Q U I N T E S S E N C E I N T E R N AT I O N A L
Potential surface alteration effects of laser-assisted periodontal surgery on existing dental restorations Evren Kilinc, DDS, PhD1+BNFT3PUISPDL #42/ Erica Migliorati, DDS, MS3/Saulius Drukteinis, DDS, MS4/ %BWJE.3PTILJOE %.% .#"51BVM#SBEMFZ %%4 .% .46
Objective: Laser-assisted gingivectomies are performed in proximity to teeth, existing restorations, and implants. In case of accidental exposures, a detrimental surface defect may cause failure. Surface interactions should be evaluated for safety margin determination of certain laser-material combinations. The purpose of this in vitro study was to assess the microscopic and visible effects of CO2 /E:"( BOEONEJPEFMBTFSJSSBEJBUJPOT on various dental materials and tooth tissue. Method and Materials: Study samples were GBCSJDBUFE × 7.5 mm irradiation surface area, 1 mm thickness) from eight material groups (amalgam, base metal, gold, palladium-silver, composite, ceramic, titanium, and extracted tooth slices). Laser irradiations were performed with CO2 /E:"( BOE nm diode lasers using the manufacturer’s recommended settings for gingivectomy at a EFHSFFBOHMFGPSTFDPOET*SSBEJBUFETVSGBDFTXFSFFWBMVBUFEVOEFS4&.BU× BOE × magnifications. Standardized photographs were obtained using a camera NPVOUTZTUFN × high-definition macro lens). The SEM images and photographs were correlated to determine surface interactions. Results:/E:"(EFUSJNFOUBMMZBGGFDUFEBMM metallic materials and tooth structures. CO2 altered amalgam, gold, and palladium-silver slightly, whereas composite, ceramic, and tooth surfaces were detrimentally altered. 5IFONEJPEFBMUFSFEBNBMHBN HPME UJUBOJVN QBMMBEJVNTJMWFS BOEDPNQPTJUFCVU only gold and palladium-silver surfaces were barely traceable. Conclusion: Within the limitations of this in vitro study, surface effects were all instant; therefore, even a short accidental exposure may be destructive in some laser-material combinations. During gingivectomies, CO2OFBSUPPUIDPMPSFESFTUPSBUJPOTBOE/E:"(OFBSNFUBMMJDSFTUPSBUJPOT BOEJNQMBOUTTIPVMECFVTFEDBSFGVMMZ5IFONEJPEFXBTGPVOEUPCFTBGFSEVFUP its reversible alterations in only some materials. Further in vivo studies are necessary to clinically apply the outcomes of this study. (Quintessence Int 2012;43:387–395)
Key words: dental materials, gingivectomy, soft tissue layers, surface
In
peri-
enhancement cases. Especially in patients
odontal surgery may be a part of esthetic
contemporary
clinical
dentistry,
with a high lip line, any periodontal surgery certainly turns into an esthetic surgery as
1
2
Associate Professor, Department of Cariology and Restorative
much as a functional one.1 Dental lasers, as
Dentistry, Nova Southeastern University, Fort Lauderdale,
alternative instruments to traditional scalpels,
Florida, USA.
are commonly used in various esthetic and
Research
Associate,
Biomaterials
Research
Lab,
Nova
Southeastern University, Fort Lauderdale, Florida, USA. 3
Assistant Professor, Department of Periodontology, University of Tennessee, Memphis, Tennessee, USA.
4
Assistant Professor, Department of Periodontology, Nova Southeastern University, Fort Lauderdale, Florida, USA.
functional applications such as gingivectomy, cosmetic gingival contouring, crown lengthening, frenectomy, removal of soft tissue pathology, subgingival curettage, periodontal pocket disinfection, implant surface decontamination, and uncovering of sub-
5
Private Practice, Gainesville, Florida, USA.
