10.59987/ads/2016.1-2.24-28
Aim. To verify the tolerance of children aged between 3 and 8 years, having class I caries and treated with Er:YAG laser in association with a new selfadhesive flowable resin in comparison with a highspeed diamond bur and a conventional flowable resin treatment.
Methods. A group of 80 healthy children (43 males and 37 females) ranging in age from 3 to 8 years, who had been diagnosed with at least one active occlusal non-cavitated superficial carious lesions in first or second deciduous molars, were selected for the present study. They were divided in 4 groups: group A: Class I occlusal cavities prepared using an Er:YAG laser and a self-adhesive flowable resin; Group B: Class I occlusal cavities prepared using an Er:YAG laser and a conventional flowable resin; Group C: Class I occlusal cavities prepared using a high-speed diamond bur and a self-adhesive flowable resin; Group D: Class I occlusal cavities prepared using a high-speed diamond bur and a conventional flowable resin. Before and after the treatments the patient tolerance was tested with the modified Wong-Baker pain level scale.
Results. In the first group, the tolerance rate was 95% with 0 score (no hurt) for 19 patients; in Group D, the tolerance rate was 75%. Just one child of group D experienced hurting worst because of non cooperative patient.
Conclusion. From these results it emerged that, although the limits of the study, Er:Yag laser in association with self-adhering composite, is very effective in pediatric dentistry and is a good treatment option especially for non cooperative patients.
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Annali di stomatologia
pediatric dentistry
Pediatric patients tolerance: a comparative study about using of Er:YAG laser and self-adhesive flowable composite for treatment of primary decayed teeth
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Original Article
2022-08-11
2022-08-11
2016-06-01
2023-12-04
24-28
Ann Stomatol (Roma)
A. Polimeni
2016
10.59987/ads/2016.1-2.24-28
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1971-1441
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pediatric dentistry
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Pediatric patients tolerance: a comparative study about using of Er:YAG laser and self-adhesive flowable composite for treatment of primary decayed teeth
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                                                                                                    Original article



    Pediatric patients tolerance: a comparative study
    about using of Er:YAG laser and self-adhesive
    flowable composite for treatment of primary




                                                                                                                 i
    decayed teeth




                                                                                                               al
    Iole Vozza, DDs, PhD                                    sociation with self-adhering composite, is very ef-




                                                                                                n
    Daniela Mari, DDS                                       fective in pediatric dentistry and is a good treat-
    Edoardo Pacifici, DDS, PhD                              ment option especially for non cooperative pa-




                                                                                             io
    Valeria Luzzi, DDS, PhD                                 tients.
    Gaetano Ierardo, DDS, PhD
    Gian Luca Sfasciotti, MD, DDS                           Key words: Er:YAG laser, occlusal cavities, self-




                                                                az
    Antonella Polimeni, MD, DDS                             adhesive flowable resin, pediatric tolerance, pedi-
                                                            atric dentistry.

    Pediatric Dentistry Division, Oral and Maxillo-facial




                                                              rn
    Sciences Department, “Sapienza” University of Rome      Introduction

                                                            Minimal invasive dentistry has been promoted with
    Corresponding author:                                   the development of new adhesive materials so to pre-




                                                            te
    Iole Vozza Department of Oral and maxillo-facial Sci-   serve healthy tooth tissue. It has allowed to complete
    ences Sapienza University of Rome                       smaller preparations by minimizing the requirement
    Via Caserta 6                                    In     for retention and resistance form (1). Therefore, alter-
    00161 Rome                                              native methods, such as lasers, have been suggest-
    E-mail: iole.vozza@uniroma1.it                          ed for caries cavity preparation. Lasers have been
                                                            used in dentistry for more than 20 years (2). Erbium:
                                                            Yttrium- Aluminum Garnet (Erbium:YAG) lasers offers
    Summary
                                          ni
                                                            an alternative to conventional bur preparation with
                                                            minimal tissue loss thanking to its 0.8mm spot beam
    Aim. To verify the tolerance of children aged be-       (3, 4). Erbium:Yag lasers emits energy in the wave-
    tween 3 and 8 years, having class I caries and          length of 2.94 μm and is well absorbed by all biologi-
                                 io

    treated with Er:YAG Laser in association with a         cal tissues, including enamel and dentin (5). Once
    new self-adhesive flowable resin in comparison          light from the laser is absorbed, it is converted to
    with a high-speed diamond bur and a convention-         heat. The overheated water vaporizes and causes
                          iz


    al flowable resin treatment. Methods. A group of        micro-explosions of tooth fragments without the risk
    80 healthy children (43 male and 37 female) rang-       of micro- and macrofractures, which have been ob-
    ing in age from 3 to 8 years, who had been diag-        served when conventional rotating instruments are
             Ed




    nosed with at least one active occlusal non-cavi-       used (6). So it is very effective for enamel and dentin
    tated superficial carious lesions in first or second    etching, caries removal and cavity preparation of pri-
    deciduous molars, were selected for the present         mary and permanent teeth (3, 7-9). It determines a
    study. They were divided in 4 groups: group A:          reduction of patient discomfort according to the ab-
    Class I occlusal cavities prepared using an             sence of contact between rotary instruments and
    Er:YAG laser and a self-adhesive flowable resin;        tooth that allows an atraumatic treatment without
 IC




