-analysis to investigate the pooled effect of data from studies that compared the combined use of semiconductor lasers and topical fluorides with the single use of fluoride on remineralization and prevention of caries. Methods: We performed literature search on Scopus, Web of Science, and PubMed. The keywords were as follows: ((diode lasers) OR (diode laser) OR (quantum cascade laser) OR (quantum cascade lasers) OR (Gallium Aluminum Arsenide lasers) OR (Gallium Aluminum Arsenide laser) OR (GaAlAs lasers) OR (GaAlAs Laser) OR (semiconductor laser) OR (semiconductor lasers)) AND ((caries) OR (dental caries) OR (remineralisation) OR (remineralization) OR (demineralization) OR (demineralisation)) AND fluoride. We carried out meta-analysis to compare the microhardness of demineralized enamel, lesion depth (LD), and percent reduction of calcium (Ca%) of sound enamel receiving F&L with F. Results: The search identified nine laboratory studies, which used 445 to 980 nm semiconductor lasers with various fluorides. The standard mean difference of microhardness of demineralized enamel between F&L and F was 1.06 [95% confidence interval (CI): 0.12 to 2.00, p = 0.03]. No difference was found in LD (95% CI: -1.63 to 0.10, p = 0.08) and Ca% (95% CI: -0.52 to 1.28, p = 0.40) on sound enamel between the two groups. Conclusions: Semiconductor lasers enhance the effect of fluoride on remineralizing but not on preventing enamel caries. Moreover, substantial heterogeneity was found among the studies, and the results should be interpreted cautiously.

Dental bleaching efficacy and impact on demineralization susceptibility of simulated stained-remineralized caries lesions

OBJECTIVES

To evaluate the efficacy of different bleaching systems on artificially created stained-remineralized caries lesions; and to assess the susceptibility of the bleached lesions to further demineralization.

METHODS

Human enamel specimens were sectioned, polished, demineralized, and randomly divided into six groups (n = 21) to create stained-remineralized lesions, either non-metallic (non-Met: G1, G2 and G3) or metallic (Met: G4, G5 and G6). G1 and G4 received no bleaching treatment, while G2 and G5 were treated with 15% carbamide peroxide (at-home bleaching protocol; 4 h/d×7), and G3 and G6 with 40% hydrogen peroxide (in-office bleaching protocol; 20min × 3). Susceptibility to further demineralization was tested after bleaching treatment. Lesion mineral loss and depth were measured by transversal microradiography, and color change by spectrophotometry. Outcomes were analyzed using ANOVA models followed by Fisher's PLSD tests (α = 0.05).

RESULTS

Metallic-stained lesions were significantly darker (all p < 0.001) and more resistant to bleaching (p < 0.005) than non-Met ones. For both stain types, the at-home bleaching protocol was more effective than the in-office (p < 0.005); however, it also increased the lesion susceptibility to demineralization (p < 0.05) [ΔΔZ mean ± SD ranging from 205 ± 73 to 313 ± 188 (at home) vs. 132 ± 45 to 206 ± 98 (in office); p < 0.05]. After bleaching, non-Met lesions were significantly more susceptible to demineralization (p < 0.05), with the ΔΔZ ranging from 206 ± 98 to 313 ± 188 compared to Met lesions ranging from 132 ± 45 to 205 ± 73.

CONCLUSIONS

At-home bleaching protocol presented greater bleaching efficacy compared to in-office bleaching protocol. After bleaching, metallic-stained lesions were more resistant to subsequent demineralization compared to non-metallic stained lesions.

CLINICAL SIGNIFICANCE

Bleaching stained-arrested caries lesions may improve aesthetics but also increase susceptibility to demineralization, depending on the type of stain involved and bleaching system used.

Bleaching of simulated stained-remineralized caries lesions in vitro

OBJECTIVE

Non-invasive esthetic treatment options for stained arrested caries lesions have not been explored. This study aimed to develop laboratory models to create stained-remineralized caries-like lesions (s-RCLs) and to test the efficacy of bleaching on their esthetic treatment.

MATERIALS AND METHODS

One hundred twelve enamel/dentin specimens were prepared from human molars, embedded, and had their color measured spectrophotometrically at baseline and after demineralization. They were randomly divided into four groups (n = 14) based on the staining/remineralization protocols for a total of 5 days: G1, no staining/no remineralization; G2, no staining/remineralization in artificial saliva (AS); G3, non-metallic staining/remineralization with sodium fluoride/AS; and G4, metallic staining/remineralization with silver diamine fluoride/AS. The lesion mineral loss (ΔZ) and depth (L) were measured using transverse microradiography along with color change (ΔE). Specimens were bleached and color was re-evaluated. Data were analyzed using ANOVA models followed by Fisher's PLSD tests (α = 0.05).

RESULTS

s-RCLs in G4 were significantly (p < 0.001) darker than G3, G2, and G1 regardless of substrate type and condition. s-RCLs in G2, G3, and G4 showed significantly lower ΔZ and L than G1 (all p < 0.001), confirming occurrence of remineralization. G4 exhibited significantly lower ΔZ and L compared to G2 (p < 0.001). Bleaching was more effective in non-metallic than in metallic stained lesions regardless of substrate type (p < 0.001).

