Laser induced molar tooth pulp chamber temperature changes

Heat generated during dental treatments affecting intrapulpal temperature: a review

INTRODUCTION

Heat is generated and transferred to the dentine-pulp complex during various dental procedures, such as from friction during cavity preparations, exothermic reactions during the polymerisation of restorative materials and when polishing restorations. For in vitro studies, detrimental effects are possible when intra-pulpal temperature increases by more than 5.5°C (that is, the intra-pulpal temperature exceeds 42.4°C). This excessive heat transfer results in inflammation and necrosis of the pulp. Despite numerous studies stating the importance of heat transfer and control during dental procedures, there are limited studies that have quantified the significance. Past studies incorporated an experimental setup where a thermocouple is placed inside the pulp of an extracted human tooth and connected to an electronic digital thermometer.

METHODS

This review identified the opportunity for future research and develop both the understanding of various influencing factors on heat generation and the different sensor systems to measure the intrapulpal temperature.

CONCLUSION

Various steps of dental restorative procedures have the potential to generate considerable amounts of heat which can permanently damage the pulp, leading to pulp necrosis, discoloration of the tooth and eventually tooth loss. Thus, measures should be undertaken to limit pulp irritation and injury during procedures. This review highlighted the gap for future research and a need for an experimental setup which can simulate pulp blood flow, temperature, intraoral temperature and intraoral humidity to accurately simulate the intraoral conditions and record temperature changes during various dental procedures.

Raman Analyses of Laser Irradiation-Induced Microstructural Variations in Synthetic Hydroxyapatite and Human Teeth

The microstructural and molecular-scale variations induced by laser irradiation treatment on human teeth enamel in comparison with synthetic hydroxyapatite (HAp) were examined through Raman microprobe spectroscopy as a function of irradiation power. The results demonstrated that laser irradiation could modify stoichiometry, microstructure, and the population of crystallographic defects, as well as the hardness of the materials. These modifications showed strong dependences on both laser power and initial nonstoichiometric structure (defective content of HPO₄), because of the occurrence of distinct reactions and structural reconstruction. The reported observations can redirect future trends in tooth whitening by laser treatment and the production of HAp coatings because of the important role of stoichiometric defects.

Assessment of Inhibition of Mineral Loss from Human Tooth Enamel by Carbon Dioxide Laser and 1.23% Acidulated Phosphate Fluoride

Aims and Objectives

The efficacy of carbon dioxide (CO₂) laser irradiation combined with fluoride in inhibiting enamel demineralization has been demonstrated by several laboratory investigations. However, there are very few reports about the in situ or in vivo caries preventive effect of CO₂ laser combined with topical fluoride on dental enamel. Hence, an in situ study was designed and carried out to assess inhibition of mineral loss from human tooth enamel by CO₂ laser and 1.23% acidulated phosphate fluoride (APF).

Material and Methods

Impressions of upper and lower arch of the volunteers were made in alginate impression material. Study models were poured, duplicated, and duly labeled. On the working model, appliances were fabricated in acrylic resin to fit the upper dental arch of the volunteers. Four enamel slabs (one from each group) were fitted on the palatal surface of the appliance as close as possible to posterior teeth. Surfaces of slabs were kept below the outer surface of acrylic. The analysis was done using SPSS version 15 (SPSS Inc., Chicago, IL, USA) Windows software program.

Results

Statistically significant increase in inhibition of mineral loss of enamel slabs when treated individually or in a combination of low power CO₂ laser and 1.23% APF solution. The application of 1.23% APF solution after low power CO₂ laser treatment showed maximum inhibition of mineral loss.

Conclusion

The combined use of this specific laser treatment plus fluoride was more successful than either laser treatment or fluoride alone in the inhibition of mineral loss in the mouth. The results of this study also suggest that the combination of low power laser treatment with fluoride therapy may be effective as a caries inhibition treatment.

