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Table of Contents   
ORIGINAL ARTICLE  
Year : 2016  |  Volume : 19  |  Issue : 2  |  Page : 175-178
Optimal power settings of aluminum gallium arsenide lasers in caries inhibition - An in vitro study


1 Department of Conservative Dentistry and Endodontics, Army Dental Centre (R&R), Delhi, India
2 Department of Conservative Dentistry and Endodontics, AB Shetty Memorial Institute of Dental Sciences, Nitte University, Mangaluru, Karnataka, India

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Date of Submission17-Nov-2015
Date of Decision05-Jan-2016
Date of Acceptance03-Feb-2016
Date of Web Publication14-Mar-2016
 

   Abstract 

Context: Incipient carious lesions are characterized by subsurface dissolution due to more fluoride ions in the 50-100 microns of the tooth's outer surface.
Aims: To determine an optimal power setting for 810 nm aluminum gallium arsenide laser for caries inhibition.
Materials and Methods: Fifty-four caries-free extracted teeth were sectioned mesiodistally. The samples were divided into 18 groups for each power setting being evaluated. Each group had six samples. The laser used is 810 nm aluminum gallium arsenide laser with power setting from 0.1 watts to 5 watts. Laser fluorescence based device was used to evaluate the effect of irradiation.
Statistical Analysis Used: Paired "t" test, one-way analysis of variance (ANOVA), Tukey's post hoc test, and the Pearson's correlation test.
Results: The paired t-test showed that there is minimum divergence from the control for 3.5 watts. Tukey's post hoc
test also showed statistically significantly results for 3.5 watts. The Pearson's correlation test showed that there was negative correlation between the watts and irradiation.
Conclusions: The power setting that gave statistically significant results was 3.5 watts.

Keywords: Aluminum gallium arsenide laser; caries inhibition; laser fluorescence

How to cite this article:
Sharma S, Hegde MN, Sadananda V, Mathews B. Optimal power settings of aluminum gallium arsenide lasers in caries inhibition - An in vitro study. J Conserv Dent 2016;19:175-8

How to cite this URL:
Sharma S, Hegde MN, Sadananda V, Mathews B. Optimal power settings of aluminum gallium arsenide lasers in caries inhibition - An in vitro study. J Conserv Dent [serial online] 2016 [cited 2019 Aug 25];19:175-8. Available from: http://www.jcd.org.in/text.asp?2016/19/2/175/178704

   Introduction Top


Dental caries is a dynamic progressive disease with varying phases of demineralization and remineralization. [1],[2] Enamel is not homogenous throughout its thickness. Hydroxyapatite crystals in outer 50-100 micron surface contain more fluoride, but below which there are more carbonate ions. So, whenever the oral conditions are conducive for demineralization, there is subsurface mineral loss and outer layer remains intact. Preventive management strategies are directed toward making the enamel more resistant toward acid dissolution. One such option is to explore the possibility of lasers in caries inhibition.

The first laser was developed by Maiman and since then initial lasers, such as CO 2 laser, have been experimented to improve acid resistance, followed by neodymium-doped yttrium aluminum garnet (Nd:YAG), erbium-doped yttrium aluminum garnet (Er:YAG), erbium, chromium-doped:yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) lasers. [3],[4] Currently, aluminum gallium arsenide laser has been shown to be an affordable and effective method for caries inhibition but the optimal power to bring about desired changes have not been explored. [4],[5],[6],[7]

Thus, this in vitro study was undertaken to determine the optimal power of aluminum gallium arsenide laser that brings upon the changes in enamel as evaluated by laser fluorescence method.

Aim

To evaluate the caries inhibitory potentiality of aluminum gallium arsenide laser at different power settings.

Objectives

To ascertain the power settings that bring about optimum caries inhibitory potentiality of aluminum gallium arsenide laser.


   Materials and methods Top


Material

  1. Laser fluorescence device (DIAGNOdent pen 2190 KaVo, Biberach, Germany).
  2. Aluminum gallium arsenide laser (Whitestar TM , Creation, Verona, Italy).
  3. Thirty-seven percent phosphoric acid gel (Total Etch™- Ivoclar Vivadent AG, Schaan/Liechtenstein).


