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July 31, 2004 at 5:54 am #3261
Background: The aim of the present study was to compare the effectiveness of an Er:YAG laser to that of ultrasonic scaling for non-surgical periodontal treatment.
Methods: Twenty patients with moderate to advanced periodontal disease were randomly treated in a split-mouth design with a single episode of subgingival debridement using either an Er:YAG laser device (160 mJ/pulse, 10 Hz) combined with a calculus detection system with fluorescence induced by 655 nm InGaAsP diode laser radiation (ERL), or an ultrasonic instrument (UI). Clinical assessments of full-mouth plaque score (FMPS), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were made at baseline and at 3 and 6 months following therapy.
Results: No differences in any of the investigated parameters were observed at baseline between the two groups. The mean value of BOP decreased in the ERL group from 40% at baseline to 17% after 6 months (P <0.0001) and in the UI group from 46% at baseline to 15% after 6 months (P <0.0001). The sites treated with ERL demonstrated mean CAL gain of 1.48 ± 0.73 mm (P <0.001) and of 1.11 ± 0.59 mm (P <0.001) at 3 and 6 months, respectively. The sites treated with UI demonstrated mean CAL gain of 1.53 ± 0.67 mm (P <0.001) and of 1.11 ± 0.46 mm (P <0.001) at 3 and 6 months, respectively. No statistically significant differences were observed between the groups (P >0.05).
Conclusion: Within the limits of the present study, it can be concluded that both therapies led to significant improvements of the investigated clinical parameters. J Periodontol 2004;75:966-973.
Comparison studies; lasers/therapeutic use; periodontal diseases/therapy; scaling.
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Periodontitis is an inflammatory disease caused by opportunistic bacteria residing in the oral cavity, leading to a loss of the supporting tissues of the teeth (i.e., periodontal ligament and alveolar bone).1 According to the cause-related concept of periodontal therapy, a major objective of treatment is to create a biologically acceptable root surface by eliminating the bacterial biofilm.1 Traditionally, root surface debridement is performed with hand instruments such as Gracey curets.
More recently, power-driven instruments, including sonic and ultrasonic scalers, have been proposed to provide better access to deep probing sites and to increase the efficiency of subgingival instrumentation. Numerous studies have reported on the comparative clinical outcome of sonic and ultrasonic versus manual instrumentation.2-5 Power driven instruments have been shown to be superior in the treatment of Class II and Class III furcations when used by experienced operators.6 Furthermore, studies indicate that manual instrumentation generally takes longer to achieve the same clinical results as sonic and ultrasonic scalers.7,8
Nevertheless, a drawback of power-driven instruments is the formation of pathogenic bacterial aerosols.9 In recent years, different laser systems such as the CO2 (carbon-dioxide), the Nd:YAG (neodymium-doped: yttrium, aluminum and garnet), the diode and the Er:YAG laser (erbium-doped: yttrium, aluminum and garnet) have been proposed as an alternative or adjunctive treatment to conventional, mechanical therapy in periodontics.10-12 Several studies have reported negative effects of the Nd:YAG and CO2 lasers when used directly on root surfaces due to carbonization and melting effects.13-15 Trylovich et al.16 reported that the Nd:YAG laser alters the biocompatibility of the cementum surface so as to make it unfavorable for fibroblast attachment. Moreover, Fourier transformed infrared spectroscopy revealed reductions in the intensity of the Amide II band, suggesting that Nd:YAG laser irradiation denatures surface proteins. Additional contamination with denaturation side products such as ammonium further decreased cell attachment.17
In contrast, the Er:YAG laser has been reported to be the most effective laser for periodontal treatment. The results from previous studies demonstrated its excellent ability to effectively ablate dental hard tissue and calculus without producing major thermal side effects (e.g., charring or fusion) to the root surface.10-12 The Er:YAG laser irradiation also failed to alter the intensity of Amide peaks I, II, or III, indicating that the chemical structure of the root surface was not changed.18,19
Furthermore, several studies have reported antimicrobial effects against periodontopathic bacteria and the removal of lipopolysaccharides by Er:YAG laser radiation.20-23 However, histological and SEM examination showed that the Er:YAG laser ablated not only the calculus, but also the superficial portion of the underlying cementum, and left a root surface similar to an acid etched appearance with a scale like texture.10-12,24 The results from controlled clinical trials and case report studies have indicated that non-surgical periodontal treatment with an Er:YAG laser leads to significant gain of clinical attachment, even over a 2-year period.25-29 However, these investigations demonstrated no benefit or only slightly improved treatment outcomes compared to conventional scaling and root planing. In order to avoid any damages to the root surface, a subgingival calculus detection system with fluorescence induced by 655 nm InGaAsP diode laser radiation has been recently included in an Er:YAG laser. Preliminary in vitro results have shown that 655 nm diode laser radiation induces significantly stronger fluorescence in subgingival calculus than in cementum, suggesting that calculus removal may be selectively performed.30 So far, the clinical relevance of this system remains questionable.