CONCLUSION

The proposed models created distinct s-RCLs. Non-metallic s-RCLs were lighter and more responsive to bleaching compared to metallic s-RCLs.

CLINICAL RELEVANCE

The developed experimental models allow the further investigation of the efficacy and safety of different clinical strategies for the esthetic management of s-RCLs.

Antibacterial effects of silver diamine fluoride on multi-species cariogenic biofilm on caries

Backgrounds

Silver diamine fluoride (SDF) has clinical success in arresting dentin caries, this study aimed to investigate its mechanism of action.

Methods

Using a computer-controlled artificial mouth, we studied the effect of 38% SDF on cariogenic biofilms and dentin carious lesions. We used five common cariogenic bacteria (Streptococcus mutans, Streptococcus sobrinus, Lactobacillus acidophilus, Lactobacillus rhamnosus and Actinomyces naeslundii) to form a cariogenic biofilm that generated carious lesions with a depth of approximately 70 um on human dentin blocks. We applied 38% SDF to the lesions in the test group and water to those in the control group. The blocks were incubated in the artificial mouth for 21 days before evaluation. Microbial kinetics, architecture, viability and distribution were evaluated every 7 days using colony forming unit (CFU), scanning electron microscopy and confocal laser scanning microscopy. The physical properties of the carious lesions were evaluated with microhardness testing, energy dispersive spectroscopy (EDS) and Fourier transform infra-red spectroscopy (FTIR).

Results

The CFU results revealed fewer colony forming units in the test group compared with the control group (p < 0.01). Scanning electron microscopy and confocal microscopy showed less bacterial growth in the test group, and confluent cariogenic biofilm in the control group (p < 0.01). The microhardness and weight percentages of calcium and phosphorus in the test group from the outermost 50mum were higher than in the control group (p < 0.05). EDS showed that calcium and phosphous were higher in outer 50 mum in test groups than in the control FTIR revealed less exposed collagen I in the test lesions compared with the control group (p < 0.01).

Conclusions

38% SDF inhibits multi-species cariogenic biofilm formation on dentin carious lesions and reduces the demineralization process.

Effects of 960-nm Diode Laser Irradiation on Calcium Solubility of Dental Enamel: Anin VitroStudy

OBJECTIVE

The aim of this study was to investigate the effects of 960 nm diode laser and acidulated phosphate fluoride on calcium solubility of human dental enamel.

BACKGROUND DATA

Interest in diode lasers has grown steadily since its invention due to its inherent advantages and its range of applications. Several other laser types have shown good results in caries prevention; however, there are few studies on dental tissue interactions using diode lasers.

METHODS

Acid resistance was evaluated using 65 enamel specimens, divided into five groups: control (C), fluoride (F), laser (L), laser + fluoride (LF), and fluoride + laser (FL). The laser was operated using the parameters of 6.5-W peak power, 5-msec pulse duration, 10-Hz repetition rate, and 33-mJ pulse energy. These parameters were previously tested regarding pulpal temperature rise and enamel morphology, and were determined to be safe. The amount of calcium lost during demineralization was measured.

RESULTS

The calcium solubility of the laser group was 12% higher than of the control group (p > 0.05). Group F showed a 33.6% increase of acid resistance (p < 0.05). When laser was associated with fluoride, the calcium solubility increased significantly (p < 0.05) compared to both the control group and the laser group. Groups treated with fluoride showed the same results (p > 0.05).

CONCLUSION

The 960-nm diode laser promoted a slight increase in calcium solubility. A statistically significant reduction on calcium solubility was achieved with the three treatments that involve fluoride (F, FL, and LF). The additional application of laser irradiation did not cause any significant increase or decrease in calcium solubility.

Preventive effect of tooth fracture by pulsed Nd:YAG laser irradiation with diamine silver fluoride solution

OBJECTIVE

The purpose of the present study was to evaluate the preventive effect of pulsed Nd:YAG laser irradiation with 38% diamine silver fluoride [Ag(NH3)2F] solution for the fracture of endodontically treated teeth in vitro.

BACKGROUND DATA

There have been no reports on the preventive effect of tooth fracture using Nd:YAG laser with Ag(NH3)2F solution.

MATERIALS AND METHODS

Twenty-eight human extracted teeth were used in this study. The teeth were randomly classified into four groups: control group, where tooth surfaces were not submitted to any treatment; group 1, where tooth surfaces were coated with 38% Ag(NH3)2F solution; group 2, where tooth surfaces were coated with Ag(NH3)2F solution and irradiated by pulsed Nd:YAG laser for 2 sec; and group 3, where tooth surfaces were coated with Ag(NH3)2F solution and irradiated by pulsed Nd:YAG laser for 10 sec. After preparation, shear tests were performed and the maximum load for the fracture was measured. Results were analyzed using the Scheffe test, and difference at p < 0.05 was considered significant.

RESULTS

The failure load for group 2 (mean, 182.5 kg) had the highest mean value and differed significantly from those for the control group (mean, 146.3 kg) and group 1 (mean, 147.1 kg; p < 0.05). The failure loads for groups 1 and 3 (mean, 150.0 kg) did not differ significantly from that for the control group (p > 0.05).

CONCLUSION

The results show that the application of 38% Ag(NH3)2F solution followed by pulsed Nd:YAG laser irradiation for 2 sec is useful for prevention of tooth fracture at endodontically treated teeth.