Efficacy+of+Lasers

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 * Efficacy of Lasers in Periodontal Therapy **

Shari: Only 5% of dentist use lasers in their practice. Lasers were first introduced in 1994. Lasers offer a broad range of wavelengths to meet the specific needs of the US dental and dental hygiene community. There are different lasers made for different procedures. I noticed a class mate already posted it so I discus it. There are many benefits associated with the use of lasers in dentistry that include: •Benign tumor removal •Early cavity detection •Fillings •Gum recontouring ( reshape gum tissue and bone) •TMD –reduction in discomfort and swelling associated with TMD •Tooth whitening •Teeth sensitivity •Nerve regeneration •Sleep apnea- they remove the tissue overgrowth in throat •Removes folds caused by dentures •Sutures are not often required •Beam sterilizes area worked on •Can reduce dental fears connected with drilling •Prevents patients from losing too much blood and help with blood clot formation •Less chances of infection •Procedure heals faster •Some procedures can be done without anesthesia

References Dental lasers and what they do. (2008). Press release distribution. from : 24-7 press release.com from:www.24-7 pressrelease.com

Brantley, A., (2008) Benefits and Risks of Laser dentistry. Dental and health articles. From: www.dentalplans.com

Reina: The laser system DIAGNOdent is a valuable adjunct to clinical examination because of caries detection with good sensitivity and specificity, but false-positive readings can occur due to fluorescence materials or molecules. The DIAGNOdent is a reproducible method that allows for longitudinal monitoring of the caries process and assessment of the outcome of preventive measures. The possibility of the assessment of caries activity on occlusal surfaces should be further evaluated by comparison of at least 2 measurements within a few months. Lussi, A., Hibst, R., & Paulus, R. (2004). DIAGNOdent: An optical method for caries detection. //Journal of Dental Research//, //83//, C80-83.

The potential use of an ND:YAG (neodymium: yttrium aluminum garnet) laser in treating periodontal disease has been advocated on the assumption that laser treatment is capable of    1. Sterilizing microflora presented inside periodontal pockets 2. Stimulating curettage of adjacent pocket epithelium 3. Enhancing the removal of calculus from root surfaces Laser-treated root segments usually exhibit surface alterations including charring, crater formation, cementum meltdown, and tracking. The organic matrix of cementum is burned off, leaving behind a resolidified substance resembling lava, unfavorable for fibroblast attachment. This is why supplemental root preparation including scaling and root planing is still required after Nd:YAG laser treatment for a hospitable root cementum surface clinically biocompatible with adjacent gingival tissue. Liu, C. M., Shyu, Y. C., Pei, S. C., Lan, W. H., & Hou, L. T. (2002, November). In vitro effect of laser irradiation on cementum-bound endotoxin isolated from periodontally diseased roots. //Journal of Periodontology//, //73//(11), 1260-1266.

Diem Lasers have many advantages in surgical procedure because it provides good homeostasis. It is very good in sealing the blood vessels and verve ending. It also provides clean areas (limited bleeding) for dental surgical procedure, such as gingival re-contour, bone regeneration. In addition, laser has been used in scaling and root planning; however, laser curettage does not have any benefits with or without scaling and root planning. It does have immediate benefit on gingival tissue because it can remove granulation tissue effectively, but in a long period of time, it does not have any additional benefit compared to traditional SRP. One of the lasers called Er:YAG is used in caries removal and RCT preparation. It’s also used to prepare for SRP. The study stated that it is a good tool that aids in SRP because it is easy to use and seal the blood vessels making SRP quicker. Another type of lasers is the Laser Fluorescence, which is DIAGNOdent. It is used to detect occlusal carious lesion. A Dental Pediatric Program has done a study in Japan stated that it is very good in caries detection that benefit people who have high risks of developing cavities. It is 90% accuracy; this makes me think that our school chooses the DIAGNOdent for us to get familiar with dental modalities because of its accuracy and easy to use. Lasers have shown to kill microorganism in periodontal pockets, but they can also destroy the surrounding tissues due to energy generate from the wavelength. The concern is that weather or not the lasers would destroy the periodontal tissue? Baberia, E, Maroto, M., Arenas, M, & Silva, C. (2008). A Clinical study of caries diagnosis with a laser Fluorescence system. //The Journal// //of American Dental Association, 139//, 572-579. Dederich, D., & Bushick, R. (2004). Lasers in dentistry: Separating science from hype. //The Journal of American Dental Association, 135//, 204-212.

