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Abd El-Aal NH, Hussein AMHMM, Banerjee A, Hammama HH. Clinical and ex-vivo effect of LASERs on prevention of early-enamel caries: systematic review & meta-analyses. Lasers Med Sci 2024; 39:107. [PMID: 38635085 PMCID: PMC11026291 DOI: 10.1007/s10103-024-04049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
To investigate the in vivo and in situ effect of different types of lasers in prevention of enamel demineralization in high caries risk cases (around orthodontic brackets, around restoration and in caries susceptible pits and fissures). PubMed was searched using the following keyword sequence; (Laser therapy OR laser irradiation OR laser application) AND (enamel caries prevention OR enamel demineralization OR enamel remineralization OR early enamel caries OR early-enamel caries OR enamel resistance OR enamel decalcification OR white spot lesions WSLs OR incipient lesion OR enamel decay OR enamel Dissolution OR enamel microhardness) AND (clinical trial OR Randomized clinical trial OR In situ study). The latest literature search was ended by "30 January 2023". PubMed was used as a primary data base for study selection. Scopus, EBSCO, and Google scholar are checked in our study after results of systematic search on PubMed. Only duplicates were found. Two meta-analyses were carried out. The first, clinical meta-analysis on incidence of white spot lesions (WSLs) following CO2 laser irradiation of enamel. The second meta-analysis on ex-vivo/in situ effect of CO2 laser on microhardness of enamel. In each meta-analysis three studies were included. Risk of bias was assessed. The search identified eight studies (four ex-vivo and four clinical trials). Regarding the clinical meta-analysis, the overall standardized mean difference was 0.21 [ 95% confidence interval (CI): 0.15-0.30, p < 0.00001]. This indicates that the incidence of new WSLs in patients who received low power CO2 laser treatment was highly significantly lower than placebo groups. The heterogeneity was considerable (I2 = 71%). In the second meta-analysis, the overall standardized mean difference was 49.55 [ 95% confidence interval (CI): 37.74, 61.37, p < 0.00001]. This indicates that microhardness of enamel receiving low power (0.4-5 W) CO2 laser irradiation is highly significantly lower than control untreated enamel. The heterogeneity was substantial (I2 = 48%). Within the limitations of this study, Low level laser therapy concept with CO2 laser seems to be effective in preventing enamel caries.Prospero registration number: CRD42023437379.
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Affiliation(s)
| | | | - Avijit Banerjee
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Aggarwal P, Anand P, Singh K, Jhingan P, Malik M, Mathur S. Comparison of micromorphological changes in enamel using SEM analysis after conventional and erbium, chromium:yttrium, scandium, gallium, and garnet hard-tissue laser fissurotomy: An in vitro study. J Indian Soc Pedod Prev Dent 2023; 41:253-257. [PMID: 37861641 DOI: 10.4103/jisppd.jisppd_214_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Background Well articulated by John Knowles - "Everything has to evolve or else it perishes." With the paradigm shift of emphasis toward the prevention of dental caries, it has been proven that laser irradiation protects against both caries initiation and caries progression. Aim The aim of the study was to evaluate and compare the micromorphology of caries-free extracted premolars using a Scanning electron microscope (SEM) after fissurotomy by conventional fissurotomy bur and erbium, chromium: yttrium, scandium, gallium, and garnet (ER, CR: YSGG) hard-tissue laser. Methodology Sixty caries-free premolars extracted atraumatically for orthodontic treatment were included in the study. The samples were divided into two groups randomly (Group 1: fissurotomy by bur, n = 30, and Group 2: fissurotomy by hard-tissue laser, n = 30). Each sample was further divided into halves from the occlusal surface wherein one-half of the occlusal surface received fissurotomy procedure and the other half was control. Samples were analyzed by scanning electron microscopy (SEM) for micromorphological changes. Results Profile image of control samples revealed the disorganization of enamel surface at the junction of fissures forming a heterogeneous tissue and agglomeration of enamel with deep pit and fissure. On the contrary, the image of experimented samples (with laser fissurotomy) showed smooth enamel surface and homogeneous enamel subsurface with wider pit and fissure owing to self-cleansing ability. Conclusion On the grounds of the present study results, it could be concluded that the intervention of ER, CR: YSGG hard-tissue laser possesses self-cleansable pit and fissures for caries prevention and has the potential to irradicate the smear layer entirely for superior attachment of remineralizing agents.
