This PDF file contains the front matter associated with SPIE Proceedings Volume 9670 including the Title Page, Copyright information, Table of Contents, Introduction, and Conference Committee listing.

The paper, will present the most important non-invasive methods for diagnostic, in different fields of dentistry. Moreover, the laser-based methods will be emphasis. In orthodontics, 3D laser scanners are increasingly being used to establish database for normative population and cross-sectional growth changes but also to asses clinical outcomes in orthognatic surgical and non-surgical treatments. In prevention the main methods for diagnostic of demineralization and caries detection in early stages are represented by laser fluorescence - Quantitative Light Florescence (QLF); DiagnoDent-system-655nm; FOTI-Fiberoptic transillumination; DIFOTI-Digital Imaging Fiberoptic transillumination; and Optical Coherence Tomography (OCT). In odontology, Laser Doppler Flowmetry (LDF) is a noninvasive real time method used for determining the tooth vitality by monitoring the pulp microcirculation in traumatized teeth, fractured teeth, and teeth undergoing different conservative treatments. In periodontology, recently study shows the ability of LDF to evaluate the health of gingival tissue in periodontal tissue diseases but also after different periodontal treatments.

Vascular malformations are a very heterogeneous group of circulatory system’s diseases that can involve different kind of vessels: arterial, venous or lymphatic ones. Many treatments, such as conventional surgery, embolization, steroid therapy and laser therapy, are available for vascular lesions. The laser approach relies more therapeutic techniques: the transmucosal thermophotocoagulation, intralesional photocoagulation, the excisional biopsy. Today laser is demonstrated to be the gold standard technique to treat vascular lesions that allows a safe and efficient treatment and a lower post-operative healing time. The only disadvantage is the risk of carbonization that could be avoided by using the multiple-spot single pulsed wave technique.

Since the early 80’s, the use of laser has been introduced in the daily dental practice and the technological development has also provided over time to optimize its use. Various types of lasers with different wavelengths have been developed for use in a handy, easy and ergonomic manner.

In daily paediatric dentistry, laser could be a very useful medical device which can completely replace the traditional high hand-piece and bur to realize a “micro-invasive” dentistry and a “clean” surgery, without bleeding and sutures. According to the international literature and in the light of recent researches, this work could give an overview on assisted laser therapy in paediatric dentistry, highlighting advantages and disadvantages of this new technology and pointing out the high compliance of the young patient.

Among present-day marketed systems ultrasonic activation appears to be the best way to activate and potentiate endodontic irrigants. An alternative for ultrasonic activation of irrigants is laser activated irrigation (LAI) or photoninitiated acoustic streaming. Based on present-day research it appears that LAI (especially with Erbium lasers) can be more efficient for debris removal out of root canals and interaction with the endodontic biofilms thanks to the induction of specific cavitation phenomena and acoustic streaming. Other wavelengths are now explored to be used for LAI. Another way to interact with biofilms is to rely on laser-induced photoporation in combination with gold nanoparticles ( AuNPs). The latter is an alternative physical method for delivering macromolecules in cells. Nanosized membrane pores can be created upon pulsed laser illumination. Depending on the laser energy, pores are created through either direct heating of the AuNPs or by vapour nanobubbles that can emerge around the AuNPs.

Nowadays the use of implants as a increasing therapy in dentistry and it has become a usual treatment in dental offices. More and more dentists have dental implants included in treatment plans for patients with missing teeth. Therefore is necessary that all dentists know all the possibilities of these treatments. Together with the emergence of dental implants, it is also beginning to see an increase in the onset of lasers in dentistry. These two new techniques in dentistry can be supplemented because as we will see the use of lasers in different cases can improve implant treatment.

The usefulness of laser for oral hard tissue procedure such as caries treatment, impacted teeth extraction, periodontal therapy, peri-implantitis management, sinus lifting is reported by several Authors [1]. Conventionally, mechanical rotary instruments and hand instruments are employed for bone surgery. Rotary instruments have better accessibility and cutting efficiency, but there is a risk of excessive heating of bone tissue and caution must be exercised to avoid the bur becoming entangled with surrounding soft tissues and the reflected flap. The main clinical advantages of the lasers are represented by minimal patient discomfort, good recovery with decreased or absent post-operative pain. In the last ten years are described in the international literature great advantages of Laser Surgery and Low Level Laser Therapy (LLLT) performed with different wavelength in addition to traditional surgical techniques to improve bone and soft tissue healing and for pain and infection control.

Hemangioma and vascular malformations in the field of oral and maxillofacial surgery is a pathology more often found in recent years in patients. The aim of this study was to evaluate the efficacy of the laser photocoagulation performed with a diode laser (Ga-Al-As) 980 nm wavelength in the treatment of vascular lesions which are located on the oral and maxillofacial areas, using color Doppler ultrasonography for evaluation of the results. We also made a comparison between laser therapy and sclerotherapy in order to establish treatment protocols and recommendations associated with this pathology. We conducted a controlled study on a group of 92 patients (38 male and 54 female patients, with an average age of 36 years) having low flow hemangioma and vascular malformations. Patients in this trial received one of the methods of treatment for vascular lesions such as hemangioma and vascular malformations: laser therapy or sclerotherapy. After laser therapy we have achieved a reduction in size of hemangioma and vascular malformations treated with such a procedure, and the aesthetic results were favorable. No reperfusion or recanalization of laser treated vascular lesions was observed after an average follow-up of 6 to 12 months. In case of sclerotherapy a reduction in the size of vascular lesions was also obtained. The 980 nm diode laser has been proved to be an effective tool in the treatment of hemangioma and vascular malformations in oral and maxillofacial area. Laser therapy in the treatment of vascular lesions was more effective than the sclerotherapy procedure.

