Patricia Aparecida Ana

Nd:YAG laser in caries prevention: a clinical trial.

It is widely known that Nd:YAG can increase enamel resistance to demineralization; however, there are no studies that report the application of Nd:YAG associated with topical application of fluoride in vivo. The aim of this study was to evaluate the effects of the Nd:YAG laser, when associated with the topical application of acidulated phosphate fluoride (APF), for preventing enamel demineralization in vivo.

Lasers effects on enamel for caries prevention

The aim of this study was to ascertain whether laser irradiation is able to reduce caries incidence. For this purpose, the effects of laser on enamel and on fluoride uptake were discussed. Current literature regarding the preventive effect of laser irradiation on dental hard tissue has been reviewed. An evaluation of the results of the available in vitro and in vivo studies on the efficacy of anticaries and induced changes on enamel by laser irradiation were also performed. Articles were selected using the Medline, Web of Science, Embase, and Cochrane databases, and the results of these studies were described. The most common lasers employed for caries prevention on enamel are Nd:YAG; CO2; Er:YAG; Er,Cr:YSGG; and argon. The percentage of inhibition of dental caries varied from 30 to 97.2%, and the association with fluoride has demonstrated the best results on inhibition of caries development. Laser irradiation under specific conditions can change the crystallographic properties of apatite crystals, increasing the acid resistance of lased enamel. The combined treatment of laser irradiation with fluoride propitiates an expressive fluoride uptake, reducing the progression of carieslike lesions, and this treatment is more effective than laser or fluoride alone. Available data suggest that lasers combined with fluoride is a promising treatment in caries prevention.

Absorption and thermal study of dental enamel when irradiated with Nd:YAG laser with the aim of caries prevention

It is widely recognized that Nd:YAG can increase enamel resistance to demineralization; however, the safe parameters and conditions that enable the application of Nd:YAG laser irradiation in vivo are still unknown. The aim of this study was to determine a dye as a photoabsorber for Nd:YAG laser and to verify in vitro a safe condition of Nd:YAG irradiation for caries prevention. Fifty-eight human teeth were selected. In a first morphological study, four dyes (waterproof India ink., iron oxide, caries indicator and coal paste) were tested before Nd:YAG laser irradiation, under two different irradiation conditions: 60 mJ/pulse and 10 Hz (84.9 J/cm2); 80 mJ/pulse and 10 Hz (113.1 J/cm2). In a second study, the enamel surface and pulp chamber temperatures were evaluated during laser irradiations. All dyes produced enamel surface melting, with the exception of the caries indicator, and coal paste was the only dye that could be completely removed. All irradiation conditions produced temperature increases of up to 615.08°C on the enamel surface. Nd:YAG laser irradiation at 60 mJ/pulse, 10 Hz and 84.9 J/cm2 promoted no harmful temperature increase in the pulp chamber (ANOVA, p < 0.05). Among all dyes tested, the coal paste was an efficient photoabsorber for Nd:YAG irradiation, considered feasible for clinical practice. Nd:YAG laser at 84.9 J/cm2 can be indicated as a safe parameter for use in caries prevention.

Effect of dental tissue conditioners and matrix metalloproteinase inhibitors on type I collagen microstructure analyzed by Fourier transform infrared spectroscopy

This study aimed to evaluate the chemical interaction of collagen with some substances usually applied in dental treatments to increase the durability of adhesive restorations to dentin. Initially, the similarity between human dentin collagen and type I collagen obtained from commercial bovine membranes of Achilles deep tendon was compared by the Attenuated Total Reflectance technique of Fourier Transform Infrared (ATR-FTIR) spectroscopy. Finally, the effects of application of 35% phosphoric acid, 0.1M ethylenediaminetetraacetic acid (EDTA), 2% chlorhexidine, and 6.5% proanthocyanidin solution on microstructure of collagen and in the integrity of its triple helix were also evaluated by ATR-FTIR. It was observed that the commercial type I collagen can be used as an efficient substitute for demineralized human dentin in studies that use spectroscopy analysis. The 35% phosphoric acid significantly altered the organic content of amides, proline and hydroxyproline of type I collagen. The surface treatment with 0.1M EDTA, 2% chlorhexidine, or 6.5% proanthocyanidin did not promote deleterious structural changes to the collagen triple helix. The application of 6.5% proanthocyanidin on collagen promoted hydrogen bond formation.

