Marcella Esteves-Oliveira

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.

Laser treatment of recurrent herpes labialis: a literature review

Recurrent herpes labialis is a worldwide life-long oral health problem that remains unsolved. It affects approximately one third of the world population and causes frequent pain and discomfort episodes, as well as social restriction due to its compromise of esthetic features. In addition, the available antiviral drugs have not been successful in completely eliminating the virus and its recurrence. Currently, different kinds of laser treatment and different protocols have been proposed for the management of recurrent herpes labialis. Therefore, the aim of the present article was to review the literature regarding the effects of laser irradiation on recurrent herpes labialis and to identify the indications and most successful clinical protocols. The literature was searched with the aim of identifying the effects on healing time, pain relief, duration of viral shedding, viral inactivation, and interval of recurrence. According to the literature, none of the laser treatment modalities is able to completely eliminate the virus and its recurrence. However, laser phototherapy appears to strongly decrease pain and the interval of recurrences without causing any side effects. Photodynamic therapy can be helpful in reducing viral titer in the vesicle phase, and high-power lasers may be useful to drain vesicles. The main advantages of the laser treatment appear to be the absence of side effects and drug interactions, which are especially helpful for older and immunocompromised patients. Although these results indicate a potential beneficial use for lasers in the management of recurrent herpes labialis, they are based on limited published clinical trials and case reports. The literature still lacks double-blind controlled clinical trials verifying these effects and such trials should be the focus of future research.

Prevention of recurrent herpes labialis outbreaks through low-intensity laser therapy: a clinical protocol with 3-year follow-up

IntroductionThe recurrent herpes labialis (RHL) is a chronic lifelonginfection that affects a great part of the world’s population.It is caused by the herpes simplex virus type 1 (HSV 1) [1].The first virus contact causes the primary infection, whichis characterized by symptoms like multiple oral vesicles,fever, chills, fatigue, and muscle aches, lasting for 10 to14 days [2]. In general, primary infection is more severethan recurrences and is more commonly observed inchildren, teenagers, and young adults [3].After the primary infection and resolution of the lesions,the virus moves through the nerve endings and establishes alatent state at sensory ganglia, most commonly thetrigeminal ganglion. The exposition of the host to severalkinds of stress causes virus reactivation and migrationthrough sensory nerves to skin and mucosa, achieving thebasal epithelium of the lips and perioral area. Replication ofthe virus at these sites takes place and initiates a clinicalepisode of recurrent herpes labialis [4]. During theseepisodes, most of the clinical symptoms such as pain,redness, and swelling are consequences of the anti-inflammatory response generated by the immune systemof the host [5]. Thus, it is well known that patients withrecurrent herpes simplex infections have two concomitantmedical problems: virus multiplication and the overreactingimmune system [5].The virus reactivation may be triggered by fever, sunexposure, menstruation, psychological stress, or physicaltrauma. Afterwards, recurrent herpes labialis infection willmanifest clinically in different stages [6, 7]. The “coldsores” are the visible sign of RHL orofacial outbreaks andappear most frequently on the lips, at the juncture of themucous membrane, and perioral skin or inside the nose [8,9]. Up to 60% of the patients will experience a prodromicstage, after which the cold sores outbreaks develop through

Screening of CO2 Laser (10.6 μm) Parameters for Prevention of Enamel Erosion

OBJECTIVE The aim of this study was to screen CO(2) laser (10.6 μm) parameters to increase enamel resistance to a continuous-flow erosive challenge. BACKGROUND DATA A new clinical CO(2) laser providing pulses of hundreds of microseconds, a range known to increase tooth acid-resistance, has been introduced in the market. METHODS Different laser parameters were tested in 12 groups (n=20) with varying fluences from 0.1 to 0.9 J/cm(2), pulse durations from 80 to 400 μs and repetition rates from 180 to 700 Hz. Non-lased samples (n=30) served as controls. All samples were eroded by exposure to hydrochloric acid (pH 2.6) under continuous acid flow (60 μL/min). Calcium and phosphate release into acid was monitored colorimetrically at 30 sec intervals up to 5 min and at 1 min intervals up to a total erosion time of 15 min. Scanning electron microscopic (SEM) analysis was performed in lased samples (n=3). Data were statistically analysed by one-way ANOVA (p<0.05) and Dunnetts post-hoc tests. RESULTS Calcium and phosphate release were significantly reduced by a maximum of 20% over time in samples irradiated with 0.4 J/cm(2) (200μs) at 450 Hz. Short-time reduction of calcium loss (≤1.5 min) could be also achieved by irradiation with 0.7 J/cm(2) (300μs) at 200 and 300 Hz. Both parameters revealed surface modification. CONCLUSIONS A set of CO(2) laser parameters was found that could significantly reduce enamel mineral loss (20%) under in vitro erosive conditions. However, as all parameters also caused surface cracking, they are not recommended for clinical use.

