Skip to main content
Advertisement
Browse Subject Areas
?

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here.

  • Loading metrics

Clinical effects of laser-based cavity preparation on class V resin-composite fillings

  • Markus Heyder ,

    Contributed equally to this work with: Markus Heyder, Stefan Kranz

    Roles Data curation, Investigation, Visualization

    Affiliation Department of Conservative Dentistry and Periodontology, University Hospital, Jena, Germany

  • Bernd Sigusch ,

    Roles Conceptualization, Methodology, Project administration, Supervision, Writing – review & editing

    ‡ BS, CHP and MR also contributed equally to this work.

    Affiliation Department of Conservative Dentistry and Periodontology, University Hospital, Jena, Germany

  • Christoph Hoder-Przyrembel ,

    Roles Conceptualization, Data curation, Formal analysis, Methodology, Validation

    ‡ BS, CHP and MR also contributed equally to this work.

    Affiliation Department of Conservative Dentistry and Periodontology, University Hospital, Jena, Germany

  • Juliane Schuetze,

    Roles Formal analysis, Validation

    Affiliation Department of Fundamental Science, University of Applied Sciences, Jena, Germany

  • Stefan Kranz ,

    Contributed equally to this work with: Markus Heyder, Stefan Kranz

    Roles Data curation, Formal analysis, Visualization, Writing – original draft, Writing – review & editing

    Stefan.Kranz@med.uni-jena.de

    Affiliation Department of Conservative Dentistry and Periodontology, University Hospital, Jena, Germany

  • Markus Reise

    Roles Resources

    ‡ BS, CHP and MR also contributed equally to this work.

    Affiliation Department of Conservative Dentistry and Periodontology, University Hospital, Jena, Germany

Abstract

The aim of the present clinically controlled two-year study was to investigate the influence of laser-based cavity preparation on the long-term performance of Class V resin-composite fillings. Class V non-carious lesions (n = 75) were randomly assigned to two test and one control group. Cavities in both test groups were prepared using an Er,Cr:YSGG laser (Waterlase MD, Biolase, Irvine, California, USA). The device was operated at 3 W (150 mJ, 30 J/cm2), 50% water, 60% air, 30 Hz in H mode. Subsequently, laser-prepared tooth surfaces in test group I (n = 21) were additionally conditioned by acid etching (etch-and-rinse). Laser-prepared cavities of test group II (n = 21) received no additional acid conditioning. After application of an adhesive, all cavities were restored using the resin-composite Venus®. For cavities in the control group (n = 33) conventional diamond burs were used for preparation which was followed by an etch-and-rinse step, too. The fillings were evaluated immediately (baseline) and after 6, 12 and 24 months of wear according to the C-criteria of the USPHS-compatible CPM-index. The results showed that after 24 month of wear, laser-preparation was associated with fillings of high clinical acceptability. Compared to conventional bur-based treatment, laser-based cavity preparation resulted in fillings with high marginal integrity and superior marginal ledge configurations (p = 0.003). Furthermore, laser-preparation combined with additional acid-conditioning (test group I) resulted in fillings with the best marginal integrity and the lowest number in marginal discoloration, especially at the enamel-composite margins (p = 0.044). In addition, total loss of fillings was also less frequently observed in both laser groups as compared to the control. The results clearly demonstrate that laser-based cavity preparation will benefit the clinical long-time performance of Class V resin-composite fillings. Furthermore, additional acid-conditioning after laser preparation is of advantage.

Introduction

In modern day dental practice, the use of lasers is common and often seen as a favourable alternative to conventional treatment methods [17].

Current dental ablative laser systems are based on innovative techniques which enable efficient and secure minimal-invasive hard-tissue preparation [811]. Especially in case of Class V lesions, laser-based cavity preparation already showed favourable characteristics In-vitro [12].

In restorative dentistry, nano-filled resin-composites are preferably used, especially because of their high aesthetic appearance and sufficient clinical performance [1315]. Nevertheless, of all resin-based composite restorations, Class V fillings are still afflicted by the lowest longevity [16]. Clinically, this appears in the formation of marginal gaps, discolorations, increased microleakage, postoperative hypersensitivity, loss of retention and secondary caries [1721]. In addition, occlusal stress shielding and the high degree of dentin sclerosis, especially found among non-carious cervical lesions, are further reasons for Class V filling failure [22].

Thus, to increase retention and the micro-tensile bonding strength, mechanical cavity preparation is recommended prior to any restorative measure [23, 24].

In this context, it was shown that especially in non-carious lesions, laser-based cavity preparation has a positive effect upon the bonding strength of resin-composite fillings [12]. In comparison to traditional bur-based treatment procedures, laser preparation leads to the formation of specific micromorphologic surface patterns which are associated with improved bonding characteristics [25]. In detail, laser treated surfaces are characterized by exposed enamel prisms, wide opened dentinal tubes and the absence of a smear layer [2629].

