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AlJameel AH, Alshehri AM, Alzuhair SH, Al Masud MH, Alasmri AJ, Alkhunefer YA, Almaflehi NS. Adjunctive Dental Procedures and Pain Assessment Among a Group of Patients Attending Dental University Hospital at King Saud University: A Cross-Sectional Study. Cureus 2023; 15:e44809. [PMID: 37809123 PMCID: PMC10558964 DOI: 10.7759/cureus.44809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Background/purpose A large percentage of people still experience discomfort and pain during dental visits, even with advancements in instrumental techniques that enable dentists to manage patients in a pain-free manner. The aim of this study was to assess the prevalence and levels of pain induced by various dental procedures, including adjunctive dental procedures. Material and methods A structured, custom-made questionnaire composed of 20 questions written in Arabic with accompanying pictures of instruments to simplify instrument identification for the patients was designed. The questionnaire was designed to investigate and determine the factors that cause pain and discomfort during dental procedures and was introduced to adult patients attending their dental appointments at the College of Dentistry. All data were collected using an online link that was distributed to patients attending dental clinics at the Dental University Hospital at King Saud University either through their mobile phones or the researcher's tablet. All data were entered and analyzed using SPSS version 25. Results A total of 158 patients participated in the study. The findings revealed that 50% of participants experienced pain from mouth mirror retraction and 28.48% experienced pain from suction. Participants also reported that the most common instruments associated with pain were the ultrasonic scaler (88.57%) and the periodontal probe (87.88%). Conclusion The findings provided valuable insights into the prevalence of pain during dental procedures and the factors that may contribute to this experience. Adjunctive dental procedures appeared to be causing a high prevalence of pain that could be avoided if dentists/dental assistants were more aware of it. These findings may have important implications for dental practitioners looking to reduce pain and improve patient experience during the provision of dental care.
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Affiliation(s)
- AlBandary H AlJameel
- Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, SAU
| | - Abdulaziz M Alshehri
- Restorative Dental Science Department, King Saud University, College of Dentistry, Riyadh, SAU
| | - Saud H Alzuhair
- Dentistry, College of Dentistry, King Saud University, Riyadh, SAU
| | | | | | | | - Nassr S Almaflehi
- Periodontics and Community Dentistry, King Saud University, Riyadh, SAU
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Erbium lasers in non-surgical periodontal therapy: an umbrella review and evidence gap map analysis. Lasers Med Sci 2022; 37:103-120. [PMID: 35029727 DOI: 10.1007/s10103-022-03504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
The literature on the efficacy of erbium lasers for nonsurgical periodontal therapy is inconsistent. The objective of the umbrella review was to collate the information available in the systematic reviews to provide a comprehensive synthesis of clinical and patient reported outcomes following the use of erbium lasers for non-surgical periodontal therapy. An electronic database search was carried out, and systematic reviews/meta-analyses which assessed the efficacy of erbium lasers as monotherapy or as an adjunct to scaling and root planing were included. The methodological quality and reporting quality of the included studies were assessed. 15 Systematic reviews/meta-analyses were obtained after title, abstract, and full text search. The meta-analyses data revealed a clinical attachment level gain, reduction in probing pocket depth at 1 and 3-month follow-up, and no additional benefit at ≥ 6-month follow-up in the erbium laser group. The evidence gap map revealed lack of clinical outcome data at > 6-month follow-up and dearth in studies assessing patient reported outcome measures and adverse events. Erbium lasers may provide short-term clinical benefits, and further studies with standardized laser parameters evaluating long-term follow-up, patient-reported outcome measures, and adverse events are needed.
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Gurpegui Abud D, Shariff JA, Linden E, Kang PY. Erbium-doped: yttrium-aluminum-garnet (Er:YAG) versus scaling and root planing for the treatment of periodontal disease: A single-blinded split-mouth randomized clinical trial. J Periodontol 2021; 93:493-503. [PMID: 34286867 DOI: 10.1002/jper.21-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND This randomized, controlled clinical trial aimed to compare the differences in periodontal clinical outcomes, duration of the procedure, and patient's experience between conventional scaling and root planing and erbium-doped: yttrium-aluminum-garnet (Er:YAG) in the treatment of generalized moderate to severe chronic periodontitis or generalized Stages II or III, and Grade B periodontitis based on the Centers for Disease Control (CDC), American Academy of Periodontology (AAP), and European Federation of Periodontology (EFP) definitions. METHODS Thirty subjects were initially recruited. In a split-mouth fashion, right and left sides were randomly allocated into two treatment arms: conventional scaling and root planing (C-SRP) versus laser-assisted scaling and root planing (L-SRP). A blinded examiner recorded clinical measurements at baseline and 3 months. Duration of the procedure was also recorded for each visit, and the patient's experience was assessed with a questionnaire at baseline, 1, and 3 months. RESULTS The final sample consisted of 26 subjects. Both treatments resulted in overall improvement, but no significant differences were found between modalities for clinical attachment gain or probing depth reduction. The duration of the procedure was approximately half for L-SRP, and postoperative sensitivity was greater in C-SRP. CONCLUSIONS The low-energy protocol with Er:YAG (50 mJ) used for the non-surgical treatment of moderate-severe chronic or Stage II-III, Grade B periodontitis performed in this study population was a treatment modality that yielded similar clinical improvements when compared to conventional scaling and root planing.