Oral leukoplakia is catalogued under the group of “potentially malignant disorders”. In daily practice, the World Health Organization definition “white patch or plaque that cannot be characterized clinically or histologically as any other disease” is completed by including the observation that it cannot be removed by simple scraping, thereby distinguishing it from pseudo-membranous candidiasis. The aim of this study is to find a definitive treatment of oral leukoplakia, because of its recurrence and its potentiality to the malignant transformation. There are currently different approaches to oral leukoplakia: scalpel surgery, systemic therapy (carotenoids, vitamins, etc.), electro-cauterization, cryotherapy and the use of the laser. In every lesion, biopsy and histological analysis has been performed to identify the stage and classification of the oral leukoplakia.

Laser can be used for the complete excision of the lesion (which is more effective, but also more invasive), for the photodynamic therapy (non-invasive procedure, which requires several applications) or for the vaporization of the lesion (very precise treatment and relatively easy to perform). Laser treatments have shown better healing, less soft tissues retraction and less post-operative pain, comparing with traditional surgery. The use of systemic therapies and smoking habit interruption (where present) has been also useful to reduce the lesions before the clinical treatments. The treatment has always to be supported by histological analysis to identify the risk and consequently planning the clinical approach.

The aim of this study was to assess the effects of the antimicrobial photodynamic laser therapy performed during the treatment of deep periodontal disease by using 40 MHz high frequency ultrasonography. The periodontal data recorded during the clinical examination before each treatment session were compared with volumetric changes of the gingiva measured on periodontal ultrasound images. The results show a significant decrease of gingival tissue inflammation proved both by a significant decrease of bleeding on probing as well as by a decrease of the gingival tissues volume on sites where the laser therapy was performed. Periodontal tissues that benefit of laser therapy besides classical non-surgical treatment showed a significant clinical improvement of periodontal status. Based on these findings we were able to conclude that the antimicrobial photodynamic laser therapy applied on marginal periodontium has important anti-inflamatory effect. The periodontal ultrasonography is a method which can provide useful data for assessing the volume changes of gingival tissues, allowing a precise monitoring of marginal periodontitis.

Platelet rich fibrin (PRF) is a tissue product of autologous origin abundant in growth factors, widely used in regenerative procedures.

Aim of the study: Evaluation of the regenerative effect of PRF added in the bony defects (after tooth removal or after cystectomy)

Material and methods: The comparative nonrandomized study included 22 patients divided into 2 groups. The first group (the test group) included 10 patients where the bony defects were treated without any harvesting material. The second group included 12 patients where the bony defects were filled with PRF. The bony defect design was not critical, with one to two walls missing. After the surgeries, a close clinically monitoring was carried out. The selected cases were investigated using both cone beam computer tomography (CBCT) and radiographic techniques after 10 weeks postoperatively.

Results: Faster bone regeneration was observed in the bony defects filled with PRF comparing with the not grafted bony defects.

Conclusions: PRF added in the bony defects accelerates the bone regeneration. This simplifies the surgical procedures and decreases the economic costs.

Introduction: Evaluating the health status of the gingival tissue represents an important objective in the daily practice. Inflammation changes the microcirculatory and micromorphological dynamics of human gingiva. Aim: The purpose of this study was to evaluate the microcirculation in subjects with moderate gingivitis and healthy gingiva by using laser Doppler flowmetry (LDF). Material and Methods: Recordings of the gingival microcirculation (GM) were taken from 20 healthy gingival sites and from 20 sites with moderate gingivitis. The gingival blood flows in the gingivitis group before treatment was significantly different from those in the healthy gingiva group. Signals were recorded with the aid of a laser Doppler MoorLab instrument VMS-LDF2 probe VP3 10 mm S/N 2482. Three consecutive determinations of the GM were registered for each site, as follows: before the initial therapy, at 24 hours after the initial therapy and then, 7 days after the initial therapy. The data were processed using the statistical analysis software SPSS v16.0.1. Results: The results of this preliminary study showed statistically significant differences among the GM values recorded before and after the initial therapy. Conclusions: LDF could be a useful, noninvasive, sensitive, reproducible, and harmless method for measuring gingival blood flow (gingival microcirculation) in humans.

Introduction: Periodontitis is a chronic inflammatory disease due to exposition to plaque and tartar. Conventional treatments consist of scaling and root planing (SRP) and antibiotics administration. Among them encouraging results have been obtained using alternative protocols, like the antimicrobial photodynamic therapy (PDT).

Aim of the Study: Evaluation of PDT effects added to conventional methods.

Materials and Methods: 11 patients (4M/7F, 37-67 years aged, non-smoking) affected by untreated chronic periodontal disease, with >3mm pockets in at least 4 teeth were divided in two groups, test and control group. Each patient had to made full-intraoral before and after the treatment. The test group received SRP+PDT, while the control group was subjected to SRP. The PDT was performed through the HELBO®TheraLite (Bredent Medical), diode laser battery powered 670nm with an output of 75mW/cm². The Helbo Blue photosensitizer, containing methylene blue, was used. The exposure time to the laser effect was of 10’’ for each site, for a total of 60’’ at 3J/cm².

Results: Both groups had a significant improvement in the reduction of pocket depth (PD), above all in the test group. Statistical analysis was performed through the T-test, evaluating PD between the two groups p=0.96 (p> 0.05), resulting not statistically significant.

Conclusion: PDT is a promising support to SRP, achieving a significant reduction in the pocket depth, but more cases are needed to confirm the validity of the used protocol.

Aim of the study: Our goal was to monitor soft tissue changes occurring during radiotherapy – both through clinical examination and using LDF – in order to establish Laser Doppler as an early diagnosis instrument in this situation, and also to assess what kind of dental procedures could be provided during radiotherapy, in order to increase patients’ quality of life.

