Pattern of transmission of laser light in teeth

Root Canal Disinfection in Permanent Molars with Apical Lesion by Antimicrobial Photodynamic Therapy: Protocol for a Blind Randomized Clinical Trial

Objective: The proposed study aims to compare the effectiveness of conventional endodontic treatment (ET) with that of ET associated with antimicrobial photodynamic therapy (aPDT) in patients with apical lesion. Methods: Controlled, double-blind, randomized clinical trial (RCT); superiority study with three parallel arms. Randomization will be conducted in exchange blocks of six, with allocation 1:1:1. The control group will receive conventional ET, while experimental group 1 (EG1) will receive conventional ET + aPDT with laser at 660 nm, fluence of 600 J/cm2; EG2 will receive conventional ET + aPDT with laser at 660 nm, fluence of 1200 J/cm2. The primary outcome will be canal disinfection before treatment, measured by analysis of colony formation (CFU/mL) and the success rate measured after 6 months on the clinical and radiographic evaluations. The mean and standard deviation will be calculated for continuous outcomes, and the CFU/mL mean between groups will be evaluated by ANOVA test. The Chi-squared test will be calculated for binary outcomes. A logistic regression analysis will be performed to assess differences in the success rate between groups, adjusted for the covariates. The Stata 18 software will be used, with a significance threshold of 5%. Conclusions: Few RCTs have evaluated the effectiveness of aPDT in root canal disinfection in patients with permanent dentition presenting apical lesion. New RCTs with larger numbers of participants are needed to support using aPDT as an adjuvant to conventional ET in root canal disinfection for routine use in clinical practice. The trial was registered prospectively in ClinicalTrials.gov (NCT05916859).

Transmission of 940 nm diode laser to the radicular area during its application as root canal disinfectant

To measure the transmitted laser power in the coronal, middle and apical root thirds during vertical and horizontal irradiation of laser. 14 mm length whole roots and longitudinal root sections were irradiated using a 940 nm diode laser with 0.5 W in continuous mode for 5 s. A power detector was placed in front of the root apex for the vertical transmitted power measurement and placed laterally to root surface for the horizontal transmission experiment. The transmitted power from the root apex vertically was 53% of the irradiated power, while for the horizontal transmission experiment for the coronal, middle and apical root thirds were 25.6%, 40.4% and 41.3%, respectively. Irradiation of root canals with 940 nm laser power can be transmitted during vertical irradiation in more than 50% of the samples, whereas less transmission happens with horizontal irradiation at apical and middle root third than coronal.

Impact of thermal photodynamic disinfection on root dentin temperature in vitro

BACKGROUND

Thermal photodynamic disinfection procedures have been proposed for adjunctive endodontic treatment. This study assessed photothermal disinfection relative to root dentin temperature and the thermal effects of simulated periodontal blood flow.

METHODS

Thirty freshly extracted human single-rooted teeth were prepared endodontically using a 45/.02 master apical file. The root surfaces were coated with wax and covered with thermoforming sheets, leaving a circumferential space of 0.25 mm after wax removal. The sheets were perforated to allow fluid circulation through the simulated periodontal space. Irradiation was performed in two groups of 30: I, 810 nm laser (1.5 W, continuous wave), 4 × 5 s; II, photothermal group: indocyanine green and 810 nm laser (200 mW, continuous wave), 20 s. Thermographic measurements were performed at different water flow rates (6, 2.6, 0 mL/min) with a baseline temperature of 37 °C. Nonparametric statistical analysis was performed (Wilcoxon).

RESULTS

The highest temperature change (median 7.52 °C, range 0.82-18.32 °C) was with 810 nm laser irradiation in group I, without any simulated blood flow. Fluid circulation resulted in a significant reduction in temperature changes in this group (median 2.14 °C, range 0.37-9.83 °C; p  < 0.05). The lowest temperature changes were in the photothermal group with a water flow rate of 6 mL/min (median 0.79 °C, range 0.00-3.88 °C; p < 0.05).

CONCLUSION

Photothermal disinfection of root canals can increase root canal dentin temperatures, but periodontal fluid circulation has a cooling effect on the outer root surface, reducing the risk of potential thermal injury to periodontal tissue.

A Spectrophotometric Study on Light Attenuation Properties of Dental Bleaching Gels: Potential Relevance to Irradiation Parameters

Background: During in-office bleaching, appropriate light sources are applied in order to enhance the activity of the bleaching gels applied onto teeth. For this method to be effective, a high absorption of light within the gel is necessary. Variation in the light attenuation capability of the gel, the duration of application and light activation can contribute towards safety hazards associated with this procedure. Methods: In this study, seven different gels and hydrogen peroxide have been evaluated for their optical properties by means of spectrophotometry (440–1000 nm). The transmitted light spectrum was used to estimate the intensity loss for each gel. The mean intensity decreases observed were statistically analysed using an analysis of variance (ANOVA). Results: The five more-pigmented gels tested indicated a very similar intensity loss of around 80%, whereas the remaining two gels showed significantly less attenuation (predominantly, p < 10⁻⁶). Conclusions: Throughout the spectrum of wavelengths examined, and according to the underlying studies evaluated, five of the gels assessed demonstrated an attenuation high enough to possibly avoid overheating of the underlying enamel dentine and pulp. An evaluation of appropriate irradiation parameters is proposed.