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Affiliation(s)
- Daniela Gurpegui Abud
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, New York.,Periodontics, Touro College of Dental Medicine at New York Medical College, Hawthorne, New York
| | - Jaffer A Shariff
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, New York.,Periodontics, Touro College of Dental Medicine at New York Medical College, Hawthorne, New York
| | - Eric Linden
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, New York
| | - Philip Y Kang
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, New York
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Qi Y, Zhang S, Zhang M, Zhou Z, Zhang X, Li W, Cai H, Zhao BC, Lee ES, Jiang HB. Effects of Physical Stimulation in the Field of Oral Health. SCANNING 2021; 2021:5517567. [PMID: 33927791 PMCID: PMC8049832 DOI: 10.1155/2021/5517567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 05/27/2023]
Abstract
Physical stimulation has been widely used in clinical medicine and healthcare due to its noninvasiveness. The main applications of physical stimulation in the oral cavity include laser, ultrasound, magnetic field, and vibration, which have photothermal, cavitation, magnetocaloric, and mechanical effects, respectively. In addition, the above four stimulations with their unique biological effects, which can play a role at the gene, protein, and cell levels, can provide new methods for the treatment and prevention of common oral diseases. These four physical stimulations have been used as important auxiliary treatment methods in the field of orthodontics, implants, periodontal, dental pulp, maxillofacial surgery, and oral mucosa. This paper systematically describes the application of physical stimulation as a therapeutic method in the field of stomatology to provide guidance for clinicians. In addition, some applications of physical stimulation in specific directions are still at the research stage, and the specific mechanism has not been fully elucidated. To encourage further research on the oral applications of physical stimulation, we elaborate the research results and development history of various physical stimuli in the field of oral health.
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Affiliation(s)
- Yanxin Qi
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - ShuXin Zhang
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Mi Zhang
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Zili Zhou
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Xinyi Zhang
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Wenhui Li
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - HongXin Cai
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Bing Cheng Zhao
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Eui-Seok Lee
- Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dentistry, Korea University, Seoul 08308, Republic of Korea
| | - Heng Bo Jiang
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
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Trombelli L, Farina R, Pollard A, Claydon N, Franceschetti G, Khan I, West N. Efficacy of alternative or additional methods to professional mechanical plaque removal during supportive periodontal therapy: A systematic review and meta-analysis. J Clin Periodontol 2021; 47 Suppl 22:144-154. [PMID: 32060940 DOI: 10.1111/jcpe.13269] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/20/2020] [Accepted: 02/10/2020] [Indexed: 12/18/2022]
Abstract
AIMS To systematically review the literature addressing the following focused questions: "What is the efficacy of either (#1) alternative or (#2) additional methods to professional mechanical plaque removal (PMPR) on progression of attachment loss during supportive periodontal therapy (SPT) in periodontitis patients?". METHODS A systematic search for randomized clinical trials was performed. Change in clinical attachment level (CAL) from baseline was the primary outcome. RESULTS Routine PMPR performed with either a combination of ultrasonic/hand instruments or Er:Yag laser showed similarly effective in preventing CAL loss. Moreover, a routine SPT regimen based on PMPR led to stability of CAL irrespective of a daily sub-antimicrobial doxycycline dose (SDD). Finally, an adjunctive photodynamic therapy (PDT) did not enhance the magnitude of CAL gain when sites with probing depth ≥4 mm were repeatedly treated. After pooling all data, the results of the meta-analysis showed no statistical differences in CAL change from baseline: mean overall CAL change was -0.233 mm (95% confidence interval: -1.065, 0.598; p = .351). CONCLUSIONS Weak evidence indicate that in treated periodontitis patients enrolled in a 3-4 month SPT based on PMPR, Er:Yag laser (as alternative), SDD and PDT (as additional) do not produce a greater clinical effect on periodontal conditions compared to PMPR.
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Affiliation(s)
- Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
| | - Alexander Pollard
- Periodontology, Clinical Trials Unit, Bristol Dental School, Bristol, UK
| | - Nicholas Claydon
- Periodontology, Clinical Trials Unit, Bristol Dental School, Bristol, UK
| | - Giovanni Franceschetti
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
| | - Iftekhar Khan
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Nicola West
- Periodontology, Clinical Trials Unit, Bristol Dental School, Bristol, UK
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Peikert SA, Fischer A, Kruse AB, Al-Ahmad A, Woelber JP, Vach K, Braun A, Ratka-Krüger P. Adjuvant Transgingival Therapy with Visible Light Plus Water-Filtered Infrared-A (VIS + wIRA) in Periodontal Therapy-A Randomized, Controlled, Stratified, Double-Blinded Clinical Trial. Antibiotics (Basel) 2021; 10:251. [PMID: 33802497 PMCID: PMC7999319 DOI: 10.3390/antibiotics10030251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 12/03/2022] Open
Abstract
The aim of this randomized, controlled, double-blinded clinical trial was to examine the additional healing effect of transgingival visible light and water-filtered infrared-A (VIS + wIRA) in the treatment of periodontitis patients compared with the standard therapy by subgingival instrumentation (SI). Therefore, forty patients with untreated periodontitis received a non-surgical periodontal treatment. Using a split-mouth study design, one quadrant of the upper jaw was randomly either exposed to VIS + wIRA four times for 20 min within two weeks in addition to SI or received only SI. Three and 6 months after intervention, clinical parameters (probing depths (PDs), clinical attachment level, bleeding on probing (BOP), furcation, tooth mobility, plaque control record, and papilla bleeding index) were re-evaluated. In the presence of PD of 4 mm and positive BOP or PD > 4 mm, SI was performed again. Moreover, the patients were asked about their discomfort using a visual analog scale from 1 to 10 for each side of the maxilla. Statistical analysis demonstrated no differences between quadrants at re-evaluation for clinical parameters (p > 0.05) after 3 and 6 months. Concerning pain perception, patients described less pain on the irradiated side (p = 0.016). In the treatment of patients with periodontitis, VIS + wIRA did not show an additional effect on the clinical outcome after 3 and 6 months. Patients described less pain on the irradiated quadrant after treatment.
