Fissure Caries Inhibition with Solea CO 2 -9.3µm short-pulsed laser - A randomized, single blind, prospective, split mouth controlled, clinical trial.

BACKGROUND:LASERs continue to gain popularity in dentistry. There continues to be new literature on the efficacy of CO2 LASERs in treating caries, increasing bond strengths and preventing acid demineralization. Recently, a pilot study has been conducted that showed increased resistance to acid demineralization after treatment with short-pulsed CO2 LASER.OBJECTIVES:The aim of the study is to assess if the use of the new CO2 - 9.3μm short-pulsed laser in addition to fluoride therapy allows rendering occlusal pit and fissures caries resistant in comparison to fluoride therapy alone in participants in a randomized, single blind, prospective, split mouth controlled, clinical trial. The fissure mineral loss will be quantified by visual exams with the International Caries Detection and Assessment System (ICDAS II), SOPROLIFE daylight and blue fluorescence, and by DIAGNOdent Laser Light-induced Fluorescence.METHODS:This study was carried out in three appointments. The first involved screening, consenting and assenting, recording of initial values, treatment with carbonate ablation settings of the Solea CO2 LASER, and fluoride varnish treatment. The second appointment consisted of a routine examination and prophylaxis, cleaning of the study surfaces, collection of data values and application of fluoride varnish. If, at the second appointment, any of the enrolled surfaces had progressed to an ICDAS value of 3 or greater, they participant was terminated from the study and the necessary treatment was rendered. The third appointment consisted of a routine examination and prophylaxis, cleaning of the study surfaces, collection of data values, placement of sealants or minimally invasive resin restorations on the treatment surfaces, and application of fluoride varnish. RESULTS:Sixty patients were recruited to participate in the study: 32 females and 28 males. The average age of the patients when they were enrolled and treated was 13.15 years old. The attrition rate thus far has been 8.3%; five subjects were lost. Three were male and two were female. Two subjects returned for the 6-month follow up but moved out of the country prior to the 12-month follow-up. Two subjects were unable to be contacted after the baseline appointment. One subject had sealants placed over the treatment and control teeth in the pre-doctoral clinic prior to the 6-month follow up appointment. Thus far, 10 participants have had at least one location on one tooth progress to ICDAS 3 or greater, forcing them to be terminated from the study pool. Four subjects had at least one ICDAS 3 or greater value at the 6-month follow-up appointment. Six subjects presented with at least one ICDAS 3 or greater value at the 12-month follow-up appointment. Total, 229 patients were screened for this study, and 60 were enrolled, a 26% enrollment. The maxillary molars were treated slightly more often than mandibular – 32 participants had in maxillary molars enrolled and 28 participants had the mandibular molars enrolled. At the time of submission of this thesis the study was still blinded as there were still participants requiring 12-month follow up appointments. When data collection is completed in December of 2019 and unblinding occurs this thesis and specifically the results and conclusion sections will be amended to contain the obtained data.CONCLUSION:The distribution of male and female participants was nearly equal, indicating that there seems to be generalized equal acceptance of laser treatment from both male and female patients. The distribution between the upper and lower arches as location for treatment were also nearly equal