As mentioned above, ultrasonic instrumentation has become nowadays an essential part of the armamentarium for non-surgical periodontal treatment. However, until now, no published data have been available concerning the clinical outcomes following treatment with an Er:YAG laser when compared to ultrasonic instrumentation. Therefore, the aim of the present study was to compare the effectiveness of an Er:YAG laser combined with a calculus detection system with fluorescence induced by 655 nm InGaAsP diode laser radiation to that of ultrasonic scaling for non-surgical periodontal treatment.
MATERIALS AND METHODS
Twenty periodontal patients, ages 29 to 62 years (mean age 51 years), were included in the study. The study was in accordance with the Helsinki Declaration of 1975, as revised in 1983 and all participants signed informed consent forms. The patient selection criteria were: 1) no periodontal treatment within the last 12 months; 2) no systemic diseases which could influence the outcome of the therapy; 3) not pregnant; 4) no use of antibiotics for the 6 months prior to treatment; and 5) good oral hygiene.
The study used a split-mouth design. Only pockets exhibiting a probing depth of >4 mm were instrumented. All quadrants were randomly treated with a single episode of subgingival debridement using either an Er:YAG laser device (single-rooted teeth, N = 407 sites; multirooted teeth, N = 269 sites), or an ultrasonic instrument (single-rooted teeth, N = 383 sites; multirooted teeth, N = 247 sites). In all cases treatment was performed within 24 hours. The distribution of the two treatment modalities was equally divided between the right and left sides.
Oral Hygiene Program
For 4 weeks before treatment, all patients were enrolled in a hygiene program and received oral hygiene instructions during two to four appointments as well as supragingival professional tooth cleaning according to individual needs. A supragingival professional tooth cleaning and reinforcement of oral hygiene was performed at baseline as well as 2, 4, 6, 8, 10, 12, 16, 20, and 24 weeks after treatment.
The treatment was performed under local anesthesia. An Er:YAG laser device|| (ERL) (wave length 2.94 μm) combined with a calculus detection system with fluorescence induced by 655 nm InGaAsP diode laser radiation was selected for laser treatment using an energy level of 160 mJ/pulse and a repetition rate of 10 Hz26-29 with water irrigation according to the manufacturer’s instructions. Fiber tips of 0.5 × 1.65 (136 mJ/pulse at the tip) and 0.5 × 1.1 mm (114 mJ/pulse at the tip) were chosen by the operator according to the situation. The treatment was performed from coronal to apical in parallel paths with an inclination of the fiber tip of 15 to 20 degrees31 to the root surface. An exciting laser radiation was delivered by an InGaAsP diode laser as red light at a wavelength of 655 nm. The diode laser beam was delivered onto the root surface with the above mentioned periodontal handpiece and the prismatically cut glass fiber tip. The mode of detection of fluorescence has been previously described.32 For treatment of the control group, an ultrasonic scaler¶ (UI) with straight and curved metal tips# was used under water irrigation according to the manufacturer’s instructions. The instrumentation for both laser and ultrasonic instrumentation was performed until the operator felt that the root surfaces were adequately debrided and planed. The amount of time needed in both groups was, on average, 5 minutes for single-rooted teeth and 9 minutes for multirooted teeth. All treatments were performed by the same experienced operator.
