Laser Er:YAG-Assisted Debonding May Be a Viable Alternative to the Conventional Method for Monocrystalline Ceramic Brackets.

In orthodontic practice, due to the increased interest among patients in smile aesthetics, different types of brackets are now being used, with those most frequently applied being ones made of polycrystalline and monocrystalline ceramic. The aim of this study was to evaluate the laser Er:YAG-assisted debonding technique compared to conventional methods for removing monocrystalline ceramic brackets from human teeth. The study sample included 60 vital teeth (frontals of the upper jaw) from 10 patients who had monocrystalline ceramic brackets and were in the final phase of orthodontic treatment. The debonding procedure was carried out following a split-mouth study design, using either the conventional technique or laser Er:YAG 2940 nm radiation. For each tooth, three variables were evaluated: the patient's sujective tooth sensitivity associated with the debonding, the time required for debonding, and pulp blood flow microdynamics after the debonding. Three evaluation instruments were used to assess and quantify the treatment effects: (i) the Wong-Baker FACES Pain Rating Scale for pain assessment; (ii) a digital stopwatch/timer to measure the time required to remove the bracket; and (iii) laser Doppler flowmetry (LDF) for recording the pulp blood flow evolution. The statistical analysis of the recorded data showed a statistically significant difference between the two debonding methods regarding the tooth sensitivity during the debonding and the time required for the procedure. The subjective tooth sensitivity was reduced from a mean ± standard deviation of 3.07 ± 1.46 to 0.47 ± 0.86 on the Wong-Baker FACES scale (Wilcoxon signed rank, p < 0.001). The necessary time for debonding was reduced by 0.697 ± 0.703 s per tooth (paired t-test, p < 0.001). There was no difference in the blood microdynamics between the two debonding techniques. According to the results of this study, the laser Er:YAG-assisted debonding technique may be a viable alternative to the conventional method for monocrystalline ceramic brackets.

Effect of the laser beam on implant site preparation: a preliminary pilot study.

The aim of this preliminary study is to histologically evaluate the effects of erbium-doped yttrium aluminum garnet (Er:YAG) laser on soft and hard tissues during implant bed preparation, in comparison with bur and cutter in order to observe the following aspects: (i) the shape of the cavity, (ii) the presence of debris, and (iii) structural modification of the cell architecture. Bone temperature changes during the preparation of the implant bed were also measured in order to evaluate thermal damage on soft and hard tissues. Er:YAG laser, Fotona X-Runner scanner and circular cutter of 5 mm diameter were compared using an in vitro model. Implant bed preparations were performed in bovine rib bone (hard tissue) and tongue muscle (soft tissue) tissues. Results of the study show that in all bur samples were present more debris and more blood cells than in laser samples, which, according to the rules of healing processes, can be a negative factor for the osseointegration process. Regarding the thermal effects on soft tissue, they were present when using MAX mode, but absent when using quantum square pulse (QSP) mode. A preliminary conclusion emphasizes the use of laser to prepare the implant site without debris formation. Nowadays, is not still present a laser device that can overtake the technical limitations of the laser scanner (i.e., deepness control and scanner movement during the preparation of the holes, etc.).

Scanning electron microscopy evaluation of the root canal morphology after Er:YAG laser irradiation.

The current limits of the endodontic disinfection strategies are not only a result of bacterial biofilm growth mode inside the root canals, they are equally due to the anatomical complexity of the root canal system, of its structure, of the dentin composition and of the factors associated with chemical disinfectants. One of the major problems is the fact that a great part of the endodontic anatomy remains uninstrumented after conventional treatment and even the accessible parts of the root canals are covered in smear layer, which results as a by-product of the instrumentation and acts as a barrier for irrigants, medication and even influencing the quality of the endodontic filling. Therefore, strategies in advanced disinfection in endodontics are developed and tested in order to meet these challenges. The present study aims to assess the possibility of improving the debridement of the root canals by using erbium-doped yttrium-aluminum-garnet (Er:YAG) laser radiation. We used extracted teeth, which were subjected to the conventional treatment protocol and then divided into three study groups: the negative control group and two other groups, which were exposed to laser radiation using two energy levels. Scanning electron microscopy (SEM) revealed the efficiency of the laser aided treatment versus the conventional methods of cleaning and disinfection of root canals.