Anatomical Shaping for Zirconia Custom Implant Abutment to Enhance Anterior Esthetic: A Clinical Technique

Abutments are used in dentistry to attach dental crowns to dental implant. Currently, zirconia custom abutment is the one which is mostly used in restorations, since it offers several advantages, especially better esthetics and prevention from infection. Several innovations are done in the implant designs and procedures to achieve better esthetics. Computer-aided design & computer-aided manufacturing (CAD/CAM) system is widely used innovative technology in dentistry. This technology offers custom implants that help to achieve better esthetics and good internal fit. This procedure used a novel technique of anatomical modification of the final abutment incisal edge from straight anatomical edge to irregular one with a mamelon-incisal effect to enhance esthetic, shade matching, and anatomical replication of incisal structure that resembles the natural incisor. Usually, dental technicians will perform facial and incisal cut-back and apply porcelain layers to the crown in order to reproduce the translucency and the other optical effects that most closely match that of natural dentin and enamel, especially at the incisal edge. These optical effects will make the prosthetic crown look more natural and esthetically pleasant. By this presented technique will help the dental technician to achieve highly esthetic crown with completely digital workflow without the need for porcelain layering. The procedure was also followed up to 3, 6, and 12 months after the surgery and found no complications or complaints from the patient and esthetically satisfied.

The combined effect of light-illuminating direction and enamel rod orientation on color adjustment at the enamel borders of composite restorations

OBJECTIVES

To investigate the effect of light-illuminating direction (from composite or enamel side) on color adjustment at the coronal and cervical enamel borders in composite restorations.

MATERIALS AND METHODS

Forty cylindrical holes (3.0-mm diameters) were prepared in bovine enamel disks (1.0-mm thickness). After application of a one-step self-etch adhesive, one of four resin composites (Estelite Asteria, EA; Estelite Pro, EP; Kalore, KA; Clearfil Majesty ES-2 Premium, MJ) was restored in the holes. After 24-h storage, the colors (L*, C*, or h* values) at the restored enamel disks over a black background were measured in a black box using a CIE XYZ camera, spotted with D65 standard illuminant either from coronal or cervical side at 45°/0° geometry. The color shifting rate was calculated at the coronal and cervical enamel borders of the composite restorations, and analyzed by three-way ANOVA with Dunnett's T3 and t test for post hoc analysis (p < 0.05).

RESULTS

The light-illuminating directions significantly affected the L* shifting rate at the cervical enamel border in EP and MJ (p < 0.05), and the C* shifting rate at the coronal enamel border in EA, EP, and MJ (p < 0.05).

CONCLUSIONS

The color appearance at the border of the composite restoration was influenced by the light-illuminating direction in conjunction with the enamel rod orientation in the coronal or cervical enamel border.

CLINICAL RELEVANCE

The line-of-vision angle would affect the perception of color adaptation at the enamel borders in the composite restorations.

Postoperative pain and antibacterial effect of 980 nm diode laser versus conventional endodontic treatment in necrotic teeth with chronic periapical lesions: A randomized control trial

Background: Many challenges encounter the endodontist, especially when dealing with necrotic teeth with chronic periapical lesions. Postoperative pain may be induced following conventional endodontic therapy and total eradication of the bacteria is almost unachievable even with recently available techniques. In recent years, diode laser usage in the endodontic field has gained acceptance. Thus, this study aimed to investigate the ability of the diode laser (DL) to decrease postoperative pain and achieve root canal sterility. Methods: 56 patients with anterior teeth with chronic periapical lesions in upper anterior teeth were randomly divided into two groups (n = 28). All patients were treated with two visits of conventional root canal treatment with ProTaper Universal. The DL group: root canals were irradiated with 200 µm fiber optic at both visits; the control group (Endo): the DL fiber was placed in root canal with no activation. Bacterial samples were collected from all the cases at each step of the treatment. Pain levels were evaluated using a numerical rating scale preoperatively, and after 6, 12, 24, 48 hours and 7 days. Bacterial count was used to detect both aerobic and anaerobic bacterial load.  Results: The qualitative pain scores revealed statistically significant lower pain levels in the DL group compared with the Endo group at all time intervals (P<0.001), except preoperatively where there was no significant difference. There was a statistically significant lower bacterial count for both aerobic and anaerobic bacteria in the DL group compared with the Endo group in both S3 samples (after laser application) and S4 samples (bacterial colonization) (P<0.001). Conclusion: The 980 nm diode laser may be a successful adjunct to conventional endodontic treatment of necrotic cases with chronic periapical lesions in terms of postoperative pain and root canal disinfection.   Trail registration: PACTR201511001275414 (date: 23 rd September 2015).

Influence of enamel prism orientations on color shifting at the border of resin composite restorations

This study aimed to investigate the influence of enamel prism orientations on color adjustment of resin composite restoration. The color measurements (L*, C*, or h* values) at the restored bovine enamel disk (1.0 mm-thick) with resin composite (Estelite Asteria, Estelite Pro, Kalore, Clearfil Majesty) were performed using a CIE XYZ camera (RC500). The color shifting rate and range at the coronal and cervical border were calculated. The coronal border was significantly lower L* and C* color shifting rate than the cervical border (p<0.05). The L* color shifting range was significantly affected by regions in the 3-mm cavity group (p<0.05), but not in the 1-mm cavity group (p>0.05), while the C* color shifting range was not significantly affected by regions (p>0.05). The coronal enamel border with diagonal-cut of enamel prisms would have an advantage for color adjustment of resin composite restorations compared to the cervical border with longitudinal-cut of enamel prisms.