After the 4-week pretreatment phase (baseline) and 3 and 6 months after the last treatment, the following clinical parameters were measured by one calibrated periodontist who was not involved in providing treatment: plaque index (PI),33 probing depth (PD) as measured from the gingival margin to the bottom of the probeable sulcus, gingival recession (GR) as measured from the cemento-enamel junction (CEJ) to the gingival margin, and clinical attachment level (CAL) as measured from the CEJ to the bottom of the probeable sulcus. Bleeding on probing (BOP) was assessed simultaneously with the pocket measurements, and the presence or absence of bleeding up to 30 seconds after probing was recorded. The measurements were made at six aspects per tooth: mesio-vestibular (mv), mid-vestibular (v), disto-vestibular (dv), mesio-oral (mo), mid-oral (o) and disto-oral (do) using a manual periodontal probe.**
After completing the examination 24 weeks after treatment, the statistical evaluations were conducted using a computer program.†† Summary statistics were calculated for baseline as well as 3- and 6-month measurements. The net difference between each pair of measurements was then calculated (baseline–3 and baseline–6 months) in both groups. Statistical analysis within groups was performed using analysis of covariance (ANCOVA) and Scheffé’s test of multiple comparisons for repeated measures with measurement time and subject included in the model to account for the split-mouth design. Comparisons between groups at the different time points were performed using the unpaired t test. All statistical procedures were based on a level of significance of 5% (P <0.05). Primary outcome variable was CAL, and post-hoc power analysis‡‡ suggested that a significant difference of 1 mm between groups would have been detected with a probability of 75%.
Five patients, each presenting with two pairs of contralateral teeth (single and multirooted) with probing depths >6 mm on at least one aspect of each tooth, were used to assess intraexaminer reliability. The examiner evaluated the patients on two separate occasions, 48 hours apart. Reliability was accepted if measurements at baseline and at 48 hours were similar to the millimeter at >90% level.
The postoperative healing was uneventful in all cases. No complications such as abscesses or infections were observed throughout the study period. At the baseline examination, there were no statistically significant differences in any of the investigated parameters (Table 1, Figure 1 and Figure 2). At 3 and 6 months BOP improved statistically significantly compared to baseline, but no statistically significant differences were found between the two groups (Table 2 and Table 3). In both groups, the CAL improved significantly compared to baseline (P <0.001). However, no statistically significant difference was observed between the two groups (Table 2 and Table 3). The effect of ERL and UI at different initial PD is shown in Figure 3 and Figure 4. Initially deeper pockets (>5 mm) showed the greatest changes in the PD, GR, and CAL. Moderately deep pockets (4 to 5 mm) showed more moderate improvements (Figure 3 and Figure 4). In particular, sites where PD was initially deep showed more GR, more CAL gain, and deeper residual PD at the 3- and 6-month examination than sites with initial moderate PD. At 6 months, the ERL group showed at initially moderately deep sites a mean CAL gain of 0.6 ± 0.4 mm and of 1.8 ± 1.7 mm at initially deep sites. At 6 months the UI group displayed a mean CAL gain of 0.6 ± 0.5 mm at initially moderate sites, and of 1.9 ± 1.7 mm at initially deep sites. No statistically significant difference was observed between the two groups.
The results of the present study indicate that non-surgical periodontal treatment with both ERL and UI may lead to clinically and statistically PD reduction and CAL gain. The fact that all pockets treated in this study healed uneventfully suggests that both treatment modalities were well tolerated. However, no statistical or clinical differences in any of the investigated parameters were observed between treatment modalities.
