ER:YAG LASER -ADVANTAGE FOR PATIENTS WITH

CHRONIC PERIODONTITIS

Prof. d-r Ana Minovska

1. INTRODUCTION- WORKING WITH NEW TECHNOLOGY, WHY?

2. WHAT IS ESSENTIAL ABOUT WORKING WITH THIS WAVELENGTH? SLAJD11

3. OUR CLINICAL STUDYS WICH SUPORTED THE BENEFITS OF USING ER:YAG . Sl.17

4. CASE PRESENTATION

ER:YAG LASER -ADVANTAGE FOR PATIENTS WITH CHRONIC PERIODONTITIS

CLINICAL DENTISTRY IS UNDERGOING A PARADIGM SHIFT THANKS TO ADVANCED LASER TECHNOLOGY.1

THIS IS PARTICULARLY DUE TO THE ERBIUM FAMILY OF LASERS.

1. Colluzzi DJ. Lasers, Types of Lasers and What Your Practice Needs: Laser Dentistry Made Easy and Profitable, www.dentaleconomics. com. 2007 April, 1-3.

• Working with light energy in dentistry is still our choice. In future it will be a must – THE PATIENTS DEMAND RISES.

• Dental laser applicable in so many dental procedures is a new level of dentistry: • Are we “better” l practitioners??? • Do the cases look differently done with laser???

CAN ALL AGREE THAT …..

1. DENTAL EDUCATION RELIES UPON THE CONCEPTS OF CLASSICAL NEWTONIAN

MECHANICS.

2. Dentists are generally familiar with how things move, the forces that move them, and the thermodynamic consequences of these forces. These are accurate explanations for everyday clinical experiences in dentistry.

The foundations of quantum mechanics were established during the first half of the 20th century by Max Planck, Niels Bohr, Werner Heisenberg, Louis de Broglie, Arthur Compton, Albert Einstein, Erwin Schrödinger, Max Born, John von Neumann, Paul Dirac, Enrico Fermi, Wolfgang Pauli, Max von Laue, Freeman Dyson, David Hilbert, Wilhelm Wien, Satyendra Nath Bose, Arnold Sommerfeld and others.

IN THE SCIENCE OF LASER-TISSUE INTERACTIONS, HOWEVER, THE CLINICAL CONSEQUENCES ARE THE RESULT OF AN ENTIRELY DIFFERENT SET OF LAWS CALLED QUANTUM MECHANICS.

3. DENTISTS USING LASERS NEED TO BE AWARE OF THESE DIFFERENT QUANTUM RULES

Er:YAG dental lasers

Energy is transferred from Laser photons to molecular water in tissue , vaporizing

the water (heat)

Vaporized water causes an immediate volumetric

expansion (pressure) in a confined environment

(tooth/tissue) producing work-ablation

WHAT IS ESSENTIAL about working with this wavelength?

Unlike the Nd:YAG laser, which relies on significant penetration into the soft tissue to achieve the desired results, the Er:YAG laser ablates soft tissue by selectively removing a few cell layers at a time.

Therefore the Er:YAG laser allows successful results that had been previously accomplish only by using more aggressive surgical techniques.

Periodontal regeneration is defined as the replacement of lost supporting tissue and is characterized by the dynamic interaction of the three tissue types : epithelium, connective tissue and bone.

It has been shown that the protective nature of epithelium causes it to travel much faster to repopulate a healing periodontal wound than the other two tissue types.

Epithelium is clearly the “enemy” of a periodontaltherapist as it relates to the healing that occurs following conventional treatment of periodontitis. If epithelial tissue is not properly managed, rapid growth may result in unpredictable periodontal regeneration.

THE ERBIUM LASER LIGHT

CAN BE USED IN THE PERIODONTAL FIELD AS AN

ADJUNCT TO CONVENTIONAL THERAPY (PHASE I) OR AS A

TOOL IN PERIODONTAL SURGERY

“INITIAL THERAPY”─ CLOSED DEBRIDEMENT of PERIODONTAL POCKETS;

3. OUR CLINICAL STUDYS WICH SUPORTED THE BENEFITS OF USING ER:YAG. STADY 1

FOLLOW UP OF CLINICAL INDICATORS FOR SUCCESSFUL TREATMENT AND PERIODONTAL STABILITY AFTER NONSURGICAL THERAPY OF PATIENTS WITH CHRONIC PERIODONTAL DISEASE, USING THE LITETOUCH ER:YAG LASER, VERSUS CONVENTIONAL MECHANICAL-HAND INSTRUMENTATION. Plaque index, PBI (papilla bleeding index), PPD (periodontal pocket depth), CAL (clinical attachment level), GR (gingival recession) and BL (bone level) were measured and evaluated

Clinical applications for low-energy setups (50mJ- 100mJ).

System calculate the optimal  require pulse width.

