Lasers Med Sci (2012) 27:371–375
DOI 10.1007/s10103-010-0869-7
ORIGINAL ARTICLE
Tensile bond strength of sealants following Er:YAG laser
etching compared to acid etching in permanent teeth
Sima Shahabi & Hossein G. Bagheri & Kosar Ramazani
Received: 22 June 2010 / Accepted: 30 November 2010 / Published online: 19 February 2011
# Springer-Verlag London Ltd 2011
Abstract The aim of this in vitro study was to assess the
effect of Er:YAG laser surface treatment on the tensile bond
strength of a sealant in permanent teeth. A total of 30 sound
third molars were selected and embedded in cold-cure
acrylic resin. The enamel surfaces were flattened by a
grinding. The teeth were randomly divided into three
groups and pretreated as follows: (1) 37% phosphoric acid;
(2) Er:YAG laser (1.5 ml/min water spray, 100 mJ energy
output, 10 Hz frequency, focal distance 17 mm); (3) Er:
YAG laser + 37% phosphoric acid. The treated surfaces
were isolated by double adhesive Sellotape and after
insertion of a split Teflon matrix at an isolated site, sealant
was applied. The specimens were thermocycled and stored
at 37°C in distilled water for 72 h, then subjected to a
tensile bond strength test (50 kgf at 0.5 mm/min). The mean
tensile bond strengths (±SD, in megapascals) were: 18.51
±5.68 in group 1, 8.06±2.69 in group 2, and 17.33±5.04 in
group 3. Data were submitted to analysis of variance and
the Tukey test. No significant difference were found
between groups 1 (37% phosphoric acid) and group 3 (Er:
YAG laser + 37% phosphoric acid) but treatment with the Er:
YAG laser alone (group 2) resulted in significantly lower
S. Shahabi (*)
Laser Research Center in Dentistry (LRCD),
Tehran University of Medical Sciences,
Tehran, Iran
e-mail: shahabis@tums.ac.ir
H. G. Bagheri
Research Center for Science and Technology in Medicine,
Tehran University of Medical Sciences,
Tehran, Iran
K. Ramazani
School of Dentistry, Tehran University of Medical Sciences,
Tehran, Iran
tensile bond strength than seen in the other groups. In this
setting, the Er:YAG laser prepared the enamel surface for
sealing but did not eliminate the need for acid etching before
sealant application.
Keywords Er:YAG laser . Tensile bond strength . Sealant .
Permanent teeth
Introduction
Modern dentistry has focused on preventive methods and
conservative techniques to apply less-invasive procedures
to tooth structure [1, 2]. The application of fissure sealants
is a proven approach to preventing caries on occlusal
surfaces [3, 4]. The long-term success rate of a fissure
sealant depends on its resistance to microleakage, its
retention and micromechanical adhesion to the enamel
surface, and remaining completely intact [5–10].
One of the new technologies that has been applied in
almost all dentistry fields is the laser. Many different types
of lasers exist and they produce different results in hard
tissue [11–13]. Laser etching is painless and does not
involve vibration or heat. Surfaces prepared with the CO2
laser show no difference in retention in comparison with
acid-etched surfaces [11, 14]. Among the various laser
types used in dentistry, the Er:YAG laser the most often
recommended, because its wavelength (2.94 μm) corre-
sponds to the main absorption band of water (about 3.0 μm)
and it is also well absorbed by the –OH groups in
hydroxyapatite [15, 16]. Er:YAG laser energy is absorbed
by the water portion of hard tissues, resulting in a temperature
increase at the site of application which leads to a rapid
volume expansion on vaporization of the water. As a result,
microexplosions are produced, causing disintegration of the
372 Lasers Med Sci (2012) 27:371–375

hard tissue [6, 17, 18]. Er:YAG laser ablation of occlusal pits
and fissures produces a highly microretentive surface for
infiltration and mechanical entanglement of sealant [7, 19,
20]. The Er:YAG laser is able to increase fluoride uptake and
decrease acid dissolution, thus creating a surface more
resistant to acid attack and caries formation [11, 21–24].
Laser irradiation of dental hard tissues modifies the calcium-
to-phosphorus ratio, reduces the carbonate-to-phosphate
ratio, and leads to the formation of more stable and less
acid-soluble compounds, thus reducing susceptibility to acid
attack and caries [25, 26]
The surface texture of the prepared tissue directly affects
the clinical performance of dental restorations [27–29].
