Comparison of Different Energy Levels of Er:YAG Laser Regarding Intrapulpal Temperature Change During Safe Ceramic Bracket Removal.

OBJECTIVE: This study was done to compare the intrapulpal temperature change generated by different energy levels of Er:YAG laser used during debonding of ceramic brackets and find the most suitable level for clinical use. MATERIAL AND METHODS: Eighty polycrystalline alumina brackets were bonded on bovine incisor teeth, which were randomly divided into 4 groups of 20. One group was assigned as control. In the study groups, after laser exposure with 2, 4, or 6 Watt energy levels, brackets were debonded using an Instron Universal Testing machine. Adhesive remnant index (ARI) scores were recorded to evaluate the site of debonding. To assess intrapulpal thermal increase, 60 human premolar teeth that were prepared in the same way, at the same energy levels, by a thermocouple were used. RESULTS: When the debonding forces, intrapulpal temperature increases, and ARI of the groups were examined, statistically significant difference was observed between the groups. Mean temperature increases of 0.67°C ± 0.12°C, 1.25°C ± 0.16°C, and 2.36°C ± 0.23°C were recorded for the 2, 4, and 6 Watt laser groups. The mean shear bond strength was 21.35 ± 3.43 megapascals (MPa) for the control group, whereas they were 8.79 ± 2.47, 3.28 ± 0.73, and 2.46 ± 0.54 MPa for the 2, 4, and 6 Watt laser groups, respectively. CONCLUSIONS: Four watts is the most efficient and safe energy level to be used, utilizing Er:YAG laser with water cooling spray for 6 sec by scanning method during debonding of polycrystalline alumina brackets without any carbonization effects and detrimental temperature changes at debond sites.

A report on the use of Er:YAG laser for pilot hole drilling prior to miniscrew insertion.

The aim of the present in vitro study was to investigate the required time period of the Er:YAG laser that is used for drilling through cortical bone when pilot hole drilling is needed before miniscrew insertion. Even though Er:YAG laser is used in various in vivo and in vitro studies, there is no accepted procedure of laser for depth control during drilling through cortical bone. The study sample consisted of 120 cortical bone segments having 1.5 and 2.0 mm of cortical bone thickness. An Er:YAG laser, with a spot size of 1.3 mm and an air-water spray of 40-50 ml/min, was used. The laser was held 2 mm away from and perpendicular to the bone surface with different laser settings. Twelve specimens were prepared for each subgroup. As the cortical bone thickness increased, the time needed to drill through the bone increased. Frequency increase directly caused a decrease in irradiation duration. When three different frequency, three different energy, and four different power values were tested for both the 1.5- and 2-mm cortical bone thicknesses, the shortest duration needed to drill through cortical bone was seen in the 3.6-W (300 mJ-12 Hz) setting. When pilot holes are drilled prior to miniscrew placement in 1.5 to 2 mm of cortical bone using Er:YAG laser, the most appropriate value is found with the 3.6-W (300 mJ-12 Hz) setting.

Pulpal thermal changes following Er-YAG laser debonding of ceramic brackets.

Lasers are effective in debonding ceramic brackets. Unfortunately, while reducing the adhesive bond strength, lasers are also reported to increase pulpal temperature. The aim of this study was to evaluate the shear bond strengths and temperature increase levels after debonding ceramic brackets using an Er-YAG laser with or without water-cooling. Sixty polycrystalline upper premolar ceramic brackets were placed on the labial surface of sixty human premolar teeth which were randomly divided into three groups of twenty. A laser pulse at 5 W for 9 seconds was delivered to each bracket in both study groups either with water-cooling (water group) or without water-cooling (waterless group) using an Er-YAG laser. Debonding was performed 45 seconds after laser exposure and shear bond strengths were measured. Data comparison revealed a statistically significant difference between the groups. Mean temperature increases of 2.41°C and 4.59°C were recorded for the water and waterless laser groups, respectively. The shear bond strength value for the control group was 22.76 MPa and 10.46 and 6.36 MPa for the water and waterless laser groups, respectively. The application of Er-YAG laser with water-cooling was an efficient and safe method of debonding ceramic brackets.

Effect of Er:YAG laser on debonding strength of laminate veneers.

