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Feng C, Ding Y, Tang L, Gui Y, Shen X, He L, Lu X, Leung WK. Adjunctive Er:YAG laser in non-surgical periodontal therapy of patients with inadequately controlled type 2 diabetes mellitus: A split-mouth randomized controlled study. J Periodontal Res 2021; 57:63-74. [PMID: 34610151 DOI: 10.1111/jre.12938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/02/2021] [Accepted: 09/17/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Limited studies are available comparing the outcomes of non-surgical periodontal therapy (NSPT) with or without adjunctive Er:YAG laser (ERL) in patients with type 2 diabetes mellitus (T2DM). This study evaluated the effects of ERL adjunctive NSPT on single-rooted teeth of inadequately controlled T2DM patients with periodontitis. METHODS Twenty-two inadequately controlled T2DM participants with periodontitis were recruited. Adopting a double-blinded split-mouth design and under block randomization, we investigated the effects of ERL in calculus removal then degranulation mode, or a sham treatment, adjunct NSPT, which included two visits of full-mouth root surface debridement delivered within 4-10 days, to test or control single-rooted teeth (Wuxi Stomatology Hospital, trial 2017-016). We followed periodontal parameters (plaque %, bleeding on probing [BOP] %, probing pocket depth [PPD], probing attachment level [PAL]) and selected systemic parameters (fasting plasma glucose [FPG], glycosylated hemoglobin [HbA1c%], high sensitivity C-reactive protein) at baseline, one, three, and six months after periodontal treatment. RESULTS The study was completed as planned. Periodontal parameters, FPG and HbA1c% of the 22 participants appeared significantly improved at six months (p < 0.001). The 44 ERL treated, compared to 44 sham treated single-rooted teeth exhibited significant improvement in BOP, mean PPD, and mean PAL at various postoperative follow-up time points (effect size ≥0.44; p < 0.001). No adverse event was reported. CONCLUSION Periodontal treatment outcomes in the T2DM patients with inadequate glycemic control were better in the single-rooted teeth received ERL adjunct NSPT. Further studies are warranted to confirm the observations reported in this short-term clinical study.
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Affiliation(s)
- Chenchen Feng
- Department of Periodontology, Wuxi Stomatology Hospital, Wuxi, Jiangsu Province, China
| | - Yi Ding
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Periodontology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liqin Tang
- Department of Periodontology, Wuxi Stomatology Hospital, Wuxi, Jiangsu Province, China
| | - Yong Gui
- Department of Periodontology, Wuxi Stomatology Hospital, Wuxi, Jiangsu Province, China
| | - Xiaoyun Shen
- Department of Periodontology, Wuxi Stomatology Hospital, Wuxi, Jiangsu Province, China
| | - Linlin He
- Department of Periodontology, Wuxi Stomatology Hospital, Wuxi, Jiangsu Province, China
| | - Xinyan Lu
- Department of Periodontology, Wuxi Stomatology Hospital, Wuxi, Jiangsu Province, China
| | - Wai Keung Leung
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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Zarif Najafi H, Estedlal T, Saki M, Azmi A, Mohamadian F, Moshkelgosha V. Er,Cr:YSGG Laser as a Means of Orthodontic Adhesive Removal: Myth or Reality? PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:558-565. [PMID: 34424743 DOI: 10.1089/photob.2020.4983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: This study aimed to compare the effect of Er,Cr:YSGG laser with a tungsten carbide bur in orthodontic finishing on the enamel surface roughness and the heat generated in the pulp chamber. Methods: Before bonding, of 125 intact extracted premolar teeth, 15 teeth were randomly assigned to the control group. Of the remaining 110 bonded teeth, 50 were used to determine the laser parameters, and 60 were included in the main in vitro study. After debonding, the teeth were randomly distributed among four study groups (n = 15) for finishing with laser beams (Er,Cr:YSGG, Waterlase) with and without polishing with Sof-Lex discs, and finishing with a bur (tungsten carbide, Reliance) with and without polishing with Sof-Lex discs. The thermal changes were measured during finishing using a thermo-controller-coupled thermocouple placed in the pulp chamber. Enamel surface roughness was evaluated qualitatively under a scanning electron microscope (SEM) and quantitatively under an atomic force microscope (AFM). Results: The thermal changes of the bur group were significantly higher than those in the laser group (p = 0.0001). Quantitatively, the surface roughness values of all the study groups were significantly higher than those of the control group (p < 0.05), with no significant difference between the study groups (p > 0.05). SEM analysis confirmed the AFM measurements. Conclusions: Er,Cr:YSGG can be recommended as an alternative for a carbide bur for adhesive agent removal after orthodontic debonding, considering its mild thermal effect on the pulp. Polishing with Sof-Lex discs did not significantly reduce the surface roughness, regardless of the finishing procedure.
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Affiliation(s)
- Hooman Zarif Najafi
- Department of Orthodontics, Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Taraneh Estedlal
- Department of Operative Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Saki
- Health System Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Azmi
- Dentist, Private Practice, Shiraz, Iran
| | - Fatemeh Mohamadian
- Department of Pediatric Dentistry, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zhou X, Lin M, Zhang D, Song Y, Wang Z. Efficacy of Er:
YAG
laser on periodontitis as an adjunctive non‐surgical treatment: A split‐mouth randomized controlled study. J Clin Periodontol 2019; 46:539-547. [PMID: 31069833 DOI: 10.1111/jcpe.13107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/03/2019] [Accepted: 03/26/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Xuan Zhou
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
| | - Mei Lin
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
| | - Dongxue Zhang
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
| | - Yiqing Song
- Department of Epidemiology Richard M. Fairbanks School of Public Health Indiana University Indianapolis Indiana USA
| | - Zuomin Wang
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
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Clinical and Microbiological Effects of the Use of Erbium: Yttrium–Aluminum–Garnet Laser on Chronic Periodontitis in Addition to Nonsurgical Periodontal Treatment: A Randomized Clinical Trial—6 Months Follow-Up. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:182-190. [DOI: 10.1089/photob.2018.4510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Decontamination of Dental Implant Surfaces by the Er:YAG Laser Beam: A Comparative in Vitro Study of Various Protocols. Dent J (Basel) 2018; 6:dj6040066. [PMID: 30513706 PMCID: PMC6313799 DOI: 10.3390/dj6040066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 12/18/2022] Open
Abstract
Oral rehabilitation with dental implants has revolutionized the field of dentistry and has been proven to be an effective procedure. However, the incidence of peri-implantitis has become an emerging concern. The efficacy of the decontamination of the implant surface, by means of lasers, is still controversial. Previous studies have revealed a reduction in osteoblast adhesion to carbon-contaminated implant surfaces. This in-vitro study aimed to evaluate the decontamination of failed implants by assessing the carbon proportion, after irradiation by low-energy erbium yttrium-aluminum-garnet laser (Er:YAG) (Fotona; 2940 nm, Ljubljana, Slovenia) for a single and for multiple passages, until getting a surface, free of organic matters; to find the appropriate procedure for dental-implant surface-decontamination. Ninety implants were used. Thirty sterile implants were kept as a negative control. Thirty failed implants were irradiated by the Er:YAG laser, for a single passage, and the other thirty, for multiple passages. The parameters used in our experiments were an irradiation energy of 50 mJ, frequency of 30 Hz, and an energy density of 3.76 J/cm2. A sapphire tip, with a length of 8 mm, was used with concomitant water spray irrigation, under air 6 and water spray 4. Super short pulse mode (SSP) was of 50 μs; irradiation speed being 2 mm/s. We used energy-dispersive X-ray spectroscopy (EDX) to evaluate the carbon proportion on the surfaces of the sterile implants, the contaminated, and the lased implants, with one (LX1) and with three passages (LX3). Statistical analysis was performed by ANOVA. Results showed mean difference between the three groups (contaminated, LX1, and LX3) with p < 0.0001, as between LX1 and Group A (p < 0.0001), while the difference between LX3 and the control group was not statistically significant. The decontamination of the implant surfaces with a low-energy Er:YAG laser with three passages, appeared to be an encouraging approach.
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Ma L, Zhang X, Ma Z, Shi H, Zhang Y, Wu M, Cui W. Clinical Effectiveness of Er: YAG Lasers Adjunct to Scaling and Root Planing in Non-Surgical Treatment of Chronic Periodontitis: A Meta-Analysis of Randomized Controlled Trials. Med Sci Monit 2018; 24:7090-7099. [PMID: 30289123 PMCID: PMC6186153 DOI: 10.12659/msm.911863] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Er: YAG lasers (ERLs) show suitable characteristics for scaling and root planing, but previous studies have drawn conflicting conclusions. This meta-analysis aimed to systematically appraise the available evidence concerning the effectiveness of ERLs as an adjunct to scaling and root planing (SRP) for non-surgical periodontal treatment. MATERIAL AND METHODS Randomized controlled trials (RCTs) comparing ERLs+SRP with SRP alone for the treatment of chronic periodontitis were searched in 9 electronic biomedical databases up to January 2018. The weighted mean differences (WMDs) and 95% confidence intervals (CIs) were counted for probing depth (PD) reduction, clinical attachment level (CAL) gain, and visual analog scale (VAS) score. Heterogeneity was evaluated with the I² statistic for interstudy comparisons and the χ²-based Q statistic for intra-study comparisons. Sensitivity analysis was conducted by switching to a random or fixed effect model based on the heterogeneity. Publication bias was measured by Begg's test. RESULTS Ten related RCTs met the inclusion criteria. There were statistically significant differences in the assessed clinical parameters at the three-month follow-up: PD reduction (WMD=0.32, 95%CI range from 0.14 to 0.51, p<0.001; p=0.003, I²=69.7%); CAL gain (WMD=0.31, 95%CI range from 0.22 to 0.40, p<0.001; p=0.209, I²=28.8%); and VAS scores (WMD=-1.38, 95%CI range from -2.45 to -0.31, p<0.001; p=0.182, I²=44%). There were no significant differences at the six- and twelve-month follow-ups. Sensitivity analysis revealed that the results were consistent. No evidence of publication bias was detected. CONCLUSIONS This systematic analysis demonstrated that ERLs+SRP provides additional short-term effectiveness and that patients experience less pain compared to SRP. There were no significant differences at the medium-term and long-term follow-ups. Long-term well-designed RCTs are required.