Heat generation caused by ablation of dental hard tissues with an ultrashort pulse laser (USPL) system

Heat generation during the removal of dental hard tissues may lead to a temperature increase and cause painful sensations or damage dental tissues. The aim of this study was to assess heat generation in dental hard tissues following laser ablation using an ultrashort pulse laser (USPL) system. A total of 85 specimens of dental hard tissues were used, comprising 45 specimens of human dentine evaluating a thickness of 1, 2, and 3 mm (15 samples each) and 40 specimens of human enamel with a thickness of 1 and 2 mm (20 samples each). Ablation was performed with an Nd:YVO4 laser at 1,064 nm, a pulse duration of 9 ps, and a repetition rate of 500 kHz with an average output power of 6 W. Specimens were irradiated for 0.8 s. Employing a scanner system, rectangular cavities of 1-mm edge length were generated. A temperature sensor was placed at the back of the specimens, recording the temperature during the ablation process. All measurements were made employing a heat-conductive paste without any additional cooling or spray. Heat generation during laser ablation depended on the dental hard tissue (enamel or dentine) and the thickness of the respective tissue (p < 0.05). Highest temperature increase could be observed in the 1-mm thickness group for enamel. Evaluating the 1-mm group for dentine, a significantly lower temperature increase could be measured (p < 0.05) with lowest values in the 3-mm group (p < 0.05). A time delay for temperature increase during the ablation process depending on the material thickness was observed for both hard tissues (p < 0.05). Employing the USPL system to remove dental hard tissues, heat generation has to be considered. Especially during laser ablation next to pulpal tissues, painful sensations and potential thermal injury of pulp tissue might occur.

Heat generation caused by ablation of restorative materials with an ultrashort pulse laser (USPL) system

Heat generation during the removal of dental restorative materials may lead to a temperature increase and cause painful sensations or damage dental tissues. The aim of this study was to assess heat generation in dental restoration materials following laser ablation using an ultrashort pulse laser (USPL) system. A total of 225 specimens of phosphate cement (PC), ceramic (CE), and composite (C) were used, evaluating a thickness of 1 to 5 mm each. Ablation was performed with an Nd:YVO(4) laser at 1,064 nm, a pulse length of 8 ps, and a repetition rate of 500 kHz with a power of 6 W. Employing a scanner system, rectangular cavities of 1.5-mm edge length were generated. A temperature sensor was placed at the back of the specimens to record the temperature during the ablation process. All measurements were made employing a heat-conductive paste without any additional cooling or spray. Heat generation during laser ablation depended on the thickness of the restoration material (p < 0.05) with the highest values in the composite group (p < 0.05), showing an increase of up to 17 K. A time delay for temperature increase during the ablation process depending on the material thickness was observed in the PC and C group (p < 0.05) with highest values for cement (p < 0.05). Employing the USPL system for removal of restorative materials, heat generation has to be considered. Especially during laser ablation next to pulpal tissues, painful sensations might occur.

Precision ablation of dental enamel using a subpicosecond pulsed laser

In this study we report the use of ultra-short-pulsed near-infrared lasers for precision laser ablation of freshly extracted human teeth. The laser wavelength was approximately 800nm, with pulsewidths of 95 and 150fs, and pulse repetition rates of 1kHz. The laser beam was focused to an approximate diameter of 50microm and was scanned over the tooth surface. The rise in the intrapulpal temperature was monitored by embedded thermocouples, and was shown to remain below 5 degrees C when the tooth was air-cooled during laser treatment. The surface preparation of the ablated teeth, observed by optical and electron microscopy, showed no apparent cracking or heat effects, and the hardness and Raman spectra of the laser-treated enamel were not distinguishable from those of native enamel. This study indicates the potential for ultra-short-pulsed lasers to effect precision ablation of dental enamel.

Temperature Response in the Pulpal Chamber of Primary Human Teeth Exposed to Nd:YAG Laser Using a Picosecond Pulsed Regime

OBJECTIVE

This study was conducted to analyze temperature variation in the pulpal chamber using the (Nd:YAG) picosecond-pulsed laser to promote ablation in enamel and dentin of primary teeth.

BACKGROUND DATA

Several previous studies reported the temperature rise in pulpal chamber during laser irradiation. Since there are no reports about pulp chamber temperature changes during irradiation with picosecond-pulsed laser, the purpose of our investigation is to quantify the intrapulpal temperature changes following picosecond-pulsed Nd:YAG laser irradiation of enamel and dentin of primary teeth.

METHODS

In this study, we used 10 intact primary exfoliated teeth: five molars and five incisors. We used a commercial neodymium:- yttrium-aluminum-garnet continuous-wave (CW)-pumped Q-switched and mode-locked Nd:YAG laser, with varying power levels (200, 300, and 350 mW) operating with 100-psec pulsed duration.