It should be pointed out that the sample size of this study was relatively small, and does not allow for definitive conclusions to be drawn. These data may serve as a basis to design a clinical trial aimed at showing statistical equivalence between the treatment modalities.34
When interpreting the present results, it should be noted that in both groups initially deeper pockets (>5 mm) showed the greatest CAL gain. Furthermore, the greatest change in the PD, GR, and CAL were observed 3 months post-treatment with even further improvements up to 6 months. In this context it is important to point to the results of previous studies which have shown that most changes in probing depth reduction and gain in clinical attachment occur within 1 to 3 months following non-surgical therapy, although healing of the periodontium may occur over the following 9 to 12 months.3,35,36 In the present study, the ERL group showed at initially moderately deep sites a mean CAL gain of 0.6 ± 0.4 mm, and of 1.8 ± 1.7 mm at initially deep sites 6 months postoperatively. At 6 months the UI group displayed at initially moderately deep sites a mean CAL gain of 0.6 ± 0.5 mm, and of 1.9 ± 1.7 mm at initially deep sites. The finding that non-surgical periodontal treatment with either an Er:YAG laser and an ultrasonic scaler may result in statistically significant improvements in PD and CAL compared to baseline is in agreement with previously reported data.2,3,25,27-29,37,38
Unfortunately, most clinical studies have not evaluated attachment level changes. Torfason et al.2 reported in a controlled study a mean PD decrease of 1.7 mm (baseline PD: 5.0 mm) 2 months after ultrasonic instrumentation. There was no statistically significant difference between ultrasonic and hand instrumentation. Badersten et al.3 reported a mean PD decrease of 1.3 mm after 13 months for both ultrasonic and hand instrumentation (baseline PD: 4.2 mm) and Loos et al.37 reported a mean PD increase of 0.5 mm for initially shallow sites (<3.5 mm), 1.2 mm for moderately deep pockets (4 to 6.5 mm), and 2.3 mm for deep pockets (>7 mm) with a mean CAL gain of 0.6 mm 24 months postoperatively. One month postoperatively, Boretti et al.38 reported a mean PD decrease of 1.82 mm and a mean CAL gain of 1.14 mm for ultrasonic scaling. In a clinical study evaluating the clinical efficiency of an Er:YAG laser for soft tissue surgery and scaling, Watanabe et al.25 reported a mean PD reduction of 3.0 mm after 1 month (baseline PD: 5.6 mm). Following non-surgical periodontal treatment with an Er:YAG laser in a controlled clinical study, Schwarz et al.27,29 reported a mean PD decrease of 2.0 mm with a mean CAL gain of 1.9 mm after 6 months and a mean PD decrease of 1.6 mm with a mean CAL gain of 1.4 mm after 24 months (baseline PD: 4.9 mm). These results were statistically significant compared to baseline. This is in accordance with the results of ERL and UI treated sites in the present study. Another important factor that influences the outcome of non-surgical periodontal treatment is the removal of subgingival calculus and the detoxification of the root surface.3,39,40 Several studies have demonstrated that ultrasonic instrumentation achieves equal or superior treatment outcomes when compared with hand instruments.2,4,5,7 However, the effectiveness of Er:YAG laser scaling, as well as its effect on the root surface, has not yet been evaluated thoroughly. Aoki et al.24 reported on the effectiveness of Er:YAG laser scaling in comparison to ultrasonic scaling in vitro. This laser provided calculus removal on a level equivalent to that provided by an ultrasonic scaler. However, the efficiency of laser scaling was lower than that of the ultrasonic device.