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Affiliation(s)
- Lei Ma
- College and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Xiaolin Zhang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University; Hebei Province Center for Disease Prevention and Control, Shijiazhuang, Hebei, China (mainland)
| | - Zhe Ma
- College and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Hong Shi
- College and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yanning Zhang
- College and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Mingxuan Wu
- College and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Wei Cui
- Department of Stomatology, No. 2 Hospital of Baoding, Baoding, Hebei, China (mainland)
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de Oliveira GJPL, Pinotti FE, da Luz Carvalho H, Scardueli CR, Marcantonio RAC. Influence of Different Proportions of External Irrigation During the Er,Cr:YSGG Laser Irradiation on Wear and Roughness of Root Surface. J Lasers Med Sci 2016; 7:51-5. [PMID: 27330699 DOI: 10.15171/jlms.2016.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the influence of different levels of external irrigation during irradiation with an erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser on the roughness and wear of dental tissue during scaling procedures. METHODS Twenty-Five uniradicular bovine teeth had the proximal surfaces planed and divided into 3 regions: upper, middle and lower. The upper region was treated with hand instruments, the middle region was not treated and served as a control, and the lower region was treated by the Er,Cr:YSGG laser. The teeth were randomly divided into five groups according to the different proportions of external irrigation used during the laser irradiation: G1: 10%; G2: 20%; G3: 30%; G4: 40% and G5: 50%. The samples were analyzed for roughness and wear on the root surface irradiated with the laser. RESULTS There were no differences in the surface roughness and wear parameters between the groups irradiated with the laser, but the laser irradiation produced a rougher surface of the dentin than treatment with hand scaling. CONCLUSION Changes in the external irrigation level did not influence the wear and roughness of root surfaces treated with an Er,Cr:YSGG laser.
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Affiliation(s)
- Guilherme José Pimentel Lopes de Oliveira
- Univ. Estadual Paulista - UNESP, Department of Diagnosis and Surgery, Araraquara School of Dentistry, Araraquara, SP, Brazil ; Department of Health Sciences, Implantology Post Graduation Course, School of Dentistry, University Center of Araraquara - UNIARA, Araraquara, São Paulo, Brazil
| | - Felipe Eduardo Pinotti
- Univ. Estadual Paulista - UNESP, Department of Diagnosis and Surgery, Araraquara School of Dentistry, Araraquara, SP, Brazil
| | - Heglécia da Luz Carvalho
- Univ. Estadual Paulista - UNESP, Department of Diagnosis and Surgery, Araraquara School of Dentistry, Araraquara, SP, Brazil
| | - Cássio Rocha Scardueli
- Univ. Estadual Paulista - UNESP, Department of Diagnosis and Surgery, Araraquara School of Dentistry, Araraquara, SP, Brazil
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Miremadi SR, Cosyn J, Schaubroeck D, Lang NP, De Moor RJG, De Bruyn H. Effects of root surface debridement using Er:YAG laser versus ultrasonic scaling - a SEM study. Int J Dent Hyg 2014; 12:273-84. [PMID: 24871380 DOI: 10.1111/idh.12074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Despite promising results of Er:YAG laser in periodontal debridement, to date there is no consensus about the ideal settings for clinical use. This experimental clinical trial aimed to determine the effects of debridement using Er:YAG laser and to compare with ultrasonic treatment. MATERIALS AND METHODS Sixty-four teeth were divided into two in vivo and in vitro subgroups. Each tooth received ultrasonic treatment on one side and Er:YAG laser debridement at either 60, 100, 160 or 250 mJ pulse(-1) and at 10 Hz on the other side on a random basis. All samples were morphologically analyzed afterwards under scanning electron microscope for surface changes and dentinal tubules exposure. Treatment duration (d) was also recorded. RESULTS Laser debridement produced an irregular, rough and flaky surface free of carbonization or meltdown while ultrasound produced a relatively smoother surface. The number of exposed dentinal tubules (n) followed an energy-dependent trend. The number of exposed tubules among the in vivo laser groups was n 60 mJ = n 100 mJ < n 160 mJ < n 250 mJ (P < 0.001). Also 160 and 250 mJ lasers led to significantly more dentinal exposure than ultrasound under in vivo condition. Within the in vitro laser groups, dentinal tubules exposure was n 60 mJ < n 100 mJ < n 160 mJ < n 250 mJ (P ≤ 0.0015). Furthermore, in vitro laser treatments at 100, 160 and 250 mJ led to significantly more dentinal denudation than ultrasound. Treatment duration (d) for the in vivo groups was d 60 mJ > d 100 mJ > d Ultrasound = d 160 mJ > d 250 mJ (P ≤ 0.046), while for the in vitro groups it was d 60 mJ > d 100 mJ = d Ultrasound = d 160 mJ >d 250 mJ (P ≤ 0.046). CONCLUSIONS Due to excessive treatment duration and surface damage, Er:YAG laser debridement at 60 and 250 mJ pulse(-1), respectively, is not appropriate for clinical use. Although laser debridement at 100 and 160 mJ pulse(-1) seems more suitable for clinical application, compared to ultrasound the former is more time-consuming and the latter is more aggressive. Using a feedback device or lower pulse energies are recommended when using laser in closed field.
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Affiliation(s)
- S R Miremadi
- Department of Periodontology, Faculty of Dentistry, Ghent University, Ghent, Belgium
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Sculean A, Schwarz F, Becker J. Anti-infective therapy with an Er:YAG laser: influence on peri-implant healing. Expert Rev Med Devices 2014; 2:267-76. [PMID: 16288590 DOI: 10.1586/17434440.2.3.267] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In addition to conventional treatment modalities (mechanical and chemical), the use of lasers has been increasingly proposed for the treatment of periodontal and peri-implant infections (i.e., cleaning and detoxification of implant surfaces). Preliminary results from basic studies have pointed to the high potential of the Erbium-doped: Yttrium, Aluminum and Garnet (Er:YAG) laser. Furthermore, preliminary clinical data indicate that treatment with this kind of laser may positively influence peri-implant healing. The aim of this research update is to evaluate, based on the currently available evidence, the use of an Er:YAG laser for the treatment of peri-implant infections and to indicate its potential as a new treatment modality.
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Affiliation(s)
- Anton Sculean
- Department of Periodontology, Radboud University Medical Center, Nijmegen, The Netherlands.
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Oliveira GJPLD, Theodoro LH, Marcantonio Junior E, Sampaio JEC, Marcantonio RAC. Effect of Er,Cr:YSGG and Er:YAG laser irradiation on the adhesion of blood components on the root surface and on root morphology. Braz Oral Res 2012; 26:256-62. [PMID: 22641446 DOI: 10.1590/s1806-83242012000300012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 01/29/2012] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to conduct an in vitro evaluation, by scanning electron microscopy (SEM), of the adhesion of blood components on root surfaces irradiated with Er,Cr:YSGG (2.78 µm) or Er:YAG (2.94 µm) laser, and of the irradiation effects on root surface morphology. Sixty samples of human teeth were previously scaled with manual instruments and divided into three groups of 20 samples each: G1 (control group) - no treatment; G2 - Er,Cr:YSGG laser irradiation; G3 - Er:YAG laser irradiation. After performing these treatments, blood tissue was applied to 10 samples of each group, whereas 10 samples received no blood tissue application. After performing the laboratory treatments, the samples were observed under SEM, and the resulting photomicrographs were classified according to a blood component adhesion scoring system and root morphology. The results were analyzed statistically (Kruskall-Wallis and Mann Whitney tests, α= 5%). The root surfaces irradiated with Er:YAG and Er,Cr:YSGG lasers presented greater roughness than those in the control group. Regarding blood component adhesion, the results showed a lower degree of adhesion in G2 than in G1 and G3 (G1 × G2: p = 0.002; G3 × G2: p = 0.017). The Er:YAG and Er,Cr:YSGG laser treatments caused more extensive root surface changes. The Er:YAG laser treatment promoted a greater degree of blood component adhesion to root surfaces, compared to the Er,Cr:YSGG treatment.
