Comparative study of the effect of Er:YAG and Er:Cr;YSGG lasers on porcelain: etching for the bonding of orthodontic brackets

This study investigated the effect of Er:YAG (smart 2940 Dplus, DEKA, Italy) and Er:CrYSGG (Waterlase iPlus, Biolase, USA) lasers on the shear bond strength (SBS) between the orthodontic brackets and dental porcelain in comparison with conventional acid etching with 9% hydrofluoric acid (HF, Ultradent, USA). A total of 60 specimens of maxillary incisor crown were prepared and randomly assigned to five groups; each group was subjected to a different porcelain surface conditioning: (1) etching with the 9% HF for 2min; (2) etching with the 9% HF for 2min followed by irradiation with the Er:CrYSGG laser (3-W power, 10-Hz frequency for 10s); (3) etching with the 9% HF for 2min followed by irradiation with the Er:YAG laser (3-W power, 10-Hz frequency for 10s); (4) Irradiation with the Er:CrYSGG laser (3-W power, 10-Hz frequency for 10s without acid etching) and (5) irradiation with the Er:YAG laser (3-W power,10-Hz frequency for 10s without acid etching). After using Transbond XT primer and Transbond XT adhesive, the metal brackets (Dentaurum, Germany equilibrium 2, optimal design) bonded to the conditioned porcelain surface. Subsequently, the specimens were thermocycled for 5000cycles and then debonded using the Universal Testing Machine (Zwick). In each group, one specimen was not bonded to brackets to allow further examination with electron microscopy. After debonding, the specimens were examined by stereomicroscope to determine their adhesive remnant index (ARI). The average SBS [Mean (SD)] values in the five groups were as follows: HF (32.58 +/- 9.21MPa), Er:CrYSGG + HF (27.81 +/- 7.66MPa), Er:YAG + HF (23.08 +/- 9.55MPa), Er:CrYSGG (14.11 +/- 9.35MPa), and Er:YAG (6.30 +/- 3.09MPa). A statistically significant difference in SBS existed between the first three groups and the two laser groups (df=4, F=18.555, p<0.001). Evaluation of ARI values showed that bond failures in the first three groups were mostly of cohesive and mixed types, but in the laser groups, they were mostly adhesive. Chi-square was not significant between groups (p=0.219). The Er:YAG laser with the stated specifications is not a suitable alternative to HF etching. In the case of Er:CrYSGG laser, although the conditioning outcome met the bond strength requirement for orthodontic brackets (that is, 6-8MPa). Therefore, the bond strength must be further improved by fine-tuning the irradiation details.