Selective removal of composite sealants with near-UV laser pulses

It is often necessary to replace pit and fissure sealants and composite restorations. This task is complicated by the necessity for complete removal of the remaining composite to enable suitable adhesion of new composite. Previous studies have shown that lasers pulses from a frequency-tripled Nd:YAG laser (355-nm) can selectively remove residual composite after orthodontic bracket removal on enamel surfaces. UV laser light is preferentially absorbed by polymeric resins and the organic content of the tooth enamel. The objective of this study was to determine if such laser pulses are suitable for selective removal of the old composite from pit and fissure sealants and restorations without damaging surrounding sound tissues. Optical coherence tomography was used to acquire optical cross sections of the occlusal topography and peripheral tooth structure non-destructively before application of the sealants, after sealant application, and after sealant removal with 355-nm laser pulses with intensities ranging from 0-10 J/cm ². Thermocouples were used to monitor the temperature in the pulp chamber during composite removal under clinically relevant ablation rates, i.e., 30 Hz and 30 mJ per laser pulse. At an irradiation intensity of 1.3 J/cm ² pit and fissure sealants were completely removed without visible damage to the underlying enamel. At intensities above 1.5 J/cm ², the laser removes the resin layer while at the same time preferentially etching the surface of the enamel. Temperature excursions in the pulp chamber of extracted teeth was limited to less than 5°C if air-cooling was used during the rapid removal (1-2 min) of sealants, water-cooling was not needed. This is the first presentation of a method for the selective removal of composite restorative materials without damage to the underlying sound tooth structure.