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Soo L, Leichter JW, Windle J, Monteith B, Williams SM, Seymour GJ, Cullinan MP. A comparison of Er:YAG laser and mechanical debridement for the non-surgical treatment of chronic periodontitis: A randomized, prospective clinical study. J Clin Periodontol 2012; 39:537-45. [DOI: 10.1111/j.1600-051x.2012.01873.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2012] [Indexed: 01/01/2023]
Affiliation(s)
- Lingfeng Soo
- Sir John Walsh Research Institute; Faculty of Dentistry; University of Otago; Dunedin; New Zealand
| | - Jonathan W. Leichter
- Sir John Walsh Research Institute; Faculty of Dentistry; University of Otago; Dunedin; New Zealand
| | - Judith Windle
- Sir John Walsh Research Institute; Faculty of Dentistry; University of Otago; Dunedin; New Zealand
| | - Brian Monteith
- Sir John Walsh Research Institute; Faculty of Dentistry; University of Otago; Dunedin; New Zealand
| | - Sheila M. Williams
- Preventive and Social Medicine, Dunedin School of Medicine; University of Otago; Dunedin; New Zealand
| | - Gregory J. Seymour
- Sir John Walsh Research Institute; Faculty of Dentistry; University of Otago; Dunedin; New Zealand
| | - Mary P. Cullinan
- Sir John Walsh Research Institute; Faculty of Dentistry; University of Otago; Dunedin; New Zealand
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Efficacy of Er:YAG laser in the treatment of chronic periodontitis: systematic review and meta-analysis. Lasers Med Sci 2011; 27:661-73. [PMID: 21553003 DOI: 10.1007/s10103-011-0928-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 04/11/2011] [Indexed: 12/16/2022]
Abstract
Scaling root planing (SRP) has been proven efficacious as the traditional treatment approach for chronic periodontitis. However, important limitations such as difficult access in deep pockets, grooves, and furcations have led to the development of new therapeutic strategies. The erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser is one of the most promising laser types for periodontal therapy. Its efficacy in radicular debris removal and root smoothing has been proven in vitro. However, the clinical effectiveness of the Er:YAG laser remains controversial. The aim of the present systematic review was to systemically assess the scientific evidence for the effectiveness of Er:YAG laser compared to SRP in the treatment of chronic periodontitis. Electronic database searches of MEDLINE, Cochrane Controlled Clinical Trial Register, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, CINAHL, Science Direct, ISI Web of Science, and SCOPUS were performed, as well as hand-searching of relevant journals through December 23, 2010. Quality assessment was made according to the CONSORT guidelines. The systematic review was performed according to the QUOROM statement and Cochrane Collaboration recommendations. Meta-analyses of the clinical attachment level gain, probing depth reduction, and changes in gingival recession were performed using weighted mean differences for continuous data with 95% confidence intervals, nested in a random effect model. No statistically significant differences were found in any of the investigated clinical parameters among the five random controlled trials (RCTs) entered into the study, indicating that there was no evidence of effectiveness. However, significant heterogeneity, a high risk of bias in three of the five included studies, and methodological shortcomings indicate that the results should be considered with caution. Future long-term, well-designed RCTs are needed to assess the scientific evidence of Er:YAG laser efficacy as an alternative treatment strategy to SRP.
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de Oliveira GJPL, Pavone C, Sampaio JEC, Marcantonio RAC. Influence of the angle of irradiation of the Er,Cr:YSGG laser on the morphology, attachment of blood components, roughness, and root wear: in vitro study. Lasers Surg Med 2011; 42:683-91. [PMID: 20976808 DOI: 10.1002/lsm.20973] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the influence of the working tip angulation of the Er,Cr:YSGG laser on the morphology, attachment of blood components, roughness, and wear on irradiated root surfaces compared to scaling and root planing (SRP). STUDY DESIGN/MATERIALS AND METHODS The present study used 45 teeth, of which 25 were used for the analysis of the morphology and the attachment of blood components and 20 were used for the analysis of the roughness and of the root wear. The teeth were randomly divided into five groups according to the treatment applied: (G1) Laser Er,Cr:YSGG-30°; (G2) Laser Er,Cr:YSGG-45°; (G3) Laser Er,Cr:YSGG-60°; (G4) Laser Er,Cr:YSGG-90°; and (G5) SRP. RESULTS The root surfaces irradiated with the Er,Cr:YSGG laser working angulation tip of 45° and 60°, and the samples scaled with manual instruments presented greater attachment of blood components than the group where the Er,Cr:YSGG laser irradiated at working tip angulation of 30° and 90° (P<0.05). The samples irradiated with the Er,Cr:YSGG laser were rougher than the samples scaled with manual instruments (P<0.05). The group that was irradiated with the Er,Cr:YSGG laser at an angle of 30° presented the least wear in comparison to all the other treatments (P<0.01). CONCLUSIONS The irradiated root surfaces proved to be rougher than those scaled with manual instruments; however, irradiation at working tip angulations of 45° and 60° produced results of attachment of blood components and root wear comparable with those obtained with manual instrumentation.
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Kim SW, Kwon YH, Chung JH, Shin SI, Herr Y. The effect of Er:YAG laser irradiation on the surface microstructure and roughness of hydroxyapatite-coated implant. J Periodontal Implant Sci 2011; 40:276-82. [PMID: 21246018 PMCID: PMC3021168 DOI: 10.5051/jpis.2010.40.6.276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 11/03/2010] [Indexed: 11/24/2022] Open
Abstract
Purpose The present study was performed to evaluate the effect of erbium:yttrium-aluminium-garnet (Er:YAG) laser irradiation on the change of hydroxyapatite (HA)-coated implant surface microstructure according to the laser energy and the application time. Methods The implant surface was irradiated by Er:YAG laser under combination condition using the laser energy of 100 mJ/pulse, 140 mJ/pulse and 180 mJ/pulse and application time of 1 minute, 1.5 minutes and 2 minutes. The specimens were examined by surface roughness evaluation and scanning electron microscopic observation. Results In scanning electron microscope, HA-coated implant surface was not altered by Er:YAG laser irradiation under experimental condition on 100 mJ/pulse, 1 minute. Local areas with surface melting and cracks were founded on 100 mJ/pulse, 1.5 minutes and 2 minutes. One hundred forty mJ/pulse and 180 mJ/pulse group had surface melting and peeling area of HA particles, which condition was more severe depending on the increase of application time. Under all experimental condition, the difference of surface roughness value on implant surface was not statistically significant. Conclusions Er:YAG laser on HA-coated implant surface is recommended to be irradiated below 100 mJ/pulse, 1 minute for detoxification of implant surface without surface alteration.
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Affiliation(s)
- Seong-Won Kim
- Department of Periodontology, Kyung Hee University School of Dentistry, Seoul, Korea
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José Pimentel Lopes de Oliveira G, Silveira Faeda R, Marcantonio E, Chiérici Marcantonio RA. Model for the evaluation of root wear by histometric analysis. Microsc Res Tech 2010; 74:920-4. [DOI: 10.1002/jemt.20976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Accepted: 11/11/2010] [Indexed: 11/10/2022]
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Rotundo R, Nieri M, Cairo F, Franceschi D, Mervelt J, Bonaccini D, Esposito M, Pini-Prato G. Lack of adjunctive benefit of Er:YAG laser in non-surgical periodontal treatment: a randomized split-mouth clinical trial. J Clin Periodontol 2010; 37:526-33. [PMID: 20507376 DOI: 10.1111/j.1600-051x.2010.01560.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM This split-mouth, randomized, clinical trial aimed to evaluate the efficacy of erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser application in non-surgical periodontal treatment. MATERIALS AND METHODS A total of 27 patients underwent four modalities of non-surgical therapy: supragingival debridement; scaling and root planing (SRP)+Er:YAG laser; Er:YAG laser; and SRP. Each strategy was randomly assigned and performed in one of the four quadrants. Clinical outcomes were evaluated at 3 and 6 months. Subjective benefits of patients have been evaluated by means of questionnaires. RESULTS Six months after therapy, Er:YAG laser showed no statistical difference in clinical attachment gain with respect to supragingival scaling [0.15 mm (95% CI -0.16; 0.46)], while SRP showed a greater attachment gain than the supragingival scaling [0.37 mm (95% CI 0.05; 0.68)]. No difference resulted between Er:YAG laser+SRP and SRP alone [0.05 mm (95% CI -0.25; 0.36)]. CONCLUSIONS The adjunctive use of Er:YAG laser to conventional SRP did not reveal a more effective result than SRP alone. Furthermore, the sites treated with Er:YAG laser showed similar results of the sites treated with supragingival scaling.
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Affiliation(s)
- Roberto Rotundo
- Department of Periodontology, University of Florence, Firenze, Italy.
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Lopes BMV, Theodoro LH, Melo RF, Thompson GMDA, Marcantonio RAC. Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with erbium:YAG laser and scaling and root planing. J Periodontol 2010; 81:682-91. [PMID: 20429647 DOI: 10.1902/jop.2010.090300] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND This study compared erbium-doped: yttrium, aluminum, and garnet (Er:YAG) laser irradiation (100 mJ/pulse; 10 Hz; 12.9 J/cm(2)) with or without conventional scaling and root planing (SRP) to SRP only for treatment of periodontal pockets. METHODS Nineteen patients with pockets from 5 to 9 mm were included. In a split-mouth design, each site was allocated to a treatment group: 1) SRPL, SRP and laser; 2) L, laser; 3) SRP, SRP only; and 4) C, no treatment. Clinical parameters of probing depth (PD), gingival recession, and clinical attachment level (CAL) were evaluated at baseline and 1, 3, 6, and 12 months after treatment. Visible plaque index, gingival bleeding index (GI), bleeding on probing (BOP), and subgingival plaque samples were also measured 12 days postoperatively, in addition to the above mentioned months. Intergroup and intragroup statistical analyses were performed (P <0.05). RESULTS GI decreased for SRPL and increased for L, SRP, and C (P <0.05) 12 days postoperatively and decreased for SRPL and SRP (P <0.05) 3, 6, and 12 months after baseline; BOP and PD decreased for all treated groups (P <0.01) 3, 6, and 12 months after treatment. CAL gain was significant for SRPL, L, and SRP (P <0.05) 3, 6, and 12 months postoperatively. SRPL and L presented a significant reduction in the percentage of sites with bacteria 6 and 12 months after treatment (P <0.05). CONCLUSION Non-surgical periodontal treatment with Er:YAG laser may be an alternative treatment for reduction and control of the proliferation of microorganisms in persistent periodontitis.
