CLINICAL COMMUNICATION

 

Lasers in periodontics

 

 

G Melman^I; V Karic^II; R Mulder^III

^IBDS(Wits), MSc(Dent)(Wits). Specialist in Paediatric Dentistry (U.K.). Department of Paediatric Dentistry, University of the Witwatersrand, School of Oral Health Sciences, Johannesburg, South Africa
^IIBDS(Bgd, EU), MSc(Dent)(Wits). Senior Lecturer, Division of Operative Dentistry, University of the Witwatersrand, School of Oral Health Sciences, Johannesburg, South Africa
^IIIBChD(UWC), MSc(Dent)(UWC). Lecturer, Department of Orthodontics and Paediatric Dentistry. University of the Western Cape, Tygerberg, Cape Town, South Africa

Correspondence

 

 

INTRODUCTION

Ablation has been described as the expansive vaporisation of tissue. In periodontal procedures the ablation capacity of the laser can be used for excision and incision of pathology. The Erbium doped lasers can be used effectively for soft tissue procedures with or without water. It is essential that the air supply is turned off when soft tissue procedures or any procedure with a flap is performed, to prevent subcutaneous emphysema. Hard tissue lasers are effective in bone ablation provided that the water is present preventing collagen denaturation and necrosis of the targeted tissue.¹ The clinician should be vigilant with the use of personal protective equipment due to the plume and blood spatter that develop. Patient comfort is increased when the hard tissue laser is used in place of the rotary drill, due to the relative low energy required to induce bone ablation.²

 

A SYNOPSIS OF LASERS IN PERIODONTICS

The lasers with the shorter wavelengths like the diode and neodinium-doped yttrium aluminium garnet (NdYAG) lasers are widely used due to their capabilities for deeper soft tissue penetration. The clinician should be conscious of the thermal tissue interaction of the various lasers in order to prevent high temperature damage to the underlying periostium and bone.^3,4 In this respect the diode lasers have preset energy and wave selection settings that indicate to the clinician whether the tip must be initiated. Starting at these pre-set settings is advisable so that tissue interaction may be assessed before venturing to increased energy levels. Root damage during periodontal pocket lasing has been noted with settings above 1.5 W for diode lasers.⁵ The presence of chromophores like melanin and haemoglobin should be considered during the selection of energy levels since these pigments impact greatly on the absorption of laser energy.⁶

 

CONCLUSION

The use of lasers (Diode, Erbium, NdYAG) in Periodontics is generally accepted as adjunctive to traditional treatment modalities. Multiple published clinical trials have indicated only a slight improvement in the clinical attachment loss, some reduction in periodontal probing pocket depths, and no significant reduction in subgingival microbial loads.⁷

The greatest stumbling block for research which may have supported the option of lasers as an adjunct to traditional periodontal treatment was the lack of homogeneity between studies identified when a meta-analysis was performed.⁸

 

ACRONYMS

Nd:YAG: Neodinium-doped yttrium aluminium garnet

 

References

1. Thomsen S. Pathologic analysis of photothermal and photomechanical effects of laser-tissue interactions. Photochem Photobiol 1991; 53: 825-35.         [ Links ]

2. Fried NM, Fried D. Comparison of Er:YAG and 9.6-microm TE CO2 lasers for ablation of skull tissue. Lasers Surg Med 2001; 28: 335-43.         [ Links ]

3. Spencer P, Cobb C M, Wieliczka DM, Glaros AG, Morris PJ. Change in temperature of subjacent bone during soft tissue laser ablation. J Periodontol 1998; 69: 1278-82.         [ Links ]

4. Fisher SE, Frame JW. The effects of the carbon dioxide surgical laser on oral tissues. Br J Oral Maxillofac Surg 1984; 22: 414-25.         [ Links ]

5. Kreisler M, Haj H, D'Hoedt B. Clinical efficacy of semiconductor laser application as an adjunct to conventional scaling and root planning. Lasers in Surgery and Medicine 2005; 37: 350-5.         [ Links ]

6. Blaiden J. Mott A. Soft-tissue lasers in dental hygiene. Page 30-31. Wiley-Blackwell 2013; ISBN: 978-0-470-95854-4.         [ Links ]

7. Cobb CM. Lasers and the treatment of chronic periodontitis. Dent Clin Am 2010; 54:35-53.         [ Links ]

8. Schwarz F, Aoki A, Becker J, et al. Laser application in non-surgical periodontal therapy: a systematic review. J Clin Periodontol 2008; 35(Suppl 8):29-44.         [ Links ]

 

 

Correspondence:
Geoffrey Melman:
Specialist in Paediatric Dentistry (U.K.), Department of Paediatric Dentistry
University of the Witwatersrand, School of Oral Health Sciences, Johannesburg
E-mail: melman@mweb.co.za