Abstract
Objectives
The aim of the present clinical randomized split-mouth study was to evaluate the effectiveness and efficiency of an Er:YAG laser for caries removal in primary molars, microbiological dentin analysis, and clinical restorations after 1 year in 29 children.
Materials and methods
The children’s teeth were randomized into two groups: (I) an Er:YAG laser group and (II) a bur preparation group. The efficiency of the treatments (the time necessary for the removal of carious tissue) was evaluated based on the time spent on caries removal in the deciduous molars. The effectiveness (caries removal capacity) of the caries removal was determined by means of a blind test in which the examiner performed a tactile and visual examination of the dentin. Microbiological analysis was performed by counting the Streptococcus mutans and Lactobacillus sp in the remaining dentin. Clinical analysis of restorations was performed using the USPHS method in combination with photographs of restored teeth, 7 days after the restorative procedure and again after 1 year. All cavities were restored with the Adper Single Bond 2/Filtek Z350 system. The obtained data were analyzed with a significance level of 5 %.
Results
The Er:YAG laser was less effective and had the same efficacy as bur preparation during caries removal at the pulpal wall of deciduous molars. In the surrounding walls, bur preparation was the more effective method. Regardless of the method employed, the affected dentin in the pulpal wall had similar amounts of S. mutans and Lactobacillus sp. The restorations were clinically accepted by the USPHS method over a 1-year period.
Conclusion
It can be concluded that caries removal with an Er:YAG laser has no influence on the clinical behavior of restorations.
Clinical relevance
Irradiation with an Er:YAG laser is appropriate for caries removal in primary teeth.
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References
Thompson V, Craig RG, Curro FA, Green WS, Ship JA (2008) Treatment of deep carious lesions by complete excavation or partial removal: a critical review. J Am Dent Assoc 139:705–712
Lula EC, Monteiro-Neto V, Alves CM, Ribeiro CC (2009) Microbiological analysis after complete or partial removal of carious dentin in primary teeth: a randomized clinical trial. Caries Res 43:354–358
Maltz M, Garcia R, Jardim JJ, de Paula LM, Yamaguti PM, Moura MS, Garcia F, Nascimento C, Oliveira A, Mestrinho HD (2012) Randomized trial of partial vs. stepwise caries removal: 3-year follow-up. J Dent Res 91:1026–1031
Massara MI, Alves JB, Brandao PR (2002) A traumatic restorative treatment: clinical, ultrastructural and chemical analysis. Caries Res 36:430–436
Kidd EAM (2004) How ‘clean’ must a cavity be before restoration? Caries Res 38:305–313
Maltz M, Oliveira EF, Fontanella V, Carminatti G (2007) Deep caries lesions after incomplete dentine caries removal: 40-month follow-up study. Caries Res 41:493–496
Maltz M, Jardim JJ, Mestrinho HD, Yamaguti PM, Podestá K, Moura MS, de Paula LM (2013) Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results. Caries Res 47:103–119
Keller U, Hibst R (1997) Effects of Er:YAG Laser in caries treatment: a clinical pilot study. Lasers Surg Med 20:32–38
Aoki A, Ishikawa I, Yamada T, Otsuki M, Watanabe H, Tagami J, Ando Y, Yamamoto H (1998) Comparison between Er:YAG laser and conventional technique for root caries treatment in vitro. J Dent Res 77:1404–1414
Hibst R, Keller U (1989) Experimental studies of the application of the Er:YAG laser on dental hard substances: I. Measurement of the ablation rate. Lasers Surg Med 9:338–344
DenBesten PK, White JM, Pelino JEP, Furnish G, Silveira A, Parkins FM (2001) The safety and effectiveness of an Er:YAG laser for caries removal and cavity preparation in children. Med Laser Appl 16:215–222
Baraba A, Perhavec T, Chieffi N, Ferrari M, Anić I, Miletić I (2012) Ablative potential of four different pulses of Er:YAG lasers and low-speed hand piece. Photomed Laser Surg 30:301–307
Bohari MR, Chunawalla YK, Ahmed BM (2012) Clinical evaluation of caries removal in primary teeth using conventional, chemomechanical and laser technique: an in vivo study. J Contemp Dent Pract 13:40–47
Krause F, Braun A, Lotz G, Kneist S, Jepsen S, Eberhard J (2008) Evaluation of selective caries removal in deciduous teeth by a fluorescence feedback-controlled Er: YAG laser in vivo. Clin Oral Invest 12:209–215
Dommisch H, Peus K, Kneist S, Krause F, Braun A, Hedderich J, Jepsen S, Eberhard J (2008) Fluorescence-controlled Er:YAG laser for caries removal in permanent teeth: a randomized clinical trial. Eur J Oral Sci 116:170–176
Mosskull Hjertton P, Bågesund M (2013) Er:YAG laser or high-speed bur for cavity preparation in adolescents. Acta Odontol Scand 71:610–615
Sarmadi R, Hedman E, Gabre P (2014) Laser in caries treatment – patient’s experiences and opinions. Int J Dent Hyg 12:67–73