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Affiliation(s)
- Beatriz Maria Valério Lopes
- Department of Periodontology, Araraquara Dental School, UNESP-São Paulo State University, Araraquara, São Paulo, Brazil
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Domínguez A, Gómez C, García-Kass AI, García-Nuñez JA. IL-1β, TNF-α, total antioxidative status and microbiological findings in chronic periodontitis treated with fluorescence-controlled Er:YAG laser radiation. Lasers Surg Med 2010; 42:24-31. [DOI: 10.1002/lsm.20873] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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In vitro investigation of intra-canal dentine–laser beam interaction aspects: I. Evaluation of ablation capability (ablation rate and efficiency). Lasers Med Sci 2009; 25:835-40. [DOI: 10.1007/s10103-009-0701-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
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Schwarz F, Aoki A, Becker J, Sculean A. Laser application in non-surgical periodontal therapy: a systematic review. J Clin Periodontol 2009; 35:29-44. [PMID: 18724840 DOI: 10.1111/j.1600-051x.2008.01259.x] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The primary aim was to address the following focused question: What is the clinical effect of laser application compared with mechanical debridement in non-surgical periodontal therapy in patients with chronic periodontitis? A secondary aim was to survey the relevant literature in relation to safety of laser applications. MATERIAL AND METHODS Electronic databases of the PubMed and the Cochrane Library were searched and completed by manual searches up to December 2007. RESULTS Following screening, 12 publications (11 studies) were eligible for the review. A meta-analysis could not be performed due to the heterogeneity of the studies. The results from a narrative synthesis indicate that Er:YAG laser monotherapy resulted in similar clinical outcomes, both in the short and the long term (up to 24 months), compared with mechanical debridement. There is insufficient evidence to support the clinical application of either CO(2), Nd:YAG, Nd:YAP, or different diode laser wavelengths. CONCLUSIONS The Er:YAG laser seems to possess characteristics most suitable for the non-surgical treatment of chronic periodontitis. Research conducted so far has indicated that its safety and effects might be expected to be within the range reported for conventional mechanical debridement. However, the evidence from the evaluated studies is weak.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany.
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Lopes BMV, Marcantonio RAC, Thompson GMA, Neves LHM, Theodoro LH. Short-term clinical and immunologic effects of scaling and root planing with Er:YAG laser in chronic periodontitis. J Periodontol 2008; 79:1158-67. [PMID: 18597597 DOI: 10.1902/jop.2008.070600] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Recently, the erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser has been used for periodontal therapy. This study compared Er:YAG laser irradiation (100 mJ/pulse, 10 Hz, 12.9 J/cm(2)) with or without conventional scaling and root planing (SRP) to SRP only for the treatment of periodontal pockets affected with chronic periodontitis. METHODS Twenty-one subjects with pockets from 5 to 9 mm in non-adjacent sites were studied. In a split-mouth design, each site was randomly allocated to a treatment group: SRP and laser (SRPL), laser only (L), SRP only (SRP), or no treatment (C). The plaque index (PI), gingival index (GI), bleeding on probing (BOP), and interleukin (IL)-1beta levels in crevicular fluid were evaluated at baseline and at 12 and 30 days postoperatively, whereas probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were evaluated at baseline and 30 days after treatment. A statistical analysis was conducted (P <0.05). RESULTS Twelve days postoperatively, the PI decreased for SRPL and SRP groups (P <0.05); the GI increased for L, SRP, and C groups but decreased for the SRPL group (P <0.05); and BOP decreased for SRPL, L, and SRP groups (P <0.01). Thirty days postoperatively, BOP decreased for treated groups and was lower than the C group (P <0.05). PD decreased in treated groups (P <0.001), and differences were found between SRPL and C groups (P <0.05). CAL gain was significant only for the SRP group (P <0.01). GR increased for SRPL and L groups (P <0.05). No difference in IL-1beta was detected among groups and periods. CONCLUSION Er:YAG laser irradiation may be used as an adjunctive aid for the treatment of periodontal pockets, although a significant CAL gain was observed with SRP alone and not with laser treatment.
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Affiliation(s)
- Beatriz M V Lopes
- Department of Periodontology, Araraquara Dental School, São Paulo State University, Araraquara, SP, Brazil
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Minas NH, Meister J, Franzen R, Gutknecht N, Lampert F, Mir M. In vitro preliminary study to evaluate the capability of Er,Cr:YSGG laser in posterior teeth root-canal preparation with step-back technique. Lasers Med Sci 2007; 24:7-12. [DOI: 10.1007/s10103-007-0507-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Accepted: 09/10/2007] [Indexed: 11/24/2022]
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Schwarz F, Jepsen S, Herten M, Aoki A, Sculean A, Becker J. Immunohistochemical characterization of periodontal wound healing following nonsurgical treatment with fluorescence controlled Er:YAG laser radiation in dogs. Lasers Surg Med 2007; 39:428-40. [PMID: 17523168 DOI: 10.1002/lsm.20509] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of the present study was to immunohistochemically characterize periodontal wound healing following nonsurgical treatment with fluorescence controlled Er:YAG laser radiation in dogs. STUDY DESIGN/MATERIALS AND METHODS Five beagle dogs suffering from naturally occurring chronic periodontitis were randomly allocated in a split-mouth design to nonsurgical periodontal treatment using either (a) an Er:YAG laser at 10.2, 12.8, 15.4, 18, and 20.4 J/cm2 (ERL1-5), or (b) an ultrasonic device (VUS) serving as control. The animals were sacrificed after 3 months. Histomorphometrical (e.g. inflammatory cell infiltrate, surface changes, cementum formation), and immunohistochemical parameters (collagen type I, CD68, matrix metalloproteinase (MMP)-8) were assessed. RESULTS Inflammatory cell infiltrates of different extent were commonly observed in all treatment groups. However, histomorphometrical analysis revealed new cementum formation with inserting collagen type I fibers along the instrumented root surfaces in most specimens of both ERL (ERL2: 31+/-81 to ERL5: 595+/-575 microm) and VUS (50+/- 215 microm) groups. This was associated with pronounced CD68 and weak MMP-8 antigen reactivity. CONCLUSION Within the limits of the present study, it was concluded that both treatment procedures (i) were effective in controlling inflammatory cell infiltrates, and (ii) may support the formation of a new connective tissue attachment.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery, Heinrich Heine University, D-40225 Düsseldorf, Germany.
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Derdilopoulou FV, Nonhoff J, Neumann K, Kielbassa AM. Microbiological findings after periodontal therapy using curettes, Er:YAG laser, sonic, and ultrasonic scalers. J Clin Periodontol 2007; 34:588-98. [PMID: 17555412 DOI: 10.1111/j.1600-051x.2007.01093.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To evaluate and compare the microbiological effects of hand instruments, Er:YAG-laser, sonic, and ultrasonic scalers in patients with chronic periodontitis. Patient perception of each treatment was documented. MATERIAL AND METHODS From 72 patients, bacterial samples were collected from the deepest pocket in each quadrant (total: 288 sites). A polymerase chain reaction kit estimated the amount of Aggregatibacter (Actinobacillus) actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythensis (Tf), and Treponema denticola (Td) at baseline as well as 3 and 6 months after therapy. One quadrant in each patient was randomly assigned to curettes (H-group), Er:YAG laser (L-group), sonic device (S-group), or ultrasonic device (U-group). RESULTS Three months post-operatively, the amounts of Pg, Pi, Tf, and Td were significantly reduced in all groups. Laser and sonic instrumentation failed to reduce Aa. Six months after therapy, significant differences were still detected for Pg (L- and U-group), for Pi and Tf (S-group), and for Td (L-, S- and U-group). Patients rated ultrasonic treatment as more preferable than hand and laser instrumentation. CONCLUSION The various treatment methods resulted in a comparable reduction of the evaluated periodontal pathogens, and bacterial increase was only partially different 6 months post-operatively. Ultrasonic instrumentation caused less discomfort.
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Affiliation(s)
- Foteini V Derdilopoulou
- Department of Operative Dentistry and Periodontology, University School of Dental Medicine, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
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Stopp S, Deppe H, Lueth T. A new concept for navigated laser surgery. Lasers Med Sci 2007; 23:261-6. [PMID: 17661124 DOI: 10.1007/s10103-007-0476-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 05/30/2007] [Indexed: 10/23/2022]
Abstract
In this article, a new concept for navigated laser surgery is presented. Mechanically rotating instruments such as drills or mills for bone treatment have the disadvantage of damaging the surrounding bone by the generated frictional heat. Cooling of the instrument cannot avoid this damage completely. Laser systems are an alternative solution for bone removal. Areas of application for bone treatment laser systems are the dental implantology and the osteotomy. The goal of the approach presented here was to combine the advantages of laser treatment with the precision and safety of navigated control. During the use of medical laser systems, the tissue is not only removed exactly in the focus of the laser. It is removed inside of a remove range around the focus. The amount of removed bone cannot be determined only by performance adjustment and the position of the laser because the size of the remove range is unknown. The new approach is to use a position- and orientation-dependent power-controlled laser. Therefore, a calibration of the laser parameters has to be accomplished. The position and orientation of the laser handpiece is measured by an optical measurement system. The laser parameters and the tissue properties are determined by a calibration procedure. On the basis of a preoperative planning, the laser remove range is adjusted by modulation of the laser power. Near to border areas or sensitive structure, the laser power is decreased. Therewith, a precise and safe bone removal according to a preoperative planning without damaging the bone by frictional heat is possible. The inaccuracies as result of simplifications by the calibration procedure have to be verified.
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Affiliation(s)
- Sebastian Stopp
- MIMED Lehrstuhl Mikrotechnik und Medizingerätetechnik, Technische Universität München, Boltzmannstr 15, 85748 Garching, Germany.
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Krause F, Braun A, Brede O, Eberhard J, Frentzen M, Jepsen S. Evaluation of selective calculus removal by a fluorescence feedback-controlled Er:YAG laser in vitro. J Clin Periodontol 2007; 34:66-71. [PMID: 17132156 DOI: 10.1111/j.1600-051x.2006.01026.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the removal of subgingival calculus and dental hard tissues depending on the threshold level of a fluorescence feedback-controlled Er:YAG laser. MATERIAL AND METHODS Twenty teeth with calculus on the root surface were treated with an Er:YAG laser. Laser settings were 140 mJ and 10 Hz. The initial fluorescence threshold level of 5 [U] was reduced at intervals of 1 [U] for every laser treatment. Areas of residual calculus (RC) were evaluated using a surface analysis software. Loss of dental hard tissues was assessed by histomorphometric analysis of undecalcified ground sections. RESULTS Using a threshold value of 5 [U], the median amount of RC was 11% (0-78%). By lowering the threshold levels, the amount of RC decreased [level 1 [U]: 0% (0-26%)]. The laser-treated root surfaces revealed a statistically significant reduction of the cementum thickness [median: 80 microm (0-250)] compared with the non-treated opposite side [median: 90 microm (30-250)] (p<0.05). CONCLUSION The amount of RC following laser irradiation depends on the fluorescence threshold level for a feedback-controlled Er:YAG laser. It might be suggested that this laser system may be used with a threshold level even lower than 5 [U] without removing a clinically relevant amount of root cementum.