RESULTS

Typical plots show differences between heating and cooling of enamel and dentin of anterior and posterior teeth. Whereas for enamel the time evolution curves are dependent on power used for the investigated range (200-350 mW), for dentin the differences are not so evident. Observing temperature enhancement for each power, we were able to analyze operational conditions where temperature changes do not exceed 5.5 degrees C. Power-time-temperature (PTT) diagrams for clinical operations were determined based on varying power level and exposition time. Through the heating-cooling cycle, we could extract conventional heating and cooling times for enamel and dentin.

CONCLUSION

We have shown that the Nd:YAG picosecond-pulsed laser is a safe tool for ablation of primary teeth in a broad range of operational parameters.

Effects of Laser Irradiation on Tensile Strength of Bovine Dentin

OBJECTIVE

The purpose of the present study was to investigate the tensile strengths of dentin after laser irradiation using three kinds of dental lasers to elucidate the laser-irradiation effect on dentin properties.

BACKGROUND DATA

Different kinds of laser devices have been developed in dentistry. The characteristics of each laser are determined by its original wavelength; however, one common feature is to generate heat in irradiated tissues, and such heat possibly affects dentin collagen, which contributes to tensile strength of the tissues.

MATERIALS AND METHODS

Er:YAG, CO2, and diode (GaAlAs) lasers were used to irradiate bovine dentin. Subsequently, tensile test specimens were made from the irradiated dentin and tensile tests were conducted. The tensile strengths were analyzed using the paired-t test and Weibull analysis. Irradiated dentin was also observed transversally using light microscopy.

RESULTS

The tensile strengths of the lased dentin and the control group for the Er:YAG, CO2, and diode lasers were 73.1 and 78.5, 70.3 and 74.3, and 64.3 and 71.0 MPa, respectively. The tensile strength of the dentin had a tendency to decrease with laser irradiation. Weibull analysis indicated that the laser influence was different among the three kinds of laser apparatuses and seemed to correspond to the depths the laser beam reached, which were suggested by light microscopy observation.

CONCLUSION

Laser irradiation could possibly decrease dentin tensile strength, which suggests the importance of careful use of laser for hard tissue treatment, considering its energy-transforming characteristics.

Effects of copper vapor laser irradiation (lambda = 510.6 nm) on the enamel and dentine of human teeth: an ultra-structural morphologic study

OBJECTIVE

A morphological and ultra-structural study of copper vapor laser (lambda = 510.6 nm) effects on enamel and dentine was performed to show the effects of this radiation.

METHODS

A total of 15 human molars were cut in half; 15 pieces were separated for irradiation on enamel and 15 for dentine. These two groups were further divided into five experimental groups, including a control group, comprised of three half-sections each, irradiated by a CVL laser with a power of 7 W, a repetition rate of 15,000 pulses/sec and exposed at 500, 600, and 800 msec and 1 sec irradiation times with a 5-sec interval between irradiations.

RESULTS

In an ultra-structural SEM exam, we observed that on the enamel surfaces irradiated for 1 sec there was morphological alteration that consisted of catering, flaking, and melting on the surfaces. There was no alteration for the other exposure times. On the dentine teeth irradiated for 1 sec, we observed an evident ultra-structural alteration of melted tissue and loss of morphological characteristics. In the dentine group irradiated by 800 msec, we observed ablation and a partial loss of morphological characteristics. In the dentine groups irradiated by 500 and 600 msec, no alteration was observed.

CONCLUSIONS

The results showed that irradiation with CVL promoted morphologic changes in the enamel as well as in the dentine and demonstrated a need for future studies in order to establish a safe protocol for further use in the odontological practice.

Temperature Analysis during Bonding of Brackets Using LED or Halogen Light Base Units

