Aldo Brugnera Junior

Laser therapy in the treatment of dentine hypersensitivity

Cervical dentine hypersensitivity is the most frequent complaint among reported odontalgias. Thus, this study evaluated the effectiveness of two types of lasers (660 nm wavelength red, and 830 nm wavelength infrared) as dentine desensitizers, as well as both the immediate and late therapeutic effects in individuals 25 to 45 years of age. A total of 40 teeth with cervical exposure were treated in 4 sessions. They were divided into 2 groups according to treatment. A 660 nm wavelength red diode laser and an 830 nm wavelength infrared diode laser were used. Dentine sensitivity to cold nociceptive stimulus was evaluated by means of a pain numeric scale from zero to 10 before each treatment session, at 15 and 30 min after irradiation, and in a follow-up period of 15, 30 and 60 days after the end of treatment. Significant levels of dentinal desensitization were only found in patients ranging in age from 25 to 35 years. The 660 nm red diode laser was more effective than the 830 nm infrared laser and a higher level of desensitization was observed at the 15 and 30 minute post-irradiation examinations. The immediate and late therapeutic effects of the 660 nm red diode laser were more evident in 25-35-year-old patients compared with those of the 830 nm infrared diode laser, in terms of the different age groups.

Effect of Er:YAG laser on adhesion of root canal sealers.

This in vitro study evaluated the effect of Er:YAG laser on adhesion to human dentin of Grossman, Endomethasone, N-Rickert, and Sealer 26 root canal sealers. The crowns of 40 human molars were cut on the occlusal side until a flat dentin surface was obtained. The teeth were divided into two groups: group 1, no laser application; and group 2, irradiation with Er:YAG laser (KaVo Key Laser 2; 11 mm focal distance, perpendicular to the dentin surface, 4 Hz frequency, 200 mJ energy, 62 J total energy and 313 pulses, 1-min application time, and 2.25 W power). Five samples were tested for each sealer and each group. An Instron universal testing machine was used for the adhesion test. Sealer 26 showed the best adhesion both with and without laser application (p < 0.01). Grossman and N-Rickert sealers had intermediate values, and Endomethasone had the worst adhesion. Application of Er:YAG laser did not alter the adhesion of Grossman, N-Rickert, or Endomethasone sealers. However, laser application increased the adhesion of Sealer 26. The epoxy resin-based root canal sealer (Sealer 26) adhered better to dentin prepared with and without Er:YAG laser than the zinc oxide/eugenol-based sealers (Endomethasone, N-Rickert, and Grossman).

Use of 660-nm Diode Laser in the Prevention and Treatment of Human Oral Mucositis Induced by Radiotherapy and Chemotherapy

OBJECTIVE The aim of this multidisciplinary study was to evaluate quantitatively and qualitatively the effect of a 660-nm diode laser in the prevention and treatment of human oral mucositis (OM) in patients suffering from head and neck cancer who had undergone radiotherapy and chemotherapy. BACKGROUND DATA OM is a severe oral lesion resulting from the toxic effects of treatment for cancer in the head and neck region. Low-level laser therapy is indicated to prevent and treat this oral complication and may be used alone or in association with conventional drug treatment, producing pain relief and wound repair. METHODS This study included 72 patients with head and neck cancer treated at the Cancer Hospital of Mato-Grosso, Brazil, and divided into a control group (C; n = 36) and a laser group (L; n = 36). Laser therapy was performed in combination with radiotherapy and chemotherapy twice a week using a diode laser (lambda = 660 nm, power = 30 mW, spot size = 2 mm, energy = 2 J per point). RESULTS Statistically significant differences were observed between the two groups. Patients in group L usually did not present with OM or pain, but all patients in group C presented with OM ranging from Level I to III associated with pain. This difference was significant from week 1 on, increased until week 4 and remained stable up to week 7. CONCLUSION Laser therapy was effective in preventing and treating oral effects induced by radiotherapy and chemotherapy, thus improving the patients quality of life.

Effects of Er:YAG laser irradiation and manipulation treatments on dentin components, part 1: Fourier transform-Raman study.

