UNIVERSIDADE ESTADUAL PAULISTA

“JÚLIO DE MESQUITA FILHO”

Instituto de Ciência e Tecnologia

Campus de São José dos Campos

ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2024.e4472

Braz Dent Sci 2024 Oct/Dec;27 (4): e4472

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in

any medium, provided the original work is properly cited.

The Er.Cr.YSGG laser’s impact in the occlusion of dentinal tubules:

in vitro study

Impacto do laser de Er.Cr.YSGG na oclusão dos túbulos dentinários: estudo in vitro

Mohammed Ziad TARIK1 , Mohamed K. DHAHIR1 , Salah A. ALKURTAS2 

1 - University of Baghdad, Institute of Laser for Postgraduate Studies. Baghdad, Iraq.

2 - Al-Turath University. Baghdad, Iraq.

How to cite: Tarik MZ, Dhahir MK, Alkurtas SA. The Er.Cr.YSGG laser’s impact in the occlusion of dentinal tubules: in vitro study. Braz

Dent Sci. 2024;27(4):e4472. https://doi.org/10.4322/bds.2024.e4472

ABSTRACT

Background: Severe discomfort due to exposed dentin that is brought on by thermal, tactile, evaporative,

electrical, osmotic, or chemical stimulation is known as dentinal hypersensitivity. It typically includes the

teeth’s facial surfaces close to the cervical boundary and, typically, in premolars and canines. It might be caused

by either cemental or enamel loss. Objective: To assess how well the Er.Cr.YSGG laser seals dentinal tubules

when it’s used on exposed dentine. Material and Methods: Twenty-nine natural posterior teeth were prepared,

sectioned, cleaned, and made ready for treatment. Samples were split into groups: Group A, the group under

negative control (N = 10), and Group B: Er.Cr.YSGG (Waterlase, I plus, Biolase Technology, Irvine, CA) was

administered (N = 10) along with a pilot research group (N = 9). Wavelength of 2780 nm, irradiation mode

is free-running pulse, power of 0.25 W, frequency of 20 Hz, pulse width of 60 μs, time of 2 seconds, Fiber tip

size: 600 μm, non-contact mode, power density of 83.33 W/cm2 with 0% water and 0% air, ber tip xed on a

distance of 1 mm perpendicular to the dentin surface with a clamp holder. Scanning electron microscopy (SEM)

was used to analyze dentin-obstructed surfaces. A qualitative evaluation of the micrographs was conducted to

analyze the shift in surface features. Data analysis was performed using (spss) software (version 26, IBM,USA)

to investigate the data’s normal distribution. The Kolmogorov-Smirnov and Shapiro-Wilk tests revealed that the

data had an abnormal distribution. Mann-Whitney U test was carried out to show a comparison between groups

(control, laser group). Results: The data obtained from the laser group showed a large reduction in tubular

diameter (0.737 μm) as compared to the control group (3.095 μm). The selected parameters (0.25W/2s, 83.33

W/cm2) were best to reduce and plug any exposed dentinal tubules without any indication of ssures or cracks.

Conclusion: The study conclusively demonstrates that Er:Cr:YSGG laser irradiation offers a viable solution for

dentin hypersensitivity by partially or completely occluding dentin tubules. Future clinical trials are warranted

to further explore its efcacy.

KEYWORDS

Dentinal tubules; Er.Cr.YSGG; Hypersensitivity; Laser; Teeth sensitivity.

RESUMO

Contexto: O desconforto severo devido à dentina exposta que é causado por estimulação térmica, tátil, evaporativa,

elétrica, osmótica ou química é conhecido como hipersensibilidade dentinária. Normalmente acomete as

superfícies vestibulares dos dentes próximas ao limite cervical e, tipicamente, em pré-molares e caninos. Pode

ser causado por perda de cemento ou esmalte. Objetivo: Avaliar o nível de ecácia do laser de Er.Cr.YSGG ao

selar os túbulos dentinários quando aplicado em dentina exposta. Material e Métodos: Vinte e nove dentes

posteriores naturais foram preparados, seccionados, limpos e preparados para tratamento. As amostras foram

divididas em grupos: Grupo A: grupo sob controle negativo (N = 10); e Grupo B: Er.Cr.YSGG (Waterlase, I plus,

Braz Dent Sci 2024 Oct/Dec;27 (4): e4472

Tarik MZ et al.

