Effects of Two Remineralizing Agents in Combination with Er:YAG and CO2 Laser Irradiation on Microhardness of Demineralized Enamel: A Preliminary In Vitro Study
Abstract
Objectives: This study assessed the effects of two remineralizing agents namely MI Paste Plus containing casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACFP) and Remin Pro containing hydroxyapatite, fluoride and xylitol (HFX) with/without erbium-doped yttrium aluminium garnet (Er:YAG) and CO2 laser irradiation on demineralized enamel microhardness.
Materials and Methods: In this in vitro study, 70 sound human premolars were mesiodistally sectioned, demineralized at a pH of 4.6 for 8 hours, and randomly divided into 7 remineralization groups (n=10): of (I) MI Paste Plus (CPP-ACFP), (II) Remin Pro (HFX), (III) MI Paste Plus+CO2 laser (0.7 W power, 50 Hz), (IV) Remin Pro+CO2 laser, (V) MI Paste Plus+Er:YAG laser (1 W power, 10 Hz), (VI) Remin Pro+Er:YAG laser, and (VII) negative control. The Vickers hardness number of specimens was then measured. The groups were compared by one-way ANOVA and Tukey’s test (α=0.05).
Results: The mean microhardness was 319.8±49.9, 325.3±44.6, 359.4±35.7, 296.4±33.7, 319.9±58.1, 358.9±28.4, and 240.0±41.6 kg/mm2 in groups 1 to 7, respectively. The difference in microhardness was significant among the groups (P<0.0001). Pairwise comparisons revealed significant differences in microhardness between all groups (P≤0.03) except between groups 1 and 2, 1 and 5, 2 and 5, and 3 and 6 (P>0.05).
Conclusion: Both Remin Pro (containing HFX) and MI Paste Plus (containing CPP-ACFP) can cause enamel remineralization. MI Paste Plus+CO2 laser irradiation and Remin Pro+Er:YAG laser irradiation were significantly more effective than the application of each remineralizing agent alone.
1. Dadgar S, Heydarian A, Sobouti F, Goli H, Rakhshan V, Heidari M. Effects of probiotic and fluoride mouthrinses on Streptococcus mutans in dental plaque around orthodontic brackets: A preliminary explorative randomized placebo-controlled clinical trial. Dent Res J. 2021;18:74.
2. Valizadeh S, Kamangar S, Nekoofar M, Behroozibakhsh M, Shahidi Z. Comparison of Dentin Caries Remineralization with Four Bioactive Cements. Eur J Prosthodont Restor Dent. 2022;30(3):223-9.
3. Huang GJ, Roloff-Chiang B, Mills BE, Shalchi S, Spiekerman C, Korpak AM, et al. Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. Am J Orthod Dentofacial Orthop. 2013 Jan;143(1):31-41.
4. Rafiei E, Fadaei Tehrani P, Yassaei S, Haerian A. Effect of CO(2) laser (10.6 μm) and Remin Pro on microhardness of enamel white spot lesions. Lasers Med Sci. 2020 Jul;35(5):1193-203.
5. Kasraei S, Kasraei P, Valizadeh S, Azarsina M. Rehardening of Eroded Enamel with CPP-ACFP Paste and CO2 Laser Treatment. BioMed Res.Int. 2021 2021/07/15;2021:3304553.
6. Heravi F, Ahrari F, Mahdavi M, Basafa S. Comparative evaluation of the effect of Er: YAG laser and low level laser irradiation combined with CPP-ACPF cream on treatment of enamel caries. J Clin Exp Dent. 2014;6(2):e121.
7. Loiola ABA, Aires CP, Curylofo-Zotti FA, Rodrigues Junior AL, Souza-Gabriel AE, Corona SAM. The Impact of CO2 Laser Treatment and Acidulated Phosphate Fluoride on Enamel Demineralization and Biofilm Formation. J Lasers Med Sci. 2019 Summer;10(3):200-6.
8. Luk K, Zhao IS, Yu OY, Zhang J, Gutknecht N, Chu CH. Effects of 10,600 nm Carbon Dioxide Laser on Remineralizing Caries: A Literature Review. Photobiomodul Photomed Laser Surg. 2020 Feb;38(2):59-65.
9. Soltanimehr E, Bahrampour E, Yousefvand Z. Efficacy of diode and CO2 lasers along with calcium and fluoride-containing compounds for the remineralization of primary teeth. BMC Oral Health. 2019 Jun;19(1):121.
