Advertisement

Lasers in Dental Science

, Volume 1, Issue 1, pp 9–21 | Cite as

Review of possible predictors for pain perception with class 1–5 cavity preparations using Er,Cr:YSGG laser: a retrospective clinical in vivo study

  • Marina PolonskyEmail author
  • Norbert Gutknecht
  • Rene Franzen
Original Article
  • 576 Downloads

Abstract

Aim

The study recorded 400 responses from 301 patients, aged 6–93, who all had carious lesions prepared with the erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) 2780-nm laser system. Different parameters, including gender, delivery method, power settings, tooth position, class type of cavity preparation, and patients’ age, were compared and analyzed for possible predictive values in anticipating the patients’ pain experience.

Methods

Class 1–5 cavity preparations were made using the Er,Cr:YSGG laser. All carious lesions fit ICDAS code 4–5 classifications. Power setting of 3.75 W was used for posterior teeth class 1–4 preparations and 2.5 W for all primary teeth, permanent anterior teeth, and all class 5 preparations. Non-anxious patients, who agreed to start cavity preparation without a local anesthetic, were instructed to stop the procedure and ask for an anesthetic injection, should they perceive a level of pain greater than their tolerance level. Anxious patients were not included in this study. Pain perception using the visual analog scale (VAS) along with the percentage of patients who needed a local anesthesia injection were recorded. The data was then analyzed using one-way ANOVA test, at significance level of α = 0.05, and Tukey pair-wise comparison, at 95% confidence interval.

Results

Eighty-five percent of cavity preparations were pain free; 15% of the preparations were found to have a degree of pain associated with them. However, only 6% requested a local anesthetic injection. There was no significant difference found between the two methods of delivery: gold handpiece (HP) vs. turbo HP. No significant differences were observed between males and females, regarding pain perception (13% vs. 18%, respectively). Posterior teeth were significantly more sensitive to laser cavity preparation, compared to anterior teeth, as indicated by the VAS pain scores (P value = 0.0001). Regarding anterior teeth, class 5 was significantly more sensitive to laser cavity preparations, when compared to class 1. In posterior teeth, there were no statistically significant differences between class 1 and 5, although pain perception was the most prevalent in class 2 preparations. Using higher-power settings (3.75 W vs. 2.5 W) for cavity preparation, the resulting pain response was significantly higher, as indicated by the VAS pain scores (P value = 0.0001). As the patients’ age increases, the frequency of those experiencing pain decreases, with the exception of a sudden spike for the cohort aged 26–35, who proved to be the most sensitive to laser cavity preparation; this group was significantly different from all other age groups (P value = 0.0001).

Conclusions

The Er,Cr:YSGG laser system is an effective method for pain-free cavity preparations for 85% of the general patient population, who do not suffer from dental anxiety. Certain patient selection criteria, including age, power settings, and class type of cavity preparation, are important in achieving an overall positive and pain-free expedience.

