journal of dentistry 39 (2011) 249254

available at www.sciencedirect.com

journal homepage: www.intl.elsevierhealth.com/journals/jden

Clinical evaluation of Er,Cr:YSGG and GaAlAs laser therapy

for treating dentine hypersensitivity: A randomized
controlled clinical trial
Hasan Guney Yilmaz a,*, Sevcan Kurtulmus-Yilmaz b, Esra Cengiz c,
Hakan Bayindir a, Yasar Aykac d
a

Department of Periodontology, Faculty of Dentistry, Near East University, Mersin 10, Turkey
Department of Prosthodontics, Faculty of Dentistry, Near East University, Mersin 10, Turkey
c
Department of Endodontics and Restorative Dentistry, Faculty of Dentistry, Near East University, Mersin 10, Turkey
d
Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
b

article info

abstract

Article history:

Objective: The advent of dental lasers has raised another possible treatment option for

Received 25 November 2010

dentine hypersensitivity (DH) and has become a research interest in the last decades. The

Received in revised form

aim of this randomized, controlled, double-blind, split mouth, clinical study was to evaluate

21 December 2010

and compare the desensitizing effects of erbium, chromium-doped:yttrium, scandium,

Accepted 7 January 2011

gallium and garnet (Er,Cr:YSGG) to galiumaluminiumarsenide (GaAlAs) laser on DH.

Methods: Fifty-one patients participated in this study for a total of 174 teeth. DH was
assessed for all groups with a visual analog scale. For each patient, the teeth were

Keywords:

randomized to three groups. In the diode laser group, sensitive teeth were irradiated with

Laser therapy

the GaAlAs laser at 8.5 J/cm2 energy density. In the Er,Cr:YSGG laser group, sensitive teeth

Dentine hypersensitivity

were irradiated with Er,Cr:YSGG laser in the hard tissue mode using a none-contact probe at

Desensitizing agents

an energy level of 0.25 W and repetition rate of 20 Hz, 0% water and 10% air. In the control
group no treatment was performed. Treatment time was 60 s for GaAlAs laser and 30 s for
Er,Cr:YSGG laser.
Results: When compared with the control group and baseline data, in both laser groups,
laser irradiation provided a desensitizing effect immediately after treatment and this effect
was maintained throughout the study ( p < 0.05). No significant differences between
Er,Cr:YSGG and GaAlAs laser groups were found at any follow-up examination ( p > 0.05).
Conclusion: Based on these findings, it may be concluded that both Er,Cr:YSGG and GaAlAs
lasers were effective in the treatment of DH following a single application.
# 2011 Elsevier Ltd. All rights reserved.

1.

Introduction

Dentine hypersensitivity (DH) is characterized by an acute,

non-spontaneous, short or long-lasting pain originating from
exposure of the dentine to thermal, chemical, mechanical, or

osmotic stimuli, which cannot be attributed to any other

dental pathology.1,2 Although different theories have been
proposed for the mechanism of DH, Brannstroms hydrodynamic mechanism3 is the most widely accepted one. According to this theory, external stimuli cause movement of fluid

* Corresponding author. Tel.: +90 5338328433; fax: +90 3926802025.

E-mail address: dr.hguneyyilmaz@gmail.com (H.G. Yilmaz).
0300-5712/$ see front matter # 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jdent.2011.01.003

