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Utilizing Fourier Transform Infrared Spectroscopy (FTIR) in specular reflectance mode chemical changes of root cement surfaces due to laser radiation were investigated. A total of 18 samples of root cement were analyzed, six served as controls. In this study laser energies were set to those known for removal of calculus or for disinfection of periodontal pockets. Major changes in organic as well as inorganic components of the cementum were observed following Nd:YAG laser irradiation (wavelength 1064 nm, pulse duration 250 μs, free running, pulse repetition rate 20 Hz, fiber diameter 320 μm, contact mode; Iskra Twinlight, Fontona, Slovenia). Er:YAG laser irradiation (wavelength 2.94 μm, pulse duration 250 μs, free running, pulse repetition rate 6 Hz, focus diameter 620 μm, air water cooling 30 ml/min; Iskra Twinlight, Fontona, Slovenia) significantly reduced the Amid bands due to changes in the organic components. After irradiation with a frequency doubled Alexandrite laser (wavelength 377 nm, pulse duration 200 ns, q-switched, pulse repetition rate 20 Hz, beam diameter 800 μm, contact mode, water cooling 30 ml/min; laboratory prototype) only minimal reductions in the peak intensity of the Amide-II band were detected.

The purpose of this investigation was to measure the maximum temperature at the Nd:YAG and Diode lasers fiberoptic tips as a function of air/water coolant, during soft tissue ablation in pig jaws. A pulsed Nd:YAG laser (1064nm) and a Diode laser (800-830 nm) were used varying parameters of power, conditioning or not of the fiber tip, under 4 settings of air/water coolant. The maximum temperature at the fiber tip was measured using an infra-red camera and the interaction of the fiber with the porcine soft tissue was evaluated. A two-factor ANOVA was used for statistical analysis (p≤0.05). Nd:YAG laser interaction with soft tissues produced temperatures levels directly proportional to power increase, but the conditioning of the fiber tip did not influence the temperature rise. On the other hand, conditioning of the fiber tip did influence the temperature rise for Diode laser. The addition of air/water coolant, for both lasers, did not promote temperature rise consistent with cutting and coagulation of porcine soft tissue. Laser parameters affect the fiberoptic surface temperature, and the addition of air/water coolant significantly lowered surface temperature on the fiberoptic tip for all lasers and parameters tested.

A variety of lasers are used for many oral soft tissue procedures. Each dental laser has specific parameters giving a wide range of operation. Lasers such as the carbon dioxide, argon and diode operate in continuous wave, while Nd:YAG, Er:YAG, Ho:YAG, and Er,Cr:YSGG are free-running pulsed lasers with high peak power and very short pulse duration. Laser tissue interaction is basically a photothermal effect and the biologic effect is dependent on the laser operating parameters, such as emission wavelength, power, emission mode, pulse duration, energy/pulse, energy density, duration of exposure, total energy and tissue characteristics. This article reviews current knowledge of laser parameters, laser-tissue interaction and applied preclinical and clinical safety and effectiveness scientific support.

Chemical action of bleaching agents applied to tooth surface is accelerated by increase in temperature. This in vitro study measured the temperature rises on the surface and in the pulp of teeth during whitening using a diode laser, a plasma arc curing (PAC) light and conventional curing lights. Extracted, non-carious single-rooted teeth were exposed to PAC light and laser at times ranging from 10 to 60 seconds and energy ranges of 2 W, 4 W, and 6 W, and to low-intensity curing lights from 1 to 4 minutes. Maximum temperature rises were analyzed for both pulpal and surface temperature. Diode laser exposures at 2 W for all times and at 4 watts for 10 seconds and PAC light exposures at 10 seconds all produced acceptably safe pulpal rises equivalent to conventional light-curing exposures. Exposures at these settings also attained surface temperature rises that were significantly higher than those using conventional light-curing. The diode laser demonstrated bleaching results equivalent to the PAC light, and both were achieved in significantly less times than conventional light- curing.

