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April 24, 2004 at 1:51 am #3257
J Periodontal Res. 2004 Feb;39(1):59-65. Related Articles, Links
Detection of subgingival calculus and dentine caries by laser fluorescence.
Kurihara E, Koseki T, Gohara K, Nishihara T, Ansai T, Takehara T.
Department of Preventive Dentistry, Kyushu Dental College, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Japan.
OBJECTIVES: Detection of subgingival calculus and dentine caries in the bottom of deep periodontal pockets is often difficult without visual observation. We thus examined the possibility of its detection using autofluorescence induced by laser irritation. METHODS: Autofluorescence was measured at various excitation and emission wavelength settings in five specimens each of sound dentine and enamel, subgingival calculus, and root caries. Periodontopathic model teeth with bacterial cells and blood clots were also irritated by laser to obtain autofluorescent images. RESULTS: Subgingival calculus and dentine caries showed a characteristic 700 nm emission when excited at 635 nm or a 720 nm emission when excited at 655 nm; sound dentine or enamel, however, did not. The calculus differentiation power, however, was higher with excitation at 635 nm than at 655 nm. The autofluorescent images photographed at an excitation of 633 nm provided clear calculus identification in periodontopathic model teeth when a 700 nm band-pass filter or a 700 nm high-pass filter was used. However, fluorescence intensity was masked when the calculus surface was covered by bacterial cells or blood clots. For clinical use, it would be important to remove subgingival plaque and debris from root surfaces before attempting to detect subgingival calculus and root caries with this manner. CONCLUSION: The autofluorescence method employing excitation of 633-635 nm was found to be a powerful tool for detecting subgingival calculus and root caries.April 24, 2004 at 2:03 am #9654
Glenn van AsSpectator
As always Ron great stuff……….
Any idea how to remove the plaque and blood subgingival.
GlennMay 29, 2004 at 3:30 pm #9657
Robert Gregg DDSSpectator
I’ve been evaluating the Detectar from Ultradent that is a calculus fluorescence detection device /= 640nm (red)
It does help me find about 25% more calculus, especially in the deeper pockets, after I have done my S/RP and ultrasonics.
It is very sensitive to false positives because ledges and root form change the incident angle to the probe. Angulation to the root/calculus determines accuracy of device.
Still very worthwhile in LANAP.
Glenn–the Detectar fits nicely into the LANAP protocol after the first pass with the FRP Nd:YAG to remove plaque and pocket debris, and control blood flow, then after the ultrasonic pass rids the root of all but residual calculus–ideal for what the Detectar is capable of.
I give it a “thumbs up”!
BobMay 29, 2004 at 4:26 pm #9655
Glenn van AsSpectator
Thanks Bob…….what is the cost of the detectar?
I think it is great that you are building on your model.
Have you ever thought of incorporating the Perioscope into the LPT protocol.
GlennMay 29, 2004 at 11:31 pm #9658
Robert Gregg DDSSpectator
I don’t know the cost. This one is on loan/evaluation.
We continue to build on the basic model of LENAP/LANAP. We will use what adds value to our clinical experience and make recommendations that contribute to improving the doctor/patient clinical outcomes.
Yes, we have thought about endoscopy as an adjunct in LPT/LANAP. Our concern is the image of the current technology for dentistry. Medical endoscopes show a much higher resolution and image clarity and definition than we have in dentistry right now. Our other concern is that the protocol can get too “tech-heavy”. We want sufficient technology to get the job done to a high rate of success (90+%), and leave room for the individual clinician to expand and develop their own particular style and value added technology w/in the context of the established protocol.
This is really a great question. While there are certain inviolate rules for wound healing, physiology, and laser tissue interations that must be attended to and performed in a certain sequence, there is enough room in the LANAP protocol for individual differences and styles of execution.
For example, we insist that patients completes all 4 quads (that are usually necessary) within one week or be on antibiotic coverage until they can complete all 4 quads if they can’t return for a week or 3.
Dr. Leigh Colby in Eugene Wash does it slightly differently. He refuses to treat any patient unless they agree to complete all 4 quads in 3 DAYS. (I’m not sure if he even gives antibiotics.) He is also more likely to extract a tooth with double digit pocket chartings than we are.
We also recommend a certain type of splint. Dr Colby uses FM fixed ortho wire………
BobJune 21, 2004 at 1:38 am #9656
񘧸 USD for a Detectar.
KenJuly 31, 2004 at 6:00 am #9653
Please see my post…calculus detection laser was used in conjunction with an Er:YAG for root planing….and achieved no benefit as that group was identical to a group that was root planed with ultrasonic only. Weird, first study they omit hand instruments to show a laser superior, then they omit hand instruments and get equivalency. What would happen if they allowed some hand instrumentation?