Effect of Er,Cr:YSGG Laser and Professional Fluoride Application on Enamel Demineralization and on Fluoride Retention

This study evaluated the effect of Er,Cr:YSGG laser irradiation and professional fluoride application on enamel demineralization and on fluoride formation and retention. In a blind in vitro study, 264 human enamel slabs were distributed into 8 groups: G1 – untreated; G2 – treated with acidulated phosphate fluoride gel (APF gel, 1.23% F) for 4 min; G3, G4 and G5 – irradiated with Er,Cr:YSGG at 2.8, 5.6 and 8.5 J/cm2, respectively; G6, G7 and G8 – preirradiated with Er,Cr:YSGG at 2.8, 5.6 and 8.5 J/cm2, respectively, and subjected to APF gel application. Twenty slabs of each group were submitted to a pH-cycling regimen, and enamel demineralization was evaluated in 10 slabs of each group. In the other 10 slabs, CaF2-like material was determined. To evaluate F formed, 10 additional slabs of each group, not subjected to the pH cycling, were submitted to analysis of CaF2-like material and fluorapatite, while the other 3 slabs of each group were evaluated by scanning electron microscopy. The F content was also measured in all pH-cycling solutions. Laser at 8.5 J/cm2 and APF treatment reduced enamel demineralization compared to the control (p < 0.05), but the combination of these treatments was not more efficient than their isolated effect. A higher concentration of retained CaF2-like material was found in laser groups followed by APF in comparison with the APF gel treatment group. The findings suggest that laser treatment at 8.5 J/cm2 was able to decrease hardness loss, even though no additive effect with APF was observed. In addition, laser treatment increased the formation and retention of CaF2 on dental enamel.

Relationship Between Surface Topography and Energy Density Distribution of Er,Cr:YSGG Beam on Irradiated Dentin: An Atomic Force Microscopy Study

OBJECTIVE The aim of this study was to assess by atomic force microscopy (AFM) the effect of Er,Cr:YSGG laser application on the surface microtopography of radicular dentin. BACKGROUND Lasers have been used for various purposes in dentistry, where they are clinically effective when used in an appropriate manner. The Er,Cr:YSGG laser can be used for caries prevention when settings are below the ablation threshold. MATERIALS AND METHODS Four specimens of bovine dentin were irradiated using an Er,Cr:YSGG laser (λ = 2.78 μm), at a repetition rate of 20 Hz, with a 750-μm-diameter sapphire tip and energy density of 2.8 J/cm(2) (12.5 mJ/pulse). After irradiation, surface topography was analyzed by AFM using a Si probe in tapping mode. Quantitative and qualitative information concerning the arithmetic average roughness (Ra) and power spectral density analyses were obtained from central, intermediate, and peripheral areas of laser pulses and compared with data from nonirradiated samples. RESULTS Dentin Ra for different areas were as follows: central, 261.26 (±21.65) nm; intermediate, 83.48 (±6.34) nm; peripheral, 45.8 (±13.47) nm; and nonirradiated, 35.18 (±2.9) nm. The central region of laser pulses presented higher ablation of intertubular dentin, with about 340-760 nm height, while intermediate, peripheral, and nonirradiated regions presented no difference in height of peritubular and interperitubular dentin. CONCLUSION According to these results, we can assume that even when used at a low-energy density parameter, Er,Cr:YSGG laser can significantly alter the microtopography of radicular dentin, which is an important characteristic to be considered when laser is used for clinical applications.

Changes in dental enamel oven heated or irradiated with Er,Cr:YSGG laser. Analysis by FTIR

This study evaluated the change that occurs in dental enamel under action of oven heating or Er,Cr:YSGG laser irradiation aiming to obtain a structure more resistant to demineralization. Enamel powder was obtained from bovine teeth. Samples were subjected to oven heating at temperatures of 200, 400, 600, 800, and 1000°C or during laser irradiation with energy densities of 7.53, 10.95, and 13.74 J/cm2. The infrared thermography was used to measure the surface temperature generated in the solid samples of enamel during lasers irradiation. The samples were analyzed by Fourier transform infrared spectroscopy (FTIR), which shows changes on enamel oven heated or laser irradiated, due to treatments, related to carbonates, adsorbed water and hydroxyl content. These compositional effects were more evident in lased samples. These changes may alter the material properties such as its solubility, and decrese of demineralization that is important for caries prevention.