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Affiliation(s)
- Felix Krause
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany.
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Moghare Abed A, Tawakkoli M, Dehchenari MA, Gutknecht N, Mir M. A comparative SEM study between hand instrument and Er:YAG laser scaling and root planing. Lasers Med Sci 2006; 22:25-9. [PMID: 17115236 DOI: 10.1007/s10103-006-0413-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Accepted: 12/31/2005] [Indexed: 12/16/2022]
Abstract
Scaling and root planing are one of the most commonly used procedures for the treatment of periodontal diseases. Removal of calculus using conventional hand instruments is incomplete and rather time-consuming. In search for more efficient and less difficult instrumentation, investigators have proposed lasers as alternatives or adjuncts for scaling and root planing. The aim of the present study was to compare the effectiveness of subgingival scaling and root planing with erbium: yttrium, aluminium, garnet (Er:YAG) laser and hand instrumentation in vitro. The mesial and distal surfaces of 15 periodontal loosed extracted teeth were treated randomly either by hand instrumentation or by Er:YAG laser irradiation. After choosing the "very long pulse mode" (pulse duration of about 700 micros), the output energy of 160 mJ with 920-microm beam diameter (RO7 Perio tip, Fidelis, Fotona, Slovenia) and frequency of 12 Hz were selected, both according to the best results of past studies. In addition, air water spray was used during the procedures. The morphology of the root surface was evaluated by three observers with a scanning electron microscopy in magnifications of 50x and 400x. The result of this setting showed that the rate of remained roughness on treated root surfaces in two groups of hand instruments and Er:YAG laser had a meaningful difference: The surface roughness in Er:YAG laser group was more than in hand instruments group. The present study could demonstrate the in vitro capability of the Er:YAG laser for scaling and root planing in periodontitis, although the effectiveness of this setting did not reach that achieved by hand instrumentation. It could be concluded that lower frequency and long pulse duration maybe more suitable for the micro-morphology of root surface after treatment. This theory is going to be tested with the same laser instrument in the next study.
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Affiliation(s)
- A Moghare Abed
- Dental School, Isfahan Medical University, Isfahan, Tehran, Iran
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Theodoro LH, Sampaio JEC, Haypek P, Bachmann L, Zezell DM, Garcia VG. Effect of Er:YAG and Diode lasers on the adhesion of blood components and on the morphology of irradiated root surfaces. J Periodontal Res 2006; 41:381-90. [PMID: 16953814 DOI: 10.1111/j.1600-0765.2005.00846.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate in vitro, by scanning electron microscopy (SEM), the adhesion of blood components on root surfaces irradiated with Er:YAG (2.94 microm) and GaAlAs Diode (808 nm) lasers and the effects on the morphology of irradiated root surfaces. METHODS One hundred samples of human teeth were obtained. They were previously planed and scaled with manual instruments and divided into five groups of 20 samples each: G1 (control group) - absence of treatment; G2--Er:YAG laser (7.6 J/cm2); G3--Er:YAG laser (12.9 J/cm2); G4--Diode laser (90 J/cm2) and G5--Diode laser (108 J/cm2). After these treatments, 10 samples of each group received a blood tissue but the remaining 10 did not. After laboratory treatments, the samples were obtained by SEM, the photomicrographs were analysed by the score of adhesion of blood components and the results were statistically analysed (Kruskall-Wallis and Mann-Whitney test). RESULTS In relation to the adhesion of blood components, the study showed no significant differences between the control group and the groups treated with Er:YAG laser (p = 0.9633 and 0.6229). Diode laser radiation was less effective than control group and Er:YAG laser radiation (p < 0.01). CONCLUSIONS None of the proposed treatments increased the adhesion of blood components in a significant way when compared to the control group. Although the Er:YAG laser did not interfere in the adhesion of blood components, it caused more changes on the root surface, whereas the Diode laser inhibited the adhesion.
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Affiliation(s)
- Letícia Helena Theodoro
- Department of Periodontology, Araraquara Dental School, State University of São Paulo, Araraquara, São Paulo, Brazil.
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Tomasi C, Schander K, Dahlén G, Wennström JL. Short-term clinical and microbiologic effects of pocket debridement with an Er:YAG laser during periodontal maintenance. J Periodontol 2006; 77:111-8. [PMID: 16579711 DOI: 10.1902/jop.2006.77.1.111] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser is considered a useful tool for subgingival debridement because the laser treatment creates minimal damage to the root surface and has potential antimicrobial effects. The aim of this randomized controlled clinical trial was to evaluate clinical and microbiologic effects of pocket debridement using an Er:YAG laser in patients during periodontal maintenance. METHODS Twenty patients at a recall visit for maintenance were consecutively recruited if presenting at least four teeth with residual probing depth (PD) > or = 5 mm. Two pockets in each of two jaw quadrants were randomly assigned to subgingival debridement using 1) an Er:YAG laser (test) or 2) an ultrasonic scaler (control). The laser beam was set at 160 mJ with a pulse frequency of 10 Hz. Clinical variables were recorded at baseline, 1 month, and 4 months after treatment. Primary clinical outcome variables were changes in PD and clinical attachment level (CAL). Microbiologic analysis of subgingival samples was performed at baseline, 2 days, and 30 days after treatment using a checkerboard DNA-DNA hybridization technique against 12 periodontal disease-associated species. RESULTS The mean initial PD was 6.0 mm (SD: 1.2) in the test group and 5.8 mm (SD: 0.9) in the control group. At 1 month post-treatment, the PD reduction was significantly greater for test than control sites (0.9 versus 0.5 mm; P <0.05). The CAL gain also was significantly greater (0.5 versus 0.06 mm; P <0.01). At the 4-month examination, no significant differences were detected in PD reduction (1.1 versus 1.0 mm) or CAL gain (0.6 versus 0.4 mm). Both treatments resulted in reduction of the subgingival microflora. No significant differences in microbiologic composition were identified between the treatment groups at various time intervals. Degree of treatment discomfort scored significantly lower for the test than the control treatment modality. CONCLUSION The results of the trial failed to demonstrate any apparent advantage of using an Er:YAG laser for subgingival debridement, except less treatment discomfort perceived by the patients.
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Affiliation(s)
- Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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Schwarz F, Bieling K, Venghaus S, Sculean A, Jepsen S, Becker J. Influence of fluorescence-controlled Er:YAG laser radiation, the Vectortm system and hand instruments on periodontally diseased root surfaces in vivo. J Clin Periodontol 2006; 33:200-8. [PMID: 16489946 DOI: 10.1111/j.1600-051x.2005.00889.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate the effects of fluorescence-controlled Er:YAG laser radiation, an ultrasonic device or hand instruments on periodontally diseased root surfaces in vivo. MATERIAL AND METHODS Seventy-two single-rooted teeth (n=12 patients) were randomly treated in vivo by a single course of subgingival instrumentation using (1-3) an Er:YAG laser (ERL1: 100 mJ; ERL2: 120 mJ; ERL3: 140 mJ; 10 Hz), or (4) the Vector ultrasonic system (VUS) or (5) hand instruments (SRP). Untreated teeth served as control (UC). Areas of residual subgingival calculus (RSC) and depth of root surface alterations were assessed histo-/morphometrically. RESULTS Highest values of RSC areas (%) were observed in the SRP group (12.5+/-6.9). ERL(1-3) (7.8+/-5.8, 8.6+/-4.5, 6.2+/-3.9, respectively) revealed significantly lower RSC areas than SRP. VUS (2.4+/-1.8) exhibited significantly lower RSC areas than SRP and ERL(1, 2). Specimens treated with SRP revealed conspicuous root surface damage, while specimens treated with ERL(1-3) and VUS exhibited a homogeneous and smooth appearance. CONCLUSION Within the limits of the present study, it may be concluded that ERL and VUS enabled (i) a more effective removal of subgingival calculus and (ii) a predictable root surface preservation in comparison with SRP.
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Affiliation(s)
- F Schwarz
- Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany.
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Crespi R, Barone A, Covani U. Effect of Er:YAG Laser on Diseased Root Surfaces: An In Vivo Study. J Periodontol 2005; 76:1386-90. [PMID: 16101373 DOI: 10.1902/jop.2005.76.8.1386] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of the present study was to observe in vivo the effects of two different power settings of an Er:YAG laser on pockets of periodontally involved root surfaces using a scanning electron microscope (SEM). METHODS Thirty-two teeth with severe periodontal disease scheduled for extraction were divided into three groups: group A was irradiated with an energy of 140 mJ, 10 Hz; group B with 160 mJ 10 Hz; group C was used as controls. Morphological changes on the treated root surfaces were evaluated using SEM observations to assess laser-induced ultrastructural changes. RESULTS All surfaces treated in both groups showed a homogeneous and smooth root surface morphology. The surface alterations were very similar with both energy values used. CONCLUSION Er:YAG laser irradiation performed with two different power settings of root surfaces in vivo showed at the SEM observation a complete absence of debris and smooth root surfaces.
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Affiliation(s)
- Roberto Crespi
- Department of Biophysical, Medical and Odontostomatological Sciences and Technologies, Medical School, University of Genova, Genova, Italy.