The Er.Cr.YSGG laser’s impact in the occlusion of dentinal tubules: in vitro study

Tarik MZ et al. The Er.Cr.YSGG laser’s impact in the occlusion of dentinal

tubules:

in vitro

study

Dessensibilizantes dentinários; Terapia a Laser;

Hipersensibilidade; Laser; Sensibilidade dentária.

INTRODUCTION

Dentin hypersensitivity (DH) is marked

by localized, acute pain in exposed dentin

triggered by external thermal, mechanical,

chemical, or osmotic stimuli, not attributable

to other dental defects or pathologies. Factors

like erosion, abrasion, and attrition, as well

as periodontal treatments or surgery, may

link it to the condition [1-4]. Several theories

have been proposed regarding the cause of

tooth hypersensitivity. One of the most well-

articulated is Brännström’s Hydrodynamic

theory [5]. It suggests that fluid flow inside

dentinal tubules may cause a painful sensation.

When dentinal tubules are exposed to cold, the

ow increases quickly, which the patient may

interpret as pain [6]. The literature mentions

a variety of dentin hypersensitivity treatment

techniques, but for them to be successful,

they must fulfill specific requirements. These

treatments need to be easy to use, provide a

long-lasting effect, operate swiftly, avoid causing

irritation or discoloration to the tooth pulp, and

be cost-effective. Obstructing the teeth’s exposed

tubules by blocking pulpal sensory neurons can

accomplish desensitization [2]. Desensitizing

products that contain potassium nitrate have the

ability to function by obstructing the synapses

between nerve cells, which in turn reduces nerve

activation and associated discomfort. Moreover,

a variety of substances, including calcium

phosphate, potassium oxalate, and sodium

uoride, have been reported to obstruct dentinal

tubules. Additionally, there have been reports

that adhesive materials, cements, varnishes, and

lasers can occlude dentinal tubules [2].

Recently the clinical application of lasers had

increased. Dentists use a variety of these lasers,

classifying them as either hard or soft. Hard

lasers consist of CO2 (carbon dioxide), Nd:YAG

(neodymium yttrium aluminum garnet), and

Er:YAG. These lasers can treat both hard and soft

tissue, although they may cause harm to the pulp.

Conversely, low-level laser treatment (LLLT),

also known as biostimulation, involves the use

of soft or cool lasers that utilize semiconductor

diode technology to produce laser energy in a

non-thermal manner [7].

In general, lasers have a wide range of

applications in dentistry, including photodynamic

therapy for cancer, orthodontic treatments

that expose partially and unerupted teeth,

removal of hypertrophic, inflamed tissue,

periodontal treatments that lengthen crowns,

and oral medicine procedures that remove

various types of tissue. Not only did they treat

dentinal hypersensitivity, but they also made

big steps forward in hard tissue treatments like

removing cavities, preparing cavities, or taking

out restorative material [7]. Erbium Chromium:

The class 4 laser employed in this investigation

is the Yttrium-Scandium-Gallium-Garnet laser

(Waterlase®, ©BIOLASE, Inc., USA). It has a

wavelength of 2780 nm. The patient will benet

from having this kind of laser at the dentist’s ofce

Biolase Technology, Irvine, CA), que foi administrado (N = 10) juntamente com um grupo de pesquisa piloto

(N = 9). As características do laser aplicado foram: comprimento de onda de 2780 nm, modo de irradiação é

pulso de corrida livre, potência de 0,25 W, frequência de 20 Hz, largura de pulso de 60 μs, tempo de 2 segundos,

tamanho da ponta da bra: 600 μm, modo sem contato, densidade de potência de 83,33 W/cm2 com 0% de