OBJECTIVE: The purpose of this study was to evaluate the debonding strength of laminate veneers after using erbium-doped: yttrium aluminium garnet (Er:YAG) laser. MATERIALS AND METHODS: A total of 60 bovine mandibular incisor teeth were divided into two groups (n = 30). Cylindrical specimens (0.7 mm × 5 mm) were fabricated from Empress II ceramic. Then, they were cemented to incisors using dual-cured resin cement (Variolink II). In the first group, no laser application was performed. The Er:YAG laser was applied on each laminate veneer at the test group for 9 s by using the scanning method. Shear force to remove the laminate veneers were applied with universal testing machine at a crosshead speed of 1 mm/min. RESULTS: Results of this study exhibited significant differences between the control (27.28 ± 2.24 MPa) and test group (3.44 ± 0.69 MPa) (P < 0.05). CONCLUSION: This study shows that application of Er:YAG laser decreased the bond strength of laminate veneers.

Prevention of demineralization around orthodontic brackets using two different fluoride varnishes.

OBJECTIVE: This in-vitro study was done to evaluate the effects of two different seal materials, Duraflor™ and Enamel Pro(®) Varnish, on enamel demineralization adjacent to orthodontic fixed appliances. METHODS: Seventy-two extracted solid premolars were allocated to three groups as one control and two study groups after brackets were placed and bonded with Transbond™ XT. The control group received no topical fluoride application after bonding, whereas in the study groups two fluoride varnishes, Enamel Pro(®) Varnish and Duraflor™ were applied on the teeth adjacent to brackets. All specimens were then immersed separately in demineralization solution for 96 hours at constant temperature. Demineralization of the enamel surface was evaluated quantitatively by cross-sectional microhardness testing: indentations were made at the edge of the bracket base (0 µm) and at 100 and 200 µm distant from it. In all of these positions, 5 indentations were made at 10, 20, 40, 70 and 90 µm of depths from the external surface of the enamel. RESULTS: The results revealed that, Enamel Pro(®) Varnish and Duraflor™ group values are higher than the values of control group at every depth. The differences between the depths showed that the microhardness values decreased significantly when the depth increased. In the control group, more demineralization occurred in every indentation compared to the study group. CONCLUSION: Duraflor™ and Enamel Pro(®) Varnish can be considered for use in clinic as an effective method to prevent or reduce demineralization during orthodontic treatment, especially in patients with poor oral hygiene.

A cephalometric comparative study of class II correction with Sabbagh Universal Spring (SUS(2)) and Forsus FRD appliances.

OBJECTIVE: The purpose of this clinical prospective study was to compare the dentofacial changes produced by the Sabbagh Universal Spring (SUS(2)) and Forsus FRD appliances in late adolescent patients with Class II malocclusion, and quantify them in comparison with an untreated group. METHOD: The study was carried out on 59 patients with skeletal and dental Class II malocclusion due to retrognatic mandible. Among these, 20 were treated with SUS(2), 20 were treated with FRD, and no treatment was done to 19 subjects as the control group. 36 cephalometric landmarks were identified on each lateral cephalometric radiograph. RESULTS: The effects of both appliances were dentoalveolar and no significant vertical and sagittal skeletal effect on maxilla and mandible was achieved. The retrusion and extrusion of the maxillary incisors as well as the protrusion and intrusion of mandibular incisors were found to be statistically significant in both treatment groups. Soft tissue profile improvement was limited in both treatment groups. CONCLUSIONS: Both appliances corrected Class II discrepancies through dentoalveolar changes; however lower incisor proclination was more prominent with the Forsus FRD.

FEM analysis of a new miniplate: stress distribution on the plate, screws and the bone.

OBJECTIVES: Non-homogeneous force distribution along the miniplates and the screws is an unsolved question for skeletal anchorage in orthodontics. To overcome this issue, a miniplate structure was designed featuring spikes placed on the surface facing the cortical bone. The aim of this study was to examine and compare the force distribution of the newly designed plate-screw systems with the conventional one. METHODS: A model of bone surface with 1.5 mm cortical thickness, along with the two newly designed miniplates and a standard miniplate-screw were simulated on the three-dimensional model. 200 g experimental force was applied to the tip of the miniplates and the consequential effects on the screws and cortical bone was evaluated using three-dimensional finite element method. RESULTS: As a result of this finite element study, remarkably lower stresses were observed on the screws and the cortical bone around the screws with the newly designed miniplate when compared with the conventional one. CONCLUSION: The newly designed miniplate that has spikes was found effective in reducing the stress on and around the screws and the force was distributed more equivalently.

Effects of different application durations of scanning laser method on debonding strength of laminate veneers.

