Effect of Laser and Fluoride Gel Application on Microroughness of Permanent Teeth

Amer N; Toema S; Mekled S

Research Article

Austin J Dent. 2024; 11(1): 1181.

Effect of Laser and Fluoride Gel Application on Microroughness of Permanent Teeth

Amer N¹; Toema S²; Mekled S³*

¹Research Center, Cairo University, Egypt

²Deartment of Pediatric, Temple University, USA

³Department of Restorative, Temple University, USA

*Corresponding author: Mekled S Department of Restorative, Temple University, 3223 N Broad St, Philadelphia, PA 19140, USA. Email: Salwa.Mekled@temple.edu

Received: May 28, 2024 Accepted: June 11, 2024 Published: June 18, 2024

Abstract

Objective: Fluoride plays an important role to reminalize white lesions and to prevent the progression of caries. Studies show that using laser and topical fluoride is effective to increase enamel resistance and reduce acid solubility.

Purpose: To evaluate the effect of laser irradiation and fluoride on microroughness of enamel of permanent lower molars.

Methods: fifteen freshly extracted, third molars were selected, then Immediately immersed in 0.09% saline. The crowns were separated from the roots then sectioned longitudinally in a mesiodistal direction. The specimens were randomly divided into three groups (n=10) as follows: white spot lesions group, fluoride gel group, and Er-YAG laser group. Then a surface roughness test was done for all samples. Data were analyzed using one-way ANOVA followed by Tukey’s post hoc test.

Results: Microroughness increased for teeth treated with ER-YAG (mean 4.50mm) compared to teeth treated with fluoride (mean 1.35mm). The results were statistically significant between all groups (p>0.05). Discussion: Although some studies recommend laser irradiation after fluoride application, our study proves that using fluoride alone improved surface microroughness.

Conclusion: Fluoride treatment improved white spot lesions microroughness. More research is needed to investigate the effect of laser on WSL microroughness.

Keywords: Fluoride; Laser; Microroughness; White lesions

Introduction

The main objective of dentistry is to prevent decay. Enamel demineralization is the initial step to inhibit decay [1-3]. Enamel demineralization occurs due to long-term bacterial plaque accumulation on enamel surfaces. When demineralization starts, enamel loses translucency to appear chalky white [3-5]. Initial demineralized enamel areas can be remineralized either physiologically through minerals found naturally in saliva [6] or externally by topical application of remineralizing agents [7-8]. Topical remineralizing agents include fluoride, bioglass paste, and low viscosity resin “infiltrate” [3].

Topical Fluoride plays a major role preventing decay; as it improves acid resistance of the enamel, enhances remineralization of incipient lesions and, in addition, it interferes with micro-organisms by inhibiting bacterial metabolism and enzymatic process [9-10]. The preventive mechanism of action of fluoridated agents involves deposition of a large amount of Calcium Fluoride (CaF2) on the enamel surface, which is consequently transformed into fluorapatite crystals [11-12].

The use of lasers accompanied with fluoride application has recently been used to arrest enamel demineralization [3]. There are many types of lasers available with different wavelengths, such as diode lasers with wavelengths ranging from 810 nm to 980 nm. Additionally, erbium lasers such as Er:YAG and Er,Cr:YSGG have proven their efficacy in dental enamel remineralization, increasing acid resistance and decreasing dental enamel solubility [3,13-14]. Lasers interact with enamel photo thermally and photochemically, resulting in recrystallization of enamel crystallites, decomposition of organic matrix, and carbonate loss. Thus, increase acid resistance and reduce enamel permeability allow sealing the enamel surface [3,15-23].

The aim of our study is to evaluate the impact of a fluoridate gel and Er:YAG irradiation on enamel micro-roughness of permanent teeth.

Materials and Methods

We collected fifteen freshly extracted lower third molars without anatomical defects. Teeth were immersed in 0.09% saline [29]. A low-speed diamond disc was used to separate the crowns of the collected teeth. Additionally, sectioning of the samples was done in a mesiodistal direction to make thirty working surfaces. Each specimen was coated with nail polish as an acid resistant varnish except for 3×3 mm exposed enamel was covered with acid-resistant adhesive tape. Then the tapes were removed, and the surfaces were cleaned with damped cotton.

Data Collection

Thirty specimens were divided into three groups (n=10), then specimens were immersed in demineralization solution for 21 days to form enamel lesions. In this study, the demineralization solution is composed of 2.2 mM monopotassium phosphate, 2.2 mM calcium chloride and 0.05 mM acetic acid having pH adjusted to 4.4 using 1 M potassium hydroxide (Figure 1).

Figure 1: Shows marking the white spot lesions.


    

    

    Figure 1: Shows marking the white spot lesions.

Study Design

The specimens were divided into three groups (n=10) as follows: Group 1: white spot lesion control group (WNL) did not receive either Fluoride application or irradiation, group 2 received application of APF gel; and group 3 received Irradiation with Er: YAG laser (2940 nm).

Acidulated Phosphate Fluoride Application

Application of an acidulated phosphate fluoride gel (Ionite fluoride gel, dharma research, USA) containing 1.23% fluoride ions on the samples of group 2. Fluoride gel was applied for four minutes using a cotton swab, then deionized water was used to wash the samples for one minute (Figure 2).

Figure 2: Shows Fluoride application


    

    

    Figure 2: Shows Fluoride application

Er:YAG Laser Irradiation

The irradiation conditions for Er:YAG laser (Light Touch) was: 2940 nm wavelength, pulse energy of 50 mJ; 0.5 W power; frequency of 10 Hz; in a pulse mode of pulse duration of 600 msec. Laser irradiation was performed by sweeping in a uniform motion both horizontally and vertically. A non-contact HO2 hand piece H14 was used with cylindrical tip 0.4 mm at a 1mm distance with air & water spray. Time of exposure was 10 sec [30].

The samples were kept in deionized water between treatment processes. All surfaces were polished then a surface roughness test was conducted using non-contact optical profilometry.

Data Collection

Surface micro-roughness test: Stylus profilometry was used to analyze the surface profile in the center of the delineated area. In this study, three readings were taken for each sample, then the average was calculated.

Statistical Analysis

Both mean and standard deviation values were calculated, then data distribution was evaluated using the Shapiro-Wilk test. One -way ANOVA and Tukey’s post hoc test were used to normally distributed and analyzed data. The significance level was set at p = 0.05 within all tests. Statistical analysis was performed with R statistical analysis software version 4.1.3 for Windows (www.R-project.org/).

Results

Micro-roughness of white lesions increased for teeth treated with ER: YAG (mean 4.50 μm) and decreased in teeth treated with Fluoride gel (mean 1.35μm) compared to teeth with white spot lesions did not receive any treatment (mean 2.10μm). The results were statistically significant between all groups (p>0.05) (Bar Chart 1, Table 1).

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Citation: Amer N, Toema S, Mekled S. Effect of Laser and Fluoride Gel Application on Microroughness of Permanent Teeth. Austin J Dent. 2024; 11(1): 1181.

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