The Antibacterial Effect of Additional Photodynamic Therapy in Failed Endodontically Treated Teeth: A Pilot Study

Introduction: Root canal therapy as a routine dental procedure has resulted in retention of millions of teeth that would otherwise be lost. Unfortunately, successful outcomes are not always achievable within initial endodontic treatments, and that necessitates further treatment. Nonsurgical retreatment is the first choice in most clinical situations. The aim of this clinical pilot study was to assess the effect of additional photodynamic therapy (PDT) on intraradicular bacterial load following retreatment of failed previously root treated teeth. Methods: Thirty single-rooted/canalled endodontically treated matured teeth (in 27 healthy patients) accompanied by apical periodontitis (AP) were selected for this study. Standard protocol was followed for nonsurgical retreatment of each tooth. Microbiological samples were taken after establishment of apical patency, finished cleaning/shaping procedure, and PDT (665 nm, 1 W, 240 seconds). All samples were cultured for 72 hours and colony-forming unit (CFU) was counted. McNemar test was used for statistical analysis of the data. The level of significance was set at 0.001. Results: Routine cleaning and shaping resulted in twenty four negative (80%) out of 30 cultures. Four additional negative results were obtained after additional PDT (93.3%). The addition of PDT to routine procedures significantly enhanced the number of bacteria-free samples (P < 0.001). Conclusion: Regarding elimination of intraradicular microbiota, additional PDT may increase the effectiveness of conventional chemomechanical preparation in previously root filled teeth accompanied by AP. Well controlled randomized clinical trials should be planned for future.

Magnification—a New Look at a Long-known Optical Property of Dentin

Light propagation in human dentin exhibits a strong directional dependence featuring the long-known optical magnification property. We hypothesized that this anisotropic effect is caused by multiple scattering at the dentin tubules, and not by fiberoptic effects, as had been previously assumed. We performed measurements of the transmitted intensity from dentin disks and compared them with Monte Carlo simulations of light propagation in dentin, considering the scattering by the tissue’s microstructure. We found that the optical anisotropy of dentin can be fully explained with this model. We concluded that the magnification property of dentin is due to multiple scattering by the dental microstructure.

Laser Application in Dentistry: Irradiation Effects of Nd:YAG 1064 nm and Diode 810 nm and 980 nm in Infected Root Canals-A Literature Overview

Objective. In endodontics, Nd:YAG laser (1064 nm) and diode laser (810 nm and 980 nm) devices are used to remove bacteria in infected teeth. A literature review was elaborated to compare and evaluate the advantages and disadvantages of using these lasers. Methods. Using combined search terms, eligible articles were retrieved from PubMed and printed journals. The initial search yielded 40 titles and 27 articles were assigned to full-text analysis. The studies were classified based upon laser source, laser energy level, duration/similarity of application, and initial and final bacterial count at a minimum of 20 prepared root canals. Part of the analysis was only reduced microorganisms and mechanically treated root canals upon preparation size of ISO 30. All studies were compared to evaluate the most favorable laser device for best results in endodontic therapy. Results. A total of 22 eligible studies were found regarding Nd:YAG laser 1064 nm. Four studies fulfilled all demanded criteria. Seven studies referring to the diode laser 980 nm were examined, although only one fulfilled all criteria. Eleven studies were found regarding the diode laser 810 nm, although only one study fulfilled all necessary criteria. Conclusions. Laser therapy is effective in endodontics, although a comparison of efficiency between the laser devices is not possible at present due to different study designs, materials, and equipment.

Photodynamic Inactivation of Root Canal Bacteria by Light Activation through Human Dental Hard and Simulated Surrounding Tissue

Introduction: Photodynamic inactivation of bacteria (PIB) may be a supportive antimicrobial approach for use in endodontics, but sufficient activation of photosensitizers (PS) in root canals is a critical point. Therefore, aim of this study was to evaluate the ability of PS absorbing blue (TMPyP) or red light (Methylene Blue; MB) for light activation through human dental hard and simulated surrounding tissue to inactivate root canal bacteria.

Methods: A tooth model was fabricated with a human premolar and two molars in an acrylic resin bloc simulating the optical properties of a porcine jaw. The distal root canal of the first molar was enlarged to insert a glass tube (external diameter 2 mm) containing PS and stationary-phase Enterococcus faecalis. Both PS (10 μM) were irradiated for 120 s with BlueV (20 mW/cm²; λ_em = 400–460 nm) or PDT 1200L (37.8 mW/cm²; λ_em = 570–680 nm; both: Waldmann Medizintechnik), respectively. Irradiation parameters ensured identical numbers of photons absorbed by each PS. Three setups were chosen: irradiating the glass pipette only (G), the glass pipette inside the single tooth without (GT) and with (GTM) simulated surrounding tissues. Colony forming units (CFU) were evaluated. Transmission measurements of the buccal halves of hemisected mandibular first molars were performed by means of a photospectrometer.

Results: PIB with both PS led to reduction by ≥ 5 log₁₀ of E. faecalis CFU for each setup. From transmission measurements, a threshold wavelength λ_th for allowing an amount of light transmission for sufficient activation of PS was determined to be 430 nm.

Conclusion: This study can be seen as proof of principle that light activation of given intra-canal PS from outside a tooth may be possible at wavelengths ≥ 430 nm, facilitating clinical application of PIB in endodontics.

Changes in Maxillary Canine Pulpal Blood Flow During Dentoalveolar Distraction Osteogenesis

OBJECTIVE

The aim of this study was to assess the effects of dentoalveolar distraction osteogenesis (DD) on the pulpal blood flow (PBF) of maxillary canines.

MATERIALS AND METHODS

A laser Doppler flowmeter (LDF) was used to measure PBF in maxillary canines of 10 patients undergoing DD (study group) and 10 nonsurgical subjects who received no orthodontic treatment (control group). PBF was measured at baseline, at 4 and 7 days postoperatively, at the end of distraction and at the end of consolidation in the study group and at similar time-points in nonsurgical control subjects. Data were analyzed using paired and Student t tests, with the significance level set at 0.05.

RESULTS

Study findings showed that baseline PBF values did not differ significantly between groups. PBF in the control group did not vary over time; however, in the study group, an initial decrease in PBF was observed at 4 days postoperatively and was followed by a gradual increase to preoperative levels at the end of distraction.

CONCLUSIONS

During the DD latency period, there appears to be a short-lived ischemic phase when perfusion of pulp tissue declines; however, blood-flow returns to normal by the end of distraction.