Influence of the additional Er:YAG laser conditioning step on the microleakage of class V restorations

The purpose of this study was to evaluate the influence of an additional Er:YAG laser conditioning step after laser cavity preparations, on the microleakage of class V composite restorations. Forty-eight bovine incisors were randomly divided into four groups: G1(control) cavities prepared with bur, G2- cavities prepared with laser (400 mJ/2 Hz), G3- cavities prepared and subsequently conditioned with Er:YAG laser (60 mJ/2 Hz); G4-idem for G3, but the laser conditioning was carried out without water-spray. All the cavities were restored using Clearfill SE Bond and Z-250 composite resin. The samples were thermal cycled for 700 cycles and then immersed in 50% silver nitrate solution. The sectioned restorations were exposed to a photoflood lamp to reveal silver nitrate penetration. The Kruskal-Walis one-way analyses of variance test and post hoc Wilcoxon pair-wise comparison were used to compare microleakage degrees. At the gingival margin G2 showed a lower microleakage mean than the control bur-prepared cavities (p = 0.0003). At occlusal margins there were no statistically significant differences between the groups (p = 0.28). It may be concluded that Er:YAG laser class V cavity preparations do not need to be followed by an additional laser conditioning step to result in levels of microleakage similar to or lower than those obtained after bur preparations.

Re- and Demineralization Characteristics of Enamel Depending on Baseline Mineral Loss and Lesion Depth in situ

Objectives: The aim of this double-blinded, randomized, cross-over in situ study was to evaluate the re- and demineralization characteristics of sound enamel as well as lowly and highly demineralized caries-like enamel lesions after the application of different fluoride compounds. Methods: In each of three experimental legs of 4 weeks, 21 participants wore intraoral mandibular appliances containing 4 bovine enamel specimens (2 lowly and 2 highly demineralized). Each specimen included one sound enamel and either one lowly demineralized (7 days, pH 4.95) or one highly demineralized (21 days, pH 4.95) lesion, and was positioned 1 mm below the acrylic under a plastic mesh. The three randomly allocated treatments (application only) included the following dentifrices: (1) 1,100 ppm F as NaF, (2) 1,100 ppm F as SnF2 and (3) 0 ppm F (fluoride-free) as negative control. Differences in integrated mineral loss (ΔΔZ) and lesion depth (ΔLD) were calculated between values before and after the in situ period using transversal microradiography. Results: Of the 21 participants, 6 did not complete the study and 2 were excluded due to protocol violation. Irrespectively of the treatment, higher baseline mineral loss and lesion depth led to a less pronounced change in mineral loss and lesion depth. Except for ΔΔZ of the dentifrice with 0 ppm F, sound surfaces showed significantly higher ΔΔZ and ΔLD values compared with lowly and highly demineralized lesions (p < 0.05, t test). Conclusion: Re- and demineralization characteristics of enamel depended directly on baseline mineral loss and lesion depth. Treatment groups should therefore be well balanced with respect to baseline mineral loss and lesion depth.

