Laser-assisted cavity preparation and adhesion to erbium-lased tooth structure: part 1. Laser-assisted cavity preparation.

The use of the ruby laser (693.4 nm) was first described in 1960, and it was applied for hard tissue ablation in 1964. Different wavelengths [Nd:YAG (1.065 microm), CO2 (9.6 microm), Ho:YAG (2.12 microm)] were consequently explored. Due to massive thermal side effects, these wavelengths caused increased temperature in dental pulp, as well as microcracks and carbonization. The use of this laser for dental hard tissue preparation was eventually abandoned. At the end of the 1980s, excimer lasers (ultraviolet) and the erbium laser (infrared) were developed, with the advantages of improved temperature control and smaller penetration depths. With the development of smaller devices and improved knowledge of how to limit damage to the surrounding tissues, new ablation techniques were established in the 1990s. There is still contradiction in the current literature, however, in that different wavelengths are advocated for hard tissue removal, and heterogeneity in laser parameters and power densities remain. In this review, the effects of the wavelengths presently used for cavity preparation are evaluated. We conclude that erbium lasers (Er:YAG and Er,Cr:YSGG) are most efficient and, with the right parameters, the thermal side effects are small. There is a substantial need for "gold standards", although this is difficult to establish in practice owing to different laser parameters (including pulse repetition rate, amount of cooling, energy delivered per pulse, and types of pulses) and target specificity (tissue interaction with sound or decayed enamel or dentin, and the extent of (de)mineralization) which influence tissue interaction.