Efficacy of Nano Silver Fluoride and/or Diode Laser In Enhancing Enamel Anticariogenicity around orthodontic brackets

PURPOSE

This in vitro study aimed to compare the anticariogenic effect of using diode laser irradiation and/or nano silver fluoride varnish around orthodontic brackets.

MATERIALS AND METHODS

60 caries-free and intact premolars were randomly divided into 3 experimental groups as follow: (1) Group I (nano silver fluoride treated group, n = 20), (2) Group II (diode laser treated group, n = 20) and (3) Group III (combined nano silver fluoride and diode laser treated group, n = 20). Anticariogenicity was assessed using polarized light, scanning electron microscope, elemental and shear bond strength analyses.

RESULTS

PLM and SEM showed presence of few demineralized areas in group I. Group II revealed a dramatic increased demineralization. Group III disclosed almost typical homogenous surface enamel. elemental analysis showed a highly significant difference between Group III and II and a significant difference between Group III and I. Shear bond strength analysis revealed a significant difference between group I and II and between group III and II. The difference between group III and I was non-significant.

CONCLUSION

Both diode laser and nano silver fluoride positively affected dental enamel with the most superior enhancement in enamel criteria was achieved by surface pretreatment by combined nano silver fluoride varnish and diode laser irradiation.

Remineralization effects of Er,Cr:YSGG and/or bioactive glass on human enamel after radiotherapy-an in vitro study

The aim was to evaluate the effects of Er,Cr:YSGG and/or bioactive glass 45S5 (BG) on the chemical and physical properties of enamel after radiotherapy. Third molar crowns were cut in half (buccal-lingually), and the mid part of the labial/oral surface was subjected to different protocols. All samples were treated with standard 70 Gy. After radiotherapy, enamel was treated with either Er,Cr:YSGG (2780 nm; pulse 60 μs) and BG or only BG, and control samples were kept in deionized water. Vickers microhardness, scanning electron microscopy (SEM), and characteristic X-ray spectroscopy (EDS) were performed before, after radiotherapy, and after treatment. Analysis of variance (ANOVA) was used. A significant drop in enamel microhardness was observed after radiotherapy (p < 0.001). After Er,Cr:YSGG and BG or BG alone, there was a significant increase in microhardness (p < 0.001), which was on average significantly higher compared to the initial measurements for Er,Cr:YSGG with BG (p < 0.001), but not observed in BG alone (p = 0.331). After radiotherapy, SEM showed increased surface roughness with eroded prisms. Er,Cr:YSGG and BG or BG alone both showed disorderly packed glass particles on the enamel surface. Radiotherapy noticeably reduced the concentrations of calcium and phosphorus. Er,Cr:YSGG and BG treatment increased the concentrations of calcium, sodium, phosphorus, and silicate. BG treatment alone increased the concetration of calcium and phosphorus. Directly induced radiotherapy led to potential damage of enamel, but afterwards treatment with Er,Cr:YSGG laser and BG resulted in a higher increase of enamel microhardness compared to BG alone, reflecting in a possible better remineralization effect.

Combined Effect of Fluoride Mouthwash and Sub-ablative Er:YAG Laser for Prevention of White Spot Lesions around Orthodontic Brackets

Background:

Development of white spot lesions (WSLs) around orthodontic brackets compromises esthetics and necessitates additional dental treatments.

Objectives:

This study aimed to assess the efficacy of fluoride mouthwash combined with Er:YAG laser irradiation for the prevention of WSLs around orthodontic brackets.

Methods:

Orthodontic brackets were bonded to 50 bovine incisors. The entire tooth surface was coated with acid-resistant varnish except for a margin around the brackets. The microhardness of the teeth was measured at the respective area using the Vickers hardness test. The teeth were then randomly divided into five groups (n=10) of control (Gc), Orthokin fluoride mouthwash (Gf), 100 mJ/cm2 Er:YAG laser (Gl), laser + mouthwash (Glf), and mouthwash + laser (Gfl). Then, the teeth underwent pH cycling according to the standard protocol for demineralization. The microhardness of the teeth was measured again, and the percentage of change in microhardness was calculated. The amount of calcium released during pH cycling was quantified using atomic absorption spectroscopy. Data were analyzed using one-way ANOVA and Tukey’s test.

Results:

Calcium release (indicative of demineralization) in the Gf, Gfl, and Glf groups was significantly lower than that in the Gc and Gl groups (P<0.05). The reduction in surface microhardness was also the same in the five groups with no significant difference (P>0.05).

Conclusion:

Fluoride mouthwash combined with Er:YAG laser or Er:YAG laser alone cannot decrease the incidence of WSLs around orthodontic brackets compared to fluoride mouthwash alone.

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

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

Application of Er,Cr:YSGG laser versus photopolymerization after silver diamine fluoride in primary teeth

Examine the effect of dental curing light and laser treatments applied after Silver Diamine Fluoride (SDF) on dentin hardness in carious primary molars. This in-vitro study consisted of 30 extracted primary molars with caries extending into dentin without pulpal involvement. The collected teeth were randomly divided into three groups: group 1: received SDF then Sub-ablative low-energy of Er,Cr:YSGG laser, group 2: received SDF followed by application of curing light for 40 s, group 3: had SDF treatment only. In all groups, 38% Ag (NH3)2F SDF was used. Vickers hardness test was performed on sound dentin below carious lesion. Kruskal-Wallis Test was used to determine the mean difference in dentin hardness of the groups at 5% Significance level using SPSS software. Surface hardness of sound dentin below the carious lesion was statistically significantly higher in the laser + SDF group (891.24 ± 37.33 kgf/mm2) versus the two other groups (Light cure + SDF = 266.65 ± 90.81 kgf/mm2 and SDF only = 117.91 ± 19.19 kgf/mm2) with p-value ≤ 0.001. Although Photopolymerization of SDF increases the surface hardness of sound dentin below the carious lesion, applying laser after SDF has the highest surface hardness due to the laser's sub-ablation of dentin.