água e 0% de ar, ponta da bra xada a uma distância de 1 mm perpendicular à superfície da dentina com um

suporte de grampo. Microscopia eletrônica de varredura (MEV) foi usada para analisar superfícies obstruídas pela

dentina. Uma avaliação qualitativa das micrograas foi conduzida para analisar a mudança nas características

da superfície. A análise de dados foi realizada usando o software (SPSS) para investigar a distribuição normal

dos dados. Os testes de Kolmogorov-Smirnov e Shapiro-Wilk revelaram que os dados tinham uma distribuição

anormal. O teste U de Mann-Whitney foi realizado para mostrar uma comparação entre os grupos (controle,

grupo laser). Resultados: Os dados obtidos do grupo laser mostraram uma grande redução no diâmetro tubular

(0,737 μm) em comparação ao grupo controle (3,095 μm). Os parâmetros selecionados (0,25 W/2s, 83,33 W/

cm2) foram os melhores para reduzir e tampar quaisquer túbulos dentinários expostos sem qualquer indicação

de ssuras ou rachaduras. Conclusão: O estudo demonstra conclusivamente que a irradiação a laser Er:Cr:YSGG

oferece uma solução viável para a hipersensibilidade dentinária ao ocluir parcial ou completamente os túbulos

dentinários. Futuros ensaios clínicos são necessários para explorar melhor sua ecácia.

Palavras-chave:

Braz Dent Sci 2024 Oct/Dec;27 (4): e4472

Tarik MZ et al.

The Er.Cr.YSGG laser’s impact in the occlusion of dentinal tubules: in vitro study

Tarik MZ et al. The Er.Cr.YSGG laser’s impact in the occlusion of dentinal

tubules:

in vitro

study

in many ways. This study set out to assess how

the Er.Cr.YSGG laser inuenced the occlusion of

exposed dentinal tubules.

MATERIAL AND METHODS

Teeth collection and preparation

We utilized twenty-nine adult human

wisdom teeth extracted for various purposes. We

discarded crowns that had caries, restorations,

cracks, or any other apparent abnormality. We

used an ultrasonic scaler (Castellani- Italy) to

clean the teeth in an apical-coronal direction,

removing any remnant cementum and attached

periodontal ligament. Next, we polished the

teeth for 20 seconds with a non-uoride paste

to remove any debris. Finally, we rinsed, dried,

and stored the teeth for 48 hours in distilled

water containing 0.1% thymol((2-Isoprpoyl-5-

methylphenol), expired date 06-2026, Uk) to

prevent any microbial growth. The teeth were

mounted on one hand of the surveyor and the

engine held on another arm for precision and

uniform sectioning of the tooth surface at a zero

plane with a double-faced diamond disk 0.2 mm

(Star dent, China) one disk for every 3 teeth, and

the cutting was done under water irrigation. The

teeth were sectioned transversely to expose the

dentine and put in an ultrasonic cleaner(HH-

S2china) for 3 min to remove the debris of

cutting, then dried with gauze. Following this, to

stimulate the surface of hypersensitive dentine,

teeth received 17% EDTA(Dia prep pro, Korea)

for 2 min. and 35% phosphoric acid for 10 sec

for smear layer removal; the prepared teeth were

then occupied in numbered containers.

Irradiation and temperature assessment for

the research groups

This study was done on 10 teeth for the

Study Group (G2); the teeth were fixed with

stainless- steel, and the handpiece of Er,Cr:

YSGG Laser was xed with a clamp 1mm from

the irradiated dentine surface.

A pilot study was conducted on nine teeth

to determine the optimal parameters (power and

exposure time) for the research group. Different

power parameters (0.25W, 0.5W, 0.75W) for

different exposure times (2 sec, 4 sec, 8 sec)

were taken.