Lia: I found research on the laser assisted new attachment procedure (LANAP). This procedure takes the place of traditional flap surgery and SRP. Six pairs of teeth with moderate to advanced perio. associated with sub gingival calculus deposits were treated There was a notch placed in the teeth at the point where the clinical and radiographically extent of calculus was located. All teeth received SRP with hand scaling and one of each pair of teeth had the laser treatment from the Nd:YAG laser. The results were that after 3 months the LANAP treated teeth showed improved probing depth reduction and greater CAL gains than the control teeth. All LANAP treated teeth showed new cementum and connective tissue attachment with no adverse histological changes.

I went to the CE course on lasers sponsored by Millennium dental technologies the maker of the PerioLase MVP-7 Nd:YAG laser. (Of course consider that the sponsor is selling it's product and may be bias) The PerioLase laser is said to have exceptional and consistent results. A local periodontist that uses it was there speaking about the great results that her office had using it. I would love to see the procedure and then the post op follow up results. The periodontist's hygienist said that the maintenance recare after the LANAP procedure was easier and the results were nice and that the patient had much less post op pain and healing was reduced. The slogan for the PerioLase is no cut.. no sew ..no fear.

R.A. Yukna, R.L., Carr,G.H., Evans. (2007). Histologic evaluation of an Nd: YAG laser assisted new attachment procedure in humans. the In ternational Journal of periodontics and Restorative Dentistry. 27, p. 577-587.

Information retrieved on 5/11/09 from, www.millenniumdental.com

Maria- Major advancements have occurred since Albert Einstein first postulated the laser in 1916. One such advancement is the creation of the diode laser. The diode laser emits concentrated energy in the form of a light beam. This beam has the ability to vaporize matter and each pulse vaporizes only a specific number of cell layers within the circumference of the beam. In the field of dental hygiene the diode laser is used in two ways. The first indication is for bacterial reduction in the soft tissue of periodontal pockets. The diode laser is set on a low wattage in a pulsed mode, which allows for only light to be emitted and not heat. The light source then vaporizes the bacteria and necrotic tissue.

Another use for the diode laser is for curettage. With curettage, a fiber is attached to the tip of the laser, which allows for generation of heat. One positive aspect of this laser is that it has the ability to distinguish between necrotic and health soft tissue. This prevents the hygienist from removing healthy tissue.

There are many benefits to the diode laser including: • Minimal use of anesthetic required • Quick and efficient • Minimal post-operative pain • Sterile (laser tip sterilizes itself in operation) • Promotes homeostasis • Minimally invasive

Current diode lasers on the market include the Odyssey diode laser, the DioDent II, SmilePro 980, and the Opus 10.

In a study conducted by Borrajo et al. (2004), researchers found that compared to scaling and root planing alone, the diode laser promoted new PDL attachment when used in conjunction with scaling and root planing. Another study by Kamma et al. (2009) found that diode laser–assisted treatment with SRP produced lower bacterial levels of Porphyromonas gingivalis, Tannerella forsythia, Actinobacillus actinomycetemcomitans, and Treponema denticola than SRP or laser diode therapy alone in patients with aggressive periodontitis. As technology continues to advance, diode lasers have the potential to become more commonplace in dental practices. Therefore, it is important for dental hygienists to stay up to date on laser technology and incorporate lasers into patient care.

Armel, J. (2009). Diode laser soft tissue therapy. Retrieved May 9, 2009, from http://www.finesmiles.com/webpages/services/laser/laser.html

Borrajo, J. L., Varela, L. G., Castro, G. L., Rodriguez-Nunez, I., & Toreira, M. G. (December, 2004). Diode laser (980 nm) as adjunct to scaling and root planing. Photomedicine and Laser Surgery, 22(6), 509-512.