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Schwarz F, Becker J. Treatment of periodontitis and peri-implantitis with an Er:YAG laser: Experimental and clinical studies. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.mla.2005.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Crespi R, Romanos GE, Barone A, Sculean A, Covani U. Er:YAG Laser in Defocused Mode for Scaling of Periodontally Involved Root Surfaces: An In Vitro Pilot Study. J Periodontol 2005; 76:686-90. [PMID: 15898927 DOI: 10.1902/jop.2005.76.5.686] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Er:YAG laser may be used on periodontally involved teeth in combination with conventional periodontal therapy in order to improve the efficacy of root instrumentation. The aim of this study was to compare the effect of hand instrumentation on root surfaces of periodontally involved teeth with Er:YAG laser application. METHODS Thirty freshly extracted, non-carious, single-rooted, periodontally diseased human teeth from adult humans with advanced periodontal disease were used in this study. The teeth were divided into three groups of 10 specimens each. Group A was treated with scaling and root planing (SRP) with curets only (control). In group B, the root surfaces were scaled with curets and then lased with an Er:YAG laser (wavelength 2.94 microm). A handpiece with a water spray was used in non-contact mode (defocused) at a distance of 1 cm from root surface. Laser parameters were set at energy of 100 to 200 mJ/pulse, with 10 Hz of frequency. In group C, the root surfaces were lased only with power settings 250 to 300 mJ/pulse and 10 Hz frequency. An epon-araldite plastic embedding technique was used for light microscopic investigation. RESULTS Histologic findings showed significant differences between the test and control sites. In control sites, after hand instrumentation, the surface was smooth, without a cementum layer, and the dentin layer presented opened tubules. Defects on the dentin layer were also present along root surfaces. In the test sites (B, C) root surfaces revealed no thermal damage; no cracking or tissue carbonization were observed. The superficial layers of lased surfaces appeared smooth and melted without alterations. CONCLUSION Based on these findings, it appears that it may be feasible to use the Er:YAG laser for root instrumentation without prior root planing if the proper parameters are followed.
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Affiliation(s)
- Roberto Crespi
- Department of Biophysical, Medical and Odontostomatological Sciences and Technologies, Medical School, University of Genoa, Italy
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Crespi R, Barone A, Covani U. Histologic Evaluation of Three Methods of Periodontal Root Surface Treatment in Humans. J Periodontol 2005; 76:476-81. [PMID: 15857084 DOI: 10.1902/jop.2005.76.3.476] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Removing subgingival plaque and calculus is a major goal of periodontal treatment. Few attempts have been made to evaluate the use of lasers for root surface debridement in periodontal therapy. The aim of the present study was to compare, histologically, the effects of hand instrumentation, ultrasonic instrumentation, and CO2 lasers on the root surfaces of teeth treated in situ. METHODS A total of 33 teeth scheduled for extraction due to severe periodontal disease were divided into three groups. In the first group, teeth were treated by ultrasonic bactericidal curettage (UBC) with an ultrasonic scaler; in the second group, teeth were treated by hand instrumentation; and in the third group, after hand instrumentation, roots were lased by a CO2 laser. The samples were then processed for histological examination. RESULTS In the first and second groups, plaque and calculus were present in interradicular septa, lacunae, and surface concavities. In the third group, surfaces of specimens treated by a low-power defocused CO2 laser showed areas devoid of cementum, with completely sealed dentinal tubules, and no bacterial cell remnants. CONCLUSIONS The CO2 laser treatment, used at low power and in the defocused mode, combined with traditional mechanical instrumentation, could improve root surface debridement of periodontally involved teeth. More extensive, long-term studies are needed to confirm this hypothesis.
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Affiliation(s)
- Roberto Crespi
- Department of Biophysical, Medical and Odontostomatological Sciences and Technologies, Medical School, University of Genova, Genova, Italy.
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Grgurević J, Grgurević L, Miletić I, Karlović Z, Krmek SJ, Anić I. In vitro study of the variable square pulse Er:YAG laser cutting efficacy for apicectomy. Lasers Surg Med 2005; 36:347-50. [PMID: 15856510 DOI: 10.1002/lsm.20168] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Variable square pulse (VSP) Er:YAG laser should be quicker than older Er:YAG lasers. The objectives were: (1) comparison of VSP laser and mechanical handpiece efficacy for apicectomy and (2) determination of optimal pulse width/energy/frequency combination. STUDY DESIGN/MATERIALS AND METHODS Sixty extracted, single-rooted mature human teeth with round apical parts were instrumented, root filled, cleaned, and divided into four groups. Apical 2 mm of each root were apicectomized with mechanical handpiece and Er:YAG laser with three different settings (LaserA = 200 mJ/300 microseconds/ 8 Hz; LaserB = 200 mJ/100 microseconds/8 Hz; LaserC = 380 mJ/100 microseconds/20 Hz). Timing results were statistically compared. RESULTS LaserC was the most efficient setting. Differences between groups were significant except between LaserC-Mechanical and LaserA-LaserC (P < 0.05). CONCLUSIONS VSP Er:YAG laser used for apicectomy is slower by a factor of 7-31 than mechanical handpiece, but treatment outcome is acceptable. Optimal settings for apicectomy with VSP laser are 380 mJ/100 microseconds/20 Hz.
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Affiliation(s)
- Josko Grgurević
- Department of Oral Surgery, School of Dental Medicine, Gundulićeva 5, 10 000 Zagreb, Croatia.
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Affiliation(s)
- Akira Aoki
- Department of Hard Tissue Engineering, Tokyo Medical and Dental University Graduate School, JapanDepartment of Hard Tissue Engineering, Tokyo Medical and Dental University Graduate School, Japan
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Sculean A, Schwarz F, Berakdar M, Romanos GE, Arweiler NB, Becker J. Periodontal treatment with an Er:YAG laser compared to ultrasonic instrumentation: a pilot study. J Periodontol 2004; 75:966-73. [PMID: 15341354 DOI: 10.1902/jop.2004.75.7.966] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of the present study was to compare the effectiveness of an Er:YAG laser to that of ultrasonic scaling for non-surgical periodontal treatment. METHODS Twenty patients with moderate to advanced periodontal disease were randomly treated in a split-mouth design with a single episode of subgingival debridement using either an Er:YAG laser device (160 mJ/pulse, 10 Hz) combined with a calculus detection system with fluorescence induced by 655 nm InGaAsP diode laser radiation (ERL), or an ultrasonic instrument (UI). Clinical assessments of full-mouth plaque score (FMPS), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were made at baseline and at 3 and 6 months following therapy. RESULTS No differences in any of the investigated parameters were observed at baseline between the two groups. The mean value of BOP decreased in the ERL group from 40% at baseline to 17% after 6 months (P<0.0001) and in the UI group from 46% at baseline to 15% after 6 months (P<0.0001). The sites treated with ERL demonstrated mean CAL gain of 1.48 +/- 0.73 mm (P<0.001) and of 1.11 +/- 0.59 mm (P<0.001) at 3 and 6 months, respectively. The sites treated with UI demonstrated mean CAL gain of 1.53 +/- 0.67 mm (P<0.001) and of 1.11 +/- 0.46 mm (P<0.001) at 3 and 6 months, respectively. No statistically significant differences were observed between the groups (P>0.05). CONCLUSION Within the limits of the present study, it can be concluded that both therapies led to significant improvements of the investigated clinical parameters.
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Affiliation(s)
- Anton Sculean
- Department of Conservative Dentistry and Periodontology, Johannes Gutenberg University, Mainz, Germany.
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Sculean A, Schwarz F, Berakdar M, Windisch P, Arweiler NB, Romanos GE. Healing of intrabony defects following surgical treatment with or without an Er:YAG laser. J Clin Periodontol 2004; 31:604-8. [PMID: 15257735 DOI: 10.1111/j.1600-051x.2004.00525.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM The aim of this controlled, parallel design clinical study was to compare the healing of intrabony periodontal defects following treatment with access flap surgery with and without debridement with an Er:YAG laser. METHODS Twenty-three patients each of whom exhibited one deep intrabony defect were randomly treated with either access flap surgery followed by root surface and defect debridement using an Er:YAG laser (KEY3) (160 mJ, 10 Hz) (test), or with access flap surgery followed by root surface and defect debridement using hand and ultrasonic instruments (control). The following clinical parameters were recorded at baseline and at 6 months: plaque index; gingival index; bleeding on probing; probing depth (PD); gingival recession; and clinical attachment level (CAL). The primary outcome variable was CAL. No statistically significant differences between the groups were found at baseline. RESULTS No serious adverse events were observed after any of the treatments. The results have shown that in the test group the PD decreased from 7.8+/-1.3 to 4.1+/-1.3 mm (p<0.001) and the CAL changed from 9.8+/-2.9 to 7.2+/-2.5 mm (p<0.001). In the control group the PD decreased from 7.8+/-0.8 to 4.6+/-1.6 mm (p<0.001) and the CAL changed from 9.2+/-1.2 to 7.7+/-1.6 mm (p<0.01). The test group displayed a higher tendency for CAL gain, although this tendency did not prove to be statistically significant. CONCLUSION Within the limits of the present study, it can be concluded that: (i) at 6 months following treatment both therapies led to significant improvements of the investigated clinical parameters, and (ii) an Er:YAG laser may represent a suitable alternative for defect and root surface debridement in conjunction with periodontal surgery.
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Affiliation(s)
- Anton Sculean
- Department of Conservative Dentistry and Periodontology, Johannes Gutenberg-University, Mainz, Germany.
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Abu-Serriah M, Critchlow H, Whitters CJ, Ayoub A. Removal of partially erupted third molars using an Erbium (Er):YAG laser: a randomised controlled clinical trial. Br J Oral Maxillofac Surg 2004; 42:203-8. [PMID: 15121264 DOI: 10.1016/j.bjoms.2004.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2004] [Indexed: 10/26/2022]
Abstract
We compared Erbium (Er):YAG laser with a surgical bur for removal of partially erupted lower third molars. Patients were randomised to be treated by either laser or bur. A total of 42 patients (laser = 22; bur = 20) were treated. A greater reduction in the range of mouth opening was found after laser than after bur treatment. Postoperative pain was more common after bur treatment. The duration of operation was considerably longer with laser than with bur. No persistent complications were encountered.
