Pulsed lasers emitting wavelengths near 400 nm can selectively ablate dental calculus without damaging underlying and surrounding sound dental hard tissue. Our results indicate that calculus ablation at this wavelength relies on the absorption of porphyrins endogenous to oral bacteria commonly found in calculus. Sub- and supragingival calculus on extracted human teeth, irradiated with 400-nm, 60-ns laser pulses at ≤8 J/cm 2 , exhibits a photobleached surface layer. Blue-light microscopy indicates this layer highly scatters 400-nm photons, whereas fluorescence spectroscopy indicates that bacterial porphyrins are permanently photobleached. A modified blow-off model for ablation is proposed that is based upon these observations and also reproduces our calculus ablation rates measured from laser profilometry. Tissue scattering and a stratified layering of absorbers within the calculus medium explain the gradual decrease in ablation rate from successive pulses. Depending on the calculus thickness, ablation stalling may occur at <5 J/cm 2 but has not been observed above this fluence.
A desired outcome of scaling and root planing is the complete removal of calculus and infected root tissue and preservation of healthy cementum for rapid healing of periodontal tissues. Conventional periodontal treatments for calculus removal, such as hand instrument scaling and ultrasonic scaling, often deeply scrape the surface of the underlying hard tissue and may leave behind a smear layer. Pulsed lasers emitting at violet wavelengths (specifically, 380 to 400 nm) are a potential alternative treatment since they can selectively ablate dental calculus without ablating pristine hard tissue (i.e., enamel, cementum, and dentin). In this study, light and scanning electron microscopy are used to compare and contrast the efficacy of in vitro calculus removal for several conventional periodontal treatments (hand instruments, ultrasonic scaler, and Er:YAG laser) to calculus removal with a frequency-doubled Ti:sapphire (λ = 400 nm). After calculus removal, enamel and cementum surfaces are investigated for calculus debris and damage to the underlying hard tissue surface. Compared to the smear layer, grooves, and unintentional hard tissue removal typically found using these conventional treatments, calculus removal using the 400-nm laser is complete and selective without any removal of pristine dental hard tissue. Based on these results, selective ablation from the 400-nm laser appears to produce a root surface that would be more suitable for successful healing of periodontal tissues.
The laser ablation rate of subgingival dental calculus irradiated at a 400-nm-wavelength, 7.4-mJ pulse energy, and 85- and 20-deg irradiation angles is measured using laser triangulation. Three-dimensional images taken before and after irradiation create a removal map with 6-μm axial resolution. Fifteen human teeth with subgingival calculus are irradiated in vitro under a cooling water spray with an ∼300-μm-diam, tenth-order super-Gaussian beam. The average subgingival calculus removal rates for irradiation at 85 and 20 deg are 11.1±3.6 and 11.5±5.9 μm/pulse, respectively, for depth removal and 4.5±1.7×105 and 4.8±2.3×105 μm3/pulse, respectively, for volume removal. The ablation rate is constant at each irradiation site but varies between sites because of the large differences in the physical and optical properties of calculus. Comparison of the average depth- and volume-removal rates does not reveal any dependence on the irradiation angle and is likely due to the surface topology of subgingival calculus samples that overshadows any expected angular dependence.
A noncontact profilometer (laser triangulation) was used to measure the removal rates of subgingival dental calculus irradiated with a frequency-doubled Ti:sapphire laser (60-ns pulse duration, 400-nm wavelength, 10-Hz repetition rate, 7-mJ pulse energy). Profilometer traces before and after irradiation were used to create a removal map with 4-μm axial and 15-μm transverse resolution. Twenty-three teeth (15 with calculus and 8 pristine) were irradiated at 90° and 45° under a cooling water spray with a super-Gaussian beam (~300-μm diameter). Subgingival calculus was selectively removed at 5.6 and 4.0 J/cm2 for 90° and 45°, respecetively, within a range of rates, between 2 to 9 μm/pulse. These ablation rates were constant during these exposures. For comparison, pristine cementum irradiated for 10 min at the same peak fluence and pulse repetition rate showed only craters, 15 to 50 μm deep, corresponding to an equivalent
removal rate three orders of magnitude smaller than that obtained for calculus. Pristine enamel was not removed under the same irradiation conditions.
A Nd:YAG laser-pumped, frequency-doubled Ti:sapphire laser is used for selective ablation of calculus. The laser provides ≤25 mJ at 400 nm (60-ns pulse width, 10-Hz repetition rate). The laser is coupled into an optical multimode fiber coiled around a 4-in.-diam drum to generate a top-hat output intensity profile. With coaxial water cooling, this is ideal for efficient, selective calculus removal. This is in stark contrast with tightly focused Gaussian beams that are energetically inefficient and lead to irreproducible results. Calculus is well ablated at high fluences ≥2J/cm2; stalling occurs below this fluence because of photobleaching. Healthy hard tissue is not removed at fluences ≤3 J/cm2.