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Affiliation(s)
- Stefanie Anna Peikert
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (A.F.); (A.B.K.); (A.A.-A.); (J.P.W.); (P.R.-K.)
| | - Anil Fischer
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (A.F.); (A.B.K.); (A.A.-A.); (J.P.W.); (P.R.-K.)
- Practice Dr. Stefan Bertram, Gewerbegasse 5, 83395 Freilassing, Germany
| | - Anne Brigitte Kruse
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (A.F.); (A.B.K.); (A.A.-A.); (J.P.W.); (P.R.-K.)
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (A.F.); (A.B.K.); (A.A.-A.); (J.P.W.); (P.R.-K.)
| | - Johan Peter Woelber
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (A.F.); (A.B.K.); (A.A.-A.); (J.P.W.); (P.R.-K.)
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straße 26, 79104 Freiburg, Germany;
| | - Andreas Braun
- Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, RWTH University Aachen, Pauwelsstraße 30, 52074 Aachen, Germany;
| | - Petra Ratka-Krüger
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (A.F.); (A.B.K.); (A.A.-A.); (J.P.W.); (P.R.-K.)
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7
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Patient-reported outcomes of laser-assisted pain control following non-surgical and surgical periodontal therapy: A systematic review and meta-analysis. PLoS One 2020; 15:e0238659. [PMID: 32941479 PMCID: PMC7498060 DOI: 10.1371/journal.pone.0238659] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022] Open
Abstract
Adjunctive use of laser devices as high reactive-level laser/light therapy (HLLT) or photobiomodulation therapy (PBMT) for periodontal therapy is known to be more effective on suppressing pain than conventional therapy, however, there are no systematic reviews addressed its effectiveness. This systematic review and meta-analysis aim to investigate the following clinical question (CQ): does adjunctive use of lasers with conventional therapy suppress the pain associated with periodontal treatment? A systematic and extensive literature search was performed to summarize the currently available knowledge to answer the CQ using the PubMed, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) conducted before June 2020. Bias risk was assessed using the Cochrane tool for the risk of bias evaluation. A meta-analysis was performed on quantitative evaluation of pain control based on patient-reported outcomes. After an independent screening of 165 initial records, ten RCTs were included. Six of them focused on surgical procedures and the others on non-surgical periodontal pocket therapy. The protocols of HLLT, PBMT, and combination with HLLT and PBMT were employed in five, four and one RCTs, respectively. Following the assessment of bias risk, it is revealed that all RCTs had methodological weaknesses regarding the blinding of key personnel, although other bias risk factors were not evident. Meta-analysis showed that HLLT using erbium lasers significantly reduced the patient-reported pain immediately after treatment (two RCTs, p < 0.0001), while PBMT using diode lasers significantly reduced pain 2-7 days after treatment (two RCTs, p < 0.0001 to p = 0.03). The presented systematic review and meta-analysis suggest that the alternative use of HLLT using erbium lasers to conventional instrumentation can significantly suppress postoperative pain and that intraoperative or postoperative PBMT using diode lasers combined with periodontal surgery can significantly reduce postoperative pain. However, the evidence is still insufficient and more well-designed RCTs are required.
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Kruse AB, Akakpo DL, Maamar R, Woelber JP, Al-Ahmad A, Vach K, Ratka-Krueger P. Trehalose powder for subgingival air-polishing during periodontal maintenance therapy: A randomized controlled trial. J Periodontol 2018; 90:263-270. [PMID: 30311948 DOI: 10.1002/jper.17-0403] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Air-polishing appears to be a promising procedure for subgingival biofilm removal in periodontal treatment. The aim of this study was to compare trehalose powder for subgingival air-polishing with sonic debridement in residual periodontal pockets during maintenance therapy. METHODS In this blinded, randomized, controlled clinical trial conducted over 6 months with a split-mouth design, single-rooted teeth in 44 participants with residual pocket depths of 5 mm and bleeding or >5 mm with and without bleeding were included in this study. Subgingival debridement was carried out using either trehalose powder with an air-polishing device (test) or a sonic device (control). The reduction in the probing depths after 3 and 6 months was defined as the primary endpoint. A visual analog scale was used to evaluate the discomfort of both procedures. RESULTS Both procedures showed statistically significant intragroup reductions in probing depths (test baseline [BL] 5.52 ± 0.93, 6 months 3.66 ± 0.81, control BL 5.55 ± 0.9, 6 months 3.68 ± 0.86, P < 0.001), clinical attachment level (test BL 6.93 ± 1.5, 6 months 5.3 ± 1.52, control BL 7.27 ± 1.8, 6 months 5.84 ± 1.71, P < 0.001), and bleeding on probing (test BL 86%, 6 months 41%, control BL 89%, 6 months 34%, P < 0.001) after 6 months with no significant intergroup differences (P > 0.05, respectively). The visual analog scale showed a significantly lower incidence of discomfort for air-polishing compared with sonic scaling (test 2.33 ± 2.14, control 4.91 ± 2.65, P < 0.001). CONCLUSIONS Subgingival air-polishing with trehalose powder showed comparable clinical outcomes to sonic scaling. Sonic scaling evoked more discomfort compared with air-polishing.
