To demonstrate that Caries Management by Risk Assessment (CAMBRA) can be successfully
implemented in dental practice, 30 dentists were recruited to perform a 2-y CAMBRA trial.
Twenty-one dentists (18 ...private practices, 3 community clinics) participated in a
randomized, controlled, parallel-arm, double-blind clinical trial with individual-level
assignment of 460 participants to standard of care (control) versus active CAMBRA
treatment (intervention). Control or active antimicrobial and remineralizing agents were
dispensed at baseline and 6-, 12-, 18-, and 24-mo recall visits according to risk level
and assigned treatment arm. Primary outcome measure was dentist-determined caries risk
level at recall. Among initially high-risk participants, secondary outcomes were recorded
disease indicators. Generalized estimating equations were used to fit log-linear models
for each outcome while accounting for repeated measurements. At 24 mo, follow-up rates
were 34.3% for high-risk participants (32.1% intervention, 37.1% control) and 44.2% for
low-risk participants (38.7% intervention, 49.5% control). Among 242 participants
classified as high caries risk at baseline (137 intervention, 105 control), a lower
percentage of participants remained at high risk in the intervention group (statistically
significant at all time points). At 24 mo, 25% in the intervention group and 54% in the
control group remained at high risk (P = 0.003). Among 192 participants
initially classified as low risk (93 intervention, 99 control), most participants remained
at low risk. At 24 mo, 89% in the intervention group and 71% in the control group were low
caries risk (P = 0.18). The percentage of initially high-risk
participants with recorded disease indicators decreased over time in both intervention and
control groups, being always lower for the intervention group (statistically significant
at the 12- and 18-mo time point). In this practice-based clinical trial, a significantly
greater percentage of high-caries-risk participants were classified at a lower risk level
after CAMBRA preventive therapies were provided. Most participants initially assessed at
low caries risk stayed at low risk (ClinicalTrials.gov NCT01176396).
The objective of this proof-of-principle laboratory pilot study was to evaluate the temperature increase in the pulp chamber in a worst case scenario during Er:YAG laser debonding of all-ceramic ...crowns. Twenty extracted molars were prepared to receive all-ceramic IPS E.max CAD full contour crowns. The crowns were bonded to the teeth with Ivoclar Multilink Automix. Times for laser debonding and temperature rise in the pulp chamber using micro-thermocouples were measured. The Er:YAG was used with 560 mJ/pulse. The irradiation was applied at a distance of 5 mm from the crown surface. Additional air–water spray for cooling was utilized. Each all-ceramic crown was successfully laser debonded with an average debonding time of 135 ± 35 s. No crown fractured, and no damage to the underlying dentin was detected. The bonding cement deteriorated, but no carbonization at the dentin/cement interface occurred. The temperature rise in the pulp chamber averaged 5.4° ± 2.2 °C. During 8 out of the 20 crown removals, the temperature rise exceeded 5.5 °C, lasting 5 to 43 s (average 18.8 ± 11.6 s). A temperature rise of 11.5 °C occurred only once, while seven times the temperature rise was limited to 6.8 ± 0.5 °C. Temperature rises above 5.5 °C occurred only when the laser was applied from one side and additional cooling from the side opposite the irradiation. Er:YAG laser energy can successfully be used to efficiently debond all-ceramic crowns from natural teeth. Temperature rises exceeding 5.5 °C only occur when an additional air/water cooling from a dental syringe is inaccurately directed. To avoid possible thermal damage and to allow further heat diffusion, clinically temperature-reduced water might be applied.
