title: Artificial caries removal and inhibition of artificial secondary caries by pulsed CO2 laser irradiation.
abstract: OBJECTIVE
  To investigate the inhibition of artifical secondary caries around restorations placed after removal of artificial caries by pulsed CO2 laser irradiation and by mechanical means.
  
  
  METHODS
  Beveled cavities were prepared mechanically on the facial surfaces of extracted human molars. Each cavity was subsequently exposed to an artificial caries (demineralizing) solution (pH 5.0) for 7 d to generate a demineralized zone approximately 100-200 microns thick on the cavity surface. The artificial carious/demineralized zones of the cavities were removed by a pulsed CO2 laser operating at a wavelength of 9.3 microns with pulse duration of 100 microseconds and an irradiation intensity of 5 J/cm2. Artificial control caries were removed mechanically with a carbide bur in a slow speed handpiece. The cavities were slightly undercut and restored with a resin-based composite without etching and bonding and the restored teeth were subjected to pH cycling solutions for 10 d as follows: Demineralization solution, pH 4.5 for 6 hrs, followed by remineralization solution, pH 7.0 for 18 hrs. Cycled teeth were sectioned through the restorations and the resulting lesions were analyzed in thin section using polarized light and Knoop microhardness.
  
  
  RESULTS
  Mean microhardness delta Z values, indicating mineral loss were: 549 (SD 191) for control, and 140 (SD 127) N = 11. This difference is significant with t = 5.543 and P = 0.000 (Paired t-test). Caries penetration: Control side--231 microns (SD 71), Laser treated side: 123 microns (SD 79) N = 6. This difference is significant with t = 5.198 and P = 0.003 (Paired t-test). The results show that the laser treatment not only removed artificial caries, but also inhibited decalcification of the cavity wall in a subsequent artificial caries challenge by as much as 81% compared to control samples. No etching and bonding was used in this pilot study, which might have influenced the results. Future studies should address the inhibition effect of the laser treatment as compared to adhesive techniques, fluoride treatments and fluoride release restorative materials.
  
  
  CONCLUSIONS
  Caries removal by a pulsed lambda = 9.3 microns CO2 laser produces a cavity surface morphology with marked resistance to artificial secondary caries as compared to mechanical removal.
authors.affiliation: Department of Operative Dentistry, Dental School, Okayama University, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Konishi
authors.forename: D
authors.initials: D
authors.lastname: Fried
authors.forename: M
authors.initials: M
authors.lastname: Staninec
authors.forename: J D
authors.initials: JD
authors.lastname: Featherstone
mesh_terms: D002245:Carbon Dioxide; D003731:Dental Caries / Q000532:radiotherapy*; D003737:Dental Cavity Preparation / Q000295:instrumentation*; D006801:Humans; D053685:Laser Therapy; D008954:Models, Biological; D008963:Molar; D010865:Pilot Projects; D055502:Secondary Prevention; D017001:Tooth Demineralization / Q000517:prevention & control*
chemical_list: D002245:Carbon Dioxide