Keywords

Pain perception Laser Er,Cr:YSGG Cavity preparation 

Notes

Acknowledgements

Biolase Technologies, Irvine, CA, USA, is acknowledged for providing the disposable MZ6 tips.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Fusayama T (1964) Improvement history of conservative dental method. In: Fusayama T (ed) Cavity preparation methods. Nagasue-Shoten, Tokyo, pp 11–15Google Scholar
  2. 2.
    Hmud R, Walsh LJ (2009) Dental anxiety: causes, complications and management approaches. J Minim Interv Dent 2(1):67–78Google Scholar
  3. 3.
    Leal SC, Matos de Menezes Abreu D, Frencken JE (2009) Dental anxiety and pain related to ART. J Appl Oral Sci 17(Suppl):84–88CrossRefPubMedGoogle Scholar
  4. 4.
    Van Wijk AJ, Hoogstratten J (2009) Anxiety and pain during dental injections. J Dent 37:700–704CrossRefPubMedGoogle Scholar
  5. 5.
    Quteish Taani DS (2002) Dental anxiety and regularity of dental attendance in younger adults. J Oral Rehabil 29:604–608CrossRefPubMedGoogle Scholar
  6. 6.
    Takamori K, Furukawa H, Morikawa Y et al (2003) Basic study on vibrations during tooth preparations caused by high-speed drilling and Er:YAG laser irradiation. Lasers Surg Med 32:25–31CrossRefPubMedGoogle Scholar
  7. 7.
    Kato J, Moriya K, Jayawardena JA, Wijeyeweera RL (2003) Clinical application of Er:YAG laser for cavity preparation in children. J Clin Laser Med Surg 21:151–155CrossRefPubMedGoogle Scholar
  8. 8.
    Liu JF, Lai YL, Shu WY, Lee SY (2006) Acceptance and efficiency of Er:YAG laser for cavity preparation in children. Photomed and Laser Surg 24:489–493CrossRefGoogle Scholar
  9. 9.
    Tanboga I, Eren F, Altinok B, Peker S, Ertugral F (2011) The effect of low level laser therapy on pain during dental tooth cavity preparation in children. Euro Archives of Paediatric Dentistry 12:93–95CrossRefGoogle Scholar
  10. 10.
    Cohen SM, Fiske J, Newton JT (2000) The impact of dental anxiety on daily living. Br Dent J 189:385–390PubMedGoogle Scholar
  11. 11.
    Cavalcanti B, Lage-Marques J, Rode S (2003) Pulpal temperature increases with Er:YAG laser and high-speed handpieces. J Prosthet Dent 90:447–451CrossRefPubMedGoogle Scholar
  12. 12.
    Glockner K, Rumpler J, Ebeleseder K, Stadtler P (1998) Intrapulpal temperature during preparation with the Er:YAG laser compared to the conventional burr: and in vitro study. J Clin Laser Med & Surg 16:153–157Google Scholar
  13. 13.
    Eversole LR, Rizoiu I, Kimmel AI (1997) Pulpal response to cavity preparation by an erbium, chromium: YSGG laser-powered hydrokinetic system. JADA 128:1099–1106PubMedGoogle Scholar
  14. 14.
    Rizoiu I, Kohanghadosh F, Mimmel AI, Eversole LR (1998) Pulpal thermal responses to an erbium, chromium:YSGG pulsed laser hydrokinetic system. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 86:220–222CrossRefGoogle Scholar
  15. 15.
    Fulop MA, Dhimmer S, Deluca JP et al (2010) A meta-analysis of the efficacy of laser phototherapy on pain relief. Clin J Pain 26:729–736PubMedGoogle Scholar
  16. 16.
    Olivi G, Genovese MD (2011) Laser restorative dentistry in children and adolescents. Eur Arch Paediatr Dent 12:68–78CrossRefPubMedGoogle Scholar
  17. 17.
    Matsumoto K, Hossain M, Hossain I, Kawano H, Kimura Y (2002a) Clinical assessment of Er,Cr:YSGG laser application for cavity preparation. J of Clin Laser Med & Surg 20:17–21CrossRefGoogle Scholar
  18. 18.
    Eren F, Altinok B, Ertugral F, Tanboga I (2013) The effect of Er,Cr:YSGG laser therapy on pain during cavity preparation in paediatric dental patients: a pilot study. OHDM 12:80–84PubMedGoogle Scholar
  19. 19.
    Shivakumar KM, Prasad S, Chandu GN (2009) International caries detection and assessment system: a new paradigm in detection of dental caries. J Conserv Dent 12(1):10–16CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Chen W (2011) The clinical applications for the ER,Cr:YSGG laser system. Chen Laser Institute, St. Louis, LAGoogle Scholar
  21. 21.
    Meister J, Franzen R, Forner K, Grebe H, Stanzel S, Lampert F, Apel C (2006) Influence of the water content in dental enamel and dentin on ablation in Er:YAG and Er:YSGG lasers. J Biomed Opt 11(3):34030CrossRefPubMedGoogle Scholar
  22. 22.
    Eberhard J, Eisenbeiss AK, Braun A, Hedderich J, Jepsen S (2005) Evaluation of selective caries removal by a fluorescence feedback-controlled Er:YAG laser in vitro. Caries Res 39(6):496–504CrossRefPubMedGoogle Scholar
  23. 23.
    Hossain M, Kimura Y, Nakamura Y et al (2001) A study on acquired acid resistance of enamel and dentin irradiated by Er,Cr:YSGG laser. J Clin Laser Med Surg 19:159–163CrossRefPubMedGoogle Scholar
  24. 24.
    Colucci V, DeSouza Gabriel AE, Scatolin RS, Serra MC, Corona SAM (2015) Effect of Er:YAG laser on enamel demineralization around restorations. Lasers Med Sci 30:1175–1181CrossRefPubMedGoogle Scholar
  25. 25.
    Chou JC, Chen CC, Ding SJ (2009) Effect of Er,Cr:YSGG laser parameters on shear bond strength and microstructure of dentin. Photomed Laser Surg 27(3):481–486CrossRefPubMedGoogle Scholar
  26. 26.
    Navimipour EJ, Oskoee SS et al (2012) Effects of laser and acid etching on shear bond strength on conventional and resin modified glass-ionomer cements to composite resin. Lasers Med Sci 27:305–311CrossRefPubMedGoogle Scholar
  27. 27.
    Muhammed G, Dayem R (2015) Evaluation of the microleakage of different class V cavities prepared by using Er:YAG laser, ultrasonic device and conventional rotary instruments with two dentin bonding systems (an in vitro study). Laser Med Sci 30:969–975CrossRefGoogle Scholar
  28. 28.
    Franzen R, Esteves-Oliveira M, Meister J, Wallerang A, Vanweersch L, Lampert F, Gutknecht N (2009) Decontamination of deep dentin by means of Er,Cr:YSGG laser irradiation. Lasers Med Sci 24(1):75–80CrossRefPubMedGoogle Scholar
  29. 29.
    Matsumoto K (1994) Tooth pain control by laser. International Congress on Laser in Dentistry, Singapore, pp 287–292Google Scholar
  30. 30.
    Keller U, Hibst R, Geurtsen W, Schilke R, Heidemann D, Klaiber B, Raab W (1998) Erbium:YAG laser application in caries therapy. Evaluation of patient perception and acceptance. J Dent 26:649–656CrossRefPubMedGoogle Scholar
  31. 31.
    Matsumoto K, Hossain M, Hossain I, Kawano H, Kimura Y (2002b) Clinical assessment of Er,Cr:YSGG laser application for cavity preparation. J of Clin Med and Laser Surg 20(1):17–21CrossRefGoogle Scholar
  32. 32.
    Poli R, Parker S (2015) Achieving dental analgesia with the Er,Cr:YSGG laser (2780 nm): a protocol for painless conservative treatment. Photomed Laser Surg 33:364–371CrossRefPubMedGoogle Scholar
  33. 33.
    Stouthard M, Hoogstraten J (1990) Prevalence of dental anxiety in the Netherlands. Community Dent Oral Epidemiol 18:139–142CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  1. 1.Alta Vista Laser Dental CentreOttawaCanada
  2. 2.Department of Operative Dentistry Periodontology and Pediatric DentistryAachenGermany
  3. 3.Aachen Dental Laser CenterAachenGermany
  4. 4.Postgraduate Education and ResearchAachenGermany
  5. 5.AALZ GmbH-Aachen Dental Laser Center, Zentrum für Bio-Medizintechnik, RWTH Aachen Campus-Campus MelatenAachenGermany

Personalised recommendations