Coluzzi, D. J. (January, 2009). Lasers for use in dental hygiene. Access. Retrieved May 9, 2009, from http://findarticles.com/p/articles/mi_m1ANQ/is_1_23/ ai_n31316678/

Kamma, J. J., Vasdekis V. G., & Romanos G. E. (February, 2009). The effect of diode laser (980 nm) treatment on aggressive periodontitis: Evaluation of microbial and clinical parameters. Photomedicine and Laser Surgery, 27(1), 11-19.

Sooy, P. A. (March, 2005). Laser hygiene: It’s the new wave. RDH, 25(3), 23-25.

Laser curettage is a controversial subject in the world of dentistry. The supposed purpose of laser curettage is to remove the diseased sulcular lining tissue. Another benefit of lasers that has been discussed in many articles is decreasing the bacterial count within the pocket. Within the AAP statement on curettage, it stated that it did not produce statistically significant results. Also, in another article from the CDA Journal it explained that damages that can actually be caused by lasers. There will be more and more advances in lasers each year. Maybe in the future they will decrease the complications that arise and be able to provide significant evidence proving the benefits of lasers in dental hygiene.

Marcia: There is a laser called LANAP ( Laser- assisted new attachment procedure) for the treatment of periodontal pockets. The laser claims to show new cementum tissue attachment in and occasionally coronal where calculus was left behind, whereas five of the six control teeth had no long junctional epithelium with no evidence of new attachment or regeneration. I know that after a tooth extraction the socket fills in with new bone so after the removal of toxins in periodontal pockets wouldn’t the pocket fill in naturally to certain extend?

Dederich, D. N., Drury, D. I. (2002). Laser Curettage: Where do we stand? Journal of the California Dental Association. Retrieved on May1, 2009 from C:\Documents and Settings\Student\Desktop\Gingival curettage.mht

Newman, M. G., Takei, H. H., Klokkevold, P. R., Carranza, F. A. (2006). Carranza’s clinical Periodontology. St.Louis, Missouri: Saunders Elsevier

Jennifer Wow lasers are looking pretty popular in dentistry. I found a couple things I want to talk about just so we would all be aware. I found one study found results of lasers providing short term analgesic effects by acting as an anti inflammatory through reducing the amount of prostaglandin synthesis, they did this studies on mice through an injection which has an initial pain as well as a delayed pain at about 20 minutes, they found the animal still had the delayed pain but not as long. This is thought to reduce pain through reducing the sensory of the nerve through laser therapy, I wondered a few things about this study like how did they tell a mouse was in pain, and they determined the time the mouse’s hind legs were in the air, (sad but this study was approved they did mention this) I was also wondering through reducing the sensitivity of the nerve is it reversible?

Pozza,D., Fregapani,P., Weber,J., Oliveila,M.,Neto,N., etal. Analgesic action of laser therapy in an animal model. (2008) Medical Oral Pathology.1(13).

The other studies I read I could not pass up, I really feel for our cancer patients and they go through so much with all the manifestations of therapy. One manifestation is the common oral mucositis. I found a study finding the use of a low power laser can increase the healing time from 16 to 6 days. The patients taking analgesics with no laser healed in 16 days where the patients on no analgesics and use of a laser healed in 6 days and experienced less pain. One of the authors stated in the abstract, this is a standard procedure in their office. Antunes,H., Ferreira,E., Matos, Y., Pinheiro,C., Ferreir,G. The impact of low power laser in the treatment of conditioning induced oral mucositis A report clinical cases and review.(2008). Medical Oral Pathology. 1;13(3).