6
Professor, Department of Oral Diagnostic Sciences, Nova
merged implants.2–6 Laser-assisted surgeries may be preferred in esthetic cases because
Southeastern University, Fort Lauderdale, Florida, USA.
of some advantages such as less scar forCorrespondence: Dr Evren Kilinc, Department of Cariology and Restorative Dentistry, Nova Southeastern University, 3200 S. University Drive, Fort Lauderdale, FL 33328. Email:
[email protected]
VOLUME 43 t /6.#&35 t MAY 2012
mation and less postoperative swelling. They were also reported to provide more precise
387
Q U I N T E S S E N C E I N T E R N AT I O N A L Kilinc et al
and visible surgical sites due to sealed
METHOD AND MATERIALS
blood vessels, less pain for the patient, and reduced bacterial transmission.2,6–11 Despite
CO2 /E:"( BOEONEJPEFTPGUUJTTVF
their advantages, soft tissue lasers were
lasers were used on eight material groups
also shown to affect the surrounding tissues
consisting of dental materials and tooth
and cause craterlike defects on enamel
structure. Each laser unit was used by the
and cementum during periodontal surgeries,
same operator using the manufacturers’ set-
which may be a problem in esthetic areas.12–16
tings for gingivectomy. The laser units and
This issue may affect a great number of
operation settings are displayed in Table 1.
general clinicians in addition to periodon-
Eight material groups were used for the
tists, since increasing numbers of general
study. Sample groups included seven den-
practitioners are known to have incorporated
UBMCJPNBUFSJBMT × 15 mm dimensions ×
dental laser technology to their practices.
1 mm thickness) and tooth slices obtained
/VNFSPVT QBUJFOUT XIP VOEFSHP QFSJ-
from extracted caries-free molars (1 mm
odontal surgery present with existing direct
thick). Polished samples of base metal,
or indirect restorations and dental implants
gold, palladium-silver, titanium, and ceram-
immediate to the surgical sites, yet the poten-
ic were provided by the manufacturer.
tial surface effects of lasers has not been
Dental amalgam and composite samples
widely reported. An unintentional but defi-
were fabricated according to the manufac-
nitely possible laser-surface interaction may
turer’s instructions by the same investigator.
cause various levels of restoration or implant
A custom-made polyoxymethylene (Delrin,
surface deformities. These alterations may
Small Parts) split mold was used to fabricate
cause esthetically unacceptable situations
the samples. Composite samples were poly-
and may also promote bacterial adhesion.17–21
NFSJ[FEJOPWFSMBQQJOHDZDMFTPGTFDPOET
The damage to the adjacent restorative mate-
according to ISO standards.24 Fabricated
rial could even be to such an extent that it
amalgam and composite samples were
may require removal of an otherwise accept-
TBOEFE EPXO UP VOJGPSN NN
able restoration. Most of the existing studies
thickness under standardized conditions
in the literature evaluate the surface effects
7JDUPS #FUB #VFIMFS VTJOH
of lasers on only one or two dental materials
BOE HSJU TJMJDPO DBSCJEF TBOE-
and mostly using only one type of laser.
QBQFS $BSCJNFU #VFIMFS "NBMHBN QPM-
More extensive studies that would cover vari-
ishing was performed using brownie and
ous types of materials and lasers may provide
greenie points (Shofu Dental). Composite
a more clear perspective for better-informed
polishing was perfomed using Enhance
clinical decisions.
points (Dentsply Caulk), Sof-Lex disks (3M
The purpose of this in vitro study was
ESPE), and Jiffy composite polishing brush-
to assess the potential effects of direct
es (Ultradent). A digital caliper was used to
irradiations of some commonly used soft
measure and confirm standard disk thick-
tissue lasers on various types of direct and
ness for all samples. The material groups
indirect restorative materials and titanium.
are displayed in Table 2.