The objective of this in vitro study was to evaluate whether irradiation of enamel with a novel CO
2
9.3-μm short-pulsed laser using energies that enhance caries resistance influences the shear bond ...strength of composite resin sealants to the irradiated enamel. Seventy bovine and 240 human enamel samples were irradiated with a 9.3-μm carbon dioxide laser (Solea, Convergent Dental, Inc., Natick, MA) with four different laser energies known to enhance caries resistance or ablate enamel (pulse duration from 3 μs at 1.6 mJ/pulse to 43 μs at 14.9 mJ/pulse with fluences between 3.3 and 30.4 J/cm
2
, pulse repetition rate between 4.1 and 41.3 Hz, beam diameter of 0.25 mm and 1-mm spiral pattern, and focus distance of 4–15 mm). Irradiation was performed “freehand” or using a computerized, motor-driven stage. Enamel etching was achieved with 37% phosphoric acid (Scotchbond Universal etchant, 3M ESPE, St. Paul, MN). As bonding agent, Adper Single Bond Plus was used followed by placing Z250 Filtek Supreme flowable composite resin (both 3M ESPE). After 24 h water storage, a single-plane shear bond test was performed (UltraTester, Ultradent Products, Inc., South Jordan, UT). All laser-irradiated samples showed equal or higher bond strength than non-laser-treated controls. The highest shear bond strength values were observed with the 3-μs pulse duration/0.25-mm laser pattern (mean ± SD = 31.90 ± 2.50 MPa), representing a significant 27.4% bond strength increase over the controls (25.04 ± 2.80 MPa,
P
≤ 0.0001). Two other caries-preventive irradiation (3 μs/1 mm and 7 μs/0.25 mm) and one ablative pattern (23 μs/0.25 mm) achieved significantly increased bond strength compared to the controls. Bovine enamel also showed in all test groups increased shear bond strength over the controls. Computerized motor-driven stage irradiation did not show superior bond strength values over the clinically more relevant freehand irradiation. Enamel that is made caries-resistant with CO
2
9.3-μm short-pulsed laser irradiation showed at least equal or significantly higher shear bond strength to pit and fissure sealants than non-laser-irradiated enamel. The risk of a sealant failure due to CO
2
9.3-μm short-pulsed laser irradiation appears reduced. If additional laser ablation is required before placing a sealant, the CO
2
9.3-μm enamel laser-cut showed equivalent or superior bond strength to a flowable sealant.
The aim of this in vitro study was to evaluate the protective effect of short-pulsed CO
2
9.3 μm laser irradiation against erosion in human enamel without and combined with TiF
4
and AmF/NaF/SnCl
2
...applications, respectively, as well as compared to the protective effect of these fluoride treatments alone. After polishing, ninety enamel samples (3 × 3mm) were used for 9 different treatment groups: 4% TiF
4
gel (pH 1.5, 24,533 ppm F
−
); AmF/NaF/SnCl
2
rinse (pH 4.5; 500 ppm F
−
, 800 ppm Sn
2
); CO
2
laser (average power 0.58 W); CO
2
laser (0.58 W) + TiF
4
; CO
2
laser (0.58 W) + AmF/NaF/SnCl
2
; CO
2
laser (0.69 W); CO
2
laser (0.69 W) + TiF
4
; CO
2
laser (0.69 W) + AmF/NaF/SnCl
2
; negative control (deionized water). TiF
4
gel was brushed on only once before the first erosive cycling, while samples treated with AmF/NaF/SnCl
2
were daily immersed in 5 ml of the solution before cycling. Laser treatment occurred with a CO
2
laser (wavelength 9.3 μm, pulse repetition rate 100 Hz, pulse duration 14.6 μs/18 μs, average power 0.58 W/0.69 W, fluence 1.9 J/cm
2
/2.2 J/cm
2
, beam diameter 0.63 mm, irradiation time 10 s, air cooling). TiF
4
was applied only once, while AmF/NaF/SnCl
2
was applied once daily before the erosive challenge. Surface loss (in μm) was measured with optical profilometry immediately after treatment, and after 5 and 10 days of erosive cycling (0.5% citric acid, pH 2.3, 6 × 2 min/day). Additionally, scanning electron microscopy investigations were performed. All application measures resulted in loss of surface height immediately after treatment. After 5 days, significantly reduced surface loss was observed after applying laser irradiation (both power settings) followed by applications of TiF
4
or AmF/NaF/SnCl
2
solution (
p
< 0.05; 2-way ANOVA and Tukey test) compared to fluoride application alone. After 10 days, compared to after 5 days, a reduced tissue loss was observed in all groups treated with AmF/NaF/SnCl
2
solution. This tissue gain occurred with the AmF/NaF/SnCl
2
application alone and was significantly higher when the application was combined with the laser use (
p
< 0.05). Short-pulsed CO
2
9.3 μm laser irradiation followed by additional application of AmF/NaF/SnCl
2
solution significantly reduces the progression of dental enamel erosion in vitro.
