Jörg Meister

Structural Changes in Human Dental Enamel after Subablative Erbium Laser Irradiation and Its Potential Use for Caries Prevention

Numerous studies have confirmed the potential of erbium laser irradiation for increasing the acid resistance of dental enamel. The objective of the present paper was to investigate the effect of subablative erbium laser irradiation on the structure and acid resistance of dental enamel by means of confocal laser scanning microscopy (CLSM). To this end, 12 samples of human dental enamel were irradiated with subablative energy densities (Φ) of an Er:YAG (λ = 2.94 µm, Φ = 6 J/cm2) and an Er:YSGG laser (λ = 2.79 µm, Φ = 8 J/cm2). The enamel surfaces of 6 samples were polished prior to irradiation. The remaining 6 samples were left intact (without polishing procedures) and, in the further course of the study, they were subjected to 1-week in situ demineralisation. All irradiated test surfaces were assigned a control surface on the same sample. The changes following laser irradiation and the in situ wearing time were assessed qualitatively using a confocal laser scanning microscope. The irradiation of dental enamel with subablative erbium laser irradiation produces fine cracks in the enamel surface. These cracks act as starting points for acid attack and favour deep demineralisation. These changes reduce or eliminate the positive effect of subablative erbium laser irradiation observed in connection with caries-preventive use. The clinical use of subablative erbium laser irradiation to prevent caries would appear not to make sense under the conditions studied.

The ablation threshold of Er:YAG and Er:YSGG laser radiation in dental enamel.

Abstract.The scientific investigation of fundamental problems plays a decisive role in understanding the mode of action and the consequences of the use of lasers on biological material. One of these fundamental aspects is the investigation of the ablation threshold of various laser wavelengths in dental enamel. Knowledge of the relationships and influencing factors in the laser ablation of hard tooth tissue constitutes the basis for use in patients and the introduction of new indications. The present paper examines the ablation threshold of an Er:YAG laser (λ=2.94 µm) and an Er:YSGG laser (λ=2.79 µm) in human dental enamel. To this end, 130 enamel samples were taken from wisdom teeth and treated with increasing energy densities of 2–40 J/cm2. The sample material was mounted and irradiated on an automated linear micropositioner. Treatment was performed with a pulse duration of τP(FWHM)≈150 µs and a pulse repetition rate of 5 Hz for both wavelengths. The repetition rate of the laser and the feed rate of the micropositioner resulted in overlapping of the single pulses.The surface changes were assessed by means of reflected light and scanning electron microscopy. On the basis of the results, it was possible to identify an energy density range as the ablation threshold for both the Er:YAG and the Er:YSGG laser. With the Er:YAG laser, the transition was found in an energy density range of 9–11 J/cm2. The range for the Er:YSGG laser was slightly higher at 10–14 J/cm2.

CO2 Laser (10.6 μm) Parameters for Caries Prevention in Dental Enamel

Although CO2 laser irradiation can decrease enamel demineralisation, it has still not been clarified which laser wavelength and which irradiation conditions represent the optimum parameters for application as preventive treatment. The aim of the present explorative study was to find low-fluence CO2 laser (λ = 10.6 μm) parameters resulting in a maximum caries-preventive effect with the least thermal damage. Different laser parameters were systematically evaluated in 3 steps. In the first experiment, 5 fluences of 0.1, 0.3, 0.4, 0.5 and 0.6 J/cm2, combined with high repetition rates and 10 μs pulse duration, were chosen for the experiments. In a second experiment, the influence of different pulse durations (5, 10, 20, 30 and 50 μs) on the demineralisation of dental enamel was assessed. Finally, 3 different irradiation times (2, 5 and 9 s) were tested in a third experiment. In total, 276 bovine enamel blocks were used for the experiments. An 8-day pH-cycling regime was performed after the laser treatment. Demineralisation was assessed by lesion depth measurements with a polarised light microscope, and morphological changes were assessed with a scanning electron microscope. Irradiation with 0.3 J/cm2, 5 μs, 226 Hz for 9 s (2,036 overlapping pulses) increased caries resistance by up to 81% compared to the control and was even significantly better than fluoride application (25%, p < 0.0001). Scanning electron microscopy examination did not reveal any obvious damage caused by the laser irradiation.

