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Clinical Study Minimally Invasive Treatment of Infrabony Periodontal Defects Using Dual-Wavelength Laser Therapy

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Clinical Study Minimally Invasive Treatment of Infrabony Periodontal Defects Using Dual-Wavelength Laser Therapy Hindawi Publishing Corporation International Scholarly Research Notices Volume 2016, Article ID 7175919, 9 pages http://dx.doi.org/10.1155/2016/7175919 Clinical Study Minimally Invasive Treatment of Infrabony Periodontal Defects Using Dual-Wavelength Laser Therapy Rana Al-Falaki,1 Francis J. Hughes,2 and Reena Wadia2 1 Al-FaPerio Clinic, 48AQueensRoad,BuckhurstHill,EssexIG95BY, UK 2Department of Periodontology, King’s College London Dental Institute, Floor 21,TowerWingGuysHospital,LondonSE19RT, UK Correspondence should be addressed to Rana Al-Falaki; [email protected] Received 23 January 2016;Revised15 April 2016;Accepted26 April 2016 Academic Editor: Jiiang H. Jeng Copyright © 2016 Rana Al-Falaki et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Surgical management of infrabony defects is an invasive procedure, frequently requiring the use of adjunctive material such as grafs or biologics, which is time-consuming and associated with expense and morbidity to the patient. Lasers in periodontal regeneration have been reported in the literature, with each wavelength having potential benefts through diferent laser-tissue interactions. Te purpose of this case series was to assess the efcacy of a new dual-wavelength protocol in the management of infrabony defects. Materials and Methods. 32 defects (one in each patient) were treated using ultrasonic debridement, followed by fapless application of Erbium, Chromium:Yttrium, Scandium, Gallium, Garnet (Er,Cr:YSGG) laser (wavelength 2780 nm), and fnal application of diode laser (wavelength 940 nm). Pocket depths (PD) were measured afer 6 months and repeat radiographs taken afer one year. Results. TemeanbaselinePDwas8.8 mm (range 6–15 mm) and 6 months later was 2.4 mm (range 2–4 mm), with mean PD reduction being 6.4 1.7 mm (range 3–12 mm). Tere was a signifcant gain in relative linear bone height (apical extent of bone), with mean percentage bone fll of 39.7 41.2%and53%ofsitesshowingatleast40%infll of bone. Conclusion. Te results compare favourably with traditional± surgery and require further validation through randomised clinical controlled trials. ± 1. Introduction certain wavelengths are ofen diluted in systematic reviews, and the conclusions have to be taken with caution, accepting Tesuccessfulmanagementofperiodontalpocketsassoci- the limitations of low numbers of studies and inconsistencies ated with infrabony defects through nonsurgical treatment in the protocols and methodology [2, 6]. alone is an unpredictable treatment modality. Teoptimum outcome of such management would be complete pocket Several diferent types of lasers have been proposed as resolution and ideally with new attachment formation. In alternatives or adjuncts to conventional surgical periodontal order to achieve this predictably, several regenerative surgical therapy, Nd:YAG [7, 8], Er:YAG [9–11], Er,Cr:YSGG [12], and techniques have been developed, alongside the use of a multi- diode lasers [13], and have shown efective use in regeneration tude of both osteoconductive or osteoinductive regenerative or at least some radiographic evidence of bone fll. materials [1]. New attachment formation is otherwise an Each has diferent mechanisms of action, with the Erbium inconsistent outcome following nonsurgical treatment alone, lasers not penetrating so deeply and being less bactericidal, although it can happen spontaneously, particularly in cases but safe to use on root surfaces and bone, while the diodes where defects are deep and narrow. and Nd:YAG lasers have greater potential to cause thermal Lasers in periodontal therapy, both surgically and non- damage to the root surface and bone but are more deeply surgically, are becoming more common, but the evidence penetrating with more of a photobiomodulatory efect [11]. base is still highly controversial. Generally, the standard of Laser energy can be delivered though thin fexible fbres research has been poor and inconsistent, making a general or tips, to sites in the periodontal pocket that conventional consensus difcult to reach [2–5]. “Lasers” have been grouped instrumentation is less able to reach [14]. together in the literature rather than looking at each wave- While in a specialist practice setting, the author had pre- length and its potential tissue interactions, so the benefts of viously reported on the fndings of bone fll using a developed 2 International Scholarly Research Notices protocol of just the Er,Cr:YSGG laser [15]. Terefore, the Next the 940 nm diode laser was used outside the pocket, purpose of this retrospective case series was to assess the by holding the contour handpiece at the gingival margin for a efectiveness of using a dual-wavelength approach with the period of 20 seconds, both buccally and lingually, at a power Er,Cr:YSGG (2780 nm) laser and more deeply penetrating setting of 1.4 W. Tis was equivalent to a dose of 5 J/cm . diode laser (940 nm) as