Laser Therapy

Badran Z, Bories C, Struillou X, Saffarzadeh A, Verner C, Soueidan A.
Dental Faculty, Nantes, 44042, France
J Oral Implantol. , 16.06.2010

Peri-implantitis is bacterial infections of peri-implant supporting tissues, involving the peri-implant bone. Several treatment protocols have been tested in clinical practice with a variable efficacy. The clinical management of per-implantitis aims for the elimination plaque and calculus, the decontamination of the failing implant surface and the regeneration of the lost bone tissue. Surface decontamination is an important part of all suggested treatments. This could be accomplished by chemical agents (chlorhexidine...), mechanical (ultrasonic...) or photonic (laser) devices. In this report, we present a case of a severe peri-implantitis that was successfully managed by a combination of a non-surgical and a surgical approach. Implant surface debridement/decontamination was obtained using an Er:YAG laser device for the of the implant surface.

© PMID: 20553143 [PubMed - indexed for MEDLINE]

Badran Z, Bories C, Struillou X, Saffarzadeh A, Verner C, Soueidan A.
Dental Faculty, Nantes, 44042, France
J Oral Implantol. , 16.06.2010

Peri-implantitis is bacterial infections of peri-implant supporting tissues, involving the peri-implant bone. Several treatment protocols have been tested in clinical practice with a variable efficacy. The clinical management of per-implantitis aims for the elimination plaque and calculus, the decontamination of the failing implant surface and the regeneration of the lost bone tissue. Surface decontamination is an important part of all suggested treatments. This could be accomplished by chemical agents (chlorhexidine...), mechanical (ultrasonic...) or photonic (laser) devices. In this report, we present a case of a severe peri-implantitis that was successfully managed by a combination of a non-surgical and a surgical approach. Implant surface debridement/decontamination was obtained using an Er:YAG laser device for the of the implant surface.

© PMID: 20553143 [PubMed - indexed for MEDLINE]

Oberhofer O, Sculean A
JOLA 8(3) 2008, 189-194, 28.10.2008

The aim of this clinical study is to compare the desensitizing effects on dentin and dental cervices of different desensitizing gels or liquids with the use of Er:YAG laser.

© Quintessenz Verlag

Oberhofer O, Sculean A
JOLA 8(3) 2008, 189-194, 28.10.2008

Purpose: The aim of this clinical study is to compare the desensitizing effects on dentin and dental cervices of different desensitizing gels or liquids with the use of Er:YAG laser. Materials and Methods: In this split-mouth-design study, 25 patients suffering from hypersensitive dental cervices or dentin were treated with DentinProtector (Vivadent, Liechtenstein) in the first quadrant, in the second quadrant with Er:YAG laser [(KEY III, KaVo, Biberach) at 80 mJ and 3 Hz, Handpiece 2060 with water irrigation, defocused, 2 min per tooth)], in the third quadrant with Duraphat, and the fourth quadrant served as an untreated control group. Results: Compared to the control group, all three treatment methods showed reduction of discomfort after 6 months. Conclusion: Desensitizing with Er:YAG laser was effective. In comparison to the use of Duraphat and DentinProtector, the good results persisted longer. It seems that the Er:YAG laser is a suitable tool for treatment of dentin hypersensitivity.

© Quintessenz Verlag

Schwarz F, Aoki A, Becker J, Sculean A
Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany
J Clin. Periodontol. 2008 Sep;35(8 Suppl):29-44, 01.09.2008

The primary aim was to address the following focused question: What is the clinical effect of laser application compared with mechanical debridement in non-surgical periodontal therapy in patients with chronic periodontitis? A secondary aim was to survey the relevant literature in relation to safety of laser applications.