Material and Method: Our study included two male patients, who received head and neck radiotherapy. Patient A, 68 years old, underwent 31 radiotherapy exposures. Patient B, 52 years old, underwent 24 exposures. They received a thorough clinical examination, and a LDF evaluation of gingival blood flow in areas close to the irradiated site, after the first, the 18^th, and the last radiotherapy exposure.

Results: Patient A presented radiotherapy induced mucositis, after the 18th radiotherapy exposure. After the last exposure the mucositis worsened, additionally, radiodermitis appeared on the neck. LDF showed an increase in blood flow of the irradiated area, even after the first exposure, and it persisted throughout treatment. Patient B showed no clinical changes, besides a hyperkeratinisation of the gingiva in the irradiated area, after the last exposure. LDF showed an overall increase in vascularity of the area throughout treatment.

Discussion: Even after the first radiotherapy exposure, and also when clinical changes were not apparent, LDF measurements revealed an increase in blood flow in the gingiva of irradiated patients. LDF might allow us to establish the most appropriate moment in time for each dental treatment, in order to increase the quality of life.

Salivary gland diseases can include reactive lesions, obstructive lesions, and benign tumors. All these clinical entities are slow growing. Salivary glands reactive lesions, such as mucoceles, can result from extravasation of saliva into the surrounding soft tissue or from retention of saliva within the duct. Sialolithiasis, one of the most common obstructive lesions, is generally due to calculi, which are attributed to retention of saliva. Monomorphic adenoma is a salivary gland benign tumor, which is exclusively resulted from proliferation of epithelial cells, with no alterations interesting the connective tissue. The elective therapy of these lesions is surgical excision because sometimes they can be accompained by difficulties during chewing and phonation and can interfere with prosthesis’s stability.

The aim of the study is to evaluate the efficacy of CO₂ laser in the treatment of patients with salivary gland diseases. Three different cases – a mucocele, a scialolithiasis and a monomorphic adenoma – were treated with CO₂ laser excision (CW and 4W), under local anesthesia. Two different techniques were used: circumferential incision for the adenoma, and mucosa preservation technique for mucocele and sialolithiasis. In each case final haemostasis was obtained by thermocoagulation, but suture was applied to guarantee good healing by sewing up the flaps. The patients were checked after twenty days and the healing was good.

The carbon dioxide laser (CO₂ laser) was one of the earliest gas laser to be developed, and is still the highest-power continuous wave laser that is currently available. In dentistry the CO₂ laser produces a beam of infrared light with the principal wavelength bands centering around 9.4 and 10.6 micrometers. Laser excision can be very useful in oral surgery. In the cases presented CO₂ laser offered, differently from traditional surgery, simplified surgical technique, shorter duration of operation, minimal postoperative pain, minimal scarring, bloodless field and the possibility to realize minimally invasive surgery. These advantages made the operation tolerable for the patients, that became more compliant. Optimum functional results can be expected.

Backgrounds: Er,Cr:YSGG (2780nm) and diode (940 nm) lasers can be used adjacent to the conventional periodontal treatment as minimally invasive non-surgical devices. Aim: To describe the short-term clinical outcomes by combining Er,Cr:YSGG (2780nm) and diode 940 nm lasers in non-surgical periodontal treatment. Materials and methods: A total of 10 patients with periodontal disease (mild, moderate, severe) – 233 teeth and 677 periodontal pockets ranging from 4 mm to 12 mm – were treated with Er,Cr:YSGG (2780nm) and diode (940 nm) lasers in adjunct to manual and piezoelectric scaling and root planning (SRP). Periodontal parameters such as mean probing depth (PD), mean clinical attachment level (CAL) and mean bleeding on probing (BOP) were evaluated at baseline and 6 months after the laser treatment using an electronic periodontal chart. Results: At baseline, the mean PD was 4.06 ± 1.06 mm, mean CAL was 4.56 ± 1.43 mm, and mean BOP was 43.8 ± 23.84 %. At 6 months after the laser supported periodontal treatments the mean PD was 2.6 ± 0.58 mm (p <0.001), mean CAL was 3.36 ± 1.24 mm (p <0.001) and mean BOP was 17 ± 9.34 % (p <0.001). Also 3 patients showed radiographic signs of bone regeneration. Conclusion: The combination of two laser wavelengths in adjunct to SRP offers significant improvements of periodontal clinical parameters such as PD, CAL and BOP. Keywords: Laser supported periodontal treatment concept, Er,Cr:YSGG and diode 940nm lasers, Scaling and root planning, Minimally invasive non-surgical device

Introduction

The effect of low level laser therapy (LLLT) on the healing process could be useful for the prevention of post-extractive Bisphosphonate-related Osteonecrosis of the Jaws (BRONJ).

The aim of the study was to investigate the effect of LLLT on the post-extractive socket healing in rats treated with zoledronic acid and dexamethasone.

Material and Methods

Thirty male Sprague-Dawley rats were divided in 4 groups: control group (C, n = 5), laser group (L, n = 5), treatment group (T, n = 10) and treatment plus laser group (T+L, n = 10). Rats of group T and T+L received zoledronate 0,1 mg/Kg and dexamethasone 1 mg/Kg every 2 days for 10 weeks. Rats of group C and L were infused with vehicle.

After 9 weeks the first maxillary molars were extracted in all rats. Rats of groups L and T+L received laser therapy (Nd:YAG, 1064 nm, 1.25W, 15Hz, 5 min, 14.37 J/cm2) in the socket area at days 0, 2, 4 and 6 after surgery. At 8 days from extraction, the sockets were clinically assessed with a grading score and the wound area was measured with a dedicate software. Histomorphometric evaluation and western blot analysis of osteopontin and osteocalcin expression were performed.