As mentioned above, histological and scanning electronic microscope examination showed that the Er:YAG laser ablated not only the calculus, but also the superficial portion of the underlying cementum, and that the instrumented root surface had characteristic microstructures.10-12,24 Although this microstructured root surface showed no cracks or thermal effects like melting after CO2- or Nd:YAG laser irradiation,11 some authors have suggested additional treatment to remove the superficially changed layer of the lased root surface using root planing via hand instruments.13,16 In this context it is important to mention the results of a previous clinical study which showed that the combined treatment Er:YAG laser and scaling and root planing did not seem to additionally improve the outcome of the therapy compared to laser treatment alone.28 In contrast, studies evaluating root surface alterations produced by ultrasonic instruments suggest that this treatment modality does less damage to the root surface than hand instruments.7,41
In the present study, an Er:YAG laser device was used in combination with a subgingival calculus detection system with fluorescence induced by 655 nm diode laser radiation. To the best of our knowledge, there is only one study available reporting that 655 nm InGaAsP diode laser radiation induces significantly stronger fluorescence in subgingival calculus than in cementum.30 It was assumed that bacteria derived byproducts, such as porphyrin which is released by the periodontopathogenic Porphyromonas sp., may be responsible for the strong fluorescence of subgingival calculus.30,42 It should be noted that the present study was not designed to evaluate the clinical efficiency of this mechanism. However, based on the clinical results, especially in comparison to the above referenced studies, it may be suggested that this system did not seem to additionally improve the outcome of non-surgical periodontal treatment. Further studies are needed in order to clarify this issue. Within the limits of the present study, it may be concluded that both therapies led to significant improvements of the investigated clinical parameters.
1. O’Leary TJ. The impact of research on scaling and root planing. J Periodontol 1986;57:69-75.
2. Torfason T, Kiger R, Selvig KA, Egelberg J. Clinical improvement of gingival conditions following ultrasonic versus hand instrumentation of periodontal pockets. J Clin Periodontol 1979;6:165-176.
3. Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. I. Moderately advanced periodontitis. J Clin Periodontol 1981;8:57-72.
4. Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. III. Single versus repeated instrumentation. J Clin Periodontol 1984;11:114-124.
5. Loos B, Kiger R, Egelberg J. An evaluation of basic periodontal therapy using sonic and ultrasonic scalers. J Clin Periodontol 1987;14:29-33.
6. Leon LE, Vogel RI. A comparison of the effectiveness of hand scaling and ultrasonic debridement in furcations as evaluated by differential dark-field microscopy. J Periodontol 1987;58:86-94.
7. Dragoo MR. A clinical evaluation of hand and ultrasonic instruments on subgingival debridement. 1. With unmodified and modified ultrasonic inserts. Int J Periodontics Restorative Dent 1992;12:310-323.
8. Copulos TA, Low SB, Walker CB, Trebilcock YY, Hefti AF. Comparative analysis between a modified ultrasonic tip and hand instruments on clinical parameters of periodontal disease. J Periodontol 1993;64:694-700.
9. Holbrook WP, Muir KF, Macphee IT, Ross PW. Bacteriological investigation of the aerosol from ultrasonic scalers. Br Dent J 1978;144:245-247.
10. Aoki A, Ando Y, Watanabe H, Ishikawa I. In vitro studies on laser scaling of subgingival calculus with an erbium: YAG laser. J Periodontol 1994;65:1097-1106.
11. Israel M, Cobb CM, Rossmann JA, Spencer P. The effects of CO2, Nd:YAG and Er:YAG lasers with and without surface coolant on tooth root surfaces. An in vitro study. J Clin Periodontol 1997;24:595-602.
12. Folwaczny M, Mehl A, Haffner C, Benz C, Hickel R. Root substance removal with Er:YAG laser radiation at different parameters using a new delivery system. J Periodontol 2000;71:147-155.
13. Cobb CM, McCawley TK, Killoy WJ. A preliminary study on the effects of the Nd:YAG laser on root surfaces and subgingival microflora in vivo. J Periodontol 1992;63:701-707.
14. Spencer P, Trylovich DJ, Cobb CM. Chemical characterization of lased root surfaces using Fourier transform infrared photoacoustic spectroscopy. J Periodontol 1992;63:633-636.
