Primary tooth enamel surface topography with in vitro argon laser irradiation alone and combined fluoride and argon laser treatment: scanning electon microscopic study.

PURPOSE: The purpose of this descriptive scanning electron microscopic study was to characterize surface alterations in primary tooth enamel after in vitro argon laser irradiation alone and combined with topical fluoride treatment either before or after argon laser irradiation. METHODS: Twenty extracted or exfoliated primary teeth underwent soft tissue debridement and a fluoride-free prophylaxis. Buccal and lingual surfaces were determined to be caries-free by macroscopic examination (stereo-zoom binocular microscope, x16). Treatment groups were: (1) no-treatment control; (2) argon laser irradiation (ALI; 11.5 J/cm2); (3) 1.23% acidulated phosphate fluoride (APF before ALI); and (4) ALI before APF. Both buccal and lingual surfaces were evaluated following standard scanning electron microscopic preparation techniques. RESULTS: With controls, enamel surfaces were relatively smooth with occasional enamel prism ends present on their surfaces. There were no areas with cavitations or surface defects. With ALI, the lased surfaces were roughened mildly to moderately irregular without cavitation of the enamel or exposure of enamel prism ends. The surfaces possessed adherent granules to globules, with most being <3 microm in greatest dimension. Only occasional fine cracks and porosities in the surface coatings were noted and these were typically less than 1 microm in width or diameter. With APF before ALI, the surfaces possessed an irregular contour, with numerous granules to globules varying in size from 1 to 3 microm in greatest dimension. With ALI before APF, a homogenous confluent surface was present that masked typical enamel surface markings. The previously noted adherent granules and globules with argon laser treatment alone or APF before ALI were not seen. The argon laser effects on the enamel surfaces were masked by the uniformity of these surface coatings. CONCLUSIONS: Argon laser irradiation and combined APF and argon laser treatment of primary tooth enamel created surfaces that may provide a protective barrier against a cariogenic attack. The surface coatings associated with combined APF and argon laser treatment may contain fluoride-rich calcium and phosphate mineral phases that could act as reservoirs for fluoride, calcium, and phosphate and provide a certain degree of protection from a caries lesion challenge.