Effect of Er:YAG Laser and Association of Protocols on the Demineralized Enamel Microhardness

Objective: The aim of this study was to analyze the microhardness of demineralized enamel following different treatments (fluoride varnish, Er:YAG laser, and Er:YAG laser associated with fluoride varnish). Methods: Forty-eight enamel blocks (4 × 4 × 7 mm) were divided into six groups (n = 8): (S) Sound; (DE) Demineralized; (DED) DE + Duraphat^® 5% (fluoride varnish); (DEL20) DE + Er:YAG laser (20 mJ pulse mode; 0.20 W; 10 Hz; 60 sec; 1.18 J/cm²; 11.83 W/cm²); (DEL50) DE + Er:YAG laser (50 mJ pulse mode; 0.50 W; 10 Hz; 60 sec; 2.95 J/cm²; 29.58 W/cm²); (DEL20D) DE + Er:YAG laser (20 mJ) + Duraphat 5%. The irradiation was performed at 1 mm distance from the surface using a tip (AS7066X, L-14 mm, D-1.3 mm in diameter) in water/air spray refrigeration (level 6). The enamel blocks were submitted to pH cycling (4 h into DES solution +20 h into RE solution for 8 days and the solutions were changed every day). Knoop microhardness was measured (50 g/15 sec, six readings per sample) and data were analyzed by Kruskal-Wallis test at 5% significance. Results: After treatments, DF group showed higher microhardness values than all the groups. Also, DEL20D group showed similar results with H group according to the microhardness analysis (p < 0.05). Conclusions: It could be concluded that Duraphat 5% treatment showed better results when compared with all tested groups, however, the association of Er:YAG Laser 20 with Duraphat 5% also showed promising results.

Effect of Er,Cr:YSGG Laser on the Prevention of Primary and Permanent Teeth Enamel Demineralization: SEM and EDS Evaluation

Objective: To evaluate in vitro the effect of the erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser on resistance of primary and permanent human enamel to demineralization using water cooling and fluoride coapplication as variable parameters. Methods: Enamel specimens were prepared from extracted primary and permanent teeth (n = 225 each). The specimens were separated into 15 subgroups (n = 15/group) based on laser application at three different power settings (0.25, 0.50, and 0.75 W), laser application with and without water cooling, and application of acidulated phosphate fluoride (APF) gel before laser treatment. Morphological changes were assessed with scanning electron microscopy (SEM), and the specimens' chemical contents were determined with energy-dispersive X-ray spectroscopy. Results: In both the primary and permanent teeth, the highest Ca and P content was observed in the noncooled 0.75 W laser group (p < 0.05), irrespective of APF pretreatment (p > 0.05). The Ca and P content for the noncooled APF +0.75 W laser group was lower than that for the APF group and the noncooled 0.75 W laser group. For both dentitions, the F mass content for the APF+laser groups was significantly higher than laser-only groups (p < 0.05). Under SEM, both the primary and permanent enamel exhibited cracks, craters, and surface roughness without water cooling, consistent with increased power output. Conclusions: Er,Cr:YSGG laser application at 0.75 W without water cooling increased enamel resistance to demineralization. Compared with topical APF application, Er,Cr:YSGG laser application barely improved enamel resistance against demineralization, and coapplication did not result in a synergistic effect.

Effect of Laser Irradiance and Fluoride Varnish on Demineralization Around Dental Composite Restorations

Introduction: This study aimed to assess the effects of CO2 and erbium-doped yttrium aluminum garnet (Er:YAG) lasers with and without fluoride varnish on demineralization around composite restorations. Methods: This in vitro experimental study evaluated 96 extracted human premolars. After preparation and restoration of class V cavities in the buccal surface of the teeth with composite resin, they were randomly divided into 8 groups of control, CO2 laser (L1), CO2 laser-NaF (L1F), NaF-CO2 laser (FL1), Er:YAG laser (L2), Er:YAG laser-NaF (L2F), NaF-Er:YAG laser (FL2) and NaF (F). The entire surface of the teeth, except for the restored cavity in the buccal surface and 1 mm around the margin, was coated with two layers of nail varnish. The teeth then underwent pH cycling for 10 days (3 hours in demineralizing solution and 21 hours in remineralizing solution) to artificially induce demineralization. The amount of calcium and phosphorous released into the cariogenic solution was quantified using atomic absorption spectroscopy and spectrophotometry. The Vickers hardness tester was used to measure the hardness of the tooth structure adjacent to composite restoration. Data were analyzed using one-way ANOVA and Tukey's test. Results: The four groups of L1F, FL1, FL2 and L2F showed minimum loss of calcium and phosphorous ions, and the mean hardness of FL1 and FL2 groups was higher than that of other groups. Conclusion: The CO2 and Er:YAG lasers alone have no significant effect on the resistance of tooth structure to cariogenic solution. However, they can exert a synergistic effect when used along with NaF varnish. Fluoride varnish applied prior to laser irradiation confers further resistance to the tooth structure and positively affects its hardness.

