The effect of Er,Cr:YSGG laser, fluoride, and CPP-ACP on caries resistance of primary enamel

  • Pinar Serdar-EymirliEmail author
  • M. D. Turgut
  • A. Dolgun
  • A. R. Yazici
Original Article


The aim of this in vitro study was to determine the effect of different remineralization agents and laser on caries resistance of primary enamel. In the study, 150 sound primary molars were used. The initial microhardness values were measured and the teeth were randomly assigned to ten treatment groups (n = 15): no treatment/negative control (C), NaF, APF, fluoride varnish (FV), CPP-ACP, laser (L), L + NaF, L + APF, L + FV, L + CPP-ACP. The microhardness values were measured after the treatments and the pH cycle. The obtained data were analyzed statistically. One sample from each group was examined before treatment, after treatment, and after the pH cycle with a scanning electron microscope. While microhardness values after treatment compared to baseline increased, microhardness after the pH cycle decreased compared to after treatment values in all experimental groups (p < 0.05). In regard to the difference in microhardness after the pH cycle and baseline, there were no statistically significant differences between groups C and NaF and between C and CPP-ACP (p > 0.05). There was a significant difference between groups L and L + FV (p < 0.05), while no significant difference was noted between groups L and L + NaF, L + APF, L + CPP-ACP (p > 0.05). As a conclusion, FV is more effective when used in combination with laser than laser alone. NaF, CPP-ACP, and laser may be insufficient in protecting the primary teeth against acid attacks compared to FV used with laser.


Dental caries Tooth remineralization Tooth demineralization Fluoride Laser therapy CPP-ACP 



The authors would like to thank Benjamin Gottsch for language revision.

Funding information

The current study was supported by the Hacettepe University Scientific Research Project Coordination Unit (Project No, TDK-2016-12277).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This in vitro study was approved by the local ethics committee of Hacettepe University, Ankara, Turkey (Project no: TDK-2016-12277).


