Thermal effect of Er:YAG and Er,Cr:YSGG used for debonding ceramic and metal orthodontic brackets: An experimental analysis

Background In orthodontics, erbium (Er:YAG) lasers can be used for bracket debonding. Objectives To assess the changes in temperature of pulp and enamel during laser debonding of brackets. Material and methods A total of 13 brackets (n = 13; 2 metal and 11 ceramic brackets) were bonded to 13 caries-free premolars extracted for orthodontic reasons. Brackets were irradiated with 2 lasers. Laser No. 1 was an erbium-chromium (Er,Cr:YSGG) laser (Waterlase Express; Biolase, Irvine, USA) with a wavelength of 2,780 nm at a power of 2.78-2.85 W, energy of 185-190 mJ, fluence of 10 ns, frequency of 25 Hz, pulse duration of 300 μs, tip diameter of 0.6 mm, air/fluid cooling of 3.5 mL/s, and time of irradiation of 5-25 s. Laser No. 2 was an Er:YAG laser (LiteTouch; Light Instruments Ltd., Yokneam, Israel) with a wavelength of 2,940 nm at a power of 4 W, energy of 200 mJ, fluence of 10 ns, frequency of 20 Hz, pulse duration of 300 μs, tip diameter of 0.8 mm, air/fluid cooling of 3.5 mL/s, and time of irradiation of 5-15 s. Two thermographic cameras (FLIR Zenmuse XT and FLIR P65; FLIR Systems, Wilsonville, USA) and type K thermocouple (Zhangzhou Weihua Electronic Co., Fujian, China) were used for precise temperature measurement on the surface of the teeth and inside them. Results When laser No. 1 was in use, the mean difference between the inner and outer temperature of the examined teeth (1.4°C) was higher than when the laser No. 2 was in use (0.6°C) (p = 0.0974). The study found that the temperature inside the tooth did not increase, and it even decreased during treatment with Er:YAG laser using water cooling, provided that appropriate proportion of water and air was used. For laser No. 1, confidence interval (CI) was between 0.7 and 2.2 and for laser No. 2 it was between 0.500 and 1.23. Only experiment for ceramic brackets was described. Conclusions These findings confirm that the use of Er:YAG family lasers for orthodontic bracket debonding in an in vitro study is safe and effective.