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Affiliation(s)
- Priyanka Aggarwal
- Department of Pediatric and Preventive Dentistry, ITS-CDSR, Muradnagar, Uttar Pradesh, India
| | - Pallavi Anand
- Department of Pediatric and Preventive Dentistry, ITS-CDSR, Muradnagar, Uttar Pradesh, India
| | - Kopal Singh
- Department of Pediatric and Preventive Dentistry, ITS-CDSR, Muradnagar, Uttar Pradesh, India
| | - Pulkit Jhingan
- Department of Pediatric and Preventive Dentistry, ITS-CDSR, Muradnagar, Uttar Pradesh, India
| | - Manvi Malik
- Department of Pediatric and Preventive Dentistry, ITS-CDSR, Muradnagar, Uttar Pradesh, India
| | - Shivani Mathur
- Department of Pediatric and Preventive Dentistry, ITS-CDSR, Muradnagar, Uttar Pradesh, India
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Dias-Moraes MC, Castro PAA, Pereira DL, Ana PA, Freitas AZ, Zezell DM. Assessment of the preventive effects of Nd:YAG laser associated with fluoride on enamel caries using optical coherence tomography and FTIR spectroscopy. PLoS One 2021; 16:e0254217. [PMID: 34234361 PMCID: PMC8263272 DOI: 10.1371/journal.pone.0254217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
Objective This in vitro study characterized and monitored, by Optical Coherence Tomography (OCT) and Fourier Transformed Infrared Spectroscopy (FTIR), the effects of the association of acidulated phosphate fluoride gel (APF-gel) and Nd:YAG (neodymiun:yttrium-aluminum-garnet) laser, as sequencial treatments, in the prevention of incipient enamel caries lesions. Methods 120 human enamel samples were randomized into 3 groups (n = 40): APF-gel (1.23% F-, 4 min.); Laser+APF (Nd:YAG laser irradiation—0.6W, 84.9J/cm2, 10Hz, followed by APF-gel); and APF+Laser (APF-gel followed by laser irradiation). The samples were subjected to a 15-day pH-cycling, evaluated by OCT (quantification of optical attenuation coefficient–OAC) and FTIR (analysis of carbonate and phosphate content) before treatments, after treatments, and on the 5th, 10th and 15th days of pH-cycling. The statistical analysis was performed (α = 5%). Results The Optical Attenuation Coefficient (OAC) assessed by OCT increases with the progression of demineralization, and the Laser+APF presented the highest values of OAC in 10th and 15th days of pH-cycling. Nd:YAG decreased the carbonate content after treatment regardless of the application order of the APF-gel, while APF-gel did not interfere in the composition of enamel. The carbonate content was also changed in the first 5 days of the pH-cycling in all groups. Conclusion Nd:YAG laser irradiation before or after the application of APF-gel did not influence the appearance of incipient caries lesions, showing no synergistic effect. Regardless of the application order of the APF-gel, laser irradiation reduces the carbonate content of the enamel, which also changes during the demineralization process. However, irradiation before the application of APF-gel increased the speed of progression of the lesions, which positively impacts public health as it can prevent caries disease, even in high risk individuals. OCT and FTIR are suitable for assessing this effect.