10. Bröchner A, Christensen C, Kristensen B, Tranæus S, Karlsson L, Sonnesen L, et al. Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate. Clin.Oral Investig. 2011;15(3):369-73.
11. Srinivasan N, Kavitha M, Loganathan S. Comparison of the remineralization potential of CPP–ACP and CPP–ACP with 900 ppm fluoride on eroded human enamel: an in situ study. Arch. Oral Biol. 2010;55(7):541-4.
12. Wu G, Liu X, Hou Y. Analysis of the effect of CPP-ACP tooth mousse on enamel remineralization by circularly polarized images.Angle Orthod. 2010;80(5):933-8.
13. Kamath U, Sheth H, Mullur D, Soubhagya M. The effect of Remin Pro® on bleached enamel hardness: An in-vitro study. Indian J Dent Res. 2013;24(6):690.
14. Khamverdi Z, Kordestani M, Panahandeh N, Naderi F, Kasraei S. Influence of CO2 Laser Irradiation and CPPACP Paste Application on Demineralized Enamel Microhardness. J.lasers Med.Sci. 2018;9(2):144.
15. Grenby T, Andrews A, Mistry M, Williams R. Dental caries-protective agents in milk and milk products: investigations in vitro. J Dent. 2001;29(2):83-92.
16. Ahrari F, Poosti M, Motahari P. Enamel resistance to demineralization following Er: YAG laser etching for bonding orthodontic brackets. Dent Res J. 2012;9(4):472.
17. Poosti M, Ahrari F, Moosavi H, Najjaran H. The effect of fractional CO 2 laser irradiation on remineralization of enamel white spot lesions. Lasers Med Sci. 2014;29(4):1349-55.
18. Bevilácqua FM, Zezell DM, Magnani R, Da Ana PA, de Paula Eduardo C. Fluoride uptake and acid resistance of enamel irradiated with Er: YAG laser. Lasers Med Sci. 2008;23(2):141-7.
19. Geraldo-Martins VR, Lepri CP, Palma-Dibb RG. Influence of Er, Cr: YSGG laser irradiation on enamel caries prevention. Lasers Med Sci. 2013;28(1):33-9.
20. Miresmaeili A, Farhadian N, Rezaei-Soufi L, Saharkhizan M, Veisi M. Effect of carbon dioxide laser irradiation on enamel surface microhardness around orthodontic brackets. Am J Orthod Dentofacial Orthop. 2014;146(2):161-5.
21. Ahrari F, Mohammadipour H-S, Hajimo-menian L, Fallah-Rastegar A. The effect of diode laser irradiation associated with photoab-sorbing agents containing remineralizing materials on microhardness, morphology and chemical structure of early enamel caries. J Clin Exp Dent. 2018;10(10):e955-e62.
22. Farhadian N, Rezaei-Soufi L, Jamalian SF, Farhadian M, Tamasoki S, Malekshoar M, et al. Effect of CPP-ACP paste with and without CO2 laser irradiation on demineralized enamel microhardness and bracket shear bond strength. Dental Press J Orthod. 2017 Jul-Aug;22(4):53-60.
23. Anusavice K. Mechanical properties of dental materials. Phillip’s science of dental materials.12th ed.university of mishigan,W.B.Saunders, 1996; Chapter 4;457:493.
24. Şakar-Deliormanli A, Güden M. Microha-rdness and fracture toughness of dental materials by indentation method. J. Biomed. Mater. Res. - B Appl. Biomater. 2006;76(2):257-64.
25. Diaz-Arnold A, Wistrom D, Swift Jr E. Topical fluoride and glass ionomer microhardness. Am J Dent. 1995;8(3):134-6.
26. Yassaei S, Aghili H, Shahraki N, Safari I. Efficacy of erbium-doped yttrium aluminum garnet laser with casein phosphopeptide amorphous calcium phosphate with and without fluoride for remineralization of white spot lesions around orthodontic brackets. Eur J Dent. 2019;12(02):210-6.
27. Jahandideh Y, Falahchai M, Pourkhalili H. Effect of Surface Treatment With Er:YAG and CO2 Lasers on Shear Bond Strength of Polyether Ether Ketone to Composite Resin Veneers. J Lasers Med Sci. 2020 Spring;11(2):153-9.
28. Heravi F, Ahrari F, Tanbakuchi B. Effect-iveness of MI Paste Plus and Remin Pro on remineralization and color improvement of postorthodontic white spot lesions. Dent Res J (Isfahan). 2018 Mar-Apr;15(2):95-103.
