In Vivo Caries-like lesion prevention with argon laser: pilot study

Richard J. Blankenaua, Randall W. Ellisa, Gary H. Westermana, G. Lynn Powell*b

acreighton University, Omaha, NE 68178

bUniversity of Utah, Salt Lake City, UT 84132

ABSTRACT
In vitro research has demonstrated the ability of argon laser irradiation to reduce demineralization or loss of tooth
structure. This clinical pilot study was conducted to investigate the effectiveness of this procedure in vivo. Using the
Ogaard model ofproducing demineralization, the experimental teeth were irradiated with argon laser (primarily 488 nm
and 514 urn) of 250 mW, approximately 12 i/cm2 fluence, prior to banding. Polarized light evaluation of the sectioned,
extracted teeth showed reduced demineralization in the experimental teeth as compared to the bilateral control teeth.
Lower powered argon laser irradiation significantly reduced demineralization clinically.

Keywords: Argon Laser, demineralization, in vivo, human

1. INTRODUCTION
Previous studies have recorded the reduction of caries-like lesions or demineralization of extracted human teeth that have
been irradiated with CO2 laser energies. Stem, et. al., in 1972, described the reduction of subsurface lesions following
Co2 laser irradiation.1 Since then others have reported that the CO2 laser of the appropriate wavelength reduced
demineralization in enamel,2'3 showed a slowing of enamel initial dissolution rates,4 reduced occiusal surface
demineralization5 and was effective in both pulsed and continuous wave mode.6 By adding a chemical inhibitor to the
lasing procedure and/or controlling the wavelength and power even greater reduction in caries-like lesions was reported.79

The argon laser has also been reported effective in reducing loss of tooth structure or size of subsurface lesions on both
enamel and root surfaces.''2 More recent studies demonstrated that combined with fluoride surface treatment or in the
demineralization solution even further reduction in loss oftooth structure or size oflesion occurred.'3'5

Dr. John Featherstone describes demineralization caused by acid attack as the precursor to dental caries.'6 When
sufficient mineral has been removed from the enamel, the structure collapses and we have cavity formation (dental caries)
that can be seen visually or by radiograph. Therefore, ifwe can prevent demineralization, we can reduce or prevent dental
caries (tooth decay).
This in vivo study was conducted to evaluate the clinical effectiveness of the argon laser to prevent or reduce
demineralization ofenamel and thereby prevent or reduce caries formation.

2. MATERIALS AND METHODS

Bicusids scheduled for orthodontic extraction and utilizing a modified orthodontic band as described by Ogaard and
Rolla were used to develop demineralization of human enamel in vivo. The protocol was approved by the Institutional
Review Board (IRB) of Creighton University.

Four orthodontic patients scheduled for extraction of bilateral bicuspids participated in the pilot study. After initial
screening and health history, the patients had full mouth impressions taken and study models made. Following the
visit, pre-formed orthodontic bands were fitted to the models, modified by welding two metal posts to the inner surface
ofthe band to create a crevice between the band and buccal surface ofthe tooth for plaque accumulation (Fig. 1). At the
second appointment (approximately one week later) the experimental tooth was lased with argon laser irradiation,
approximately 12 J/cm2 fluence by an HGM Model 5 argon laser (primarily 488 nm, and 514 nm), using 250 mW, 10
seconds and approximately a 5 mm diameter beam. The control tooth on the opposite side of the mouth was not lased.
The modified orthodontic bands were then cemented in place on both the experimental and the control tooth.

In Lasers in Dentistry VI, John D. B. Featherstone, Peter Rechmann, Daniel Fried,

242 Editors, Proceedings of SPIE Vol. 3910 (2000) 101 7-2661/00/$1 5.00

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 Five weeks from the time of band placement, the teeth were extracted by an oral surgeon at Creighton University.
Following extraction and removal of the band, the teeth (both control and experimental) were sectioned longitudinally
through the demmeralization lesions and prepared for polarized light evaluation. The sections were imbibed with water
and photomicrographs were taken. Mean surface zone and body of the lesion depths were obtained using a Visilog 5. 1 . I
image analysis software (Noesis Vision Inc., Quebec, Canada) and taking measurements along the inner aspect of the
surface zone and body ofthe lesion. Because ofthe research design, the body ofthe lesion depths from the bilateral lased
and control teeth from the same patient were compared providing the statistical difference in demineralization for that
patient.

3. RESULTS
The argon laser irradiation significantly reduced the demineralization of the enamel under the experimental conditions.
The teeth that were lased prior to band placement averaged a 29.1% reduction in lesion depth as compared to the unlased
teeth (Table 1). The reduction ranged from 23.4% for pair #4, to 33% in pair #1 . Measurements were taken from the
photomicrographs ofthe teeth (Fig. 2, 3).
The reduction in depth of demineralization (lesion depth) was significant for the lased samples as compared to the
unlased controls.

4. DISCUSSION
Although the effects of laser irradiation on dental caries and tooth structure were explored some 30 years ago,'82 the risk
of thermal damage to the adjacent hard tissue and pulp was such that much of the research was abandoned. However
with improved laser technology, a number of different types of lasers with varying tissue penetration and energy levels
have been developed2' . Currently a number of lasers which emit different wavelengths and varied energy levels have been
adapted for use in dentistry22. One of these is the argon laser (emitting primarily 476, 488, and 514 nm) currently
cleared by the FDA for clinical use in photopolymerization of light-activated materials, oral soft tissue surgery, bleaching
of teeth, and are used clinically by practitioners as an adjunct to periodontal therapy, for pulpotomies, and root canal
therapy. Several reports have been published on the in vitro success of the argon laser to reduce the loss of tooth
structure or demineralization10'5 but not in vivo. This study is the first in vivo report of successfully reducing the
amount of demineralization clinically with the argon laser or any laser in the United States. The argon laser was chosen
for use because of success in vitro in reducing demineralization, safety of use has been established by research and
clearance by the FDA for these powers on tooth structure for other purposes.

The Ogaard and Rolla model'7 was chosen because of its ability to develop demineralization in a short period of time
and at no risk to the patient since the tooth was scheduled for extraction.

5. CONCLUSION
These first clinical results are consistent with laboratory results that low power laser irradiation (250 mW-approximately
12 J/cm2) can significantly reduce demineralization of enamel.

ACKNOWLEDGMENTS
Supported in part by University of Utah Laser Institute and Creighton University Health Futures Foundation.

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*
Correspondence: Email: DentalEd@hsc.utah.edu; Telephone: 801-581-8951; Fax: 801-585-6485.

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 Table 1. Demineralization of Bilateral Paired Bicuspids
Depth of Lesions in mm

Pair I Control Tooth .17959

Lased Tooth .11976
.05983 33% decrease
Pair 2 Control Tooth .3 13622
Lased Tooth .2 13445
.100 177 31.9% decrease
Pair 3 Control Tooth .178528
Lased Tooth .1282 18
.503 10 28.1% decrease
Pair 4 Control Tooth .154 163
Lased Tooth .118004
.36159 23.4A decrease

Range 23.4-33%
Average Decrease 29.1%

FIG.1 Creation of a crevice for plaque accumulation.

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 FIG. 2 Control group (no treatment) at 5 seeks.

FIC. 3 FperinentaI group treated with argon Iaer for 10 seconds at 250 at 5 seeks.

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