Tawnya With the advancements in technology we have heard of many products available to clinicians to aid in patient care, as professionals we must be current on what manufactures suggest and what the research indicates before we choose to add this to our dental regimen. As we know gingival curettage has proven to be no more effective then manual and power scaling, but where does the AAP stand on laser curettage, is there improvement with the laser over manual? The research I read suggested the use of lasers offered no additional advantage in attachment level then traditional SRP’s but did provide less bleeding, more patient comfort and decreased sensitivity. The decreased sensitivity can be attributed to damage to the pulp. If the clinician is not trained and following proper techniques, the patient could suffer permanent damage to their hard and soft tissues. Clinicians using laser treatment must be trained and educated in the proper usage and keep current with research. American Academy of Periodontology. (2002). Statement regarding gingival curettage. //Journal of Periodontology. 73//(10), 1229-1230. American Academy of Periodontology. Statement regarding use of dental lasers for excisional new attachment procedure (ENAP). http:www.perio.org. Retrieved May 1, 2009. Dederich, D., and Drury, G. (2002). Laser curettage: Where do we stand? //Journal of the California Dental Association

Brein// Soft Tissue Dental Lasers used in dental hygiene use photo thermal technology to reduce the bacteria in the periodontal pockets. These lasers have been around since th1990's and were large and well as expensive. Now these lasers are compact and more attainable. These dental lasers deliver light energy locally to the infected site to eradicate the bacteria by causing a rupture of the cell wall. Laser energy is delivered by light to which there are no contra-indications and to which the bacteria cannot develop a resistance to. Studies show that incorporating the laser with S and R treatment can; Reduce the bacterial count within the pocket, coagulate the diseased tissue only so it can then be removed, can help with healing through biostimulatory effects, as well as reduce the need for chemotherapeutics.

Dental Clinics of North America. Lasers in Clinical Dentistry Oct 2004; Vol. 48, No. 4.

Gutierrez T. Diode Laser for Bacterial Reduction and Coagulation: An Adjunctive Treatment for Periodontal Disease. Cont Oral Hyg Dec 2005; Vol. 5, No. 12: 20-21.

Lasers have many therapeutic applications in dentistry and have gained in popularity over the last several years. They were originally created to detect caries in the 1960s but evolved into other avenues of periodontal and endodontic applications. Some current uses for lasers include the following: • Sulcular Debridement (sometimes termed Laser Curettage), • Laser-Assisted New Attachment Procedure (LANAP), • Reduction of Bacteria Levels in periodontal pockets (sometimes termed Pocket Sterilization), • Laser-facilitated Wound Healing, • Laser Root Planing, • Aid in the Diagnosis of Caries (Laser Fluorescence), • Hard Tissue Applications including endodontics. Although there are many proponents of using lasers to treat chronic periodontitis and soft tissue curettage, the evidence of their effectiveness remains inconclusive. In 2007, a literature review was conducted regarding the research that has been done. They reviewed over 278 research studies and found inconsistent results among the studies. Some factors influencing the inconsistent results include “different laser wavelengths; wide variations in laser parameters, insufficient reporting of parameters that, in turn, does not allow calculation of energy density; differences in experimental design, lack of proper controls, and differences in severity of disease and treatment protocols; and measurement of different clinical endpoints.” If the tests were standardized, I believe we could really find out how effective laser treatment is. It is important for the hygienist to keep updated with current research and uses for lasers.

ADA Positions and Statements- Statement on Lasers in Dentistry. Retrieved on May 8th 2009 from http://www.lanap.com/

Cobb, C. M. (2006). Lasers in periodontics: A review of the literature. Journal of Periodontology, 77(4), 545-564.

Yukna, R., Carr, R., & Evans, G. (2007). Histological evaluation of an Nd:YAG laser-assisted new attachment procedure in humans. The International Journal of Periodontics and Restorative Dentistry. (27)577-587.

Dorinda Lasers are sued for a number of dental procedures. One of the procedures I found includes using low level lasers to reduce post adjustment pain during orthodontics. A study was conducted and provided information that the pain scores did reduce slightly on the subjects tested when exposed to the lower level laser treatment however, it was not a complete reduction of pain. The study also concluded that although low level laser was found to be unable to provide immediate pain reduction, the lower level laser could cause a reduction in the intensity of the pain. In addition lasers can also be effective at reducing bacteria in periodontal pockets making lasers effective and beneficial for patients especially those with more calculus. Assaf, M., Yilmaz, S., Kuru, B., Ipci, S., Noyun, U., & Kadir, T. (2007, August). Photomedicine and laser Surgery. Effect of the Diode Laser on Bacteremia Associated with Dental Ultrasonic Scaling: A Clinical and Microbiological Study. Mary Ann Liebert, Inc. Publisher, 25(4), 250-256.

