Lasers In Dental Hygiene Powerpoint

Clinical Application of Lasers

In Dental Hygiene

Introduction to lasers in dentistry . . . History

• Thirty years ago when lasers were first considered for dental use, it was thought they would replace the mechanical drills used to remove cavities. In 1964 lasers were reported to vaporize dental enamel using a pulsed ruby laser.• The first lasers approved for dental procedures involved soft tissue surgery and procedures including gingivectomy, frenectomy, curettage, crown lengthening, biopsy, and other gingival procedures.  These lasers included the carbon dioxide lasers, Nd:YAG (neodymium:yttrium-aluminum-garnet), argon, and diode lasers.  

• Today the argon laser has been cleared for curing of commonly used tooth colored fillings in the mouth and bleaching.  The most recently approved laser for dental use is the Er:YAG laser cleared for use on soft and hard tissues of the mouth, including cavity repairs of teeth.

Advantages of Laser . . .• Calculus removal• High bactericidal capacity with laser irradiation• Reduced use of local anesthesia • Increased productivity• Greater hemostasis• Minimal wound contraction • Retard epithelial proliferation apically along healing root surface to enhance periodontal tissue regeneration

• Reduced noise factor

Indications for Lasers in the Medically Compromised Client . . .

• Blood thinners: If a client is on Coumadin or takes aspirin everyday and the physician does not want the client to stop them, laser treatment is beneficial because of the reduced chance of bleeding during treatment

• If the client has high BP and the use of Epinephrine is contraindicated

• Client is allergic or hypersensitive to Epinephrine, causing rapid heartbeat whenever interacting with Novocaine

Disadvantages of laser . . . • Laser irradiation: can interact with tissues even in the non-contact mode, meaning laser beams may reach the client’s eye and other tissues surrounding the target in the oral cavity

• Need specific eyewear according to wavelength of laser for clinician and client

• Cost and size still constitute an obstacle for clinical application in dental hygiene

Types of lasers & indications . . .

Contraindications to laser treatment . . .Dental lasers cannot be implemented for the following clients:

• If the client suffers from an acute disease

• He or she is ill from a mental disease, and cannot be followed-up by their physician

• He or she suffers from a skin disease, and is allergic to light

• A woman who has given birth to a baby less than five months ago

Erbium Lasers . . . • Er:YAG (Erbium-doped:Yittrium-Aluminum-Garnet)

• Er,Cr:YSGG (Erbium-Chromium doped:Yittrium-Selenium- Gallium-Garnet)

• Recently, Er:YAG and Er,Cr:YSGG laser scaling was introduced as an alternative or adjunctive to conventional scaling and root debridement

• Of all the lasers available, the absorption of Er:YAG and Er,Cr:YSGG lasers in water is nearly the highest.

• These lasers efficiently ablate all biological tissues that contain water molecules

• The erbium laser group has emerged as a promising laser system for periodontal indications

Wavelength: 2,940 nanometers

Wavelength: 2,780 nanometers

In a recall client with early to moderate periodontitis and recurrent pocket depths of 4mm or greater does laser hygiene in conjunction with scaling and root planing versus conventional scaling lead to a reduction in pocket depths and greater attachment levels?

With this said we are left to ask . . .

Clinical Periodontal Research of. . . Er: YAG (Erbium-doped:Yittrium-Aluminum-Garnet)• Watanabe et al. demonstrated efficient calculus removal with no side effects and uneventful reduction of pockets after Er:YAG scaling• Schwarz et al. reported that equal or slightly better results were observed at six months after laser treatment of periodontal pockets, compared to conventional debridement using hand scalers and found significantly higher reduction of bleeding on probing scores and improvements in clinical attachment level after laser treatment

Clinical Periodontal Research of . . . Er,Cr:YSGG (Erbium-Chromium doped:Yittrium-Selenium-

Gallium-Garnet)

• 10 pts with early to moderate periodontitis

• 30-60yrs of age

• Study conducted between March and Sept of 2006

• Participation based on signed and informed consent forms

• Pt selection criteria based on:

• No perio tx received in the last 12 months

• No systemic diseases that would influence the outcome of tx

• No systemic antibiotics in last 6 months

• Non-smokers

Clinical Periodontal Research of . . .Er,Cr:YSGGA total of 130 patients were examined

Criteria for teeth selection:

• Every tooth had to exhibit gingival inflammation w. positive B.O.P, sub-G calculus and PD of 4 mm on every tooth

• Every quadrant was split in four

• Patients received treatment for at least two quadrants using test control methods

Two tx modes performed:

• Protocol A (control method): conventional scaling and root planing

• Protocol B (test method): SRP plus Er, Cr: YSGG laser therapy

Histological Effects of Lasers . . . • Ultrasonic debridement results in a smooth surface smear layer which contains dental debris, bacterial endotoxins, contaminated root cementum and subgingival plaque• Laser irradiation induced glazed microstructures present a rough root surface • The lased root surfaces enhance adhesion and proliferation of fibroblasts

• This is a potential explanation for greater periodontal reattachment• Scientific evidence has frequently stated that laser irradiation exhibits high bactericidal properties

• Irradiation helps to remove epithelial lining and granulation tissue within periodontal pockets

• Therefore laser de-epithelialization blocks the down-growth of epithelium and so enhances periodontal reattachment

Results of Pilot Study . . .

• Post op healing uneventful

• No complications observed during tx

• After 3 months % of plaque free surfaces increased to 47.4% in laser + SRP and 34.6% in SRP

• Therefore more pronounced decreased in plaque levels noted in group with laser-SRP treated teeth

• After three months bleeding scores were reduced by 20.5% in laser + SRP and only 17% in SRP alone

• Reduction of periodontal depth occurred more significantly in Laser + SRP group than SRP alone

In conclusion . . .

• Due to more efficient attachment level restoration, combined tx of lasers with root planing and scaling is more advantageous when compared to SRP alone.

• Er:YAG or Er;Cr:YSGG laser + SRP and SRP alone, lead to significant short term improvements in all clinical parameters investigated

Both lasers possess the following beneficial characteristics:

• Soft tissue ablation with minimal damage and maximized tissue regeneration

• High bactericidal effect and elimination of lipopolysaccharides

• Ability to remove bacterial plaque and calculus

Using Lasers in Practice . . .

• Studying all the research on lasers and their benefits for periodontally compromised clients; we would both use lasers as an adjunctive therapy to normal Scaling and Root Planning in our practice!

Thank you for your attention!

By: Mandy and Tanya