Pretreatment of enamel with phosphoric acid is a conven-
tional method to create microporosities which lead to
sealant micromechanical retention. The surface topography Fig. 1 Sample preparation using a Teflon split mould
of lased permanent enamel exhibits a micro-roughened
Phosphoric acid was applied for 30 s, and the samples
appearance similar to that obtained with conventional acid
were then rinsed for 20 s and dried. The Er:YAG laser was
etching [30–32]. Scanning electron microscopy examina-
set in defocused mode and the enamel surface was
tions of Er:YAG laser-irradiated permanent teeth enamel
irradiated for 30 s at 100 mJ energy output, 10 Hz
have revealed scaly, rough zones with altered hydroxyap-
frequency and focal distance of 17 mm. Double adhesive
atite crystals [7, 32–34]. The aim of this study was to
Sellotape with a 3-mm diameter hole was attached to the
evaluate the effect of laser enamel surface treatment alone,
prepared surfaces to limit sealant application precisely to
or associated with acid-etching, on the tensile bond strength
the isolated area. After surface preparation of each
of a resin-based fissure sealant in permanent teeth.
specimen a split Teflon matrix was adapted to the isolated
area. Fissure sealant (Guardian Seal; Kerr, Orange, CA)
was injected into the Teflon matrix using a Centrix injector
Materials and methods
to produce an even inverted cone of sealant (Fig. 1). A
microscope slide was placed on the Teflon matrix to
A total of 30 sound third molar teeth were selected and
provide an equal distance from the light cure device tip
stored in 0.4% sodium azide solution at room temperature
for all samples. The fissure sealant was polymerized for
for 6 months. The teeth were rinsed and embedded in clear
20 s using a QTH light cure device (Coltolux 75; Coltene
cold-cure acrylic resin using a Teflon mould (20×25 mm).
Whaledent, NJ) with a light intensity of 450 mW/cm2, and
After complete polymerization, the enamel face of the formed
the matrix was removed. The light output intensity was
rectangular cube was ground using SiC paper in a grinding
measured using a radiometer (Optilux, Model 100; Kerr,
device under water cooling to produce a flat surface of enamel
Orange, CA). This procedure resulted in an inverted cone
on the tip of the largest cusp. The samples were randomly
of sealant with a height of 4 mm and the larger diameter
divided into three groups (ten samples in each group) to
6 mm. Radiation was applied for a further 20 s to ensure
receive the following pretreatments:
complete polymerization. The samples were subjected to a
Group 1: 37% phosphoric acid etching gel thermocycling regimen of 400 cycles in water baths at 5°C
Group 2: Er:YAG laser (Smart 2940D Plus; DEKA Laser, and 55°C. The dwell time was 30 s and the transfer time
Firenze, Italy) between baths was 3 s. The specimens were then stored at
Group 3: Er:YAG laser + 37% phosphoric acid 37°C in distilled water for 72 h. The samples were

Table 1 Mean tensile bond

strength (megapascals) in Group N Mean Standard deviation Standard error 95% confidence Interval for Mean
each group, and their
standard deviations and Lower Upper
standard errors
1 10 18.5112 5.68101 1.79649 14.4472 22.5751
2 10 17.3330 5.04957 1.59681 13.7207 20.9452
3 10 8.0648 2.69977 .85374 6.1335 9.9961
All 30 14.6363 6.53971 1.19398 12.1943 17.0783
Lasers Med Sci (2012) 27:371–375
Table 2 Results of the one-way
ANOVA Sum of squares
Between groups 654.718
Within groups 585.547
Total 1240.266
transferred to a universal testing machine (STM, Santam,
Tehran, Iran). The moulded teeth were placed in the lower
part of the testing machine and sealants cone was inserted
inverted into an apparatus with an internal shape that
coincided with that of the formed sealant. The tensile bond
strength test was performed with a cross-head speed of
0.5 mm/min using a 50 kgf load cell until fracture occurred.
The tensile bond strength was determined and expressed in
megapascals for each specimen. Averages and standard
deviations were calculated and quantitative data were
compared between groups using analysis of variance
(ANOVA). Multiple comparisons were performed using
the Tukey test at a significance level of 0.05.
Fracture types were also evaluated by visual inspection
and three types were observed: (1) adhesive failure at the
interface between the enamel and sealant, (2) cohesive
failure in the sealant, and (3) mixed failure (when both the
sealant and the interface were involved).
Results
The means and their respective standard deviations for each
group are shown in Table 1, and the results of the one-way
ANOVA are presented in Table 2. The highest mean tensile
bond strength was seen in group 1 (37% phosphoric acid
etching). The lowest mean tensile bond strength was seen in
group 2 (Er:YAG laser conditioning). Statistical analysis
showed no significant difference (P>0.05) in mean tensile
bond strength between group 1 and group 3 (Er:YAG laser +
37% phosphoric acid), but the mean tensile bond strengths in
both of these groups were significantly different (P<s0.0001)
from that in group 2.
