Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › Periodontal treatment
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dkimmelSpectatorPeriodontal tx before the laser was pretty sight forward in my office. Depending on the type tx ranged from simple OHI and prophys to RPCs , irragations and use of different subgingival antimicrobals. Often we refered for sx and just as often a patient declines and we watch and rescale as needed.
For example. Type 3 perio patient. Would get 4 appts of RPC with OHI( Arestin in pockets >4mm). Then a Fine scale with OHI and followed at 2 mo with post op probing and a 3 mo recall.
Now that I have the Waterlase and the Smilelaser now what?
Is everyone routinely doing a decontamination on all prophy patients?
Decontamination on all active perio sites?
Degranulation after RPC?
Any Degranulation with out RPC?
What frequencies do you use. Only once ? Every week for 4 weeks?
So far I have only seen hints of how treat is done and nothing specific!
Being a newbie I can tell you it feel sa lot like Voodoo Magic moving that tip around in a pocket!!
DAvid
Robert GreggParticipantHi David,
“Is everyone routinely doing a decontamination on all prophy patients?”
If you mean recall or perio maintenance patients, yes.
“Decontamination on all active perio sites?”
Absolutely!
“Degranulation after RPC?”
Well, what do you mean by degranulation?
“Any Degranulation with out RPC?”
Same question….
“What frequencies do you use. Only once ? Every week for 4 weeks?”
Current diode protocols are full mouth decontamination once a week depending on pocket depth. .4-.8 watts
“So far I have only seen hints of how treat is done and nothing specific!”
Probably should get some training from diode trainer like Bob Barr or Don Coluzzi.
QUOTEBeing a newbie I can tell you it feel sa lot like Voodoo Magic moving that tip around in a pocket!!Yes, I remember the feeling–or lack there of. But it is working therapeutically.
Bob
(Edited by Robert Gregg at 9:01 pm on Mar. 17, 2003)
AnonymousGuestHi David,
I would second the recommendation of getting some training from Bob Barr and Gloria, see http://www.rwebstudio.com/cgi-bin….topic=5
The simple version of Tx is
scale/rt plane then-
1. treat quadrant with deepest pocket 1st
2. activated tip used to deepithelialize 1mm short of pocket depth
3. decontaminate pocket ,placement of tetracycline
4. 1 week later- do #2 followed by #3 in new quadrant and return to 1st quadrant to decontaminate again 1mm shorter than previous tx.
Occlusal adjustment as necessary.
Rule of thumb is pocket depth minus 3=# of treatments
7mm pocket will be revisited 4 times.
The de-epi is done w/ activated tip continous w/ local
The decontam is done w/ nonactivated tip , pulsed /no local
We’ve got nice results 6mm and less. Often resolve to 2’s and 3’s. Not been doing it long enough for xray’s to check bone.That being said, from my investigation and time spent w/ Bob G., I think his Periolase MVP-7 offers a much better result, with less patient time and retreatment. I’ll probably be selling my diode when the MVP-7 arrives , so if you know anyone who’s interested ….?
Hope that helps,
SwpmnSpectatorRon:
Ha ha ha!!!! I got a good chuckle out of the last paragraph in your post. Sounds a lot like some of the frustrations I post with my Erbium. Actually it’s not really funny but that’s why we are here – to learn from one another.
Keep us informed on your experiences with the Nd: YAG once it arrives.
Al
dkimmelSpectatorBob, Thanks for the reply. By degranualation I would be refering to curettage.
Do you have a link to Don Coluzzi ? Plan on seeing Bob sometime this year. Going to see Rosenberg next month and plan on seeing Mark in July!
Ron ,Thanks but I am confused about the MVP-7.
David
AnonymousGuestSorry David,
I was referring to the Periolase MVP-7 that Bob Gregg and Del have developed.
http://www.millenniumdental.com/main.html
Didn’t mean to be confusing,I was kind of poking fun at myself because, if this forum was here last July and if I had done better research and investigation before buying my Twilite, I’m sure I would only have a Waterlase and Periolase MVP-7 and no diode. Instead I’ll have all 3.
Sounds like you’re going to be learning some great things, from some great people.
Be sure to share with the rest of us later,
Robert GreggParticipantRon,
Thanks for the support!
David,
There are two ways to think about “degranulation”. One is actually heating up the proteins to a point the granulation tissue “sticks” to the fiber and can be removed from the sulcus (aka sulcular debridement), and then “laser de-epithelializattion” (aka laser curettage) to remove the inner ulcerated and diseased lining of the perio pocket.
A link to Don Coluzzi is:
don@laser-dentistry.com
<a href="http://www.laser-dentistry.comSounds” target=”_blank”>http://www.laser-dentistry.com
Sounds like you’re gonna get some god education. Give my regards to Stu, Don and Bob when you see them.