The Antibacterial Efficacy of Photo-Activated Disinfection, Chlorhexidine and Sodium Hypochlorite in Infected Root Canals: An in Vitro Study

INTRODUCTION

This study compared the efficacy of light-activated low-power laser, 2% chlorhexidine (CHX) and 2.5% NaOCl in eliminating Enterococcus faecalis (E. faecalis) from the root canal system.

METHODS AND MATERIALS

The root canals of 60 maxillary central incisors were contaminated with E. faecalis and then the bacteria were incubated for 24 h. All the root canals were instrumented in a crown-down manner with #4 and 3 Gates-Glidden drills, followed by RaCe rotary files (40/0.10, 35/0.08, and 30/0.06). The samples were randomly assigned to three experimental groups and one control group (n=15). In the control group no intervention was made. In the photo-activated disinfection (PAD) group, laser therapy was undertaken with diode laser beams (with an output power of 100 mW/cm(2)) for 120 sec. For the other two experimental groups, root canals were irrigated either with 5 mL of 2% CHX or 2.5% NaOCl solutions, respectively. The Kruskal-Wallis test was used to compare the CFU values of the bacteria and post-hoc Bonferroni test was used for pairwise comparisons. The level of significance was set at 0.05.

RESULTS

The inhibition of bacterial growth in all the experimental groups was significantly superior to the control group (P<0.05). There was no significant difference between the effect of PAD and 2% CHX (P=0.05). The effect of 2.5% NaOCl was significantly better than that of the PAD technique (P<0.001). In addition, 2.5% NaOCl was significantly better than 2% CHX (P=0.007).

CONCLUSION

Photodynamic therapy was effective in reducing the E. faecalis counts in comparison with the control group, but 2.5% NaOCl solution was the most effective protocol.

Microhardness of composite resin cured through different primary tooth thicknesses with different light intensities and curing times: In vitro study

Objective:

The aim of this study was to evaluate the effect of increased exposure time and light intensity on microhardness of cured composite through different thicknesses of tooth structure in primary teeth.

Materials and Methods:

One hundred and seventy cylindrical resin composite specimens were prepared. All specimens were divided into 17 experimental and control groups. “Light-emitting diode” light curing unit (LCU) applied directly or through 1, 2, and 3 mm thicknesses tooth slices for experimental groups. The irradiation protocols were 25 and 50 s at 650 mW/cm² and 15 and 30 s at 1100 mW/cm². The “quartz-tungsten-halogen” LCU (400 mW/cm²) for 40 s was used in control group. Microhardness was measured by the Vickers hardness test.

Results:

Indirectly cured specimens and those cured through a 1 mm thick tooth structure, an increase in intensity caused hardness drop. In the specimens cured through 2 and 3 mm thick tooth structures, increased intensity and/or exposure time did not show any appropriate changes on microhardness.

Conclusion:

Irradiation through a 1.0 mm thick tooth slice resulted in reduced microhardness although it was still within the clinically acceptable level. The hardness values of the specimens cured through 2 or 3 mm thick tooth slices fell below the clinically acceptable level even after doubling the exposure time and/or light intensity.

Effects of photodynamic therapy on Enterococcus faecalis biofilms

Microbial biofilms are involved in almost all infectious pathologies of the oral cavity. This has led to the search for novel therapies specifically aimed at biofilm elimination. In this study, we used atomic force microscopy (AFM) to visualize injuries and to determine surface roughness, as well as confocal laser scanning microscopy (CLSM) to enumerate live and dead bacterial cells, to determine the effects of photodynamic therapy (PDT) on Enterococcus faecalis biofilms. The AFM images showed that PDT consisting of methylene blue and a 670-nm diode laser (output power 280 mW during 30 s) or toluidine blue and a 628-nm LED light (output power 1000 mW during 30 s) induced severe damage, including cell lysis, to E. faecalis biofilms, with the former also causing an important increase in surface roughness. These observations were confirmed by the increase in dead cells determined using CLSM. Our results highlight the potential of PDT as a promising method to achieve successful oral disinfection.

Changes in maxillary incisor dental pulp blood flow during intrusion by mini-implants

AIM

The aim of this clinical study was to identify changes in pulpal blood flow (PBF) in human central incisors resulting from short- and long-term intrusive orthodontic forces from mini-implants.

MATERIALS AND METHODS

A total of 40 sound upper central and lateral incisors in 20 patients scheduled for intrusion for orthodontic reasons were divided into two groups. From each group, 20 teeth were subjected to intrusive force from mini-implants (Group 1 = Light Force: 40 g; Group 2 = Heavy Force: 120 g), whereas the remaining 20 contralateral teeth were not subjected to forces from mini-implants and served as controls. Laser-Doppler flowmetry (LDF) measurements were recorded at baseline and at 3 days and 3 weeks following intrusion.

RESULTS

PBF decreased significantly at 3 days (Light Force Group: 7.72 ± 0.50; Heavy Force Group: 7.72 ± 0.52) and then increased towards baseline at 3 weeks (Light Force Group: 10.37 ± 0.58; Heavy Force Group: 10.31 ± 0.45) following intrusion.

CONCLUSIONS

In other words, despite slight regressive changes in pulpal tissue in the short-term, PBF improved after 3 weeks following intrusion by mini-implants, indicating that the changes observed in PBF is reversible, even following radical incisor intrusion.

Clinical and radiographical evaluation of the healing of large periapical lesions using triple antibiotic paste, photo activated disinfection and calcium hydroxide when used as root canal disinfectant

OBJECTIVES

To evaluate clinically and radio graphically, the healing following nonsurgical treatment of periapical lesions when Photo Activated Disinfection(PAD), triple antibiotic paste and calcium hydroxide was used as root canal disinfectant.