an adjunct to conventional non- Patients were advised to commence brushing as normal2 surgical therapy, in the resolution of periodontal pockets the next day and to use appropriate sized interdental brushes. associated with infrabony defects, which in the majority of No antibiotics or occlusal adjustment was carried out in any cases may have otherwise required fapped regenerative or of these cases. osseous surgery to treat efectively. Periodontal reassessment consisting of pocket depth, bleeding on probing, and mobility was carried out at 2 2. Materials and Methods months and 6 months, and periapical radiographs (parallel- ing technique with holders) were repeated on those sites that Patients were diagnosed at consultation with either chronic were associated with infrabony defects, at a minimum of 12 periodontics or aggressive periodontitis based on the 1999 months afer treatment. International Classifcation for Periodontal Diseases and All consecutive cases where an infrabony defect had been Conditions [16]. Full mouth periapical radiographs were treated and 12-month follow-up radiographs were available taken at that stage and appropriate risk-related treatment were included in the radiographic and statistical analyses planning was recommended. (32 consecutive patients in total). Exclusions were those All patients were treated by the same operator, with a patients who had conficting medical histories, such as combination of conventional root surface instrumentation, immune-compromised, or had been treated with adjunctive followed by Er,Cr:YSGG and then diode laser application. Te antibiotics. procedure is shown in Figures 1(a)–1(j). Local anaesthetic was Before and afer radiographs for each infrabony site were administered at all sites afected by pocketing. Teanaesthetic randomly placed side by side on a black viewing background. used was 2%lignocainehydrochloridesolutionwith1 : 80000 Teradiographswereassessedforrelativelinearboneheight adrenaline and was administered as a combination of buccal by an independent, blinded examiner (RW) by measuring and palatal infltrations and/or inferior dental blocks, to root length from CEJ to apex, CEJ to coronal extent of achieve full tooth and sof tissue anaesthesia. Supra- and sub- bone height (COR) on the root surface, and CEJ to most gingival debridement were then carried out using ultrasonic apical extent of bone on the root surface (API) (as shown in scaling tips of varying angles (Dentsply Cavitron, inserts FSI Figure 2). TeAPIandCORmeasurementsweredividedby 100,FSISLI10 L, and 10 R). Following this, the laser energy total root length to calculate relative apical and coronal linear was applied. bone heights. Tis was frst carried out using a 14 mm, 500-micron radial fring zirconia periodontal tip (Biolase, Irvine Califor- nia, RFPT5). Te settings used were power 1.5 W, f r e q u e n c y 3. Results 30 Hz, 50%water,40% air, and H (short pulse 60 s) mode. Tetipwasinsertedintothebaseofthepocketandmain- No adverse efects were reported following the treatment, and while no visual analogue scale was used, there was anecdotal tained at an angle parallel to the long axis of the root! and the epithelial lining as much as possible. Once it touched bone, reporting of little or no need for analgesics postoperatively it was withdrawn slightly and constantly moved vertically in most cases and no postoperative infections requiring (apicocoronal), up and down the pocket, and side to side antibiotics, and those patients who had previously conven- (either buccolingual or mesiodistal depending on location of tional surgery carried out reported a much more “pleasant” the pocket), with slow smooth sweeping motions. Tis was experience. continued until no further deposits of granulation tissue were Tirty-two sites associated with infrabony defects, from seen to be coming out of the pocket. A periodontal curette 32 patients, were included in the analysis. 22 were female was then used by scraping it along the bony walls of the defect, and 10 male, with a mean age of 56.7 10.7 years (range to remove any fnal pieces of granulation tissue. Te laser tip 32–79 years). Of those, 3 of the patients were smokers. Te was then reinserted and moved slowly and angled this time mean baseline pocket depth (PD) was±8.8 mm (range 6– frstly parallel to the root surface and then towards all the 15 mm). Temeanpocketdepth6 months afer treatment bone surrounding the root, now that the granulation tissue was 2.4 mm (range 2–4 mm), and the mean PD reduction was had been removed, the aim being energy contact with all 6.4 1.7 mm (range 3–12 mm). Temaximumpocketdepth the hard tissues (bone and root surface). Telasertipwas afer 6 months was 4 mm. Te results for each site are shown run gently along the surrounding bone, as there is a degree in more± detail in Figure 3. of tactile feel with this type of laser and tip. Finally the tip Tere was no signifcant change in supracrestal bone was run outside the pocket, parallel to the tissue, to disrupt height. However, there was a signifcant gain in relative linear the epithelium surrounding the tooth by a distance from the bone height (apical extent of bone) in all sites.
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