For power 0.25W, we tested three different

times: 2 seconds, 4 seconds, and 8 seconds to

determine the optimal result. The results were

recorded and analyzed to identify the differences

in the effect of each parameter on the sample.

The pilot study followed the same procedure for

the other two power parameters.

According to the earlier, the chosen

parameters for pilot trials were (0.25W and 2sec).

Samples have been divided into groups,

each consisting of ten samples

Group 1(G1) control group did not receive

any treatment.

Group (G2) study group: Er, Cr:YSGG laser

treatment (Waterlase, 1 plus, Biolase Technology,

Irvine, CA) as depicted in Figure 1. Wavelength of

2780 nm, irradiation mode is free-running pulse,

power of 0.25 W, frequency of 20 Hz, pulse width

of 60 μs, time of 2 seconds, Fiber tip size: 600

μm, non-contact mode, power density of 83.33

W/cm2 with 0% water and 0% air, ber tip xed

on a distance of 1 mm perpendicular to the dentin

surface with a clamp holder.

Temperature and irradiance measurement

for the study group

To assess temperature, one root canal prepared

with the SX-le (protaper les) and treated with

deionized water and then dried with a paper

point is now ready for insertion of the head of the

thermocouple probe (prośket MT-1232, 1st Edition,

2013, Taiwan) to the opposite side of the irradiated

surface. The study was carried out on ten teeth for

the study group (G2). The teeth were secured with

a stainless-steel rack, the thermocouple probe was

positioned at the root of the teeth and set in place,

and the Er, Cr:YSGG laser handpiece was clamped

1 mm from the irradiated dentine surface. Then,

after 50 seconds, as soon as the pulp’s temperature

reached a stable state in the water path, the teeth

were irradiated using the 2780 nm Er, Cr:YSGG

laser, and temperature was recorded every second

Figure 1 - Settings for laser exposure group.

Braz Dent Sci 2024 Oct/Dec;27 (4): e4472

Tarik MZ et al.

The Er.Cr.YSGG laser’s impact in the occlusion of dentinal tubules: in vitro study

Tarik MZ et al. The Er.Cr.YSGG laser’s impact in the occlusion of dentinal

tubules:

in vitro

study

for 60 seconds, which was a 2-second exposure time

and a 58-second observation time for documenting

any increase in temperature during the exposure

period and the irradiated tooth’s recuperation time

during the observation period.

SEM results

Surfaces of dentin revealed different levels

of dental tubule occlusion with various samples.

SEM micrographs showing the control group

after they were treated with 17% EDTA for

two minutes and 35% phosphoric acid for ten

seconds to remove the smear layer. The smear

layer does not cover the dentin; the tubules

were fully opened, as shown in Figure 2. The

diameters of control samples were measured by

SEM analysis and showed a mean (3.095 um).The

protocol we followed in measuring the samples

involved randomly selecting ten dentinal tubules

from each sample at a constant magnication of

10000x for all samples. The mean for each sample

was calculated, and the result was considered as

the outcome for each individual sample.

All dentin samples treated by Er,Cr:YSGG

Laser at a wavelength of 2780 nm, narrowing

with some of the occluded tubules, were observed

at power 0.25 W for an application time of 2 sec.

Figure 3 showed minimal surface precipitate and

total obliteration of most of the dentinal tubules.

The remaining tubules underwent some changes,

including a narrowing of their diameter.

Figure 2 - SEM views of two samples (control group). Magniﬁcation 10000x. A) open dentinal tubules sample 1; B)open dentinal tubules sample 2.

Figure 3 - SEM for two samples views of treated dentin (0.25w, 2sec). Magniﬁcation: 10000x.

Figure 4 - Illustrated diameters of study group with Magniﬁcation

20000x.

Braz Dent Sci 2024 Oct/Dec;27 (4): e4472

Tarik MZ et al.

The Er.Cr.YSGG laser’s impact in the occlusion of dentinal tubules: in vitro study

Tarik MZ et al. The Er.Cr.YSGG laser’s impact in the occlusion of dentinal

tubules:

in vitro

study

The diameters of treated samples were

measured by SEM analysis and showed a mean

reduction equal to 0.737 um, as shown in

Figure 4.