250

journal of dentistry 39 (2011) 249254

inside dentinal tubules inwardly or outwardly, promoting

mechanical deformation of nerve endings at the pulp/dentine
interface, which is transmitted as a painful sensation. Under
normal conditions, dentine is covered by enamel or cementum
and is not sensitive to direct stimulation. DH occurs only with
the exposure of the peripheral terminations of dentinal
tubules.4 There are various treatment methods for DH and
the effectiveness of these methods is directly associated with
their capacity to support the sealing of dentinal tubules to
prevent dentinal fluid flow or blocking nerve activity.5,6 The
agents most frequently used for DH treatment can be
classified as follows: protein precipitants, tubule-occluding
agents or tubule sealants.5
The use of lasers opens a new dimension in the treatment
of DH. Several different theories have been suggested to
explain the effect of laser irradiation on dentine, that involve
sealing of dentinal tubules by melting and re-crystallization
of dentine, evaporation of the dentinal fluid, analgesic effect
related to depressed nerve transmission or obliterating the
dentinal tubules with tertiary dentine production.79 Many
lasers, including heliumneon (HeNe), neodymium-doped:yttrium, aluminium and garnet (Nd:YAG), erbium-doped:YAG (Er:YAG) and carbon dioxide (CO2), have desensitizing
effects.68,10 Recently, the results of galiumaluminium
arsenide (GaAlAs) diode laser irradiation in DH treatment
were successful in clinical trials.6,9,11 Erbium, chromiumdoped:yttrium, scandium, gallium and garnet (Er,Cr:YSGG)
laser is expected to show efficiency in dental applications.
1214
However, to the best of our knowledge, there are no
published data available concerning the clinical outcome of a
desensitizing treatment with an Er,Cr:YSGG laser. Therefore,
the aim of this in vivo study was to evaluate and compare the
desensitizing effects of Er,Cr:YSGG laser and GaAlAs diode
laser at 3-month follow-up. The study tested the null
hypotheses that laser treatment of dentine had no effect
on the level of DH of patients, and that the effect of a
Er,Cr:YSSG laser was not different from that of a GaAlAs diode
laser.

2.

Materials and methods

2.1.

Patient selection

Fifty-one patients (22 males and 29 females) with 174 teeth

affected by DH between the ages of 18 and 60 (mean age:
44  9.7 years) volunteered for this study. For inclusion in
the study the subjects had to have 3 or more hypersensitive
teeth in different quadrants. Exclusion criteria included
carious lesions on the selected or neighbouring teeth,
defective restorations, any professional desensitizing therapy on the selected teeth during the last 6 months, use of
desensitizing toothpaste in the last 3 months; being under
analgesics/anti-inflammatory drugs at the time of the study,
pregnancy or smoking. After having received oral and
written information about the intention and the design of
the study, and having signed the informed consent form,
the subjects were included in the study. Study protocol and
related consent forms were approved by our Institutional
Review Board.

2.2.

Evaluation of dentine hypersensitivity

The vitality of all experimental teeth was controlled at the

beginning and end of the trial by means of an electric pulp
tester (Digitest, Parkel, NY, USA). For 4 weeks before
treatment, all patients were enrolled in an oral hygiene
programme and received oral hygiene instructions on two
appointments as well as professional tooth cleaning according to individual needs. Prior to the application of lasers in all
groups, DH was assessed by an evaporative stimulus. A strong
air-blast from a dental syringe was directed to the exposed
cervical area for 3 s at a distance of 1 cm and at right angle to
the buccal site of the assigned teeth, whilst adjacent teeth
were isolated with cotton rolls. Air stimulus time was
controlled by a chronometer and the distance was measured
by a UNC-15 periodontal probe (Hu-Friedy, Chicago, IL, USA).
Patients were asked to record their overall sensitivity by
marking a point on a 10 cm visual analog scale (VAS),
anchored at each end by the phrases No pain and
Unbearable pain. All stimuli were given by one operator
in the same dental chair with the same equipment yielding
similar air pressure (5560 psi) and air temperature (2122 8C)
each time.

2.3.

