Anna-Marie A. Arrastia-Jitosho

CO2 laser treatment of traumatic pulpal exposures in dogs

Successful non‐devitalizing treatment of localized pulpal lesions in mature teeth is not ensured using conventional endodontic techniques. The objective of this study was to evaluate CO2 laser surgical treatment of pulpal exposures in canine patients.

Visualization and quantification of dentin structure using confocal laser scanning microscopy

Dentin was visualized using a new fluorescence technique and confocal laser scanning microscopy. Thirty extracted human teeth showing no clinical signs of caries were investigated. All teeth were horizontally sectioned to approximately 200 μm thickness and sections were subjected to different pretreatment conditions as follows: vacuum only, ultrasonication only, sodium hypochlorite only, sodium hypochlorite and vacuum, sodium hypochlorite and ultrasonication, and a combination of sodium hypochlorite, vacuum, and ultrasonication. Some samples were left untreated to serve as control. Following pretreatment, rhodamine 123 fluorescent dye was used for staining at concentrations ranging from 10 -3 to 10 -7 M for 1 to 24 h at pH 6.0, 6.5, or 7.4. Optical staining occurred at pH 7.4 and concentrations ≥ 10 -5 M over 3 h or longer. Surface images obtained using confocal laser scanning microscopy were similar to those observed by scanning electron microscopy without the need for sample-altering conventional scanning electron microscope preparation techniques. Subsurface imaging to a depth of approximately 60 μm was achieved using confocal laser microscope techniques. This fluorescence technique offers a useful new alternative for visualization and quantification of dentin.

Novel approach to laser Doppler measurement of pulpal blood flow

A modified laser Doppler flowmetry technique that significantly improves the performance of the current technique in measuring pulpal blood flow is described. A preliminary model demonstrates that, by using a forward-scattered geometry, the detected signal will have a much higher signal-to-noise ratio and calibration capacity. The forward-scattered signal is readily detectable because teeth are relatively thin organs with moderate optical loss. Preliminary experiments comparing forward-scattered detection with conventional back-scattered detection were carried out using an extracted, perfused human molar. The results showed that: (1) the existing back-scattering method produced readings that fluctuated by as much as 187% in response to small changes in sensor position relative to the tooth and (2) the forward-scattered method produced consistent readings (within 10%) that were independent of the sensor position, a signal-to-noise ratio that was at least 5.6 times higher than that obtained by the back-scattering method, and a linear response to flow rate. The results validated the findings of the preliminary model and clearly showed the superiority of the forward-scattering geometry.

Novel laser Doppler flowmeter for pulpal blood flow measurements

We have proposed and experimentally demonstrated a new configuration of laser Doppler flowmetry for dental pulpal blood flow measurements. To date, the vitality of a tooth can be determined only by subjective thermal or electric tests, which are of questionable reliability and may induced pain in patient. Non-invasive techniques for determining pulpal vascular reactions to injury, treatment, and medication are in great demand. The laser Doppler flowmetry technique is non-invasive; however, clinical studies have shown that when used to measure pulpal blood flow the conventional back-scattering Doppler method suffers from low signal-to-noise ratio (SNR) and unreliable flux readings rendering it impossible to calibrate. A simplified theoretical model indicates that by using a forward scattered geometry the detected signal has a much higher SNR and can be calibrated. The forward scattered signal is readily detectable due to the fact that teeth are relatively thin organs with moderate optical loss. A preliminary experiment comparing forward scattered detection with conventional back- scattered detection was carried out using an extracted human molar. The results validated the findings of the simple theoretical model and clearly showed the utility of the forward scattering geometry. The back-scattering method had readings that fluctuated by as much as 187% in response to small changes in sensor position relative to the tooth. The forward scattered method had consistent readings (within 10%) that were independent of the sensor position, a signal-to-noise ratio that was at least 5.6 times higher than the back-scattering method, and a linear response to flow rate.

Visualization and quantification of healthy and carious dentin structure using confocal laser scanning microscopy

In this study, a fluorescence technique was developed for visualization of dentin using confocal laser scanning microscopy (CLSM). Eighteen extracted human teeth were used: 13 showing no clinical signs of caries and 5 with visually apparent decay. Preliminary study: All teeth were horizontally sectioned to approx. 200 micrometers thickness and pre-treated as follows: no pretreatment; vacuum only; ultrasonication only; sodium hypochlorite (NaOCl) only; vacuum and NaOCl; ultrasonication and NaOCl; or vacuum, ultrasonication and NaOCl. Samples were stained with Rhodamine 123 fluorescent dye at a concentration of 10-5 M in phosphate buffer saline for 1 to 24 hours. Caries study: Dentin surfaces, some with pre-existing caries, were visualized using CLSM. Most dentin tubules in sound dentin appeared open using CLSM, but most dentin tubules in carious dentin appeared closed or narrowed. Surface images obtained using CLSM were similar to those seen by SEM, but additional subsurface imaging was possible using CLSM at depth intervals of 1 micrometers to a depth of 30 - 50 micrometers . This technique shows good potential for non-invasive surface and subsurface imaging of dentin structures.