Scanning electron microscopy (SEM)
A custom-made polyoxymethylene sam-
and digital photography methods were uti-
ple holder facilitated upright positioning of
lized to evaluate the surface alteration of
each material sample.
carbon dioxide (CO2
OFPEZNJVNEPQFE
In all of the 24 study groups, laser irra-
ZUUSJVN BMVNJOVN HBSOFU /E:"(
BOE
EJBUJPOT XFSF QFSGPSNFE GPS TFDPOET
ONEJPEFMBTFSTPOEFOUBMCJPNBUFSJBMT
The laser beam was aimed at a 45-degree
such as ceramic, composite, dental amal-
angle to the vertical axis of the sample to
gam, base metal, high noble metal, noble
better simulate the clinical scenario (n = 8).
metal, and titanium in addition to sectioned
Each irradiation surface area was restricted
teeth. The safety of each laser on each
UP× 7.5 mm dimensions (Fig 1).
type of material or tooth was determined. The lasers altering the surface topography,
Irradiations were strictly timed to ensure a DPOTJTUFOUNNTFDJSSBEJBUJPOTQFFE
especially to a detrimental extent, were
/E:"( BOE EJPEF GJCFS UJQT XFSF DMFBWFE
addressed and discussed.
CFGPSF FBDI TBNQMF JSSBEJBUJPO /P DMFBWJOH
388
VOLUME 43 t /6.#&35 t MAY 2012
Q U I N T E S S E N C E I N T E R N AT I O N A L Kilinc et al
Table 1
Laser devices and settings
Instruments
Model (manufacturer)
Settings
Tips
CO2
Ultraspeed (DEKA)
18 )[ MFWFM 8 gingivectomy I setting
Perio insert, cylindric tip
/E:"(
"%5%-BTF6QHSBEF 8
8 )[
NJDSPOGJCFSUJQ
ONEJPEFMBTFS
0EZTTFZ/BWJHBUPS *WPDMBS7JWBEFOU
8 DPOUJOVPVTXBWF )[
*OJUJBUFENJDSPOUJQ
Table 2
Dental material groups used in the study
Material Dental amalgam
Name
Manufacturer
Valiant Ph.D.
Lot no. -9$.3
Ivoclar Vivadent
#BTFNFUBM
*14E4JHO
Ivoclar Vivadent
M19918
(PME
"RVBSJVT)BSE
Ivoclar Vivadent
- .
Palladium-silver
IPS d.Sign 53
Ivoclar Vivadent
-
Titanium
(SBEF
Atlantic Metals & Alloys
Ceramic
IPS Empress Esthetic (ETC 2 shade)
Ivoclar Vivadent
(
Composite
Tetric Evoceram (bleach M shade)
Ivoclar Vivadent
Tooth
—
5*(3
—
—
Fig 1 The angulated positioning of the laser handpiece on the material sample.
was necessary for the CO2 laser. The CO2
lens). The original photographs appeared
laser was operated under a water flow fol-
BQQSPYJNBUFMZUJNFTUIFJSBDUVBMTJ[F
lowing the manufacturer’s recommendations. A camera mount system was used to capture standardized photographs from
Irradiated
surfaces
were
evaluated
VOEFS 4&. '&*1IJMJQT 2VBOUB BU NBHOJGJDBUJPOTPG×BOE ×.
B QSFTFU NN EJTUBODF " EJHJUBM DBN-
The definition and severity of the mark-
era and a high-definition macro lens were
ings that varied between the lasers and
VTFE GPS JNBHJOH /JLPO 1 /JLPO
dental materials were compared using the
64" 0QUFLB × high-definition macro
photographs and SEM images.
VOLUME 43 t /6.#&35 t MAY 2012
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Q U I N T E S S E N C E I N T E R N AT I O N A L Kilinc et al
Amalgam irradiations 1IPUPHSBQI ×)
Base metal irradiations 4&. ×)
4&. ×)
1IPUPHSBQI ×)
CO2
CO2
/E:"(
/E:"(
Diode
Diode
Fig 2
Amalgam surfaces.
RESULTS
Fig 3
4&. ×)
Base metal surfaces.
the photographs, SEM images showed that they generated very fine markings of approx-
The potential surface alteration effects of CO2 /E:"( BOE ON EJPEF MBTFST were evaluated from optical and micro-
imately 13 and 6 microns, respectively. (PME TBNQMFT TIPXFE UIBU BMM MBTFST caused visible surface dents (see Fig 4).