Results

Group T+L showed a trend toward a better clinical grading score compared to group T (grade I 22% Vs 28 % - grade II 56% Vs 28% - grade III 22% Vs 44%, respectively). The average wound area was similar among the groups. Inhibition of osteoclastic alveolar bone resorption was found in groups T and T+L (P<0.001). Rats of groups L and T+L showed a significant higher expression of osteocalcin compared to rats of groups C and T (C=0.3993; L=1.394; T=0.2922; T+L=1.156; P=0.0001). The expression of osteopontin did not show significant differences in the groups treated with Nd:YAG compared to the ones that did not receive laser irradiation.

Conclusion

Our findings suggest that laser irradiation after tooth extraction can promote osteoblast differentiation, as demonstrated by the higher expression of osteocalcin. Thus, laser irradiation could be considered a way to improve socket healing in conditions at risk for MRONJ development.

Introduction: The use of lasers has become a practice in modern periodontology and it is a fact that the use of diodes in the dental office can bring a real benefit in periodontal surgery.

Material and method: These case reports describe few of various soft tissue procedures that were performed with diode laser 940 nm (Epic 10, Biolase Inc., USA).

Discussions: There are a few immediate benefits of the intervention: the “periodontal bandage” belongs to the patient, the procedure is painless, performed under a superficial anesthesia and the psychological impact on the patient, as well as the acceptance, are superior to conventional methods of dentistry.

Conclusions: Diode lasers at the level of periodontium have become a significant part of the dentistry, reducing the patient’s stress and giving satisfaction to practitioners as well.

Aim: The present study aims to assess the level of vascularisation of the lower frontal gingiva of smoker patients, in comparison with non-smokers by using Laser Doppler Flowmetry (LDF), in order to determine the changes in gingival microcirculation. Material & methods: 16 volunteers were included in this study and separated into 2 equal groups: non-smoker subjects in Group I and smoker subjects in Group II. All patients were submitted to a visual examination and professional cleaning The gingival bloodflow of each patient was recorded in 5 zones using LDF, resulting in a total of 80 recordings. LDF was done with the Moor Instruments Ltd. "moorLAB“ Laser Doppler. All data were collected as graphs, raw values and statistically analyzed.

Results: After strict analysis results show that Group II presents a steady level of gingival microcirculation with even patterns in the graph, while Group I shows many signs of damage to it‘s microvascular system through many irregularities in the microcirculation level and graph patterns. Conclusion: The results suggest that prolonged smoking has a definitive effect on the gingival vascularisation making it a key factor in periodontal pathology.

The applications of lasers in medicine, both in the field of diagnosis and treatment are gaining momentum. In dentistry in particular, numerous types of lasers with a wide range of characteristics are being utilized in all fields. In consequence, a lot of experience and knowledge has been gained in the last two decades in this domain; this resulted in the development of novel technologies and devices. A brief overview is made in the first part of this article on these topics. The treatment of periodontal disease with laser therapy is pointed out, as well as the photodynamic therapy which is using LLLT for the activation of the sensitizing gel that is introduced in the periodontal pockets. This paper reviews also the application of photodynamic therapy in clinical trials which have different results; a standardization of the protocol utilized for this procedure is concluded to be necessary.

Introduction: Leukoplakia is a potentially malignant epithelial lesion with carcinomatous percentages transformation comprehended between 1% and 7% for the homogeneous forms and from 4% to 15% for the non-homogeneous ones. Their removal can be performed by scalpel or laser surgery (excision or vaporization). Photodynamic therapy (PDT) is a bloodless treatment option, based on the involvement of three elements: light, photosensitizer and oxygen. When the molecules of the photosensitizer are activated by a low power laser, energy is transferred to molecular oxygen creating highly reactive radicals of oxygen, that have a cytotoxic effect on target cells.

Aim of the study: According to several studies in Literature, it has been decided to evaluate through an initial clinical trial, the efficacy of PDT using topical aminolevulinic acid (5-ALA) activated by a laser diode (λ = 635 nm) to treat potentially oral malignant lesions and to illustrate the advantages and disadvantages derived from the use of this technique.

Materials and Methods: Five patients, affected by oral leukoplakia (OL) and oral verrucous leukoplakia (OVL) on the mucosal cheeks, labial commissure, fornix and retromolar areas, have been treated using the PDT. Irradiation time with Diode laser: 1000s. Irradiation mode: Scanning. 5 cycles of 3 minute + final cycle of 100 seconds. Each cycle has been interrupted by pauses of 3 minutes.

Results and conclusion: PDT results to be effective in the treatment of OL, especially on OVL. In fact, OVL, due to its irregularity, has got an area of increased retention for the gel that is more difficult to be removed by salivary flow. This could explain the better results obtained in this case rather than in those ones of OL. Furthermore, the advantages have been represented by: less invasivity, high sensitivity for altered tissues, minimal scar tissue, less side effects and no pain during and after operation. In contrast to this, the disadvantages were: longer treatment duration and the high cost.

Introduction: LLLT in oral cavity believed to reduce pain after endodontic surgery and wisdom tooth removal, to accelerate wound healing and to have an anti-inflammatory and regenerative effect. The aim of this systematic review therefore was to assess the proof available for the efficacy of low-level laser treatment in reducing pain and swelling after endodontic surgery.

Methods: The PubMed service of the U.S. National Library of Medicine was searched with applicable search strategies. No language restriction was applied. The last electronic search was accomplished on August 31, 2015. All randomized clinical trials on the efficiency of low-level laser treatment in reducing pain and swelling after endodontic surgery was considered for the Meta-analysis. Quality consideration of the included randomized clinical trials was appraised according to CONSORT guidelines.

