Laser Literature

Effectiveness of Diode

Purpose:
–Test S/RP vs. S/RP + Diode
Methods & Materials:
–S/RP vs. S/RP + DiodeResults & Conclusions:
No benefit to diode

Changes S/RP S/RP + Diode
PD 0.9 0.7
CPAL 0.8 0.7
Recession 0.1 0

Purpose:
–Test ablation of P. gingivalisin vitro with pulsed dental lasers

Methods & Materials:
–Diode, Nd:YAG (PerioLase)

Results & Conclusions:
–Kill rate for pulsed Periolase of Pg is 16 times greater than 810 diode

Harris DH, Loomer PM.  Ablation of Porphyromonasgingivalis in vitro with pulsed dental lasers.  AADR, March 2013.

Purpose:
Methods & Materials:–Measure effects of Diode laser in treatment of periodontal pockets
Results & Conclusions:–Lased 3 times (initial, 2mo, 4 mo)
Pocket depths increased 7% premolars, 10% molars, 13.5% for anterior teeth1.5 times hotter than PeriolaseMoritz, Schoop, et al.  Treatment of periodontal pockets with a Diode laser.  1998.

Effectiveness of LANAP

Laser applications: Treatment of Periodontitis

Purpose
Methods–To histologically evaluate effects of LANAP treatment on periodontal regeneration
–22 pts–Notch at base of calculus–Split mouth designLNAP / S/RP
–3 months later, block sections

–1 year follow up

Results & Conclusions
–New cementum attachment was observed in 6/6 patients

–New connective tissue attachment was seen in 4/6 LANAP patients

–New bone was seen in 6/6 LANAP patients

–There was less recession in the treated groups

–There was improved probing attachment level in the treated groups

Yukna, Carr and Evans. HIstologic Evaluation of an Nd:YAG laser assisted new attachment procedure in humans. Int J Periodontics Restorative Dent 2007 27:576-587

Additional Human Histology with LANAPMarc Nevins [1]
–More severe cases (PD <9mm)–60% regeneration or new attachmentAlice Moran [2]
7mm pocket and 8mm pocket both had regeneration and new attachment

Pt (tooth #) Healing mechanism
1 (21) Regeneration
2 (25)2 (29) LJENew Attachment
3 (21)3 (22) LJELJE
4 (4) LJE
5 (19)5 (22) RegenerationRegeneration
6 (14) Regeneration
8 (15) Regeneration

  1. Nevins 2008.  IJPRD 2012.
  2. Moral A.  2008.  Institute for Advanced Laser Dentistry.

LANAP data from ColoradoPurpose:–Evaluate effectiveness of LANAP instructors & Boot Camp studentsMethods & Materials:
–LANAP protocol–22 pts (4 moderate, 18 severe) Type IV cases

Results & Conclusions:
93.5% of treated patients reported pockets of 3mm or less

6.6% of treated patients reported pockets 4-6mm

There were no sites over 7mm in the treated group

There was a dramatic shift from disease to health in the LANAP treated sites

Pockets Initial 1 year Post Tx
PD ≤3mm 52% 93.5%
PD 4-6mm 36.6% 6.6%
PD 7-9mm 8.9% 0%
PD ≥10mm 0.7% 0%

PerioLase selectively removes diseased epithelium

Purpose:
–Determine the effects of the Periolase laser on gingival crevicular tissues

Methods & Materials:
–6 patients

–24 gingival specimens

Results & Conclusions:
The pulsed Nd:YAG laser removed the sulcular lining of periodontal pockets without damaging the subjacent connective tissue

Picture1

Gold SI and Vilardi MA.  Pulsed laser beam effects on gingiva.  J ClinPeriodontol 1994;21:391-396.