TDPQJDQPJOUTPGWJFX3FTVMUTBSFEJTQMBZFE
*O QBSUJDVMBS UIF /E:"( MBTFS EBNBHFE
by the dental material for better comparison
the material’s surface to a greater extent
of the lasers (Figs 2 to 9).
of approximately 375 microns. According
*OBNBMHBN POMZUIF/E:"(MBTFSQSP-
to the SEM evaluations, the markings were
duced a craterlike detrimental effect, which
approximately 15 times wider than the CO2
would most likely necessitate the removal
MBTFS BOE UJNFT XJEFS UIBO UIF EJPEF
of the restoration (see Fig 2). The markings
Diode markings were measured to be the
show that this particular laser irradiation
finest and the most reversible ones.
damaged the surface instantly in approxiNBUFMZBNJDSPOEJBNFUFS EFNPOTUSBU-
Palladium-silver samples were visibly BGGFDUFE CZ /E:"( BOE ON EJPEF
ing that even an accidental exposure may
MBTFST TFF'JH /E:"(MBTFSNBSLTXFSF
CF DSJUJDBM 5IF ON EJPEF MBTFS NBSL-
deeper and approximately 395 microns,
ings were barely visible without any mag-
which was about 9 times wider than the
nification. Markings initiated by CO2 were
diode markings. The CO2 laser irradiation
visible as fine scratches and demonstrated
markings were not visible to the naked eye.
approximately an 18-micron diameter in the SEM imaging.
Titanium surfaces were visibly affected POMZ CZ UIF /E:"( MBTFS JSSBEJBUJPOT TFF
#BTF NFUBM TVSGBDFT XFSF POMZ WJTJCMZ
'JH 5IF FGGFDU PG /E:"( MBTFS JSSBEJB-
BGGFDUFE CZ /E:"( MBTFS JSSBEJBUJPOT TFF
tion showed surface cracks with an approxi-
Fig 3). The markings were circular by defini-
NBUFMZNJDSPOXJEUIEJBNFUFS5IF$02
tion and appeared shallower compared with
laser did not have any visible effect. In fact,
/E:"( BNBMHBN JSSBEJBUJPOT &WFO UIPVHI
it was difficult to differentiate surface irregu-
both CO2 and diode laser irradiation mark-
larities from laser irradiations on the SEM
ings were not visible to the naked eye or in
due to the imperfections in the polish. Diode
VOLUME 43 t /6.#&35 t MAY 2012
4&. ×)
Q U I N T E S S E N C E I N T E R N AT I O N A L Kilinc et al
Gold irradiations
PdAg irradiations
1IPUPHSBQI ×)
4&. ×)
4&. ×)
1IPUPHSBQI ×)
CO2
CO2
/E:"(
/E:"(
Diode
Diode
Fig 4
Gold surfaces.
Fig 5
Titanium irradiations
4&. ×)
4&. ×)
4&. ×)
4&. ×)
Palladium-silver surfaces.
Composite irradiations
1IPUPHSBQI ×)
4&. ×)
4&. ×)
1IPUPHSBQI ×)
CO2
CO2
/E:"(
/E:"(
Diode
Diode
Fig 6
Titanium surfaces.
Fig 7
Composite surfaces.
lasers did not show any detectable effect
surfaces were carbonized and damaged to
in the digital images, but the SEM evalua-
a great extent with a diameter of approxi-
tion revealed scattered markings of a cir-
NBUFMZNN/E:"(MBTFSBMTPDBVTFE
DVMBS OBUVSF XJUI BQQSPYJNBUFMZ NJDSPO
a visible effect, but the damage appeared
diameter.
to be around one-quarter that of CO2. The
The
effect
of
lasers
varied
greatly
diode laser did not show any visible effects
depending on the composite material (see
to the naked eye; nevertheless, SEM evalu-
Fig 7). Composite surfaces were irreparably
ations showed a smaller diameter irradia-
affected by the CO2 laser irradiations. The
UJPOQBUIPGBQQSPYJNBUFMZNJDSPOT
VOLUME 43 t /6.#&35 t MAY 2012
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Q U I N T E S S E N C E I N T E R N AT I O N A L Kilinc et al
Ceramic irradiations
Tooth irradiations
1IPUPHSBQI ×)
4&. ×)
4&. ×)
1IPUPHSBQI ×)
CO2
CO2
/E:"(
/E:"(
Diode
Diode
Fig 8
Ceramic surfaces.
