CO2 lasers can be operated at high laser pulse repetition rates for the rapid and precise removal of dental decay. Excessive heat accumulation and peripheral thermal damage is a concern when using high pulse repetition rates. Peripheral thermal damage can adversely impact the mechanical strength of the irradiated tissue, particularly for dentin, and reduce the adhesion characteristics of the modified surfaces. The interpulpal temperature rise was recorded using microthermocouples situated at the roof of the pulp chamber on teeth that were occlusally ablated using a rapidly-scanned CO2 laser operating at 9.3 μm with a pulse duration of 10 to 15 μs and repetition rate of 300 Hz over a 2 min time course. The adhesion strength of laser treated enamel and dentin surfaces was measured for various laser scanning parameters with and without post-ablation acid etching using the single-plane shear test. The mechanical strength of laser-ablated dentin surfaces were determined via the four-point bend test and compared to control samples prepared with 320 grit wet sand paper to simulate conventional preparations. Thermocouple measurements indicated that the temperature remained below ambient temperature if water-cooling was used. There was no discoloration of either dentin or enamel laser treated surfaces, the surfaces were uniformly ablated, and there were no cracks visible. Four-point bend tests yielded mean mechanical strengths of 18.2 N (s.d. = 4.6) for ablated dentin and 18.1 N (s.d. = 2.7) for control (p > 0.05). Shear tests yielded mean bond strengths approaching 30 MPa for both enamel and dentin under certain irradiation conditions. These values were slightly lower than nonirradiated acid-etched control samples. Additional studies are needed to determine if the slightly lower bond strength than the acid-etched control samples is clinically significant.
Pulsed CO2 lasers show great promise for the rapid and efficient ablation of dental hard tissues. Our objective was to demonstrate that CO2 lasers operated at high repetition rates can be used for the rapid removal of dentin without excessive thermal damage and without compromising adhesion to restorative materials. Human dentin samples (3x3mm2) were rapidly ablated with a pulsed CO2 laser operating at a wavelength of 9.3-µm, pulse repetition rate of 300-Hz and an irradiation intensity of 18-J/cm2. The bond strength to composite was determined by the modified single plane shear test. There were 8 test groups each containing 10 blocks: negative control (non-irradiated non-etched), positive control (non-irradiated acid-etched), and six laser treated groups (three etched and three non-etched sets). The first and second etched and non-etched sets were ablated at a speed of 25 mm/sec and 50 mm/sec with water, respectively. The third set was also ablated at 50 mm/sec without application of water during laser irradiation. Minimal thermal damage was observed on the dentin surfaces for which water cooling was applied. Bond strengths exceeded 20 MPa for laser treated surfaces that were acid-etched after ablation (25-mm/sec: 29.9-MPa, 50-mm/sec: 21.3-MPa). The water-cooled etched laser groups all produced significantly stronger bonds than the negative control (p<0.001) and a lower bond strength than the positive control (p<0.05). These measurements demonstrate that dentin surfaces can be rapidly ablated by a CO2 lasers with minimal peripheral thermal damage. Additional studies are needed to determine if a lower bond strength than the acid-etched control samples is clinically significant where durability of these bonded restoration supersedes high bond strength.