© Wiley; PMID: 18724840 [PubMed - indexed for MEDLINE]

Schwarz F, Aoki A, Becker J, Sculean A
Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany
J Clin. Periodontol. 2008 Sep;35(8 Suppl):29-44, 01.09.2008

OBJECTIVES: The primary aim was to address the following focused question: What is the clinical effect of laser application compared with mechanical debridement in non-surgical periodontal therapy in patients with chronic periodontitis? A secondary aim was to survey the relevant literature in relation to safety of laser applications. MATERIAL AND METHODS: Electronic databases of the PubMed and the Cochrane Library were searched and completed by manual searches up to December 2007. RESULTS: Following screening, 12 publications (11 studies) were eligible for the review. A meta-analysis could not be performed due to the heterogeneity of the studies. The results from a narrative synthesis indicate that Er:YAG laser monotherapy resulted in similar clinical outcomes, both in the short and the long term (up to 24 months), compared with mechanical debridement. There is insufficient evidence to support the clinical application of either CO(2), Nd:YAG, Nd:YAP, or different diode laser wavelengths. CONCLUSIONS: The Er:YAG laser seems to possess characteristics most suitable for the non-surgical treatment of chronic periodontitis. Research conducted so far has indicated that its safety and effects might be expected to be within the range reported for conventional mechanical debridement. However, the evidence from the evaluated studies is weak.

© Wiley; PMID: 18724840 [PubMed - indexed for MEDLINE]

Krause F, Braun A, Brede O, Eberhard J, Frentzen M, Jepsen S
Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
J Clin Periodontol. 2007 Jan;34(1):66-71. Epub 2006 Nov 27, 01.01.2007

To evaluate the removal of subgingival calculus and dental hard tissues depending on the threshold level of a fluorescence feedback-controlled Er:YAG laser.

© PMID: 17132156 [PubMed - indexed for MEDLINE]

Krause F, Braun A, Brede O, Eberhard J, Frentzen M, Jepsen S
Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
J Clin Periodontol. 2007 Jan;34(1):66-71. Epub 2006 Nov 27, 01.01.2007

OBJECTIVES: To evaluate the removal of subgingival calculus and dental hard tissues depending on the threshold level of a fluorescence feedback-controlled Er:YAG laser. MATERIAL AND METHODS: Twenty teeth with calculus on the root surface were treated with an Er:YAG laser. Laser settings were 140 mJ and 10 Hz. The initial fluorescence threshold level of 5 [U] was reduced at intervals of 1 [U] for every laser treatment. Areas of residual calculus (RC) were evaluated using a surface analysis software. Loss of dental hard tissues was assessed by histomorphometric analysis of undecalcified ground sections. RESULTS: Using a threshold value of 5 [U], the median amount of RC was 11% (0-78%). By lowering the threshold levels, the amount of RC decreased [level 1 [U]: 0% (0-26%)]. The laser-treated root surfaces revealed a statistically significant reduction of the cementum thickness [median: 80 microm (0-250)] compared with the non-treated opposite side [median: 90 microm (30-250)] (p<0.05). CONCLUSION: The amount of RC following laser irradiation depends on the fluorescence threshold level for a feedback-controlled Er:YAG laser. It might be suggested that this laser system may be used with a threshold level even lower than 5 [U] without removing a clinically relevant amount of root cementum.

© PMID: 17132156 [PubMed - indexed for MEDLINE]

Schwarz F, Jepsen S, Herten M, Sager M, Rothamel D, Becker J
Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany
J Clin Periodontol. 2006 Aug;33(8):584-95, 01.08.2006

The aim of the present study was to evaluate non-submerged and submerged healing of ligature induced peri-implantitis in dogs.