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Affiliation(s)
- Anne B Kruse
- Center for Dental Medicine, Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Freiburg, Germany
| | - Dodji L Akakpo
- Center for Dental Medicine, Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Freiburg, Germany
| | - Rabie Maamar
- Center for Dental Medicine, Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Freiburg, Germany
| | - Johan P Woelber
- Center for Dental Medicine, Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Freiburg, Germany
| | - Ali Al-Ahmad
- Center for Dental Medicine, Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Freiburg, Germany
| | - Kirstin Vach
- Department of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany
| | - Petra Ratka-Krueger
- Center for Dental Medicine, Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Freiburg, Germany
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9
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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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10
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Sumra N, Kulshrestha R, Umale V, Chandurkar K. Lasers in non-surgical periodontal treatment – a review. J COSMET LASER THER 2018; 21:255-261. [DOI: 10.1080/14764172.2018.1525744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nida Sumra
- Consulting Periodontist, Private Practice, Mumbai, India
| | | | - Vinay Umale
- Senior Lecturer, Department of Orthodontics, Yogita Dental College, Khed Maharashtra, India
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11
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Yuan F, Zheng J, Sun Y, Wang Y, Lyu P. Regulation and Measurement of the Heat Generated by Automatic Tooth Preparation in a Confined Space. Photomed Laser Surg 2018; 35:332-337. [PMID: 28590837 DOI: 10.1089/pho.2016.4242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess and regulate heat generation in the dental pulp cavity and circumambient temperature around a tooth during laser ablation with a femtosecond laser in a confined space. BACKGROUND DATA The automatic tooth preparing technique is one of the traditional oral clinical technology innovations. In this technique, a robot controlled an ultrashort pulse laser to automatically complete the three-dimensional teeth preparing in a confined space. The temperature control is the main measure for protecting the tooth nerve. METHODS Ten tooth specimens were irradiated with a femtosecond laser controlled by a robot in a confined space to generate 10 teeth preparation. During the process, four thermocouple sensors were used to record the pulp cavity and circumambient environment temperatures with or without air cooling. A statistical analysis of the temperatures was performed between the conditions with and without air cooling (p < 0.05). RESULTS The recordings showed that the temperature with air cooling was lower than that without air cooling and that the heat generated in the pulp cavity was lower than the threshold for dental pulp damage. CONCLUSIONS These results indicate that femtosecond laser ablation with air cooling might be an appropriate method for automatic tooth preparing.
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Affiliation(s)
- Fusong Yuan
- 1 Center of Digital Dentistry, Peking University School and Hospital of Stomatology , Beijing, China .,2 National Engineering Laboratory, Digital and Material Technology of Stomatology , Beijing, China .,3 Research Center of Engineering and Technology for Digital Dentistry , Ministry of Health, Beijing, China
| | - Jianqiao Zheng
- 1 Center of Digital Dentistry, Peking University School and Hospital of Stomatology , Beijing, China .,2 National Engineering Laboratory, Digital and Material Technology of Stomatology , Beijing, China .,3 Research Center of Engineering and Technology for Digital Dentistry , Ministry of Health, Beijing, China
| | - Yuchun Sun
- 1 Center of Digital Dentistry, Peking University School and Hospital of Stomatology , Beijing, China .,2 National Engineering Laboratory, Digital and Material Technology of Stomatology , Beijing, China .,3 Research Center of Engineering and Technology for Digital Dentistry , Ministry of Health, Beijing, China
| | - Yong Wang
- 1 Center of Digital Dentistry, Peking University School and Hospital of Stomatology , Beijing, China .,2 National Engineering Laboratory, Digital and Material Technology of Stomatology , Beijing, China .,3 Research Center of Engineering and Technology for Digital Dentistry , Ministry of Health, Beijing, China
| | - Peijun Lyu
- 1 Center of Digital Dentistry, Peking University School and Hospital of Stomatology , Beijing, China .,2 National Engineering Laboratory, Digital and Material Technology of Stomatology , Beijing, China .,3 Research Center of Engineering and Technology for Digital Dentistry , Ministry of Health, Beijing, China
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Müller S, Huber H, Goebel G, Wimmer G, Kapferer-Seebacher I. Pain perception during debridement of hypersensitive teeth elicited by two ultrasonic scalers. Clin Oral Investig 2017; 21:1559-1564. [PMID: 27743214 PMCID: PMC5442201 DOI: 10.1007/s00784-016-1971-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/04/2016] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The ultrasonic NO PAIN technology (Electro Medical Systems, Nyon, CH) promises minimal pain during debridement due to linear oscillating action combined with a sinusoidal power output and feedback control. The aim of the present study was to measure pain perception on a visual analogue scale (VAS) during supportive periodontal therapy including debridement of hypersensitive teeth. Two ultrasonic scalers were used, one with and one without NO PAIN technology. MATERIAL AND METHODS In a randomized-controlled clinical study with split-mouth design, 100 hypersensitive teeth matched for air blast hypersensitivity were either treated with the ultrasonic device Piezon Master 700 or the Mini Piezon (both EMS, Nyon, CH). Pain perception during debridement was assessed by a VAS (range 0-10). RESULTS The average VAS for the test device Piezon Master 700 with NO PAIN technology was 3.16 ± 2.10, and for the control device Mini Piezon without NO PAIN technology 3.40 ± 2.59 (p = 0.490). Placing an arbitrary threshold at the VAS score of 3 for significant pain experience, 60 % of the subjects experienced no significant pain with either instrument. CONCLUSION No statistically significant difference in perceived pain between the instruments used was found. CLINICAL RELEVANCE Both ultrasonic devices showed very small pain intensities during debridement of highly hypersensitive teeth and can therefore be recommended for supportive periodontal therapy.