The Er:YAG laser has been proposed as a useful tool for caries removal. In this study, we report a prospective parallel controlled study of the Dental Erbium Laser for caries removal and cavity preparation in pediatric patients. A total of 92 patients in two separate sites were randomized to treatment in a 2:1 ratio laser to conventional dental drill. The subject ages ranged from 4 to 18 years with a mean of 10.5 years with an even distribution by gender. The mean recorded treatment energy for caries removal was 147 mJ and for cavity preparation was 170 mJ. There were no significant differences in pain reported by the drill or laser treated subjects, and no complications or adverse events were reported after treatment or at any other interval during the study. The determination of success was based on four criteria: (1) acceptable caries removal, (2) acceptable cavity preparation, (3) maintenance of pulp vitality, and (4) restoration intact and serviceable. Using these criteria, it was found that all 32 of the drill procedures were a success and 59 out of 60 laser procedures were a success. This study shows that the Erbium-YAG laser is suitable for caries removal and cavity preparation in children.

The curriculum guidelines for dental laser education were developed through a consensus process with members from dental academia, industry and private practice. This document was developed at a workshop on the development of standards for dental laser education and laser instructor certification held at the University of California, San Francisco on July 25 and 26, 1992. A working draft is currently being circulated among dental laser educators, researchers, practitioners, organized dentistry and members of industry. After further discussion, modification and review, the final document will be widely distributed and updated annually. Any questions concerning the guidelines may be addressed to the authors of this document in care of the organizer. Suggestions for the improvement of this standard and endorsement of this document are invited.

This study evaluated the ablation rate in dentin and enamel of the Nd:YAG laser (1 - 2W, 10Hz) and the Er:YAG laser (1 - 2.5W, 10Hz), compared to the high-speed drill, low-speed drill and air abrasion (fine and extra-fine particle size). Subsequently, the effectiveness of caries removal and restoration in enamel of the Nd:YAG laser at the same powers and pulse repetition rate was compared to the high-speed drill, low-speed drill, and air abrasion. Enamel and dentin of 1mm thick mid-coronal sections from extracted third molars were ablated by Er:YAG laser ((lambda) equals 2.94 micrometer), Nd:YAG laser ((lambda) equals 1.06 micrometer) both with air/water spray, high-speed drill with 300 carbide bur, and low-speed drill with $1/4 round bur and air abrasions at 160 psi, with fine air abrasion at 50 micrometer and extra fine at 27 micrometer particle size. Removal (ablation) rate defined as dentin or enamel thickness divided by time required for perforation of the samples was determined for lasers, drills and air abrasion. Multifactor randomized ANOVA (p less than 0.05) considered removal rate as a function of treatment conditions. Removal Rate (micrometers per second) Enamel Dentin High-speed drill 273 +/- 47.34 493 +/- 1.73 Low-speed drill 0 42 +/- 14.25 Nd:YAG 2W 0 103 +/- 37 Er:YAG 2W 35 +/- 10 348 +/- 101 Air abrasion/fine 220 +/- 27 433 +/- 99 Air abrasion/extra fine 151 +/- 13 203 +/- 30 Er:YAG laser at 2W 10Hz ablated both enamel and dentin faster than the low-speed drill but slower than the high-speed drill, while the Nd:YAG laser at identical power and pulse rate did not ablate healthy enamel but was capable of removing dentin. To determine caries removal rate in enamel, extracted superficial carious molars (n equals 35) that included minimal explorer penetration and radiographic confirmation of caries extent were selected. Samples were randomly distributed into treatment groups: high-speed drill (HS), low-speed drill (LS), Nd:YAG laser (L), Nd:YAG with air-water spray (A/W), air abrasion fine (F) and air abrasion extra-fine (EF). The amount of time required to achieve caries removal was measured. Subsequently, the teeth were embedded in resin and cut longitudinally into 0.5mm sections with a diamond saw for inspection of caries removal. Utilizing single-factor random design ANOVA (p less than 0.05), data were analyzed and compared. All treatments successfully removed caries in enamel, with significant differences in amount of tissue removed and time of treatment. Time of removal procedure indicated L greater than A/W greater than LS greater than HS very much greater than F equals EF. Width of tissue removed (mm): HS equals 1.59 plus or minus 0.26, LS equals 0.91 plus or minus 0.38, L equals 0.60 plus or minus 0.17, A/W equals 0.54 plus or minus 0.18, EF equals 0.81 plus or minus 0.19 and F equals 0.79 plus or minus 0.15. The Nd:YAG laser was the most conservative of the treatment methods tested, followed by air abrasion, low-speed and high-speed drilling. Lasers are slower and more conservative while air abrasion is faster and more conservative than conventional dental drills.