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Affiliation(s)
- Marcia Cristina Dias-Moraes
- Center for Lasers and Applications, Instituto de Pesquisas Energeticas e Nucleares, IPEN—CNEN/SP, Sao Paulo, SP, Brazil
| | - Pedro Arthur Augusto Castro
- Center for Lasers and Applications, Instituto de Pesquisas Energeticas e Nucleares, IPEN—CNEN/SP, Sao Paulo, SP, Brazil
| | - Daísa Lima Pereira
- Center for Lasers and Applications, Instituto de Pesquisas Energeticas e Nucleares, IPEN—CNEN/SP, Sao Paulo, SP, Brazil
| | - Patrícia Aparecida Ana
- Center for Engineering, Modelling and Applied Social Sciences, Universidade Federal do ABC, Sao Bernardo do Campo, SP, Brazil
| | - Anderson Zanardi Freitas
- Center for Lasers and Applications, Instituto de Pesquisas Energeticas e Nucleares, IPEN—CNEN/SP, Sao Paulo, SP, Brazil
| | - Denise Maria Zezell
- Center for Lasers and Applications, Instituto de Pesquisas Energeticas e Nucleares, IPEN—CNEN/SP, Sao Paulo, SP, Brazil
- * E-mail:
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Al-Maliky MA, Frentzen M, Meister J. Laser-assisted prevention of enamel caries: a 10-year review of the literature. Lasers Med Sci 2019; 35:13-30. [PMID: 31399861 DOI: 10.1007/s10103-019-02859-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 08/01/2019] [Indexed: 01/13/2023]
Abstract
Since the invention of lasers in dentistry, investigations in caries prevention by the use of laser radiation have been proposed. There are several mechanisms stated for this purpose such as photothermal and/or photochemical interaction processes with the enamel. Alone or in conjugation with topical fluoride application, this treatment modality may improve enamel acid resistance in high-caries-risk populations. Data collection was done by searching the keywords caries, prevention, and laser in PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar. Lasing protocols of the collected literature and their effectiveness as well as examination methods used to verify treatment outcomes have been evaluated. One hundred eighteen publications were found for the last 10 years. The wavelengths investigated for caries prevention are mainly located in the near and the mid-infrared spectral range. In the evaluated period of time, investigations using CO2; Er:YAG; Er,Cr:YSGG; Er:YLF; fundamental, second, and third harmonic generations of Nd:YAG; diodes; and argon ion lasers were found in the databases. Accounting for 39% of the literature, CO2 laser was the most examined system for this purpose. Reviewing the literature in this narrative review showed that all laser systems presented a positive effect in varying degrees. Laser irradiation could be an alternative or synergistic to topical fluoridation for enamel caries prevention with longer lasting effect. Further research should be focused on selecting proper laser settings to avoid damage to enamel and developing effective evidence-based clinical protocols.
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Affiliation(s)
- Mohammed Abbood Al-Maliky
- Department of Periodontology, Operative and Preventive Dentistry, Dental Faculty, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany. .,Center of Applied Medical Laser Research and Biomedical Optics (AMLaReBO), University of Bonn, Bonn, Germany. .,Department of Biomedical Applications, Institute of Laser for Postgraduate Studies, University of Baghdad, Baghdad, Iraq.
| | - Matthias Frentzen
- Department of Periodontology, Operative and Preventive Dentistry, Dental Faculty, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany
| | - Jörg Meister
- Department of Periodontology, Operative and Preventive Dentistry, Dental Faculty, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany.,Center of Applied Medical Laser Research and Biomedical Optics (AMLaReBO), University of Bonn, Bonn, Germany
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Pereira DL, Freitas AZ, Bachmann L, Benetti C, Zezell DM, Ana PA. Variation on Molecular Structure, Crystallinity, and Optical Properties of Dentin Due to Nd:YAG Laser and Fluoride Aimed at Tooth Erosion Prevention. Int J Mol Sci 2018; 19:ijms19020433. [PMID: 29389868 PMCID: PMC5855655 DOI: 10.3390/ijms19020433] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 11/16/2022] Open
Abstract
This in vitro study evaluated the compositional, crystalline, and morphological effects promoted by Nd:YAG laser on root dentin, and verified the effects of laser and topical acidulated phosphate fluoride application (APF-gel) on dentin erosion. 180 bovine dentin slabs were randomized into 4 groups (n = 45): G1–untreated, G2–APF-gel (1.23% F−, 4 min), G3–Nd:YAG (1064 nm, 84.9 J/cm2, 10 Hz), and G4–APF-gel application followed by Nd:YAG laser irradiation. The compositional, crystalline, and morphological effects promoted by treatments were investigated on five samples of each experimental group. The other samples were submitted to a 5-day, 10-day, or 15-day erosive and abrasive demineralization and remineralization cycling in order to create erosion lesions. The area and depth of lesions, as well as the optical attenuation coefficient, were assessed, and all data were statistically analysed (p < 0.05). Nd:YAG laser promoted the reduction of carbonate, the formation of tetracalcium phosphate, as well as the melting and recrystallization of the dentin surface. Laser significantly decreased the area and depth of erosion lesions and altered the optical attenuation coefficient when compared to untreated and APF-gel groups, but the association of APF-gel and laser did not promote an additional effect. Nd:YAG laser irradiation can be a promissory treatment to prevent dentin erosion and the abrasion process.
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Affiliation(s)
- Daísa L Pereira
- Center for Engineering, Modeling and Applied Social Sciences, Universidade Federal do ABC, Sao Bernardo do Campo, SP 09606-045, Brazil.