Laser treatment

In this split-mouth study, for each patient, selected teeth were

randomly assigned to Er,Cr:YSGG laser group, GaAlAs diode
laser group or control group by the lottery method. In the diode
laser group, sensitive teeth were irradiated with the GaAlAs
laser (LaserSmile, Biolase Technology, Irvine, CA, USA) using
810 nm continuous waveform at 8.5 J/cm2 energy density. In
the Er,Cr:YSGG laser group, sensitive teeth were irradiated at
2780 nm with Er,Cr:YSGG laser (Waterlase MD, Biolase
Technology, Irvine, CA, USA) in the hard tissue mode with
the MZ6 sapphire tip (600 mm diameter, 6 mm length) using
non-contact mode at an energy level of 0.25 W, repetition rate
of 20 pulses/s and pulse duration of 140 ms, 0% water and 10%
air. Treatment time was 60 s for GaAlAs laser and 30 s for
Er,Cr:YSGG laser by scanning the cervical part in an overlapping pattern. At the control group, no treatment was
performed. The patients did not know what kind of therapy
each tooth was receiving. All laser irradiations were performed by the same examiner. If any subjects had more than 3
sensitive teeth, all teeth on the same side received the same
treatment. The effectiveness of all treatments was assessed at
four examination periods; immediately, at 1 week, 1 and 3
months after treatment by one examiner who was not aware
of the type of treatment applied. All patients used a soft
toothbrush and toothpaste without any anti-hypersensitivity
agent. These products were provided by the researchers. In
addition, subjects were asked not to use any mouthrinse and/
or fluoride products during the study.

2.4.

Sample size calculation

A minimum clinically significant difference in VAS scores of

0.6 was determined from the available literature on DH.15 The
power analysis was conducted based on this minimum
clinically significant difference in VAS scores, using alpha at

251

journal of dentistry 39 (2011) 249254

Table 1 Demographic characteristics of patients.

Characteristics
Age (year)
Range
Mean
Standard deviation
Gender
Male
Female

Table 2 Distribution of teeth included the study.

Data
1860
44
9.7
22
29

level 0.05, at 80% power and a s of 1.16. On the basis of these

data, the number of patients required to be enrolled to conduct
this study was calculated as 40.

2.5.

Statistical analysis

Mean values of the clinical parameters were calculated for all

groups. Normality of the data distribution was checked by the
KolmogorovSmirnov test. Nonparametric tests were chosen
because the data were not distributed normally. Intra-group
time-dependent data were analysed by Friedmans test, and
Wilcoxons rank sum test was used to evaluate the differences
within groups at each time point. Values of p < 0.05 were
accepted as statistically significant.

3.

Teeth
Maxillary central incisors
Maxillary lateral incisors
Maxillary canine
Maxillary premolars
Maxillary molars
Mandibular central incisors
Mandibular lateral incisors
Mandibular canine
Mandibular premolars
Mandibular molars

8
12
14
34
10
18
18
20
32
8

effects of treatments at the different time points can be seen in

Fig. 1. When compared with the control group, in the Er,Cr:YSGG
and GaAlAs laser groups, laser irradiation provided a desensitizing effect immediately after treatment that was maintained
throughout the study ( p < 0.05) (Table 3). No significant
differences between the laser groups were found at any time
points ( p > 0.05) (Table 3). Intragroup comparisons revealed
that the differences between baseline scores and immediately,
1 week, 1 and 3 months after treatment were statistically
significant in Er,Cr:YSGG and GaAlAs laser groups (Table 3). In
the control group no significant differences were found at the
intragroup comparisons (Table 3).

Results
4.

All 51 patients completed the 3-month study period. Their

baseline demographic characteristics are presented in Table 1.
Thirty-eight percent of teeth were maxillary or mandibular
premolars, followed by mandibular central and mandibular
lateral incisors (Table 2). No complications such as adverse pulp
effects were observed throughout the study. The response of
the patients to the air stimuli throughout the study, and the

[()TD$FIG]

Number of teeth
included in study

Discussion

Traditional DH treatment is based on the application of

desensitizing agents, which obliterates the dentinal tubules
exposed to the oral environment.1214 Since the use of tubule
occlusive agents has some disadvantages such as need for
repeated applications, longer treatment time and patient
compliance, the need for use of alternative treatment

Fig. 1 Reduction of dentine hypersensitivity in all groups at 3-month follow-up.