Lasers are currently limited in their ability to remove hard tissue. Furthermore, many laser systems, such as the long pulse infrared lasers used to ablate bone or hard dental tissue, also generate unacceptable heat levels and cause collateral tissue damage. Ultrashort pulse lasers, however, are highly efficient, quiet, and relatively free of charge. With recent developments now allowing operation at high pulse repetition rates, ultrashort pulse systems can yield significant material volume removal which can potentially match or even exceed conventional technology while still maintaining the minimal collateral damage characteristics. In this paper, the interaction characteristics of two pulse regimes with enamel and dentin: 350 fs pulse ablation of hard dental tissues is compared to the interaction with one nanosecond pulses. Ablation rates were characterized and surface morphology, and structure were evaluated using a scanning electron microscope.

Laser modification of the dentin may increase the mechanical retention of composite resin restorations. The purpose of this study was to evaluate the effect of the Nd:YAG laser on dentin bonding. 170 dentin specimens were prepared by horizontal sectioning through the middle coronal third of molars. A 5 mm area of 140 samples were treated at powers of 0.3 to 3.0 W, pulse frequencies of 10 to 30 Hz, and energies of 30 to 150 mJ/pulse. The remaining 30 were untreated dentin sections. Samples were pumiced and bonded with Scotchbond 2 and Silux Plus composite, then light cured and stored at 100% humidity for 24 hours prior to debonding. Shear bond strength was measured and the type of failure was determined. Laser modification of the dentin improved bond strength by 68% compared with the controls. Microscopic examination of the lased samples after debonding showed that 5% failed adhesively at the dentin-resin interface, while 95% failed cohesively within the resin. Therefore, lasers increased dentin bond strengths by improving micromechanical retention.

Laser energy transmission through enamel and dentin may effect pulpal safety. In this research, energy transmission was measured by placing enamel and dentin samples directly on an optical detector (both specular and diffuse transmission). Recently-extracted non-carious third molars were cut at thicknesses of 0.5, 1.0, 1.5, and 2.0 (+/- 0.25) mm. Laser exposure was effected using a pulsed contact-delivered infrared Nd:YAG laser with 320 micrometers fiberoptic probe, moved continuously across the surface for 30 seconds per measurement. Transmitted energy was measured following every 50 pulses; three replications were performed per treatment condition. Power was applied on enamel and dentin at 8 parameters: 0.3, 0.5, 0.7 and 1.0 W with frequency of 10 Hz and at 1.0, 2.0, 2.5, and 3.0 W with frequency of 20 Hz (total measurements n equals 864). Multifactor ANOVA confirmed that transmission through enamel was greater than through dentin. Energy transmission increased with both power and frequency. In enamel, transmission decreased as thickness increased. The most significant determinant of energy transmission was the incident surface energy per pulse. Means for samples 0.5 mm thick, at 1 W, 10 Hz: in enamel, 53% of the laser energy was transmitted through the sample, compared with 14% through dentin. For samples 2.0 mm thick: in enamel, 38% of the laser energy was transmitted compared with 17% in dentin.© (1996) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The absence of a hard tissue model reflecting the properties of the inner and middle ear has made it difficult to draw consistent conclusions on the many experimental laser studies in ear surgery. Porcine otic capsule tissue has been studied by our group extensively in a wide variety of laser-tissue interaction studies and is an economically attractive and simple to use hard tissue source. Porcine otic capsule was harvested from the temporal bone of freshly sacrificed domestic pigs via a craniotomy approach. The technique when performed with power instruments takes less than 5 minutes and the entire otic capsule bone is removed intact as the suture line is not fused to the remaining petrous apex. The tissue specimen contains a vestibule, cochlea, oval and round windows, and internal auditory canals which can be used as an intact middle ear/inner ear system. The tissue can also be micromachined into thin slabs of bone varying for 100 - 1000 micrometers in thickness. In order to quantify more precisely the laser-tissue interactions in otic capsule, optical properties (absorption and scattering) and physical properties were determined (acoustic impedance). The tissue has been used in a wide variety of basic studies investigating the laser-tissue interactions with argon, KTP, (Nd:YAG), carbon dioxide, Ho:YAG, Er:YAG, and XeCl lasers. Porcine otic capsule is an ideal tissue on which standardized test can be performed to compare the relative effects of various laser in otosurgical models.

