Journal of Clinical Laser Medicine & Surgery

Volume 19, Number 6, 2001

Mary Ann Liebert, Inc.
Pp. 297–303

Analysis of Surface Roughness of Enamel and Dentin after

Er,Cr:YSGG Laser Irradiation

MOZAMMAL HOSSAIN, B.D.S., Ph.D., YUKIO NAKAMURA, D.D.S., Ph.D.,

YOSHISHIGE YAMADA, D.D.S., Ph.D., NOBUYUKI SUZUKI, D.D.S.,
YOSHIKO MURAKAMI, D.D.S, Ph.D., and KOUKICHI MATSUMOTO, D.D.S., Ph.D.
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ABSTRACT

Objective: The purpose of this investigation was to compare the surface roughness of enamel and dentin fol-
lowing the Er,Cr:YSGG laser irradiation and acid etching. Background Data: Laser-roughened enamel or
dentin surfaces have been expected to enhance restorative materials bond strength. Materials and Methods:
Er,Cr:YSGG laser irradiation was performed in one half of each polished enamel or dentin sample at 3 W
(33.9 J/cm2, with air 70% and water 20%,) pulse energy for 6 sec. Then the other half was treated with 37%
phosphoric acid for 30 sec. Surface roughness and morphological studies were performed. Results: It was
found that surface roughness was significantly increased with the laser system. Scanning electron microscopy
analysis showed that irradiated surface produces a rough surface that was completely lacking of a smear layer;
there was also no cracking of enamel or dentin. Conclusion: Er,Cr:YSGG laser irradiation could provide an ef-
fective and alternative method to the acid etch technique.

INTRODUCTION improves upon acid etching techniques.12–14 A comparative

study disclosed that CO 2 and Nd:YAG systems induced surface

T HE MECHANICAL PREPARATION of dental cavities with rotat-

ing or manual instruments produces a thin smear layer that
covers the dentin and enamel walls.1 This smear layer has a
thickness of 1–10 mm, and it cannot be removed by the ordinary
water spray.2–4 If left untouched, it will weaken the bond
strength between filling materials and the cavity walls.5 There-
fore, etching of the cavity walls has been recommended to ac-
complish complete removal of this layer with acidic condition-
ers that are applied to enamel and dentin utilizing a total-etch
technique. Their mechanism is principally based on the com-
bined effect of hybridization and formation of resin tags.6–8
Traditionally, an aqueous gel preparation of 37% phosphoric
acid at pH 1 one has been recommended. However, this is a
strong acid, and care must be taken not to damage the collagen
matrix of the dentin.9 It has been reported that chemical
changes produce modification of the fraction of organic matter
and decalcification of the inorganic component.10,11
As a possible alternative to acid conditioning, the use of laser
therapy shows promise from the current research. Preliminary
research indicates that enamel etching with the CO2 laser for
bonding agent adhesion has shown to be facilitated by or even
roughness comparable to that of acid etching.13 In the laser pre-
treatment of dentin, it was thought that this surface might be
more desirable for bonding composite resin restorative.15 Many
researchers have suggested the use of different types of lasers as
an alternative to dentin conditioning.16–18 Recently, the
Er,Cr:YSGG laser has been introduced in the dental clinic,
which is said to be effective in cavity preparation and which
produces minimum injury to the pulp and surrounding tis-
sues.19–21
The purpose of this investigation was to compare the surface
roughness of enamel and dentin following the application of
Er,Cr:YSGG laser and acid etching, in vitro.
MATERIALS AND METHODS
Sample preparation
Extracted, noncaries human incisor and molar teeth were
used. Twenty incisor teeth were used for enamel studies, and 20
molar teeth were used for dentin studies.

Department of Endodontics, Showa University School of Dentistry, Tokyo, Japan.

297
 298 Hossain et al.

TABLE 1. SURFACE ROUGHNESS OF ENAMEL AND Enamel surfaces were prepared by vertical sectioning
DENTIN SUBJECTED TO ACID ETCHING through the middle third of the teeth crown and finished with
OR ER,CR; YSGG LASER IRRADIATION 1,000-grit paper. Dentin surfaces were prepared by horizontal
sectioning through the middle third of the teeth crown and fin-
Hard tissue Treatment Roughness (mm)
ished with 1,000-grit paper.
In each enamel or dentin sample, two treatments were given:
Enamel acid 85 6 8 *
one for laser irradiation and the other was used for acid etching
laser 160 6 90000 (control).
Dentin acid 90 6 4 *
laser 164 6 60000 Laser device and irradiation
Values are expressed as the mean 6 SD. A Millennium™ Er,Cr:YSGG laser (Biolase Technology
*Significance difference (p , 0.01). Inc., San Clemente, CA) was used. This laser system emits pho-
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FIG. 1. Measurements of the surface roughness of enamel after acid etching, using a color laser three-dimensional microscope.
(A) Enamel surface showed a roughen area of 88 mm. (B) Three-dimensional image.
 Surface Roughness with the Er,Cr:YSGG Laser 299