252

journal of dentistry 39 (2011) 249254

Table 3 Mean degree of VAS scores and standard deviation in all groups over 3 months.
Group
Er.Cr:YSGG
GaAlAs
Control

Baseline
7.2  1.4
7.1  1.3
6.9  1.4

Immediate
*,#

1.5  1.4
1.7  1.3y,#
6.6  1.6

Week 1
*,#

1.2  1.1
1.6  1.3y,#
6.5  1.5

Month 1

Month 3

*,#

1 1.1*,#
1.1  1.1y,#
6.4  1.4

1.1 1.2
1.2  1.2y,#
6.6  1.4

Post treatment VAS scores were lower than baseline VAS scores at Er,Cr:YSGG group, p < 0.05, Friedmans test.
Post treatment VAS scores were lower than baseline VAS scores at GaAlAs group, p < 0.05, Friedmans test.
#
The differences at immediate, 1 week, 1 and 3 months after treatment were statistically significant between laser groups and control group,
p < 0.05, Wilcoxons rank sum test.
y

modalities has arisen.14 With the development of laser

technology, a new treatment option for DH has occurred in
the last decade. Most experimental and clinical studies
regarding the effectiveness of low level laser therapy (LLLT)
on DH were performed using semiconductor diode lasers with
wavelengths in the range of 635830 nm, and dosages in the
range of 210 J/cm2,6,11,16 GaAlAs laser irradiation at maximum
power of 60 mW does not affect the enamel or dentine surface
morphologically. However, a small fraction of the laser energy
at 830 nm wavelength is transmitted through dental hard
tissues to reach the pulp. These lasers treatments have an
immediate analgesic effect by depressing nerve transmission.
According to physiological experiments, this immediate effect
of GaAlAs laser is caused by blocking the depolarization of Cfibre afferents.6
In this clinical trial an Er,Cr:YSGG laser was also used for
the treatment of DH. The Er,Cr:YSGG laser is a relatively new
device which can ablate enamel and dentine due to its high
absorption in water and its strong absorption by hydroxyl
radicals existing in the hydroxyapatite structure.1719 Earlier
studies showed that the Er,Cr:YSGG laser could create precise
hard tissue removal by the interaction of laser energy with
atomized water droplets at the tissue interface with the
ablation of hard tissue.17,18 Er,Cr:YSGG laser uses not only
existing water in tissue but also exogenic water for ablation.20
Since it has been reported that, the exogenous water has a
greater affect than endogenous water on the dentine ablation,21 in the present study Er,Cr:YSGG laser was used without
water. The results of a previous study22 showed that
carbonization occurred even at 0.5 W when Er,Cr:YSGG laser
was used without water. Therefore, the energy settings of the
present study were lower than the threshold for carbonization, melting and surface roughness. The high absorption of
the Er,Cr:YSGG laser emission wavelength (2.78 mm) in water
may result in the deposition of insoluble salts from the
exposed tubules by evaporation of the dentinal fluid. Thus, it
could be suggested that this deposition is responsible for
obturation of the dentinal tubules and reducing DH. Er:YAG
laser has similar effects with Er,Cr:YSGG laser since its
wavelength (2.94 mm) is very close to that of the Er,Cr:YSGG
laser.17 Schwarz et al.8 theorized that Er:YAG shows its
immediate efficiency on DH using the above-mentioned
mechanism. Another possible mechanism of the Er,Cr:YSGG
laser on DH is its effect on the neural receptor TRPVl which is
known to be stimulated by heat. Anecdotal reports in dentistry
have suggested that the Er,Cr:YSGG laser may assist in local
anaesthesia on a short-term basis.23,24 Park et al.25 reported
that thermal-sensitive TRPs in dental sensory nerves may
serve as tooth pain sensors. Thus, Er,Cr:YSGG laser treatment