Preservation of natural tooth structure requires early detection of the carious lesion and is associated with comprehensive patient dental care. Processes aiming to detect carious lesions in the ...initial stage with optimum efficiency employ a variety of technologies such as magnifying loupes, transillumination, light and laser fluorescence (QLF® and DIAGNOdent®) and autofluorescence (Soprolife® and VistaCam®), electric current/impedance (CarieScan®), tomographic imaging and image processing. Most fluorescent caries detection tools can discriminate between healthy and carious dental tissue, demonstrating different levels of sensitivity and specificity. Based on the fluorescence principle, an LED camera (Soprolife®) was developed (Sopro‐Acteon, La Ciotat, France) which combined magnification, fluorescence, picture acquisition and an innovative therapeutic concept called light‐induced fluorescence evaluator for diagnosis and treatment (LIFEDT). This article is rounded off by a Soprolife® illustration about minimally or even non‐invasive dental techniques, distinguishing those that preserve or reinforce the enamel and enamel‐dentine structures without any preparation (MIT1– minimally invasive therapy 1) from those that require minimum preparation of the dental tissues (MIT2 – minimally invasive therapy 2) using several clinical cases as examples. MIT1 encompasses all the dental techniques aimed at disinfection, remineralizing, reversing and sealing the caries process and MIT2 involves a series of specific tools, including microburs, air abrasion devices, sonic and ultrasonic inserts and photo‐activated disinfection to achieve minimal preparation of the tooth. With respect to minimally invasive treatment and prevention, the use of lasers is discussed. Furthermore, while most practices operate under a surgical model, Caries Management by Risk Assessment (CaMBRA) encourages a medical model of disease prevention and management to control the manifestation of the disease, or keep the oral environment in a state of balance between pathological and preventive factors. Early detection and diagnosis and prediction of lesion activity are of great interest and may change traditional operative procedures substantially. Fluorescence tools with high levels of magnification and observational capacity should guide clinicians towards a more preventive and minimally invasive treatment strategy.
The objective of this in vitro study was to evaluate whether irradiation of enamel with a novel CO sub(2) 9.3- mu m short-pulsed laser using energies that enhance caries resistance influences the ...shear bond strength of composite resin sealants to the irradiated enamel. Seventy bovine and 240 human enamel samples were irradiated with a 9.3- mu m carbon dioxide laser (Solea, Convergent Dental, Inc., Natick, MA) with four different laser energies known to enhance caries resistance or ablate enamel (pulse duration from 3 mu s at 1.6 mJ/pulse to 43 mu s at 14.9 mJ/pulse with fluences between 3.3 and 30.4 J/cm super(2), pulse repetition rate between 4.1 and 41.3 Hz, beam diameter of 0.25 mm and 1-mm spiral pattern, and focus distance of 4-15 mm). Irradiation was performed "freehand" or using a computerized, motor-driven stage. Enamel etching was achieved with 37% phosphoric acid (Scotchbond Universal etchant, 3M ESPE, St. Paul, MN). As bonding agent, Adper Single Bond Plus was used followed by placing Z250 Filtek Supreme flowable composite resin (both 3M ESPE). After 24 h water storage, a single-plane shear bond test was performed (UltraTester, Ultradent Products, Inc., South Jordan, UT). All laser-irradiated samples showed equal or higher bond strength than non-laser-treated controls. The highest shear bond strength values were observed with the 3- mu s pulse duration/0.25-mm laser pattern (mean plus or minus SD=31.90 plus or minus 2.50 MPa), representing a significant 27.4% bond strength increase over the controls (25.04 plus or minus 2.80 MPa, P less than or equal to 0.0001). Two other caries-preventive irradiation (3 mu s/1 mm and 7 mu s/0.25 mm) and one ablative pattern (23 mu s/0.25 mm) achieved significantly increased bond strength compared to the controls. Bovine enamel also showed in all test groups increased shear bond strength over the controls. Computerized motor-driven stage irradiation did not show superior bond strength values over the clinically more relevant freehand irradiation. Enamel that is made caries-resistant with CO sub(2) 9.3- mu m short-pulsed laser irradiation showed at least equal or significantly higher shear bond strength to pit and fissure sealants than non-laser-irradiated enamel. The risk of a sealant failure due to CO sub(2) 9.3- mu m short-pulsed laser irradiation appears reduced. If additional laser ablation is required before placing a sealant, the CO sub(2) 9.3- mu m enamel laser-cut showed equivalent or superior bond strength to a flowable sealant.