Schoop U, Kluger W, Moritz A, Nedjelik N, Georgopoulos A, Sperr W (2004) Bactericidal effect of different laser systems in the deep layers of dentin. Lasers Surg Med 35:111–116
Ando Y, Aoki A, Watanabe H, Ishikawa I (1996) Bactericidal effect of erbium YAG laser on periodontopathic bacteria. Lasers Surg Med 19:190–200
Dos Santos Antonio MP, Moura-Netto C, Camargo SE, Davidowicz H, Marques MM, Maranhão de Moura AA (2012) Bactericidal effects of two parameters of Er:YAG laser intracanal irradiation: ex-vivo study. Lasers Med Sci 27:1165–1168
Messias DCF, de Souza-Gabriel AE, Palma-Dibb RG, Rodrigues AL, Serra MC (2006) Efficiency and effectiveness of Er:YAG laser on carious tissue removal. J Oral Laser Appl 6:181–188
Schulz KF, Altman DG, Moher D (2010) CONSORT Group - Statement: updated guidelines for reporting parallel group randomised trials. Ann Int Med 152:726–732
Gold OG, Jordan HV, Hout JV (1973) A selective medium for Streptococcus mutans. Arch Oral Biol 18:1357–1364
Torres CP, Chinelatti MA, Gomes-Silva JM, Borsatto MC, Palma-Dibb RG (2007) Tensile bond strength to primary dentin after different etching times. J Dent Child 74:113–117
Cvar JF, Ryge G (2005) Reprint of criteria for the clinical evaluation of dental restorative materials. Clin Oral Investig 9:215–232
Paddick JS, Brailsford SR, Kidd EA, Beighton D (2005) Phenotypic and genotypic selection of microbiota surviving under dental restorations. Appl Environ Microbiol 71:2467–2472
Schwass DR, Leichter JW, Purton DG, Swain MV (2013) Evaluating the efficiency of caries removal using an Er:YAG laser driven by fluorescence feedback control. Arch Oral Biol 58:603–610
Apel C, Birker L, Meister J, Weiss C, Gutknecht N (2004) The caries-preventive potential of subablative Er:YAG and Er:YSGG laser radiation in an intraoral model: a pilot study. Photomed Laser Surg 22:312–317
Wen X, Liu L, Nie X, Zhang L, Deng M, Chen Y (2010) Effect of pulse Nd:YAG laser on bond strength and microleakage of resin to human dentine. Photomed Laser Surg 28:741–746
Koyuturk AE, Ozmen B, Cortcu M, Tokay U, Tosun G, Erhan SM (2014) Effects of Er:YAG laser on bond strength of self-etching adhesives to caries-affected dentin. Microsc Res Tech 77:282–288
Bahrololoomi Z, Heydari E (2014) Assessment of Tooth Preparation via Er:YAG Laser and Bur on Microleakage of Dentin Adhesives. J Dent (Tehran) 11:172–178
Yamada Y, Hossain M, Nakamura Y, Murakami Y, Matsumoto K (2002) Microleakage of composite resin restoration in cavities prepared by Er:YAG laser irradiation in primary teeth. Eur J Paediatr Dent 3:39–45
Moncada G, Silva F, Angel P, Oliveira OB Jr, Fresno MC, Cisternas P, Fernandez E, Estay J, Martin J (2014) Evaluation of dental restorations: a comparative study between clinical and digital photographic assessments. Oper Dent 39:45–56
Yazici R, Baseren M, Gorucu J (2010) Clinical comparison of bur- and laser-prepared minimally invasive occlusal resin composite restorations: two-year follow-up. Oper Dent 35:500–507
Bönecker M, Toi C, Cleaton-Jones P (2003) Mutans streptococci and lactobacilli in carious dentine before and after Atraumatic Restorative Treatment. J Dent 31:423–428
Banerjee A, Kidd EA, Watson TF (2000) In vitro evaluation of five alternative methods of carious dentine excavation. Caries Res 34:144–150
Kidd EA, Ricketts DN, Pitts NB (1993) Occlusal caries diagnosis: a changing challenge for clinicians and epidemiologists. J Dent 21:323–331
Albuquerque R Jr, Head TW, Mian H, Rodrigo A, Müller K, Sanches K, Ito IY (2004) Reduction of salivary S aureus and mutans group streptococci by a preprocedural chlorhexidine rinse and maximal inhibitory dilutions of chlorhexidine and cetylpyridinium. Quintessence Int 35:635–640
Moritz A, Jakolitsch S, Goharkhay K, Schoop U, Kluger W, Mallinger R, Sperr W, Georgopoulos A (2000) Morphologic changes correlating to different sensitivities of Escherichia coli and enterococcus faecalis to Nd:YAG laser irradiation through dentin. Lasers Surg Med 26:250–261
Kita T, Ishii K, Yoshikawa K, Yasuo K, Yamamoto K, Awazu K (2014) In vitro study on selective removal of bovine demineralized dentin using nanosecond pulsed laser at wavelengths around 5.8 μm for realizing less invasive treatment of dental caries. Lasers Med Sci 7 [Epub ahead of print].
Acknowledgments
This study was supported by FAPESP (2011/00272-5). The author thanks CAPES for the PhD support. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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The authors declare that they have no conflicts of interest.
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Valério, R.A., Borsatto, M.C., Serra, M.C. et al. Caries removal in deciduous teeth using an Er:YAG laser: a randomized split-mouth clinical trial. Clin Oral Invest 20, 65–73 (2016). https://doi.org/10.1007/s00784-015-1470-z
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DOI: https://doi.org/10.1007/s00784-015-1470-z