Comparative analysis of root surface smear layer removal by different etching modalities or erbium:yttrium–aluminum–garnet laser irradiation. A scanning electron microscopy study

Abstract

The purpose of this study was to evaluate the effect of erbium:yttrium-aluminum-garnet (Er:YAG) laser (2.94 mum) irradiation on the removal of root surface smear layer of extracted human teeth and to compare its efficacy with that of citric acid, ethylenediamine tetra-acetic acid (EDTA), or a gel containing a mixture of tetracycline hydrochloride (HCl) and citric acid, using scanning electron microscopy (SEM). Thirty human dentin specimens were randomly divided into six groups: G1 (control group), irrigated with 10 ml of physiologic saline solution; G2, conditioned with 24% citric acid gel; G3, conditioned with 24% EDTA gel; G4, conditioned with a 50% citric acid and tetracycline gel; G5, irradiated with Er:YAG laser (47 mJ/10 Hz/5.8 J/cm(2)/pulse); G6, irradiated with Er:YAG laser (83 mJ/10 Hz/10.3 J/cm(2)/pulse). Electron micrographs were obtained and analyzed according to a rating system. Statistical analysis was conducted with Kruskal-Wallis and Mann-Whitney tests (P < 0.05). G1 was statistically different from all the other groups; no statistically significant differences were observed between the Er:YAG laser groups and those undergoing the other treatment modalities. When the two Er:YAG laser groups were compared, the fluency of G6 was statistically more effective in smear layer removal than the one used in G5 (Mann-Whitney test, P < 0.01). Root surfaces irradiated by Er:YAG laser had more irregular contours than those treated by chemical agents. It can be concluded that all treatment modalities were effective in smear layer removal. The results of our study suggest that the Er:YAG laser can be safely used to condition diseased root surfaces effectively. Furthermore, the effect of Er:YAG laser irradiation on root surfaces should be evaluated in vivo so that its potential to enhance the healing of periodontal tissues can be assessed.

An in vitro scanning electron microscopic study comparing MTAD (intracanal irrigant) and various root biomodifiers on periodontally involved human teeth

“…Hence, the application of MTAD as a root biomodifier may have a significant role in periodontal wound healing and future new attachment both in vitro and in vivo. garnet (YAG) laser, [14] and erbium:YAG laser [11] and many more.…”

“…It has the ability to remove the smear layer and also exert a potent antimicrobial activity. [11] This is the first study, which aim to use MTAD as a root biomodifier. The aim of the present in vitro SEM study was to comparatively evaluate the efficacy of MTAD (novel intracanal irrigant) and traditional root biomodifiers for smear layer removal and dentinal tubule opening on periodontally involved human teeth.…”

Demineralizing Agents Versus Er: Yag Laser Irradiation Effect on Root Surface Demineralization:a Scanning Electron Microscopic Study.

“…The laser beam was focused in a contact mode. [28], [29] In the case of contact ablation the procedure is quicker and the energy fluency needed is lower as compared to non contact ablation.…”

Minimally invasive erbium flap (MINIETM flap)—a retrospective surgical treatment for chronic periodontitis

“…In vitro and in vivo papers have mixed results on the efficacy of smear layer removal, to enhance connective tissue attachments, with EDTA, HTCL, and citric acid application to the root surfaces [58]. In fact, Er:YAG laser and EDTA treated roots show similar micromorphology to each other [59,60].…”