15. Wilder-Smith P, Arrastia AM, Schell MJ, Liaw LH, Grill G, Berns MW. Effect of ND:YAG laser irradiation and root planing on the root surface: Structural and thermal effects. J Periodontol 1995;66:1032-1039.
16. Trylovich DJ, Cobb CM, Pippin DJ, Spencer P, Killoy WJ. The effects of the Nd:YAG laser on in vitro fibroblast attachment to endotoxin-treated root surfaces. J Periodontol 1992;63:626-632.
17. Thomas D, Rapley J, Cobb C, Spencer P, Killoy W. Effects of the Nd:YAG laser and combined treatments on in vitro fibroblast attachment to root surfaces. J Clin Periodontol 1994;21:38-44.
18. Gaspirc B, Skaleric U. Morphology, chemical structure and diffusion processes of root surface after Er:YAG and Nd:YAG laser irradiation. J Clin Periodontol 2001;28:508-516.
19. Sasaki KM, Aoki A, Masuno H, Ichinose S, Yamada S, Ishikawa I. Compositional analysis of root cementum and dentin after Er:YAG laser irradiation compared with CO2 lased and intact roots using Fourier transformed infrared spectroscopy. J Periodontal Res 2002;37:50-59.
20. Ando Y, Aoki A, Watanabe H, Ishikawa I. Bactericidal effect of erbium YAG laser on periodontopathic bacteria. Lasers Surg Med 1996;19:190-200.
21. Yamaguchi H, Kobayashi K, Osada R, et al. Effects of irradiation of an erbium:YAG laser on root surfaces. J Periodontol 1997;68:1151-1155.
22. Sugi D, Fukuda M, Minoura S, et al. Effects of irradiation of Er:YAG laser on quantity of endotoxin and micro-hardness of surface in exposed root after removal of calculus. Jpn J Cons Dent 1998;41:1009-1017.
23. Folwaczny M, Mehl A, Aggstaller H, Hickel R. Antimicrobial effects of 2.94 micron Er:YAG laser radiation on root surfaces: An in vitro study. J Clin Periodontol 2002;29:73-78.
24. Aoki A, Miura M, Akiyama F, et al. In vitro evaluation of Er:YAG laser scaling of subgingival calculus in comparison with ultrasonic scaling. J Periodontal Res 2000;35:266-277.
25. Watanabe H, Ishikawa I, Suzuki M, Hasegawa K. Clinical assessments of the erbium:YAG laser for soft tissue surgery and scaling. J Clin Laser Med Surg 1996;14:67-75.
26. Schwarz F, Sculean A, Arweiler N, Reich E. Non-surgical periodontal treatment with an Er:YAG laser (in German). Parodontologie 2000;4:329-336.
27. Schwarz F, Sculean A, Georg T, Reich E. Periodontal treatment with an Er:YAG laser compared to scaling and root planing. A controlled clinical study. J Periodontol 2001;72:361-367.
28. Schwarz F, Berakdar M, Georg T, Reich E, Sculean A. Clinical evaluation of an Er:YAG laser combined with scaling and root planing for non-surgical periodontal treatment. A controlled, prospective clinical study. J Clin Periodontol 2003;30:26-34.
29. Schwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker J. Periodontal treatment with an Er:YAG laser or scaling and root planing. A 2-year follow-up split-mouth study. J Periodontol 2003;74:590-596.
30. Folwaczny M, Heym R, Mehl A, Hickel R. Subgingival calculus detection with fluorescence induced by 655 nm InGaAsP diode laser radiation. J Periodontol 2002;73:597-601.
31. Folwaczny M, Thiele L, Mehl A, Hickel R. The effect of working tip angulation on root substance removal using Er:YAG laser radiation: An in vitro study. J Clin Periodontol 2001;28:220-226.
32. Lussi A, Megert B, Longbottom C, Reich E, Francescut P. Clinical performance of a laser fluorescence device for detection of occlusal caries lesions. Eur J Oral Sci 2001;109:14-19.