The purpose of our investigation is to compare the intrapulpal temperature changes following blue LED system and halogen lamp irradiation at the enamel surface of permanent teeth. The fixation of brackets using composite resin is more comfortable and faster when using a photo-curable composite. Several light sources can be used: halogens, arc plasma, lasers, and recently blue LED systems. An important aspect to be observed during such a procedures is the temperature change. In this study, we have used nine human extracted permanent teeth: three central incisors, three lateral incisors, and three canines. Teeth were exposed to two light sources: blue LED system (preliminary commercial model LEC 470-II) and halogen lamp (conventional photo-cure equipment). The surface of teeth was exposed for 20, 40, and 60 sec at the buccal and lingual enamel surface with an angle of 45 degrees. Temperature values measured by a thermistor placed at pulpar chamber were read in time intervals of 1 sec. We obtained plots showing the temperature evolution as a function of time for each experiment. There is a correlation between heating quantity and exposition time of light source: with increasing exposition time, heating increases into the pulpal chamber. The halogen lamp showed higher heating than the LED system, which showed a shorter time of cooling than halogen lamp. The blue LED system seems like the indicated light source for photo-cure of composite resin during the bonding of brackets. The fixation of brackets using composite resin is more comfortable and faster when using a photo-curable composite. Blue LED equipment did not heat during its use. This could permit a shorter clinical time of operation and better performance.

Clinical efficacy of semiconductor laser application as an adjunct to conventional scaling and root planing

BACKGROUND AND OBJECTIVES

The aim of the in vitro study was to examine the clinical efficacy of semiconductor laser periodontal pocket irradiation as an adjunct to conventional scaling and root planing.

MATERIALS AND METHODS

Twenty-two healthy patients with a need of periodontal treatment (15 women, 7 men, mean age 45.0 +/- 10.8 years) with at least four teeth in all quadrants, were included. All of them underwent a conventional periodontal treatment including scaling and root planing. Using a split mouth design, two randomly chosen quadrants (one upper and the corresponding lower one) were subsequently treated with an 809 nm GaAlAs laser operated at a power output of 1.0 Watt using a 0.6 mm optical fiber. The teeth in the control quadrants were rinsed with saline. The clinical outcome was evaluated by means of plaque index (PI), gingival index (GI), bleeding on probing (BOP), sulcus fluid flow rate (SFFR), Periotest (PT), probing pocket depth (PPD), and clinical attachment loss (CAL) at baseline and at 3 months after treatment. A total of 492 teeth in both groups were evaluated and differences between the laser and the control teeth were analyzed using the Wilcoxon test (P < 0.05).

RESULTS

Teeth treated with the laser revealed a significantly higher reduction in tooth mobility, pocket depth, and clinical attachment loss. Twelve percent of the teeth in the laser group showed an attachment gain of 3 mm or more, compared to 7% in the control group. An attachment gain of 2-3 mm was found in 24% of the teeth in the laser group and 18% in the control group. No significant group differences, however, could be detected for the plaque index, gingival index, bleeding on probing, and the sulcus fluid flow rate.

CONCLUSIONS

The higher reduction in tooth mobility and probing depths is probably not predominantly related to bacterial reduction in the periodontal pockets but to the de-epithelization of the periodontal pockets leading to an enhanced connective tissue attachment. The application of the diode laser in the treatment of inflammatory periodontitis at the irradiation parameters described above is a safe clinical procedure and can be recommended as an adjunct to conventional scaling and root planing.

Increased fluoride uptake and acid resistance by CO2 laser-irradiation through topically applied fluoride on human enamel in vitro

OBJECTIVES

The aim of the current in vitro study was to evaluate the effect of CO(2)-laser treatment immediately after applying amine fluoride solution on enamel. It was hypothesized that such a treatment would increase enamel fluoride uptake, and reduce dissolution rate and thermal surface alterations.

METHODS

Fluoride uptake was determined in 40 human enamel sections randomly assigned to four groups (n=10), which were either left untreated (1), exposed to a 1% amine fluoride solution for 15s without irradiation (2), irradiated for 15s with a continuous-wave carbon dioxide laser (3), or laser-treated for 15s through the amine fluoride solution applied immediately beforehand (4). Fluoride uptake was determined with an ion selective electrode after acid dissolution of the specimens (surface and subsurface layers). For the determination of acid resistance, another 40 enamel sections were treated according to the above protocol. Acid resistance was determined in surface and subsurface layers by measuring eluted calcium upon 3% lactic acid exposure with atomic absorption spectrometry. Enamel surface alterations after laser irradiation were monitored using scanning electron microscopy.

RESULTS

Laser irradiation through the fluoride solution led to significantly higher fluoride contents in the surface enamel layer compared to fluoride treatment alone or laser treatment alone (p=0.002). Laser treatment with or without fluoride resulted in an increased acid resistance of enamel specimens. Fewer surface alterations were observed upon SEM examination of specimens irradiated through the amine fluoride solution compared to counterparts treated with laser only.