may cause dental analgesia via TRPVl inhibition. In a recent

paper, Ryu et al.26 tested the effects of a Er,Cr:YSGG laser (the
same as was used in the current study) at energies similar to
those used in the current study, on cultured trigeminal
neurons and cell cultures overexpressing TRPVl. They also
used the laser on TRPV1 knockout mice vs. control mice,
injected in the hindpaw with 0.33 mM capsaicin, the essence
of hot peppers. In normal animals, this substance elicits
intense hindpaw linking/shaking responses. When they used
the water cooled Er,Cr:YSGG laser to treat the capsaicintreated site, the mice showed significant reductions in painrelated behaviour. Similar laser treatment of TRPV1 knockout
mice did not show any analgesia. The authors speculated that
the laser acts directly on the TRPV channel function in sensory
neurons rather than by damaging cells. The high bactericidal
potential of Er,Cr:YSGG laser27 is also important since bacteria
have the ability to lower pain thresholds in sensitive teeth as a
result of increased inflammatory mediator synthesis.28 Recently Franzen et al.29 reported that, Er,Cr:YSGG laser
irradiation at 0.25 W without water spray reduced microorganisms on dentine surfaces without signs of carbonization
or melting. In this clinical trial, both Er,Cr:YSGG and GaAlAs
lasers produced immediate desensitizing effects after a single
treatment.
The long-term duration of desensitizing effects is as critical
as the rapid reduction of DH. Previous studies reported that
the effects of many topical desensitizing agents, dentifrices,
and products containing ferric aluminium and potassium
oxalates are not permanent, because they do not adhere to the
dentine surface.30 However, histological studies have reported
that when the diode laser is used with correct parameters,
besides the immediate analgesic effect, pulpal hard tissue
formation is enhanced as a reaction to laser light in the dental
pulp over a long time period.31,32 Stimulation of odontoblasts,
production of reactionary irregular dentine and obliteration of
dentinal tubules provoked by diode laser may be reasons for
the prolonged suppression of pain in DH.16 Er,Cr:YSGG laser
light is more highly absorbed by OH ions than water molecules
so Er,Cr:YSGG laser can cause a rise in surface temperature
and thus change the mineral content of enamel and dentine.33
Recently, de Freitas et al.34 indicated that low power laser
irradiation with the Er,Cr:YSGG laser at 0.25 W or 0.5 W can be
an alternative to the use of fluoride for the caries preventive
treatment. They stated that, this irradiation was claimed to
make the surface more resistant to acid as a result of chemical
alterations in the enamel structure. Thus, the authors
speculate that Er,Cr:YSGG laser reduces DH in long-term
due to the caries preventive and solubility reducing effects on
dental hard tissues. The current study demonstrated that,

journal of dentistry 39 (2011) 249254

positive results of irradiation of both lasers were maintained

for 3-months without any side effects.

5.

Conclusion

Both the Er,Cr:YSGG laser and the GaAlAs diode laser

irradiation seem to be suitable for routine clinical treatment
for DH, due to the rapid and 3-months clinical effectiveness
without adverse reactions. Also laser treatment seems to be
more comfortable and faster than traditional DH treatment,
since the time consuming procedures such as isolation of
operation field and repeated applications were eliminated.
Further studies are necessary to evaluate the morphological
alterations of the dentine surfaces under scanning electron
microscopy after Er,Cr:YSGG laser application for DH
treatment.