Effect of the usage of Er,Cr:YSGG laser with and without different remineralization agents on the enamel erosion of primary teeth

The aim of the present study was to evaluate the effects of different remineralization agents associated with erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) (0.5 W power, 20 Hz frequency, 60% water, 40% air, 25 mJ pulse energy, 8.84 J/cm² fluence, 60 μs pulse duration, 600 μm tip diameter, and an approximate 1-1.5 mm distance to the target) laser irradiation on erosion induced by the consumption of carbonated drinks in human primary enamel. There were 8 groups and 10 primary teeth in each g0roup. The distribution was as follows: group 1, casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF); group 2, Er,Cr:YSGG laser+CPP-ACPF; group 3, fluor varnish; group 4, Er,Cr:YSGG Laser+fluoride varnish; group 5, ROCS® medical mineral gel; group 6, Er,Cr:YSGG laser + ROCS® medical mineral gel; group 7, Er,Cr:YSGG laser; and group 8, artificial saliva. The samples in the groups were submerged in artificial saliva and acid twice a day for 6 s at 6-h intervals and were then exposed to an erosion cycle 15 times. In the groups in which the Er,Cr:YSGG laser was applied in combination with the remineralization agents, the laser application was made first, and then the remineralization agents were applied for 4 min in each group. The Friedman and Wilcoxon signed-rank tests and the Bonferroni correction were used in statistical analyses, and the significance level was taken as p < 0.05. According to the results, all agents had a statistically significant difference (groups 1, 2, 3, 4, and 6: p = 0.005, p < 0.017; groups 5 and 7: p = 0.007, p < 0.017) between BL-RM periods. However, all agents had a statistically significant remineralization effect on primary teeth enamel (groups 1, 2, 3, 6, and 7: p = 0.005, p < 0.017; group 4: p = 0.011, p < 0.017) except that group 5 (p = 0.074, p < 0.017) between DM-RM periods. The coadministration of an agent with the laser did not make any difference at a statistical level (p = 0.804, p > 0.05). The results were supported by scanning electron microscopy (SEM) and X-ray diffraction (XRD) analysis. As a result of this study, CPP-ACPF had a notable impact in terms of the remineralization effect on eroded enamel, and the Er,Cr:YSGG laser alone may be an alternative method, which may be related to the modified hydroxyapatite structure, 38.5% H_0.56Ca_4.56O₁₃P₃Y_0.44, that was determined in XRD analysis.

Artificial Caries Resistance in Enamel after Topical Fluoride Treatment and 445 nm Laser Irradiation

Objective

This in vitro study is aimed at investigating the caries preventive effectiveness of 445 nm diode laser in combination with topical fluoridation.

Materials and methods

A total of 30 caries-free bovine teeth were used in this study. Eighteen teeth were covered with nail varnish except four windows on the labial surface. The windows were assigned to no treatment/control (C), laser (L) (0.3 W, 60 s, and 90 J/cm²), fluoride (F), and fluoride followed by laser (FL) treatment groups. Artificial caries lesions were created, and the teeth were sectioned and investigated under polarized light microscopy for quantitative measurement of the resulted lesion depth. Ten teeth were used for surface temperature measurement and two teeth for scanning electron microscopy (SEM). Extra twelve human molars were used for the intrapulpal temperature measurement. The absorbance of fluoride at 445 nm was measured.

Results

The means of lesion depth for the C, L, F, and FL groups were 123.48 (±21.93), 112.33 (±20.42), 99.58 (±30.68), and 89.03 (±30.38) μm, respectively. The pairwise differences of the L, F, and FL groups compared with the C group were significant (p < 0.05). The differences between groups were tested: FL versus L p=0.02, F versus L p=0.16, and FL versus F p=0.91, and the difference of the F versus FL was not significant (p=0.91). Temperature increment at the enamel surface and pulp roof were ∆T = 16.67 (±4.11) and 2.12 (±0.66)°C, respectively. The topical fluoride absorbance at 445 nm is five orders higher than that at 810 nm. SEM shows that after laser irradiation the enamel surface was intact and without thermal damage.

Conclusions

The 445 nm laser irradiation may be useful for caries prevention, and its effectiveness is lower than those previously achieved using the argon ion laser.

Laser-assisted prevention of enamel caries: a 10-year review of the literature

Since the invention of lasers in dentistry, investigations in caries prevention by the use of laser radiation have been proposed. There are several mechanisms stated for this purpose such as photothermal and/or photochemical interaction processes with the enamel. Alone or in conjugation with topical fluoride application, this treatment modality may improve enamel acid resistance in high-caries-risk populations. Data collection was done by searching the keywords caries, prevention, and laser in PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar. Lasing protocols of the collected literature and their effectiveness as well as examination methods used to verify treatment outcomes have been evaluated. One hundred eighteen publications were found for the last 10 years. The wavelengths investigated for caries prevention are mainly located in the near and the mid-infrared spectral range. In the evaluated period of time, investigations using CO₂; Er:YAG; Er,Cr:YSGG; Er:YLF; fundamental, second, and third harmonic generations of Nd:YAG; diodes; and argon ion lasers were found in the databases. Accounting for 39% of the literature, CO₂ laser was the most examined system for this purpose. Reviewing the literature in this narrative review showed that all laser systems presented a positive effect in varying degrees. Laser irradiation could be an alternative or synergistic to topical fluoridation for enamel caries prevention with longer lasting effect. Further research should be focused on selecting proper laser settings to avoid damage to enamel and developing effective evidence-based clinical protocols.

Effect of Erbium:Yttrium-Aluminum-Garnet Laser Combined with Mineralizing Agents on Microhardness of Demineralized Dentin

Objective The aim of this study was to assess the combined effect of erbium:yttrium-aluminum-garnet (Er:YAG) laser and mineralizing agents including casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride in improving the resistance of demineralized dentin at new demineralization process.