© Wiley; PMID: 16899102 [PubMed - indexed for MEDLINE]

Schwarz F, Jepsen S, Herten M, Sager M, Rothamel D, Becker J
Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany
J Clin Periodontol. 2006 Aug;33(8):584-95, 01.08.2006

OBJECTIVE: [corrected] The aim of the present study was to evaluate non-submerged and submerged healing of ligature induced peri-implantitis in dogs. MATERIAL AND METHODS: Peri-implantitis was induced by ligature placement in five beagle dogs (n = 30 implants). The defects were randomly and equally allocated in a split-mouth design to either closed treatment + non-submerged healing (CNS), or open treatment + submerged healing (OS) using an Er:YAG laser (ERL), an ultrasonic device (VUS), or plastic curettes + local application of metronidazole gel (PCM), respectively. The animals were sacrificed after 3 months. Clinical, radiological and histological (e.g. new bone-to-implant contact (BIC)) parameters were assessed. RESULTS: All treatment procedures resulted in statistically significant improvements of all clinical parameters at both CNS and OS implants. Radiological improvements were merely observed at OS implants. Histomorphometrical analysis revealed that all CNS implants exhibited comparable low amounts of new BIC (1.0-1.2%), while mean BIC was statistically significant higher in the respective OS groups [ERL (44.8%), PCM (14.8%), VUS (8.7%)]. CONCLUSION: Within the limits of the present study, it was concluded that (i) OS improved the outcome of treatment in comparison with CNS and (ii) ERL seemed to be more suitable to promote re-osseointegration than PCM and VUS.

© Wiley; PMID: 16899102 [PubMed - indexed for MEDLINE]

Schwarz F, Bieling K, Venghaus S, Sculean A, Jepsen S, Becker J
Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany
J Clin Periodontol. 2006 Mar;33(3):200-8, 01.03.2006

The aim of the present study was to evaluate the effects of fluorescence-controlled Er:YAG laser radiation, an ultrasonic device or hand instruments on periodontally diseased root surfaces in vivo.

© Wiley; PMID: 16489946 [PubMed - indexed for MEDLINE]

Schwarz F, Bieling K, Venghaus S, Sculean A, Jepsen S, Becker J
Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany
J Clin Periodontol. 2006 Mar;33(3):200-8, 01.03.2006

OBJECTIVES: The aim of the present study was to evaluate the effects of fluorescence-controlled Er:YAG laser radiation, an ultrasonic device or hand instruments on periodontally diseased root surfaces in vivo. MATERIAL AND METHODS: Seventy-two single-rooted teeth (n=12 patients) were randomly treated in vivo by a single course of subgingival instrumentation using (1-3) an Er:YAG laser (ERL1: 100 mJ; ERL2: 120 mJ; ERL3: 140 mJ; 10 Hz), or (4) the Vector ultrasonic system (VUS) or (5) hand instruments (SRP). Untreated teeth served as control (UC). Areas of residual subgingival calculus (RSC) and depth of root surface alterations were assessed histo-/morphometrically. RESULTS: Highest values of RSC areas (%) were observed in the SRP group (12.5+/-6.9). ERL(1-3) (7.8+/-5.8, 8.6+/-4.5, 6.2+/-3.9, respectively) revealed significantly lower RSC areas than SRP. VUS (2.4+/-1.8) exhibited significantly lower RSC areas than SRP and ERL(1, 2). Specimens treated with SRP revealed conspicuous root surface damage, while specimens treated with ERL(1-3) and VUS exhibited a homogeneous and smooth appearance. CONCLUSION: Within the limits of the present study, it may be concluded that ERL and VUS enabled (i) a more effective removal of subgingival calculus and (ii) a predictable root surface preservation in comparison with SRP.

© Wiley; PMID: 16489946 [PubMed - indexed for MEDLINE]

Eberhard J, Eisenbeiss AK, Braun A, Hedderich J, Jepsen S
Department of Operative Dentistry and Periodontology, University Hospital Schleswig-Holstein, Kiel, Germany
Caries Res. 2005 Nov-Dec;39(6):496-504, 01.12.2005

To establish a fluorescence threshold level that could guide a therapeutic Er:YAG laser through a caries lesion to determine a therapeutic endpoint of caries removal.