During the visual examination of the
Fig 9
4&. ×)
Tooth surfaces.
DISCUSSION
ceramic surfaces, only CO2 laser-irradiated ones were visibly affected. SEM evaluations
When a laser light reaches tissue, it can
showed multiple microcracks and deformi-
reflect, scatter, be absorbed, or be trans-
ties, revealing irreversible surface damage
mitted to the surrounding tissues in a dif-
(see Fig 8). The long-term effect of the dam-
ficult-to-control direction.25 Existing direct
age on clinical longevity was considered
and indirect restorations are commonly
more intense than it would appear to the
present in close proximity to laser-assisted
OBLFEFZFJOBDMJOJDBMTFUUJOH5IF/E:"(
gingivectomy operation sites. Some other
and diode lasers did not cause any surface
studies demonstrated that a possible sur-
damage on ceramic.
face damage on a dental restoration may
Tooth surfaces were uniformly and det-
lead to esthetic problems as well as micro-
SJNFOUBMMZ BGGFDUFE CZ /E:"( JSSBEJBUJPOT
cracks, fractures, and bacterial adhesion,
(see Fig 9). SEM images showed carbon-
which also may either lead to secondary
ized, cracked, melted surfaces where the
caries formation at the cavosurface margins
diameter could not be measured due to
or periodontal problems.16,17,26 In today’s
its size. The CO2 laser caused detrimental
dentistry, where dentists are constantly
effects on most of the surfaces, but some
trying to reduce chairside time, removal
selective irradiated areas were not affected.
of sound restorations due to unplanned
The diode laser affected a limited area of one
clinical complications is not feasible and
of the samples. All other diode-irradiated
can be cumbersome. This particular study
surfaces appeared intact both in the photo-
evaluated three commonly used soft tissue
graphs and SEM evaluations.
lasers on various universally placed dental
392
VOLUME 43 t /6.#&35 t MAY 2012
4&. ×)
Q U I N T E S S E N C E I N T E R N AT I O N A L Kilinc et al
biomaterials and tooth surfaces, which pro-
the severity was not evident even with the
vided a larger set of data to discuss.
approximately tenfold magnification of the
The purpose was to compare and provide
digital images. The surface cracks in the
a more informed selection between laser
ceramic, which were only detectible in the
devices when there is more than one option
SEM image would most likely affect the clini-
or to aid the decision process as to whether
DBM TVSWJWBM USFNFOEPVTMZ )ZQPUIFUJDBMMZ
a laser-assisted gingivectomy method is
speaking, the patient may present with a
feasible depending on the type of pre-
fractured ceramic veneer shortly after a CO2
existing restorations.
laser gingivectomy procedure, and the clini-
The in vitro methods can give only an
cian may not form a correlation between the
idea about the potential surface alteration
two. These composite and ceramic findings
effects since the laboratory environment
were expected because nonmetallic resto-
cannot be compared with an in vivo envi-
rations were reported to be prone to surface
ronment. This study does not claim to fully
alteration by the CO2 laser. Also, the CO2
simulate the oral situation or provide the
laser was previously shown to produce sur-
feedback of a clinical study; nevertheless,
face cracks in the ceramic material.22
the authors believe that such in vitro studies
When the patients have pre-existing tita-
facilitating a micrographic view may pro-
nium implants, amalgam fillings, or restora-
vide more detailed information that would
tions with palladium-silver collars, the use
be missing in a clinical setting. The results
PG /E:"( MBTFST TIPVME CF SFDPOTJEFSFE
of this study would be very valuable in
These materials were irreversibly damaged
conjunction with the results of a follow-up in
JO BO JOTUBOU NBOOFS CZ UIF /E:"( 5IF
vivo study. The investigators used an expe-
/E:"( MBTFS JT B TIPSUXBWFMFOHUI MBTFS
rienced operator rather than a laser setup
and the beams of this laser are known to be
for better simulation of the oral environment
better absorbed by metallic surfaces com-
following a pilot study with consistent mark-
pared with CO2 laser beams.8 This risk has
ings. An experimental setup would require
been pointed out by some researchers.8,23
a much larger surface irradiation area for
Full metal or metal-ceramic restorations with
constant readings but could also provide
metal collars fabricated in gold or base
reliable results.