Materials and Methods One hundred and twenty healthy dentin surfaces were prepared and demineralized using acidic solutions. Primary microhardness was measured (h1), and samples were randomly divided into six groups. Each group received a different protocol as follows: Group A (control group): no additional treatment, Group B: applying a fluoridated gel, Group C: applying a CPP-ACP-containing cream, Group D: irradiation of Er:YAG laser, Group E: irradiation of Er:YAG laser combined with the application of a fluoridated agent, and Group F: irradiation of Er:YAG laser combined with the application of CPP-ACP-containing cream. Microhardness values were measured afterward (h2). Then, all the groups were re-exposed to acidic solution, and microhardness was measured for the third time (h3). The microhardness data were analyzed using analysis of variance and Scheffe's post hoc test.

Results Although application of mineralizing agents increased the microhardness of demineralized dentin in comparison with the control group, no significant difference was observed using two agents. Comparison of laser groups showed an increase in microhardness only after the irradiation of Er:YAG laser combined with the application of a fluoridated agent. Demineralizing process reduced the microhardness values in all the groups, but the application of a CPP-ACP agent caused the least reduction among the laser irradiated groups. Comparison of hardness changes at the beginning and end of the experiment did not show any significant differences between the groups.

Conclusion Comparison of treatment modalities used in this study exhibited that fluoride had the greatest impact on dentin resistance. Laser irradiation on demineralized dentin did not increase the hardness or resistance to acidic attacks.

Adhesion of Streptococcus mutans and Streptococcus sanguinis on Er:YAG Laser-Irradiated Dental Enamel: Effect of Surface Roughness

Objective: To determine surface roughness caused by Er:YAG laser irradiation and its effect on the increase in bacterial adhesion. Background: Er:YAG laser was proposed as a strategic device to reduce caries by its ability to generate chemical and structural changes in tooth enamel; in turn, it produces undesirable effects on the tooth surface that could increase its roughness and allow a greater accumulation of microorganisms. Methods: Eighty-four samples of human enamel were divided into seven groups (n = 12): G1_control (no laser irradiation); G2_100/H₂O, G3_200/H₂O, and G4_300/H₂O were irradiated with Er:YAG laser (12.7, 25.5, and 38.2 J/cm², respectively) under water irrigation. In addition, G5_100, G6_200, and G7_300 were irradiated with the energy densities described above and no water irrigation. Surface roughness measurements were recorded before and after treatment using a profilometer. Afterward, three samples per group were incubated in a microorganism suspension for the tetrazolium salt (XTT) assay. Biofilm morphology was observed using scanning electron microscopy and confocal laser scanning microscope. One-way analysis of variance and t-tests were performed for statistical analysis (p < 0.05). Results: There were no statistically significant differences in roughness values in the G5_100 group before and after treatment, but there were statistically significant differences observed in the other groups evaluated (p < 0.05). No significant differences in adhesion of both strains were detected in irradiated groups compared with G1_control. Conclusions: The increase in roughness on dental enamel surfaces was proportional to the irradiation conditions. However, the increase in surface roughness caused by Er:YAG laser irradiation did not affect Streptococcus mutans and S. sanguinis adhesion.

Er,Cr:YSGG laser associated with acidulated phosphate fluoride gel (1.23% F) for prevention and control of dentin erosion progression

To evaluate the effect of Er,Cr:YSGG laser, associated with fluoride application, on the prevention/control of dentin erosion. Dentin slabs were embedded in acrylic resin, flattened, and polished. Half of the specimens were previously eroded (10 min immersion in 1% citric acid solution) and half were kept sound. The specimens (n = 10 each substrate) were randomly allocated into the experimental groups, according to the following treatments: control (no treatment); APF gel (1.23% F, 1 min); Er,Cr:YSGG laser irradiation (P1: 0.25 W, 20 Hz, 2.8 J/cm², tip S75, beam diameter of 750 μm, 1 mm away from the surface); Er,Cr:YSGG laser irradiation (P2: 0.50 W, 20 Hz, 5.7 J/cm², tip S75, beam diameter of 750 μm, 1 mm away from the surface); APF gel + Er,Cr:YSGG laser P1 and; APF gel + Er,Cr:YSGG laser P2. Afterwards, the specimens underwent an erosion-remineralization cycling, consisting of a 5-min immersion into 0.3% citric acid, followed by 60-min exposure to artificial saliva. This procedure was repeated 4×/day, for 5 days. Surface loss (SL, in μm) was determined by optical profilometry. Specimens from each group were analyzed by environmental scanning electron microscopy (n = 3). Data were statistically analyzed (α = 0.05). For the eroded specimens, APF gel presented the lowest SL, being different from the control. For the sound specimens, none of the groups differed from the control, except for Er,Cr:YSGG laser P2, which presented the highest SL. When substrates were compared, only the eroded specimens of the control and APF + Er,Cr:YSGG laser P1 Groups showed higher SL. Selective structure removal was observed for the laser-treated groups. None of the Er,Cr:YSGG laser parameters were effective in the prevention/control dentin erosion. The laser was also unable to enhance the protection of fluoride against dentin erosion.

Evaluation of Surface Roughness and Bacterial Adhesion on Tooth Enamel Irradiated With High Intensity Lasers

The aim was to evaluate the surface roughness and bacterial adhesion on enamel irradiated with high intensity lasers, associated or not to a fluoride varnish. Eighty fragments of bovine enamel were equally divided in 8 groups (n=10). Group 1 was not treated and Group 2 received only a 5% fluoride varnish application. The other groups were irradiated with an Er:Cr:YSGG (8.92 J/cm2), an Nd:YAG (84.9 J/cm2) and a diode laser (199.04 J/cm2), associated or not to a 5% fluoride varnish. The surface roughness was measured before and after treatments. Afterward, all samples were incubated in a suspension of S. mutans at 37 °C for 24 h. The colony-forming units (CFU) were counted by a stereoscope and the results were expressed in CFU/mm2. One-way ANOVA and the Tukey´s test compared the roughness data and the Student´s test compared the results obtained in the bacterial adhesion test (a=5%). The results showed that the irradiated samples without varnish presented the same roughness and the same bacterial adhesion that the non-irradiated samples. However, samples irradiated in the presence of fluoride varnish showed higher surface roughness and higher bacterial adhesion than the non-irradiated samples and those irradiated without varnish. Presence of pigments in the varnish increased the lasers' action on the enamel surface, which produced ablation in this hard tissue and significantly increased its surface roughness. For this reason, the enamel's susceptibility to bacterial adhesion was higher when the irradiation of the samples was made in presence of fluoride varnish.