Procedure

The laser included in the study was 810 nm aluminum gallium arsenide laser (Whitestar TM],[ Creation, Verona, Italy) with power setting of 0.1-5 watts. Fifty-four freshly extracted teeth that were caries free and without any structural defect were selected. They were sectioned mesiodistally, in order to obtain 108 samples and the tooth section was coated with nail varnish to obtain windows of 3 mm Χ 3 mm on facial surface, which aided in standardizing the sample's dimensions. The samples were divided into 18 groups for each power setting being evaluated. Each group had six samples. The power settings range of 0.1-5 watts was selected. For each sample, the preoperative value of the exposed tooth section was evaluated by laser fluorescence method (DIAGNOdent pen 2190 KaVo, Biberach, Germany) and this served as control. The tooth section was surface treated with 37% acid etchant gel (Total Etch™- Ivoclar Vivadent AG, Schaan/Liechtenstein) for 20 s. The laser fluorescence device's values were noted. Then, they were irradiated in a noncontact mode with biostimulation handpiece aluminum gallium arsenide laser of 810 nm wavelength for 30 s, and each group was individually evaluated for different power settings for example Group 1 was evaluated for 0.1 watts, and six samples were evaluated in that group. The power setting that were evaluated were 0.1 watts, 0.2 watts, 0.3 watts, 0.4 watts, 0.5 watts, 0.6 watts, 0.7 watts, 0.8 watts, 0.9 watts, 1 watts, 1.5 watts, 2 watts, 2.5 watts, 3 watts, 3.5 watts, 4 watts, 4.5 watts, and 5 watts. The biostimulation handpiece was held stationary in a noncontact mode at an angle of 90΀ to occlusal surface of the tooth, 2 mm away from occlusal surface, so that laser irradiation field covers the entire occlusal surface. After irradiation for 30 s, the laser fluorescence method reading was again noted. The results were tabulated and computed. The statistical analysis was done using one-way analysis of variance (ANOVA) testing, paired "t" test was used to compare the control and test groups, Tukey's post hoc test and Pearson's correlation test were used to compare the correlation between watts and irradiation.


   Results Top


Paired t-test was applied to compare whether divergence from control is significant or not. The inference drawn is if there is less divergence from the control those values of watts should be considered for the treatment. Thus, the best results seen are with 3.5 watts.

Tukey's post hoc test compares the means of every treatment to the means of every other treatment; that is, it applies simultaneously to the set of all pairwise comparisons. The inference drawn from the test are that values that are statistically significant and are computed, out of which 3.5 watts is the optimal watts followed by 2 watts, 2.5 watts, 5 watts, 3 watts, and 4.5 watts.

Graph 1: Comparison of the mean values of the three groups that is control, demineralization, and treatment by laser irradiation was done. The laser fluorescence method was used to evaluate and compare among the control group, demineralized group, and treated group. There is an increase in values from baseline that is control when the samples are demineralized. But on being treated by laser irradiation, the values decrease and are comparable to that of the corresponding control. [Additional file 1]

Graph 2: The graph shows a correlation between watts and laser fluorescence values of irradiated surface. The statistical test of correlation that is Pearson's parametric test was applied and inference drawn was that there is negative correlation between the watts and irradiation. If the watts was increased, the value of laser fluorescence method reading was closer to that of the control. The power settings that gave statistically significant results were at setting of 3.5 watts. [Additional file 2]


   Discussion Top


Moriyama et al. in an in vitro study evaluated the effectiveness of fluorescence-based methods and concluded that the laser fluorescence method was a more effective diagnostic tool to detect in situ demineralization and remineralization. [8] Bahrololoomi inferred that laser fluorescence is an effective method for detection of demineralization in an in vitro condition, but it was not so efficient in the detection of remineralization. [9] Based on the studies by Fung, [10] Patil, [11] and Vashisht, [12] who used laser fluorescence to assess remineralization, it was decided upon to use it too as an evaluator for watts selection in this study. The laser fluorescence method picks up fluorescence based on the porosity of the enamel surface. Laser irradiation changes the lattice arrangement and thus laser fluorescence method value decreases with laser irradiation.

The CO 2 laser was the first laser that showed reduced dissolution of enamel in acid. The hypothesized mechanisms of actions have ranged from reduced permeability of enamel to chemicals agents caused by melting of hydroxyapatite crystals to changed enamel crystal lattice orientation. [4],[5],[6],[7] Carounanidy has hypothesized that laser-activated fluoride method can enhance the remineralization potential by reducing the critical pH. [13] Boran TL, Powell compared different lasers, such as Er:YAG, Er:YSGG, Nd:YAG, diode, CO 2 , argon, and found that all lasers cause caries inhibition but the mechanism of action of each may differ. [14],[15] Currently, aluminum gallium arsenide laser is being investigated as an alternative to high-powered lasers. The hypothesized mechanism of action is that these wavelengths selectively target and remove carbonate ions from hydroxyapatite crystals that result in increasing acid resistance of enamel. [4],[5],[6],[7]

De Sant'anna and Vitale [16],[17] in their respective studies found the diode laser an effective caries inhibition device. All studies agreed upon the caries inhibitory role of lasers but none ascertained the parameters such as optimal watts to bring about the desired result. [3],[4],[16],[17]

In the current study, we correlated the effect of different watts on demineralized enamel. Graph 1 illustrates that there is a significant increase in the laser fluorescence method values in demineralized group from control when the means of all groups of samples are compared. The result indicates a statistically significant decrease of laser fluorescence method values in the treatment group that is irradiated by different watts. It can be inferred that when evaluated by laser fluorescence method there is an appreciable change for all the watts under study. Thus, our study is in agreement with the works of de Sant'anna et al[16] and Vitale et al[17] proving that diode lasers bring about a structural change that is corroborated by fall in values of laser fluorescence method that are closer to the values of the control.