A smear layer is created during the cleaning and shaping of root canal systems. The Nd:YAG laser has been shown to be effective in removing that smear layer and any tissue remnants from prepared root canal systems suggesting that it may aid in root canal sterilization without detrimental thermal effects to adjacent tissues. The root canal system of 72 single-rooted teeth was conventionally prepared and sterilized using gamma radiation. The teeth were divided into three groups of 24 each, 8 of which were inoculated only with sterile broth and remained as negative controls. Sixteen teeth of each group were inoculated with one of three organisms of 10 6 to 10 10 CFU/(mu) l: B subtilis (BS), E. coli (EC) and S. marcescens (SM) (10 (mu) l). Eight in each group were not treated further and served as positive controls. Sixteen test teeth were treated with the laser three times using each exposure parameter: 1 W, 10 Hz pulses per second (pps); 2 W, 20 Hz; and 3 W, 30 Hz inserted to the radiographic apex. Laser exposures were completed while withdrawing the fiber from the root canal system. At completion of laser exposure, all teeth were cultured, using sterile paper points and plated on brain heat infusion agar. Three cultures were taken for each tooth, the plates incubated for 72 hours, and read for the presence of growth of colony-forming units. The laser was able to reduce the number of organisms placed in root canal systems, and suggests that the laser may be used in root canal therapy for bacterial reduction and cleaning of the root canal space.

This presentation addresses the interplay between commerce and conscience. The relationship between industry and academia must be free of both true and apparent conflict of interest. Obviously, the matter is of great importance, since as scientists and clinicians, our integrity is our most valuable asset. This is no less true for the manufacturers of dental laser technology. Ethics, then, is a bottom-line issue for all concerned. Often, in spite of good intentions, there has been no clear-cut policy on this issue. Occasionally, when there has been policy, there has been no mechanism for implementation. Universities have conflict-of-interest requirements, while industry and others in the profession do not. In the academic sphere, we are obligated to be open, thorough, honest and scrupulous in our research and educational activities. Recently, the Board of Directors of the Academy of Laser Dentistry unanimously passed a resolution clarifying their position on conflict-of-interest issues. We offer it to SPIE so that ultimately, we may face our profession and business colleagues squarely, and with full and faithful disclosure. Issues of conflict of interest, principal investigators, financial interests, and recommendations for full disclosure are presented.

High-repetition rate, fiberoptic-delivered Nd:YAG lasers have increased oral soft tissue laser applications. This study focused on three parameters: the temperature rise occurring in deeper tissue during excision, the histology of thermal coagulation during excision of oral tissue, and effects of accidental exposure to adjacent hard tissue. Thermocouples were placed 5.0 +/- 0.5 mm in bone below fresh bovine gingiva and at the same depth in tongue; temperatures in the underlying tissue were measured during laser excision. An Nd:YAG laser with 100 microsecond(s) pulse duration was used to excise the tissue using a 200 or 300 micrometers diameter fiber in contact with the tissue. The soft tissue was excised using constant force and rate with laser powers of 1.5, 3, 5, and 10 W, and a variety of pulse rates. The tissue was bioprepared, sectioned and stained with hematoxylin and eosin. The width and depth of the tissue removed as well as lateral and deep thermal coagulation were measured in histologic sections with a measuring microscope (10x). Multifactor randomized ANOVA showed that probe diameter and repetition rates were not significant variables (p

