A transparent highly mineralized outer surface zone is formed on caries lesions during remineralization that reduces the permeability to water and plaque generated acids. However, it has not been established how thick the surface zone should be to inhibit the penetration of these fluids. Near-IR (NIR) reflectance coupled with dehydration can be used to measure changes in the fluid permeability of lesions in enamel and dentin. Based on our previous studies, we postulate that there is a strong correlation between the surface layer thickness and the rate of dehydration. In this study, the rates of dehydration for simulated lesions in enamel with varying remineralization durations were measured. Reflectance imaging at NIR wavelengths from 1400-2300 nm, which coincides with higher water absorption and manifests the greatest sensitivity to contrast changes during dehydration measurements, was used to image simulated enamel lesions. The results suggest that the relationship between surface zone thickness and lesion permeability is highly non-linear, and that a small increase in the surface layer thickness may lead to a significant decrease in permeability.
Selective removal of caries lesions with high precision is best accomplished using lasers operating at high pulse repetition rates utilizing small spot sizes. Conventional flash-lamp pumped Er:YAG lasers are poorly suited for this purpose, but new diode-pumped solid-state (DPSS) Er:YAG lasers have become available operating at high pulse repetition rates. Microradiography was used to determine the mineral content of the demineralized dentin of 200-μm thick sections with natural caries lesions prior to laser ablation. The purpose of this study was to explore the use of a DPSS Er:YAG laser for the selective removal of demineralized dentin and natural occlusal lesions on extracted teeth.
Both laser irradiation and fluoride treatment alone are known to provide increased resistance to acid dissolution. CO2 lasers tuned to a wavelength of 9.3 μm can be used to efficiently convert the carbonated hydroxyapatite of enamel to a much more acid resistant purer phase hydroxyapatite (HAP). Further studies have shown that fluoride application to HAP yields fluoroapatite (FAP) which is even more resistant against acid dissolution. Previous studies show that CO2 lasers and fluoride treatments interact synergistically to provide significantly higher protection than either method alone, but the mechanism of interaction has not been elucidated. We recently observed the formation of microcracks or a “crazed” zone in the irradiated region that is resistant to demineralization using high-resolution microscopy. The microcracks are formed due to the slight contraction of enamel due to transformation of carbonated hydroxyapatite to the more acid resistant pure phase hydroxyapatite (HAP) that has a smaller lattice. In this study, we test the hypothesis that these small cracks will provide greater adhesion for topical fluoride for greater protection against acid demineralization.
UV and IR lasers can be used to specifically target protein, water, and the mineral phase of dental hard
tissues to produce varying changes in surface morphology. In this study, we irradiated enamel and dentin
surfaces with various combinations of lasers operating at 0.355, 2.94, and 9.4 μm, exposed those surfaces
to topical fluoride, and subsequently evaluated the influence of these changes on surface morphology and
permeability. Digital microscopy and surface dehydration rate measurements were used to monitor changes
in the samples overtime. The surface morphology and permeability (dehydration rate) varied markedly with
the different laser treatments on enamel. On dentin, fluoride was most effective in reducing the
permeability.
Below the threshold for laser ablation, the mineral phase of enamel is converted into a purer phase hydroxyapatite with increased acid resistance. Studies suggest the possibility of achieving the conversion without visible surface alteration. In this study, changes in the surface morphology, reflectivity, and acid resistance were monitored with varying irradiation intensity. Bovine enamel specimens were irradiated using a CO2 laser operating at 9.4 μm with a Gaussian spatial beam profile—1.6 to 3.1 mm in diameter. After laser treatment, samples were subjected to demineralization to simulate the acidic intraoral conditions of dental decay. The resulting demineralization and erosion were assessed using polarization-sensitive optical coherence tomography, three-dimensional digital microscopy, and polarized light microscopy. Distinct changes in the surface morphology and the degree of inhibition were found within the laser-treated area in accordance with the laser intensity profile. Subtle visual changes were noted below the melting point for enamel that appear to correspond to thresholds for denaturation of the organic phase and thermal decomposition of the mineral phase. There was significant protection from laser irradiation in areas in which the reflectivity was not increased significantly, suggesting that aesthetically sensitive areas of the tooth can be treated for caries prevention.
Several studies over the past 20 years have identified that carbon dioxide lasers operating at wavelengths between 9.3 and 9.6-μm with pulse durations near 20-µs are ideal for hard tissue ablation. Those wavelengths are coincident with the peak absorption of the mineral phase and the pulse duration is close to the thermal relaxation time of the deposited energy of a few microseconds to minimize peripheral thermal damage and long enough to minimize plasma shielding effects to allow efficient ablation at practical rates. The desired pulse duration near 20-μs has been difficult to achieve since it is too long for TEA lasers and too short for RF-excited lasers for efficient operation. Recently, Coherent Inc. (Santa Clara, CA) developed the J5-V laser for microvia drilling which can produce laser pulses greater than 100 mJ in energy at 9.4-μm with a pulse duration of 26-µs and it can achieve pulse repetition rates of 3 KHz. We report the first results using this laser to ablate enamel and dentin. The onset of plasma shielding does not occur until the fluence exceeds 100 J/cm2 allowing efficient ablation at rates exceeding 50-μm per pulse. This laser is ideally suited for the selective ablation of carious lesions.
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