Lim, M., Lew, K., & Tay, D. (1995, December). A clinical investigation of the efficacy of low level laser therapy in reducing orthodontic post adjustment pain. American Journal of Orthodontics and Dentofacial Orthopedics 108, (6), 614-622 Noo: Laser is an acronym for Light Amplification by stimulation of radiation. In the early 1900’s, Albert Einstein described it as a phenomenon where in molecules, excited by source of energy, ultimately create a very organized pattern of energy that can be directed in specific way. In dentistry, the first time a laser received approval for use in oral soft and hard tissue was in 1987 and the first laser (ER:YAG) was approved for cutting enamel and dentin in the mouth was in 1997. One study talks about how laser works in scaling and root planing. The study stated the laser de-epithelialize the tissue lining the pocket, thus opening it up. A level of homeostasis is also achieved with the sue of the laser, and better access and visualization allow better opportunity to create a cleaner, smoother root surface with routine ultrasonic and handheld scalers. The end result is an increase in connective tissue reattachment and reduced periodontal pockets versus the long juctional epithelium attachment seen post scaling and root planning. Another study states the activated water molecules attraction to water and hydroxyappatite may aid in the cleaning of the root surface due to change in consistency of the calculus, making it much easier to remove by hand scalers. They also state that there might be sterilization effect from the laser to activate water molecules entering the pocket itself that facilitates the healing process. Borrajo, J. L., Varela, L. G., Castro, G. L., Rodriguez-Nunez, I., & Toreira, M. G. (December, 2004). Diode laser (980 nm) as adjunct to scaling and root planing. Photomedicine and Laser Surgery, 22(6), 509-512. Coluzzi, D. J. (January, 2009). Lasers for use in dental hygiene. Access. Retrieved May 9, 2009, from http://findarticles.com/p/articles/mi_m1ANQ/is_1_23/ ai_n31316678/

Ceri: Laser curettage has been around for a little while now. In the office that I worked in the doctor used a couple of different lasers, he used the diagnodent, as well as a YAG type of laser with the microfiber end. He used that laser for a variety of reasons, but I wanted to discuss the laser being used for a frenectomy.

First I want to explain what a frenectomy is; in this case I am speaking of the labial frenectomy. You can use a simple excision using an elliptical pattern from the frenum down to the periosteum. The muscle attachment is dissected from the periosteum.

The Z plasty technique is basically the same as the simple technique and two pointed flaps are created and rotated and stitched close to the wound.

The laser is minimally invasive, in a lot of cases sutures are not required because the tissue is cauterized as the laser is acting. The end result is much more attractive with a laser than with a scalpel.

From the article I researched it stated that the frenectomy procedure was done with minimal anesthesia, minimal invasion, no sutures, minimal discomfort, no antibiotics and no post operative appointment.

Often in many cases only topical anesthetic is used. The procedure time is minimized as well as the recovery time.

From what I can tell the cost remains the same whether you do the traditional frenectomy or the laser frenectomy. It is around $250.

Bornstein, E. (October, 2003). A laser technique for frenum removal. Retrieved from perioeducation.com May 9, 2009.

Laser Dentistry. Retrieved May 9, 2009 from http://www.r4md.com/dentistry/laser.html

I picked the Diode Laser by Zaplasers to show how it has evolved through the years. Lasers are used in multiple medical fields such as medical, ophthalmology, plastic surgery, ENT (ear, nose & throat), and ginecological surgeries. In periodontology, laser has many uses including cleaning and sterilizing any surgical site. Radaelli, C., Gouw-Soares, S., & Zezell, D. (2002). The use of diode laser in periodontics. //LMBDA Scientifica Srl.// Retrieved May 11th, 2009, from http://www.zaplasers.com/bridge/Docs/diodelaseinperiodontics.pdf
 * Jackie**
 * The word LASER means Light Amplification by Stimulated Emission of Radiation**.