Results: Only two randomized clinical trials were attained. These studies clarified that laser treatment could reduce pain and swelling, but the results were not significant.

Conclusions: Low-level laser therapy can be advantageous for the reduction of postoperative pain but there is no strong confirmation for its efficiency. Its clinical utility and applicability relating to endodontic surgery, Along with the optimal energy dosage and the number of laser treatments needed after surgery, still, demand further research and experiment.

Oral mucositis is a debilitating and dose limiting side effect of oncotherapy in cancer patients. Low Level Laser Therapy (LLLT) is a promising new intervention for the treatment of oral mucositis. Aims and objectives: 1. Perform a systematic review of available literature on the therapeutic effect of LLLT on established oral mucositis. 2. Formulate recommendations for future studies based on results of review. Methods: Electronic search oflow level laser therapy in the treatment of oral mucositis was conducted and eligible studies reviewed. Results: Four studies met the inclusion criteria and were analyzed. A total of 109 patients were included, 59 of which received LLLT as a therapeutic measure. An overall success rate of 81.4% success rate was reported in regard to OM. Conclusion: The review demonstrated the positive therapeutic effect of LLLT on oral mucositis. However, the need for future studies with standardized reporting of parameters and methods is needed to increase the level of evidence of this intervention.

Objectives: study of soft and hard tissues around implants. Material and methods: For the immunohistochemical and histological study of the implant/soft tissue interface, we examined pieces of peri-implant mucosa harvested from 35 patients. The implant/bone interface was assessed using histologic and histomorphometric examination of hard tissues around unloaded, early loaded or delayed loaded dental implants with pre-established design, with a sandblasted and acid-etched surface, placed both in extraction sockets, or after bone healing following tooth removal. This study was performed on 9 common race dogs. Results: The histological study of the implant/soft tissue interface showed regenerative modifications and moderate chronic subepithelial inflammatory reactions. Immunohistochemical evaluation of the soft tissue biopsies revealed the presence of specific immunocompetent cells and proteins of the matrix metalloproteinase (MMP) expression. Bone-implants contacts were more obvious in the apical half of the implants and at the edges of the threads, than between them. A mature, lamelliform bone containing lacunae with osteocytes and lack of connective tissue were noticed around implants that were late placed and loaded. The new-formed bone was also abundant in the crestal zone, not only in the apical part of the implants. Conclusions: A thorough understanding of the microstructure of dental implant/soft and hard tissue interface will improve the longevity of osseointegrated implants.

The aim of the present short-term study is to investigate efficiency of laser therapy as adjunct to conventional periodontal therapy in patients with chronic periodontitis. Methods. The study protocol included 44 patients (20 males, 24 females; age 45-60) with moderate and advanced chronic periodontitis, recruited in Private Clinic Krondent (Brasov, Romania). The patients were randomly assigned in two groups, one group (test-sites group, 22 patients) treated by ultrasonic scaling and root planning followed by laser therapy (940 nm diode laser and 2780 nm Er:Cr:YAG laser) and second group (control-sites group, 22 patients) treated only by ultrasonic scaling and root planning. All patients were submitted to initial evaluation, recording of bleeding on probing (BOP) and probing of pockets depth (PPD), oral hygiene instruction and motivation. Indices BOP and PPD for the assessed periodontal sites were also recorded at 8 weeks, 16 weeks and 24 weeks after treatment. Results. Periodontal inflammatory parameters PPD (PPD≥4mm) were significantly lower in test-sites group as compared with control-sites group at 2 months (82% vs. 90%), 4 months (42% vs. 62%), and 6 months (11% vs. 30%).Periodontal parameters BOP were lower among patients in control-sites group and test-sites group at 2 months (38% vs. 32%), and significantly lower in test-sites group at 4 months (42% vs.26%), and 6 months (44% vs. 24%). Conclusions. The additional use of laser therapy increases significantly the efficiency of periodontal treatment comparing with conventional periodontal therapy.

Endodontic surgery involves the incision and flap elevation, the access to the root tip, its resection, the cavity retrograde preparation and filling it with biocompatible material that provides a good seal of the apex[1]. Apicoectomy is compulsory in endodontic surgery. The final stage involves the root retropreparation and the carrying out of the retrograde obturation. In order to perform the retrograde preparation the endodontist can use various tools such as lowspeed conventional handpieces, sonic and ultrasonic equipment. The ideal depth of the preparation should be 3 mm, exceeding this value may affect the long-term success of the obturation [2]. Resection at the depth of 3 mm reduces apical ramifications by 98% and lateral root canals by 93%. The ultrasonic retropreparation has numerous advantages compared to the dental drill. Firstly, the cavity will be in the axis of the tooth which implies a minimum destruction of the root canal morphology. The preparations are precise, and the cutting pattern is perpendicular to the long axis of the root, the advantage being the reduction in the number of dentinal tubules exposed at the resected area [3]. Therefore, the retrograde filling is the procedure when an inert and non-toxic material is compacted in the apically created cavity.[4,5]. The Er:YAG laser is the most common wavelength indicated for dental hard tissue preparation. Its natural selectivity offers a significant advantage compared to the conventional hard tissue preparation [6-9].The purpose of this in vitro study was to investigate the quality of Er:YAG laser apical third preparation using Scanning Electron Microscopy (SEM), in comparison with the conventional ultrasonic method.

AIM: The aim of this study is to detect incipient caries and enamel demineralization using laser fluorescence.This serves only as an auxilary aid to identify and to monitor the development of these lesions.