references

1. Holland GR, Narhi MN, Addy M, Gangarosa L, Orchardson R.

Guidelines for the design and conduct of clinical trials on
dentine hypersensitivity. Journal of Clinical Periodontology
1997;24:80813.
2. Dowell P, Addy M. Dentine hypersensitivity a review.
Aetiology, symptoms and theories of pain production.
Journal of Clinical Periodontology 1983;10:34150.
3. Brannstrom M. Sensitivity of dentine. Oral Surgery Oral
Medicine Oral Pathology Oral Radiology 1966;21:51726.
4. Pashley DH, Tay FR, Haywood VB, Collins MA, Drisko CL.
Consensus-based recommendations for the diagnosis and
management of dentin hypersensitivity. Compendium of
Continuing Education in Dentistry 2008;29. Special issue: 17.
5. Al-Sabbagh M, Brown A, Thomas MV. In-office treatment of
dentinal hypersensitivity. Dental Clinics of North America
2009;53:4760.
6. Kimura Y, Wilder-Smith P, Yonaga K, Matsumoto K.
Treatment of dentine hypersensitivity by lasers: a review.
Journal of Clinical Periodontology 2000;27:71521.
7. Moritz A, Schoop U, Goharkhay K, Aoid M, Reichenbach P,
Lothaller MA, et al. Long-term effects of CO2 laser irradiation
on treatment of hypersensitive dental necks: results of an
in vivo study. Journal of Clinical Laser Medicine and Surgery
1998;16:2115.
8. Schwarz F, Arweiler N, Georg T, Reich E. Desensitizing
effects of an Er:YAG laser on hypersensitive dentine. Journal
of Clinical Periodontology 2002;29:2115.
9. Corona SA, Nascimento TN, Catirse AB, Lizarelli RF, Dinelli
W, Palma-Dibb RG. Clinical evaluation of low-level laser
therapy and fluoride varnish for treating cervical dentinal
hypersensitivity. Journal of Oral Rehabilitation 2003;30:11839.
10. Birang R, Poursamimi J, Gutknecht N, Lampert F, Mir M.
Comparative evaluation of the effects of Nd:YAG and
Er:YAG laser in dentin hypersensitivity treatment. Lasers in
Medical Science 2007;22:214.
11. Sicilia A, Cuesta-Frechoso S, Suarez A, Angulo J, Pordomingo
A, De Juan P. Immediate efficacy of diode laser application
in the treatment of dentine hypersensitivity in periodontal
maintenance patients: a randomized clinical trial. Journal of
Clinical Periodontology 2009;36:65060.
12. Gillam DG, Newman HN, Davies EH, Bulman JS, Troullos ES,
Curro FA. Clinical evaluation of ferric oxalate in relieving
dentine hypersensitivity. Journal of Oral Rehabilitation
2004;31:24550.