Influence of the pulse duration of an Er:YAG laser system on the ablation threshold of dental enamel

Abstract.The present study examines the dependence of the ablation threshold on the duration of the applied laser pulses in the dental enamel of human wisdom teeth. To this end, 600 treatments with the Er:YAG laser (λ=2940 nm) were carried out on a total of 50 extracted teeth. The laser light was coupled into a fluoride glass light guide for this purpose, in order to ensure almost gaussian distribution of the light in a radially symmetrical beam. The beam diameter on the specimen was 610 µm. The radiant exposure on the tooth surface was varied between 2 and 20 J/cm2, while the duration of the pulses applied was changed in four steps from 100 µs to 700 µs. The irradiated tooth surfaces were examined for visible signs of ablation under a reflected-light microscope. The experiments revealed that, when pulses of shorter duration are used, the limit at which ablation sets in is reduced by up to approx. 3 J/cm2. This expands the ablation threshold range of Er:YAG laser radiation to between 6 and 10 J/cm2. In this context, both the pulse duration and the radiant exposure have a statistically significant influence on the ablation threshold (logistic regression, p<0.0001). Although the ablation threshold of the dental enamel can be changed by varying the pulse duration of the Er:YAG laser, no clinical consequences can be expected, as the shift is only slight.

Influence of the spatial beam profile on hard tissue ablation Part I: Multimode emitting Er:YAG lasers

AbstractUniform dosimetry is a prerequisite for reproducible laser applications in research and practice. The light–tissue interaction is dependent on the absorbed energy (J) per unit of time (τ) in the case of pulsed lasers, and on the absorbed power (W) per unit of volume (e.g. mm3) in the case of continuous-wave (cw) lasers, and thus directly dependent on the energy distribution within the laser beam. Consequently, precise knowledge of the spatial beam profile, and of the pulse duration and treatment time, is indispensable. The objective of this paper was a theoretical study of the impact of different mode profiles on energy distribution in the beam. Also examined was the question of the influence of changes in the laser parameters on the mode structure. Three erbium:YAG lasers (λ=2.94 μm) were used for this purpose. The transversal mode structure of the lasers was observed by irradiating thermal paper and verified by means of calculations. The effect induced in the mode profile by changing the pulse energy and pulse repetition rate was investigated. The results of the tests show that changes in the laser parameters result in jumps in the transversal modes and associated energy distributions in the beam. The experiments confirm that simply changing the transversal modes has a substantial effect on the threshold energy required for the ablation of dental enamel (50 mJ with TEM00, 22.6 mJ with TEM31). In practice, inhomogeneity makes it impossible to determine the irradiated area in order to calculate the energy or power density. In addition, the energy distribution in the beam changes as a result of variation of the laser output energy and the pulse repetition rate. Consequently, simply measuring the beam diameter yields a totally incorrect result for the applied flux density when using a beam profile with a relatively high mode.

Influence of the spatial beam profile on hard tissue ablation, Part II: pulse energy and energy density distribution in simple beams

When calculating applied flux densities in practice, the beam profile of a laser is often erroneously assumed to be homogeneous. In addition, there is usually no consistency in the choice of a suitable measuring method for determining the beam diameter. This failure to observe the inhomogeneous intensity distribution within the beam cross-section, combined with the imprecise knowledge of the beam diameter, leads to flux densities being stated that represent mean values at best. The present paper gives definitions for the flux densities of simple, radially symmetrical beam cross-sections, taking the top-hat and Gaussian profiles as examples. In connection with the inhomogeneous energy distribution in the Gaussian beam, a concept of integral and local energy density is discussed, which differs from the customary definition of the energy density as a constant. Also presented are the consequences of the mathematical concepts in terms of measurement, giving particular consideration to the case where the energy density as the measured variable matches the integral energy density. The significance of the integral and local energy density for hard-tissue ablation is described, based on the practical example of the ablation of dental hard substance. The central result is that the integral flux density is directly accessible as a measured variable, while the effect on the tissue is determined by the local flux density. If the form of the beam is known, the integral flux density can be converted into the local flux density.

Multireflection pumping concept for miniaturized diode-pumped solid-state lasers

An innovative pump concept for diode-pumped, solid-state lasers is introduced as an example for an Er:YSGG laser, permitting its miniaturization. Embedded in a multireflective pump cavity, the laser crystal is simultaneously side and end pumped. Specially calculated and shaped deflecting optics distribute the coaxially input pumping light homogeneously over the lateral surface of the crystal, therefore reducing the size of the laser head, including the optical resonator, to a length of 27.5 mm and an outside diameter of 12.5 mm. The differential efficiency achieved is between 8.7% and 24%. The laser emits energy of 15.7 mJ at an absolute efficiency of 9.1% and a repetition rate of 4 Hz.

Ablation of articular cartilage with an erbium:YAG laser: An ex vivo study using porcine models under real conditions—ablation measurement and histological examination

The use of an erbium:YAG laser in arthroscopic surgery has the advantage of a precise treatment of soft tissue. Due to the high absorption in water, the laser energy is perfectly matched to smoothing the hydrous, fibrillated articular cartilage surface. In minimal invasive surgery, the workspace is filled with aqueous liquids for enlargement. This appears contrary to the absorption characteristics of erbium:YAG laser radiation in water. The purpose of this study was to evaluate the ablated volume per pulse of cartilage lesions and the potential side effects including thermal damage and tissue necrosis.