MATERIAL AND METHODS

Sixty patients (20 for PAD, 20 for triple antibiotic paste, 20 for calcium hydroxide) with periapical lesions in the maxillary and mandibular anterior region were selected from the outpatient section of the Department of Conservative Dentistry & Endodontics, Govt. Dental College, Kozhikode to participate in this study. The patients were selected with a preoperative score of 4 or 5. There were no significant differences for the PAI Scores between the three groups at the start of the experiment .Intracanal disinfection was done in the three groups followed by obturation. The patients recalled at 3,6,12,18 months interval.

RESULTS

At 18 months follow up 15 % of cases failed in calcium hydroxide group,5% in triple antibiotic paste and no failure cases were seen in PAD group. Success criteria were divided into strict and loose, while the former had statistically significant p value the latter did not. Kruskal-Wallis Test showed an increased mean value for PDT and a significant change in p value. Bonferroni post hoc test was done to compare if there is any significant change between groups. Only significant change was found between calcium hydroxide and photoactivated disinfection .

CONCLUSION

PAD was more effective intracanal disinfectant at 6,12 and 18 months. Key words:Calcium, hydroxide, photo activated disinfection, triple antibiotic paste, root canal disinfection.

Pulp and periradicular testing

Pulp and periradicular testing is crucial to the initial trauma evaluation and to subsequent monitoring of the traumatized teeth and supporting structures. An accurate diagnosis serves as the basis for therapeutic intervention and helps to ensure that destruction of the dental structures will be minimized and function will be regained. The purpose of this review is to present the current best evidence for accurate diagnostic testing of the pulp and periapex of traumatized teeth. Five databases were searched for literature pertaining to pulpal testing and trauma. Widely recognized textbooks were also consulted. Currently used pulp vitality testing is constrained by its subjective character and by the fact that it is a measure of neuronal status and not true pulpal viability. Tests that measure tissue perfusion more accurately reflect pulpal vitality, but they are not available commercially. This review discusses the specificity, sensitivity, and accuracy of commonly used tests, with emphasis on the applicability of certain tests to specific patient presentations in trauma. Factors that influence test selection are discussed, and specific recommendations are made on the basis of best evidence. Although differences exist between the various studies as to the accuracy of commonly used pulpal and periradicular tests, most of these have acceptable predictive value. Pulpal and periradicular tests in the trauma patient should be used in conjunction with clinical and radiographic observations to arrive at a diagnosis and treatment plan.

Improvement of the detection of human pulpal blood flow using a laser Doppler flowmeter modified for low flow velocity

OBJECTIVE

Human pulpal blood flow (PBF) signals as measured by laser Doppler flowmeter (LDF) decrease with age. Although this decrease is considered to be due in part to slow blood flow, information regarding this velocity in humans has been lacking. The aims of the present study were to estimate the blood flow velocity in human dental pulp and to evaluate the validity of LDF modified for the measurement of slow blood flow.

DESIGN

Mean blood flow velocities at the upper central incisor, gingiva, fingertip and forearm of 28 volunteers (mean age: 38.6 years old) were estimated using LDF with a frequency analyser. Blood flow signals at these measurement areas were recorded using two different LDFs: (a) one with a standard blood flow range; and (b) one modified for low blood flow velocity.

RESULTS

The frequency range of the Doppler shift measured at the teeth with an opaque rubber dam was the narrowest (median: 4.3kHz) among all of the measurement areas. The estimated mean blood flow velocity was the slowest at the teeth with a dam (median: 0.18mm/s). LDF for low blood flow velocity detected larger and clearer pulsatile blood flow signals from the teeth with dams than did standard LDF.

CONCLUSIONS

The present results indicate that the velocity of PBF in humans is very low and that LDF modified for the measurement of slow blood flow is appropriate for PBF measurement in humans.

Antimicrobial efficacy of a high-power diode laser, photo-activated disinfection, conventional and sonic activated irrigation during root canal treatment

AIM

To evaluate the antimicrobial effect of a diode laser irradiation, photo-activated disinfection (PAD), conventional and sonic activated irrigation with 2.5% sodium hypochlorite (NaOCl) on Enterococcus faecalis.

METHODOLOGY

Root canals of 120 human extracted teeth with single straight canals were prepared with ProTaper files, sterilized, contaminated with an E. faecalis suspension and incubated for 7 days. They were then randomly distributed into six groups: G1, diode laser irradiation (2 W, 3 × 20 s); G2, PAD (100 mW, 60 s); G3, PAD with 3D Endoprobe (100 mW, 60 s); G4, 30-gauge syringe irrigation with NaOCl (60 s); G5, sonic agitation of NaOCl with the EndoActivator system (60 s); G6, 30-gauge syringe irrigation with NaCl (60 s). The pattern of colonization was visualized by scanning electron microscopy. The root canals were sampled by flushing with saline solution at baseline and after the treatments. The number of bacteria in each canal was determined by plate count. The presence and the absence of E. faecalis in root canals were also demonstrated by polymerase chain reaction (PCR).

RESULTS

There was a significant reduction in the bacterial population after all treatments (P < 0.001). The PAD, using both laser systems, and the sonic activated NaOCl irrigation were significantly more effective than diode irradiation and single NaOCl irrigation in reducing CFUs (P < 0.05). High-power diode laser and single NaOCl irrigation had an equal antibacterial effect (P > 0.05).

CONCLUSIONS

The PAD and EndoActivator system were more successful in reducing the root canal infection than the diode laser and NaOCl syringe irrigation alone.

Optical properties of enamel and translucent composites by diffuse reflectance measurements

OBJECTIVES

The aim of this study was to evaluate the optical properties of natural enamel and translucent composites by diffuse reflectance measurements and Kubelka-Munk's theory.

