Biomedical subjects

P Wilder-Smith

Publications and source records attributed to P Wilder-Smith.

At least 19 recordsLinked to original sources

PubMed2002

Er:YAG laser modification of root canal dentine: influence of pulse duration, repetitive irradiation and water spray.

The aim of this study was to determine the effects of varying parameters of Er:YAG laser irradiation with and without water spray cooling on root canal dentine in vitro. After horizontally removing tooth crowns from extracted human teeth, roots were axially sectioned into thin slices, exposing the root canal surface. An Er:YAG laser delivered 10-30 J/cm(2) into a 0.4-mm diameter laser spot on the root canal surface. Single pulses of different lengths (80-280 micro s) were applied with and without water spray cooling/irrigation, and sequences of three pulses at a repetition rate of 30 Hz were applied at selected pulse parameters. The irradiated samples were investigated using both confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). At most irradiation conditions, the root canal dentine surface was ablated. Three-dimensional images from CLSM revealed that the cavity walls were not smooth. Depths of the cavities revealed significant differences between the cavities. No debris was observed at the surface of cavities at any irradiation condition. Strong melting and recrystallisation, or unusually flat surfaces with open dentinal tubules were obtained with sequences of three pulses without water cooling. CLSM is an effective tool for investigation of laser effects on root canal dentine. By varying the irradiation conditions, the Er:YAG laser can induce different modifications of root canal surface, which may be very interesting for root canal preparation.

Dental Pulp Cavity↗

PubMed2000

Treatment of dentine hypersensitivity by lasers: a review.

BACKGROUND, AIMS: Since the development of the ruby laser by Maiman in 1960, a variety of papers on potential applications for lasers in dentistry have been published. The purpose of this paper is to summarise laser applications for the treatment of dentine hypersensitivity. The effects of laser on pulp tissue and problems on laser treatment are also reviewed. This article reviews the role of lasers for the treatment of dentine hypersensitivity since 1985, summarises many research reports from the last decade, and surmises what the future may hold for lasers in this treatment. METHOD: To date, 4 kinds of lasers have been used for the treatment of dentine hypersensitivity, and the effectiveness ranged from 5.2 to 100%, which was dependent on the laser type and parameters used. The mechanism involved in laser treatment of dentine hypersensitivity are relatively unknown. RESULTS: These require clarification to result in safely effective treatment optimization. In general, the efficiency for the treatment of dentine hypersensitivity using lasers is higher than other methods, but in severe cases, it is less effective. CONCLUSION: It is necessary to consider the severity of dentine hypersensitivity before laser use.

Dental Pulp↗

PubMed2000

Lasers in endodontics: a review.

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of papers on potential applications for lasers in endodontics have been published. The purpose of this paper is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilization of root canals, root canal shaping and obturation and apicectomy. The effects of laser on root canal walls and periodontal tissues are also reviewed. The essential question is whether a laser can provide equal or improved treatment over conventional care. Secondary issues include treatment duration and cost/benefit ratio. This article reviews the role of lasers in endodontics since the early 1970s, summarizes many research reports from the last decade, and surmises what the future may hold for lasers in endodontics. With the potential availability of many new laser wavelengths and modes, much interest is developing in this promising field.

Dental Pulp↗

PubMed2000

Morphological study of the effects of CO2 laser emitted at 9.3 microm on human dentin.

OBJECTIVE: The purpose of this study was to investigate the effects of dentin ablation using a carbon dioxide (CO2) laser emitted at 9.3 microm by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). BACKGROUND DATA: There have been no reports on effects of CO2 laser irradiation emitted at 9.3 microm on dentin by SEM and CLSM. METHODS: Thirty extracted human teeth showing no clinical signs of caries were used. All teeth were horizontally sectioned to approximately 200 microm thickness and sections were irradiated using a 9.3 microm CO2 laser at different parameters as follows: 26 mJ [energy density (ED) 53.0 J/cm2] and 30 mJ (ED 61.1 J/cm2). After laser irradiation, samples were treated with sodium hypochlorite, stained using rhodamine-123, and observed with CLSM followed by SEM procedures. RESULTS: No craters or cracks were observed, but many small molten and rehardened particles were documented on the sample surface using SEM. Some small cracks were seen in the subsurface layer, and some patent dentinal tubules were detected using CLSM. CONCLUSION: These results suggest that laser irradiation at these parameters affected the sample surface only (less than 20 microm) and would be less harmful to thermal damage of dental pulp for dentin ablation.

Carbon Dioxide↗

PubMed1999

Effects on oral soft tissue produced by a diode laser in vitro.