PerioLase prevents recolonization

Purpose:
–Compare Periolase to S/RP

Methods & Materials:
–10 pts

–S/RP vs S/RP + PerioLase

–Cultured for Bacteroides, Fusobacterium, Actinomyces, and Veillonella

Results & Conclusions:
Subgingivaltx with Periolase is equally/more effective as S/RP in reducing/inhibiting the recolonization of the tested bacteria up to 28 days

Lin P.  A comparative effect of the Nd:YAG laser with root planing on subgingival anaerobes in periodontal pockets.  J Dent Res 1992;71:299.  Abstract 1547

PerioLase facilitates calculus removal

Purpose:
–Investigate effects of Periolase on calculus removal

Methods & Materials:
–Nd:YAGvs Control

–Strokes to completely remove calculus counted

Results & Conclusions:
–Lased calculus = 3.8 strokes

–Non-lased calculus = 6.5 strokes

–Significant

Removal of subgingival calculus facilitated by Nd:YAG

Tseng P.  The effect of Nd:YAG laser treatment on subgingival calculus in vitro.  J Dent Res 1991;70(4):457, Abstract 62

PerioLase prior to open heart surgery

Purpose:
–Evaluate Periolase protocol prior to cardiovascular surgery

Methods & Materials:
–92 patients requiring open heart surgery

–All periodontitis patients, all at risk for bacterial endocarditis

–H2O2 + CHX + S/RP + NdYAG

Results & Conclusions:
–Bacteria detected in only 1 patient

All 92 pts were 0% growth at 1, 2, 3 days postoperatively

Pinero J.  Nd:YAG-Assisted periodontal curettage to prevent bacteremia before cardiovascular surgery.  Dentistry Today.  March 1998:17;3.

PerioLase works in shallow and deep pockets

Purpose:
–To evaluate pocket depth reduction using LANAP

Methods & Materials:
–Multi-center study

–75 pts

Results & Conclusions:
Stable 3 years out

Deeper pockets do better than shallower pockets

Picture2

Gregg R.  Sulcular debridement with pulsed Nd:YAG.  Proc. SPIE Vol 4610.

PerioLase works in shallow and deep pocketsPurpose:–To evaluate pocket depth reduction using LANAPMethods & Materials:
–Multi-center study–75 pts

Results & Conclusions:
Stable 3 years out

Deeper pockets do better than shallower pockets

LANAP > S/RP

Picture3

Gregg R.  Sulcular debridement with pulsed Nd:YAG.  Proc. SPIE Vol 4610.

Long-Term Results

Tilt Wood McFall McLeod
# Patients 107 63 100 114
Type III 34 (32%) 57 (90%) 37 (37%) 42 (37%)
Type IV 73 (68%) 6 (10%) 63 (63%) 72 (63%)
Average yrs in Maintenance 6.2 13.6 19 12.5
Average teeth in treatment 25.2 25.5 26.2 25.4
# Teeth lost per patient 0.43 1.8 2.6 1.9

Dr. Lloyd Tilt.  2008.  Institute of Advanced Laser Dentistry.

Literature review misc…

  • Significantly reduced post-therapy levels of bacteria following adjunctive laser therapy [1]
  • Laser treated sites showed a tendency to improve steadily until 6 months post-tx, different from the S/RP alone group [2]
  • Significant clinical improvements following laser and ultrasonic tx.  Significant decreaes of P. gingivalis and amount of interleukin-1 in the laser-treated sites, similar to the ultrasonic sites. [3]
  1. Hatit, B.  The effects of a pulsed Nd:YAG laser on subgingival bacterial flor and on cementum: an in vivo study.  J Clin Laser Med Surg 1996;14:137-143
  2. Neil ME, Mellonig JT.  Clinical efficacy of the Nd:YAG laser for combination periodontitis therapy.  PractPeriodonticsAesthet Dent 1997;9:1-5
  3. Miyazaki et al .  Effects of Nd:YAG and CO2 laser treatment and ultrasonic scaling on periodontal pockets of chronic periodontitis patients.  J Periodontol 2003; 74:175-180

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