tons at a wave length of 2.78 mm, which was pulsed with a du-
ration of 140–200 mm and a repetition rate of 20 Hz. The power
output can be varied from 0 to 6 W. The beam spot size is
0.442 3 mm2 with the use of a 750-mm-diameter fiber.
Laser irradiation was performed at 3 W (33.9 J/cm2, with air
70% and water 20%) pulse energy using the Er,Cr:YSGG laser
for 6 sec.
Acid etching
A 37% phosphoric acid gel (Clearfil etching agent; Kuraray
Co., Ltd., Tokyo, Japan) was used for acid etching. The gel was
applied for 30 sec, and then rinsed with deionized water for an-
other 30 sec and dried with oil-free compressed air for 20 sec.
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Evaluations
Surface roughness studies. The roughness of each sample
was measured with a color laser three-dimensional (3D) micro-
scope (Keyence Corporation, Tokyo, Japan). Statistical analy-
sis of the data was performed using the Mann-Whitney U test,
and a value of p , 0.01 was considered significant.
Morphol ogical studies. Specimens were dehydrated with a
graded series of ethanol, dried to a critical point with CO2, and
mounted on aluminium stubs. All specimens were sputter-
coated with platinum at the thickness of 15 mm for scanning
electron microscopic (SEM; JSM-T22OA; JOEL, Tokyo,
Japan) examination at 20 KV.

FIG. 2. Measurements of the surface roughness of enamel after Er,Cr:YSGG laser irradiation, using a color laser three-dimen-
sional microscope. (A) Enamel surface showed a roughen area of 164 mm. (B) Three-dimensional image.
 300 Hossain et al.

RESULTS Scanning electron microscopy observation

Surface roughness studies
Table 1 shows the data of surface roughness produced after
acid etch and laser treatment observed using a color laser 3D
microscope. Figures 1 and 2 are the representative photographs
of measuring the surface roughness with this device. It was
found that roughness values for the laser-treated surface ranged
from 150 to 170 mm, which was greater than that of the acid-
etched surface (73–94 mm). There was a statistically significant
difference between the lased and etched surface (p , 0.01).
SEM observation of the polished enamel or dentin surface re-
vealed the presence of smear layer that occluded the enamel
prisms or the dentinal tubules.
Enamel or dentin surface treated with the 37% phosphoric
acid showed some different structures: smear layer was com-
pletely removed from the enamel or dentin surface, and thus the
enamel prisms or dentinal tubules were clearly visible. How-
ever, enamel surface clearly displayed protruding prism
sheaths, between which the body of the prism had been eroded
away (Fig. 3A). Dentin surface displayed patent dentin tubules,

A
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FIG. 3. Representative scanning electron microscope (SEM) photographs of enamel or dentin surface treated with 37% phos-
phoric acid. (A) Enamel surface clearly displayed protruding prism sheaths, between which the body of the prism had been eroded
away (original magnification, 35,000; bar 5 5 mm. (B) Dentin surface displayed patent dentin tubules, and intertubular dentin sur-
faces were found to have a granulated appearance (original magnification, 35,000; bar 5 5 mm).
 Surface Roughness with the Er,Cr:YSGG Laser 301

and intertubular dentin surfaces were found to have a granu- DISCUSSION

lated appearance (Fig. 3B).
On the other hand, the lased enamel or dentin surface pro-
duced a rough surface with recrystallization, and there was also
a lack of smear layer. In the enamel surface, protruding prism
sheaths were noted without any sign of erosion (Fig. 4A). In the
dentin surface, the orifice of dentinal tubules was almost ex-
posed, and intertubular dentin seemed to ablate more than the
peritubular dentin, showing a protrusion of the dentinal tubules
(Fig. 4B).
Evaluation technique
Analysis of surface roughness is important for evaluation of
the degree of restorative material bond strength with the tooth
substances in restorative and preventive dentistry. Several tech-
niques have been applied to evaluate the surface roughness of
enamel or dentin. A profilometer to measure the degree of sur-
face roughness precisely has been previously used.22 However,