Analysis of Bacterial Activity in Sound and Cariogenic Biofilm: A Pilot in vivo Study

Dental caries is a multifactorial disease with many associated microbial taxa, but only a few are notably contributing to acidogenicity. The ribosome number and the corresponding 16S ribosomal RNA (rRNA) concentration are considered a molecular indicator for general metabolic activity of bacteria, as they are elevated with increased anabolic and catabolic activities. We hypothesize that the activity of aciduric/acidogenic bacterial taxa, reflected by a rise in ribosomal counts, could resolve differences between plaque biofilm from sound surfaces and caries lesions. The included subjects were allocated to two groups: caries-free (CF) or caries-active (CA). CF subjects presented one donor site, namely one sound surface (CFS, n = 10), whereas CA subjects presented two donor sites: a cavitated lesion with an ICDAS score of 5-6 (CAC, n = 13), and a sound reference surface (CAS, n = 13). Four aciduric/acidogenic bacterial taxa (Streptococcus mutans, lactobacilli, Bifidobacterium dentium, and Scardovia wiggsiae) and one asaccharolytic taxon (fusobacteria) as a contrast were selected. 16S rRNA and 16S rRNA genes were quantified by quantitative PCR. Based on these parameters, bacterial and ribosomal counts, as well as relative activities were calculated as the quotient of relative ribosomal abundance and relative genome abundance. Caries-associated bacteria showed the highest relative activity in caries lesions (e.g. lactobacilli CAC: 177.5 ± 46.0%) and lower activities on sound surfaces (e.g. lactobacilli CAS: 96.3 ± 31.5%), whereas asaccharolytic fusobacteria were most active on sound surfaces and less active in caries lesions (CFS: 275.7 ± 171.1%; CAS: 205.8 ± 114.3%; CAC: 51.1 ± 19.0%). Thus, the present study suggests different activity patterns for biofilms from CF and CA individuals.

Combined Tin-Containing Fluoride Solution and CO2 Laser Treatment Reduces Enamel Erosion in vitro

The aim of this in vitro study was to evaluate the effect of combined CO2 laser and tin-containing fluoride treatment on the formation and progression of enamel erosive lesions. Ninety-six human enamel samples were obtained, stored in thymol solution and, after surface polishing, randomly divided into 6 different surface treatment groups (n = 16 in each group) as follows: no treatment, control (C); one CO2 laser irradiation (L1); two CO2 laser irradiations (L2); daily application of fluoride solution (F); combined daily fluoride solution + one CO2 laser irradiation (L1F), and combined daily fluoride solution + two CO2 laser irradiations (L2F). Laser irradiation was performed at 0.3 J/cm2 (5 µs/226 Hz/10.6 µm) on day 1 (L1) and day 6 (L2). The fluoride solution contained AmF/NaF (500 ppm F), and SnCl2 (800 ppm Sn) at pH 4.5. After surface treatment the samples were submitted to an erosive cycling over 10 days, including immersion in citric acid (2 min/0.05 M/pH = 2.3) 6 times daily and storage in remineralization solution (≥1 h) between erosive attacks. At the end of each cycling day, the enamel surface loss (micrometers) was measured using a 3D laser profilometer. Data were statistically analyzed by means of a 2-level mixed effects model and linear contrasts (α = 0.05). Group F (-3.3 ± 2.0 µm) showed significantly lower enamel surface loss than groups C (-27.22 ± 4.1 µm), L1 (-18.3 ± 4.4 µm) and L2 (-16.3 ± 5.3 µm) but higher than L1F (-1.0 ± 4.4 µm) and L2F (1.4 ± 3.2 µm, p < 0.05). Under the conditions of this in vitro study, the tin-containing fluoride solution caused 88% reduction of enamel surface loss, while its combination with CO2 laser irradiation at 0.3 J/cm2 hampered erosive loss almost completely.

Caries-Preventive Effect of NaF, NaF plus TCP, NaF plus CPP-ACP, and SDF Varnishes on Sound Dentin and Artificial Dentin Caries in vitro