MATERIALS AND METHODS: 6 patients were involved in this study, three females and three male. Each patient underwent a professional cleaning, visual examination of the oral cavity, and then direct inspection using DiagnoCam and DIAGNOdent. After data recording each patient was submitted to retro-alveolar X-ray on teeth that were detected with enamel lesions. All data was collected and analyzed statistically.

RESULTS: Of 36 areas considered in clinically healthy, 24 carious surfaces were found using laser fluorescence, a totally non-invasive method for detecting incipient carious lesions compared with the radiographic examination.

CONCLUSIONS: This method has good applicability for patients because it improves treatment plan by early detection of caries and involves less fear for anxious patients and children.

Objectives: To evaluate the dental anxiety level and the degree of acceptance of laser assisted pedodontic treatments from the children part. Also, we want to underline the advantages of laser use in pediatric dentistry, to make this technology widely used in treating dental problems of our children patients.

Methods: Thirty pediatric dental patients presented in the Department of Pedodontics, University of Medicine and Pharmacy „Victor Babeş”, Timişoara were evaluated using the Wong-Baker pain rating scale, wich was administered postoperatory to all patients, to assess their level of laser therapy acceptance.

Results: Wong-Baker faces pain rating scale (WBFPS) has good validity and high specificity; generally it’s easy for children to use, easy to compare and has good feasibility. Laser treatment has been accepted and tolerated by pediatric patients for its ability to reduce or eliminate pain. Around 70% of the total sample showed an excellent acceptance of laser dental treatment.

Conclusions: Laser technology is useful and effective in many clinical situations encountered in pediatric dentistry and a good level of pacient acceptance is reported during all laser procedures on hard and soft tissues.

Quite recently, we introduced a novel Optical Coherence Tomography (OCT) method, termed as Master Slave OCT (MS-OCT), especially to deliver en-face images. MS-OCT operates like a time domain OCT, selecting signal from a selected depth only while scanning the laser beam across the sample. Time domain OCT allows real time production of an en-face image, although relatively slowly. As a major advance, the Master Slave method allows collection of signals from any number of depths, as required by the user. MS-OCT is an OCT method that does not require resampling of data and can be used to deliver en-face images from several depths simultaneously. However, as the MS-OCT method requires important computational resources, the number of multiple depth en-face images produced in real-time is limited. Here, we demonstrate that taking advantage of the parallel processing feature of the MS-OCT technology by harnessing the capabilities of graphics processing units (GPU)s, information from 384 depth positions is acquired in one raster with real time display of 40 en-face OCT images. These exhibit comparable resolution and sensitivity to the images produced using the traditional Fourier domain based method. The GPU facilitates versatile real time selection of parameters, such as the depth positions of the 40 images out of a set of 384 depth locations, as well as their axial resolution. Here, we present in parallel with the 40 en-face OCT images of a human tooth, a confocal microscopy lookalike image, together with two B-scan OCT images along rectangular directions.

Optical Imaging is being conducted as a therapeutic non-invasive. Many kinds of the light source are selected for this purpose. Recently the oral cancer screening is conducted by using light-induced tissue autofluorescence examination such as several kinds of handheld devices. However, the mechanism of its action is still not clear. Therefore basic experimental research was conducted. One of auto fluorescence Imaging (AFI) device, VELscope^TM and near-infrared (NIR) fluorescence imaging using ICG-labeled antibody as a probe were compared using oral squamous cell carcinoma (OSCC) mouse models. The experiments revealed that intracutaneous tumor was successfully visualized as low density image by VELscope^TM and high density image by NIR image. In addition, VELscope^TM showed higher sensitivity and lower specificity than that of NIR fluorescence imaging and the sensitivity of identification of carcinoma areas with the VELscope^TM was good results. However, further more studies were needed to enhance the screening and diagnostic uses, sensitivity and specificity for detecting malignant lesions and differentiation from premalignant or benign lesions. Therefore, additional studies were conducted using a new developed near infrared (NIR) fluorescence imaging method targeting podoplanine (PDPN) which consists of indocyanine green (ICG)-labeled anti-human podoplanin antibody as a probe and IVIS imaging system or a handy realtime ICG imaging device that is overexpressed in oral malignant neoplasm to improve imaging for detection of early oral malignant neoplasm. Then evaluated for its sensitivity and specificity for detection of oral malignant neoplasm in xenografted mice model and compared with VELscope^TM. The results revealed that ICG fluorescence imaging method and VELscope^TM had the almost the same sensitivity for detection of oral malignant neoplasm. The current topics of optical imaging about oral malignant neoplasm were reviewed.

We present the handheld scanning probes that we have recently developed in our current project for biomedical imaging in general and for Optical Coherence Tomography (OCT) in particular. OCT is an established, but dynamic imagistic technique based on laser interferometry, which offers micrometer resolutions and millimeters penetration depths. With regard to existing devices, the newly developed handheld probes are simple, light and relatively low cost. Their design is described in detail to allow for the reproduction in any lab, including for educational purposes. Two probes are constructed almost entirely from off-the-shelf components, while a third, final variant is constructed with dedicated components, in an ergonomic design. The handheld probes have uni-dimensional (1D) galvanometer scanners therefore they achieve transversal sections through the biological sample investigated - in contrast to handheld probes equipped with bi-dimensional (2D) scanners that can also achieve volumetric (3D) reconstructions of the samples. These latter handheld probes are therefore also discussed, as well as the possibility to equip them with galvanometer 2D scanners or with Risley prisms. For galvanometer scanners the optimal scanning functions studied in a series of previous works are pointed out; these functions offer a higher temporal efficiency/duty cycle of the scanning process, as well as artifact-free OCT images. The testing of the handheld scanning probes in dental applications is presented, for metal ceramic prosthesis and for teeth.