29. Cochrane N, Saranathan S, Cai F, Cross K, Reynolds E. Enamel subsurface lesion remineralisation with casein phosphopeptide stabilised solutions of calcium, phosphate and fluoride. Caries Res. 2008;42(2):88-97.
30. Memarpour M, Shafiei F, Rafiee A, Soltani M, Dashti MH. Effect of hydroxyapatite nanoparticles on enamel remineralization and estimation of fissure sealant bond strength to remineralized tooth surfaces: an in vitro study. BMC Oral Health. 2019 May 28;19(1):92.
31. Cardoso CA, Cassiano LP, Costa EN, Souza ESCM, Magalhaes AC, Grizzo LT, et al. Effect of xylitol varnishes on remineralization of artificial enamel caries lesions in situ. J Dent. 2016 Jul;50:74-8.
32. Valizadeh S, Rahimi Khub M, Chiniforush N, Kharazifard MJ, Hashemikamangar SS. Effect of Laser Irradiance and Fluoride Varnish on Demine-ralization Around Dental Composite Restorations. J Lasers Med Sci. 2020 Fall;11(4):450-5.
33. Jordão MC, Forti GM, Navarro RS, Freitas PM, Honório HM, Rios D. CO2 laser and/or fluoride enamel treatment against in situ/ex vivo erosive challenge. J Appl Oral Sci. 2016 May-Jun;24(3):223-8.
34. Silva C, Mantilla T, Engel Y, Tavares J, Freitas P, Rechmann P. The effect of CO2 9.3 μm short-pulsed laser irradiation in enamel erosion reduction with and without fluoride applications-a randomized, controlled in vitro study. Lasers Med Sci. 2020 Jul;35(5):1213-1222.
35. Takate V, Kakade A, Bheda P, Dighe K, Rathore NS, Chauhan NS. Assessment of Inhibition of Mineral Loss from Human Tooth Enamel by Carbon Dioxide Laser and 1.23% Acidulated Phosphate Fluoride. J Int Soc Prev Community Dent. 2019 Jan-Feb;9(1):47-54.
36. Asl-Aminabadi N, Najafpour E, Samiei M, Erfanparast L, Anoush S, Jamali Z, et al. Laser-Casein phosphopeptide effect on remineralization of early enamel lesions in primary teeth. J Clin Exp Dent. 2015;7(2):e261-e7.
37. Nair AS, Kumar RK, Philip ST, Ahameed SS, Punnathara S, Peter J. A Comparative Analysis of Caries Inhibitory Effect of Remineralizing Agents on Human Enamel Treated With Er:YAG Laser: An In-vitro Atomic Emission Spectrometry Analysis. J Clin Diagn Res 2016;10(12):ZC10-ZC3.
38. Hossain M, Nakamura Y, Kimura Y, Yamada Y, Ito M, Matsumoto K. Caries-preventive effect of Er:YAG laser irradiation with or without water mist. J Clin Laser Med Surg. 2000 Apr;18(2):61-5.
2. Valizadeh S, Kamangar S, Nekoofar M, Behroozibakhsh M, Shahidi Z. Comparison of Dentin Caries Remineralization with Four Bioactive Cements. Eur J Prosthodont Restor Dent. 2022;30(3):223-9.
3. Huang GJ, Roloff-Chiang B, Mills BE, Shalchi S, Spiekerman C, Korpak AM, et al. Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. Am J Orthod Dentofacial Orthop. 2013 Jan;143(1):31-41.
4. Rafiei E, Fadaei Tehrani P, Yassaei S, Haerian A. Effect of CO(2) laser (10.6 μm) and Remin Pro on microhardness of enamel white spot lesions. Lasers Med Sci. 2020 Jul;35(5):1193-203.
5. Kasraei S, Kasraei P, Valizadeh S, Azarsina M. Rehardening of Eroded Enamel with CPP-ACFP Paste and CO2 Laser Treatment. BioMed Res.Int. 2021 2021/07/15;2021:3304553.
6. Heravi F, Ahrari F, Mahdavi M, Basafa S. Comparative evaluation of the effect of Er: YAG laser and low level laser irradiation combined with CPP-ACPF cream on treatment of enamel caries. J Clin Exp Dent. 2014;6(2):e121.