As already proven by Galafassi et al. in a 12-month clinical trial, laser-based cavity preparation has a positive effect upon the performance of Class I composite restorations [30]. Furthermore, Er:YAG laser-prepared Class V fillings revealed a more sufficient marginal seal on occlusal and gingival margins as compared to conventional bur-cut restorations In-vitro [31].

To date, clinical studies evaluating the long-term outcome of laser-preparation especially in Class V resin-composite restorations are still rare [32].

Therefore, the present clinical trial aimed at investigating the performance of Class V fillings with cavities prepared using an Er,Cr:YSGG solid-state laser in non-carious cervical lesions. The results were compared to the outcome of Class V fillings placed in traditional bur-cut cavities. Since laser-treated tooth surfaces are of rough appearance the need of an additional acid conditioning is still controversially discussed [32, 33]. In this regard, the present study also observed the effect of an additional etch-and-rinse approach on the clinical long-term success of laser-prepared Class V composite restorations, too.

Materials and methods

Patient recruitment

The present study involved a total of 29 patients recruited from the Department of Conservative Dentistry and Periodontology, Jena University Hospital, Germany. Each patient showed at least one non-carious defect in the cervical region with exposed dentin (Fig 1A). Defects in molars were not included in the study. All participants had to be at least 18 years of age. The age distribution ranged in between 22 and 89 years with a mean age of 56.24 years. The study has been approved by the Ethical Committee of the Friedrich Schiller University, Jena, Germany (No. 2013-05/07) and written informed consent of each patient was given prior to any therapy.

thumbnail
Fig 1. Non-carious cervical lesions of teeth 44 and 45 after laser preparation and restoration with Venus® (Heraeus Kulzer, Germany).

Class V resin-composite restauration of a non-carious cervical lesions in premolars (44, 45). (A) Initial lesion. (B) After Er,Cr:YSGG laser-based cavity preparation. (C) Cured and finished resin-composite restauration.

https://doi.org/10.1371/journal.pone.0270312.g001

Teeth with cervical lesions due to caries and teeth intended for denture prosthetics in the nearby future were excluded from the study. Other reasons for exclusion were (i) insufficient oral hygiene (approximal plaque index and bleeding on probing > 30%), (ii) excessive smoking (> 20 cigarettes per day), and/or (iii) the consumption of > 5 cups of coffee or black tea per day.

Within this study, a total of 75 Class V lesions were included. After randomization, the patients were assigned into two test groups and one control group (Table 1):

  1. Test group I: laser cavity preparation followed by etch-and-rinse (L + e&r), n = 21,
  2. Test group II: laser cavity preparation without etch-and-rinse (L–e&r), n = 21,
  3. Control group: cavity preparation using conventional diamond burs, n = 33.

Laser-based cavity preparation

In both test groups laser-based preparation was carried out using an Er,Cr:YSGG laser (Waterlase MD, Biolase, Irvine, California, USA). The device was operated at 3 W (150 mJ, 30 J/cm2), 50% water, 60% air, 30 Hz in H mode. For preparation, a “MG6“sapphire tip with a diameter of 600 μm and a length of 6 mm was used and guided across the tooth surface at distances of 1–1.5 mm, until a laser-typical roughened surface of whitish-opaque appearance was received (Fig 1B). An air/water flow rate of 33 ml/min was applied.

Bur-based cavity preparation

In the control group, conventional bure-based preparation was carried out, following the rules of retentive preparation with bevelled enamel edges. For this purpose, a cylindrical 107 μm diamond bur was used (Komet, Gebr. Brasseler GmbH & Co. KG, Lemgo, Germany) in a contra-angle handpiece 1:5 under constant water cooling (KaVo Dental, Biberach/Riß, Germany). In the marginal region adjacent to the enamel an additional bevel of at least 1 mm of width was prepared, using a flame-shaped 46 μm fine-grain diamond bur (Komet, Gebr. Brasseler GmbH & Co. KG, Lemgo, Germany).

Composite application

Prior to the placement of a restauration, the cervical margin was exposed by means of a retraction cord (Ultrapak®, #0 and #00; Ultradent, South Jordan, USA).

In test group I and in the control group, total etching was performed by applying 37% orthophosphoric acid gel for 15 s on dentin and 30 s on enamel (Total Etch™, Ivoclar Vivadent AG, Schaan, Liechtenstein).

Subsequently, all cavities were treated with Gluma® Solid Bond P and Gluma® Solid Bond S (Heraeus Kulzer GmbH, Hanau, Germany) as advised by the manufacturer followed by light curing for 40 s each (Translux® PowerBlue®, Heraeus Kulzer GmbH, Hanau, Germany).