METHODS

Twenty natural enamel slabs and 80 composite replicas using four brands of translucent composites (Gradia Direct, Venus, Brilliant New line and Beautiful II; n=20) were evaluated at thicknesses of 1.0mm. The spectral distributions of enamel and composites were measured by means of a reflectance spectrophotometer. Optical constants including scattering coefficient (S), absorption coefficient (K), light reflectivity (RI) and infinite optical thickness (X(∞)) were calculated from the spectral reflectance data using Kubelka's equations. Paired t-tests were performed to evaluate the differences of optical constants (S, K, RI and X(∞)) between natural enamel and composites.

RESULTS

The optical constants S and K decreased with increasing wavelength, while RI and X(∞) increased with increasing wavelength within the visible spectrum. The values of enamel were in the range of the optical constants of these composites within the visible spectrum. However, there were significant differences of optical constants (S, K, RI and X(∞)) between enamel and translucent composites (p<0.05).

CONCLUSIONS

The optical constants of translucent composites were not completely consistent with that of natural enamel. In addition, the optical properties of these translucent composites varied with the brands of the composites.

Influence of filler distribution on the color parameters of experimental resin composites

OBJECTIVES

Simulating the optical properties of natural tooth would be the final goal for esthetic restorative materials. Filler distribution in resin composites determines the scattering in composite materials, which in turn would influence the color parameters such as lightness, chroma and hue. The objective of this study was to determine the influence of filler size and amount on the color parameters of experimental resin composites.

METHOD

Color of 11 experimental resin composites with two different sized fillers (LG: 0.77 microm and SG: 0.50 microm) in 10-70 wt% was measured by a spectrophotometer. Color coordinates (CIE L*, a* and b*), chroma and hue angle were determined. Optical constants including scattering coefficient (S), absorption coefficient (K) and light reflectivity (RI) were calculated. To determine the influence of the amount of filler on the optical parameters, Pearson correlations between the amount of filler (%) and color parameters and optical constants were calculated. Correlations between the optical constants (S, K and RI) and color parameters were calculated (p<0.05).

RESULTS

S value increased as the amount of filler increased. RI value generally increased as the amount of filler increased for LG filler group, and increased up to 40% filler for SG filler group. CIE L* value increased as the amount of filler increased in both of LG and SG filler groups. CIE L* value was highly correlated with S and RI values for both filler groups (r=0.961-0.974).

CONCLUSION

Lightness was highly correlated with the amount of filler, S and RI values (r=0.932-0.974). But the correlation coefficients between the amount of filler and chroma/hue were moderate (r=0.406-0.827); therefore, pigmentation would be tried to simulate the color of resin composites to those of natural tooth. Optical properties of resin composites could be partly simulated to those of teeth by controlling the filler distribution.

Penetration depth of laser Doppler flowmetry beam in teeth

OBJECTIVE

The aim of this study was to determine the penetration depth of laser light in teeth for contact and noncontact probe tip.

STUDY DESIGN

Fifty-one freshly extracted human mature maxillary and mandibular single rooted teeth were selected for the study. A laser Doppler flowmeter was used as a laser source. A digital camera was used to take pictures (with "night shot" mode in total darkness). When probe tip was in contact and when it was 1 mm away from the tooth, the depths of the areas illuminated in high and low density were measured.

RESULTS

In contact probe, root was illuminated to 4.28 +/- 0.14 mm depth with high density and 13.27 +/- 0.27 mm depth with low density. In noncontact probe, 4.36 +/- 0.16 mm with high density and 13.28 +/- 0.30 mm with low density of illumination were seen on the root. Between contact and noncontact probe situations the difference was not statistically significant in the depth of illumination. On the other hand, in both groups the difference between areas illuminated in high and low density was statistically significant (P < .05).

CONCLUSION

Contact or noncontact of the probe on tooth surface did not show any significant difference in light penetration. Besides, we think that, for the present, it is impossible to eliminate the contamination from periodontal tissues completely even if the necessary precautions (periodontal paste etc.) are taken.

Photo-Activated Disinfection Of The Root Canal: A New Role For Lasers In Endodontics

Because micro-organisms play a crucial role in the development of pulpal and periapical disease, the prognosis of endodontic therapy is intimately related to the presence of bacteria within the root canal system. Micro-organisms may persist in the apical region of the root canal system despite chemomechanical preparation. The usefulness of Class IV lasers (such as Nd:YAG, diode, KTP and Er:YAG) for photo-thermal disinfection of the root canal has been demonstrated in numerous studies. An alternative approach to microbial killing in the root canal system by laser light involves the use of low-power lasers to drive a photochemical reaction that produces reactive oxygen species, a technique termed photo-activated disinfection (PAD). By using exogenous photosensitisers such as tolonium chloride, killing of all types of bacteria can be achieved. In vitro studies of PAD have demonstrated its ability to kill photosensitised oral bacteria (such as E. faecalis), and more recently microbial killing in vivo in the root canal system has been demonstrated. While PAD can be undertaken as part of the routine disinfection of the root canal system, it also has potential use for eradicating persistent endodontic infections for which conventional methods have been unsuccessful.

Effect of gingiva on laser doppler pulpal blood flow measurements

The purpose of this study was to evaluate the effect of labial and palatinal gingiva on laser Doppler pulpal blood flow measurements. Twenty upper central incisor teeth determined to be vital from 20 volunteers were included into the study. To stabilize the probe, a laboratory-made acrylic splint positioned the probe labially on the cervical third of the tooth crown. We collected measurements without any gingival covering, and under three conditions: after application of an opaque paste on the labial gingiva, the palatal gingiva, or both the labial and palatal gingiva. The measurement values decreased 46% when there was opaque paste on labial gingiva, 10% on palatinal gingiva, and 63% on both. The decrease in the values when there was an opaque paste on palatinal gingiva was not statistically significant (p > 0.05). The differences between all other groups were statistically significant (p < 0.05). In these measurements, the contribution of labial gingiva to laser Doppler pulpal blood flow measurements is more than that of palatinal gingiva.