CONCLUSIONS

CO(2) laser light application through an amine fluoride solution may be useful and effective in the prevention of caries.

Crystalline structure of dental enamel after Ho:YLF laser irradiation

Irradiation of teeth with lasers using specific wavelengths and energy densities produces surface melting. This effect has been already applied to different procedures such as caries prevention and hypersensitivity reduction. The aim of this study is to characterize the crystalline structure of bovine enamel after holmium laser irradiation. A holmium laser (Ho:YLF) with emission wavelength of 2065 nm was used. Enamel tissues were irradiated in ablative regime and their structures before and after irradiation were analyzed using the powder X-ray diffraction technique. The X-ray diffraction patterns of non-irradiated enamel correspond to carbonated hydroxyapatite and those produced by irradiated samples indicate the existence of a mixture of two crystalline phases: hydroxyapatite and tetracalcium phosphate. The structural characteristics of holmium irradiated enamel were compared with those of the same tissue irradiated with other lasers.

Safety parameters for pulp temperature during selective ablation of caries by KTP laser in vitro

OBJECTIVE

To define the optimal parameters of KTP laser irradiation during a selective caries removal.

MATERIALS AND METHODS

Twelve decayed human teeth, recently extracted were used. Their root canals were prepared for insertion of a thermocouple probe into the pulp chamber. The demineralized tissues were colored by Acid Red 52 before proceeding to different conditions of irradiation.

RESULTS

Pulpal temperature increases (below 3 degrees C) were found under the following parameters with 15 sec of continuous lasing: 400 mWatts, 0.10-msec pulse width, PRR <50 Hz for efficient caries removal. A resting time average of 70 sec was necessary to allow pulp temperature to get back to its baseline.

CONCLUSION

KTP laser can be used safely and without any pulp over-heating under certain irradiation conditions.

Laser-induced temperature changes in dentine

OBJECTIVE

The purpose of this work is to study the temperature rise and potential thermal damage caused during ablation of human dentine using a super pulsed carbon dioxide laser of 9.6-microm wavelength, equipped with a water-cooling spray and scanner system.

BACKGROUND DATA

There have been no reports on thermal effects of super pulsed CO2 laser of 9.6 microm wavelength on human dentine recently.

MATERIALS AND METHODS

Two different types of samples were investigated to yield data most consistent with a typical clinical situation. Human dentine slices and crown segments were studied at a drilling depth of 1.0 +/- 0.1 mm and 2.5 +/- 0.5 mm, respectively. A control group treated with a conventional hand piece was compared to four laser groups with settings varying from 2 to 8 W.

RESULTS

In the laser group demonstrating the highest elevation in temperature of the four studied, dentine slices lased at 2 W for 15 sec showed a mean temperature rise of less than 1.68 degrees C at an ablation rate of 0.86 +/- 0.08 mm. Conventional drilling with a comparable ablation rate of 0.76 +/- 0.59 mm resulted in a mean rise of 2.87 degrees C. The laser groups of crown segments revealed a constant decrease in temperature. SEM observations were lacking the typical morphological changes seen in earlier studies, specifically extensive melting, charring or cracking.

CONCLUSION

A maximum rise of mean temperature to 1.68 degrees C in closest vicinity to the pulpal chamber and the morphological unaltered dentine surfaces demonstrate the safe and tissue preserving character of the superpulsed 9.6 microm CO2 laser. The laser caused an even lower temperature rise than conventional drilling. Moreover, the laser showed acceptable efficacy with ablation rates that did not significantly differ from the conventional dental drill.

Effects of CO2 laser on fluoride uptake in enamel

OBJECTIVES

The objective of this study was to investigate the effects of CO(2) laser on fluoride uptake in the loosely- and firmly-bound forms in enamel.

METHODS

Five human molars were cut into halves before being treated with 2.0% NaF topical gel. Each half had three windows on the enamel surface, including one control and two experimental windows irradiated by two laser therapies. One half of each tooth was treated with 1 M KOH solution to remove the loosely-bound fluoride (calcium fluoride). A tooth section was obtained from each window and the relative fluorine concentration was analyzed with Secondary Ion Mass Spectrometry (SIMS). The morphology of the enamel surfaces in the windows was examined using an Environmental Scanning Electron Microscope (ESEM).

