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      Removal of Composite Restoration from the Root Surface in the Cervical Region Using Er: YAG Laser and Drill—In Vitro Study

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          Abstract

          Background: Recently, the defects of the tooth surface in the cervical region are often restored using composite filling materials. It should meet the needs of the patients regarding esthetics and material stability. The aim of the study was to analyze the tooth root surface at the cervical region after the removal of the composite filling material by means of the Erbium-doped Yttrium Aluminium Garnet (Er: YAG) laser or drill using the scanning electron microscopy (SEM) and fluorescence microscopy. Materials and Methods: For the purposes of this study, 14 premolar teeth ( n = 14) were removed due to orthodontic reasons. The rectangular shape cavities with 3 mm in width and 1.5 mm in height were prepared with a 0.8 mm bur on high-speed contra-angle in the tooth surface just below cemento-enamel junction (CEJ) and filled with the composite material. The composite material was removed with the Er: YAG laser at a power of 3.4 W, energy 170 mJ, frequency 20 Hz, pulse duration 300 μs, tip diameter 0.8 mm, air/fluid cooling 3 mL/s, and time of irradiation: 6 sec, at a distance from teeth of 2 mm (G1 group, n = 7) or a high-speed contra-angle bur (G2 group, n = 7). After the removal of composite material, the surfaces of teeth were examined using the scanning electron microscopy (SEM) and fluorescence microscopy. Results: The Er: YAG irradiation allowed to remove completely the composite material from the tooth cavity. The study confirmed, that the ends of collagen fibers were only partially denatured after the Er: YAG laser application. Conclusion: It has been proved that using the Er: YAG laser is an effective and safe method of composite removal for the dentin surface.

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          Pulp response to externally applied heat

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            Dentin bonding-variables related to the clinical situation and the substrate treatment.

            The wetness of dentin surfaces, the presence of pulpal pressure, and the thickness of dentin are extremely important variables during bonding procedures, especially when testing bond strength of adhesive materials in vitro with the intention of simulating in vivo conditions. The ultimate goal of a bonded restoration is to attain an intimate adaptation of the restorative material with the dental substrate. This task is difficult to achieve as the bonding process is different for enamel and for dentin-dentin is more humid and more organic than enamel. While enamel is predominantly mineral, dentin contains a significant amount of water and organic material, mainly type I collagen. This humid and organic nature of dentin makes this hard tissue very challenging to bond to. Several other substrate-related variables may affect the clinical outcome of bonded restorations. Bonding to caries-affected dentin is hampered by its lower hardness and presence of mineral deposits in the tubules. Non-carious cervical areas contain hypermineralized dentin and denatured collagen, which is not the ideal combination for a bonding substrate. Physiological transparent root dentin forms without trauma or caries lesion as a natural part of aging. Similar to the transparent dentin observed underneath caries lesions, the tubule lumina become filled with mineral from passive chemical precipitation, making resin hybridization difficult. An increase in number of tubules with depth and, consequently, increase in dentin wetness, make bonding to deeper dentin more difficult than to superficial dentin. While the application of acidic agents open the pathway for the diffusion of monomers into the collagen network, it also facilitates the outward seepage of tubular fluid from the pulp to the dentin surface, deteriorating the bonding for some of the current adhesives. Some dentin desensitizers have shown some promise as they can block dentinal tubules to treat and prevent sensitivity and simultaneously blocking the tubular fluid from flowing to the surface. A new approach to stop the degradation of dentin-resin interfaces is the use of MMP inhibitors. Although still in an early phase of in vitro and clinical research, this method is promising. Copyright 2009 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
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              The current status of laser applications in dentistry.

              A range of lasers is now available for use in dentistry. This paper summarizes key current and emerging applications for lasers in clinical practice. A major diagnostic application of low power lasers is the detection of caries, using fluorescence elicited from hydroxyapatite or from bacterial by-products. Laser fluorescence is an effective method for detecting and quantifying incipient occlusal and cervical carious lesions, and with further refinement could be used in the same manner for proximal lesions. Photoactivated dye techniques have been developed which use low power lasers to elicit a photochemical reaction. Photoactivated dye techniques can be used to disinfect root canals, periodontal pockets, cavity preparations and sites of peri-implantitis. Using similar principles, more powerful lasers can be used for photodynamic therapy in the treatment of malignancies of the oral mucosa. Laser-driven photochemical reactions can also be used for tooth whitening. In combination with fluoride, laser irradiation can improve the resistance of tooth structure to demineralization, and this application is of particular benefit for susceptible sites in high caries risk patients. Laser technology for caries removal, cavity preparation and soft tissue surgery is at a high state of refinement, having had several decades of development up to the present time. Used in conjunction with or as a replacement for traditional methods, it is expected that specific laser technologies will become an essential component of contemporary dental practice over the next decade.
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                Author and article information

                Journal
                Materials (Basel)
                Materials (Basel)
                materials
                Materials
                MDPI
                1996-1944
                07 July 2020
                July 2020
                : 13
                : 13
                : 3027
                Affiliations
                [1 ]Department of Experimental Surgery and Biomaterial Research, Wroclaw Medical University, Bujwida 44, 50-345 Wroclaw, Poland; wojciech.zakrzewski@ 123456student.umed.wroc.pl (W.Z.); zbigniew.rybak@ 123456umed.wroc.pl (Z.R.)
                [2 ]Department of Conservative Dentistry and Pedodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland; maciej.dobrzynski@ 123456umed.wroc.pl
                [3 ]Department of Histology and Embriology, Wroclaw University of Environmental and Life Sciences, Norwida 31, 50-375 Wroclaw, Poland; piotr.kuropka@ 123456upwr.edu.pl
                [4 ]Laser Laboratory at Dental Surgery Department, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland; jacek.matys@ 123456wp.pl
                [5 ]Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422 Wroclaw, Poland; m.malecka@ 123456intibs.pl
                [6 ]Dental Surgery Department, Medical University of Wroclaw, 50-425 Wroclaw, Poland; jan.kiryk@ 123456umed.wroc.pl (J.K.); marzena.dominiak@ 123456wp.pl (M.D.); kinga.grzech-lesniak@ 123456umed.wroc.pl (K.G.-L.)
                [7 ]Faculty of Pharmacy, Wroclaw Medical University, Borowska 211 A, 50-566 Wroclaw, Poland; katarzyna.wiglusz@ 123456umed.wroc.pl
                Author notes
                [* ]Correspondence: r.wiglusz@ 123456intibs.pl ; Tel.: +48-71-3954-159; Fax: +48-71-344-10-29
                Author information
                https://orcid.org/0000-0003-2368-1534
                https://orcid.org/0000-0002-0682-4743
                https://orcid.org/0000-0002-3801-0218
                https://orcid.org/0000-0002-8988-1515
                https://orcid.org/0000-0001-8943-0549
                https://orcid.org/0000-0002-5700-4577
                https://orcid.org/0000-0001-8458-1532
                Article
                materials-13-03027
                10.3390/ma13133027
                7372447
                32645864
                ce7ecf6b-dc9a-428d-9249-8edc1b7d1b87
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 20 May 2020
                : 03 July 2020
                Categories
                Article

                cervical root surface,er: yag laser,laser ablation,smear layer,vaporization

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