- Center for Lasers and Applications, Instituto de Pesquisas Energéticas e Nucleares, IPEN-CNEN/SP, Sao Paulo, SP 05508-000, Brazil.
| | - Anderson Z Freitas
- Center for Lasers and Applications, Instituto de Pesquisas Energéticas e Nucleares, IPEN-CNEN/SP, Sao Paulo, SP 05508-000, Brazil.
| | - Luciano Bachmann
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de Sao Paulo, Ribeirao Preto, SP 14040-900, Brazil.
| | - Carolina Benetti
- Center for Engineering, Modeling and Applied Social Sciences, Universidade Federal do ABC, Sao Bernardo do Campo, SP 09606-045, Brazil.
| | - Denise M Zezell
- Center for Lasers and Applications, Instituto de Pesquisas Energéticas e Nucleares, IPEN-CNEN/SP, Sao Paulo, SP 05508-000, Brazil.
| | - Patricia A Ana
- Center for Engineering, Modeling and Applied Social Sciences, Universidade Federal do ABC, Sao Bernardo do Campo, SP 09606-045, Brazil.
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Belcheva A, El Feghali R, Nihtianova T, Parker S. Effect of the carbon dioxide 10,600-nm laser and topical fluoride gel application on enamel microstructure and microhardness after acid challenge: an in vitro study. Lasers Med Sci 2018; 33:1009-1017. [PMID: 29354864 DOI: 10.1007/s10103-018-2446-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/12/2018] [Indexed: 11/29/2022]
Abstract
The aim of this in-vitro study was to evaluate positive effects of the carbon dioxide laser (CO2, 10,600 nm) with acidulated phosphate fluoride (APF) gel on enamel acid resistance. Twenty extracted human third molars (40 surfaces) were randomly assigned into four groups: group C, untreated control; group L, CO2 laser alone group; group F, APF 1.23% fluoride gel; and group FL, APF 1.23% gel and laser. Samples from group L were irradiated with a CO2 laser for 30s. The parameter settings used were average power, 0.73 W; time on, 100 μs; time off, 40 ms; tip-to-tissue distance, 20 mm; tip diameter 700 μm; and energy density with movements, 5 J/cm2. Samples from group F were treated with the APF gel for 4 min, and the gel was washed off with distilled water. The enamel samples from group FL were treated with APF gel for 4 min and then irradiated with the CO2 laser for 30s without removing the gel. Each enamel sample was placed in 50 ml soft drink (pH = 2.75) for 10 min then rinsed with deionized water and stored in artificial saliva at 37 °C for 1 h. Samples were assessed for Vickers hardness number (VHN) before and after treatments and subjected to SEM analysis. Data were analyzed using a one-way analysis of variance (ANOVA) and Tukey's test (α < 0.05). After the acid challenge, the untreated C group was demineralized to a great extent and the enamel surface was with the lowest mean score of microhardness. The observed VHN in the control (C group) had a mean value of 176.13, the scores in the CO2 laser group (L group) were with mean value of 238.40, the F group with a mean value of 218.45, and the fluoride-treated and laser-irradiated FL group-with a mean of 268.28 VHN. Paired t test performed to compare groups C, L, F, and FL has shown that group FL has greater resistance to decrease in microhardness of dental enamel (P ≤ 0.05) on exposure to acidic protocol. After the acid challenge, the fluoride-treated and laser-irradiated samples (group FL) showed the least diminution in enamel surface microhardness. The sub-ablative carbon dioxide laser irradiation in combination with fluoride treatment is more effective in protecting enamel surface and resisting demineralization than CO2 laser irradiation or fluoride alone.
