Low-power pulsed Nd:YAG laser irradiation for pre-emptive anaesthesia: A morphological and histological study.

Background and aims: To determine if tooth structure or dental pulp of normal healthy human premolar teeth to be extracted for orthodontic reasons exhibit morphological or histological changes following dental anaesthesia by pulsed Nd:YAG laser and subsequent cavity preparation (CP). Materials (Subjects) and Methods: 54 bilateral paired of human, healthy premolar teeth identified for inclusion in a clinical trial of Nd:YAG-induced anaesthesia and subsequently extracted for orthodontic reasons, were randomly divided into 4 treatment groups: Group 1 - teeth (n=44) were irradiated with 150 µs pulsed Nd:YAG laser-1064 nm (American Dental Laser, dLase300, Sunrise Technologies Inc., Folsom, CA, USA; Average power: 1.1 ± 0.2 W, power density: 39+ 0.7 W/cm2, area 0.28 cm2, 15 Hz; energy density:0. 260+ 0.047 J/cm2) +Sham EMLA (cream without active component) followed by cavity preparation (CP); Group 2 - Teeth (n=44) - were treated with EMLA + Sham Laser (1 mW 632.8-nm He:Ne laser aiming beam only) with CP; Group 3 Teeth (n=10) - were irradiated with pulsed Nd:YAG laser as above but minus CP; Group 4 (n=10)- was a Control group with teeth untreated (no Laser, EMLA or CP). Clinical anaesthesia was assessed by electric pulp testing (EPT) and CP. Teeth in each of the 4 groups were processed for examination by i) scanning electron microscopy (SEM); ii) longitudinal undecalcified ground sectioning (LUGS); iii) light microscopy of pulpal tissues or iv) dye penetration. Results: Both Laser and EMLA groups demonstrated no alteration to mineralized tooth structure and dentinal permeability. Mild superficial pulpal changes were found in both groups (3/18 teeth) and of no statistical difference (p>0.99, the McNemar test). Neither Laser nor the Control groups minus CP, showed pulpal changes. Conclusions: Low-power pulsed Nd:YAG laser dose, as used in the clinical trial to induce anaesthesia, does not cause morphological damage to the mineralized tooth structure. Both Laser and EMLA groups showed minor superficial pulpal change following cavity preparation which was not statistically significant. Laser and Control groups minus preparation had no pulpal changes.