Laser technology is now being clinically investigated for the removal of carious enamel and dentin. This study used an animal model to evaluate histological pulpal effects from laser exposure. The molars of 24 Sprague-Dawley rats (n equals 264) were exposed to either a pulsed 1.06 micrometers Nd:YAG laser (120 microseconds, 320 micrometer diameter fiber), air rotor drill preparation or left untreated as controls. The following treatment conditions were investigated: control group (n equals 54); high speed drill with carbide bur (n equals 39); laser exposure at 50 mJ/p at 10 Hz (n equals 27), 100 mJ/p at 10 Hz (n equals 66) and 100 mJ/p at 20 Hz (n equals 39). A sixth treatment condition was investigated: root surface hypersensitivity, which included incremental laser exposure from 30 to 100 mJ/p at 10 Hz (n equals 39). The animals were euthanized either immediately after treatment, at one week, or at one month. The jaws were fixed and bioprepared. Remaining dentin thickness was measured, and ranged from 0.17 +/- 0.04 mm to 0.35 +/- 0.09 mm. The pulp tissue was examined for histologic inflammatory response. No evidence of pulpal involvement or adverse pulpal effects were found at any time period in teeth receiving 50 mJ/p. When histologic samples were compared with controls, all observations were similar. Of the 210 exposed teeth, 2 teeth receiving 100 mJ/p demonstrated abscess formation and were exfoliated. Further, in the rat molar when remaining dentin thickness was less than 0.5 mm, exposed to 100 mJ/p, threshold pulpal effects occurred. The response of rat pulp to laser exposure indicated no histologically measurable response to pulsed laser energy at 50 mJ/p.© (1995) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The purpose of this study was to determine the microhardness and extent of bacterial reduction of contaminated dentin following pulsed fiber optic delivered Nd:YAG laser exposure. Knoop hardness was determined before and after laser exposures from 0.3 to 3.0 W and repetition rates of 10 to 30 Hz. Half the sections were covered with an organic black pigment before laser exposure to evaluate the use of the pigment as an initiator to increase laser absorbance on the surface. Repeated measures design was employed to determine the microhardness of cut and polished dentin sections. Additional dentin sections were sterilized by gamma irradiation and then inoculated with B. subtilis, E. coli or B. stearothermophilus. The contaminated sections were exposed to contact delivered Nd:YAG laser. Cultures were obtained from the dentin surfaces and the colony forming units counted. Increased microhardness was found for all laser treatments above the physical modification. Bacterial reduction was obtained but complete sterilization was not.© (1994) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Nd:YAG and carbon dioxide lasers are used for a wide variety of soft tissue applications. As clinicians explore hard tissue applications, such as caries removal and surface modifications, questions arise as to the safety of these new procedures. In this study, thermal characteristics of laser application on enamel and dentin were investigated. Infrared thermography was used to evaluate thermal penetration depth, diameter of hot spot, and the extent of thermal perturbation on dentin and enamel surfaces. Scanning electron microscopy was then used to examine the treated surfaces and correlate the results to the thermal measurements. Laser parameters which have previously been reported in applications of Nd:YAG and CO 2 lasers to dentin and enamel were studied. Our results indicate that, in spite of comparable thermal effects, application of the CO 2 laser created unacceptable thermal damage to adjacent tissue.