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Affiliation(s)
- A Belcheva
- Department of Pediatric Dentistry, Faculty of Dental medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - R El Feghali
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - T Nihtianova
- Department of Pediatric Dentistry, Faculty of Dental medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - S Parker
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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Ramalho KM, Hsu CYS, de Freitas PM, Aranha ACC, Esteves-Oliveira M, Rocha RG, de Paula Eduardo C. Erbium Lasers for the Prevention of Enamel and Dentin Demineralization: A Literature Review. Photomed Laser Surg 2015; 33:301-19. [DOI: 10.1089/pho.2014.3874] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karen Müller Ramalho
- Department of Stomatology, School of Dentistry of the University of São Paulo (USP) Prof. São Paulo, SP, Brazil
| | - Chin-ying Stephen Hsu
- Department of Dentistry, Faculty of Dentistry, National University of Singapore (NUS), Singapore
| | - Patrícia Moreira de Freitas
- Department of Restorative Dentistry, School of Dentistry of the University of São Paulo (USP), São Paulo, SP, Brazil
| | - Ana Cecília Correa Aranha
- Department of Restorative Dentistry, School of Dentistry of the University of São Paulo (USP), São Paulo, SP, Brazil
| | - Marcella Esteves-Oliveira
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Rodney Garcia Rocha
- Department of Stomatology, School of Dentistry of the University of São Paulo (USP) Prof. São Paulo, SP, Brazil
| | - Carlos de Paula Eduardo
- Department of Restorative Dentistry, School of Dentistry of the University of São Paulo (USP), São Paulo, SP, Brazil
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Influence of the Nd:YAG laser pulse duration on the temperature of primary enamel. ScientificWorldJournal 2015; 2015:396962. [PMID: 25874244 PMCID: PMC4385661 DOI: 10.1155/2015/396962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/23/2014] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to evaluate the temperature change on specimens of primary enamel irradiated with different pulse duration of Nd:YAG laser. Fifteen sound primary molars were sectioned mesiodistally, resulting in 30 specimens (3.5 × 3.5 × 2.0 mm). Two small holes were made on the dentin surface in which K-type thermocouples were installed to evaluate thermal changes. Specimens were randomly assigned in 3 groups (n = 10): A = EL (extra long pulse, 10.000 μs), B = LP (long pulse, 700 μs), and C = SP (short pulse, 350 μs). Nd:YAG laser (λ = 1.064 μm) was applied at contact mode (10 Hz, 0.8 W, 80 mJ) and energy density of 0.637 mJ/mm(2). Analysis of variance (ANOVA) was performed for the statistical analysis (P = 0.46). Nd:YAG laser pulse duration provided no difference on the temperature changes on primary enamel, in which the following means were observed: A = EL (23.15°C ± 7.75), B = LP (27.33°C ± 11.32), and C = SP (26.91°C ± 12.85). It can be concluded that the duration of the laser pulse Nd:YAG increased the temperature of the primary enamel but was not influenced by different pulse durations used in the irradiation.
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Zamudio-Ortega CM, Contreras-Bulnes R, Scougall-Vilchis RJ, Morales-Luckie RA, Olea-Mejía OF, Rodríguez-Vilchis LE, García-Fabila MM. Morphological and Chemical Changes of Deciduous Enamel Produced by Er:YAG Laser, Fluoride, and Combined Treatment. Photomed Laser Surg 2014; 32:252-9. [DOI: 10.1089/pho.2013.3622] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Carmen M. Zamudio-Ortega
- Universidad Autónoma del Estado de México, Facultad de Odontología, Centro de Investigación y Estudios Avanzados en Odontología (CIEAO), Toluca, Estado de México, México
| | - Rosalía Contreras-Bulnes
- Universidad Autónoma del Estado de México, Facultad de Odontología, Centro de Investigación y Estudios Avanzados en Odontología (CIEAO), Toluca, Estado de México, México
| | - Rogelio J. Scougall-Vilchis
- Universidad Autónoma del Estado de México, Facultad de Odontología, Centro de Investigación y Estudios Avanzados en Odontología (CIEAO), Toluca, Estado de México, México
| | - Raúl A. Morales-Luckie
- Universidad Autónoma del Estado de México-Universidad Nacional Autónoma de México, Centro Conjunto de Investigación en Química Sustentable (CCIQS), San Cayetano de Morelos, Toluca, Estado de México, México
| | - Oscar F. Olea-Mejía
- Universidad Autónoma del Estado de México-Universidad Nacional Autónoma de México, Centro Conjunto de Investigación en Química Sustentable (CCIQS), San Cayetano de Morelos, Toluca, Estado de México, México
| | - Laura E. Rodríguez-Vilchis
- Universidad Autónoma del Estado de México, Facultad de Odontología, Centro de Investigación y Estudios Avanzados en Odontología (CIEAO), Toluca, Estado de México, México
| | - María M. García-Fabila
- Universidad Autónoma del Estado de México, Facultad de Química, Toluca, Estado de México, México
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