33. Löe H. The gingival index, the plaque index and the retention index system. J Periodontol 1967;38:610-616.
34. Gunsolley JC, Elswick RK, Davenport JM. Equivalence and superiority testing in regeneration clinical trials. J Periodontol 1998;69:521-527.
35. Kaldahl WB, Kalkwarf KL, Patil KD, Dyer JK, Bates RE Jr. Evaluation of four modalities of periodontal therapy. Mean probing depth, probing attachment level and recession changes. J Periodontol 1988;59:783-793.
36. Cugini MA, Haffajee AD, Smith C, Kent RL Jr, Socransky SS. The effect of scaling and root planing on the clinical and microbiological parameters of periodontal diseases: 12-month results. J Clin Periodontol 2000;27:30-36.
37. Loos B, Nylund K, Claffey N, Egelberg J. Clinical effects of root debridement in molar and non-molar teeth. A 2-year follow-up. J Clin Periodontol 1989;16:498-504.
38. Boretti G, Zappa U, Graf H, Case D. Short-term effects of phase I therapy on crevicular cell populations. J Periodontol 1995;66:235-240.
39. Nyman S, Sarhed G, Ericsson I, Gottlow J, Karring T. Role of “diseased” root cementum in healing following treatment of periodontal disease. An experimental study in the dog. J Periodontal Res 1986;21:496-503.
40. Kepic TJ, O’Leary TJ, Kafrawy AH. Total calculus removal: An attainable objective? J Periodontol 1990;61:16-20.
41. Jacobson L, Blomlof J, Lindskog S. Root surface texture after different scaling modalities. Scand J Dent Res 1994;102:156-160.
42. Duerden B. Gram-negative non-spore-forming anaerobes and Mobiluncus. In: Emmerson AM, Hawkey PM, Gillespie SH, eds. Principles and Practice of Clinical Bacteriology. Chichester, UK: John Wiley and Sons;1997:155-180.
* Department of Conservative Dentistry and Periodontology, Johannes Gutenberg University, Mainz, Germany.
† Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany.
‡ Department of Oral Surgery and Implantology, Johann Wolfgang Goethe University of Frankfurt, Dental School (Carolinum), Frankfurt, Germany.
§ Department of Conservative Dentistry and Periodontology, Albert-Ludwigs-University, Freiburg, Germany.
|| KEY3, KaVo, Biberach, Germany.
¶ Cavitron Select, Dentsply, Konstanz, Germany.
# FSI Slimline, Dentsply.
** PCP 12, Hu-Friedy Co., Chicago, IL.
†† SPSS version 10.0, SPSS Inc., Chicago, IL.
‡‡ G*Power Analysis Window 2.0, Edgar Erdfelder, Department of Psychology, University of Bonn, Bonn, Germany.
Correspondence: Dr. Anton Sculean, Department of Conservative Dentistry and Periodontology, Johannes Gutenberg University, Augustusplatz 2, D-55131 Mainz, Germany. E-mail: [email=”email@example.com.”]firstname.lastname@example.org.[/email]
Accepted for publication November 14, 2003.
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© Copyright 1999-2004 by the American Academy of Periodontology; all rights reserved. Each subscriber to the Journal of Periodontology is hereby granted permission of the Academy to download one copy of each article for non-commercial purposes. Disclaimers apply.July 31, 2004 at 5:57 am #9672
Other studies excluded ultrasonics when comparing an Er:YAG for root planing.
This study didn’t and the Er:YAG did no better than a cavitron…and a calculus detection laser was used as well! May have been the Detectar. NO CALCULUS detection laser was used for the ultrasonic.
In addition, concerns about damage to the root were mentioned, but said they must be insignificant because clinically things went well.July 31, 2004 at 11:01 am #9669
Wow, I hope those studies were a cut and paste job
Not having used the Detectar in conjunction w/ the laser, my concerns are that unless the Detectar locked the erbium beam onto the fluorescing calculus , (like radar on an enemy plane) its additional benefit seems limited. I can picture some difficulty with the Detector going off, and then repositioning the erbium beam to hit the calculus. I think I’ll wait for the Alexendrites for laser scaling.