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Affiliation(s)
- S Müller
- Department of Dental Prosthetics and Restorative Dentistry, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - H Huber
- Department of Dental Prosthetics and Restorative Dentistry, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - G Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Schöpfstr. 41, 6020, Innsbruck, Austria
| | - G Wimmer
- Department of Restaurative Dentistry, Periodontology and Prosthodontics, Medical University of Graz, Billrothgasse 4, 8010, Graz, Austria
| | - I Kapferer-Seebacher
- Department of Dental Prosthetics and Restorative Dentistry, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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de Oliveira GJPL, Cominotte MA, Beraldo TPP, Sampaio JEC, Marcantonio RAC. A microscopic analysis of the effects of root surface scaling with different power parameters of Er,Cr:YSGG laser. Microsc Res Tech 2015; 78:529-35. [PMID: 25951453 DOI: 10.1002/jemt.22505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 02/19/2015] [Accepted: 03/22/2015] [Indexed: 11/12/2022]
Abstract
The aim of this study was to evaluate the effects of different power parameters of an Erbium, Cromium: Yttrium, Scandium, Gallium, Garnet laser (Er,Cr:YSGG laser) on the morphology, attachment of blood components (ABC), roughness, and wear on irradiated root surfaces. Sixty-five incisive bovine teeth were used in this study, 35 of which were used for the analysis of root surface morphology and ABC. The remaining 30 teeth were used for roughness and root wear analysis. The samples were randomly allocated into seven groups: G1: Er,Cr:YSGG laser, 0.5 W; G2: Er,Cr:YSGG laser, 1.0 W; G3: Er,Cr:YSGG laser, 1.5 W; G4: Er,Cr:YSGG laser, 2.0 W; G5: Er,Cr:YSGG laser, 2.5 W; G6: Er,Cr:YSGG laser, 3.0 W; G7: scaling and root planning (SRP) with manual curettes. The root surfaces irradiated by Er,Cr:YSGG at 1.0 W and scaling with manual curettes presented the highest degrees of ABC. The samples irradiated by the Er,Cr:YSGG laser were rougher than the samples treated by the manual curette, and increasing the laser power parameters caused more root wear and greater roughness on the root surface. The Er,Cr:YSGG laser is safe to use for periodontal treatment, but it is not appropriate to use irradiation greater than 1.0 W for this purpose.
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Chandavarkar SM, Ram SM. A comparative evaluation of the effect of dentin desensitizers on the retention of complete cast metal crowns. Contemp Clin Dent 2015; 6:S45-50. [PMID: 25821374 PMCID: PMC4374318 DOI: 10.4103/0976-237x.152937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Desensitizers are used to reduce dentin hypersensitivity. They affect the surface texture of prepared dentin and may alter the retention of fixed restorations. AIMS The aim was to evaluate the effect of dentin desensitizers on the retention of complete cast metal crowns luted with glass ionomer cement. SUBJECTS AND METHODS Fifty freshly extracted human premolars were subjected to standardized tooth preparation (20° total convergence, 4 mm axial height) with a computer numerically controlled machine. Individual cast metal crowns were fabricated from a base metal alloy. Dentin desensitizers included none (control), a glutaraldehyde (GLU) based primer (Gluma desensitizer), casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP) (GC Mousse), erbium, chromium: YSGG laser (Waterlase MD Turbo, Biolase) and Pro-Argin (Colgate Sensitive Pro-Relief desensitizing polishing paste). After desensitization, crowns were luted with glass ionomer cement and kept for 48 h at 37°C in 100% relative humidity. The samples were tested using a universal testing machine by applying a load at a crosshead speed of 0.5 mm/min. STATISTICAL ANALYSIS USED Statistical analysis included One-way ANOVA, followed by the Scheffe post-hoc test with P < 0.05. RESULTS All dentin desensitizers showed significantly different values: Pro-Argin (4.10 Megapascals [Mpa]) < CPP-ACP (4.01 mpa) < GLU based primer (3.87 Mpa) < Virgin dentin (3.65 Mpa) < LASER (3.37 Mpa). CONCLUSIONS On comparing the effect of prepared virgin dentin, GLU based primer, CPP-ACP, LASER and Pro-Argin on the retention of complete cast metal crowns luted with glass ionomer cement on prepared teeth, it can be concluded that Pro-Argin and CPP-ACP showed the best retention in this in vitro study.