Subsequently, the cavities were filled with the resin-composite Venus® (Heraeus Kulzer GmbH, Hanau, Germany), which was applied in 2 mm thick layers, with each being light-cured for 40 s. For finishing the restoration flame-shaped fine and extra fine diamond finishing burs (Komet, Gebr. Brasseler GmbH & Co. KG, Lemgo, Germany; red ring 46 μm, yellow ring 25 μm) were used. The final finish was applied using silicone polishers (Busch & Co. KG, Engelskirchen, Germany, yellow, blue) (Fig 1C).

Clinical evaluation

All fillings were evaluated by a trained and blinded independent professional using a 2.5x magnification head-worn loupe (EYEMAG Smart sports, Bajohr, Carl Zeiss Meditec AG, Jena, Germany).

Tactile and visual clinical evaluation of the fillings was carried out immediately after application (baseline) and after 6, 12, and 24 months of wear, with the aid of a mirror and a fine dental probe (# 3A, Hu-Friedy Mfg. Co., Inc., Chicago, Illinois, USA).

The qualitative assessment of each filling was performed according to the C-criteria of the US Public Health Service compatible CPM index [13, 14, 3436]. In brief, the C-criteria comprise a clinical evaluation of the anatomical form, marginal integrity, marginal ledge condition, degree of marginal discoloration and the overall clinical acceptance by 4 different grades with ‘code 0’ best and ‘code 3’ worst value. All criteria were assessed separately for the enamel-composite and the dentine-composite filling margins.

Statistical analysis

Statistical data analysis was performed using SPSS® version 19 for Windows (SPSS Inc., Chicago, IL, USA).

Changes to all restorations starting at baseline up to the final inspection were examined by means of the Friedman test. The Kruskal-Wallis test was used for the global statistical comparison of the methods. Significance between and within the groups was tested by applying the Mann-Whitney U-test.

The level of significance was set to p < 0.05.

Results

During the study period, 53 cervical restorations out of 75 fillings placed at baseline (70,7%) could be evaluated throughout the entire observation time, while 22 fillings could not be re-evaluated because of total (n = 8) or partial loss (n = 12), or because patients did not show up to the recall appointment (n = 2).

As shown in Table 2, all 75 fillings displayed correct anatomical forms at baseline (Code 0). Throughout the 2-year examination period, partial changes in the filling contour (Code 1) were detected among all groups.

thumbnail
Table 2. Results evaluated according to the C-criteria “anatomical form”.

https://doi.org/10.1371/journal.pone.0270312.t002

Total loss of fillings (Code 3) occurred most frequently within the control group. In detail, after 6 months of wear 4 restorations were lost completely, followed by another two fillings after 12 months and one after 24 months.

In test group I only one filling was lost completely (Code 3) after 12 months of wear, whereas in test group II none of the placed restorations were entirely lost during the 24-month study period.

Besides that, partial lost (Code 2) was documented within the control group at all examination points (n = 4), while in test group I partial lost occurred after 6 and 24 months of wear (n = 5) and in test group II after 12 months (n = 3), only.

All teeth remained vital throughout the entire examination period.

For the criteria “anatomical form”, no significant differences were determined among all evaluation points.

The integrity of the filling margins was examined separately for the enamel and dentin margins (Table 3). At all examination times, fillings in the test groups showed less insufficient margins adjacent to the enamel (Code 1 and 2) as compared to the control. After one year this result turned up to be significant (p = 0.003). Between both test-groups no significant difference was observed (p = 0.513).

thumbnail
Table 3. Evaluation of Class V restorations according to the C-criteria “marginal integrity”, “marginal ledge”, “marginal discoloration” of the CPM index.

https://doi.org/10.1371/journal.pone.0270312.t003

At the composite-dentin margins similar results were obtained. After one year of wear in test group I filling margins in the region adjacent to the dentin were explorable at a distinctly lower rate compared to the control group. After 24 months of wear, only one filling in test group II was rated with code 3 in the region adjacent to the dentin. Overall, in regard to the criteria “marginal integrity” no significance differences were detected at all evaluation points. The obtained p-values ranged in between p = 0.797 for 6 month and p = 0.438 for 12 month.

Similar results were documented for the marginal ledge assessment. Here again, in both test groups fewer ledge formation in the region adjacent to the enamel were observed compared to the control group. These results turned out to be significant after one year of wear (p = 0.003). In test group I most of the fillings were not afflicted by marginal ledge formation (Code 0). Whereas among the control-group positive ledges were more frequently detected.

Insufficient marginal ledge formation adjacent to dentin (apical region) were also less frequently observed in both test groups as compared to the control. Notably, in all groups the number of insufficient marginal ledges increased by time (Table 3).