BACKGROUND AND OBJECTIVES: This investigation determined incision characteristics and soft-tissue damage resulting from standardized incisions using a wide range of laser modes and parameters of a diode laser at 810 nm. STUDY DESIGN/MATERIALS AND METHODS: Histologic examinations were performed to verify vertical and horizontal tissue damage as well as incision depth and width. RESULTS: Incision depth and width correlated strongly with average powers, but not with laser parameters or the used tips. No laser damage was visible to the naked eye in the bone underlying the incisions in the range between 0.5-4.5 W. CONCLUSION: The remarkable cutting ability and the tolerable damage zone clearly show that the diode laser is a very effective and, because of its excellent coagulation ability, useful alternative in soft-tissue surgery of the oral cavity.

Animals↗

PubMed1998

Clinical preconditions and treatment modality: effects on pulp surgery outcome.

BACKGROUND: The purpose of this research was to evaluate the factors affecting the outcome of localized laser pulp surgery in the canine model. STUDY DESIGN/MATERIALS AND METHODS: Pulpal exposures 2 mm and 5 mm in diameter were prepared in eight healthy teeth in each of five dogs. The total of 40 teeth were left open to infection from the oral cavity for 3 hours or 72 hours; 2-3 mm of surface pulpal tissue were then removed using a fresh diamond bur or a CO2 laser emitting@9.3 microns, at 3.5 W average power in the Superpulse mode. Teeth were monitored clinically and radiographically by one blinded, pre-standardized clinician for 3 months. RESULTS: Chi-square test and Fisher's Exact test (2-tail) results associated laser treatment with significantly better clinical and radiographic outcome (P < 0.001). Using regression analysis, duration of pulpal exposure to contamination by the oral environment was identified as primary determinant for treatment outcome within the laser-treated and control groups (P = 0.0018). CONCLUSION: Clinical preconditions significantly affect the outcome of pulp surgery treatments.

Animals↗

PubMed1998

Laser-induced thermal events in empty and pulp-filled dental pulp chambers.

BACKGROUND AND OBJECTIVE: The purpose of this investigation was to evaluate: 1. thermal events during laser irradiation @2.1 microns of the pulp; 2. whether these effects are adequately modeled using an empty pulp chamber/root canal. STUDY DESIGN/MATERIALS AND METHODS: In extracted human teeth, pulpal access was prepared and thermocouples placed 2, 3 mm apical to the center of the irradiation spot. Pulp-filled or empty pulp chambers were irradiated using a Ho:YAG laser: Spot Size: 1 mm; Power: 1, 2, 3.5, 4.5 W; PRR: 5, 12 Hz; DURATION: 10 sec. Thermal measurements were repeated 3x. RESULTS: Thermal trends did not differ significantly and correlated positively with power (P < 0.01), PRR (P < 0.01), irradiation duration (P < 0.05). No significant difference was determined between temperatures in empty and pulp-filled chambers at all parameters at 5 Hz and at 1-2 W at 12 Hz (P < 0.05, 2-tailed Student's t-test). At 12 Hz and > 3.5 W, pulp chamber temperatures exceeded those in pulpal tissue (P < 0.05). CONCLUSION: Pulp tissues must be present to ensure clinical relevance of thermal measurements.

Animals↗

PubMed1998

Effects of a 532 nm Q-switched nanosecond pulsed laser on dentin.

The purpose of this study was to determine whether a nanosecond-pulsed, frequency-doubled Nd:YAG laser emitting at 532 nm can be used as an alternative to mechanical methods of root canal treatment or as an adjunct to conventional endodontic preparation. Laser parameters whose thermal effects did not exceed safety thresholds for adjacent periodontal tissues were selected in a preliminary study. In 27 extracted human teeth, root canals were irradiated for 30 to 60 s at fluences of 2 to 2.2 J/cm2, and 10 Hz. Samples were observed using SEM. Laser irradiation could achieve smear layer removal after minimal manual preparation. However, results were inhomogeneous, and at higher energy densities thermal damage was observed, especially in the fully manually prepared samples. Nanosecond-pulsed irradiation at 532 nm can achieve complete smear layer removal. However, mechanisms must be developed to monitor laser effects and avoid potential damage to collateral structures.

Dentin↗

PubMed1997

Effects of nanosecond pulsed Nd: YAG laser irradiation on dentin resistance to artificial caries-like lesions.

