Evaluation of dental hard tissues irradiated with ultra-short pulsed lasers : influence on surface morphology and microtensile bond strength

摘要

The advance of restorative dentistry has landed in the era of esthetic adhesive restorations and minimally invasive approach, for which innovative techniques and advanced materials are constantly introduced. Conservative techniques aim not only to remove carious dental substrate, but also to prepare cavity surfaces for adhesive restoration. The main objective of this study was to evaluate the possibility of introducing ultra-short pulsed lasers in Restorative Dentistry, in attempt to fulfill the basic requirements of adequate conservative restoration, by maintaining the well-known benefits of lasers for caries removal, but also overcoming disadvantages related to current laser sources available for this purpose, such as temperature increase and damaged adhesion to resin composite. In order to better evaluate the interaction between ultra-short pulsed lasers and dental substrates, experimental procedures were divided in three phases. Phase 1 aimed to evaluate the effect of different wavelengths (355 nm, 532 nm, 104 nm, and 1064 nm), pulse durations (pico and femtoseconds) and irradiation protocols (surface scanning speed, sample thickness, cooling method, pulse repetition rate) on enamel and dentin. For Phase 2, laser parameters with most favorable results in Phase 1 were evaluated to relate temperature increase to ablation rate or ablation efficiency. Phase 3 aimed to analyze adhesive interface and microtensile bond strength to dentin irradiated with the selected parameters by using etch-and-rinse and self-etch adhesive systems with different bonding protocols (Clearfil SE Bond with and without Primer, Adper Single Bond with and without acid etching). The results of Phase 1 indicate that dentin and enamel irradiated with 1045-nm fs-laser and 1064-nm ps-laser present a rough surface without carbonization. Irradiation should be conducted with higher scanning speed, and no additional cooling during irradiation was necessary. All parameters provided selective tissue ablation, with higher ablations rate for dentin than enamel. Phase 2 indicated that all parameters tested provoked temperature increase of up to 6.1ºC for enamel and 4.6ºC for dentin, when temperature increase was measured at the back side of 1-mm thick samples without cooling during irradiation, except for higher power for ps-laser, for which temperature increased up to 12ºC for enamel and 15ºC for dentin. Microtensile bond strength values varied according to laser parameters and adhesive systems used. Adhesion to dentin irradiated with ultra-short pulsed lasers resulted in similar or significantly higher bond strength values than control groups, for all laser parameters analyzed. Based on the results of this study, ultra-short pulsed lasers presented favorable results for cavity preparation in dentin and enamel regarding surface morphology and temperature increase. Adhesion to irradiated dentin was either similar or superior to traditional techniques. Thus, ultra-short pulsed lasers are considered a promising technique for the promotion of laser-supported minimally invasive approach.