Discoloration of the filling margins were detected among all groups most frequently in the region adjacent to the enamel. After two years of wear, fillings in test group I showed the lowest rates in discolorations (Code 1 and 2) compared to test group II and the control group, which was rated to be significant (p = 0.044).

In summary, in both laser test groups the highest number in clinically acceptable fillings were detected after 6, 12 and 24 months of wear (Fig 2).

thumbnail
Fig 2. Clinical acceptance.

The diagram shows the results assessed for the C-criteria “clinical acceptance” for all groups after 6, 12 and 24 months of wear.

https://doi.org/10.1371/journal.pone.0270312.g002

Discussion

The present In-vivo-study clearly demonstrates, that laser-based cavity preparation has a positive impact on the long-term performance of Class V resin-composite restorations. Moreover, fillings placed in laser-prepared cavities that were additionally conditioned with phosphoric acid showed the best clinical results.

In the present study an Er,Cr:YSGG laser operated at 3 W (150 mJ, 30 J/cm2), 50% water, 60% air, 30 Hz in H mode was used for preparation, equipped with a “MG6“sapphire tip of 600 μm in diameter and 6 mm in length. The sapphire tip was guided in a distance of app. 1 mm over the tooth surface until a rough surface of whitish-opaque appearance was received.

As already observed by various authors, laser based preparation leads to dentin and enamel surfaces with superior bonding characteristics [12, 29, 37].

Microscopic studies have revealed that laser-ablation results in the formation of specific irregular micro-retentive surface patterns that are characterized by exposed enamel prisms, wide opened dentinal tubes and the absence of a smear layer [11, 2629, 38]. Further, it was shown that in comparison to bur-cut surfaces, a more sufficient hybrid layer with a pronounced formation of resin tags can be established on laser-prepared dentin surfaces [39, 40]. In this context, the mentioned characteristics might probably be seen as reasons for the superior performance of laser-prepared fillings in the present study.

The clinical performance of the placed resin-composite restorations was evaluated according to the C-criteria of the US Public Health Service compatible CPM-index. The index enables a standardized clinical assessment which includes an evaluation of the anatomical form, marginal integrity, marginal ledge configuration, degree of marginal discoloration and overall clinical acceptance [13, 14, 3436].

In detail, as shown in the present clinical study, after one year of wear excellent results were documented especially for the criteria ‘marginal integrity’ with the highest values examined for the enamel-composite margins. In this context it was proven in a recent In-vivo study of our group that especially the integrity of the filling margin has a strong effect upon the survival rate of resin-composite fillings [14].

Furthermore, the present study revealed that insufficient ledge formation was less frequently detected among fillings placed in laser-cut cavities, too. The occurrence of positive and also negative ledges was observed to a higher extent in the control group in which conventional burs were used for preparation. Similar to these results, previous findings of our group showed that negative marginal ledges are formed to a much higher rate within the first period of wear [13, 14].

In regard to the criteria “marginal discoloration” the present study showed, that discolorations especially at the composite enamel margins were found to a significant higher rate in the control group as compared to the laser groups. Further, throughout the entire study period the highest number in fillings without discolorations were detected in test group I (laser preparation in combination with etch-and-rinse).

The results are in line with previous findings obtained from In-vitro studies which confirm that compared to bur-based treatment, laser preparation is associated with improved bonding properties and less marginal discoloration [41, 42].

Overall, in the present study the highest number in clinically correct fillings was detected among both laser groups. Similar results were described by Hamidi et al. who also reported on superior effects of laser-based cavity preparation In-vivo [43].

Besides filling preparation, ablative dental lasers can be used in other treatment fields, such as caries removal or endodontic therapy, too [17, 22, 4446]. But, especially in case of non-carious cervical lesions, laser preparation can be seen as a preferable alternative to conventional bur-based treatment procedures.

The present study showed that conventional preparation was associated with high numbers in fillings that were completely lost. In detail, only one filling was lost completely in test group I, whereas 7 fillings were totally lost in the bur-treated control group. In addition, none of the restorations placed at baseline were lost completely in test group II. It is interesting to mention, that Preussker et al. reported similar results for Class V filling after bur-based preparation [47].

However, there are still controversial discussions about the efficiency of laser-preparation and the right choice of adhesive systems used in combination with or without acid pre-treatment [32, 33, 48]. Since laser treatment leads to rough and uneven surfaces without smear layer, application of self-etch adhesive systems is advised. Nevertheless, it seems to be of advantage when laser-cut tooth surfaces are additionally conditioned with phosphoric acid [32]. In this regard, Kiryk et al. clearly showed that Er:YAG laser-based preparation in combination with conventional acid conditioning results in improved adhesion properties [27].