Porcelain laminate veneers as esthetic and minimally invasive restorations are being used as an alternative to full veneer crowns. However, the removal of porcelain veneers that have failed may be an uncomfortable and time-consuming procedure because of the high bond strength between the porcelain laminate veneers and the tooth surface. The purpose of this study was to prepare a simple and reliable method for porcelain laminate veneer debonding by using an Er:YAG laser with the scanning method and to determine the amount of lasing time required. Eighty cylindrical specimens with a thickness of 0.7 mm and a diameter of 5 mm were fabricated from Empress II ceramic material. They were cemented on the labial surface of extracted bovine mandibular incisors using Variolink II (Ivoclar Vivadent AG, Schaan, Liechtenstein) and light cured for 40 s. The specimens were randomly divided into four groups of 20. The first group was assigned as the control group and no laser application was performed. The Er:YAG laser was applied on each specimen in the other three study groups for 3, 6, and 9 s by using the scanning method. One second after the lasing, a mechanical force was applied to remove the laminate veneers by using an Instron Universal Testing machine. Results of this study exhibited statistically significant differences between the control group and the three study groups. Intergroup comparison of shear bond strengths of the three study groups showed a statistically significant difference (p = 0.0001). This study showed that all three application times of Er-YAG laser were effective for debonding ceramic laminate veneers by softening the adhesive resin.

Comparison of shear bond strengths of ceramic brackets after different time lags between lasing and debonding.

Laser use is effective in the debonding of ceramic brackets. However, a standardization of the laser debonding techniques used has not yet been implemented. The purpose of this study was to evaluate the effect of the time lag elapsed between lasing and shearing on debonding of ceramic brackets. One hundred polycrystalline ceramic brackets were placed on human premolar teeth, which were randomly divided into five groups of 20. One group was assigned as the control. The Er-YAG laser was applied on each bracket in four experimental groups at 5 W for 6 s with the scanning method. Debonding was performed 1 s, 18 s, 30 s, or 60 s after laser exposure. Shear bond strengths and adhesive remnant index scores were measured. Statistically significant difference was observed between the control and experimental groups when the data for the shear bond strengths was considered (p < 0.05). Adhesive remnant index scores of the groups were not statistically different (p > 0.05). Debonding ceramic brackets after 18 s when lased 6 s using an Er-YAG laser with the scanning method is safe and also suitable for clinical use since three brackets can be debonded at a time in succession.

Debonding of ceramic brackets by a new scanning laser method.

INTRODUCTION: The purpose of this in-vitro study was to develop a new method to debond ceramic brackets by scanning with an Er:YAG laser. METHODS: Sixty bovine mandibular incisors were randomly divided into 2 groups of 30. Polycrystalline ceramic brackets were placed on their labial surfaces by using the orthodontic composite adhesive Transbond XT (3M Unitek, Monrovia, Calif) and light cured for a total of 40 seconds. The first group was the control group, with no laser application performed. The Er:YAG laser was used on each bracket in the study group at 4.2 W for 9 seconds with the scanning method. The force required for debonding the brackets was applied 45 seconds after laser exposure. Shear bond strengths were measured in megapascals with a universal testing machine, and adhesive remnant index scores were assigned to each specimen. RESULTS: Statistically significant (P <0.001) lower shear bond strengths were found in the laser group (9.52 MPa) compared with the control group (20.75 MPa). Likewise, the adhesive remnant index scores were statistically different (P <0.001); the laser group had twice as many samples with adhesive, with the adhesive remnant index scores of 2 or 3. CONCLUSIONS: The application of the Er:YAG laser with the scanning method is effective for debonding ceramic brackets by degrading the adhesive through thermal softening.

Effect of blood and saliva contamination on shear bond strength of brackets bonded with 4 adhesives.

INTRODUCTION: The purpose of this study was to assess the effect of blood and saliva contamination on the shear bond strength of 4 orthodontic adhesives. METHODS: Four adhesives (Transbond XT primer [3M Unitek, Monrovia, Calif], Transbond Plus self-etch primer [3M Unitek], Assure hydrophilic primer [Reliance, Itasca, Ill], and SmartBond cyanoacrylate [Gestenco, Gothenburg, Sweden]) were used to bond stainless steel maxillary central incisor brackets to 120 bovine permanent mandibular incisors. The teeth were randomly divided into 12 groups of 10 specimens, and each primer-adhesive combination was tested under different enamel conditions: dry, and blood and saliva contamination after priming. Shear forces were applied to the samples with a testing machine. Bond strengths were measured in megapascals. RESULTS: Statistical evaluations showed that the shear bond strength of the SmartBond cyanoacrylate adhesive group was significantly lower than all other groups; however, it was the only adhesive that was not affected by contamination. Saliva and blood contamination resulted in significant drops in shear bond strengths of the Transbond XT and Assure groups. Transbond Plus self-etch primer was also negatively affected by blood contamination, although it was suitable for bonding with saliva contamination.