In Vitro Comparison Of Fluoride Gel Alone and in Combination With Er,Cr:YSGG Laser on Reducing White Spot Lesions in Primary Teeth

Introduction: Laser therapy has been suggested as a method for caries-prevention, and ErCr:YSGG laser is increasingly used in dentistry. This study aimed to compare the efficacy of fluoride gel alone and in conjunction with Er,Cr:YSGG laser for remineralization of white spot lesions (WSLs) in primary teeth. Methods: This study was conducted on 20 primary teeth with WSLs extracted for orthodontic reasons. Three sections were made of each tooth at the site of WSLs. The surface area of WSLs was measured under a stereomicroscope at ×25 magnification. Samples were assigned to 3 groups of control (group 1), exposure to 1.23% APF gel for 4 minutes (group 2) and Er,Cr:YSGG laser (0.5 W power, 20 Hz frequency, 60% water, 40% air, pulse duration of 5±1 seconds) plus fluoride (group 3). All samples were stored in artificial saliva for 10 days and then the surface area of the WSLs was measured again under a stereomicroscope. Data were analyzed using the Kruskal-Wallis, MannWhitney and Wilcoxon signed rank tests. Results: The reduction in surface area of the WSLs was significantly different between the control and fluoride (P<0.001) and also the control and laser plus fluoride groups (P<0.001); the difference between fluoride and laser plus fluoride groups was not significant (P=0.265). Comparison of the surface area of WSLs before and after the intervention showed no significant difference in group one (P=0.737) while this difference in groups 2 (P<0.001) and 3 (P<0.001) was statistically significant. Conclusion: The results showed that Er,Cr:YSGG laser irradiation plus 1.23% APF gel was not significantly different from the application of fluoride gel alone in enhancing the remineralization of WSLs.

Sub-ablative Er,Cr:YSGG laser irradiation under all-ceramic restorations: effects on demineralization and shear bond strength

This study evaluated the caries resistant effects of sub-ablative Er,Cr:YSGG laser irradiation alone and combined with fluoride in comparison with fluoride application alone on enamel prepared for veneer restorations. And also, evaluated these treatments' effects on the shear bond strength of all-ceramic veneer restorations. One hundred and thirty-five human maxillary central teeth were assigned to groups of 1a-control, 1b-laser treated, 1c-fluoride treated, 1d-laser + fluoride treated for shear bond testing and to groups of 2a-positive control(non-demineralised), 2b-laser treated, 2c-fluoride treated, 2d-laser + fluoride treated, 2e-negative control (demineralised) for microhardness testing (n = 15, N = 135). Demineralisation solutions of microhardness measurements were used for the ICP-OES elemental analysis. The parameters for laser irradiation were as follows: power output, 0.25 W; total energy density, 62.5 J/cm² and energy density per pulse, 4.48 J/cm² with an irradiation time of 20 s and with no water cooling. Five percent NaF varnish was used as fluoride preparate. ANOVA and Tukey HSD tests were performed (α = 5%). Surface treatments showed no significant effects on shear bond strength values (p = 0.579). However, significant differences were found in microhardness measurements and in elemental analysis of Ca and P amounts (p < 0.01). Surface-treated groups showed significantly high VNH values and significantly low ICP-OES values when compared with non-treated (-control) group while there were no significance among surface-treated groups regarding VHN and ICP-OES values. Sub-ablative Er,Cr:YSGG treatment alone or combined with fluoride is as an effective method as at least fluoride alone for preventing the prepared enamel to demineralization with no negative effect on shear bond strength.

Formation of Fluorohydroxyapatite with Silver Diamine Fluoride

Silver diamine fluoride (SDF) is found to promote remineralization and harden the carious lesion. Hydroxyapatite crystallization is a crucial process in remineralization; however, the role of SDF in crystal formation is unknown. We designed an in vitro experiment with calcium phosphate with different SDF concentrations (0.38, 1.52, 2.66, 3.80 mg/mL) to investigate the effect of this additive on the nucleation and growth of apatite crystals. Two control groups were also prepared-calcium phosphate (CaCl2·2H2O + K2HPO4 in buffer solution) and SDF (Ag[NH3]2F in buffer solution). After incubation at 37 oC for 24 h, the shape and organization of the crystals were examined by bright-field transmission electron microscopy and electron diffraction. Unit cell parameters of the obtained crystals were determined with powder X-ray diffraction. The vibrational and rotational modes of phosphate groups were analyzed with Raman microscopy. The transmission electron microscopy and selected-area electron diffraction confirmed that all solids precipitated within the SDF groups were crystalline and that there was a positive correlation between the increased percentage of crystal size and the concentration of SDF. The powder X-ray diffraction patterns indicated that fluorohydroxyapatite and silver chloride were formed in all the SDF groups. Compared with calcium phosphate control, a contraction of the unit cell in the a-direction but not the c-direction in SDF groups was revealed, which suggested that small localized fluoride anions substituted the hydroxyl anions in hydroxyapatite crystals. This was further evidenced by the Raman spectra, which displayed up-field shift of the phosphate band in all the SDF groups and confirmed that the chemical environment of the phosphate functionalities indeed changed. The results suggested that SDF reacted with calcium and phosphate ions and produced fluorohydroxyapatite. This preferential precipitation of fluorohydroxyapatite with reduced solubility could be one of the main factors for arrest of caries lesions treated with SDF.