As witnessed in the present study, too, pre-treatment with 37% orthophosphoric acid resulted in superior performance rates. Both, after one and two years of wear, the share of clinically correct fillings was higher in test group I (laser-preparation followed by acid-conditioning) as compared to test group II (laser-preparation without etch-and-rinse).

Best results were especially obtained for the enamel-composite margins. In this regard, it becomes obvious that laser-preparation followed by acid etching is associated with the best bonding effects. According to the classification of Silverstone, type I etching pattern are afflicted with the most superior adhesive properties [49, 50]. As a result of Er:YAG laser conditioning, similar structures compared to Silverstone’s type III patterns are received which are characterized by enamel prisms with damaged peripheral and central regions [27, 51, 52].

The results of the present study are in line with other authors that also reported on improved bonding properties when orthophosphoric acid was used to pre-treat laser prepared tooth surfaces [33, 5355].

The present study concludes that laser-preparation in combination with an additional step of acid-etching will clearly improve the long-term performance of Class V resin-composite restorations.

Conclusions

The present clinical study reveals, that Class V composite fillings placed in non-carious lesions after Er,Cr;YSGG laser-based cavity preparation shows significantly better clinical long-term results as compared to restorations that are associated with conventional burr-based cavity preparation. Moreover, surface pre-conditioning with an etching agent after laser preparation will further improve the clinical performance.

Acknowledgments

We acknowledge the department of Fundamental Science, University of Applied Sciences, Jena, Germany for their great support.