    Group B: Class I occlusal cavities prepared using       noise, pressure and vibration (6). Then reduced need
    an Er:YAG laser and a conventional flowable             for local anesthesia takes advantage for collaboration
    resin; Group C: Class I occlusal cavities prepared      and tolerance of patients, above all for pediatric pa-
    using a high-speed diamond bur and a self-adhe-         tients (10). It has been found that laser irradiated sur-
C




    sive flowable resin; Group D: Class I occlusal          faces show a rough, clean surface without smear lay-
    cavities prepared using a high-speed diamond            er covering bur prepared cavities. This could be more
    bur and a conventional flowable resin. Before and       favorable for the adhesion of restorative materials
    after the treatments the patient tolerance was          (10-11). Actually flowable resin composites are the
@




    tested with the modified Wong-Baker pain level          most used materials due to their fluid injectability and
    scale. Results. In the first group, the tolerance       non-stickiness characteristics (12). Recently, new
    rate was 95% with 0 score (no hurt) for 19 pa-          self-adhering flowable resins have been developed.
    tients; in Group D, the tolerance rate was 75%.         They have shown greater usefulness in uncoopera-
    Just one child of group D experienced hurting           tive patients. Yazici et al. have also found in vitro that
    worst because of non cooperative patient. Con-          Laser treatment increased the dentin bonding values
    clusion. From these results it emerged that, al-        of the self-adhesive flowable resin (13). The aim of
    though the limits of the study, Er:Yag laser in as-     this study was to verify the tolerance of children aged

    24                                                                        Annali di Stomatologia 2016;VII (1-2): 24-28
    Pediatric patients tolerance: a comparative study about using of Er:YAG laser and self-adhesive flowable composite for
    treatment of primary decayed teeth

    between 3 and 8 years, having class I caries and              and dried for 5 seconds, leaving the dentin slightly
    treated with Er:YAG Laser in association with a new           moist. All the flowable resin composites were applied
    self-adhesive flowable resin in comparison with a             according to the manufacturer’s recommendations.
    high-speed diamond bur and a conventional flowable            For the conventional flowable resin the adhesive
    resin treatment.                                              used (Optibond Solo Plus, Kerr, Orange, CA, USA)




                                                                                                                    i
                                                                  was applied onto the dentin surface according to the




                                                                                                                  al
                                                                  manufacturer’s instructions (Figs. 2, 3). All the proce-
    Materials and methods                                         dures were performed without local anesthesia. All
                                                                  the restorations were done by the same operator




                                                                                                      n
    Selection Criteria                                            (DM) with cotton roll isolation and a chairside assis-
                                                                  tant. Of the 40 laser-prepared restorations, 29 were
    A group of 80 healthy children (43 male and 37 fe-            placed in lower molars and 11 in upper molars. In




                                                                                                   io
    male) ranging in age from 3 to 8 years, who had been          bur-prepared cavities, 24 restorations were placed in
    diagnosed with at least one active occlusal non-cavi-         lower molars and 16 in upper molars. Before and af-
    tated superficial carious lesions in first or second de-      ter the treatments the patient tolerance was tested




                                                                       az
    ciduous molars, were selected for the present study.          with the modified Wong-Baker pain level scale (15)
    Exclusion criteria were the presence of frank occlusal        (Fig. 1). A descriptive statistics was used to evaluate
    cavitation, poor oral hygiene, serious systemic dis-          the results.
    eases and bruxism. A written informed consent was




                                                                     rn
    obtained from all parents of little patients. The re-
    search was conducted in full accordance with the              Results
    World Medical Association Declaration of Helsinki




                                                                   te
    and the research protocol and consent form for the            The results of the present study are summarized in
    current study were reviewed and approved by the               Table1.
    Medical Ethics Committee of Sapienza University of            Just one child of group D experienced hurting worst
    Rome. Caries lesions in the selected sites were as-           because of non cooperative patient. In the first group,
    sessed by visual inspection performed with patients
                                                          In      where Class I occlusal cavities were prepared using
    positioned in a dental chair with reflector light, air/wa-    an Er:YAG laser and a self-adhesive flowable resin,
    ter spray and a plane buccal mirror using the visual-         the tolerance rate was 95% with 0 score (no hurt) for
    ranked method developed by Ekstrand et al. (14) un-           19 patients; in the second group, where Class I oc-
                                                   ni
    der standardized conditions. They patients enrolled           clusal cavities were prepared using an Er:YAG laser
    were divided randomly into 4 groups of 20 children            and a conventional flowable resin the tolerance rate
    each:                                                         was 90%; in the third group, where Class I occlusal
                                        io