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Affiliation(s)
- Saili M Chandavarkar
- Bethany Hospital, Thane, STVJS Charitable Trust, Thane, Shri Vagad Welfare Hospital, Kutch, India
| | - Sabita M Ram
- Department of Prosthodontics, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
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15
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Bühler J, Amato M, Weiger R, Walter C. A systematic review on the patient perception of periodontal treatment using air polishing devices. Int J Dent Hyg 2015; 14:4-14. [DOI: 10.1111/idh.12119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J Bühler
- Department of Periodontology, Endodontology and Cariology; School of Dental Medicine; University of Basel; Basel Switzerland
| | - M Amato
- Department of Periodontology, Endodontology and Cariology; School of Dental Medicine; University of Basel; Basel Switzerland
| | - R Weiger
- Department of Periodontology, Endodontology and Cariology; School of Dental Medicine; University of Basel; Basel Switzerland
| | - C Walter
- Department of Periodontology, Endodontology and Cariology; School of Dental Medicine; University of Basel; Basel Switzerland
- Department of Oral Surgery; School of Dentistry; University of Birmingham; Birmingham UK
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Graetz C, Schwendicke F, Plaumann A, Rauschenbach S, Springer C, Kahl M, Sälzer S, Dörfer CE. Subgingival instrumentation to remove simulated plaque in vitro: influence of operators' experience and type of instrument. Clin Oral Investig 2014; 19:987-95. [PMID: 25231069 DOI: 10.1007/s00784-014-1319-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/09/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is uncertainty regarding the benefits and risks of hand versus powered root surface instrumentation. Moreover, the influence of operators' experience on treatment results is unclear. We compared newly developed sonic, ultrasonic and hand instruments, hypothesizing that powered devices allow to remove more simulated plaque in less time than hand instruments, with significant influence of operators' experience. METHODS Sonic scaler (AIR), ultrasonic scaler (TIG) device and double Gracey curettes (GRA) were utilized by seven experienced operators (EOs) and four less experienced operators (LOs) in periodontitis manikin heads. The time required for treatment, the proportion of residual-simulated plaque and the weight loss caused by scaling as a proxy for root surface destruction were measured. RESULTS Using different instruments led to significantly different proportions of removed simulated plaque regardless of operators' experience (AIR, 80.2 ± 21.3 %, TIG, 69.9 ± 22.5 %, GRA, 73.1 ± 20.0 %) (p < 0.001). Treatment times did not significantly differ between EO and LO (p > 0.05). Weight loss was increased when using hand instead of powered instruments (p < 0.001), with significantly higher weight loss induced by LO than EO (p = 0.004). CONCLUSION Within the present study, EO did not remove more simulated plaque in less time but induced less root surface destruction. Using a sonic device was most beneficial for plaque removal. CLINICAL RELEVANCE Successful root surface debridement requires both time and training regardless of the used instrument. Hand instruments might cause more damage to root surfaces, especially in the hands of less experienced operators.
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Affiliation(s)
- Christian Graetz
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany,
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Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Lasers for the Treatment of Dentin Hypersensitivity. J Dent Res 2013; 92:492-499. [DOI: 10.1177/0022034513487212] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
This systematic review and meta-analysis assessed the efficacy of lasers in reducing dentin hypersensitivity (DH) as compared with placebo or no treatment. Seven electronic databases and a manual search resulted in 2,538 unique publications. After selection, 13 studies were included in the meta-analysis. A CONSORT-based quality assessment revealed that 3 and 10 studies were at low and high risk of bias, respectively. A random-effects model with the generic inverse variance standardized mean difference (SMD) was used because of expected heterogeneity. Meta-analyses of the baseline-end of follow-up changes in pain revealed no differences for Er,Cr:YSSG vs. placebo (SMD = 2.49; 95% CI, -0.25 to 5.22; p = .07) but did reveal differences in favor of lasers for Er:YAG vs. placebo (SMD, 2.65; 95% CI, 1.25 to 4.05; p = .0002), Nd:YAG vs. placebo (SMD, 3.59; 95% CI, 0.49 to 6.69; p = .02), and GaAlAs vs. placebo (SMD, 3.40; 95% CI, 1.93 to 4.87; p < .00001). High and significant heterogeneity was found for all comparisons. In conclusion, Er:YAG, Nd:YAG, and GaAlAs lasers appear to be efficacious in reducing DH. However, given the high heterogeneity of the included studies, future randomized controlled clinical trials are needed to confirm these results.