RESULTS

Significant laser-induced increases in the uptake of fluoride were revealed in both loosely-bound and firmly-bound apatitic fluoride, with both laser treatments (all p<0.001). Calcium fluoride-like deposits on the enamel surfaces receiving the combined laser-fluoride treatment were revealed by ESEM.

CONCLUSIONS

The finding of this study substantiated the laser effect in increasing the fluoride uptake into enamel.

Pulpal temperature increases with Er:YAG laser and high-speed handpieces

STATEMENT OF PROBLEM

During tooth preparation, both high-speed handpieces and lasers generate heat, which, if not controlled, can cause pulpal necrosis.

PURPOSE

The aim of this study was to compare temperature increases produced by a high-speed dental handpiece with those produced by a relatively new instrument, the Er:YAG (erbium: yttrium-aluminum-garnet) laser.

MATERIALS AND METHODS

Thirty bovine mandibular incisors were reduced to an enamel/dentin thickness of 2.5 mm. Class V preparations were completed to a depth of 2.0 mm, measured with a caliper or by a mark on the burs. A thermocouple was placed inside the pulp chamber to determine temperature increases (degrees C). Analysis was performed on the following groups (n=10): Group I, high-speed handpiece without water cooling, Group II, high-speed handpiece with water cooling (30 mL/min), and Group III, the noncontact Er:YAG laser (2.94 microm at 350 mJ/10 Hz) with water cooling (4.5 mL/min). The temperature increases were recorded by a computer linked to the thermocouples. The data were analyzed using the Kruskal-Wallis test. The Dunn multiple comparison test was used as post hoc test (alpha=.05).

RESULTS

The average temperature rises were: 11.64 degrees C (+/- 4.35) for Group I, 0.96 degrees C (+/- 0.71) for Group II, and 2.69 degrees C (+/- 1.12) for Group III. There were no statistical differences between Groups II and III; both II and III differed from Group I significantly (P=.000 and P=.002, respectively).

CONCLUSION

The preparations made with the high-speed and the laser instrument generated similar heat increases under water cooling. Water cooling was essential to avoid destructive temperature increases when using both the high-speed handpiece and laser.

Intrapulpal temperature changes during root surface irradiation with an 809-nm GaAlAs laser

OBJECTIVE

The aim of this study was to explore, in vitro, whether the irradiation of human root surfaces with a diode laser might induce nonphysiologic intrapulpal temperature elevations and, therefore, jeopardize pulp vitality.

STUDY DESIGN

The pulps were removed from human maxillary and mandibular incisors extracted for periodontal reasons. The root canals were enlarged to an apical size #60 file. The teeth were radiographed with standard dental films and a millimeter grid to determine root thickness. The thickness of dentin between the root surface and the pulp in the irradiation areas was 1, 2, and 3 mm. To determine intrapulpal temperature changes during laser irradiation, 0.5-mm K-type thermocouples were inserted. An 809 nm GaAlAs laser with a 400-micron optical fiber was used. The power output varied between 0.5 and 2.5 W in the continuous-wave mode (0 Hz). Irradiation was continued for up to 120 seconds.

RESULT

Temperature elevations between 0.5 and 32.0 degrees C were registered in an energy- and time-dependent manner. Dentin thickness had a significant effect on intrapulpal temperature changes (Mann Whitney U test, P <.05), with a thinner dentin layer resulting in higher temperature elevations.

CONCLUSION

Diode-laser irradiation may jeopardize pulp vitality. It must be recommended to limit power output to 0.5 W and the time of irradiation to 10 seconds when lasing the root surfaces of lower incisors and first maxillary premolars. With other teeth, a power output of 1.0 W and an exposure time of 10 seconds must not be exceeded to ensure a safe clinical application.

Effect of CO2 laser on pulpal temperature and surface morphology: an in vitro study

OBJECTIVES

The objective of this study was to evaluate the potential effects on underlying dental hard tissues of a high pulse rate carbon dioxide (CO2) laser that was designed for soft tissue surgery.

METHODS

Eighteen extracted human teeth were sectioned longitudinally, cleaned, and varnished, leaving nine exposed windows on each: six on the coronal surface (enamel) and three on the root surface (cementum, dentin). The CO2 irradiation conditions used were: wave length 10.6 microm; 1.2-2.6J/cm(2) fluence per pulse; repetition rate 120-1000Hz; 100-200ms pulse duration; and cumulative fluences ranging from 14 to 2200J/cm(2). Each window was irradiated with a 0.3mm beam diameter at one of nine power settings for 0.1, 0.5, or 1.0s. The pulp chamber temperature was measured with a microthermocouple. The irradiated teeth were evaluated by Polarized Light Microscopy (PLM) and Scanning Electron Microscopy (SEM).