BACKGROUND AND OBJECTIVE: Previous investigations have demonstrated improved enamel caries resistance after laser irradiation. In this study, effects of nanosecond pulsed Nd:YAG laser irradiation on crown/root dentin susceptibility to caries-like lesions were investigated. STUDY DESIGN/MATERIALS AND METHODS: Extracted human molar teeth were irradiated using a Q-switched nanosecond pulsed Nd:YAG laser. All teeth except controls were irradiated at: fluence, 1 or 5 J/cm2; spot size, 3 mm; and then subjected to demineralization. Measurements of caries lesion depth using scattering light microscopy and SEM were performed. RESULTS: Lesion depth measurements did not differ significantly between controls and irradiated samples (P < 0.01), but SEM results showed some irradiation-induced alterations on crown and root dentin surfaces. Irradiated surfaces were partially melted, with sometimes narrowed or occluded tubules. CONCLUSION: No consistent caries-protective effect of Q-switched nanosecond pulsed Nd:YAG laser irradiation on crown and root dentin was determined, but laser-induced morphological changes were observed.

Dental Caries↗

PubMed1997

Morphological effects of ArF excimer laser irradiation on enamel and dentin.

BACKGROUND AND OBJECTIVE: The aim of this investigation to determine the range of morphological and ablative effects that can be achieved on dental enamel and dentin using ArF excimer laser irradiation at a wavelength of 193nm. STUDY DESIGN/MATERIALS AND METHODS: Caries-free coronal enamel and dentin surfaces of 20 extracted human teeth were subjected to irradiation at 193nm using a Lamda-Physik model EMG 103 MSC and ArF fill. Morphology of cavity floors and walls were assessed by light microscopy and SEM. RESULTS: Morphological surface effects and ablation could be controlled effectively and reliably by choice of parameter combination, allowing the operator to achieve either a smooth, flat, or increasingly rough surface with differing degrees of selective ablation. No signs of thermal damage were apparent. CONCLUSION: Excimer laser irradiation at 193nm provided clinically useful cavity preparations and surface morphological effects.

Dental Enamel↗

PubMed1997

CO2 laser treatment of traumatic pulpal exposures in dogs.

BACKGROUND AND OBJECTIVE: Successful non-devitalizing treatment of localized pulpal lesions in mature teeth is not ensured using conventional endodontic techniques. The objective of this study was to evaluate CO2 laser surgical treatment of pulpal exposures in canine patients. STUDY DESIGN/MATERIALS AND METHODS: 17 permanent teeth with pulpal exposures of < or = 48 h duration received localized laser pulp surgery. Laser Parameters: pulse duration: 0.01 s, pulse interval: 1.0 s, spot size: 0.004 cm2, fluence: 276 J/cm2. Exposures were dressed with CaOH and Glass ionomer. Clinical and radiographic evaluations were performed by one blinded clinician 24 and 52 weeks after treatment. RESULTS: 15/17 laser-treated teeth assessed over > or = 1 year post-treatment remained clinically and radiographically healthy. CONCLUSION: These results demonstrate the feasibility of using the CO2 laser for localized pulp surgery. Further studies must optimize laser parameters and identify the range of clinical pathologies which can be treated using this modality.

Animals↗

PubMed1997

The influence of laser parameter configurations at 9.3 microns on incisional and collateral effects in soft tissue.

These investigations were performed to determine histologic and incisional consequences of varying pulse duration, duty cycle, and average powers during laser incision at 9.3 microns in soft tissue. In 19 fresh pigs' jaws six standardized incisions 3 cm long were made per parameter with a template and motorized jig. Laser parameters investigated were average power: 1 to 9 W, duty cycle: 10% to 80%, and pulse duration: 1 to 200 msec. The gated Cw mode was used. Incision width and depth and collateral tissue effects were assessed statistically with general linear procedures. Multiple factors were found to influence the outcome of laser irradiation. Depth of incision correlated positively with average power. Tissue damage correlated strongly and negatively with all three variables. These results demonstrate that a wide range of surgical and collateral effects can be achieved with one specific laser device depending on the parameter configuration selected.

Animals↗

PubMed1997

Investigating the range of surgical effects on soft tissue produced by a carbon dioxide laser.

The authors investigated the surgical and collateral effects on soft tissue of a carbon dioxide laser emitting at 9.3 micrometers. Specifically, incision widths and depths as well as effectiveness were studied. Three different laser modes were investigated: gated continuous wave, or Cw, Superpulse and OptiPulse (Medical Optics). Incision depths correlated positively with average power; higher powers produced deeper incisions. The gated Cw mode quickly produced wide, deep incisions; Superpulse achieved narrower, deep incisions; OptiPulse caused very narrow, shallow incisions. Collateral damage to adjacent tissues was reduced by a factor of about 2 using Superpulse, and by a factor of 10 using OptiPulse. A wide range of effects is achieved in soft tissue, depending on the laser parameter combination used.

Animals↗

PubMed1995

Thermal effects of CO2 laser on the pulpal chamber and enamel of human primary teeth: an in vitro investigation.

