Norbert Gutknecht

Bactericidal Effect of a 980-nm Diode Laser in the Root Canal Wall Dentin of Bovine Teeth

OBJECTIVE The aim of this in vitro study was to investigate the antibacterial depth effect of continuous wave laser irradiation with a wavelength of 980 nm in the root canal wall dentin of bovine teeth. BACKGROUND DATA The long-term success of an endodontic therapy often fails due to remaining bacteria in the root canal or dentin tubules, which cannot be sufficiently eliminated through the classical root canal preparation technique nor through rinsing solutions. MATERIALS AND METHODS A total of 102 slices of bovine root dentin of different thicknesses (100, 300 and 500 micro m) were prepared. The samples were inoculated from one side with 5 micro L of an enterococcus faecalis suspension of defined concentration. Four slices per slice thickness served as a control group; the rest of the 30 slices per thickness were subjected to laser irradiation - 10 each of these slices were irradiated with distal outputs of 1.75, 2.3, and 2.8 Watts (W). After drying them for 30 sec, the back of the inoculated dentin slice was irradiated for 32 seconds with a 200- micro m fiber optical waveguide under constant movement of the fibers. The remaining bacteria were then detached in NaCl under vibration. The eluate produced by this was - taking account of the degree of dilution - plated out on sheep blood agar plates. After 24 h of incubation, the grown bacterial colonies were able to be counted out and evaluated. By doing so, they were compared with the non-irradiated, but otherwise identically treated control group. RESULTS With a slice thickness of 100 micro m, the 980-nm diode laser achieved a maximum bacterial reduction of 95% at 1.75 W, 96% at 2.3 W, and 97% at 2.8 W. With a slice thickness of 300 micro m, a maximum of 77% of the bacteria was destroyed at 1.75 W, 87% at 2.3 W, and 89% at 2.8 W. The maximum bacterial reduction with a slice thickness of 500 micro m was 57% at 1.75 W, 66% at 2.3 W, and 86% at 2.8 W. CONCLUSION The results of this research show that the 980-nm diode laser can eliminate bacteria that have immigrated deep into the dentin, thus being able to increase the success rate in endodontic therapy.

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.

Irradiation of infected root canals with a diode laser in vivo : Results of microbiological examinations

It was shown in previous studies [1] that the Nd:YAG laser can be used as an excellent tool for killing bacteria in root canals. The present examinations were carried out with a high power diode laser in comparison with a conventionally treated control group.

Demineralization of Er:YAG and Er,Cr:YSGG Laser-Prepared Enamel Cavities in vitro

The aim of the present study was to establish whether cavity preparation by means of an erbium laser with efficient water cooling is capable of reducing the susceptibility of the prepared dental enamel to demineralization and thus of achieving a potential caries-protective effect in the region of cavity margins. To this end, cavities limited to the enamel were prepared in the crowns of 10 teeth each using an Er:YAG (λ = 2,940 nm) and an Er,Cr:YSGG laser (λ = 2,780 nm). A control cavity prepared conventionally with a diamond drill in the same occlusal zone was assigned to each of these cavities. The specimens were then subjected to a pH-cycling caries model. Analysis was performed by quantitatively measuring the demineralization front under a polarized-light microscope. The results of the study showed that enamel cavities prepared with the erbium lasers used display a statistically significant acceleration of demineralization compared to conventionally prepared cavities (p < 0.01). The Er:YAG laser cavities revealed demineralization to a depth of 133.9 (SD 25.7) µm, while the value observed with the Er,Cr:YSGG laser was 133.8 (SD 25.8) µm. The depth of demineralization in the control groups was only 77.4 (SD 13.8) µm and 79.3 (SD 37.6) µm. No difference could be found between the two lasers (p = 0.98). Based on these in vitro tests, it cannot be assumed that use of the erbium laser for cavity preparation offers any advantages in terms of resistance to secondary caries in clinical practice.

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.

Laser wavelengths and oral implantology.

In modern implant dentistry there are several clinical indications for laser surgery. Different laser systems have a considerable spectrum of application in soft and hard peri-implant tissues. The literature was searched for clinical application of different laser wavelengths in peri-implant tissues: second-stage surgery of submerged implants, treatment of infrabony defects, removal of peri-implant hyperplastic overgrowths, and, possibly, the preparation of bone cavities for implant placement. This report describes the state-of-the-art application of different laser systems in modern implant dentistry for the treatment of peri-implant lesions and decontamination of implant surfaces. Our study evaluated in vitro examinations, clinical experience and long-term clinical studies. The exact selection of the appropriate laser system and wavelength was dependent on the scientific evaluation of recent literature and the level of changes in implant and tissue temperatures during laser application. The significant reduction in bacteria on the implant surface and the peri-implant tissues during irradiation and the cutting effects associated with the coagulation properties of the lasers are the main reasons for laser application in the treatment of peri-implant lesions and the successful long-term prognosis of failing oral implants. The various applications of lasers in implant dentistry are dependent on the wavelength and laser–tissue interactions.

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.

Shear bond strength of composite bonded to Er,Cr:YSGG laser-prepared dentin.

OBJECTIVE The purpose of this in vitro study was to evaluate dentin bond strength to resin composite following high-speed rotary or Er,Cr:YSGG laser preparation using two different adhesive systems. MATERIALS AND METHODS One hundred and forty dentin specimens were prepared from human molars. Seventy specimens were prepared with a high-speed diamond bur and 70 of the specimens were prepared with an Er,Cr:YSGG laser. Each group was subdivided into 7 groups of 10 teeth and etched with either 37% H3PO4, laser etched at two different power levels (1.25 W and 3 W), or not etched. Nano-hybrid composite resin cylinders 4 x 2 mm in size (Tetric EvoCeram, Vivadent) were bonded to the dentin surfaces with the application of an etch-and-rinse adhesive (Exite/Vivadent), or a self-etching adhesive (AdheSe/Vivadent). After storage in distilled water and thermocycling, a shear bond strength test was performed on all specimens and the data were statistically analyzed. RESULTS ANOVA detected significant differences between the tested groups (p < 0.001). Duncans multiple comparison test showed that Excite-applied specimens that were prepared with laser and laser etched (1.25 W or 3 W) had higher mean bond strengths. Both AdheSe- and Excite-applied specimens prepared with the diamond bur and laser etched (1.25 W) showed the lowest mean bond strength values (p < 0.05). CONCLUSION The results suggest that dentin surfaces prepared with the Er,Cr:YSGG laser and etched with the laser (at either 1.25 or 3 W) may provide comparable or increased composite resin bond strengths, depending on the adhesive used.