Nd:YAG laser irradiation associated with fluoridated gels containing photo absorbers in the prevention of enamel erosion

This study evaluated the combined effect of Nd:YAG laser irradiation and fluoridated gels containing photo absorbers against enamel erosion. Enamel specimens from bovine teeth were polished, eroded (10 min, with 1% citric acid, pH = 2.6), and randomly allocated into the experimental groups (n = 8), according to the different surface treatments: fluoridated gels (F: 9047 ppm F and F + Sn: 9047 ppm F and 3000 ppm Sn), with or without photo absorbers (E: erythrosine and MB: methylene blue), and associated or not with Nd:YAG laser irradiation (in contact; 0.5 W; 50 mJ; ~41.66 J/cm²; 10 Hz; 40 s; pulse duration of 120 μs). A placebo gel (PLA) associated or not with laser was used as control. All gels had pH = 4.5 and were applied for 2 min. Laser irradiation was performed during gel application. The specimens were then submitted to a 5-day erosion-remineralization cycling model using 0.3% citric acid (pH = 2.6), 4×/day. Enamel surface loss (SL) was analyzed by optical profilometry in the end of the cycling (in μm). Data were analyzed by ANOVA and Tukey tests (α = 0.05). Means (SD) of SL for the groups were the following (different superscript letters imply significant difference among groups): PLA (21.02 ± 1.28)^a, PLA + laser (19.20 ± 0.96)^ab, laser (17.47 ± 1.50)^b, F + Sn + E + laser (13.69 ± 0.62)^c, F + E + laser (13.52 ± 1.16)^c, F (13.10 ± 1.08)^c, F + laser (11.94 ± 1.44)^cd, F + Sn + MB + laser (11.90 ± 4.02)^cd, F + MB + laser (11.42 ± 1.42)^cd, F + Sn (11.12 ± 1.20)^cd, and F + Sn + laser (10.35 ± 0.89)^d. In conclusion, all fluoridated gels and the Nd:YAG laser irradiation reduced erosion development, but the combination of treatments did not promote further protection. The addition of photo absorbers to the fluoridated gels did not influence the anti-erosive effect of the combination of laser plus fluoridated gels.

A Comparative Analysis of Caries Inhibitory Effect of Remineralizing Agents on Human Enamel Treated With Er:YAG Laser: An In-vitro Atomic Emission Spectrometry Analysis

INTRODUCTION

The tug of war to maintain tooth integrity is dependent on a ratio between demineralization and remineralization. Hence, demineralization should be retarded and remineralization should be enhanced to maintain a natural equilibrium in the oral cavity.

AIM

To compare in-vitro acid resistance of human enamel when using Casein Phosphopeptides Amorphous Calcium Phosphate (CPP-ACP) [GC Tooth mousse] cream, Casein Phosphopeptide Amorphous Calcium Fluoride Phosphate (CPP-ACFP) [GC Tooth mousse plus] cream, Er:YAG laser alone, combination of CPP-ACP with Er:YAG laser, CPP-ACFP with Er:YAG laser.

MATERIALS AND METHODS

An in-vitro study was done on 100 specimens which were prepared from 50 human premolars to investigate the caries inhibitory effect of remineralizing agents and laser on enamel using an atomic emission spectrometry analysis. The enamel specimens were randomly allocated into 6 groups: Untreated (control); CPP-ACP (GC Tooth mousse); CPP-ACFP (GC Tooth mousse plus); Er:YAG laser treatment alone; CPP-ACP with Er:YAG laser; CPP-ACFP with Er: YAG laser. Then specimens were immersed individually in 5ml of acetate buffer solution (0.1mol/L, pH 4.5) and incubated at 37°C for 24 hours, to determine the acid resistance by analyzing the calcium release using atomic emission spectrometry. An ANOVA model was constructed (p-value 0.05), followed by post-hoc Tukey's test for multiple pair wise comparisons of mean values.

RESULTS

There was a significant difference among the various groups with respect to amount of calcium released (p<0.001). The lowest mean score of calcium release was observed for CPP-ACFP with Er:YAG laser followed by CPP-ACFP but the differences between these groups were statistically not significant (p>0.05). Similarly the differences between CPP-ACP with Er:YAG laser and CPP-ACP also were not significant (p>0.05). The highest mean score of calcium release was for Er:YAG laser and no significant statistical difference was noticed in comparison with control group (p>0.05).

CONCLUSION

Combination of CPP-ACFP with Er:YAG laser is more effective in decreasing enamel demineralization when compared with other groups.

Craniofacial Wound Healing with Photobiomodulation Therapy: New Insights and Current Challenges

The fundamental pathophysiologic response for the survival of all organisms is the process of wound healing. Inadequate or lack of healing constitutes the etiopathologic basis of many oral and systemic diseases. Among the numerous efforts to promote wound healing, biophotonics therapies have shown much promise. Advances in photonic technologies and a better understanding of light-tissue interactions, from parallel biophotonics fields such as in vivo optical imaging and optogenetics, are spearheading their popularity in biology and medicine. Use of high-dose lasers and light devices in dermatology, ophthalmology, oncology, and dentistry are now popular for specific clinical applications, such as surgery, skin rejuvenation, ocular and soft tissue recontouring, and antitumor and antimicrobial photodynamic therapy. However, a less well-known clinical application is the therapeutic use of low-dose biophotonics termed photobiomodulation (PBM) therapy, which is aimed at alleviating pain and inflammation, modulating immune responses, and promoting wound healing and tissue regeneration. Despite significant volumes of scientific literature from clinical and laboratory studies noting the phenomenological evidence for this innovative therapy, limited mechanistic insights have prevented rigorous and reproducible PBM clinical protocols. This article briefly reviews current evidence and focuses on gaps in knowledge to identify potential paths forward for clinical translation with PBM therapy with an emphasis on craniofacial wound healing. PBM offers a novel opportunity to examine fundamental nonvisual photobiological processes as well as develop innovative clinical therapies, thereby presenting an opportunity for a paradigm shift from conventional restorative/prosthetic approaches to regenerative modalities in clinical dentistry.