The formation of dental biofilm follows specific mechanisms of initial colonization on the surface, microcolony formation, development of organized three dimensional community structures, and detachment from the surface. The structure of the plaque biofilm might restrict the penetration of antimicrobial agents, while bacteria on a surface grow slowly and display a novel phenotype; the consequence of the latter is a reduced sensitivity to inhibitors. The aim of this study was to evaluate with different optoelectronic methods the morphological characteristics of the dental biofilm. The study was performed on samples from 25 patients aged between 18 and 35 years. The methods used in this study were Spectral Domain Optical Coherence Tomography (SD-OCT) working at 870 nm for in vivo evaluations and Scanning Electron Microscopy (SEM) for validations. For each patient a sample of dental biofilm was obtained directly from the vestibular surface of the teeth's. SD-OCT produced C- and B-scans that were used to generate three dimensional (3D) reconstructions of the sample. The results were compared with SEM evaluations. The biofilm network was dramatically destroyed after the professional dental cleaning. OCT noninvasive methods can act as a valuable tool for the 3D characterization of dental biofilms.

The teeth affected by pathologic attrition can be restored by a minimally invasive approach, using Tizian overlays. In this study we prove the advantages of a fast swept source (SS) OCT system in the evaluation of Tizian overlays placed in an environment characterized by high occlusal forces. 12 maxillary first premolars were extracted and prepared for overlays. The Tizian overlays were subjected to 3000 alternating cycles of thermo-cycling (from -10°C to +50°C) and to mechanical occlusal overloads (at 800 N). A fast SS OCT system was used to evaluate the Tizian overlays before and after the mechanical and thermal straining. The SS (Axsun Technologies, Billerica, MA) has a central wavelength of 1060 nm, sweeping range of 106 nm (quoted at 10 dB) and a 100 kHz line rate. The depth resolution of the system, measured experimentally in air was 10 μm. The imaging system used for this study offers high spatial resolutions in both directions, transversal and longitudinal of around 10 μm, a high sensitivity, and it is also able to acquire entire tridimensional (3D)/volume reconstructions as fast as 2.5 s. Once the full dataset was acquired, rendered high resolutions en-face projections could be produced. Using them, the overlay (i.e., cement) abutment tooth interfaces were remarked both on B-scans/two-dimensional (2D) sections and in the 3D reconstructions. Using the system several open interfaces were possible to detect. The fast SS OCT system thus proves useful in the evaluation of zirconia reinforced composite overlays, placed in an environment characterized by high occlusal forces.

The aim of this study was to evaluate the efficacy of commercial toothpastes containing sodium fluoride (NaF), stannous fluoride (SnF2), or casein phosphopeptides (CPP)-amorphous calcium phosphate (ACP)/NaF regarding their potential to inhibit enamel erosion. Twenty-eight 4×4 mm enamel specimens were randomly allocated into 4 groups (n=7): negative control; Pronamel (NaF); Pro Health (SnF₂/NaF); Mi Paste Plus (CPP-ACP/NaF). Erosive cycles with 0.5% citric acid, 5 times, 3 minutes/day for 7 days were performed. After the first and last cycle of each day, toothpaste slurries were applied for 2 min. The quantitative analysis was accomplished using Contact Profilometry and Optical Coherence Tomography (OCT), complemented by roughness and qualitative scanning electron microscopy (SEM) analysis. OCT and Profilometry analysis showed similar effectiveness in measuring the reduction of mineral loss. A significant increase in the mean roughness values was observed on eroded surface and also on treated surface as revealed by scanning electron microscopy. The use of SnF₂/NaF toothpaste was the most effective method for reducing mineral loss. As quantitative methods, OCT and Contact Profilometry showed no statistical differences. OCT, which was used for this purpose for the first time, has the advantage of being noninvasive, and therefore have the potential for clinical application.

Digital impressions were introduced to overcome some of the obstacles due to traditional impression materials and techniques. The aim of this in vitro study is to compare the accuracy of all ceramic crowns obtained with digital impression and CAD-CAM technology with the accuracy of those obtained with conventional impression techniques. Two groups of 10 crowns each have been considered. The digital data obtained from Group 1 have been processed and the all-ceramic crowns were milled with a CAD/CAM technology (CEREC MCX, Sirona). The all ceramic crowns in Group 2 were obtained with the classical technique of pressing (emax, Ivoclar, Vivadent). The evaluation of the marginal adaptation was performed with Time Domain Optical Coherence Tomography (TD OCT), working at a wavelength of 1300 nm. Tri-dimensional (3D) reconstructions of the selected areas were obtained. Based on the findings in this study, one may conclude that the marginal accuracy of all ceramic crowns fabricated with digital impression and the CAD/CAM technique is superior to the conventional impression technique.

Introduction. Dental ceramics show better biocompatibility and aesthetic properties in dental constructs with regard to metals. However, they also have an insufficient mechanical stability, as well as low resistance limits due to their fragility. Taking into account these aspects, glass infiltrated with ceramic materials such as alumina (i.e., zirconiareinforced ceramics) is being nowadays considered a better material for full fixed partial prostheses (FPPs) than ceramics: the former has a higher mechanical resistance, which makes it more appropriate for restoration areas, where there is an increased mechanical stress. The interest for zirconia is growing due both to its resistance and to the possibility to develop such prostheses using the CAD/CAM technology.