References

  1. 1. Eick S, Meier I, Spoerlé F, Bender P, Aoki A, Izumi Y, et al. In Vitro-Activity of Er:YAG Laser in Comparison with other Treatment Modalities on Biofilm Ablation from Implant and Tooth Surfaces. PLoS One. 2017;12(1):e0171086. Epub 20170126. pmid:28125700; PubMed Central PMCID: PMC5268770.
  2. 2. García-Sanz V, Paredes-Gallardo V, Bellot-Arcís C, Mendoza-Yero O, Doñate-Buendía C, Montero J, et al. Effects of femtosecond laser and other surface treatments on the bond strength of metallic and ceramic orthodontic brackets to zirconia. PLoS One. 2017;12(10):e0186796. Epub 20171019. pmid:29049418; PubMed Central PMCID: PMC5648233.
  3. 3. García-Sanz V, Paredes-Gallardo V, Mendoza-Yero O, Carbonell-Leal M, Albaladejo A, Montiel-Company JM, et al. The effects of lasers on bond strength to ceramic materials: A systematic review and meta-analysis. PLoS One. 2018;13(1):e0190736. Epub 20180102. pmid:29293633; PubMed Central PMCID: PMC5749860.
  4. 4. Ionescu AC, Brambilla E, Azzola F, Ottobelli M, Pellegrini G, Francetti LA. Laser microtextured titanium implant surfaces reduce in vitro and in situ oral biofilm formation. PLoS One. 2018;13(9):e0202262. Epub 20180907. pmid:30192766; PubMed Central PMCID: PMC6128459.
  5. 5. Kranz S, Huebsch M, Guellmar A, Voelpel A, Tonndorf-Martini S, Sigusch BW. Antibacterial photodynamic treatment of periodontopathogenic bacteria with indocyanine green and near-infrared laser light enhanced by Trolox(TM). Lasers Surg Med. 2015;47(4):350–60. Epub 20150308. pmid:25753989.
  6. 6. Voos AC, Kranz S, Tonndorf-Martini S, Voelpel A, Sigusch H, Staudte H, et al. Photodynamic antimicrobial effect of safranine O on an ex vivo periodontal biofilm. Lasers Surg Med. 2014;46(3):235–43. Epub 20140129. pmid:24473989.
  7. 7. Sarmadi R, Andersson EV, Lingström P, Gabre P. A Randomized Controlled Trial Comparing Er:YAG Laser and Rotary Bur in the Excavation of Caries—Patients’ Experiences and the Quality of Composite Restoration. Open Dent J. 2018;12:443–54. Epub 20180531. pmid:29988202; PubMed Central PMCID: PMC5997848.
  8. 8. Subramaniam P, Pandey A. Assessment of Microleakage of a Composite Resin Restoration in Primary Teeth Following Class III Cavity Preparation Using Er, Cr: YSGG laser: An In Vitro Study. J Lasers Med Sci. 2016;7(3):172–6. Epub 20160718. pmid:28144438; PubMed Central PMCID: PMC5262484.
  9. 9. Tao S, Li L, Yuan H, Tao S, Cheng Y, He L, et al. Erbium Laser Technology vs Traditional Drilling for Caries Removal: A Systematic Review with Meta-Analysis. J Evid Based Dent Pract. 2017;17(4):324–34. Epub 20170518. pmid:29197434.
  10. 10. Özlek E, Neelakantan P, Akkol E, Gündüz H, Uçar AY, Belli S. Dentinal Tubule Penetration and Dislocation Resistance of a New Bioactive Root Canal Sealer Following Root Canal Medicament Removal Using Sonic Agitation or Laser-Activated Irrigation. Eur Endod J. 2020;5(3):264–70. pmid:33353924; PubMed Central PMCID: PMC7881371.
  11. 11. Deeb JG, Bencharit S, Dalal N, Abdulmajeed A, Grzech-Leśniak K. Using Er:YAG laser to remove lithium disilicate crowns from zirconia implant abutments: An in vitro study. PLoS One. 2019;14(11):e0223924. Epub 20191105. pmid:31689289; PubMed Central PMCID: PMC6830778.
  12. 12. Sun X, Ban J, Sha X, Wang W, Jiao Y, Wang W, et al. Effect of Er,Cr:YSGG Laser at Different Output Powers on the Micromorphology and the Bond Property of Non-Carious Sclerotic Dentin to Resin Composites. PLoS One. 2015;10(11):e0142311. Epub 20151106. pmid:26544034; PubMed Central PMCID: PMC4636353.
  13. 13. Dietz W, Montag R, Kraft U, Walther M, Sigusch BW, Gaengler P. Longitudinal micromorphological 15-year results of posterior composite restorations using three-dimensional scanning electron microscopy. J Dent. 2014;42(8):959–69. Epub 20140506. pmid:24814136.
  14. 14. Montag R, Dietz W, Nietzsche S, Lang T, Weich K, Sigusch BW, et al. Clinical and Micromorphologic 29-year Results of Posterior Composite Restorations. J Dent Res. 2018;97(13):1431–7. Epub 20180801. pmid:30067429.
  15. 15. Jandt KD, Sigusch BW. Future perspectives of resin-based dental materials. Dent Mater. 2009;25(8):1001–6. Epub 20090329. pmid:19332352.
  16. 16. Hayes M, Brady P, Burke FM, Allen PF. Failure rates of class V restorations in the management of root caries in adults—a systematic review. Gerodontology. 2016;33(3):299–307. Epub 20141114. pmid:25395000.
  17. 17. Chandra PV, Harikumar V, Ramkiran D, Krishna MJ, Gouda MV. Microleakage of class V resin composites using various self-etching adhesives: an in vitro study. J Contemp Dent Pract. 2013;14(1):51–5. Epub 20130101. pmid:23579893.