The effects of laser etching, decontamination, and storage treatments on dentin components were studied using Fourier transform (FT)-Raman spectroscopy. Thirty bovine incisors were prepared to expose the dentin surface and then divided in two main groups based upon the decontamination process and storage procedure: autoclaved (group A, n=15) or stored in thymol aqueous solution (group B, n=15). The surfaces of the dentin slices were schematically divided into four areas, with each one corresponding to a treatment subgroup. The specimens were either etched with phosphoric acid (control subgroup) or irradiated with erbium-doped yttrium-aluminum-garnet (Er:YAG) laser (subgroups: I-80 mJ, II-120 mJ, and III-180 mJ, and total energy of 12 J). Samples were analyzed by FT-Raman spectroscopy; we collected three spectra for each area (before and after treatment). The integrated areas of five Raman peaks were calculated to yield average spectra. The areas of the peaks associated with phosphate content (P<0.001), type I collagen, and organic C-H bonds (P<0.05) were reduced significantly in group A (control). Analyses of samples irradiated with reduced laser energies did not show significant changes in the dentin components. These results suggest that thymol storage treatment is advised for in vitro study; furthermore, 12 J of Er:YAG laser energy does not affect dentin components.

Laser phototherapy in dentistry.

Light is an important source of energy for most forms of life on Earth. Ancient Greeks and Romans already knew that solar light helped cure several illnesses. Ancient Egyptians even used phototherapy to treat some skin diseases. However, they did not know how it actually worked. Laser therapy started empirically in the 1960s and since then it has gained credibility and followers throughout the world. In the last two decades, thousands of studies have been published in scientific journals, enabling clinical use based on scientific evidence. Photomedicine and Laser Surgery is itself the result of the growing use of phototherapy in all medical areas. Laser phototherapy (LPT) is a modality of clinical treatment that results in nonthermal effects on tissues and whose biological effects promote a slight increase in temperature (not higher than 18C). The magnitude of its effects depends on the cells’ physiological status and=or the clinical stage of the condition prior to irradiation. Scientific studies have shown that the primary mechanisms of LPT are related to the interaction between photons and molecules in the tissue, while the secondary mechanisms are related to the effect of the chemical changes induced by the former. This set of reactions has an analgesic, anti-inflammatory, and healing effect on tissues. Several authors have experienced excellent results using LPT in dentistry. Its main clinical indications are alveolitis, temporomandibular dysfunction, apthae and thrush, gingivitis, herpetic gingivostomatitis (herpes simplex), benign migratory glossitis (geographic tongue), buccal burning syndrome, dentinal hypersensitivity, implantology, mucositis, trigeminal neuralgia, odontalgia, idiopathic facial paralysis (Bell’s palsy), paresthesia, pericementitis, pericoronaritis, periodontitis, angular cheilitis, tissue healing (post-operatory), and traumatic ulcer. Therapeutic lasers should never be used without a precise diagnosis of the pathology to be treated. This demands profound knowledge of dental specialties and laser properties such as the laser’s irradiation parameters, wavelength (nm), power (W) input and output, power density or irradiance (W=cm), energy density or fluence ( J=cm), duration of each session (seconds), frequency of treatment (weekly) and number of sessions, energy per point ( J) and total energy ( J), continuous wave or pulse laser, and spot size (cm). In addition the operator should by all means comply with the safety rules. It has been observed that LPT effects are dose dependent. The irradiation dose or energy density is one of the most important parameters in laser therapy. If the dose is too low, results may not be accomplished and if it is too high, the desired effect may be inhibited. However, dosimetry is not limited to dose calculation expressed by DE ( J=cm)1⁄4P (W) t (sec)=A (cm). A patient’s age and fitness, pathology diagnosis, size of lesion, tissue, stage of illness, and laser parameters are decisive factors when calculating dose. Nonetheless, there is no consensus as to how to calculate the dose in laser therapy, because photobiomodulation obtained by LPT is not limited to the area that receives the light beam but also occurs in the nearby surrounding area. There are different kinds of applications in dentistry. Laser is applied directly on hard tissues, such as teeth. On the other hand, soft tissues require scattered light and dose is calculated using SAEF (spatial average energy fluence) ( J=cm)1⁄4P (W) t (s) n=A (cm). The World Association for Laser Therapy (WALT) offers guidelines and recommendations to promote dosimetry accuracy and appropriate conduct of clinical research (see www.walt.nu).17 Although many questions still remain unanswered, the clinical results obtained by using LPT in the dental clinic should encourage professionals to keep using this powerful tool in order to further develop its potential. LPT is currently and will forever be a part of modern medicine and dentistry.