Three-dimensional finite element thermal analysis of dental tissues irradiated with Er,Cr:YSGG laser.

In the present study, a finite element model of a half-sectioned molar tooth was developed in order to understand the thermal behavior of dental hard tissues (both enamel and dentin) under laser irradiation. The model was validated by comparing it with an in vitro experiment where a sound molar tooth was irradiated by an Er,Cr:YSGG pulsed laser. The numerical tooth model was conceived to simulate the in vitro experiment, reproducing the dimensions and physical conditions of the typical molar sound tooth, considering laser energy absorption and calculating the heat transfer through the dental tissues in three dimensions. The numerical assay considered the same three laser energy densities at the same wavelength (2.79 microm) used in the experiment. A thermographic camera was used to perform the in vitro experiment, in which an Er,Cr:YSGG laser (2.79 microm) was used to irradiate tooth samples and the infrared images obtained were stored and analyzed. The temperature increments in both the finite element model and the in vitro experiment were compared. The distribution of temperature inside the tooth versus time plotted for two critical points showed a relatively good agreement between the results of the experiment and model. The three dimensional model allows one to understand how the heat propagates through the dentin and enamel and to relate the amount of energy applied, width of the laser pulses, and temperature inside the tooth.

Compositional and crystallographic changes on enamel when irradiated by Nd:YAG or Er,Cr:YSGG lasers and its resistance to demineralization when associated with fluoride

This study investigated the compositional and crystallographic changes on enamel when irradiated by Er,Cr:YSGG (λ=2.7μm, 8.5J/cm2) or Nd:YAG (λ=1064nm, 84.9J/cm2 associated with black coating), its resistance to demineralization when irradiation is associated with fluoride (APF-gel), and CaF2-like material formation and retention. Sample surfaces were analyzed by ATR-FTIR (4000-650cm-1, 4cm-1) resolution. Irradiation with Er,Cr:YSGG laser promoted a significant decrease on carbonate content of enamel. After Nd:YAG irradiation, it was observed a significant decrease of carbonate and amides I and II. X-ray diffraction showed that both laser irradiations promoted formation of α-tricalcium phosphate and tetracalcium phosphate, and a significant increase on the crystal growth of the enamel apatite (ANOVA, p<0.05 was used for all analysis). These changes can explain the improved resistance of enamel to demineralization observed in the second part of the study, in which 240 enamel slices were divided in 8 groups, received 4 min of professional fluoride gel (APF-gel 1.23%F-) applied before or after irradiation. After treatments, the formation of calcium fluoride (CaF2) was determined. The remaining slabs of each group were submitted to a 10-day pH-cycling model and, subsequently, enamel demineralization was evaluated by cross-sectional microhardness. Both lasers significantly reduced enamel demineralization (ANOVA, p<0.05), and the previous APF-gel application followed by laser showed the higher reduction of enamel demineralization. CaF2 formed before pH-cycling was significantly higher in groups were APF was associated with laser irradiation. After demineralization, these groups also presented higher CaF2 retention in respect to isolated treatments (only APF or only laser), suggesting its anticaries potential.

Effect of papain-based gel on type I collagen--spectroscopy applied for microstructural analysis.

Considering the improvement of biomaterials that facilitate atraumatic restorative techniques in dentistry, a papain-based gel can be used in the chemomechanical removal of decayed dental tissue. However, there is no information regarding the influence of this gel on the structure of sound collagen. The aim of the present study was to investigate the adsorption of a papain-based gel (PapacarieTM) to collagen and determine collagen integrity after treatment. A pilot study was first performed with 10 samples of type I collagen membrane obtained from bovine Achilles deep tendon to compare the influence of hydration (Milli-Q water) on infrared bands of collagen. In a further experiment, 10 samples of type I collagen membrane were used to evaluate the effects of PapacarieTM on the collagen microstructure. All analyses were performed using the attenuated total reflectance technique of Fourier transform infrared (ATR-FTIR). The results demonstrated that the application of PapacarieTM does not lead to the degradation of collagen and this product can be safely used in minimally invasive dentistry. As the integrity of sound collagen is preserved after the application of the papain-based gel, this product is indicated for the selective removal of infected dentin, leaving the affected dentin intact and capable of re-mineralization.