We also found a negative correlation between the watts and the irradiation values as assessed by laser fluorescence method. The value that brings about the best results is 3.5 watts [Graph 2]. It can be deduced that between 2 watts and 3.5 watts, the changes in enamel are appreciable. None of the studies in past have established the optimal watts that leads to making the tooth more resistant to decay.

The least amount of deviation that is there from the control i.e. the closest the laser fluorescence value to that of the control, the more successful is the treatment. This has shown that 3.5 watts is the most optimal value as it has shown laser fluorescence values closest to the corresponding control. The results are statistically significant.


   Conclusion Top


Thus, it can be concluded that irradiation by 3.5 watts brings about the optimal desired changes in enamel that renders the tooth more acid resistant.

Acknowledgment

Mr. SS Tanwar was acknowledged for the statistical analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

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Fejerskov O, Nyvad B, Kidd E. Dental Caries: The Disease and its Clinical Management. 3 rd ed. Wiley Blackwell; 2015.p. 7-9  Back to cited text no. 1
    
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Featherstone JD. Dental caries: A dynamic disease process. Aust Dent J 2008;53:286-91.   Back to cited text no. 2
    
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Rajab M. Root caries prevention potential of chopped CO2 laser: An in vitro study. Almustansiria dental journal 2008;5:1-6.  Back to cited text no. 3
    
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Hossain M, Kimura Y, Nakamura Y, Yamada Y, Kinoshita JI, Matsumoto K. A study on acquired acid resistance of enamel and dentin irradiated by Er,Cr:YSGG laser. J Clin Laser Med Surg 2001;19:159-63.  Back to cited text no. 4
    
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Rodgrigues LKM, Freitas PM. Lasers in caries prevention. In: Freitas PM, Simões A. Lasers in Dentistry: Guide for Clinical Practice.1 st ed. Wiley Blackwell; 2015. p. 126-132  Back to cited text no. 5
    
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8.
Moriyama CM, Rodrigues JA, Lussi A, Diniz MB. Effectiveness of fluorescence-based methods to detect in situ demineralization and remineralization on smooth surfaces. Caries Res 2014;48:507-14.  Back to cited text no. 8
    
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Bahrololoomi Z, Musavi SA, Kabudan M. In vitro evaluation of the efficacy of laser fluorescence (DIAGNOdent) to detect demineralization and remineralization of smooth enamel lesions. J Conserv Dent 2013;16:362-6.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
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Fung L, Smales R, Ngo H, Mount G. Diagnostic comparison of three groups of examiners using visual and laser fluorescence methods to detect occlusal caries in vitro. Aust Dent J 2004;499:67-71; quiz 101.  Back to cited text no. 10
    
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Vashisht R, Indira R, Ramachandran S, Kumar A, Srinivasan MR. Role of casein phosphopeptide amorphous calcium phosphate in remineralization of white spot lesions and inhibition of Streptococcus mutans? J Conserv Dent 2013;16:342-6.  Back to cited text no. 11
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Boran TL, Zakariasen KL. Effect of Low-Level CO 2 Laser Radiation on the Inhibition of Smooth-Surface Caries - In-Vitro Study. Laser Surgery: Advanced Characterization, Therapeutics, and Systems II. Vol. 1200. Los Angeles, CA. Proc. SPIE; 1990. p. 403-9.   Back to cited text no. 14
    
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Lynn PG. Prevention of dental caries by laser irradiation: A review. J Oral Laser Appl 2006;6:255-7.   Back to cited text no. 15
    
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de Sant′anna GR, dos Santos EA, Soares LE, do Espírito Santo AM, Martin AA, Duarte DA, et al. Dental enamel irradiated with infrared diode laser and photo absorbing cream: Part 1 - FT-Raman study. Photomed Laser Surg 2009;27:499-507.  Back to cited text no. 16
    
17.
Vitale MC, Zaffe D, Botticell AR, Caprioglio C. Diode laser irradiation and fluoride uptake in human teeth. Eur Arch Paediatr Dent 2011;12:90-2.  Back to cited text no. 17
    

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Correspondence Address:
Sonali Sharma
482 Pocket E, Mayur Vihar Phase II, Delhi - 110 091
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0707.178704

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