Optical diagnosis and characterization of dental caries with polarization-resolved hyperspectral stimulated Raman scattering microscopy

We report the utility of a rapid polarization-resolved hyperspectral stimulated Raman scattering (SRS) imaging technique developed for optical diagnosis and characterization of dental caries in the tooth. Hyperspectral SRS images (512 × 512 pixels) of the tooth covering both the fingerprint (800-1800 cm(-1)) and high-wavenumber (2800-3600 cm(-1)) regions can be acquired within 15 minutes, which is at least 10(3) faster in imaging speed than confocal Raman mapping. Hyperspectral SRS imaging uncovers the biochemical distributions and variations across the carious enamel in the tooth. SRS imaging shows that compared to the sound enamel, the mineral content in the body of lesion decreases by 55%; while increasing up to 110% in the surface zone, indicating the formation of a hyper-mineralized layer due to the remineralization process. Further polarized SRS imaging shows that the depolarization ratios of hydroxyapatite crystals (ν 1-PO4 (3-) of SRS at 959 cm(-1)) of the tooth in the sound enamel, translucent zone, body of lesion and the surface zone are 0.035 ± 0.01, 0.052 ± 0.02, 0.314 ± 0.1, 0.038 ± 0.02, respectively, providing a new diagnostic criterion for discriminating carious lesions from sound enamel in the teeth. This work demonstrates for the first time that the polarization-resolved hyperspectral SRS imaging technique can be used for quantitatively determining tooth mineralization levels and discriminating carious lesions from sound enamel in a rapid fashion, proving its promising potential of early detection and diagnosis of dental caries without labeling.

Synergistic Inhibition of Enamel Demineralization by Peptide 8DSS and Fluoride

The biomimetic peptide 8DSS has shown beneficial effects in promoting remineralization of demineralized enamel in vitro. Here we examined the ability of 8DSS alone and in combination with fluoride to inhibit enamel demineralization during pH-cycling mimicking intraoral conditions. Enamel blocks were subjected to 9 days of pH-cycling in the presence of 1,000 ppm NaF (positive control), distilled-deionized water (DDW; negative control), 25 μM 8DSS alone, 25 μM 8DSS with 500 ppm NaF (8DSS-FL) or 25 μM 8DSS with 1,000 ppm NaF (8DSS-FH) twice daily for 1 min each time. The blocks were analyzed in terms of surface microhardness (SMH), fluoride uptake and mineral content. The 8DSS-treated blocks showed significantly lower mineral loss, shallower lesions and higher SMH than the DDW-treated blocks. No significant differences were observed between the blocks treated with 8DSS alone or fluoride alone. The blocks treated with 8DSS alone or DDW showed similar amounts of fluoride uptake, which was the lowest of all the treatment groups. The blocks treated with 8DSS-FL or 8DSS-FH did not differ significantly, and both groups showed significantly greater SMH and fluoride uptake as well as significantly lower mineral loss and shallower lesions than the NaF-treated blocks. Mineral content was significantly higher in the 8DSS-treated blocks than in the DDW-treated blocks from the surface layer (10 µm) to the lesion depth (110 µm), and it was significantly higher in the blocks treated with 8DSS-FL or 8DSS-FH than in the NaF-treated blocks from 10 to 90 µm. These findings illustrate the potential of 8DSS for inhibiting enamel demineralization and for enhancing the anticaries effect of NaF.

Effect of silver diamine fluoride and ammonium hexafluorosilicate applications with and without Er:YAG laser irradiation on the microtensile bond strength in sound and caries-affected dentin

BACKGROUND AND OBJECTIVE

Cariostatic and preventive agents are applied to create caries-resistant dentin surfaces and may affect subsequent resin bonding. The aim of this study was to investigate the effect of different agents with and without Er:YAG laser irradiation on the microtensile bond strength (µTBS) of resin composite to sound dentin (SD) and caries-affected dentin (CAD), and to assess the morphological and chemical changes in the specimens.

MATERIALS AND METHODS

Ninety-six extracted molar teeth were divided into a control group (deionized water) and two experimental groups (ammonium hexafluorosilicate [SiF], silver diamine fluoride [SDF]), that subdivided according to different conditions (SD, CAD, SD+laser irradiation, CAD+laser irradiation). After treatment procedures, the teeth were restored and the µTBS was tested with a universal testing machine. Morover, 144 teeth were prepared and after treatment modalities; morphological changes of the surface were investigated and elemental analyses were performed using scanning electron microscope/energy dispersive spectroscopy (SEM-EDS). The data were analyzed using Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

SDF and SiF applications reduced the µTBS values in both the SD and CAD subgroups (P < 0.05). Laser irradiation increased the µTBS values in the SiF group and the values were adversely affected in the SDF group (P < 0.05). Fluoride content of the specimens increased in all of the treatment groups, compared with the control group. Silver content was detected only in the SDF group, and silicon was detected only in the SiF group.

CONCLUSIONS

The µTBS values of resin composite, surface morphology and chemical characteristics of dentin were affected by the material type, dentin condition and laser irradiation and the use of SiF and SDF solutions under the resin restorations do not seem appropriate.