RESULTS

The pulp chamber temperature rise ranged from 0.5 to 19 degrees C depending on the location of the window and distance to pulp chamber. SEM revealed crystal fusion in both enamel and dentin at all cumulative fluences. At cumulative fluences of 40J/cm(2), 200 pulses/second and higher, measurable tissue loss was observed with PLM both in dentin and enamel.

CONCLUSIONS

These results indicate there are threshold conditions above which pulsed CO2 laser light used for soft tissue surgery may cause detrimental changes to underlying oral hard tissue and to the pulp.

Laser-induced thermal events in empty and pulp-filled dental pulp chambers

BACKGROUND AND OBJECTIVE

The purpose of this investigation was to evaluate: 1. thermal events during laser irradiation @2.1 microns of the pulp; 2. whether these effects are adequately modeled using an empty pulp chamber/root canal.

STUDY DESIGN/MATERIALS AND METHODS

In extracted human teeth, pulpal access was prepared and thermocouples placed 2, 3 mm apical to the center of the irradiation spot. Pulp-filled or empty pulp chambers were irradiated using a Ho:YAG laser: Spot Size: 1 mm; Power: 1, 2, 3.5, 4.5 W; PRR: 5, 12 Hz;

DURATION

10 sec. Thermal measurements were repeated 3x.

RESULTS

Thermal trends did not differ significantly and correlated positively with power (P < 0.01), PRR (P < 0.01), irradiation duration (P < 0.05). No significant difference was determined between temperatures in empty and pulp-filled chambers at all parameters at 5 Hz and at 1-2 W at 12 Hz (P < 0.05, 2-tailed Student's t-test). At 12 Hz and > 3.5 W, pulp chamber temperatures exceeded those in pulpal tissue (P < 0.05).

CONCLUSION

Pulp tissues must be present to ensure clinical relevance of thermal measurements.

In vitro study of the effects of Nd:YAG laser probe parameters on bovine oral soft tissue excision

BACKGROUND AND OBJECTIVES

Lasers are now used for intraoral, soft tissue procedures. The effects of Nd:YAG probes on cutting efficiency and temperature rise were evaluated in vitro.

STUDY DESIGN/MATERIALS AND METHODS

Three hundred twenty-micron 400-microns, 500-microns, and 600-microns probes were used to ablate bovine gingiva, mucosa, and tongue at various power and frequency settings. Thermocouples positioned under the subjacent cortical bone measured temperature rise. Tissue samples were evaluated histologically.

RESULTS

Mean pooled temperature rise was 1 degree C at 3 W and 1.4 degrees C at 5 W. Excision width ranged from 0..63 mm to 0.79 mm at tested settings, cutting depths from 0.19 mm to 0.49 mm, lateral and deep coagulation from 0.27 mm to 0.62 mm.

CONCLUSION

Temperature rise in bone was related to increased power. Cutting efficiency of laser probes was not significantly improved by increased power. Probes of 320 to 500 microns provided efficient cutting at 3 W and 5 W, thus reducing the potential for unacceptable temperature rise in bone.

Pulsed Nd:YAG laser irradiation of the tooth pulp in the cat: I. Effect of spot lasing

BACKGROUND AND OBJECTIVE

The purpose of the present study was to evaluate physiologically pulpal nerve responses and to elucidate histopathologically the pulp tissue reactions to "spot irradiation" with a pulsed Nd:YAG laser.

STUDY DESIGN/MATERIALS AND METHODS

Antidromic compound action potentials and the pulpal blood flow (PBF) were recorded from the canine tooth of a sodium pentobarbitone-anesthetized cat. The laser irradiation-induced pulp tissue changes were histologically investigated.

RESULTS

The coronal antidromic compound action potentials disappeared in all the teeth tested during lasing, and the time needed to erase them was significantly shortened with increases in lasing power (P < 0.05). The radicular PBF increased when spot irradiation was performed, and the coronal PBF also temporarily increased with low-powered lasing. Histologic investigation revealed that spot irradiation with the laser produced severe damage in the pulp tissue in a dose-dependent manner.

