Concepts in Laser Periodontal Therapy - Thesis Example

This strategy is aimed at abating, if not eliminating, etiologic agents of the disease, like microbial film and subgingival calculus [14], and restoring periodontal attachment level through the reconnection of periodontal fibers with newly formed cementum [2,52]. For nonsurgical management of early to moderate chronic periodontitis, scaling and root planing (SRP) remains the traditional initial approach of treatment. Scaling removes plaque, calculus, and stain from the crown and root surfaces while root planing entails the complete debridement of cementum or dentin from the root surface for the purpose of smoothing it and displacing calculus [12].

The procedure also extends to adjacent periodontal tissues [1]. Although the positive effects of SRP in chronic periodontitis have been, time and again, validated, i.e., “reduction of clinical inflammation, microbial shifts to a less pathogenic subgingival flora, decreased probing depth, gain of clinical attachment, and less disease progression,”[14] This procedure has known drawbacks. The use of lasers in the dental application was first noted in 1964, when the ruby laser was first used, unsuccessfully, however, on enamel and dentine.

There are currently three types of lasers with the dental application: gas lasers, such as CO2; diode lasers, viz., InGaAsP, GaAlAs and GaAs, and; solid-state lasers, e.g., Nd: YAG, Er: YAG and Er, Cr: YSGG [42]. Lasers are designed to ablate or, to vaporize, only the diseased tissue from the inner epithelial lining of a periodontal pocket resulting in a better, more predictable end result to treatment, a process that involves cauterizing blood vessels, nerve endings, and lymph glands, providing hemostasis, postoperative pain control and rapid healing [51].

Gas and diode lasers are excellent for soft-tissue ablation and hemostatic purposes but often result in carbonization, thermal damage [42], and induced melting when utilized on the root surface of alveolar bone [60], limiting their use to soft tissue procedures. As observed by several researchers, neither CO2 nor diode lasers are effective in removing calculus from the root surfaces [51]. In the present study, comparative therapies were conducted on patients with early to moderate periodontitis.

The first therapy was the conventional SRP and the second was SRP with Er, Cr: YSGG laser as an adjunct. The study was done for a period of one year and was purposely conducted to engender comparative clinical results between the two modes of therapy. The study showed that although both non-surgical treatments have significantly improved all clinical parameters investigated, the therapy consisting of SRP and Er, Cr: YSGG laser as an adjunct has a longer clinical effect than that of SRP alone. 2.0 Literature Review 2.

1 The Melcher Hypothesis: The Importance of PDL in Periodontal Healing As far back as 1984, Antony Melcher had already stressed the importance of the periodontal ligament (PDL hereafter) in periodontal healing noting that of the four connective tissues comprising the periodontium, i.e. PDL, cementum, alveolar bone, gingival lamina propia, it is only the PDL that contains all phenotypes of fibroblasts, osteoblast, and cementoblast (48).