BMC oral health · 2026
Synergistic effect of Er, Cr: YSGG laser and nano-hydroxyapatite on the remineralization of initial enamel lesions: a microhardness, surface roughness and SEM analysis.
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Kaplan Ecehan, Özdemir Sergen, Dündar Ayşe, Barutçugil Çağatay, Bayram Edip
Аннотация
BACKGROUND: Initial enamel lesions represent a reversible stage of dental caries, yet conventional remineralization methods often face challenges in acid resistance. This study aimed to evaluate the synergistic effect of Er, Cr: YSGG laser and nano-hydroxyapatite (nano-HA) on the remineralization of initial enamel lesions and their sustainability against subsequent acid challenges.
METHODS: One hundred bovine incisors were used to create artificial white spot lesions. Specimens were randomly assigned to five groups (n = 20): G1 (CPP-ACP + F), G2 (Nano-HA), G3 (Er, Cr: YSGG laser), G4 (Laser + Nano-HA), and G5 (Nano-HA + Laser). After treatment, specimens underwent a 10-day pH-cycling protocol (6 h demineralization/18 h artificial saliva). Surface microhardness (Vickers), surface roughness (Ra), and surface morphology (SEM) were evaluated at three stages: post-demineralization, post-remineralization, and post-pH-cycling. Data were analyzed using Two-way and Repeated Measures ANOVA with Tukey HSD post-hoc tests (p < 0.05).
RESULTS: Laser-assisted groups (G3, G4, and G5) exhibited significantly higher microhardness values compared to G1 and G2 across all stages (p < 0.05). Following pH-cycling, G4 (Laser + Nano-HA) showed significantly higher hardness preservation compared to G5 (Nano-HA + Laser) (p < 0.05). While laser application significantly increased surface roughness in all measurement stages (p < 0.05), the application of nano-HA in G4 and G5 partially masked these irregularities. SEM analysis confirmed that G4 provided a more compact and homogeneous mineral layer, with fewer longitudinal cracks after acid challenge compared to other groups.
CONCLUSIONS: The combination of Er, Cr: YSGG laser and nano-HA, particularly when the laser is applied first, significantly enhances the remineralization efficacy and acid resistance of enamel. This synergistic approach offers a promising clinical alternative for the long-term management of initial caries lesions.
METHODS: One hundred bovine incisors were used to create artificial white spot lesions. Specimens were randomly assigned to five groups (n = 20): G1 (CPP-ACP + F), G2 (Nano-HA), G3 (Er, Cr: YSGG laser), G4 (Laser + Nano-HA), and G5 (Nano-HA + Laser). After treatment, specimens underwent a 10-day pH-cycling protocol (6 h demineralization/18 h artificial saliva). Surface microhardness (Vickers), surface roughness (Ra), and surface morphology (SEM) were evaluated at three stages: post-demineralization, post-remineralization, and post-pH-cycling. Data were analyzed using Two-way and Repeated Measures ANOVA with Tukey HSD post-hoc tests (p < 0.05).
RESULTS: Laser-assisted groups (G3, G4, and G5) exhibited significantly higher microhardness values compared to G1 and G2 across all stages (p < 0.05). Following pH-cycling, G4 (Laser + Nano-HA) showed significantly higher hardness preservation compared to G5 (Nano-HA + Laser) (p < 0.05). While laser application significantly increased surface roughness in all measurement stages (p < 0.05), the application of nano-HA in G4 and G5 partially masked these irregularities. SEM analysis confirmed that G4 provided a more compact and homogeneous mineral layer, with fewer longitudinal cracks after acid challenge compared to other groups.
CONCLUSIONS: The combination of Er, Cr: YSGG laser and nano-HA, particularly when the laser is applied first, significantly enhances the remineralization efficacy and acid resistance of enamel. This synergistic approach offers a promising clinical alternative for the long-term management of initial caries lesions.