The objective of this in vitro study was to evaluate whether irradiation of enamel with a novel CO2 9.3-mum short-pulsed laser using energies that enhance caries resistance influences the shear bond ...strength of composite resin sealants to the irradiated enamel. Seventy bovine and 240 human enamel samples were irradiated with a 9.3-mum carbon dioxide laser (Solea, Convergent Dental, Inc., Natick, MA) with four different laser energies known to enhance caries resistance or ablate enamel (pulse duration from 3 mus at 1.6 mJ/pulse to 43 mus at 14.9 mJ/pulse with fluences between 3.3 and 30.4 J/cm2, pulse repetition rate between 4.1 and 41.3 Hz, beam diameter of 0.25 mm and 1-mm spiral pattern, and focus distance of 4-15 mm). Irradiation was performed "freehand" or using a computerized, motor-driven stage. Enamel etching was achieved with 37% phosphoric acid (Scotchbond Universal etchant, 3M ESPE, St. Paul, MN). As bonding agent, Adper Single Bond Plus was used followed by placing Z250 Filtek Supreme flowable composite resin (both 3M ESPE). After 24 h water storage, a single-plane shear bond test was performed (UltraTester, Ultradent Products, Inc., South Jordan, UT). All laser-irradiated samples showed equal or higher bond strength than non-laser-treated controls. The highest shear bond strength values were observed with the 3-mus pulse duration/0.25-mm laser pattern (mean±SD=31.90±2.50 MPa), representing a significant 27.4% bond strength increase over the controls (25.04±2.80 MPa, Pless than or equal to0.0001). Two other caries-preventive irradiation (3 mus/1 mm and 7 mus/0.25 mm) and one ablative pattern (23 mus/0.25 mm) achieved significantly increased bond strength compared to the controls. Bovine enamel also showed in all test groups increased shear bond strength over the controls. Computerized motor-driven stage irradiation did not show superior bond strength values over the clinically more relevant freehand irradiation. Enamel that is made caries-resistant with CO2 9.3-mum short-pulsed laser irradiation showed at least equal or significantly higher shear bond strength to pit and fissure sealants than non-laser-irradiated enamel. The risk of a sealant failure due to CO2 9.3-mum short-pulsed laser irradiation appears reduced. If additional laser ablation is required before placing a sealant, the CO2 9.3-mum enamel laser-cut showed equivalent or superior bond strength to a flowable sealant.