The percentages of each type of fracture in each group
are shown in Fig. 2. In group 1 (37% phosphoric acid) the
predominant type of fracture was cohesive (80%). In
contrast, in group 2 10% of fractures were cohesive and
the most frequent type of fracture was mixed (involvement
of both sealant and interface; 60%). In group 3 (Er:YAG
laser followed by acid) the most frequent type of fracture
was cohesive (40%), but this was much lesser than the
80% in group 1. Additionally, in group 3 adhesive
fractures, like mixed fractures, represented 30% of all
fractures.
373
df Mean square F P value
2 327.359 15.095 0.0001
27 21.687
29
Discussion
Various methods have been used to prepare surfaces prior
to sealant placement in an attempt to increase sealant
retention [1]. It is thought that the Er:YAG laser produces a
suitable microretentive pattern for sealant adhesion [13, 17,
24], and can increase enamel resistance to acid attack [22,
24] and acid etching which makes enamel surfaces
vulnerable to caries attack, particularly when resin penetra-
tion is insufficient [35]. The mechanism of tissue removal
by laser, unlike acid etching, is not demineralization.
Instead, a microablative process causes vaporization of water
and dental organic components, promoting microexplosive
destruction of inorganic substances [17, 25]. It is also thought
to have an antibacterial effect by entrapping free ions and
forming remineralization microspaces [25, 26, 36].
In the present study, samples conditioned only by
phosphoric acid showed the highest tensile bond strength
values, statistically similar to the samples conditioned by
the Er:YAG laser followed by acid etching. A possible
explanation for these results could be that the Er:YAG laser
does not provide homogeneous, uniform microporosities
similar to those created by phosphoric acid [6, 7, 19, 22,
23] because the process of tissue removal is based on
nonselective thermally induced microexplosive ablation [7].
Furthermore, as the Er:YAG laser beam emission is not
continuous, nonlased areas would be left, and a regular
homogeneous pattern would not be obtained [7, 37]. Such
an irregular microstructure could be the reason for bond
100%
80%
60%
40% Mixed
20% Adhesive
0% Cohesive
Fig. 2 Percentages of each fracture type
374
failure. Another factor that affects the bond between sealant
and a laser-etched surface is the presence of substances
produced by destruction of the enamel substrate by
irradiation, which block the intra- and interprismatic spaces.
Therefore, diffusion of sealant into the treated surface
would be restricted [38]. In addition Er:YAG laser radiation
forms a more stable and acid-resistant enamel [22]. This
may affect permeability of the enamel to the acid. Thus acid
etching would be insufficient for effective removal of the
laser-altered layer resulting in a similar pattern to that
obtained by acid alone [24]
As in the present study, Lepri et al. [22] reported that
the Er:YAG laser is not able to increase the effectiveness
of conventional acid etching and consequently does not
improve the bond strength of the sealant. In our study,
application of the Er:YAG laser alone to the enamel
surface resulted in the lowest bond strength values, similar
to those reported previously [27, 39]. Borsatto et al. [40]
found that preparing occlusal pits and fissures exclusively
with an Er:YAG laser did not result in optimal entangle-
ment of the sealant into laser-treated enamel. Other
microleakage studies has also shown that the Er:YAG
laser irradiation does not eliminate the need for acid
etching prior to sealant insertion [7, 40].
The type of failure mirrors the treated surface pattern.
The predominant type of failure in the acid-etched group
was cohesive failure indicating that the adhesive interface
was preserved. In contrast, the major types of fracture in the
laser-etched group and the laser- and acid-etched group
were adhesive and mixed failure, respectively, indicating
that the adhesive interface was the site of focused stress
which is a result of an irregular and uneven etching pattern
[27, 38, 41]. Adhesive and mixed failures indicate that the
explosions cause microfractures or, at least, structural
weakness in the remaining enamel. When the Er:YAG laser
ablates enamel, pieces of enamel weakened by the
explosive process cover much of the surface. While the
bond to these particles may be strong, the fragments are not
firmly attached to the underlying tooth, and so fracture.
As indicated in this study and other similar studies, the
use of the Er:YAG laser for surface treatment prior to
sealant application still does not eliminate the need for acid
etching [6, 7, 19, 27, 41–43]. Further studies with different
laser parameters and long-term clinical trials may be
required to define the most suitable protocol for improving
adhesion to laser-irradiated enamel. The variety of dental
materials should also be considered.
Conclusion
According to the methods used and the findings of this
study, and bearing in mind the limitations of an in vitro
Lasers Med Sci (2012) 27:371–375
study, we conclude that treating the enamel surface with
only an Er:YAG laser results in a significantly lower bond
strength than traditional acid etching. Further, treating the
enamel surface with a combination of Er:YAG laser and
acid etching does not increase the bond strength compared
to acid-etching alone. Hence, we do not recommend Er:
YAG laser surface treatment using either stated protocol
before application of pit and fissure sealants.
Acknowledgment This study was supported by a grant from the
Vice Chancellor of Research of Tehran university of Medical
Sciences.
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