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Affiliation(s)
- M Abu-Serriah
- Department of Oral and Maxillofacial Surgery, Biotechnology and Craniofacial Research Section, Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, Scotland, UK
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Schwarz F, Aoki A, Sculean A, Georg T, Scherbaum W, Becker J. In vivo effects of an Er:YAG laser, an ultrasonic system and scaling and root planing on the biocompatibility of periodontally diseased root surfaces in cultures of human PDL fibroblasts. Lasers Surg Med 2004; 33:140-7. [PMID: 12913887 DOI: 10.1002/lsm.10201] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of the present study was to investigate the in vivo effects of an Er:YAG laser (ERL), an ultrasonic system and scaling and root planing (SRP) on the biocompatibility of periodontally diseased root surfaces in cultures of human periodontal ligament fibroblasts (PDL). STUDY DESIGN/MATERIALS AND METHODS Forty single rooted teeth, considered for extraction due to severe periodontal destruction, have been randomly assigned to the following groups: (1) ERL at 160 mJ/pulse and 10 Hz, or (2) Vector ultrasonic system (VUS), or (3) SRP using hand instruments, or (4) untreated control (C). Immediately after instrumentation, all test and control teeth were extracted and root specimens (4 mm2) were prepared from all mesial and distal surfaces (n=80). Following the prescribed treatments, the root specimens were incubated with human PDL fibroblast cultures. Adherent cells were stained with methylene blue and counted using a reflected light microscope and the cell density per mm2 was calculated. Additionally, the cell morphology was investigated using SEM (n=8 teeth). RESULTS Cell counts within each group yielded the following means and standard deviations (cells/mm2): ERL, 111+/-27; VUS, 75+/-25; SRP, 41+/-17; control, 25+/-11. Analysis of variance (ANOVA) revealed significant differences in the number of attached cells between the test and control groups (P<0.001, P<0.001, P<0.01, respectively). ERL and VUS treated specimens showed significantly higher numbers of cells/mm2 than the SRP group (P<0.001, respectively). The difference between the ERL and VUS group was statistically significant (P<0.001). CONCLUSIONS The results of the present study indicate that (i) ERL, VUS, and SRP promote the attachment of PDL fibroblasts on previously diseased root surfaces, (ii) periodontally diseased root surfaces inhibit the adherence of PDL fibroblasts, and (iii) the surface structure of ERL and VUS instrumented roots seem to offer better conditions for the adherence of PDL fibroblasts than SRP.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany.
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Schwarz F, Sculean A, Berakdar M, Szathmari L, Georg T, Becker J. In vivo and in vitro effects of an Er:YAG laser, a GaAlAs diode laser, and scaling and root planing on periodontally diseased root surfaces: a comparative histologic study. Lasers Surg Med 2003; 32:359-66. [PMID: 12766958 DOI: 10.1002/lsm.10179] [Citation(s) in RCA: 218] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of the present histologic study was to compare the in vivo and in vitro effects of an erbium: yttrium, aluminum, and garnet (Er:YAG) laser (ERL), combined with a fluorescent calculus detection system, a diode laser (DL) and scaling and root planing (SRP) on periodontally diseased root surfaces. STUDY DESIGN/MATERIALS AND METHODS Twenty-four single rooted teeth, considered for extraction due to severe periodontal destruction, were included in the study. Prior to extraction all mesial root surfaces were randomly assigned to the following treatment groups: (1) ERL combined with a calculus detection system with fluorescence induced by 655 nm InGaAsP DL radiation (160 mJ/pulse and 10 pulses/second under water irrigation) (ERL), or (2) GaAlAs DL (1.8 W, pulse/pause relation 1:10), or (3) SRP using hand instruments. Immediately after extraction, all distal root surfaces were treated with the same instruments under standardized conditions. For light microscopic investigation, a plastic embedding technique was used to cut the undecalcified roots into 30 microm thick crossections. The following parameters were recorded by on blind examiner: remaining debris, root surface morphology, and thermal side effects. RESULTS Root surfaces instrumented with both, ERL in vivo and DL in vitro exhibited no detectable surface alterations. In contrast, ERL scaling in vitro and SRP in vivo/in vitro produced superficial microchanges in root cementum. However, irradiation with DL in vivo caused severe damages to the root surface (i.e., crater formation). There were no signs of thermal side effects in all laser treated groups. ERL provided subgingival calculus removal on a level equivalent to that provided by SRP. DL was unsuitable for calculus removal, since macroscopic inspection revealed the presence of large amounts of subgingival calculus. CONCLUSIONS The present in vivo results showed that (i) ERL, combined with a fluorescent calculus detection system, provided a selective subgingival calculus removal on a level equivalent to that provided by SRP, and (ii) DL, using this power output, was unsuitable for calculus removal and altered the root surface in an undesirable manner.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery, Heinrich Heine University, 40225 Düsseldorf, Germany.
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Schwarz F, Rothamel D, Sculean A, Georg T, Scherbaum W, Becker J. Effects of an Er : YAG laser and the Vector®
ultrasonic system on the biocompatibility of titanium implants in cultures of human osteoblast-like cells. Clin Oral Implants Res 2003; 14:784-92. [PMID: 15015956 DOI: 10.1046/j.0905-7161.2003.00954.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the present study was to investigate the effects of an Er:YAG laser (ERL) and the Vector ultrasonic system (VS) on the biocompatibility of titanium implants in cultures of human osteoblast-like cells (SAOS-2). One hundred and sixty-eight titanium discs with four different surfaces (sand-blasted and acid-etched, titanium plasma-sprayed, machine-polished, and hydroxyapatite-coated) were used to evaluate cell attachment. The samples were equally and randomly assigned to the following groups: (1) an ERL at an energy level of 100 mJ/pulse and 10 Hz using a special application tip, (2) the VS using carbon fibre tips, or (3) untreated control (C). The discs were placed in culture plates, covered with a solution of SAOS-2 cells, and incubated for 7 days. The specimens were then washed with phosphate buffer to remove cells not attached to the surface, and the adherent cells were stained with hematoxilin-eosin. Cells were counted using a reflected light microscope and the cell density per mm2 was calculated. Additionally, cell morphology and surface alterations of the titanium discs after treatment were investigated using scanning electron microscopy (SEM). All titanium discs treated with ERL demonstrated nearly the same cell density per mm2 as the untreated C surfaces. There was a significant decrease in the number of cells that attached to the implant surfaces treated with VS. The SEM examination showed no visible differences between lased and C titanium surfaces. All surfaces treated with VS showed conspicuous surface damage and debris of the used carbon fibres. The results of the present study indicate that (i) ERL does not damage titanium surfaces and subsequently does not influence the attachment rate of SAOS-2 cells, and (ii) VS, used with this type of carbon fibre tip, does not seem to be suitable for the instrumentation of titanium surfaces.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany.
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Schwarz F, Sculean A, Georg T, Becker J. Clinical evaluation of the Er:YAG laser in combination with an enamel matrix protein derivative for the treatment of intrabony periodontal defects: a pilot study. J Clin Periodontol 2003; 30:975-81. [PMID: 14761120 DOI: 10.1034/j.1600-051x.2003.00412.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of the present study was to compare the combination therapy of deep intrabony periodontal defects using an Er:YAG laser (ERL) and enamel matrix protein derivative (EMD) to scaling and root planing+ ethylenediaminetetraacetic acid (EDTA)+EMD. MATERIAL AND METHODS Twenty-two patients with chronic periodontitis, each of whom displayed 1 intrabony defect, were randomly treated with access flap surgery and defect debridement with an Er:YAG (160 mJ/pulse, 10 Hz) plus EMD (test) or with access flap surgery followed by scaling and root planing (SRP) with hand instruments plus EDTA and EMD (control). The following clinical parameters were recorded at baseline and at 6 months: plaque index, gingival index, bleeding on probing (BOP), probing depth (PD), gingival recession, and clinical attachment level (CAL). No differences in any of the investigated parameters were observed at baseline between the two groups. RESULTS Healing was uneventful in all patients. At 6 months after therapy, the sites treated with ERL and EMD showed a reduction in mean PD from 8.6 +/- 1.2 mm to 4.6 +/- 0.8 mm and a change in mean CAL from 10.7 +/- 1.3 mm to 7.5 +/- 1.4 mm (p < 0.001). In the group treated with SRP+EDTA+EMD, the mean PD was reduced from 8.1 +/- 0.8 mm to 4.0 +/- 0.5 mm and the mean CAL changed from 10.4 +/- 1.1 mm to 7.1 +/- 1.2 mm (p < 0.001). No statistically significant differences in any of the investigated parameters were observed between the test and control group. CONCLUSION Within the limits of the present study, it may be concluded that both therapies led to short-term improvements of the investigated clinical parameters, and the combination of ERL and EMD does not seem to improve the clinical outcome of the therapy additionally compared to SRP+EDTA+EMD.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany.