The sources of laser Doppler blood-flow signals recorded from vital and root canal treated teeth

OBJECTIVES

The aim was to determine the strength of signals derived from the dental pulp and those from the surrounding tissues in human teeth using the laser Doppler flowmetry (LDF).

METHODS

Twenty-six vital teeth (13 experimental and 13 controls) from 12 patients were used. Experimental teeth had root canal treatment in a single visit and their healthy antimeres were controls. Blood flow measurements were made before and after local anaesthesia, after root canal preparation, following root canal filling and coronal restoration.

RESULTS

Perfusion unit (PU) values recorded from empty pulp chamber were determined to be only 30% lower than the values recorded before anaesthesia from the experimental intact teeth. When the measurements in the group were compared with each other the values of variation in the both groups were not statistically significant. The variation between the groups when the measurement values before anaesthesia, 10min after anaesthesia and after coronal restoration were compared, it was not statistically significant (P>0.05). The variation between the groups after preparation and root canal filling in their values of measurements was important statistically (P<0.05). The measurement values of the study group were lower than that of the control group.

CONCLUSIONS

In pulpal, LDF a major portion of the signal comes from tissues other than pulp. Without taking precautions (such as rubber-dam application) in pulp blood flow measurements, the results may be inconsistent.

Coronal pulp size in molars: a study of bitewing radiographs

AIM

To: (i) study coronal pulp dimensions in human first molar teeth; (ii) investigate the effects of restorations on pulp size; (iii) determine differences in dimensions between teeth of Mongoloid patients and teeth of other ethnic groups; and (iv) record the presence of pulp stones.

METHODOLOGY

Bitewing radiographs of 121 subjects (mean age, 20.9 years) were taken under standardized conditions. The films were digitally scanned and nine measurements were made from the image of each first molar. The data were analysed in terms of presence or absence of restorations and in terms of racial group. Differences were examined using Student's t-test, Pearson correlations and Levene's test.

RESULTS

A total of 445 teeth were analysed. Large crowns were correlated to large pulps. Teeth restored with occlusal and proximal restorations had significantly smaller pulps (P = 0.044 and 0.004, respectively), but no difference was found in pulp area in the clinical crown between the restoration types. Mongoloid crowns were shorter and more bulbous. Pulp areas of maxillary molars and pulp widths at the cervix of mandibular molars were significantly larger in Mongoloids. The pulp area in the clinical crown correlated to pulp horn height for Mongoloids and others and for maxillary and mandibular teeth. No differences were found between the heights of pulp horns in the Mongoloid and other teeth. Four of the pulp measurements demonstrated sexual dimorphism. Stones were present in almost 10% of the subjects, representing 4% of the tooth pulps examined.

CONCLUSION

Even teeth with shallow occlusal restorations had reduced pulp spaces. There were significant differences in pulp and crown dimensions between the teeth of Mongoloid patients and those of other patients.

In vitro study of caries detection through sound dentin using a laser fluorescence device, DIAGNOdent

The objective of this study was to investigate the feasibility of proximal surface caries detection using a laser fluorescence device, DIAGNOdent, through the sound dentin surrounding the cavity wall after removal of occlusal caries. Extracted sound human molars were ground to prepare horizontal and vertical dentin plates 1.4 mm thick. Extracted carious human molars were reduced in thickness horizontally from the occlusal surfaces until exposure of the dentin caries. The dentin plate was placed on the carious tooth. Before and after gradual thinning of the dentin plate from approximately 1.4 mm to 0.2 mm thick, the dentin caries was measured 10 times through the plate by the laser fluorescence device with a cone-shaped tip or a broad tip. When the dentin plate was reduced to less than 0.3 mm thick (using a combination of a horizontal plate and cone-shaped tip) or 0.2 mm thick (using the other combinations), the values measured with the laser fluorescence device were significantly larger than the values before reducing the thickness of the dentin. Based on these results, the device offers potential use as one of the screening tests for proximal surface caries detection through sound dentin when the sound dentin between tip and caries is thin.

An in vitro comparison of the bactericidal efficacy of lethal photosensitization or sodium hyphochlorite irrigation on Streptococcus intermedius biofilms in root canals

AIM

To compare the bacterial killing of Streptococcus intermedius biofilms in root canals using lethal photosensitization with various combinations of photosensitizer concentration and laser light dose or 3% sodium hypochlorite (NaOCl) irrigation.

METHODOLOGY

Extracted teeth (n = 35) with single canals were selected and the canals prepared to apical size 25 with a 10% taper. The teeth were autoclaved and the canals inoculated with Streptococcus intermedius in brain heart infusion broth and were incubated for 48 h to allow a biofilm to form. The teeth were then subjected to 3% NaOCl irrigation (n = 4) or lethal photosensitization using combinations of a range of toluidine blue O (TBO) photosensitizer concentrations (12.5, 25, 50, 100 microgram/mL-1) and light doses (60, 90, 120, 300, 600 s equivalent to energy doses of 2.1-21 J) using a 35-mW helium-neon low power laser targeted at the access cavity (n = 4 for each combination). Controls consisted of laser light only (TBO = 0 microgram/mL-1) (n = 4), TBO only (light dose = 0 s) (n = 4), and no treatment (positive control n = 17). Following treatment the canal contents were sampled with sterile paper points, the sample was dispersed in transport medium, serially diluted and cultured on blood agar to determine the number of colony forming units (CFU).

RESULTS

The combination of 100 microgram/mL-1 TBO and 600 s (21 J) of laser energy achieved maximum reduction in recovered viable bacteria (5 log10 CFU). TBO at low concentrations (< or =50 microgram/mL-1) was not bactericidal but treatment with 100 microgram/mL-1 TBO alone reduced recovered viable bacteria by 3 log10 CFU. Laser light alone had limited bactericidal effect. No viable bacteria were recovered following treatment with 3% NaOCl.