The pulsed Nd:YAG laser has been proposed as an alternative to the dental handpiece for caries removal in enamel and dentin. The purpose of this study was to systematically evaluate, in vitro, the process of caries removal and restoration in enamel and dentin. The effectiveness of this device was investigated utilizing scanning electron microscopy to determine the behavior of dentin after laser treatment of artificially created carious lesions in dentin. Histologic sections of extracted teeth after laser treatment and restoration demonstrated successful caries removal and restoration using the pulsed fiber optic delivered Nd:YAG laser as compared to both high and low speed rotary instrumentation. The adjacent enamel and dentin were unaffected by the laser irradiation although slight carbonization was seen on the dentin surface. Thermocouples placed in the pulp chamber during caries removal confirmed previous studies that showed laser parameters up to 1 W and 10 Hz being the same as conventional caries removal in the amount of heat generated which reaches the pulp. The addition of air/water coolant decreased pulpal temperature.© (1994) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The use of laser energy to clean, shape, and sterilize a root canal system space involves the generation of heat due to the thermal effect of the laser on the organic tissue contents and dentin walls of that space. If heat generation is above physiologic levels, irreparable damage may occur to the periodontal ligament and surrounding bone. This study measured temperature rise on the outer root surfaces of extracted teeth during intracanal laser exposure. Thirty single rooted, recently extracted teeth free of caries and restorations were accessed pulps extirpated and divided into three groups. Each root canal system was treated with a 1.06 micrometers pulsed Nd:YAG laser with quartz contact probes. Temperatures were recorded for all surfaces (mesial distal, buccal, lingual, apical) with infrared thermography utilizing a detector response time of 1 (mu) sec, sensitivity range (infrared) of 8 to 12 micrometers and a scan rate of 30 frames/sec.

The determination of the thermal effects of Nd:YAG laser energy on enamel and dentin is critical in understanding the clinical applications of caries removal and surface modification. Recently extracted non-carious third molars were sterilized with gamma irradiation. Calculus and cementum were removed using scaling instruments and 600 grit sand paper. The smear layer produced by sanding was removed with a solution of 0.5 M EDTA (pH 7.4) for two minutes. Enamel and dentin surfaces were exposed to a pulsed Nd:YAG laser with 150 microsecond(s) pulse duration. Laser energy was delivered to the teeth with a 320 micrometers diameter fiberoptic delivery system, for exposure times of 1, 10 and 30 seconds. Laser parameters varied from 0.3 to 3.0 W, 10 to 30 Hz and 30 to 150 mJ/pulse. Other conditions included applications of hot coffee, carbide bur in a dental air-cooled turbine drill and soldering iron. Infrared thermography was used to measure the maximum surface temperature on, and thermal penetration distance into enamel and dentin. Thermographic data were analyzed with a video image processor to determine the diameter of maximum surface temperature and thermal penetration distance of each treatment. Between/within statistical analysis of variance (p

Conventional cleaning and shaping of root canal systems employs hand and/or rotaryinstrumentation to remove the contents of the canal and shape the canal to receive a filling material. With the advent of the Nd:YAG laser system another method of accomplishing proper cleaning and shaping is evaluated. Single rooted teeth were radiographed bucco-lingually and mesio-distally and were divided into 2 groups. The first group was accessed and the root canalsystems cleaned and shaped with a step back technique utilizing hand files and gates glidden burs.At completion of the procedure the teeth were again radiographed at the same positions as thoseprior to the procedure. The teeth were split longitudinally and examined under scanning electronmicroscopy to assess cleaning. The second group of teeth were accessed, and cleaning and shapingwas accomplished using the Nd:YAG laser in combination with hand files and rotary instruments.These teeth were subjected to the same analysis as those in the first group. The before and afterradiographs of each group were subjected to image analysis to determine effectiveness of the twomethods in shaping the canal systems. We will discuss the ability of Nd:YAG to clean and shaperoot canal spaces and remove smear layer and organic tissue remnants from those areas.1. INTRODUCTIONEndodontics is the removal of diseased tissue from the root canal system space of a tooth.Preparation of root canal system spaces involves the removal of organic tissue canal contents andshaping of the canal space to receive a filling material. The cleaning, shaping, and filling of theroot canal space is necessary to preserve the tooth in its natural position and return it to health andnormal function. Since the root canal space has a curved and complex geometry, hand instrumentsused to achieve proper preparation must be able to negotiate the space through its entire length.Conventional methods utilize a series of tapered stainless steel files, 25 to