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Eberhard J, Ehlers H, Falk W, Açil Y, Albers HK, Jepsen S. Efficacy of subgingival calculus removal with Er:YAG laser compared to mechanical debridement: an in situ study. J Clin Periodontol 2003; 30:511-8. [PMID: 12795789 DOI: 10.1034/j.1600-051x.2003.00052.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of the present study was to compare the effectiveness of subgingival calculus removal from periodontally involved root surfaces with an Er:YAG laser compared to hand instrumentation in situ. METHODS The mesial and distal surfaces of 30 single-rooted teeth with untreated periodontitis were treated either by hand instrumentation (scaling and root planing (SRP)) or by Er:YAG laser irradiation with the aim of achieving a calculus-free root surface. Subgingival plaque samples were obtained before and immediately after treatment for microbiological evaluation by culture and DNA probe analysis. The teeth were extracted and the residual calculus was measured by means of digitized planimetry. The morphology of the root surface was evaluated by scanning electron microscopy, and undecalcified sections were analyzed to determine residual calculus and the extent of cementum removal following both treatments. RESULTS Following laser irradiation, 68.4+/-14.4% of the root surface was calculus free in contrast to 93.9+/-3.7% after SRP when both treatments were performed for the same time (2:15+/-1:00 min). If laser irradiation was allowed twice the time used for hand instrumentation, 83.3+/-5.7% of the root surface was devoid of calculus. The effectiveness of both treatments was not related to initial probing depth. The histologic evaluation showed that after SRP 73.2% of root dentin was completely denuded from cementum, while only a minimal cementum reduction was apparent after laser irradiation. Both treatment modalities resulted in a similar reduction of periodontopathogens. DISCUSSION The present investigation could demonstrate the in vivo capability of the Er:YAG laser to remove calculus from periodontally involved root surfaces, although the effectiveness did not reach that achieved by hand instrumentation. The lack of cementum removal in contrast to SRP may qualify the laser as an alternative approach during supportive periodontal therapy.
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Affiliation(s)
- Jörg Eberhard
- Departments of Operative Dentistry and Periodontology and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
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Schwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker J. Periodontal treatment with an Er:YAG laser or scaling and root planing. A 2-year follow-up split-mouth study. J Periodontol 2003; 74:590-6. [PMID: 12816290 DOI: 10.1902/jop.2003.74.5.590] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Non-surgical periodontal treatment with an Er:YAG laser has been shown to result in significant clinical attachment level gain; however, clinical results have not been established on a long-term basis following Er:YAG laser treatment. Therefore, the aim of the present study was to present the 2-year results following non-surgical periodontal treatment with an Er:YAG laser or scaling and root planing. METHODS Twenty patients with moderate to advanced periodontal destruction were treated under local anesthesia, and the quadrants were randomly allocated in a split-mouth design to either 1) Er:YAG laser (ERL) using an energy level of 160 mJ/pulse and 10 Hz, or 2) scaling and root planing (SRP) using hand instruments. The following clinical parameters were evaluated at baseline and at 1 and 2 years after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). Subgingival plaque samples were taken at each appointment and analyzed using dark-field microscopy for the presence of cocci, non-motile rods, motile rods, and spirochetes. The primary outcome variable was CAL. No statistically significant differences between the groups were found at baseline. Power analysis to determine superiority of ERL treatment showed that the available sample size would yield 99% power to detect a 1 mm difference. RESULTS The sites treated with ERL demonstrated mean CAL change from 6.3 +/- 1.1 mm to 4.5 +/- 0.4 mm (P < 0.001) and to 4.9 +/- 0.4 mm (P < 0.001) at 1 and 2 years, respectively. No statistically significant differences were found between the CAL mean at 1 and 2 years postoperatively. The sites treated with SRP showed a mean CAL change from 6.5 +/- 1.0 mm to 5.6 +/- 0.4 mm (P < 0.001) and to 5.8 +/- 0.4 mm (P < 0.001) at 1 and 2 years, respectively. The CAL change between 1 and 2 years did not present statistically significant differences. Both groups showed a significant increase of cocci and non-motile rods and a decrease in the amount of spirochetes. However, at the 1- and 2-year examination, the statistical analysis showed a significant difference for the CAL (P < 0.001, respectively) between the 2 treatment groups. CONCLUSION It was concluded that the CAL gain obtained following non-surgical periodontal treatment with ERL or SRP can be maintained over a 2-year period.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery, Heinrich Helne University, Westdeutsche Kieferklinik, Düsseldorf, Germany.
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Folwaczny M, Benner KU, Flasskamp B, Mehl A, Hickel R. Effects of 2.94 microm Er:YAG laser radiation on root surfaces treated in situ: a histological study. J Periodontol 2003; 74:360-5. [PMID: 12710756 DOI: 10.1902/jop.2003.74.3.360] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous scanning electron microscopy (SEM) studies using extracted teeth have shown the potential of infrared Er:YAG laser radiation to remove subgingival calculus without causing severe thermal changes, e.g., charring or fusion, to the irradiated root surface. The purpose of the present study was to examine the morphologic changes on root surfaces following Er:YAG laser irradiation in situ using histological observation. METHODS The periodontal pockets of 6 premolars, canines, and incisors that remained in situ in the jaws of human corpses were irradiated with Er:YAG laser radiation at 60 mJ, 100 mJ, or 180 mJ. The pockets were treated in a similar manner to normal clinical circumstances with a total amount of either 50 or 100 laser pulses. Following laser treatment, the entire tooth, marginal gingiva, and underlying alveolar bone were removed from the jaw. The sections were embedded in methyl-methacrylate, serially cross-sectioned, stained with hematoxylin and eosin or gallamine blue, and examined under a light microscope. Additionally, the extension of the thermally changed tissue areas was determined using digital images and histometry. RESULTS The histological examination revealed two kinds of thermal changes within the laser-treated root surface. Firstly, a thin superficial layer 5 to 10 microm in width was observed. The surface of this layer showed ultrastructural irregularities. Secondly, a semicircular more deeply stained area close to the apical end of the scaling track beneath the irradiated cementum was observed. The depth of this area ranged from 255 microm to 611 microm and appeared to be independent of the radiation energy. CONCLUSION In contrast to previous SEM studies, the histological examination indicated thermal changes within the hard tissue bordering the periodontal pocket following Er:YAG laser irradiation.
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Affiliation(s)
- Matthias Folwaczny
- Department of Operative Dentistry and Periodontology, Ludwig-Maximilians University, Munich, Germany.
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Petersilka GJ, Bell M, Häberlein I, Mehl A, Hickel R, Flemmig TF. In vitro evaluation of novel low abrasive air polishing powders. J Clin Periodontol 2003; 30:9-13. [PMID: 12702105 DOI: 10.1034/j.1600-051x.2003.300102.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM OF THE STUDY Though efficient in stain and plaque removal, air polishing is highly abrasive on root cementum or dentin even if working parameters are adjusted to minimize damage. As abrasiveness is also influenced by the physical properties of the powders used, the aim of the study was to evaluate the safety of novel low abrasive air polishing powders in vitro. MATERIAL AND METHODS Using four novel air polishing powders (A, B, C and D) and a standard sodium bicarbonate (NaHCO3) powder, roots of 126 extracted teeth were air polished under standardized conditions at various working parameter combinations (distance: 2 mm, 4 mm and 6 mm; powder and water setting: low, medium and high) at an angulation of 90 degrees for 20 s. Instrumentation was performed in triplicate; resulting root defects were quantified laser-optically. RESULTS Mean defect depths after application of powders A, B, C and D were significantly lower than with standard powder (A: 17.9 +/- 10.9 micro m, B: 48.2 +/- 32.7 micro m, C: 92.5 +/- 57.9 micro m, D: 33.9 +/- 19.6 micro m, NaHCO3: 163.1 +/- 71.1 micro m) (Kruskal-Wallis test). Among the experimental powders, D was transported most reliably in the air polishing unit and allowed complete removal of disclosed plaque as assessed on freshly extracted teeth. CONCLUSION The novel air polishing powder D is of low abrasiveness to root cementum and dentin while being effective in removing dental plaque. Thus, it may be useful for safe and efficient plaque removal on exposed root surfaces.
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Affiliation(s)
- G J Petersilka
- Clinic of Periodontology, University Münster Clinic, Westfalian Wilhelm University Münster, Germany.
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Folwaczny M, George G, Thiele L, Mehl A, Hickel R. Root surface roughness following Er:YAG laser irradiation at different radiation energies and working tip angulations. J Clin Periodontol 2002; 29:598-603. [PMID: 12354084 DOI: 10.1034/j.1600-051x.2002.290703.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The determination of roughness of root surfaces following treatment with 2.94 micro m Er:YAG laser radiation at different radiation energies and working tip angulations. MATERIALS AND METHODS The study sample comprised 85 extracted human molars, premolars, canines and incisors (n = 85). The source of laser radiation was an Er:YAG laser device (KAVO-Key II, System Aesculap Meditec) emitting pulsed infrared radiation at a wavelength of 2.94 micro m, with a pulse duration of 250 micro s, and a pulse repetition rate of 10 pps. The samples were randomly divided into three experimental units, for treatment with a constant amount of 380 laser pulses at a radiation energy of 60 mJ, 100 mJ, and 180 mJ. Each experimental unit was divided into five subgroups of five samples, which were irradiated at a working tip angulations of 15 degrees, 30 degrees, 45 degrees, 60 degrees, and 90 degrees. Five samples were treated mechanically using curettes. Five samples were left untreated as control. The mean (Ra) and maximum (Rmax) surface roughness of each sample was measured using a profilometer. The statistical analysis was undertaken using anova and Scheffé-test at a level of significance of 5% (p < 0.05). RESULTS Er:YAG laser radiation led to an Ra which ranged from 0.52 micro m (+/- 0.10) to 0.81 micro m (+/- 0.26) and to an Rmax between 3.4 micro m (+/- 0.48) and 9.26 micro m (+/- 3.08). The Ra and Rmax for samples treated with curettes was 0.51 micro m (+/- 0.11) and 5.08 micro m (+/- 4.98), respectively. That for the untreated control samples were 0.53 micro m (+/- 0.15) and 7.07 micro m (+/- 5.48), respectively. CONCLUSIONS The mean and maximum surface roughness of root surfaces following irradiation with Er:YAG laser was not significantly different to that obtained on samples treated with conventional hand instruments or left untreated. Furthermore, the surface roughness does not depend on the radiation energy and the angulation of the working tip.
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Affiliation(s)
- Matthias Folwaczny
- Department of Operative Dentistry and Periodontology, Ludwig-Maximilians-University, Munich, Germany.
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