metal would possibly be irreversibly dam-
5IF TFDPOE JSSBEJBUJPOT NBZ OPU
aged with the use of this laser. The damage
completely represent an accidental expo-
PO BNBMHBN SFTUPSBUJPOT CZ UIF /E:"(
sure during a surgical operation since the
laser is well reported in previous stud-
operator’s tactile senses would probably
ies.27,28 The possible release of the mercury
avoid such an exposure for longer than 2 to
vapor from the amalgam surface should
TFDPOET/FWFSUIFMFTT UIFTFFWBMVBUJPOT
also be considered in such a situation, and
showed that the surface damages were
proper suctioning should be performed.27
all instant. In other words, an accidental
The metallic samples in this study were also
exposure of 2 seconds and an irradiation
affected by the CO2 and diode lasers but the
PGTFDPOETEJEOPUEJGGFSJOUFSNTPGUIF
alterations appeared reversible. The safety
topography on a given surface. Therefore,
of lasers can vary greatly with different
the authors believe that the results of these
parameters.18,29 The parameters of the CO2
evaluations have clinical significance dur-
and the diode lasers in this study can be
ing laser-assisted gingival surgeries.
considered as safe for titanium. This finding
According to the evaluations, in the presence of adjacent tooth-colored restorations such as composite and ceramic, CO2
would agree with some studies that found CO2 and diodes safe for the implants. Tooth samples sectioned mesiodistally
lasers should be operated with great cau-
JODMVEFEEFOUJOBOEFOBNFMTVSGBDFT#PUI
tion, because the surface alterations were
enamel and dentin surfaces were detrimen-
detrimental. The severely damaged clinical
UBMMZBGGFDUFECZUIF/E:"(MBTFSBOEJOB
view of irradiated composite restorations
uniform manner. The finding is in agreement
would be alarming and hard to miss for the
with some studies that showed microcracks
operator. On the other hand, the ceramic
JO EFOUJO BGUFS /E:"( JSSBEJBUJPO16 On
surface alterations could be deceiving since
the other hand, the CO2 laser selectively
VOLUME 43 t /6.#&35 t MAY 2012
393
Q U I N T E S S E N C E I N T E R N AT I O N A L Kilinc et al
damaged the irradiated surfaces. The man-
CONCLUSION
ufacturer’s recommended settings for the gingivectomy included a pulsed wave for
Within the limitations of this in vitro study,
this laser. Pulsed waves were shown to
laser-assisted periodontal surgeries, if not
be safer on tooth surfaces compared with
operated attentively, may be the cause of
the continuous mode, which is considered
unwanted and esthetically unacceptable
to be more destructive.13 Some areas on
surface alterations. Laser-initiated surface
the tooth samples were not affected by
alterations on all dental materials were all
the CO2 laser at all, but the affected areas
instant; therefore, even a short acciden-
were severely altered. The diode lasers
tal exposure may be destructive in some
were previously shown to be safer on the
groups. CO2 lasers around tooth-colored
tooth structures when operated with set-
SFTUPSBUJPOT BOE /E:"( MBTFS BSPVOE
tings similar to those used in this study.31
implants, amalgams, and metal indirect res-
/FWFSUIFMFTT UIF IJHIFS QPXFST JO EJPEF
torations should be operated carefully dur-
lasers were also found destructive for the
JOHHJOHJWFDUPNJFT5IFONEJPEFMBTFS
tooth surfaces.32 In this study, almost all of
was found to affect most of the materials
the diode laser irradiations appeared to be
but appeared safer due to more reversible
safe on the tooth sections, but one certain
alterations. If the teeth are not shielded dur-
area of just one irradiation was detrimentally
ing laser-assisted gingivectomies, it is rec-
affected. The selective damages in the two
ommended to apply routine postoperative
latter lasers may be due the differences in
polishing procedures to almost all types of
the humidity level on the surfaces of the
restorations. Further clinical studies are nec-
extracted teeth. The samples were kept in
essary to validate the findings of this study.