This study is to evaluate the effectiveness of the laser called Diode Laser to threat periodontal pockets. Fifty people participated and the results showed that the laser group had a BOP reduction of 96.6 % and the control group (no Diode Laser group) only had a 66.7% BOP reduction when these patients had their re-care appointment every 6 months. The study also revealed that the laser group had a significant bacterial count reduction compared to the control group. These bacteria include //A//.a., //Prevotela//, and //Porfiromonas// gingivalis. Prior the laser treatment, all the participants had their teeth scaled and the laser was used in the deepest pocket. Moritz, A., Schoop, U., Goharkhay, K., Schauer, P. Doerbudak, O., Wernisch, J., & Sperr, W. (1998). Treatment of periodontal pocket with a diode laser. //Laser in Surgery and Medicine, 22,// 302-311.

This other study is on the same laser but many years later; the Diode soft-tissue. The laser was used to treat soft-tissue, periodontal pockets, and perio surgery. The laser is also a surgical instrument that leaves minimal bleeding, swelling, with low post operative pain. It is used to perform tissue retraction during restorative procedure, gingivectomy, gingivoplasty, crown-lengthening, frenectomy, bacterial decontamination, and removal of diseased epithelial lining during periodontal treatment. Reichwage, D. (2008). Lasers the benefits of a soft-tissue laser. Tretrieved May 7th 2009, from http://www.zaplasers.com/bridge/Docs/DE_Nov2008_softtissue_article.pdf

Other lasers available: 1. - PerioScan: Can differentiate between calculus and healthy root surface. The screen of these laser shows green light which means halthy root surface and the blue light indicates calculus. 2. - Odyssey diode lasers: with 3 different models to treat soft tissue and preventive care. 3 - Styla MicroLaser: Won the Medical Design Excellence Awards in 2009. Used microlasers for soft tissue use. It is small and has a wireless foot pedal.

Drina: Research that I found stated that lasers in dental hygiene can actually benefit the patient. PerioPulse UltraSpeed CO2 is an example of the laser used in hygiene only. It vaporizes the biofilm and dehydrates the epithelium. The laser works in two ways. It is the first thing done before scaling and root planning. It is used in the sulcus to reduce bacteria. It doesn’t generate heat but a low wattage pulse. It can also be used in laser-assisted periodontal therapy (LAPT) where it does generate heat and done after ultrasonic scaling and hand instruments to remove granulation tissue. One good thing about the laser is that it can differentiate between necrotic tissue and healthy tissue. Reference: [|http://www.dekalasers.com/public_html/index.php?page=products&action=view&pid=14] http://www.rdhmag.com/articles/article_display.html?id=223742

It seems today technology changes so quickly that it is like having a second job trying to keep up with it. The evidence remains that traditional SRP as compared to Laser therapy in phase I periodontal treatment, is very similar, when it comes to CAL and pocket depths. However, knowing some of the additional benefits that the use of the laser provides, for both the patient and the clinician, is what makes researching this modality worthwhile. Increase in patient comfort, decrease in bleeding, decrease in bacteria present and decrease in operator fatigue are just a few of the benefits lasers have to offer in dental hygiene. Lasers are also useful in other areas of dentistry, which is good information for us to know so we may educate our patients on how exactly lasers are used.
 * Efficacy of Lasers - Stacy**

Soft tissue lasers are used to eradicate bacteria in the periodontal pocket. Today chemotherapeutics are a common means to lower the bacterial count, however, lasers offer the same benefit without the potential contraindication for some patients. Again, this is another benefit to the use of lasers. Based on the evidence that has been presented in this discussion, it does seem that more research needs to be done. The research needs to focus in on exactly what wavelength and what settings are best for the different cases that present in clinic. Something to think about… How would we raise awareness to encourage more research on this subject? References: Cobb,C. (2007). Lasers in periodontics: A review of the literature. Journal of Periodontology, 78(4): 545-7.

Retrieved: May 19, 2009 from: http://www.dentalcompare.com/featuredarticle.asp?articleid=235