Materials and methods. 24 all ceramic FPPs created with CAD/CAM technology were used. The models were scanned with Zeno Wieland Scanner, a one touch scanning machine which requires between 45-60 s for a full model scan. The scanner provides 3 axis-architecture and automatic data processing. The zirconia infrastructures resulted from milling zirconia green disks in Wieland units, followed by the deposition of ceramic masses and then by burning procedures. All the samples were assessed with a Time Domain Optical Coherence Tomography (TD-OCT) system working at a wavelenght of 1300 nm. Using OCT investigations, material defects were detected in the areas of maximal tension, i.e. the connectors, the oclusal, and the cervical areas. These samples with defects in the above areas have not been considered for the study further on. Finally, the samples were loaded in a MultiTest 5 i Mecmesin system and tested until fracture occurred. The MultiTest 5-i creates tensile and compression forces of up to 5 kN.

Results and discussions. All the test samples survived a dynamic load of 1.2 x 107 cycles and a thermal cycle mixer simulator version; signs of failure in terms of fracture lines were observed in all samples. The average value of the force necessary to break the FPPs obtained from the tests is 1750 N.

Conclusions. Conventional metal-ceramic fixed partial dentures are still considered the standard for edentulous spaces in the posterior region. Therefore, the resistance of metal-ceramic fixed partial dentures has served in this study as a guide for new ceramics tests. All the values from this study conducted in FPP with zirconia frames were much lower than the values reported for metal ceramic fixed partial dentures (i.e., 2500-3000 N), but higher that 1000 N, which is considered the lowest resistance point to be utilized in the rear region of the oral cavity.

Erosion is the progressive loss of tooth substance by chemical processes that do not involve bacterial action. The affected teeth can be restored by using IPS e.max Press “table tops”, which replace the occlusal surfaces. In this study we applied a fast in-house Swept Source Optical Coherence Tomography (SS OCT) system to analyze IPS e.max Press “table tops”. 12 maxillary first premolars have been extracted and prepared for “table tops”. These restorations were subjected to 3000 alternating cycles of thermo-cycling in a range from -10°C to +50°C; mechanical occlusal loads of 200 N were also applied. Using SS OCT we analyze the marginal seal of these restorations, before and after applying the mechanical and thermal strain. The characteristics of the SS OCT system utilized are presented. Its depth resolution, measured in air is 10 μm. The system is able to acquire entire volumetric reconstructions in 2.5 s. From the dataset acquired high resolution en-face projections were also produced. Thus, the interfaces between all ceramic “table tops” and natural teeth were analyzed on the cross-sections (i.e., the B-scans) produced and also on the volumetric (tri-dimensional (3D)) reconstructions, several open interfaces being detected. The study therefore demonstrates the utility of SS OCT for the analysis of lithium disilicate glass ceramic “table tops”.

In clinical dental practice it is often difficult or even impossible to distinguish and control interfacial adhesive defects from adhesive restorations using visual inspection or other traditional diagnostic methods. Nonetheless, non-invasive biomedical imaging methods like Optical Coherence Tomography (OCT) may provide a better view in this diagnostic outline. The aim of this study is to explore evaluations of the marginal adaptation of class I resin composites restorations using Time Domain (TD) OCT. Posterior human teeth have been chosen for this study. The teeth were stored in 0.9% physiological saline solution prior to use. A classical round-shaped class I cavity was prepared and cavities were restored with Charisma Diamond composite by Heraeus Kulzer and using a system of etch and rinse boding. The specimens were subjected to water storage and then to thermo-cycling. Three dimensional (3-D) scans of the restoration were obtained using a TD-OCT system centered at a 1300 nm wavelength. Open marginal adaptation at the interfaces and gaps inside the composite resins materials were identified using the proposed method. In conclusion, OCT has numerous advantages which justify its use for in vitro, as well as for in vivo studies. It can therefore be considered for non-invasive and fast detection of gaps at the restoration interface.

Holography is a well-developed method with a large range of applications, including dentistry. This study uses holographic methods for the study of total dental prosthesis. The issue is that the transformation of wax denture base in polymethylacrylate causes dimensional alterations and retractions in the final dental constructs. These could cause the failure of the stability of the complete denture in the oral cavity. Thus, the aim of this study is to determine and to compare using holography, total prosthesis obtained using three different manufacturing methods: pressing, injection, and polymerization. Each of the three types of dentures thus produced were recorded over the previously wax complete base holographic plates. The dimensional alterations that appear after using the different activation methods were thus determined. The most significant modification was remarked in the custom press technology, while the smallest variations were detected in the injection alternative.

Background: The principal aim of our study was to evaluate digital impressions, taken with spray powder and powderfree scan systems, in order to determine the influence of the dentist’s commitment to training as a critical factor regarding quality.

Material and method: Two digital intraoral impression systems from the same manufacture (Sirona) : Apollo DI and CEREC Omnicam, were used to scan 16 crown preparations on teeth on a typodont maxillary model. Because an Apollo Di intraoral camera is a powder system, an adhesive was applied before using the powder spray. Three groups were used to scan the crown preparations in order to determine coating thickness homogeneity. One group consisted of senior year dental students, a second consisted of prosthodontics residents, and the third consisted of prosthodontics specialists. The same procedure was applied with a CEREC Omnicam intraoral camera, which is a powder-free system. By using the two systems software parameters we were able to determine the scanning precision.

Results: Homogeneity scores for Apollo Di regarding the spray layer was significantly thinner for all dental surfaces in the first group, while the second group had thinner coatings for buccal and distal surfaces. For the third group, the crown preparations were coated more homogeneously than the first two groups. The powder-free system CEREC Omnicam can, to a degree, mask the lack of experience in direct optical impressions by avoiding the poor quality coating, which can lead to defective marginal adaptation of definitive restoration.

Conclusions: The dentist’s lack of experience can be mitigated, and partially avoided, by using powder-free systems. At the same time, the dentist can give more time towards learning how to integrate computerized fabricated restoration into the practice. The commitment to training is a critical factor in the successful integration of the technology. In addition, scanning marginal preparation details needs time in order to develop technical and manual skills.