distilled water at all times other than the actual irradiation, but testing time may have dehydrated some areas and worsened the effect.33 Furthermore, some studies show
ACKNOWLEDGMENT
that polished tooth surfaces such as in an intact tooth surface would be less affected
This study was supported by Ivoclar Vivadent.
by the CO2 compared with sectioned tooth slices; therefore, the results could have been different if the samples were polished.34 The number, size, and direction of
REFERENCES
the dentin tubules may affect the severity of the laser.33 When the irradiation surface is vertical to the directions of the dentin tubules, the laser was demonstrated to show higher ablation.33 The clinical results on vital teeth may vary. The results of this study recommend
1. Hempton TJ, Dominici JT. Contemporary crownlengthening therapy: A review. J Am Dent Assoc 2010;141:647–655. 2. Romanos G, Nentwig GH. Diode laser (980 nm) in oral and maxillofacial surgical procedures: Clinical observations based on clinical applications. J Clin Laser Med Surg 1999;17:193–197.
different laser selections for different types
3. Andreana S. The use of diode lasers in periodontal
of restorations. Doing this may not be
therapy: Literature review and suggested tech-
very feasible in a clinical situation where
nique. Dent Today 2005;24:132–135.
there are various pre-existing restorations
4. Moritz A, Schoop U, Goharkhay K, et al. Treatment of
in a quadrant. On the other hand, it may be
periodontal pockets with a diode laser. Lasers Surg
more time-consuming to replace or even fix an existing restoration after irreversible laser-initiated surface damage.
Med 1998;22:302–311. 5. Sarver DM, Yanosky M. Principles of cosmetic dentistry in orthodontics: Part 2. Soft tissue laser technology and cosmetic gingival contouring. Am J Orthod Dentofacial Orthop 2005;127:85–90. 6. Parker S. Surgical laser use in implantology and endodontics. Br Dent J 2007;202:377–386.
394
VOLUME 43 t /6.#&35 t MAY 2012
Q U I N T E S S E N C E I N T E R N AT I O N A L Kilinc et al
7. Sarver DM. Use of the 810 nm diode laser: Soft tis-
22. Akova T, Yoldas O, Toroglu MS, Uysal H. Porcelain
sue management and orthodontic applications of
surface treatment by laser for bracket-porcelain
innovative technology. Pract Proced Aesthet Dent
bonding. Am J Orthod Dentofacial Orthop 2005;
2006;18:7–13.
128:630–637.
8. Kato T, Kusakari H, Hoshino E. Bactericidal efficacy of
23. Romanos GE, Everts H, Nentwig GH. Effects of
carbon dioxide laser against bacteria-contaminated
diode and Nd:YAG laser irradiation on titanium
titanium implant and subsequent cellular adhe-
discs: A scanning electron microscope examination.
sion to irradiated area. Lasers Surg Med 1998;23: 299–309. 9. Fontana CR, Kurachi C, Mendonca CR, Bagnato VS.
J Periodontol 2000;71:810–815. 24. ISO 4049: Dentistry-Polymer-based filling, restorative and luting materials.
Microbial reduction in periodontal pockets under
25. Aoki A, Sasaki KM, Watanabe H, Ishikawa I. Lasers in
exposition of a medium power diode laser: An
nonsurgical periodontal therapy. Periodontol 2000
experimental study in rats. Lasers Surg Med 2004; 35:263–268.
2004;36:59–97. 26. Shin SI, Min HK, Park BH, et al. The effect of Er:YAG
10. Barak S, Kaplan I. The CO2 laser in the excision of
laser irradiation on the scanning electron micro-
gingival hyperplasia caused by nifedipine. J Clin
scopic structure and surface roughness of various
Periodontol 1988;15:633–635.
implant surfaces: An in vitro study. Lasers Med Sci
11. Yague-Garcia J, Espana-Tost AJ, Berini-Aytes L,
2011;26:767–776.