253

13. Hoang-Dao BT, Hoang-Tu H, Tran-Thi NN, Koubi G, Camps J,

About I. Clinical efficiency of a natural resin fluoride varnish
(Shellac F) in reducing dentin hypersensitivity. Journal of Oral
Rehabilitation 2009;36:12431.
14. Tengrungsun T, Sangkla W. Comparative study in
desensitizing efficacy using the GaAlAs laser and dentin
bonding agent. Journal of Dentistry 2008;36:3925.
15. Yates RJ, Newcombe RG, Addy M. Dentine hypersensitivity:
a randomised, double-blind placebo-controlled study of the
efficacy of a fluoride-sensitive teeth mouthrinse. Journal of
Clinical Periodontology 2004;31:8859.
16. Pesevska S, Nakova M, Ivanovski K, Angelov N, Kesic L,
Obradovic R, et al. Dentinal hypersensitivity following
scaling and root planning: comparison of low-level laser
and topical fluoride treatment. Lasers in Medical Science
2010;25:64750.
17. Hossain M, Nakamura Y, Yamada Y, Kimura Y, Matsumoto
N, Matsumoto K. Effects of Er,Cr:YSGG laser irradiation in
human enamel and dentin: ablation and morphological
studies. Journal of Clinical Laser Medicine and Surgery
1999;17:1559.
18. Hadley J, Young DA, Eversole LR, Gornbein JA. A laserpowered hydrokinetic system for caries removal and cavity
preparation. The Journal of American Dental Association
2000;131:77785.
19. Olivi G, Angiero F, Benedicenti S, Iaria G, Signore A, Kaitsas
V. Use of the erbium, chromium:yttriumscandium
galliumgarnet laser on human enamel tissues. Influence of
the airwater spray on the lasertissue interaction:
scanning electron microscope evaluations. Lasers in Medical
Science 2010;25:7937.
20. Ekworapoj P, Sidhu SK, McCabe JF. Effect of different power
parameters of Er,Cr:YSGG laser on human dentine. Lasers in
Medical Science 2007;22:17582.
21. Meister J, Franzen R, Forner K, Grebe H, Stanzel S, Lampert F,
et al. Influence of the water content in dental enamel and
dentin on ablation with erbium YAG and erbium YSGG
lasers. Journal of Biomedical Optics 2006;11:3403010.
22. Ting CC, Fukuda M, Watanabe T, Aoki T, Sanaoka A,
Noguchi T. Effects of Er,Cr:YSGG laser irradiation on the root
surface: morphologic analysis and efficiency of calculus
removal. Journal of Periodontology 2007;78:215664.
23. Matsumoto K, Hossain M, Hossain NM, Kawano H, Kimura
Y. Clinical assessment of Er,Cr:YSGG laser application for
cavity preparation. Journal of Clinical Laser Medicine and
Surgery 2002;20:1721.
24. Jacobson B, Berger J, Kravitz R, Patel P. Laser pediatric
crowns performed without anesthesia: a contemporary
technique. Journal of Clinical Pediatric Dentistry 2003;28:
112.
25. Park CK, Kim MS, Fang Z, Li HY, Jung SJ, Choi SY, et al.
Functional expression of thermo-transient receptor
potential channels in dental primary afferent neurons:
implication for tooth pain. The Journal of Biological Chemistry
2006;281:1730411.
26. Ryu J-J, Yoo S, Kim KY, Park J-S, Bang S, Lee SH, et al. Laser
modulation of heat and capsaicin receptor TRPVl leads to
thermal antinociception. Journal of Dental Research
2010;89:145560.
27. Arnabat J, Escribano C, Fenosa A, Vinuesa T, Gay-Escoda C,
Berini L, et al. Bactericidal activity of erbium,
chromium:yttriumscandiumgalliumgarnet laser in root
canals. Lasers in Medical Science 2010;25:80510.
28. Olgart L, Brannstrom M, Johnson G. Invasion of bacteria into
dentinal tubules. Experiments in vivo and in vitro. Acta
Odontologica Scandinavica 1974;32:6170.
29. Franzen R, Esteves-Oliveira M, Meister J, Wallerang A,
Vanweersch L, Lampert F, et al. Decontamination of deep
dentin by means of erbium, chromium:yttriumscandium

254

journal of dentistry 39 (2011) 249254

galliumgarnet laser irradiation. Lasers in Medical Science

2009;24:7580.
30. Orchardson R, Gillam DG. Managing dentin
hypersensitivity. The Journal of American Dental Association
2006;137:9908.
31. Ferreira AN, Silveira L, Genovese WJ, de Araujo VC, Frigo L,
de Mesquita RA, et al. Effect of GaAIAs laser on reactional
dentinogenesis induction in human teeth. Photomedicine and
Laser Surgery 2006;24:35865.
32. Dilsiz A, Canakci V, Ozdemir A, Kaya Y. Clinical evaluation
of Nd:YAG and 685-nm diode laser therapy for

desensitization of teeth with gingival recession.

Photomedicine and Laser Surgery 2009;27:8438.
33. Harashima T, Kinoshita J, Kimura Y, Brugnera A, Zanin F,
Pecora JD, et al. Morphological comparative study on
ablation of dental hard tissues at cavity preparation by
Er:YAG and Er,Cr:YSGG lasers. Photomedicine and Laser
Surgery 2005;23:525.
34. de Freitas PM, Rapozo-Hilo M, Eduardo Cde P, Featherstone
JD. In vitro evaluation of erbium, chromium:yttrium
scandiumgalliumgarnet laser-treated enamel
demineralization. Lasers in Medical Science 2010;25:16570.