© Wiley; PMID: 16251795 [PubMed - indexed for MEDLINE]

Eberhard J, Eisenbeiss AK, Braun A, Hedderich J, Jepsen S
Department of Operative Dentistry and Periodontology, University Hospital Schleswig-Holstein, Kiel, Germany
Caries Res. 2005 Nov-Dec;39(6):496-504, 01.12.2005

AIM: To establish a fluorescence threshold level that could guide a therapeutic Er:YAG laser through a caries lesion to determine a therapeutic endpoint of caries removal. MATERIALS AND METHODS: A total of 65 extracted human teeth, 35 with dentine caries and 30 healthy, were used for this study. An Er:YAG laser system that emitted at a wavelength of 2.94 microm was used. The laser was equipped with a laser fluorescence feedback system, excitation wavelength 655 nm, to control the irradiation by the Er:YAG laser. The evaluated threshold levels of the fluorescence feedback system were 3, 7, 8, 10, 12, 15 and 20. After treatment the teeth were prepared for histological staining according to the method of Brown and Brenn for the identification of bacteria. The specimens were subjected to a quantitative evaluation of residual bacteria on the treated dentine surface. In addition, the internal fluorescence of dentine and potential fluorescence changes of dentine after laser irradiation were evaluated. RESULTS: About 80% of the irradiated dentine surface showed residual bacteria with threshold levels of 20, 15, 12, and 10. Residual bacteria were not found with threshold levels of 7 and 3. The study revealed a significant increase in dentine fluorescence after laser irradiation. CONCLUSION: The results of the present in vitro study indicate that a fluorescence threshold level of 7 or 8 units can guide an Er:YAG laser to a complete removal of carious dentine. Copyright 2005 S. Karger AG, Basel.

© Wiley; PMID: 16251795 [PubMed - indexed for MEDLINE]

Atsushi Takeda, Tomoo Anjo, Masaaki Takashina, Arata Ebihara and Hideaki Suda
International Congress Series, Volume 1248, May 2003, Pages 261-263 , 01.05.2003

Surgical endodontics was performed using an Er:YAG laser on 23 patients (4 males, 19 females) exhibiting periapical pathosis. After mucoperiosteal flap reflection, osteotomy was performed over the lesion using a low-speed dental engine with a round bur (#6–8).

© International Congress Series, Volume 1248, May 2003, Pages 261-263

Atsushi Takeda, Tomoo Anjo, Masaaki Takashina, Arata Ebihara and Hideaki Suda
International Congress Series, Volume 1248, May 2003, Pages 261-263 , 01.05.2003

Surgical endodontics was performed using an Er:YAG laser on 23 patients (4 males, 19 females) exhibiting periapical pathosis. After mucoperiosteal flap reflection, osteotomy was performed over the lesion using a low-speed dental engine with a round bur (#6–8). Root-end resection was then performed using an Er:YAG laser (100 mJ, 10 pps) with copious saline coolant. The root apex cavity for the retrograde root canal filling was prepared using either an ultrasonic device or Er:YAG laser. The clinical condition of the patients was evaluated at 1 week, 1 month, and 3 months after surgery. The mean irradiation time (±S.D.) for apicoectomy using the Er:YAG laser was 123.9±113.2 s. No adverse reactions were seen during the laser irradiation procedure, and no harmful sequelae were observed during the follow-up periods. It is concluded that apicoectomy using the Er:YAG laser would be both safe and practical. However, improvement of the laser device to limit the operation time would offer considerable advantages.

© International Congress Series, Volume 1248, May 2003, Pages 261-263

Hibst R, Stock K, Gall R, Keller, U
SPIE 1392(1997); 14-21, 01.05.2003

Recently it has been shown that bacterias can be sterilized by Er:YAG laser irradiation. By optical fiber transmission the bactericidal effect can also be used in endodontics. In order to explore potential laser parameters, we further investigated sterilization of caries and measured temperatures in models simulating endodontic treatment.