  18. 18. Jacker-Guhr S, Ibarra G, Oppermann LS, Lührs AK, Rahman A, Geurtsen W. Evaluation of microleakage in class V composite restorations using dye penetration and micro-CT. Clin Oral Investig. 2016;20(7):1709–18. Epub 20151205. pmid:26637997.
  19. 19. Lodovici E, Reis A, Geraldeli S, Ferracane JL, Ballester RY, Rodrigues Filho LE. Does adhesive thickness affect resin-dentin bond strength after thermal/load cycling? Oper Dent. 2009;34(1):58–64. pmid:19192838.
  20. 20. Lopes Coutinho TC, Almeida Tostes M. Comparison of microleakage of different margin types around Class V resin restorations in primary teeth. Eur J Paediatr Dent. 2013;14(3):246–51. pmid:24295013.
  21. 21. Wood I, Jawad Z, Paisley C, Brunton P. Non-carious cervical tooth surface loss: a literature review. J Dent. 2008;36(10):759–66. Epub 20080725. pmid:18656296.
  22. 22. Lee WC, Eakle WS. Stress-induced cervical lesions: review of advances in the past 10 years. J Prosthet Dent. 1996;75(5):487–94. pmid:8709012
  23. 23. Mahn E, Rousson V, Heintze S. Meta-Analysis of the Influence of Bonding Parameters on the Clinical Outcome of Tooth-colored Cervical Restorations. J Adhes Dent. 2015;17(5):391–403. pmid:26525003.
  24. 24. Stewardson D, Creanor S, Thornley P, Bigg T, Bromage C, Browne A, et al. The survival of Class V restorations in general dental practice: part 3, five-year survival. Br Dent J. 2012;212(9):E14. Epub 20120511. pmid:22576479.
  25. 25. Verma M, Kumari P, Gupta R, Gill S, Gupta A. Comparative evaluation of surface topography of tooth prepared using erbium, chromium: Yttrium, scandium, gallium, garnet laser and bur and its clinical implications. J Indian Prosthodont Soc. 2015;15(1):23–8. pmid:26929482; PubMed Central PMCID: PMC4762284.
  26. 26. Kiryk J, Matys J, Grzech-Leśniak K, Dominiak M, Małecka M, Kuropka P, et al. SEM Evaluation of Tooth Surface after a Composite Filling Removal Using Er:YAG Laser, Drills with and without Curettes, and Optional EDTA or NaOCl Conditioning. Materials (Basel). 2021;14(16). Epub 20210810. pmid:34442991; PubMed Central PMCID: PMC8401124.
  27. 27. Kiryk J, Matys J, Nikodem A, Burzyńska K, Grzech-Leśniak K, Dominiak M, et al. The Effect of Er:YAG Laser on a Shear Bond Strength Value of Orthodontic Brackets to Enamel-A Preliminary Study. Materials (Basel). 2021;14(9). Epub 20210421. pmid:33919108; PubMed Central PMCID: PMC8122582.
  28. 28. Freitas PM, Navarro RS, Barros JA, de Paula Eduardo C. The use of Er:YAG laser for cavity preparation: an SEM evaluation. Microsc Res Tech. 2007;70(9):803–8. pmid:17576132.
  29. 29. Wang JH, Yang K, Zhang BZ, Zhou ZF, Wang ZR, Ge X, et al. Effects of Er:YAG laser pre-treatment on dentin structure and bonding strength of primary teeth: an in vitro study. BMC Oral Health. 2020;20(1):316. Epub 20201110. pmid:33172456; PubMed Central PMCID: PMC7653740.
  30. 30. Galafassi D, Scatena C, Galo R, Curylofo-Zotti FA, Corona SAM, Borsatto MC. Clinical evaluation of composite restorations in Er:YAG laser-prepared cavities re-wetting with chlorhexidine. Clin Oral Investig. 2017;21(4):1231–41. Epub 20160704. pmid:27376544.
  31. 31. Baghalian A, Nakhjavani YB, Hooshmand T, Motahhary P, Bahramian H. Microleakage of Er:YAG laser and dental bur prepared cavities in primary teeth restored with different adhesive restorative materials. Lasers Med Sci. 2013;28(6):1453–60. Epub 20121108. pmid:23135785.
  32. 32. Silva AC, Melo P, Ferreira JC, Oliveira T, Gutknecht N. Adhesion in Dentin Prepared with Er,Cr:YSGG Laser: Systematic Review. Contemp Clin Dent. 2019;10(1):129–34. pmid:32015655; PubMed Central PMCID: PMC6975010.
  33. 33. Fattah T, Kazemi H, Fekrazad R, Assadian H, Kalhori KA. Er,Cr:YSGG laser influence on microleakage of class V composite resin restorations. Lasers Med Sci. 2013;28(5):1257–62. Epub 20120926. pmid:23010956.
  34. 34. Gaengler P, Hoyer I, Montag R. Clinical evaluation of posterior composite restorations: the 10-year report. J Adhes Dent. 2001;3(2):185–94. pmid:11570687.
  35. 35. Gaengler P, Hoyer I, Montag R, Gaebler P. Micromorphological evaluation of posterior composite restorations—a 10-year report. J Oral Rehabil. 2004;31(10):991–1000. pmid:15387840.
  36. 36. Pflaum T, Kranz S, Montag R, Güntsch A, Völpel A, Mills R, et al. Clinical long-term success of contemporary nano-filled resin composites in class I and II restorations cured by LED or halogen light. Clin Oral Investig. 2018;22(4):1651–62. Epub 20171028. pmid:29080928.
  37. 37. Jhingan P, Sachdev V, Sandhu M, Sharma K. Shear Bond Strength of Self-etching Adhesives to Cavities Prepared by Diamond Bur or Er,Cr:YSGG Laser and Effect of Prior Acid Etching. J Adhes Dent. 2015;17(6):505–12. pmid:26734674.