    Group A: Class I occlusal cavities were prepared us-          cavities were prepared using a high-speed diamond
    ing an Er:YAG laser (Fidelis Plus II, Emmeciquattro           bur and a self-adhesive flowable resin, the tolerance
    Fotona, Italy) with wavelength 2,940 nm, 200 mJ en-           rate was 80%; in the last group, where Class I oc-
                               iz


    ergy and 15 Hz and a self-adhesive flowable resin             clusal cavities were prepared using a high-speed dia-
    (Vertise Flow, Kerr Corp, Orange CA, USA).                    mond bur and a conventional flowable resin, the toler-
    Group B: Class I occlusal cavities were prepared us-          ance rate was 75%.
               Ed




    ing an Er:YAG laser (Fidelis Plus II, Emmeciquattro
    Fotona, Italy) with wavelength 2,940 nm, 200 mJ en-
    ergy and 15 Hz and a conventional flowable resin              Discussion and conclusion
    (Premise Flow, Kerr Corp).
    Group C: Class I occlusal cavities were prepared us-          Anxiety in Dentistry is frequent and includes both chil-
    ing a high-speed diamond bur (835/010-4ML, Diatech            dren and adults. It has been found that most of dental
 IC




    Dental AG, Heerbrugg, Switzerland) under constant             fears origin probably from mismanagement by the
    water cooling and a self-adhesive flowable resin (Ver-        dentists during childhood (16). Nature of pain is vari-
    tise Flow, Kerr Corp, Orange CA, USA).                        able and depends on objective and subjective factors
    Group D: Class I occlusal cavities were prepared us-          (17). Until children reach school age, they cannot dif-
C




    ing a high-speed diamond bur (835/010-4ML, Diatech            ferentiate between pain and anxiety so it’s very im-
    Dental AG, Heerbrugg, Switzerland) under constant             portant to manage pain and fear successfully (18).
    water cooling and a conventional flowable resin               The use of laser can be an efficient strategic therapy
    (Premise Flow, Kerr Corp).                                    in pediatric dentistry due to minimal invasion (19) al-
@




    Visual and tactile feedback from an explorer was              though no statistical differences were reported by dif-
    used to determine the end of caries removal. No ad-           ferent authors between Er:YAG laser and air-rotor
    ditional “extension for prevention” and no visible            method in the effectiveness of caries removal (20,
    preparation of undercuts was performed after the le-          21). The development of flowable composites im-
    sions were completely excavated. The etching was              proved the management of uncooperative patients.
    performed for 15 seconds with a 37.5% phosphoric              Some authors (22) proposed a self-adhesive flowable
    acid etchant (Gel Etchant, Kerr, Orange, CA, USA)             resin for the restoration of small class I cavities, class
    then rinsed for 15 seconds with an air-water spray            V cavities, non-carious cervical lesions, and for a lin-

    Annali di Stomatologia 2016;VII (1-2): 24-28                                                                         25
    I. Vozza et al.


                                                                                            Figure 1. Wong Baker scale.




                                                                                                                    i
                                                                                                   n              al
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                                                                    az
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                                                                te
                                                         In
                                              ni
                                    io
                            iz
               Ed
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C
@




    Figure 2. Case report of group A and C.


    ing in class I and class II restorations, pit and fissure   as this new self-adhering flowable resin composite
    sealings, and porcelain repairs (22). Salerno et al.        established on primary dentin bond strengths values
    showed remarkably strong elastic capacities of a self-      similar to those of glass ionomer cements routinely
    adhesive flowable resin (23). Pacifici et al. (24) found    used for restorations of primary teeth. From these re-

    26                                                                           Annali di Stomatologia 2016;VII (1-2): 24-28
    Pediatric patients tolerance: a comparative study about using of Er:YAG laser and self-adhesive flowable composite for
    treatment of primary decayed teeth




                                                                                                                                          i
                                                                                                                       n                al
                                                                                                                    io
                                                                                 az
                                                                               rn
                                                                             te
                                                                  In
    Figure 3. Case report of group B and D.
                                                   ni
    Table 1. Results of technique acceptance from different groups of patients using Wong-Baker scale
                                         io

                      0 (no hurt)         2 (hurts            4 (hurts             6 (hurts              8 (hurts             10 (hurts
                                          little bit)         little more)         even more)            whole lot)            worst)
                               iz


    GROUP A           19                                                           1
    GROUP B           17                  1                   2
    GROUP C
               Ed




                      14                  2                   3                                          1
    GROUP D           13                  2                   1                    1                     2                    1



    sults it emerged that, although the limits of the study,                      in paediatric patients following minimally invasive dentistry
                                                                                  concepts. European Journal of Paediatric Dentistry.
 IC




    Er:Yag laser in association with self-adhering com-
    posite is very effective in pediatric dentistry and is a                      2008;9(2):81-87.
                                                                             4.   Eberhard J, Bode K, Hedderich J, Jepsen S. Cavity size dif-
    good treatment option especially for non cooperative
                                                                                  ference after caries removal by a fluorescence-con- trolled
    patients.
                                                                                  Er:YAG laser and by conventional bur treatment. Clinical Oral
C




                                                                                  Investigations. 2008;12(4):311-318.
                                                                             5.   Matsumoto K, Hossain M, Hossain MM, Kawano H, Kimu-
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@




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