Temperature measurement

For temperature measurement, no changes

in samples temperature were recorded during

exposure or after that during observation time.

Statistical results

Data analysis was performed using SPSS

software (version 26, IBM, USA) to investigate the

data’s normal distribution. Both the Kolmogorov-

Smirnov and the Shapiro-Wilk tests were used,

they revealed that the data had an abnormal

distribution (p>0.00). So they were described

by (median, mean, standard deviation) and non-

parametric assessment. Mann-Whitney U test was

carried out to show a comparison between groups

(control, laser group). The data obtained from the

laser group showed a large reduction in tubular

diameter (mean, median) as compared to the

control group (median, mean) as shown in Table I.

Figure 5 illustrates the comparison between

the control and laser groups. The laser and

control groups exhibited a statistically signicant

difference (p-value 0.000) as shown in Table II.

DISCUSSION

Dentinal hypersensitivity can be mitigated by

reducing the uid circulation within the dentinal

tubules, so obstructing signals from reaching the

odontoblastic process [8]. In hypersensitive teeth,

the tubule diameter is considerably broader than

those of teeth that are not sensitive. Different

techniques can be used to block dentinal tubules,

initially by closing the dentin surface, occluding

in their orices, or occluding in the subsurface

dentin in their tubules [3,9]. For effective

desensitization, the treatment in our study

centered on reducing and obstructing the radius

of dentinal tubules by using Er.Cr.YSGG laser

with specications (0.25W/2s, 83.33 W/cm2).

This investigation involved exams completed

immediately post-exposure utilizing Scanning

Electron Microscopy (SEM). The samples

underwent multiple preparatory procedures:

Cleaning: samples were subjected to ultrasonic

Table I - Shows the mean tubular diameter for (A) control group

(B) laser group

Samples A Mean Samples B Mean

1 3.448 1 0.477

2 3.306 2 0.7

3 2.747 3 1.03

4 2.126 4 0.404

5 2.508 5 0.507

6 2.309 6 0.98

7 3.437 7 1.078

8 3.492 8 0.966

9 4.34 9 0.633

10 3.234 10 0.451

Figure 5 - Illustrates the comparison between the control and laser group.

Table II - Shows the impact of Er,Cr: YSGG laser used for this study

on the diameter of dentinal tubules

Group Median Mean Std. Deviation p-value*

Control 2.954 3.095 0.957 >0.000

Laser 0.640 0.737 0.315

*Mann-Whitney test.

Braz Dent Sci 2024 Oct/Dec;27 (4): e4472

Tarik MZ et al.

The Er.Cr.YSGG laser’s impact in the occlusion of dentinal tubules: in vitro study

Tarik MZ et al. The Er.Cr.YSGG laser’s impact in the occlusion of dentinal

tubules:

in vitro

study

scaling in an apico-coronal direction to eliminate

residual cementum and periodontal ligament.

Polishing: Samples were polished with non-

uoride paste for 20 seconds to eliminate debris,

then rinsed and dried. Storage: The purified

samples were maintained for 48 hours in distilled

water with 0.1% thymol to inhibit microbial

proliferation.

The dentinal tubules were deliberately

expanded to replicate dentine hypersensitivity.

Two chemical agents, 17% EDTA gel and 35%

phosphoric acid, were employed to replicate

the condition of sensitive dentine. This essential

measure was implemented to guarantee that the

prepared dentin surface was devoid of leftover

substances, including the smear layer and plugs.

The FDA had allowed the use of erbium lasers

on hard tissues; therefore, it is decided to employ

the Er.Cr.YSGG laser of 2780 nm (Waterlase®)

group for this therapy. This is consistent with

other research [10-17]. 0.25 W of power is used

for 2 sec from Er.Cr:YSGG laser. According to

Aranha et al. [18], the Er.Cr.YSGG laser, which

belongs to the family of erbium lasers, has

signicant absorption in the bound water of a

tooth’s crystalline structure, which results in the

expansion and detonation of dental hard tissues.