  38. 38. Grzech-Leśniak K, Bencharit S, Dalal N, Mroczka K, Deeb JG. In Vitro Examination of the Use of Er:YAG Laser to Retrieve Lithium Disilicate Crowns from Titanium Implant Abutments. J Prosthodont. 2019;28(6):672–6. Epub 20190612. pmid:31125150.
  39. 39. Yu DG, Kimura Y, Kinoshita J, Matsumoto K. Morphological and atomic analytical studies on enamel and dentin irradiated by an erbium, chromium:YSGG laser. J Clin Laser Med Surg. 2000;18(3):139–43. pmid:11799978.
  40. 40. Aranha AC, De Paula Eduardo C, Gutknecht N, Marques MM, Ramalho KM, Apel C. Analysis of the interfacial micromorphology of adhesive systems in cavities prepared with Er,Cr:YSGG, Er:YAG laser and bur. Microsc Res Tech. 2007;70(8):745–51. pmid:17394200.
  41. 41. Aranha AC, Turbino ML, Powell GL, Eduardo Cde P. Assessing microleakage of class V resin composite restorations after Er:YAG laser and bur preparation. Lasers Surg Med. 2005;37(2):172–7. pmid:16037969.
  42. 42. Yazici AR, Baseren M, Gorucu J. Clinical comparison of bur- and laser-prepared minimally invasive occlusal resin composite restorations: two-year follow-up. Oper Dent. 2010;35(5):500–7. pmid:20945740.
  43. 43. Hamidi MM, Ercan E, Dülgergil Ç T, Çolak H. Evaluation of the clinical success of class I cavities prepared by an Er:YAG laser-5-year follow-up study. Lasers Med Sci. 2015;30(7):1895–901. Epub 20150414. pmid:25869241.
  44. 44. Dias-Moraes MC, Castro PAA, Pereira DL, Ana PA, Freitas AZ, Zezell DM. Assessment of the preventive effects of Nd:YAG laser associated with fluoride on enamel caries using optical coherence tomography and FTIR spectroscopy. PLoS One. 2021;16(7):e0254217. Epub 20210707. pmid:34234361; PubMed Central PMCID: PMC8263272.
  45. 45. Jardim Del Monaco R, Tavares de Oliveira M, de Lima AF, Scarparo Navarro R, Zanetti RV, de Fátima Teixeira da Silva D, et al. Influence of Nd:YAG laser on the penetration of a bioceramic root canal sealer into dentinal tubules: A confocal analysis. PLoS One. 2018;13(8):e0202295. Epub 20180822. pmid:30133509; PubMed Central PMCID: PMC6104986.
  46. 46. Su D, Hu X, Wang D, Cui T, Yao R, Sun H. Semiconductor laser irradiation improves root canal sealing during routine root canal therapy. PLoS One. 2017;12(9):e0185512. Epub 20170928. pmid:28957407; PubMed Central PMCID: PMC5619785.
  47. 47. Preussker S, Pöschmann M, Kensche A, Natusch I, Koch R, Klimm W, et al. Three-year prospective clinical performance of a one-step self-etch adhesive and a nanofiller hybrid resin composite in Class V lesions. Am J Dent. 2014;27(2):73–8. pmid:25000664.
  48. 48. Oznurhan F, Olmez A. Morphological analysis of the resin-dentin interface in cavities prepared with Er,Cr:YSGG laser or bur in primary teeth. Photomed Laser Surg. 2013;31(8):386–91. Epub 20130716. pmid:23859751.
  49. 49. Lopes GC, Thys DG, Klaus P, Oliveira GM, Widmer N. Enamel acid etching: a review. Compend Contin Educ Dent. 2007;28(1):18–24; quiz 5, 42. pmid:17278628.
  50. 50. Risnes S, Li C. Obtaining scratch-free specimens of dental enamel prepared by sectioning, grinding, polishing, and acid etching for scanning electron microscopy. Microsc Res Tech. 2018;81(9):997–1003. Epub 20181020. pmid:30341967.
  51. 51. Hossain M, Nakamura Y, Tamaki Y, Yamada Y, Murakami Y, Matsumoto K. Atomic analysis and knoop hardness measurement of the cavity floor prepared by Er,Cr:YSGG laser irradiation in vitro. J Oral Rehabil. 2003;30(5):515–21. pmid:12752933.
  52. 52. Visuri SR, Gilbert JL, Wright DD, Wigdor HA, Walsh JT Jr., Shear strength of composite bonded to Er:YAG laser-prepared dentin. J Dent Res. 1996;75(1):599–605. pmid:8655766.
  53. 53. Bertrand MF, Semez G, Leforestier E, Muller-Bolla M, Nammour S, Rocca JP. Er:YAG laser cavity preparation and composite resin bonding with a single-component adhesive system: relationship between shear bond strength and microleakage. Lasers Surg Med. 2006;38(6):615–23. pmid:16671101.
  54. 54. Rechmann P, Bartolome N, Kinsel R, Vaderhobli R, Rechmann BMT. Bond strength of etch-and-rinse and self-etch adhesive systems to enamel and dentin irradiated with a novel CO(2) 9.3 μm short-pulsed laser for dental restorative procedures. Lasers Med Sci. 2017;32(9):1981–93. Epub 20170815. pmid:28812169.
  55. 55. Marotti J, Geraldo-Martins VR, Bello-Silva MS, de Paula Eduardo C, Apel C, Gutknecht N. Influence of etching with erbium, chromium:yttrium-scandium-gallium-garnet laser on microleakage of class V restoration. Lasers Med Sci. 2010;25(3):325–9. Epub 20081115. pmid:19011950.