Thermotransduction and heat stress in dental structures during orthodontic debonding : Effectiveness of various cooling strategies.

OBJECTIVES: Recent studies have indicated possible thermal damage to pulpal tissue during orthodontic debonding. This study aimed to analyze the thermal loads acting upon dental structures and their transfer to the pulp during orthodontic debonding. Specific goals were to analyze temperature changes in local dental tissues, thermotransduction to the pulp cavity, and the effectiveness of common cooling strategies and of simulated intrapulpal circulation. MATERIALS AND METHODS: Metal brackets were bonded to five extracted human molars and subsequently removed. While a carbide bur was applied to debond the residual composite from the tooth surface, various cooling strategies (no/air/water cooling) were employed with or without simulated intrapulpal circulation, accompanied by temperature measurements with a thermographic infrared camera on the enamel surface and with measuring probes in the pulp cavity. Appropriate evaluation software was used to calculate the enamel-to-pulp temperature gradients and for statistical analysis. RESULTS: Significant differences in temperature rise and heat development over time, both on the enamel surfaces and in the pulp cavities were found. The mean temperature rises associated with no/air/water cooling were 90.7/46.6/9.2 °C on the enamel surface versus 9/8/4.6 °C inside the pulp. However, thermotransduction from enamel to pulp remained below 10 % of the surface measurements in all groups. Simulated intrapulpal microcirculation was found to significantly reduce intrapulpal temperature levels. CONCLUSION: During debonding of residual bracket adhesives, provided that a carbide bur is properly used, our data indicate a low risk of reaching critical intrapulpal temperatures even in the absence of dedicated cooling and no risk if the instrumentation is accompanied by air or water cooling.

Effect of simulated pulpal fluid circulation on intrapulpal temperature following irradiation with an Nd:YVO4 laser.

It is suggested that pulpal fluid circulation has an impact on pulp temperature increase during heat-generating dental treatment procedures. Thus, the aim of the study was to assess the effect of a simulated pulpal fluid circulation on temperature changes inside the pulp chamber following laser irradiation of the tooth surface. Twenty freshly extracted human multirooted teeth were included and cross-sectioned along the long axis exposing two root canals each. The pulp chamber and root canals were cleaned from remaining soft tissues to achieve access for a temperature sensor and two cannulas to allow fluid circulation. Cross sections were glued together, and the roots were encased with silicone impression material to ensure the position of the connected devices. Each tooth was irradiated by employing a neodymium-doped yttrium orthovanadate (Nd:YVO4) laser at 1,064 nm with a pulse duration of 9 ps and a repetition rate of 500 kHz. A commercially available scanning system (SCANcube 7, SCANLAB) deflected the beam by providing rectangular irradiated areas of 0.5 mm edge length. Measurements were performed with four different settings for fluid circulation: without any water and with water (23 °C) at a flow rate of 6, 3, and 0 ml/min. The primary outcome measure was the maximum temperature difference (ΔT) after laser irradiation. Highest temperature changes (median 3.6 K, range 0.5-7.1 K) could be observed without any fluid inside the pulp chamber. Water without circulation decreased ΔT values statistically significantly (median 1.4 K, range 0.2-4.9 K) (p < 0.05). Lowest temperature changes could be observed with a water flow rate of 6 ml/min (median 0.8 K, range 0.2-3.7 K) (p < 0.05). Pulpal fluid circulation has a cooling effect on temperature increase caused by laser irradiation of dental hard tissues. Studies on heat generation during dental treatment procedures should include this aspect to assess a potential thermal injury of pulp tissue.