Thermal and microstructural effects of nanosecond pulsed Nd:YAG laser irradiation on tooth root surface

Plaque, calculus and altered cementum removal by scaling and root planing is a fundamental procedure in periodontal treatment. However, the residual smear layer contains cytotoxic and inflammatory mediators which adversely affect healing. Chemical smear layer removal is also problematic. In previous investigations effective smear layer removal was achieved using long pulsed irradiation at 1.06 μ. However, laser irradiation was not adequate as an alternative to scaling and root planing procedures and concurrent temperature rises exceeded thermal thresholds for pulpal and periodontal safety. It was the aim of this study to determine whether nanosecond pulsed irradiation at 1.06 μ could be used as an alternative or an adjunct to scaling and root planing. Sixty freshly extracted teeth were divided as follows: 5 control, 5 root planed only, 25 irradiated only, 25 root planed and irradiated. Irradiation was performed at fluences of 0.5 - 2.7 J/cm2, total energy densities of 12 - 300 J/cm2, frequencies of 2 - 10 Hz using the Medlite (Continuum) laser. Irradiation-induced thermal events were recorded using a thermocouple within the root canal and a thermal camera to monitor surface temperatures. SEM demonstrated effective smear layer removal with minimal microstructural effects. Surface temperatures increased minimally (< 3 C) at all parameters, intrapulpal temperature rises remained below 4 C at 2 and 5 Hz, F < 0.5 J/cm2. Without prior scaling and root planing, laser effects did not provide an adequately clean root surface