  1. 1.
    Raucci-Neto W, de Castro-Raucci LM, Lepri CP, Faraoni-Romano JJ, Gomes da Silva JM, Palma-Dibb RG (2015) Nd:YAG laser in occlusal caries prevention of primary teeth: a randomized clinical trial. Lasers Med Sci 30(2):761–768. CrossRefPubMedGoogle Scholar
  2. 2.
    Petersen PE, Phantumvanit P (2012) Perspectives in the effective use of fluoride in Asia. J Dent Res 91(2):119–121. CrossRefPubMedGoogle Scholar
  3. 3.
    Lima YB, Cury JA (2003) Seasonal variation of fluoride intake by children in a subtropical region. Caries Res 37(5):335–338CrossRefGoogle Scholar
  4. 4.
    Ten Cate JM (2004) Fluorides in caries prevention and control: empiricism or science. Caries Res 38(3):254–257. CrossRefPubMedGoogle Scholar
  5. 5.
    Moslemi M, Fekrazad R, Tadayon N, Ghorbani M, Torabzadeh H, Shadkar MM (2009) Effects of ER,Cr:YSGG laser irradiation and fluoride treatment on acid resistance of the enamel. Pediatr Dent 31(5):409–413PubMedGoogle Scholar
  6. 6.
    Rosin-Grget K, Peros K, Sutej I, Basic K (2013) The cariostatic mechanisms of fluoride. Acta Med Acad 42(2):179–188. CrossRefPubMedGoogle Scholar
  7. 7.
    Ten Cate J, Featherstone JDB (1996) Physicochemical aspects of fluoride enamel interactions. In: Fejerskov O, Ekstrand J, Burt BA (eds) Fluoride in dentistry, 2nd edn. Munksgaard, Copenhagen, pp 252–269Google Scholar
  8. 8.
    Featherstone JD (2000) The science and practice of caries prevention. J Am Dent Assoc 131(7):887–899CrossRefGoogle Scholar
  9. 9.
    Valerio RA, Rocha CT, Galo R, Borsatto MC, Saraiva MC, Corona SA (2015) CO2 laser and topical fluoride therapy in the control of caries lesions on demineralized primary enamel. ScientificWorldJournal 2015:547569. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    American Dental Association Council on Scientific A (2006) Professionally applied topical fluoride: evidence-based clinical recommendations. J Am Dent Assoc 137(8):1151–1159CrossRefGoogle Scholar
  11. 11.
    Fontana M, Gonzalez-Cabezas C, Haider A, Stookey GK (2002) Inhibition of secondary caries lesion progression using fluoride varnish. Caries Res 36(2):129–135. CrossRefPubMedGoogle Scholar
  12. 12.
    O'Mullane DM, Baez RJ, Jones S, Lennon MA, Petersen PE, Rugg-Gunn AJ, Whelton H, Whitford GM (2016) Fluoride and oral health. Community Dent Health 33(2):69–99PubMedGoogle Scholar
  13. 13.
    Featherstone JD (1999) Prevention and reversal of dental caries: role of low level fluoride. Community Dent Oral Epidemiol 27(1):31–40CrossRefGoogle Scholar
  14. 14.
    Kumar VL, Itthagarun A, King NM (2008) The effect of casein phosphopeptide-amorphous calcium phosphate on remineralization of artificial caries-like lesions: an in vitro study. Aust Dent J 53(1):34–40. CrossRefPubMedGoogle Scholar
  15. 15.
    Asl-Aminabadi N, Najafpour E, Samiei M, Erfanparast L, Anoush S, Jamali Z, Pournaghi-Azar F, Ghertasi-Oskouei S (2015) Laser-Casein phosphopeptide effect on remineralization of early enamel lesions in primary teeth. J Clin Exp Dent 7(2):e261–e267. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ana PA, Tabchoury CP, Cury JA, Zezell DM (2012) Effect of Er,Cr:YSGG laser and professional fluoride application on enamel demineralization and on fluoride retention. Caries Res 46(5):441–451. CrossRefPubMedGoogle Scholar
  17. 17.
    Tagomori S, Iwase T (1995) Ultrastructural change of enamel exposed to a normal pulsed Nd-YAG laser. Caries Res 29(6):513–520CrossRefGoogle Scholar
  18. 18.
    van As G (2004) Erbium lasers in dentistry. Dent Clin N Am 48(4):1017–1059, viii. CrossRefPubMedGoogle Scholar
  19. 19.
    Anaraki SN, Serajzadeh M, Fekrazad R (2012) Effects of laser-assisted fluoride therapy with a CO2 laser and Er, Cr:YSGG laser on enamel demineralization. Pediatr Dent 34(4):e92–e96PubMedGoogle Scholar
  20. 20.
    Steiner-Oliveira C, Nobre-dos-Santos M, Zero DT, Eckert G, Hara AT (2010) Effect of a pulsed CO2 laser and fluoride on the prevention of enamel and dentine erosion. Arch Oral Biol 55(2):127–133. CrossRefPubMedGoogle Scholar
  21. 21.
    Bahrololoomi Z, Lotfian M (2015) Effect of diode laser irradiation combined with topical fluoride on enamel microhardness of primary teeth. J Dent (Tehran) 12(2):85–89Google Scholar
  22. 22.
    Azevedo DT, Faraoni-Romano JJ, Derceli Jdos R, Palma-Dibb RG (2012) Effect of Nd:YAG laser combined with fluoride on the prevention of primary tooth enamel demineralization. Braz Dent J 23(2):104–109CrossRefGoogle Scholar
  23. 23.
    Subramaniam P, Pandey A (2014) Effect of erbium, chromium: yttrium, scandium, gallium, garnet laser and casein phosphopeptide-amorphous calcium phosphate on surface micro-hardness of primary tooth enamel. Eur J Dent 8(3):402–406. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Westerman GH, Hicks MJ, Flaitz CM, Powell GL (2006) In vitro caries formation in primary tooth enamel: role of argon laser irradiation and remineralizing solution treatment. J Am Dent Assoc 137(5):638–644CrossRefGoogle Scholar