A
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FIG. 4. Representative scanning electron microscope (SEM) photographs of enamel or dentin surface treated with Er,Cr:YSGG
laser irradiation. (A) In the enamel surface, protruding prism sheaths were noted without any sign of erosion (original magnifica-
tion, 35,000; bar 5 5 mm). (B) In the dentin surface, the orifice of dentinal tubules was almost exposed and intertubular dentin
seemed to ablate more than the peritubular dentin, showing a protrusion of the dentinal tubules (original magnification, 35,000;
bar 5 5 mm).
 302
this may not generate a comprehensive picture of the surface.
SEM analysis has adequately described the changes of surface
roughness, but it is associated with a lack of quantitative analy-
sis of the roughness values. In our present study, a color laser
3D profile microscope was used to assess the enamel or dentin
surface roughness after acid etching or laser irradiation. It has
some major advantages: (1) This instrument can search pre-
cisely the microroughness of the treated area in color. (2) It can
provide magnification similar to that of SEM. (3) It utilizes a
laser beam and computer analysis for scanning. (4) It can work
both in dry and wet conditions, eliminating the need for a pre-
treatment procedure (e.g., decalcification or dehydration).
Laser device, energy density, and application
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Heat generation during laser irradiation of enamel or dentin
has often caused major thermal side effects (such as carboniza-
tion, melting, and cracking of the tooth structure), and pulpal
damage.23–28 However, the laser system used in the present
study minimizes thermal side effects by improvements in the
delivery system. It uses a pulsed-beam system, fiber delivery,
and a sapphire tip bathed in a mixture of air and water vapor. It
has been reported that using water spray with this laser system
minimizes the heat generation and, therefore, the risk of ther-
mal side effects could be avoided.19–21
Regarding energy density used for cavity preparation with
Er,Cr:YSGG laser irradiation, a power density of 5 or 6 W has
been recommended by the manufacturer for enamel or dentin.
However, in the present study, an energy density of 3 W, which
is actually used for cutting soft tissue, to avoid any cavity for-
mation.
Surface roughness
From the present study, it was found that the use of
Er,Cr:YSGG laser irradiation showed promise for enamel or
dentin etching. Roughness values for the laser-treated surface
ranged from 150 to 170 mm, which was significantly greater
than that of the acid-etched surface (73–94 mm). It seemed
that etching with the Er,Cr:YSGG laser could provide an al-
ternative method to acid etching. However, the roughness
values measured by the color laser 3D microscope in our pre-
sent study were high when compared with those measured by
profilometer in previous research using the CO2 and
Nd:YAG laser.13 The reason for this difference in roughness
values is not clear. However, several considerations could be
taken into account. First, differences between the laser de-
vices and energy density used may have affected measure-
ments. Second, differences in the evaluation technique may
explain the discrepancy. It has been reported that cavity
preparation with the Er,Cr:YSGG laser system is often ac-
companied by various patterns of microirregularity, which
could be the reason for increased surface roughness with this
system. Regarding the roughness analysis technique, in our
present study, a color laser 3D microscope was used rather
than the profilometer. It is possible that the color laser 3D mi-
croscope analyzes roughness more precisely.
Considerable additional research is necessary before using
this laser irradiation technique for enamel and dentin etching in
the clinic.
Hossain et al.
Scanning electron microscopy observation
SEM-analyzed laser-etched enamel or dentin surfaces
showed some different structures than are currently achieved
during normal restorative procedures with acid etching. With
acid etching (using phosphoric acid), the enamel surface clearly
displayed protruding prism sheaths, between which the body of
the prism had been eroded away (Fig. 1A). This appearance
was similar to that in a previous study.11 On the other hand, the
lased enamel or dentin surface produced a rough surface with
recrystallization. In the enamel surface, protruding prism
sheaths were noted without any sign of erosion (Fig. 2A). In the
dentin surface, the orifice of dentinal tubules was almost ex-
posed and intertubular dentin seemed to ablate more than the
peritubular dentin, showing a protrusion of the dentinal tubules
(Fig. 2B). Acid etching has some major disadvantages, such as
an increase in dentin permeability and in dentin wetness, and an
increased potential for pulpal irritation and denaturation of col-
lagen.11 It is possible that laser etching may obviate the need for
acid etching. However, there is no study of bond strength using
the Er,Cr:YSGG laser with enamel or dentin. Several previous
studies have demonstrated that bond strengths are weaker with
the CO2 laser than with acid etching.12–14 Therefore, further re-
search is necessary to determine the most ideal laser parameters
and clinical techniques to achieve an etched-enamel surface
that is consistently as good or better than acid-etched surfaces.
Other clinical benefits such as caries prevention may be a re-
sult of laser etching. In our present study, it has not been deter-
mined if laser etching causes increased resistance to enamel de-
calcification. However, SEM observation showed that laser
irradiation produces recrystallization of enamel or dentin surface,
which is thought to have a caries prevention effect. Previous re-
search has shown that human enamel or dentin can be altered by
Er,Cr:YSGG laser energy to make it susceptible to this subsur-
face demineralization.29,30 Since this laser radiation renders
enamel and dentin more resistant to subsurface demineralization
and artificial caries, the incidence of recurrent caries around
restorations that employed laser etching may be reduced.
CONCLUSION
From our present study, it can be concluded that laser etching
could provide an alternative to acid etching. Other improve-
ments may include a reduction in clinical time. However, clini-
cal studies are required to determine the extent of any benefits
gained by laser etching.
ACKNOWLEDGMENT
The authors are grateful to the Japan Society for the Promo-
tion of Science for supporting Mozammal Hossain.
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Address reprint requests to:
Dr. Koukichi Matsumoto
Department of Endodontics
Showa University School of Dentistry
2-1-1 Kitasenzoku, Ohta-ku
Tokyo 145-8515, Japan
E-mail: Koukichi@senzoku.showa-u.ac.jp
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