CONCLUSION

The present study suggests that spot irradiation with a pulsed Nd:YAG laser risks producing nerve injury and irreversible tissue damage in the pulp with lasing for the purpose of desensitizing hypersensitive dentin.

Human teeth exposed to argon laser irradiation: determination of power-time-temperature working conditions

OBJECTIVE

This study was conducted to establish the operating parameters of the argon laser without thermal damage to the pulp tissue for clinical applications.

SUMMARY BACKGROUND DATA

Previous studies have mainly compared the temperature modifications of the pulp chamber in a very limited situation, where a complete view of the thermal history cannot be obtained nor even extrapolated to new applications.

METHODS

We used samples of molar and premolar tooth where a class V cavity was prepared and illuminated with an argon laser at different power levels, fixing the exposition area for all cases. Situations including open cavity and teeth restoration were analyzed. High-precision thermistors were placed in four different positions, one of which was inside the pulp chamber. The temperature evolution was monitored continuously by an interfaced computer during all laser exposure. Special attention was paid to the intrapulpal temperature variation because it is considered the most vulnerable thermal region. The temperature time evolution allowed the determination of the operating conditions (power-time-temperature variation) in which the use of the argon laser causes no pulpal damage. As a function of temperature variation, we divided the whole parameter space (power-time-temperature) into zones and the optimum zone of operation was determined.

CONCLUSIONS

We created a diagram called power-time-temperature (PTT) where zones of temperature increased under laser irradiation allow the verification of which condition is safe for clinical laser application. The results have a broad use when this type of analysis is applicable.

Cutting efficiency of a mid-infrared laser on human enamel

In this study, the cutting ability of a newly developed dental laser was compared with a dental high-speed handpiece and rotary bur for removal of enamel. Measurements of the volume of tissue removed, energy emitted, and time of exposure were used to quantify the ablation rate (rate of tissue removal) for each test group and compared. Cutting efficiency (mm3/s) of the laser was calculated based on the mean volume of tissue removed per pulse (mm3/pulse) and unit energy expended (mm3/J) over the range of applied powers (2, 4, 6, and 8 W). The specimens were then examined by light microscopy and scanning electron micrographs for qualitative analysis of the amount of remaining debris and the presence of the smear layer on the prepared enamel surface. Calculations of the cutting efficiency of the laser over the range of powers tested revealed a linear relationship with the level of applied power. The maximum average rate of tissue removal by the laser was 0.256 mm3/s at 8 W, compared with 0.945 mm3/s by the dental handpiece. Light microscopy and scanning electron micrograph examinations revealed a reduction in the amount of remaining debris and smear layer in the laser-prepared enamel surfaces, compared with the conventional method. Based on the results of this study, the cutting efficiency of the high-speed handpiece and dental bur was 3.7 times greater than the laser over the range of powers tested, but the laser appeared to create a cleaner enamel surface with minimal thermal damage. Further modifications of the laser system are suggested for improvement of laser cutting efficiency.

Laser-induced thermal events in empty and pulp-filled dental pulp chambers

BACKGROUND AND OBJECTIVE

The purpose of this investigation was to evaluate: 1. thermal events during laser irradiation @2.1 microns of the pulp; 2. whether these effects are adequately modeled using an empty pulp chamber/root canal.

STUDY DESIGN/MATERIALS AND METHODS

In extracted human teeth, pulpal access was prepared and thermocouples placed 2, 3 mm apical to the center of the irradiation spot. Pulp-filled or empty pulp chambers were irradiated using a Ho:YAG laser: Spot Size: 1 mm; Power: 1, 2, 3.5, 4.5 W; PRR: 5, 12 Hz;

DURATION

10 sec. Thermal measurements were repeated 3x.

RESULTS

Thermal trends did not differ significantly and correlated positively with power (P < 0.01), PRR (P < 0.01), irradiation duration (P < 0.05). No significant difference was determined between temperatures in empty and pulp-filled chambers at all parameters at 5 Hz and at 1-2 W at 12 Hz (P < 0.05, 2-tailed Student's t-test). At 12 Hz and > 3.5 W, pulp chamber temperatures exceeded those in pulpal tissue (P < 0.05).

CONCLUSION

Pulp tissues must be present to ensure clinical relevance of thermal measurements.