As reported by Hu et al. [19], the

desensitization with Erbium laser is accomplished

by water molecule absorption to produce a

microblasting action and deposition of insoluble

salts that narrow or block down dentinal tubules.

This results in a reduction of the tubular surface

diameter by up to 50%.

The clinical uses of high- and low-intensity

dental lasers have been the subject of a great

deal of research. Low-level laser therapy

induces photophysical, photobiological, and

photochemical effects on the cells of irradiated

tissues, while high-intensity lasers act by

increasing temperature to ablate, vaporize, cut,

and coagulate dental tissue [20].

Dentin exhibits low thermal conductivity,

which may lead to a notable increase in local

temperature. In the case of laser applications

in this study, the fundamental consequences

are photothermal and photomechanical effects.

Dentine primarily consists of hydroxyapatite

crystals and water, making infrared-emitted

lasers the most effective for its treatment [21].

Furthermore, Erbium lasers perform thermal

ablation on enamel and dentine, a process that is

mediated by water and characterized by explosive

effects. Because of the surrounding hard tissue,

this application causes the water in the subsurface

layers to heat up to a temperature of over 100 °C.

This pressure overcomes the strength of the tissue,

generating an “explosion” with the extirpation

of hard tissues. In order to accommodate this

occurrence, it’s crucial to stay below the melting

point of dentine or enamel, which varies according

on the kind of laser (for example, the ablation

threshold of Er, Cr: YSGG lasers can reach up to

800 °C, and CO2 lasers can reach 1000 °C) [22].

Brännström’s hydrodynamic theory

suggested that dentine hypersensitivity is due

to the movement of fluid within the dentinal

tubules. Obstruction of the tubules diminishes

uid mobility that activates nerve endings in the

dentin, resulting in reduced pain and discomfort

from stimuli like as temperature uctuations,

pressure, and osmotic changes. This underscores

the signicance of the research in diminishing

sensitivity by decreasing the diameter of the

tubules with minimal power and time.

Finally, the main purpose of our study

conducted in vitro was to examine the laser’s

occlusion of dentinal tubules; The laser’s impact

on nerves wasn’t taken into consideration.

As a limitation of the study we consider

that aging protocols to investigate the long term

effects of tubule occluding agents should be

performed in future studies.

CONCLUSION

The findings of this study indicate that

Er:Cr:YSGG laser irradiation can partially

or completely occlude dentin tubules, thus

recommending its consideration for the

management of dentin hypersensitivity in future

clinical trials.

Author’s Contributions

MZT: Investigation, Writing – Original

Draft Preparation. MKD: Supervision. SAA:

Supervision.

Conict of Interest

The authors have no conicts of interest to

declare.

Braz Dent Sci 2024 Oct/Dec;27 (4): e4472

The Er.Cr.YSGG laser’s impact in the occlusion of dentinal

tubules:

in vitro

study

Tarik MZ et al.

The Er.Cr.YSGG laser’s impact in the occlusion of dentinal tubules: in vitro study

Tarik MZ et al. The Er.Cr.YSGG laser’s impact in the occlusion of dentinal

tubules:

in vitro

study

Date submitted: 2024 July 29

Accept submission: 2024 Dec 12

Mohammed Ziad Tarik

(Corresponding address)

University of Baghdad, Institute of Laser for Postgraduate Studies, Baghdad, Iraq.

E-mail: mohammed.zeyed2202m@ilps.uobaghdad.edu.iq

Funding

This research did not receive any specic

grant from funding agencies in the public,

commercial, or not-for-prot sectors.

Regulatory Statement

Not applicable, as in vitro studies do not

require approval from an ethics committee,

according to the Department of Biomedical

Applications, Institute of Laser for Postgraduate

Studies, University of Baghdad.

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