Effects of diverse laser parameters at 9.3 μm on soft tissue and bone

These investigations were performed to determine thermal, histological and incisional effects in soft tissue of laser irradiation at 9.3 um. Specifically, the consequences of varying pulse duration, interval and frequency, peak and average powers and energy densities were studied. In fresh pigs jaws, 6 standardized incisions, 3 cm in length, were made per parameter using a template and motorized jig. Incisions were made at various standardized anatomical sites, and surface thermal events monitored using an IR camera. Laser parameters investigated: power: 1 - 11 W, duty cycle: 10 - 90%, Pulse duration: 1 - 200 ms, at gated continuous wave. Superpulse and OptiPulseTM modes with 300 us pulses were also investigated. Incision width and depth as well as collateral tissue effects were assessed statistically. They were directly related to the parameters used. Ease of incision and effects on underlying bone were also parameter-related.

Preliminary report on use of CO2 laser treatment of traumatic pulpal exposure in dogs: a clinical study

The objective of this study was to evaluate carbon-dioxide laser surgical treatment of pulpal exposures in canine patients. Seventeen permanent teeth with exposures of less than or equal to 48 h were randomly allocated to receive either (1) localized laser pulp surgery to remove all compromised soft tissues or (2) localized pulp surgery using a large round sterile bur under sterile saline irrigation. Single laser pulses were used at 0.01 s pulse duration, 1.0 s pulse interval, a spot size of 0.004 cm2 and an energy density of 276 J/cm2. Exposures were dressed with CaOH and glass ionomer. Clinical and radiographic evaluations were performed by one blinded clinician 4, 12, 24 and 52 weeks after treatment using standard scales of 0-(-1). Fifteen/seventeen laser-treated teeth assessed over greater than or equal to 1 year post-treatment remained clinically and radiographically healthy.

Effect of laser parameters and mode on pulp surgery outcome

The objective of this study was to determine the effectiveness of localized laser pulp surgery in the canine model. Effects of laser parameters on treatment outcome were also investigated. Pulpal exposure 3 mm in diameter were prepared in healthy teeth and left open to infection from the oral cavity for 72 hours. Pulpal tissue was then removed using high speed handpiece with sterile irrigation, or a CO2 laser. Teeth were monitored clinically, radiographically for 3 months. Results for each criterion were evaluated on a scale of 0-(-2). After sacrifice, histological assessment was made soft and hard tissue response. Results for each category were evaluated on a standard scale of 0-(-2). All evaluations were performed by 1 blinded, pre-standardized clinician. Statistical assessment using the chi-square test and Fishers Exact Test associated laser treatment with a significantly better clinical, radiographic and histological treatment outcome. NIH RRO1192, seed grant funding form Loma Linda University, the Edna P. Jacobsen Charitable Trust for Animals, Inc.

Thermal and microstructural effects of nanosecond pulsed Nd:YAG laser irradiation on tooth root surface

Plaque, calculus and altered cementum removal by scaling and root planing is a fundamental procedure in periodontal treatment. However, the residual smear layer contains cytotoxic and inflammatory mediators which adversely affect healing. Chemical smear layer removal is also problematic. In previous investigations effective smear layer removal was achieved using long pulsed irradiation at 1.06 (mu) . However, laser irradiation was not adequate as an alternative to scaling and root planing procedures and concurrent temperature rises exceeded thermal thresholds for pulpal and periodontal safety. It was the aim of this study to determine whether nanosecond pulsed irradiation at 1.06 (mu) could be used as an alternative or an adjunct to scaling and root planing. Sixty freshly extracted teeth were divided as follows: 5 control, 5 root planed only, 25 irradiated only, 25 root planed and irradiated. Irradiation was performed at fluences of 0.5 - 2.7 J/cm2, total energy densities of 12 - 300 J/cm2, frequencies of 2 - 10 Hz using the Medlite (Continuum) laser. Irradiation-induced thermal events were recorded using a thermocouple within the root canal and a thermal camera to monitor surface temperatures. SEM demonstrated effective smear layer removal with minimal microstructural effects. Surface temperatures increased minimally (< 3 C) at all parameters, intrapulpal temperature rises remained below 4 C at 2 and 5 Hz, F < 0.5 J/cm2. Without prior scaling and root planing, laser effects did not provide an adequately clean root surface.