BACKGROUND AND OBJECTIVE: Thermal effects of direct exposure of the pulp chamber to CO2 laser irradiation were evaluated and potentially safe parameters for its clinical application were determined. STUDY DESIGN/MATERIALS AND METHODS: Using conventional methods, the pulp chambers of freshly extracted primary cuspids were exposed and then subjected to CO2 laser irradiation at the following parameters: 2, 4, 6, 8, 10, 15, and 20 Watts power settings; 0.76 mm diameter spot size; total energy densities between 4-1,058 J/cm2; exposure time between .01-60 s. Exposures in the continuous wave mode were performed in some specimens. In others, single firings of a .01 s pulse duration and a 1 s pulse interval were conducted. Temperature measurements were conducted using a thermocouple and thermal camera. RESULTS: Significant statistical differences in maximum temperature rise on enamel were observed in groups that received total energy densities > or = 8 J/cm2 (P < or = 0.01); within the pulp chambers these were observed in groups that used > or = 44 J/cm2 (P < or = 0.01). CONCLUSION: Parameters appropriate for pulpotomy were observed at energy densities up to 176 J/cm2 in the continuous wave mode and 264 J/cm2 using single pulses, wherein temperature rises below 5.5 degrees C were recorded on tooth surface.

Body Temperature↗

PubMed1995

Root canal preparation using the second harmonic KTP:YAG laser: a thermographic and scanning electron microscopic study.

Thermal and microstructural events resulting from KTP laser use during root canal preparation were investigated in 30 extracted single-rooted human teeth. In the first section of this study, thermal events occurring on the root surfaces of 18 teeth during and after exposure of the root canal were measured using thermography. A variety of parameters were used to determine settings that would be effective without causing thermal damage to the periodontal ligament. In the second section of the study, root canals of 12 teeth exposed to KTP laser irradiation at parameters derived from section 1 were evaluated using Scanning electron microscopy. KTP laser application at a power setting of 3 W, an exposure time of 2 s, and a frequency of 5 Hz, applied five times, removed smear layer and debris from the root canal surface at temperatures below the thermal injury threshold for periodontal tissue.

Argon↗

PubMed1995

Effects of ultrasonic root-end cavity preparation on the root apex.

This study determined the effect of bur and ultrasonic preparation on the root apex. After cleaning, shaping, and obturation of root canals of 47 single-rooted teeth and resection of their apexes were done, 24 root-end cavities were prepared with a bur, and the rest were prepared with ultrasonic tips attached to two different ultrasonic units. After photographs of the prepared root ends were taken, their resin replicas were prepared and examined with a scanning electron microscope. Photographs and scanning electron microscope photomicrographs were examined for the presence or absence of cracks. The results showed a significantly higher incidence of crack formation in the walls of root-end cavities prepared by ultrasonic tips compared with those made by the bur.

Analysis of Variance↗

PubMed1995

Incision properties and thermal effects of three CO2 lasers in soft tissue.

OBJECTIVES: It was the aim of this study to determine thermal and histologic events resulting from soft tissue incision with three CO2 lasers: one emitting light energy via a hollow waveguide at 9.3 microns; the others emitting light energy at 10.6 microns, one via a hollow waveguide, the other through an articulated arm delivery system. STUDY DESIGN: Thirty standardized incisions were made in the oral mucosa of pig's mandibles with three different lasers at actual power levels of 1, 4 and 12 W. Thermal events were recorded with thermocouples, and a histologic examination was performed to determine vertical and horizontal tissue damage as well as incision depth and width. RESULTS: Thermal and histologic results were related to parameters and beam characteristics rather than wavelength. CONCLUSION: In addition to wavelength, many variables can contribute to the surgical characteristics of a laser.

Animals↗

PubMed1995

Effect of ND:YAG laser irradiation and root planing on the root surface: structural and thermal effects.

Effects of ND:YAG laser irradiation on untreated and root planed tooth roots were investigated to determine whether a cleaning effect and/or removal of smear layer could be achieved without concomitant microstructural or thermal damage. Sixty (60) healthy extracted teeth were either untreated, irradiated only, root planed only, or irradiated and root planed. Intra-pulpal and surface temperatures were monitored during irradiation, then SEM was performed. Smear layer elimination was achieved without inducing hard tissue microstructural damage at 5W, using pulse durations and intervals of 0.1 s, a fluence of 0.77 J/cm2, and a total energy density of approximately 700 J/cm2. However, these results were not consistent in all samples. At these parameters, intra-pulpal temperature increases of 9 to 22 degrees C and surface temperature increases of 18 to 36 degrees C were recorded. Thus, despite their effectiveness for smear layer removal, these parameters may not be appropriate for clinical use as an adjunct to conventional periodontal therapy.

Body Temperature↗