Gay-Escoda C. Treatment of oral mucocele-scalpel
27. Cernavin I, Hogan SP. The effects of the Nd:YAG
versus CO2 laser. Med Oral Patol Oral Cir Bucal 2009;
laser on amalgam dental restorative material. Aust
14: e469–e474.
Dent J 1999;44:98–102.
12. Goultschin J, Gazit D, Bichacho N, Bab I. Changes in
28. Turkmen C, Sazak H, Gunday M. Effects of the
teeth and gingiva of dogs following laser surgery:
Nd:YAG laser, air-abrasion, and acid-etchant on fill-
A block surface light microscope study. Lasers Surg Med 1988;8:402–408.
ing materials. J Oral Rehabil 2006;33:64–69. 29. Vescovi P, Corcione L, Meleti M, et al. Nd:YAG laser
13. Barone A, Covani U, Crespi R, Romanos GE. Root
versus traditional scalpel. A preliminary histological
surface morphological changes after focused versus
analysis of specimens from the human oral mucosa.
defocused CO2 laser irradiation: A scanning electron microscopy analysis. J Periodontol 2002;73:370–373.
Lasers Med Sci 2010;25:685–691. 30. Stubinger S, Etter C, Miskiewicz M, et al. Surface
14. Powell GL, Whisenant BK, Morton TH. Carbon diox-
alterations of polished and sandblasted and acid-
ide laser oral safety parameters for teeth. Lasers
etched titanium implants after Er:YAG, carbon diox-
Surg Med 1990;10:389–392.
ide, and diode laser irradiation. Int J Oral Maxillofac
15. Pick RM, Pecaro BC, Silberman CJ. The laser gingi-
Implants 2010;25:104–111.
vectomy. The use of the CO2 laser for the removal
31. Kreisler M, Meyer C, Stender E, Daublander M,
of phenytoin hyperplasia. J Periodontol 1985;56:
Willershausen-Zonnchen B, d‘Hoedt B. Effect of
492–496.
diode laser irradiation on the attachment rate
16. Ariyaratnam MT, Wilson MA, Blinkhorn AS. An analysis of surface roughness, surface morphology and
of periodontal ligament cells: An in vitro study. J Periodontol 2001;72:1312–1317.
composite/dentin bond strength of human dentin
32. Schwarz F, Sculean A, Berakdar M, Szathmari L,
following the application of the Nd:YAG laser. Dent
Georg T, Becker J. In vivo and in vitro effects of an
Mater 1999;15:223–228.
Er:YAG laser, a GaAlAs diode laser, and scaling and
17. Cernavin I. A comparison of the effects of Nd:YAG
root planing on periodontally diseased root sur-
and Ho:YAG laser irradiation on dentine and enam-
faces: A comparative histologic study. Lasers Surg
el. Aust Dent J 1995;40:79–84.
Med 2003;32:359–366.
18. Deppe H, Horch HH, Henke J, Donath K. Peri-implant
33. Mehl A, Kremers L, Salzmann K, Hickel R. 3D volume-
care of ailing implants with the carbon dioxide laser.
ablation rate and thermal side effects with the
Int J Oral Maxillofac Implants 2001;16:659–667.
Er:YAG and Nd:YAG laser. Dent Mater 1997;13:
19. Kreisler M, Gotz H, Duschner H. Effect of Nd:YAG,
246–251.
Ho:YAG, Er:YAG, CO2, and GaAIAs laser irradiation on
34. McCormack SM, Fried D, Featherstone JD, Glena
surface properties of endosseous dental implants.
RE, Seka W. Scanning electron microscope observa-
Int J Oral Maxillofac Implants 2002;17:202–211.
tions of CO2 laser effects on dental enamel. J Dent
20. Mazouri Z, Walsh LJ. Damage to dental composite
Res 1995;74:1702–1708.
restorations following exposure to CO2 laser radiation. J Clin Laser Med Surg 1995;13:73–76. 21. Noda M, Okuda Y, Tsuruki J, Minesaki Y, Takenouchi Y, Ban S. Surface damages of zirconia by Nd:YAG dental laser irradiation. Dent Mater J 2010;29: 536–541.
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