7. Loiola ABA, Aires CP, Curylofo-Zotti FA, Rodrigues Junior AL, Souza-Gabriel AE, Corona SAM. The Impact of CO2 Laser Treatment and Acidulated Phosphate Fluoride on Enamel Demineralization and Biofilm Formation. J Lasers Med Sci. 2019 Summer;10(3):200-6.
8. Luk K, Zhao IS, Yu OY, Zhang J, Gutknecht N, Chu CH. Effects of 10,600 nm Carbon Dioxide Laser on Remineralizing Caries: A Literature Review. Photobiomodul Photomed Laser Surg. 2020 Feb;38(2):59-65.
9. Soltanimehr E, Bahrampour E, Yousefvand Z. Efficacy of diode and CO2 lasers along with calcium and fluoride-containing compounds for the remineralization of primary teeth. BMC Oral Health. 2019 Jun;19(1):121.
10. Bröchner A, Christensen C, Kristensen B, Tranæus S, Karlsson L, Sonnesen L, et al. Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate. Clin.Oral Investig. 2011;15(3):369-73.
11. Srinivasan N, Kavitha M, Loganathan S. Comparison of the remineralization potential of CPP–ACP and CPP–ACP with 900 ppm fluoride on eroded human enamel: an in situ study. Arch. Oral Biol. 2010;55(7):541-4.
12. Wu G, Liu X, Hou Y. Analysis of the effect of CPP-ACP tooth mousse on enamel remineralization by circularly polarized images.Angle Orthod. 2010;80(5):933-8.
13. Kamath U, Sheth H, Mullur D, Soubhagya M. The effect of Remin Pro® on bleached enamel hardness: An in-vitro study. Indian J Dent Res. 2013;24(6):690.
14. Khamverdi Z, Kordestani M, Panahandeh N, Naderi F, Kasraei S. Influence of CO2 Laser Irradiation and CPPACP Paste Application on Demineralized Enamel Microhardness. J.lasers Med.Sci. 2018;9(2):144.
15. Grenby T, Andrews A, Mistry M, Williams R. Dental caries-protective agents in milk and milk products: investigations in vitro. J Dent. 2001;29(2):83-92.
16. Ahrari F, Poosti M, Motahari P. Enamel resistance to demineralization following Er: YAG laser etching for bonding orthodontic brackets. Dent Res J. 2012;9(4):472.
17. Poosti M, Ahrari F, Moosavi H, Najjaran H. The effect of fractional CO 2 laser irradiation on remineralization of enamel white spot lesions. Lasers Med Sci. 2014;29(4):1349-55.
18. Bevilácqua FM, Zezell DM, Magnani R, Da Ana PA, de Paula Eduardo C. Fluoride uptake and acid resistance of enamel irradiated with Er: YAG laser. Lasers Med Sci. 2008;23(2):141-7.
19. Geraldo-Martins VR, Lepri CP, Palma-Dibb RG. Influence of Er, Cr: YSGG laser irradiation on enamel caries prevention. Lasers Med Sci. 2013;28(1):33-9.
20. Miresmaeili A, Farhadian N, Rezaei-Soufi L, Saharkhizan M, Veisi M. Effect of carbon dioxide laser irradiation on enamel surface microhardness around orthodontic brackets. Am J Orthod Dentofacial Orthop. 2014;146(2):161-5.
21. Ahrari F, Mohammadipour H-S, Hajimo-menian L, Fallah-Rastegar A. The effect of diode laser irradiation associated with photoab-sorbing agents containing remineralizing materials on microhardness, morphology and chemical structure of early enamel caries. J Clin Exp Dent. 2018;10(10):e955-e62.
22. Farhadian N, Rezaei-Soufi L, Jamalian SF, Farhadian M, Tamasoki S, Malekshoar M, et al. Effect of CPP-ACP paste with and without CO2 laser irradiation on demineralized enamel microhardness and bracket shear bond strength. Dental Press J Orthod. 2017 Jul-Aug;22(4):53-60.
23. Anusavice K. Mechanical properties of dental materials. Phillip’s science of dental materials.12th ed.university of mishigan,W.B.Saunders, 1996; Chapter 4;457:493.
24. Şakar-Deliormanli A, Güden M. Microha-rdness and fracture toughness of dental materials by indentation method. J. Biomed. Mater. Res. - B Appl. Biomater. 2006;76(2):257-64.
