Thermal Safety of Er:YAG and Er,Cr:YSGG Lasers in Hard Tissue Removal

Objective: The aim of this study was to compare the thermal safety of Er:YAG and Er,Cr:YSGG lasers with conventional multi-use and single-use diamond burs. Background Data: Thermal effect of tooth preparation is mostly evaluated through the pulp chamber because it is difficult to measure the temperature of the preparation surface. A new in vitro method was introduced to simultaneously evaluate the heat increase of the preparation surface together with the pulp chamber. Methods: Six laser and bur instrument groups were used to make standardized preparations on buccal surfaces of 60 intact third molars. The preparations removed an equal volume of hard tissue from each tooth (4mm occluso-gingival x 8mm mesial-distal x 1.6mm bucco-lingual). The teeth also included tunnel preparations from the opposite (lingual) surface, exposing the pulpal axial wall (axial dentin wall in contact with the pulp chamber from the preparation surface site). An infrared thermal camera was positioned to capture the preparation surface in direct vision, while the pulpal axial wall was indirectly reflected to the thermal camera via a minimal-energy-loss mirror. Data from both surfaces were analyzed statistically using Nested Least Squares Analysis. Results: The laser groups generated significantly lower heat compared to bur groups on the preparation surfaces. In contrast, both lasers generated greater pulpal heat increase, and the Er: YAG laser group showed significance (p < 0.0001). Conclusions: Lasers produced less heat on the preparation surface but more on the pulpal axial wall. However the temperature rise was less than the 5.5 degrees C threshold margin of safety.