Inhibition of enamel demineralisation using "Nd-YAG and diode laser assisted fluoride therapy"

AIM

This in vitro study was to evaluate the irradiation efficacy of the Diode laser and the Nd-YAG laser either un-assisted or assisted by acidulated phosphate fluoride (APF) treatment on enamel's acid resistance.

METHODS

Seventy-two enamel samples, obtained from 12 extracted human molars, were randomly assigned to 6 groups as follows: (1) Control (C); (2) Exposed to APF gel (F); (3) Diode laser (DL); (4) Irradiated with Diode laser through APF gel (DL/F); (5) Nd-YAG laser (NL) and (6) Irradiated with Nd-YAG laser through APF gel (NL/F). The specimens were individually demineralised in an acidified hydroxyethylcellulose system, and the acid resistance was evaluated by determining the calcium ion dissolution using atomic absorption spectrometry.

RESULTS

The average concentration of the calcium ion determined in groups 1 to 6 was 901, 757, 736, 592, 497 and 416 parts per million micrograms/gram, respectively. The results showed that demineralisation in the NL/F group was significantly less than the other groups and the control group was significantly greater than the other groups (P < 0.001).

CONCLUSION

The effect of Nd-YAG laser irradiation, used alone or in combination with APF, in decreasing the enamel demineralisation was greater than all the other groups.

Laser-Casein phosphopeptide effect on remineralization of early enamel lesions in primary teeth

Background

The aim of this study was to assess the effect of Nd:YAG laser irradiation following casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application on calcium and phosphate concentration and surface microhardness (SMH) of enamel surface in artificial white spot lesions of primary teeth.

Material and Methods

Eighty teeth with artificial white spot lesions were randomly divided into four groups: (A) distilled and deionized water, (B) Nd:YAG laser, (C) CPP-ACP crème, & (D) CPP-ACP plus laser. SMH was measured using Vickers diamond indenter in Vickers Hardness Number (VHN). Two samples of each group were analyzed using scanning electron microscope (SEM). The results were analyzed with the SPSS 17/win.

Results

The subjects of group D demonstrated a significant increase in the calcium and phosphate contents of enamel surface compared to those of groups A (P < 0.001, P < 0.001), B (P < 0.001, P < 0.001) and C (P = 0.024, P = 0.04), respectively. A statistically significant difference was seen for mean VHN between groups A and B (P = 0.002). SEM evaluations confirmed the results.

Conclusions

The combination of Nd:YAG laser and CPP-ACP crème could be recommended as an effective preventive modality for remineralizing of white spot lesions in primary teeth.

Key words:CPP-ACP, enamel remineralization, microhardness, Nd:YAG, primary teeth, SEM.

Er:YAG laser irradiation to control the progression of enamel erosion: an in situ study

This in situ study evaluated the effect of Er:YAG laser irradiation in controlling the progression of enamel erosion-like lesions. Fifty-six enamel slabs (330 KHN ± 10 %) with one fourth of the surface covered with resin composite (control area) were submitted to initial erosion-like lesion formation with citric acid. The slabs were divided into two groups: irradiated with Er:YAG laser and non-irradiated. Fourteen volunteers used an intraoral palatal appliance containing two slabs, in two phases of 5 days each. During the intraoral phase, in a crossed-over design, half of the volunteers immersed the appliance in citric acid while the other half used deionized water, both for 5 min, three times per day. Enamel wear was determined by an optical 3D profilometer. ANOVA revealed that when deionized water was used as immersion solution during the intraoral phase, lower values of wear were showed when compared with the groups that were eroded with citric acid, whether irradiated or non-irradiated with Er:YAG laser. When erosion with citric acid was performed, Er:YAG laser was not able to reduce enamel wear. Small changes on enamel surface were observed when it was irradiated with Er:YAG laser. It may be concluded that Er:YAG laser irradiation did not reduce the progression of erosive lesions on enamel submitted to in situ erosion with citric acid.

Prevention of dentine caries using silver diamine fluoride application followed by Er:YAG laser irradiation: an in vitro study

To evaluate the preventive effect of Er:YAG laser (EYL) irradiation followed by silver diamine fluoride (SDF) application on dentine with cariogenic biofilm challenge. Twenty-four dentine slices were prepared from extracted sound human third molars. Each slice was cut into four parts for SDF application, followed by EYL irradiation (group SL), SDF application (group S), EYL irradiation (group L) and water (group W). The specimens were subjected to cariogenic biofilm challenge for 12 h, followed by immersion in a buffered remineralising solution containing calcium chloride and sodium hypophosphate for 12 h at 37 °C. Surface morphological changes in the specimens were examined using scanning electronic microscopy. Elemental analysis was performed using energy-dispersive X-ray spectrometry. Micro-mechanical properties were investigated by nano-indentation. The specimen surfaces of groups SL and L showed laser melting contours with narrowed dentinal orifices. Group S showed a partial tubular occlusion. A porous surface was observed in group W, indicating demineralisation. The mean (SD) fluoride weight percentages were 3.93 (0.91), 3.10 (0.61), 0.17 (0.09) and 0.32 (0.07) in groups SL, S, L and W, respectively, (p < 0.001; SL, S > L, W). The mean (SD) micro-hardness values in GPa were 1.84 (0.22), 0.49 (0.13), 0.41 (0.11) and 0.30 (0.06) in groups SL, S, L and W, respectively, (p < 0.001; SL > S > L, W). The mean (SD) elastic moduli in GPa were 75.1 (7.2), 20.0 (1.3), 24.3 (5.2) and 20.2 (2.8) in groups SL, S, L and W, respectively, (p < 0.001; SL > S, L, W). SDF application followed by EYL irradiation on a dentine surface increased its resistance to cariogenic biofilm challenge.