STUDY 1

LITETOUCH ER:YAG LASER WAS USED FOR LASER ASSISTED GINGIVAL CURETTAGE AND ROOT SCALING and detocsification

Index/Treatment

Baseline 3 Months P value

PILaser SRPP value

1.250.63961.42860.735p>0.05

0.890.6790.67860.7653p>0.05

P<0.01P<0.01

PBILaserSRPP value

2,21430.98562.46430.6314p>0.05

0.89290.62311.32140.6636P<0.01

P<0.01P<0.01

PPDLaserSRPP value

5.26791.01345.251.0996p>0.05

3.80360.85644.39290.985P<0.01

P<0.01P<0.01

CALLaserSRPP value

6.16071.16826.10711.123p>0.05

4.28570.9675.28571.0129P<0.01

P<0.01P<0.01

GRLaserSRPP value

0.92860.65660.96430.8304p>0.05

0.60710.6790.94640.6652P<0.01

P<0.01p>0.05

Bone levelLaserSRPP value

6.48211.26846.60711.2385p>0.05

4.8751.058561.018P<0.01

P<0.01P<0.01

pred tretman posle tretman0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.25

0.8929

1.4286

0.678600000000001

Pi-plack index

laserultrazvuk

pi

0

0.5

1

1.5

2

2.5 2.214

2.4643

0.8929

1.3214

Papilla bleeding idex

before treatmentafter treatment

pbi

laser hand instrumenta-tion

0

1

2

3

4

5

6 5.2679 5.25

3.8036

4.3929

Periodontal probing depth

before treatmentafter treatmentppd

laser hand instrumentation

0

1

2

3

4

5

6

76.1607 6.1071

4.2857

5.2857

clinical attachment level

before treatmentafter treatment

cal

laser hand instrumentation

0

1

2

3

4

5

6

76.4821

4.875

6.6071

6

Bone level

bone

Before

After

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0.9286

0.607100000000001

0.9643 0.9464

Gingival recession

grLaser

Hand instrumentation

pbi pi cal ppd gr bone0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

1.32

0.35

1.875

1.46

0.32

1.61

1.14

0.750.82 0.86

0.017

0.6

Difference before and after treatment

laserultrazvuk

ultra-sonicHand instrumenta-

tion

Our comparative study have demonstrated statistically highly significant

difference between laser treated patients (p<0,01) and classically with

mechanical debridement for PBI, PPD, CAL and bone level. Our results

are consistent with the results of Feist, Schwarz, Folwaczny and Sculean.

Contrary to mechanical treatment with conventional instruments, the

excellent ablation of tissue with laser treatment is expected to promote

healing of periodontal tissues, ablating the inflamed lesions and

epithelial lining of the soft tissue wall within periodontal pockets.

STADY 2ACUTE PHASE OF HEALING - LASER

ASSISTED POCKET DEBRIDEMENT VERSUS CONVENTION HAND

INSTRUMENTATION

Low-level Er:YAG irradiation , facilitate or promote the normality of tissue repair, and thereby enhance the sequence of events that take the tissues from their injured to their ‘normal’ state.

Recent researches suggests that Er:YAG laser irradiation stimulates the proliferation of cultured HGFs and indicates that the low-level Er:YAG laser irradiation may be of therapeutic benefit for wound healing.1

1. Akira Aoki at al. Photobiomodulation Laser Strategies in Periodontal Therapy. Lecture Notes in Electrical Engineering. 2008, Volume 12, V, 181-190,.

DETECTION OF: Myeloperoxidaza, CD68 , CD3, CD20, Vimentin, CD34.

The purpose of this study was to show the immunohistochemical and histomorfometryc analysis of the initial phase of tissue healing after laser assisted pocket debridement compared with classical manual instrumentation

POCKET TISSUE BIOPSY WAS PREFORMED 24 AND 72 HOURS AFTER PERIODONTAL TREATMENT.

А SPLIT-MOUTH DESIGN; АTTACHMENT LOST 5 mm ON ONE ASPECT OF THE TOOTH

laser

72 hours after treatment with Er:YAG laser. (the epithelium is removed). No evidence of thermal damage. Slight increasing of PMN cells count and neovascularization is observed.

iinfInphlamatory infiltrate

Ne

х 4

х 20

THESE FINDINGS CAN BE ADDRESS TO LASERS TRANSFER OF ENERGY TO SURROUNDING TISSUES IN THE FORM OF HEAT ABLE TO INDUCE A HEAT SHOCK RESPONSE AND MUCH LESS TRAUMA.

FURTHER RESEARCH IS STILL REQUIRED FOR THE INTERACTION OF THESE IMMUNE CELLS, THEIR SECRETORY PRODUCTS, AND OTHER WOUND ELEMENTS BEFORE OUR UNDERSTANDING OF WOUND HEALING, AFTER LOW –LEVEL ER: YAG IRRADIATION, IS COMPLETE.

WE HOPE THAT, IN THE NEAR FUTURE, A BETTER KNOWLEDGE OF THE BIOLOGICAL RULES AND THE MECHANISMS OF LASER LIGHT ON THE HEALING PROCESS WILL CONTRIBUTE TO THE IMPROVEMENT OF PERIODONTAL TREATMENT.

4 years ago

4. CASE PRESENTATION

PeriodontologyHT 100mJ/35Hz, ST 50mJ/30Hz, before and after 2 years

• Anesthesia as needed (topical or injected) • Calculus removal employing an Erbium laser and/or an ultrasonic • Laser bacterial reduction of soft tissue • Laser de-epithelization to facilitate cellular kinetics• Post-op instruction/home care instruction

ER: YAG LASER SYSTEMS APPLYING THE

ABLATION EFFECT OF LIGHT ENERGY,

WHICH IS COMPLETELY DIFFERENT FROM

CONVENTIONAL MECHANICAL DEBRIDEMENT,

IS A NEW THERAPEUTIC MODALITY ;

SCIENTIFIC LITERATURE CLEARLY INDICATES

THAT PERIODONTISTS AND GENERAL

PRACTITIONERS MAY HAVE A NEW

TECHNOLOGY TO FACILITATE THE TREATMENT

OF PERIODONTAL DISEASE WHILE ACHIEVING

RESULTS WITHIN THE STANDARD OF CARE.

THANK YOU FOR YOUR ATTENTION