25. Diaz-Arnold A, Wistrom D, Swift Jr E. Topical fluoride and glass ionomer microhardness. Am J Dent. 1995;8(3):134-6.
26. Yassaei S, Aghili H, Shahraki N, Safari I. Efficacy of erbium-doped yttrium aluminum garnet laser with casein phosphopeptide amorphous calcium phosphate with and without fluoride for remineralization of white spot lesions around orthodontic brackets. Eur J Dent. 2019;12(02):210-6.
27. Jahandideh Y, Falahchai M, Pourkhalili H. Effect of Surface Treatment With Er:YAG and CO2 Lasers on Shear Bond Strength of Polyether Ether Ketone to Composite Resin Veneers. J Lasers Med Sci. 2020 Spring;11(2):153-9.
28. Heravi F, Ahrari F, Tanbakuchi B. Effect-iveness of MI Paste Plus and Remin Pro on remineralization and color improvement of postorthodontic white spot lesions. Dent Res J (Isfahan). 2018 Mar-Apr;15(2):95-103.
29. Cochrane N, Saranathan S, Cai F, Cross K, Reynolds E. Enamel subsurface lesion remineralisation with casein phosphopeptide stabilised solutions of calcium, phosphate and fluoride. Caries Res. 2008;42(2):88-97.
30. Memarpour M, Shafiei F, Rafiee A, Soltani M, Dashti MH. Effect of hydroxyapatite nanoparticles on enamel remineralization and estimation of fissure sealant bond strength to remineralized tooth surfaces: an in vitro study. BMC Oral Health. 2019 May 28;19(1):92.
31. Cardoso CA, Cassiano LP, Costa EN, Souza ESCM, Magalhaes AC, Grizzo LT, et al. Effect of xylitol varnishes on remineralization of artificial enamel caries lesions in situ. J Dent. 2016 Jul;50:74-8.
32. Valizadeh S, Rahimi Khub M, Chiniforush N, Kharazifard MJ, Hashemikamangar SS. Effect of Laser Irradiance and Fluoride Varnish on Demine-ralization Around Dental Composite Restorations. J Lasers Med Sci. 2020 Fall;11(4):450-5.
33. Jordão MC, Forti GM, Navarro RS, Freitas PM, Honório HM, Rios D. CO2 laser and/or fluoride enamel treatment against in situ/ex vivo erosive challenge. J Appl Oral Sci. 2016 May-Jun;24(3):223-8.
34. Silva C, Mantilla T, Engel Y, Tavares J, Freitas P, Rechmann P. The effect of CO2 9.3 μm short-pulsed laser irradiation in enamel erosion reduction with and without fluoride applications-a randomized, controlled in vitro study. Lasers Med Sci. 2020 Jul;35(5):1213-1222.
35. Takate V, Kakade A, Bheda P, Dighe K, Rathore NS, Chauhan NS. Assessment of Inhibition of Mineral Loss from Human Tooth Enamel by Carbon Dioxide Laser and 1.23% Acidulated Phosphate Fluoride. J Int Soc Prev Community Dent. 2019 Jan-Feb;9(1):47-54.
36. Asl-Aminabadi N, Najafpour E, Samiei M, Erfanparast L, Anoush S, Jamali Z, et al. Laser-Casein phosphopeptide effect on remineralization of early enamel lesions in primary teeth. J Clin Exp Dent. 2015;7(2):e261-e7.
37. Nair AS, Kumar RK, Philip ST, Ahameed SS, Punnathara S, Peter J. A Comparative Analysis of Caries Inhibitory Effect of Remineralizing Agents on Human Enamel Treated With Er:YAG Laser: An In-vitro Atomic Emission Spectrometry Analysis. J Clin Diagn Res 2016;10(12):ZC10-ZC3.
38. Hossain M, Nakamura Y, Kimura Y, Yamada Y, Ito M, Matsumoto K. Caries-preventive effect of Er:YAG laser irradiation with or without water mist. J Clin Laser Med Surg. 2000 Apr;18(2):61-5.
| Issue | Vol 21 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v21i11.15223 | |
| Keywords | ||
| Lasers Gas Lasers Solid-State Casein Phosphopeptide-Amorphous Calcium Phosphate Nanocomplex Hydroxyapatites Sodium Fluoride Tooth Remineralization | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mapar M, Gholizadeh S, Moalemnia M. Effects of Two Remineralizing Agents in Combination with Er:YAG and CO2 Laser Irradiation on Microhardness of Demineralized Enamel: A Preliminary In Vitro Study. Front Dent. 2024;21.
