Laser-assisted cavity preparation and adhesion to erbium-lased tooth structure: part 2. present-day adhesion to erbium-lased tooth structure in permanent teeth.

With the introduction of the Er:YAG laser, it has become possible to remove enamel and dentin more effectively and efficiently than with other lasers. Thermal damage is reduced, especially in conjunction with water spray. Since FDA (Federal Drug Administration) approval of the Er:YAG laser in 1997--for caries removal, cavity preparation and conditioning of tooth substance - there have been many reports on the use of this technique in combination with composite resins. Moreover, cavity pretreatment with Er:YAG laser (laser etching) has been proposed as an alternative to acid etching of enamel and dentin. Reports evaluating the adhesion of glass-ionomer cements to Er:YAG-lased tooth substance are scarce. This article reviews the literature regarding adhesion and sealing efficacy using different (pre)treatment protocols in association with Er:YAG laser preparation. Recent research has shown that lasing of enamel and dentin may result in surface and subsurface alterations that have negative effects on both adhesion and seal. It is concluded that at present, it is advisable to respect the conventional pretreatment procedures as needed for the respective adhesive materials. Although the majority of present day reports show that microleakage and bond strength are negatively influenced by laser (pre)treatment (compared with conventional preparation), there is ongoing discussion of how adhesion is best achieved on Er:YAG-lased surfaces.