The aim of this study was to compare the caries-preventive effect of different fluoride varnishes on sound dentin as well as on artificial dentin caries-like lesions. Bovine dentin specimens (n = 220) with one sound surface (ST) and one artificial caries lesion (DT) were prepared and randomly allocated to 11 groups. The interventions before pH cycling were as follows: application of a varnish containing NaF (22,600 ppm F^-; Duraphat [NaF₀/NaF₁]), NaF plus tricalcium phosphate (22,600 ppm F^-; Clinpro White Varnish Mint [TCP₀/TCP₁]), NaF plus casein phosphopeptide-stabilized amorphous calcium phosphate complexes (CPP-ACP; 22,600 ppm F^-; MI Varnish [CPP₀/CPP₁]), or silver diamine fluoride (SDF; 35,400 ppm F^-; Cariestop 30% [SDF₀/SDF₁]) and no intervention (N_NB/N₀/N₁). During pH cycling (14 days, 6 × 120 min demineralization/day) half of the specimens in each group were brushed (10 s; 2 times/day) with either fluoride-free (“0”; e.g., TCP₀) or 1,100 ppm F^- (“1”; e.g., TCP₁) dentifrice slurry. In another subgroup, the specimens were pH cycled but not brushed (N_NB). Differences in integrated mineral loss (ΔΔZ), lesion depth (ΔLD), and colorimetric values (ΔΔE) were calculated between the values after initial demineralization and those after pH cycling, using transversal microradiography and photographic images. After pH cycling, no discoloration could be observed. Furthermore, N_NB, N₀, and N₁ showed significantly increased ΔZ_DT/LD_DT and ΔZ_ST/LD_ST values, indicating further demineralization. In contrast, CPP₀, CPP₁, SDF₀, and SDF₁ showed significantly decreased ΔZ_DT/LD_DT values, indicating remineralization (p ≤ 0.004; paired t test). CPP₀, CPP₁, SDF₀, and SDF₁ showed significantly higher changes in ΔΔZ_DT/ΔLD_DT and ΔΔZ_ST/ΔLD_ST than N_NB, N₀, and N₁ (p < 0.001; Bonferroni post hoc test). In conclusion, under the conditions chosen, all fluoride varnishes prevented further demineralization. However, only NaF plus CPP-ACP and SDF could remineralize artificial dentin caries-like lesions under net-demineralizing conditions, thereby indicating that NaF plus CPP-ACP and SDF may be helpful to high-caries-risk patients.

Effects of Self-Assembling Peptide P11-4, Fluorides, and Caries Infiltration on Artificial Enamel Caries Lesions in vitro

The application of a self-assembling peptide on noncavitated caries lesions is supposed to be a feasible approach to facilitate remineralization and mask their unfavorable appearance. However, demineralizing conditions are common in the oral environment, so the aim of this pH-cycling study was to compare recommended and novel treatment methods regarding their ability to hamper demineralization and as a consequence mask artificial enamel caries lesions. Artificial caries lesions were prepared in bovine enamel and randomly allocated to 11 groups (n = 22). Treatments before pH-cycling were as follows: the application of a self-assembling peptide (Curodont™ Repair [C]), a low-viscosity resin (Icon® [I]), 2 fluoride solutions (10,000 ppm F^-: Elmex fluid [E] and 43,350 ppm F^-: Tiefenfluorid® [T]), and no intervention (N). During pH-cycling (28 days, 6 × 60 min demineralization/day) half of the specimens in each group were brushed (10 s; 2 ×/day) with either fluoride-free (named e.g., C₀) or NaF (1,100 ppm F^-; e.g., C₁) dentifrice slurry. In another subgroup specimens were pH-cycled but not brushed (N_NB). Differences in integrated mineral loss (ΔΔZ), lesion depth (ΔLD), and colorimetric values (ΔΔE) were calculated between values after pre-demineralization, surface treatment, and pH-cycling. Specimens of C₀, C₁, N_NB, N₀, N₁, T₀, and E₀ showed significantly increased ΔZ and LD values after pH-cycling (p ≤ 0.003; paired t test). C₀, C₁, N_NB, and N₀ showed significantly higher changes in ΔΔZ than E₁, I₀, I₁, and T₁ (p < 0.001; ANOVA). Significantly reduced colorimetric values could only be observed for I₁, I₀, E₁, and E₀ after treatment and after pH-cycling (p ≤ 0.027; paired t test). In conclusion, under the conditions chosen only the application of a low-viscosity resin could mask caries lesions significantly, whereas self-assembling peptides could neither inhibit lesion progression nor mask the lesions considerably.