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Affiliation(s)
- F. Sgolastra
- Department of Life, Health, and Environmental Sciences, School of Dentistry, University of L’Aquila, Italy
| | - A. Petrucci
- Department of Life, Health, and Environmental Sciences, School of Dentistry, University of L’Aquila, Italy
| | - M. Severino
- Department of Life, Health, and Environmental Sciences, School of Dentistry, University of L’Aquila, Italy
| | - R. Gatto
- Department of Life, Health, and Environmental Sciences, School of Dentistry, University of L’Aquila, Italy
| | - A. Monaco
- Department of Life, Health, and Environmental Sciences, School of Dentistry, University of L’Aquila, Italy
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Braun A, Krillke RF, Frentzen M, Bourauel C, Stark H, Schelle F. Heat generation caused by ablation of dental hard tissues with an ultrashort pulse laser (USPL) system. Lasers Med Sci 2013; 30:475-81. [PMID: 23666547 DOI: 10.1007/s10103-013-1344-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 04/30/2013] [Indexed: 11/26/2022]
Abstract
Heat generation during the removal of dental hard tissues may lead to a temperature increase and cause painful sensations or damage dental tissues. The aim of this study was to assess heat generation in dental hard tissues following laser ablation using an ultrashort pulse laser (USPL) system. A total of 85 specimens of dental hard tissues were used, comprising 45 specimens of human dentine evaluating a thickness of 1, 2, and 3 mm (15 samples each) and 40 specimens of human enamel with a thickness of 1 and 2 mm (20 samples each). Ablation was performed with an Nd:YVO4 laser at 1,064 nm, a pulse duration of 9 ps, and a repetition rate of 500 kHz with an average output power of 6 W. Specimens were irradiated for 0.8 s. Employing a scanner system, rectangular cavities of 1-mm edge length were generated. A temperature sensor was placed at the back of the specimens, recording the temperature during the ablation process. All measurements were made employing a heat-conductive paste without any additional cooling or spray. Heat generation during laser ablation depended on the dental hard tissue (enamel or dentine) and the thickness of the respective tissue (p < 0.05). Highest temperature increase could be observed in the 1-mm thickness group for enamel. Evaluating the 1-mm group for dentine, a significantly lower temperature increase could be measured (p < 0.05) with lowest values in the 3-mm group (p < 0.05). A time delay for temperature increase during the ablation process depending on the material thickness was observed for both hard tissues (p < 0.05). Employing the USPL system to remove dental hard tissues, heat generation has to be considered. Especially during laser ablation next to pulpal tissues, painful sensations and potential thermal injury of pulp tissue might occur.
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Affiliation(s)
- Andreas Braun
- Department of Operative Dentistry and Endodontology, University of Marburg, Georg-Voigt-Strasse 3, 35039, Marburg, Germany,
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Sanz-Moliner JD, Nart J, Cohen RE, Ciancio SG. The Effect of an 810-nm Diode Laser on Postoperative Pain and Tissue Response After Modified Widman Flap Surgery: A Pilot Study in Humans. J Periodontol 2013; 84:152-8. [DOI: 10.1902/jop.2012.110660] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Slot DE, Timmerman MF, Versteeg PA, van der Velden U, van der Weijden FA. Adjunctive clinical effect of a water-cooled Nd:YAG laser in a periodontal maintenance care programme: a randomized controlled trial. J Clin Periodontol 2012; 39:1159-65. [PMID: 23082801 DOI: 10.1111/jcpe.12007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Various laser systems are currently available for intra-oral use. Neodymium:Yttrium-Aluminium Garnet lasers(Nd:YAG) have been approved by the US Food and Drug Administration for soft tissue treatment in the oral cavity. OBJECTIVES The aim of this study was to test whether the use of a water-cooled Nd:YAG laser during a maintenance care programme as an adjunct to supragingival and subgingival debridement (scaling and root planing, SRP) with hand and ultrasonic instruments results in clinical improvement compared with SRP alone. MATERIAL AND METHODS This study was an examiner-blind, randomized and controlled clinical trial using a split-mouth design. Thirty subjects were selected, originally diagnosed with moderate to severe generalized periodontitis, following a periodontal maintenance care programme (PMC). Immediately after SRP in two randomly assigned contra-lateral quadrants, all pockets ≥5 mm were additionally treated with a Nd:YAG laser (1064 nm, 4W, 250-μsec pulse). Clinical assessments [probing pocket depth PPD, bleeding on pocket probing (BOPP)] were performed pre-treatment and at 6 months. Based on these assessments, the periodontal inflamed surface area (PISA) was calculated. RESULTS At 6 months, the clinical parameters had significantly improved for both regimens. No statistically significant differences between treatment modalities were observed for PPD and BOPP scores at any time. PISA scores supported these findings. CONCLUSIONS In residual pockets ≥5 mm, treated in a PMC, the adjunctive use of an Nd:YAG laser does not provide a clinically significant additional advantage.