Thanks for sharing,August 2, 2004 at 4:18 am #9673
The detectar has a few too many false negative because of the angle of the beam…and it seems just because it says it’s there, doesn’t mean you can remove it!
It took me 20 minutes with a perioscope to remove one piece I could see at a demo.August 2, 2004 at 1:52 pm #9678
I can testify that the Detectar adds considerable time to the search for elusive calculus and false positives!
BobAugust 2, 2004 at 2:16 pm #9676
“The sites treated with ERL demonstrated mean CAL gain of 1.48 ± 0.73 mm (P <0.001) and of 1.11 ± 0.59 mm (P <0.001) at 3 and 6 months, respectively.” versus 4.1mm in the Yukna/LANAP/LSU/IADR study using FRP Neodymium:YAG.
Excuse me while I yawn. 😉
This study has no human histology to determine whether the results were via repair (long junctional epithelium), new attachment or ankylosis.
The Yukna FRP Nd:YAG and Laser ANAP human histology study at three months demostrated cementum-mediated NA.
Swartz’s study was funded by KaVo the manufacturer of the Key3 erbium YAG and a built in red laser fluorescence feedback calculus detector.
I’m sorry, but if the clinical results aren’t any better than this–even with cementum NA then why bother?
At least this company is funding some research in an attempt to support their technology, and the results are being published. I give them credit for that!
BobAugust 3, 2004 at 1:22 am #9670
Er for calculus removal sounds good! The Detectar sounds good. Once you have used a perioscope and have seen where calculus is left by a qualifed person, then you realize it just is not going to be better then a peizo and handscaling. It will be impossible to angle the Detectar or the Er in the sulcus to even locate the calculus much less remove it.
I am waiting to see how the Periolase does with the perioscope. I am in hopes that the calculus is easier to remove once it has been lased. We are now up to two teeth in two hours with the perioscope after over a year. Then again the last case was 2 hours on one lineangle and CEJ.
DavidAugust 3, 2004 at 3:23 pm #9674
How is dentalview functioning as a company right now? I was told by Stombaugh that they can’t even pay attention right now.
Agreed on it sounds good but won’t fly.
I know that the hygienist that spoke for perioscope was asking Bob about degranulating for better vision…can’t think of her name to save my life right now.August 3, 2004 at 5:41 pm #9671
DentalView is hanging on by a thread. It is really a shame. Kim Kutch is still on the advisory board, I think.
I sure hope they hang in there or someone buys them up. Hard to believe but the ROI has been greater for the Perioscope then the lasers. Though the new patient inflow is far greater with the lasers.
Degranulation for better vision is a big plus! I use my Diode to do this. If only the hygenist coud use the diode life would be easier.August 4, 2004 at 2:01 am #9680
SwpmnSpectatorQUOTEAt least this company is funding some research in an attempt to support their technology, and the results are being published. I give them credit for that!
In the middle of my yawn the quoted comment cracked me up. If you hit a square peg hard enough you can force it into a round hole. With current erbs, I suggest sticking to composite restoration preps and certain soft tissue procedures.
AlAugust 4, 2004 at 12:29 pm #9675
Glenn van AsSpectator
GlennAugust 4, 2004 at 2:30 pm #9679QUOTEQuote: from lookin4t on 11:23 am on Aug. 3, 2004
How is dentalview functioning as a company right now? I was told by Stombaugh that they can’t even pay attention right now.
Agreed on it sounds good but won’t fly.
I know that the hygienist that spoke for perioscope was asking Bob about degranulating for better vision…can’t think of her name to save my life right now.
Anna PattersonAugust 4, 2004 at 2:33 pm #9677
It’s hard to get a audible laugh out of me this time of the day, but your post did it!