© Elsevier Verlag

Hibst R, Stock K, Gall R, Keller, U
SPIE 1392(1997); 14-21, 01.05.2003

Recently it has been shown that bacterias can be sterilized by Er:YAG laser irradiation. By optical fiber transmission the bactericidal effect can also be used in endodontics. In order to explore potential laser parameters, we further investigated sterilization of caries and measured temperatures in models simulating endodontic treatment. It was found out that the bactericidal effect is cumulative, with single pulses being active. This offers to choose all laser parameters except pulse energy (radiant exposure) from technical, practical or safety considerations. For clinical studies the following parameter set is proposed for efficient and safe application (teeth with a root wall thickness > 1 mm, and prepared up to ISO 50): pulse energy: 50 mJ, repetition rate: 15 Hz, fiber withdrawal velocity: 2 mm/s. With these settings 4 passes must be performed to accumulate the total dose for sterilization.

© Elsevier Verlag

Schwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker J
Department of Oral Surgery, Heinrich Helne University, Westdeutsche Kieferklinik, Düsseldorf, Germany
J Periodontol 72(3)2001; 361-367, 01.05.2003

Non-surgical periodontal treatment with an Er:YAG laser has been shown to result in significant clinical attachment level gain; however, clinical results have not been established on a long-term basis following Er:YAG laser treatment. Therefore, the aim of the present study was to present the 2-year results following non-surgical periodontal treatment with an Er:YAG laser or scaling and root planing.

© Wiley; PMID: 12816290 [PubMed - indexed for MEDLINE]

Schwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker J
Department of Oral Surgery, Heinrich Helne University, Westdeutsche Kieferklinik, Düsseldorf, Germany
J Periodontol 72(3)2001; 361-367, 01.05.2003

BACKGROUND: Non-surgical periodontal treatment with an Er:YAG laser has been shown to result in significant clinical attachment level gain; however, clinical results have not been established on a long-term basis following Er:YAG laser treatment. Therefore, the aim of the present study was to present the 2-year results following non-surgical periodontal treatment with an Er:YAG laser or scaling and root planing. METHODS: Twenty patients with moderate to advanced periodontal destruction were treated under local anesthesia, and the quadrants were randomly allocated in a split-mouth design to either 1) Er:YAG laser (ERL) using an energy level of 160 mJ/pulse and 10 Hz, or 2) scaling and root planing (SRP) using hand instruments. The following clinical parameters were evaluated at baseline and at 1 and 2 years after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). Subgingival plaque samples were taken at each appointment and analyzed using dark-field microscopy for the presence of cocci, non-motile rods, motile rods, and spirochetes. The primary outcome variable was CAL. No statistically significant differences between the groups were found at baseline. Power analysis to determine superiority of ERL treatment showed that the available sample size would yield 99% power to detect a 1 mm difference. RESULTS: The sites treated with ERL demonstrated mean CAL change from 6.3 +/- 1.1 mm to 4.5 +/- 0.4 mm (P < 0.001) and to 4.9 +/- 0.4 mm (P < 0.001) at 1 and 2 years, respectively. No statistically significant differences were found between the CAL mean at 1 and 2 years postoperatively. The sites treated with SRP showed a mean CAL change from 6.5 +/- 1.0 mm to 5.6 +/- 0.4 mm (P < 0.001) and to 5.8 +/- 0.4 mm (P < 0.001) at 1 and 2 years, respectively. The CAL change between 1 and 2 years did not present statistically significant differences. Both groups showed a significant increase of cocci and non-motile rods and a decrease in the amount of spirochetes. However, at the 1- and 2-year examination, the statistical analysis showed a significant difference for the CAL (P < 0.001, respectively) between the 2 treatment groups. CONCLUSION: It was concluded that the CAL gain obtained following non-surgical periodontal treatment with ERL or SRP can be maintained over a 2-year period.

© Wiley; PMID: 12816290 [PubMed - indexed for MEDLINE]