  25. 25.
    ten Cate JM, Duijsters PP (1982) Alternating demineralization and remineralization of artificial enamel lesions. Caries Res 16(3):201–210. CrossRefPubMedGoogle Scholar
  26. 26.
    Karlinsey RL, Mackey AC, Blanken DD, Schwandt CS (2012) Remineralization of eroded enamel lesions by simulated saliva in vitro. Open Dent J 6:170–176. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Karlinsey RL, Mackey AC, Walker TJ, Frederick KE, Blanken DD, Flaig SM, Walker ER (2011) In vitro remineralization of human and bovine white-spot enamel lesions by NaF dentifrices: a pilot study. J Dent Oral Hyg 3(2):22–29PubMedPubMedCentralGoogle Scholar
  28. 28.
    Mathew A, Reddy NV, Sugumaran DK, Peter J, Shameer M, Dauravu LM (2013) Acquired acid resistance of human enamel treated with laser (Er:YAG laser and Co2 laser) and acidulated phosphate fluoride treatment: an in vitro atomic emission spectrometry analysis. Contemp Clin Dent 4(2):170–175. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Santos DM Jr, Nogueira RD, Lepri CP, Goncalves LS, Palma-Dibb RG, Geraldo-Martins VR (2014) In vitro assessment of the acid resistance of demineralized enamel irradiated with Er, Cr:YSGG and Nd:YAG lasers. Pediatr Dent 36(7):137–142PubMedGoogle Scholar
  30. 30.
    de Freitas PM, Rapozo-Hilo M, Eduardo Cde P, Featherstone JD (2010) In vitro evaluation of erbium, chromium:yttrium-scandium-gallium-garnet laser-treated enamel demineralization. Lasers Med Sci 25(2):165–170. CrossRefPubMedGoogle Scholar
  31. 31.
    Tagomori S, Morioka T (1989) Combined effects of laser and fluoride on acid resistance of human dental enamel. Caries Res 23(4):225–231. CrossRefPubMedGoogle Scholar
  32. 32.
    Hossain MM, Hossain M, Kimura Y, Kinoshita J, Yamada Y, Matsumoto K (2002) Acquired acid resistance of enamel and dentin by CO2 laser irradiation with sodium fluoride solution. J Clin Laser Med Surg 20(2):77–82. CrossRefPubMedGoogle Scholar
  33. 33.
    Meurman JH, Hemmerle J, Voegel JC, Rauhamaa-Makinen R, Luomanen M (1997) Transformation of hydroxyapatite to fluorapatite by irradiation with high-energy CO2 laser. Caries Res 31(5):397–400. CrossRefPubMedGoogle Scholar
  34. 34.
    Ramos-Oliveira TM, Ramos TM, Esteves-Oliveira M, Apel C, Fischer H, Eduardo Cde P, Steagall W, Freitas PM (2014) Potential of CO2 lasers (10.6 microm) associated with fluorides in inhibiting human enamel erosion. Braz Oral Res 28:1–6CrossRefGoogle Scholar
  35. 35.
    Mohan AG, Ebenezar AV, Ghani MF, Martina L, Narayanan A, Mony B (2014) Surface and mineral changes of enamel with different remineralizing agents in conjunction with carbon-dioxide laser. Eur J Dent 8(1):118–123. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Esteves-Oliveira M, Pasaporti C, Heussen N, Eduardo CP, Lampert F, Apel C (2011) Rehardening of acid-softened enamel and prevention of enamel softening through CO2 laser irradiation. J Dent 39(6):414–421. CrossRefPubMedGoogle Scholar
  37. 37.
    de Oliveira RM, de Souza VM, Esteves CM, de Oliveira Lima-Arsati YB, Cassoni A, Rodrigues JA, Brugnera Junior A (2017) Er,Cr:YSGG laser energy delivery: pulse and power effects on enamel surface and erosive resistance. Photomed Laser Surg 35(11):639–646. CrossRefPubMedGoogle Scholar
  38. 38.
    Ramalho KM, Hsu CY, de Freitas PM, Aranha AC, Esteves-Oliveira M, Rocha RG, de Paula Eduardo C (2015) Erbium lasers for the prevention of enamel and dentin demineralization: a literature review. Photomed Laser Surg 33(6):301–319. CrossRefPubMedGoogle Scholar
  39. 39.
    Salehzadeh Esfahani K, Mazaheri R, Pishevar L (2015) Effects of treatment with various remineralizing agents on the microhardness of demineralized enamel surface. J Dent Res Dent Clin Dent Prospects 9(4):239–245. CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Topaloglu-Ak A, Eden E (2010) Caries in primary molars of 6-7-year-old Turkish children as risk indicators for future caries development in permanent molars. J Dent Sci 5(3):150–155. CrossRefGoogle Scholar
  41. 41.
    ter Pelkwijk A, van Palenstein Helderman WH, van Dijk JW (1990) Caries experience in the deciduous dentition as predictor for caries in the permanent dentition. Caries Res 24(1):65–71CrossRefGoogle Scholar
  42. 42.
    Helfenstein U, Steiner M, Marthaler TM (1991) Caries prediction on the basis of past caries including precavity lesions. Caries Res 25(5):372–376CrossRefGoogle Scholar
  43. 43.
    Bruszt P (1959) Relationship of caries incidence in deciduous and permanent dentitions. J Dent Res 38(2):416. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric Dentistry, School of DentistryHacettepe UniversityAnkaraTurkey
  2. 2.Hacettepe University Dental Laser Application and Research CenterAnkaraTurkey
  3. 3.School of Science, College of ScienceEngineering and Health RMIT UniversityMelbourneAustralia
  4. 4.Department of Restorative Dentistry, School of DentistryHacettepe UniversityAnkaraTurkey

Personalised recommendations