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Affiliation(s)
- Dagmar E Slot
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
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Sanz I, Alonso B, Carasol M, Herrera D, Sanz M. Nonsurgical Treatment of Periodontitis. J Evid Based Dent Pract 2012; 12:76-86. [DOI: 10.1016/s1532-3382(12)70019-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ratka-Krüger P, Mahl D, Deimling D, Mönting JS, Jachmann I, Al-Machot E, Sculean A, Berakdar M, Jervøe-Storm PM, Braun A. Er:YAG laser treatment in supportive periodontal therapy. J Clin Periodontol 2012; 39:483-9. [PMID: 22276957 DOI: 10.1111/j.1600-051x.2012.01857.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2012] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To assess clinical and microbiological outcomes of an Er:YAG laser in comparison with sonic debridement in the treatment of persistent periodontal pockets in a prospective randomized controlled multicentre study design. MATERIAL AND METHODS A total of 78 patients in supportive periodontal therapy with two residual pockets were included, 58 were available for the whole follow-up period. Root surfaces were instrumented either with a sonic scaler (Sonicflex(®) 2003 L) or with an Er:YAG laser (KEY Laser(®) 3). Clinical attachment levels (CAL), Probing depths (PD), Plaque control record (PCR) and Bleeding on probing (BOP) were assessed at baseline, 13 and 26 weeks after treatment. In addition, microbiological analysis was performed employing a DNA diagnostic test kit (micro-IDent(®) Plus). RESULTS Probing depths and CAL were significantly reduced in both groups over time (p < 0.05), without significant differences between the groups (p > 0.05). BOP frequency values decreased significantly within both groups (p < 0.05), with no difference between the laser and the sonic treatment (p > 0.05). PCR frequency values did not change during the observation period (p > 0.05). Microbiological analysis failed to expose any significant difference based on treatment group or period. CONCLUSION Employing both sonic and laser treatment procedures during supportive periodontal care, similar clinical and microbiological outcomes can be expected.
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Affiliation(s)
- Petra Ratka-Krüger
- Department of Operative Dentistry and Periodontology, University School of Dentistry, Freiburg, Germany
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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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Heat generation caused by ablation of restorative materials with an ultrashort pulse laser (USPL) system. Lasers Med Sci 2011; 27:297-303. [PMID: 21229372 DOI: 10.1007/s10103-010-0875-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
Abstract
Heat generation during the removal of dental restorative materials may lead to a temperature increase and cause painful sensations or damage dental tissues. The aim of this study was to assess heat generation in dental restoration materials following laser ablation using an ultrashort pulse laser (USPL) system. A total of 225 specimens of phosphate cement (PC), ceramic (CE), and composite (C) were used, evaluating a thickness of 1 to 5 mm each. Ablation was performed with an Nd:YVO(4) laser at 1,064 nm, a pulse length of 8 ps, and a repetition rate of 500 kHz with a power of 6 W. Employing a scanner system, rectangular cavities of 1.5-mm edge length were generated. A temperature sensor was placed at the back of the specimens to record the temperature during the ablation process. All measurements were made employing a heat-conductive paste without any additional cooling or spray. Heat generation during laser ablation depended on the thickness of the restoration material (p < 0.05) with the highest values in the composite group (p < 0.05), showing an increase of up to 17 K. A time delay for temperature increase during the ablation process depending on the material thickness was observed in the PC and C group (p < 0.05) with highest values for cement (p < 0.05). Employing the USPL system for removal of restorative materials, heat generation has to be considered. Especially during laser ablation next to pulpal tissues, painful sensations might occur.
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Yilmaz HG, Cengiz E, Kurtulmus-Yilmaz S, Leblebicioglu B. Effectiveness of Er,Cr:YSGG laser on dentine hypersensitivity: a controlled clinical trial. J Clin Periodontol 2011; 38:341-6. [DOI: 10.1111/j.1600-051x.2010.01694.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tsurumaki JDN, Souto BHM, Oliveira GJPLD, Sampaio JEC, Marcantonio Júnior E, Marcantonio RAC. Effect of instrumentation using curettes, piezoelectric ultrasonic scaler and Er,Cr:YSGG laser on the morphology and adhesion of blood components on root surfaces: a SEM study. Braz Dent J 2011; 22:185-92. [DOI: 10.1590/s0103-64402011000300002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study used scanning electron microscopy (SEM) to evaluate the morphology and adhesion of blood components on root surfaces instrumented by curettes, piezoelectric ultrasonic scaler and Er,Cr:YSGG laser. One hundred samples from 25 teeth were divided into 5 groups: 1) Curettes; 2) Piezoelectric ultrasonic scaler; 3) Curettes plus piezoelectric ultrasonic scaler; 4) Er,Cr:YSGG laser; 5) Curettes plus Er,Cr:YSGG laser. Ten samples from each group were used for analysis of root morphology and the other 10 were used for analysis of adhesion of blood components on root surface. The results were analyzed statistically by the Kruskall-Wallis and Mann-Whitney tests with a significance level of 5%. The group treated with curettes showed smoother surfaces when compared to the groups were instrumented with piezoelectric ultrasonic scaler and the Er,Cr:YSGG laser. The surfaces instrumented with piezoelectric ultrasonic scaler and Er,Cr:YSGG laser, alone or in combination with hand scaling and root planing, did not differ significantly (p>0.05) among themselves. No statistically significant differences (p>0.05) among groups were found as to the adhesion of blood components on root surface. Ultrasonic instrumentation and Er,Cr:YSGG irradiation produced rougher root surfaces than the use of curettes, but there were no differences among treatments with respect to the adhesion of blood components.
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