CONCLUSIONS

The combined use of a photosensitizing agent and a low power laser directed at the access cavity was bactericidal to S. intermedius biofilms in root canals but was unable to achieve total kill, unlike 3% NaOCl.

Blood flow changes in human dental pulps when capsaicin is applied to the adjacent gingival mucosa

OBJECTIVE

The purpose of this study was to determine whether changes occur in pulpal blood flow when capsaicin is applied to the adjacent gingival or alveolar mucosa in human beings.

STUDY DESIGN

Laser Doppler flowmetry was used to measure changes in pulpal blood flow (PBF) after applying capsaicin to adjacent gingival mucosa in 20 human volunteers. The procedure was repeated on 10 subjects after administration of an ipsilateral inferior alveolar nerve block and on the other 10 subjects after application of topical anesthetic to their adjacent gingival and alveolar mucosa.

RESULTS

PBF increased in 16 subjects and did not change in 4 subjects after capsaicin application. Ipsilateral inferior alveolar nerve block did not alter this effect. Pretreatment with topical lidocaine resulted in no change or decreased PBF in 8 subjects and increased PBF in 2 subjects.

CONCLUSION

Changes occur in the PBF of the mandibular canine teeth of some humans when capsaicin is applied to the adjacent gingival or alveolar mucosa.

Pattern of transmission of laser light through carious molar teeth

AIMS

The aims of this study were to investigate the pattern of transmission of laser light through carious human molar teeth, and to examine the effect on light transmission of reactions to caries in the dentine.

METHODOLOGY

Sectioned carious human molars were examined whilst illuminated from their external surfaces by a helium-neon laser probe of 0.5 mm diameter. The pattern of light transmission was observed and selected specimens were photographed. The passage of light through the surrounding dentine toward the pulp space was investigated by confocal microscopy. Further carious and restored teeth were illuminated from three buccal and three lingual sites to establish the probability of light being able to reach the coronal pulp space.

RESULTS

For all 31 teeth examined, it was possible to illuminate the pulp space from a position on the buccal side. The presence of intracoronal restorations did not necessarily prevent light transmission to the pulp. Confocal microscopy demonstrated conduction of light within dystrophic deposits of irregular secondary dentine.

CONCLUSIONS

The presence of carious lesions or restorations in molar teeth does not necessarily interfere with transmission of laser light to the pulp space. Light is conducted within irregular secondary dentine. With appropriate probe placement, assessments of pulp health in diseased posterior teeth may be possible using laser Doppler flowmetry.

Laser light transmission in teeth: a study of the patterns in different species

AIM

The aim of this study was to investigate the pattern of light transmission through teeth of different species and to examine laser light propagation within enamel from various animal sources.

METHODOLOGY

Sectioned teeth from five species--pig, horse, sheep, cat and rat--were evaluated. Samples were illuminated individually by a helium-neon laser light from the buccal surface using a probe 0.5 mm in diameter placed at varying angles between 60 and 120 degrees C. The pattern of light transmission was observed macroscopically. Further evaluation of laser light transmission in enamel was achieved using confocal microscopy.

RESULTS

In each species, light was transmitted through the tooth to the pulp, but in the cat and the rat, light was also transmitted to the far side of the tooth. Despite the different patterns of enamel in the species, light was transmitted through enamel to dentine.

CONCLUSION

Light from a laser Doppler probe appeared to reach the dental pulp in all the species: however, in the mammals with smaller teeth, light may also have been able to reach the periodontium and thus the reflected signal may not be entirely of pulpal origin.

Scattering of laser light directed onto the labial surface of extracted human upper central incisors

The purpose of this study was to evaluate the scatter of light through human teeth with laser Doppler flowmetry. An optical probe (probe 1), which mounted two optical fibers (one for light illumination and another for the measurement of backscattered light intensity) was placed on the labial surface of the extracted teeth. Another optical probe (probe 2) for the measurement of transmitted-light intensity was placed either on the mesial, distal, or palatal surface or in the canal of the teeth. The light intensity at probe 1 was stable, irrespective of the location of probe 2, whereas the transmitted light intensity at probe 2 tended to increase as probe 2 moved to more incisal positions on the mesial, distal, and palatal tooth surfaces. The results indicate that the light scatters to a wide area outside the tooth and provides information regarding the surrounding tissue blood flow.

Effect of probe design and bandwidth on laser Doppler readings from vital and root-filled teeth

Laser Doppler flowmetry has been shown to be useful in assessing blood flow in teeth. This study investigated the effect of probe design and bandwidth on laser Doppler readings from vital and root-filled teeth using an 810 nm light source, and established the sensitivity and specificity of each probe/bandwidth combination. Readings were taken from 20 human subjects with a root-filled tooth and a vital contralateral tooth using each of the probes with 0.125 mm, 0.375 mm and 0.5 mm fibre separations and three bandwidths (3.1 kHz, 14.9 kHz and 20 kHz). Ten pairs of traces from each group were examined by 10 trained observers who indicated whether the traces had come from a vital or root-filled tooth. The sensitivity and specificity of each combination were calculated from the accuracy of their replies. This was repeated for five observers but with additional information from Fourier analysis. Median readings from vital teeth were higher than those from root-filled teeth for all combinations. This difference was only significant at the 95% confidence level for the 0.5 mm probe with the two lower bandwidths. The 0.125 mm fibre separation probe showed good specificity. The other two probes had better sensitivity but poor specificity. The best specificity and sensitivity was shown by the 0.5 mm probe/3.1 kHz bandwidth combination. All sensitivities and specificities increased when additional information from Fourier analysis was available, but the 0.5 mm probe/3.1 kHz combination still had the best sensitivity and specificity.