What question did this study set out to answer?

This study investigates how combining Er, Cr: YSGG laser with nano-hydroxyapatite affects enamel remineralization and acid resistance.

May 28, 2026Open Access

Synergistic effect of Er, Cr: YSGG laser and nano-hydroxyapatite on the remineralization of initial enamel lesions: a microhardness, surface roughness and SEM analysis

Key Points

This study investigates how combining Er, Cr: YSGG laser with nano-hydroxyapatite affects enamel remineralization and acid resistance.
One hundred bovine incisors created with artificial white spot lesions were randomly assigned to five treatment groups.
Post-treatment analysis involved microhardness, surface roughness, and SEM at different stages of a pH-cycling protocol.
Statistical analysis was performed using Two-way and Repeated Measures ANOVA with Tukey HSD.
Laser-assisted groups (G3, G4, G5) had significantly higher microhardness values than G1 and G2 (p < 0.05).
G4 showed greater hardness preservation after pH-cycling compared to G5 (p < 0.05).
SEM analysis revealed G4 offered a more compact mineral layer and fewer cracks after acid challenge than other groups.

Abstract

Abstract Background Initial enamel lesions represent a reversible stage of dental caries, yet conventional remineralization methods often face challenges in acid resistance. This study aimed to evaluate the synergistic effect of Er, Cr: YSGG laser and nano-hydroxyapatite (nano-HA) on the remineralization of initial enamel lesions and their sustainability against subsequent acid challenges. Methods One hundred bovine incisors were used to create artificial white spot lesions. Specimens were randomly assigned to five groups ( n = 20): G1 (CPP-ACP + F), G2 (Nano-HA), G3 (Er, Cr: YSGG laser), G4 (Laser + Nano-HA), and G5 (Nano-HA + Laser). After treatment, specimens underwent a 10-day pH-cycling protocol (6 h demineralization/18 h artificial saliva). Surface microhardness (Vickers), surface roughness (Ra), and surface morphology (SEM) were evaluated at three stages: post-demineralization, post-remineralization, and post-pH-cycling. Data were analyzed using Two-way and Repeated Measures ANOVA with Tukey HSD post-hoc tests ( p < 0.05). Results Laser-assisted groups (G3, G4, and G5) exhibited significantly higher microhardness values compared to G1 and G2 across all stages ( p < 0.05). Following pH-cycling, G4 (Laser + Nano-HA) showed significantly higher hardness preservation compared to G5 (Nano-HA + Laser) ( p < 0.05). While laser application significantly increased surface roughness in all measurement stages ( p < 0.05), the application of nano-HA in G4 and G5 partially masked these irregularities. SEM analysis confirmed that G4 provided a more compact and homogeneous mineral layer, with fewer longitudinal cracks after acid challenge compared to other groups. Conclusions The combination of Er, Cr: YSGG laser and nano-HA, particularly when the laser is applied first, significantly enhances the remineralization efficacy and acid resistance of enamel. This synergistic approach offers a promising clinical alternative for the long-term management of initial caries lesions.

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Cite This Study

KAPLAN et al. (Tue,) studied this question.

synapsesocial.com/papers/6a17dd313fad632b0f9d9db9 https://doi.org/https://doi.org/10.1186/s12903-026-08597-9

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