Use of laser fluorescence in dental caries diagnosis: a fluorescence x biomolecular vibrational spectroscopic comparative study

The aim of this work was to verify the existence of correlation between Raman spectroscopy readings of phosphate apatite (~960 cm-1), fluoridated apatite (~575 cm-1) and organic matrix (~1450 cm-1) levels and Diagnodent® readings at different stages of dental caries in extracted human teeth. The mean peak value of fluorescence in the carious area was recorded and teeth were divided in enamel caries, dentin caries and sound dental structure. After fluorescence readings, Raman spectroscopy was carried out on the same sites. The results showed significant difference (ANOVA, p<0.05) between the fluorescence readings for enamel (16.4 ± 2.3) and dentin (57.6 ± 23.7) on carious teeth. Raman peaks of enamel and dentin revealed that ~575 and ~960 cm-1 peaks were more intense in enamel caries. There was significant negative correlation (p<0.05) between the ~575 and ~960 cm-1 peaks and dentin caries. It may be concluded that the higher the fluorescence detected by Diagnodent the lower the peaks of phosphate apatite and fluoridated apatite. As the early diagnosis of caries is directly related to the identification of changes in the inorganic tooth components, Raman spectroscopy was more sensitive to variations of these components than Diagnodent.

Molecular analysis of Er:YAG laser irradiation on dentin

The aim of this study was to evaluate by dispersive Raman spectroscopy the mineral and organic components of human dentin before and after laser irradiation and acid etching. The occlusal enamel of six non-carious human third molars was removed providing 6 dentin discs, which were divided in four quadrants each of them receiving a different surface treatment: etching with a 37% phosphoric acid gel (control); irradiation by Er:YAG laser (KaVo Key Laser II) with 80 mJ, 3 Hz, 30 s (group I); 120 mJ, 3 Hz, 30 s (group II); and 180 mJ, 3 Hz, 30 s (group III). The Raman spectra of normal (untreated) and treated dentin were analyzed and the mineral and the organic component were evaluated. Results were submitted to statistical analysis by ANOVA and Tukeys test at 5% significance level. The minerals and organic content were less affected in the control group and group I (p>0.05). Group II presented more reduction in mineral content (p<0.01) whereas in group III the inorganic (p<0.05) and organic (p<0.01) content were more affected. Dispersive Raman spectroscopy provided valid information of dentin chemical constituents with non-chemical sampling preparation.

Effects of the bleaching procedures on enamel micro-hardness: Plasma Arc and diode laser comparison

BACKGROUND AND AIMS One of the major side effects of vital bleaching is the reduction of enamel micro-hardness. The purpose of this study was to evaluate the influence of two different bleaching systems, Plasma Arc and GaAlAs laser, on the enamel micro-hardness. MATERIALS AND METHODS 15 freshly extracted human third molars were sectioned to prepare 30 enamel blocks (5×5 mm). These samples were then randomly divided into 2 groups of 15 each (n=15): a plasma arc bleaching group (: 350-700 nm) + 35% Hydrogen Peroxide whitening gel and a laser bleaching group (GaAlAs laser, λ: 810 nm, P: 10 W, CW, Special Tip) + 35% Hydrogen Peroxide whitening gel. Samples were subjected to the Vickers micro-hardness test (VHN) at a load of 50 g for 15s before and after treatment. Data were statistically analyzed by a Mann-Whitney test (p≤0.05). RESULTS In the GaAlAs laser group, the enamel micro-hardness was 618.2 before and was reduced to 544.6 after bleaching procedures. In the plasma arc group, the enamel micro-hardness was 644.8 before and 498.9 after bleaching. Although both techniques significantly reduced VHN, plasma arc bleaching resulted in a 22.62% reduction in VHN for enamel micro-hardness, whereas an 11.89% reduction in VHN was observed for laser bleaching; this difference is statistically significant (p<0.001). CONCLUSION Both bleaching techniques reduced enamel micro-hardness, although the reduction is much less significant with the GaAlAs laser than with the plasma arc. Therefore GaAlAs laser bleaching has fewer harmful effects than plasma arc in respect to enamel micro-hardness reduction.

Temperature changes in different groups of teeth during cavity preparaton with Er:YAG laser

Objective: Various studies have recommended parameters for the use of Er:YAG laser for the treatment of enamel and dentis caries; however, none have studied the increase in temperature caused by laser in individual groups of teeth. Summary Background Data: The effect of preparation with Er:YAG laser on the pulp temperature changes is one of the major problems in using the laser for preparation of dental hard tissue. Methods: The authors studied the intrapulpar temperature changes in 10 incisors, 10 canines, 10 premolars and 10 molars during Class V cavity preparation with focused short pulse (250 μs/pulse) and very short pulse (80-120 μs/pulse) Er:YAG laser, using the following parameters: 10 Hz frequency, 500 mJ per pulse, 6 s, 10 mm distance, 25 ml/min water flow, at 23°C and 65% humidity. Results: The greatest increase in temperature was foundin the incisors and the least increase in the molars at both pulse modes. Conclusions:The very short pulse mode caused less of an increase in temperature in the pulp chamber in all teeth than the short pulse mode.