The aim of this in vitro study was to evaluate the protective effect of short-pulsed CO
9.3 μm laser irradiation against erosion in human enamel without and combined with TiF
and AmF/NaF/SnCl
...applications, respectively, as well as compared to the protective effect of these fluoride treatments alone. After polishing, ninety enamel samples (3 × 3mm) were used for 9 different treatment groups: 4% TiF
gel (pH 1.5, 24,533 ppm F
); AmF/NaF/SnCl
rinse (pH 4.5; 500 ppm F
, 800 ppm Sn
); CO
laser (average power 0.58 W); CO
laser (0.58 W) + TiF
; CO
laser (0.58 W) + AmF/NaF/SnCl
; CO
laser (0.69 W); CO
laser (0.69 W) + TiF
; CO
laser (0.69 W) + AmF/NaF/SnCl
; negative control (deionized water). TiF
gel was brushed on only once before the first erosive cycling, while samples treated with AmF/NaF/SnCl
were daily immersed in 5 ml of the solution before cycling. Laser treatment occurred with a CO
laser (wavelength 9.3 μm, pulse repetition rate 100 Hz, pulse duration 14.6 μs/18 μs, average power 0.58 W/0.69 W, fluence 1.9 J/cm
/2.2 J/cm
, beam diameter 0.63 mm, irradiation time 10 s, air cooling). TiF
was applied only once, while AmF/NaF/SnCl
was applied once daily before the erosive challenge. Surface loss (in μm) was measured with optical profilometry immediately after treatment, and after 5 and 10 days of erosive cycling (0.5% citric acid, pH 2.3, 6 × 2 min/day). Additionally, scanning electron microscopy investigations were performed. All application measures resulted in loss of surface height immediately after treatment. After 5 days, significantly reduced surface loss was observed after applying laser irradiation (both power settings) followed by applications of TiF
or AmF/NaF/SnCl
solution (p < 0.05; 2-way ANOVA and Tukey test) compared to fluoride application alone. After 10 days, compared to after 5 days, a reduced tissue loss was observed in all groups treated with AmF/NaF/SnCl
solution. This tissue gain occurred with the AmF/NaF/SnCl
application alone and was significantly higher when the application was combined with the laser use (p < 0.05). Short-pulsed CO
9.3 μm laser irradiation followed by additional application of AmF/NaF/SnCl
solution significantly reduces the progression of dental enamel erosion in vitro.
The objective of this in vitro study was to evaluate whether irradiation of enamel with a novel CO
9.3-μm short-pulsed laser using energies that enhance caries resistance influences the shear bond ...strength of composite resin sealants to the irradiated enamel. Seventy bovine and 240 human enamel samples were irradiated with a 9.3-μm carbon dioxide laser (Solea, Convergent Dental, Inc., Natick, MA) with four different laser energies known to enhance caries resistance or ablate enamel (pulse duration from 3 μs at 1.6 mJ/pulse to 43 μs at 14.9 mJ/pulse with fluences between 3.3 and 30.4 J/cm
, pulse repetition rate between 4.1 and 41.3 Hz, beam diameter of 0.25 mm and 1-mm spiral pattern, and focus distance of 4-15 mm). Irradiation was performed "freehand" or using a computerized, motor-driven stage. Enamel etching was achieved with 37% phosphoric acid (Scotchbond Universal etchant, 3M ESPE, St. Paul, MN). As bonding agent, Adper Single Bond Plus was used followed by placing Z250 Filtek Supreme flowable composite resin (both 3M ESPE). After 24 h water storage, a single-plane shear bond test was performed (UltraTester, Ultradent Products, Inc., South Jordan, UT). All laser-irradiated samples showed equal or higher bond strength than non-laser-treated controls. The highest shear bond strength values were observed with the 3-μs pulse duration/0.25-mm laser pattern (mean ± SD = 31.90 ± 2.50 MPa), representing a significant 27.4% bond strength increase over the controls (25.04 ± 2.80 MPa, P ≤ 0.0001). Two other caries-preventive irradiation (3 μs/1 mm and 7 μs/0.25 mm) and one ablative pattern (23 μs/0.25 mm) achieved significantly increased bond strength compared to the controls. Bovine enamel also showed in all test groups increased shear bond strength over the controls. Computerized motor-driven stage irradiation did not show superior bond strength values over the clinically more relevant freehand irradiation. Enamel that is made caries-resistant with CO
9.3-μm short-pulsed laser irradiation showed at least equal or significantly higher shear bond strength to pit and fissure sealants than non-laser-irradiated enamel. The risk of a sealant failure due to CO
9.3-μm short-pulsed laser irradiation appears reduced. If additional laser ablation is required before placing a sealant, the CO
9.3-μm enamel laser-cut showed equivalent or superior bond strength to a flowable sealant.
PDF