Bob
dkimmelSpectatorBob,
Thanks as it is much clearer with regards to sulcular debridement and laser curettage. Was that a slight slip with the drop of the O?
Ron,
Your notes on perio tx were a great help. I to am starting to question my decision on buying the diode laser. Live and learn.
I am hoping I will learn alot next month. This has been a rather fustrating week. I really do not have a feel for using the laser on hard tissue. It is almost most like I am trying to use an air brush. I just don’t seem to get the Watts, air,water and hand motion down to make the preps look like I expect. Much to learn and so little time!
David
Robert GreggParticipantHi David,
How funny!:biggrin:
Yes that was a slip of the “o”. Some folks just may hold one or all of these guys in such high esteem!!
We may never live it down if you go now and tell them I referred to them as “gods”.
Bob
BNelsonSpectatorHi All,
I have to agree with you all on Bob and Del’s Nd:Yag. I just finished a great 3 days in Cerritos with both of them learning to use my new MVP-7. So much to learn, and I was thinking about a diode after the Biolase meeting. Glad I met Bob first, as this laser seems to do a whole lot more a lot better.
Ron- As far has the erbium and hard tissue, I picked up a handful of extracted teeth from the oral surgeon and spend a few afternoons playing with those. Sure helps if you haven’t tried it.Best regards,
Bruce
RodSpectatorRon,
I also have heard great things about the Periolase, but I’ve got a question for you regarding the diode. Are you unhappy with the results, or are the results less than you’d hoped for?
The results I’m seeing with my diode are blowing me away. Of course, the laser is simply one of the tools I’m using. But you seem very disappointed with the diode. Why?
Rod
AnonymousGuestRod,
Since August I am now on my 3rd machine. I’ve had to reschedule patients and explain time and time again why we have to postpone tx. This last time I was without the laser for a week. We’ve also had 3 fibers separate at the connector (where the fiber attaches to the machine- the metal connector separates in 2) Its hard to get healing from the bottom up if you can’t do the followup because the machine is down.Biolase is very cooperative in helping to straighten things out but its just frustrating. I also didn’t get an answer from them about whether my year warranty starts over with the delivery of the 3rd machine.
I’ve also been disappointed in the whitening (I didn’t buy it for that though) -limited results and some cases of very sensitive teeth. Seems everyone needs to follow up with trays.
I have thought the diode is great for cases like the one you just posted and for perio when pockets are in the 5-6 mm range. Greater than that and my results have been less than I expected. I also think its a pain going back and decomtaminating time and time again. 9 mm pocket gets revisited 6 times.
I guess as I begin to understand more of the physics involved I worry more about how hot the activated tip is and collateral damage.
The diode has made me put a lot more clench marks in my biteguard than the Waterlase ever has 😉
SwpmnSpectatorRon:
That is quite disappointing regarding the mechanical problems with your Diode. “Ah feel your pain” on a different system.
Interesting that you aren’t particularly impressed with the Diode bleaching. Many people, e.g. John Kanca, feel there is no light or laser effect on “in-office” bleaching. We’ve had good initial results with Ultradent Opalescence Xtra Boost(no light/laser) but also see the need for follow up with “take home” trays.
I’d like to learn more about Diode/Nd: YAG lasers for treatment of periodontitis as my interests have only been with the Erbium for hard tissue treatment. Couple of questions:
1) Is there a body of scientific evidence which shows a significant difference between treating periodontitis with root planing vs. root planing combined with Diode or Nd: YAG laser?
2) Within those studies, is there evidence that attachment loss greater than the 5-6 mm pockets you mentioned can be successfully treated without surgery and by using Diode or Nd: YAG lasers?
Anyone else that is in the know feel free to respond and help educate me.
Al
AnonymousGuestWell Al ,
Here’s 1 –
Lasers Surg Med 1998;22(5):302-11 Related Articles, Links
Treatment of periodontal pockets with a diode laser.Moritz A, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J, Sperr W.
Department of Conservative Dentistry, Dental School of the University of Vienna, Austria.
BACKGROUND AND OBJECTIVE: The aim of this study is to examine the long-term effect of diode laser therapy on periodontal pockets with regard to its bactericidal abilities and the improvement of periodontal condition. STUDY DESIGN/MATERIALS AND METHODS: Fifty patients were randomly subdivided into two groups (laser-group and control-group) and microbiologic samples were collected. There have been six appointments for 6 months following an exact treatment scheme. After evaluating periodontal indices (bleeding on probing, Quigley-Hein) including pocket depths and instruction of patients in oral hygiene and scaling therapy of all patients, the deepest pockets of each quadrant of the laser-group’s patients were microbiologically examined. Afterwards, all teeth were treated with the diode laser. The control-group received the same treatment but instead of laser therapy were rinsed with H2O2. Each appointment also included a hygienic check-up. After 6 months the final values of the periodontal indices and further microbiologic samples were measured. The total bacterial count as well as specific bacteria, such as Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis, were assessed semiquantitatively. RESULTS: The bacterial reduction with diode laser therapy was significantly better than in the control group. The index of bleeding on probing improved in 96.9% in the laser-group, whereas only 66.7% in the control group. Pocket depths could be more reduced in the laser group than in the control group. CONCLUSION: The diode laser reveals a bactericidal effect and helps to reduce inflammation in the periodontal pockets in addition to scaling. The diode laser therapy, in combination with scaling, supports healing of the periodontal pockets through eliminating bacteria.
Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 9671997 [PubMed – indexed for MEDLINE]
Of course you might want to consult the expert also known as – rfw in the DT active cases, right Bob G? :biggrin:
RodSpectatorHi Ron,
I have a big problem with my ‘non-surgical’ (meaning no-flap and no sutures) perio approach. The problem is that it’s TOO effective. Damn! I LOVE, LOVE, LOVE perio surgery and bone regeneration procedures. And now I just don’t get much chance to do them.
I don’t follow all the ‘rules’. I don’t expect ANYbody to follow my lead, because I don’t have any formal publications/studies/scientific numbers, etc. This is one of these things that makes sense to ME, works for ME, is used by ME, and I’m NOT suggesting that anyone try this if they are very ‘evidence’ based regarding scientific literature.
To me, root planing is numero uno! Even before the diode laser, I’ve gotten incredible results with non-surgical. Not uncommon to take 7-8 mm pockets to a 2 or 3. Yes, I’m assuming I get a long junctional epithelial attachment, but I’ve found them to be, in general, very durable if the patient continues proper home care.
There’s root planing, and then there’s ROOT PLANING. The ‘star’ of my technique is the Zeza ultrasonic curette insert. It’s actually a REAL curette in the form of a 25K ultrasonic (Cavitron type) insert. Gotta be SURE not to get the ‘surgical’ version — otherwise you’ll cut grooves in the roots.
When I say these root plane, I ain’t kiddin’. Holy moly! I use Arestin liberally, however I do NOT subscribe to the recommendation to avoid flossing. Why? If the Arestin is say, 7 mm into a pocket, how is floss gonna remove it? So I have my patients floss, with the idea that anywhere they could remove the Arestin by flossing, they don’t need Arestin anyway. Heck, you just took the time to do all this non-surgical treatment, and now you’re gonna tell the patients NOT to floss for a week or more? No way. Your most important healing is taking place during that first week.
Next (I’d better hide on this one), I put all my patients on doxycycline for two weeks. I insist we complete their mouth within the first week so that they still have a full week of doxycycline after we are totally finished.
Doxycycline is not only antibacterial, but it reduces natural collagenase. It’s also been shown to enhance root attachment of fibroblasts. Now, I’m not saying we’re gonna get a fibrous attachment, but in my book, any medication that can be shown to enhance fibroblast attachment has GOT to be making the tissues ‘happy’, and I’ll take ‘happy’ tissue any day.
So anyway, killer SRP and Arestin. Before the Arestin I use the diode. I use it at 1 watt continuous with the tip initiated well. I don’t fool around. I get in there and paint out the epithelium from the pocket. Yeah, I know, it was clearly shown at the 1989 World Workshop in Perio at Princeton that removal of sulcular epithelium is ineffective. I see otherwise. I’ll tell ya, there ain’t no way you can remove the epithelium as effectively without a laser.
I use the laser on that visit, and that’s it! I do NOT go back in to decomtaminate. I just don’t see the reason. Even though the Arestin will be gone within 7-10 days, there is substantivity and the effect will last much longer. And I’ve got them on doxycycline for 2 weeks, and doxy is partially excreted, unchanged, through the sulcus/pocket.
I’ve got my patients using the Hydrofloss after 10 days also. But ONLY after diligent brushing and flossing. I’ve got them on Peridex, including use in the Hydrofloss. I turn them into homecare fanatics. I scare the holy **** out of the patients by telling them the TRUTH about what will happen in the future if they don’t perform proper home care. Are these ‘scare tactics’? Well, if telling them the truth is scary, then so be it. And I tell them exactly that.
Anyway, I keep kinda hoping (not really) that on re-eval there will be seen a need for surgery (because I love doing it), but usually we are so amazed at the results that our jaw drops. It continues to flip me out each and every time.
Anyway, from what I’ve seen, the laser simply makes my routine more effective. It’s not a magic bullet on it’s own. I can’t say for other types of lasers, but I would not even CONSIDER laser perio treatment without killer SRP.
Someday, I hope to get around to checking out Bob’s laser more closely. Now THAT sounds major cool! Like some others, I do have some skepticism about actual bone regeneration, but only because I just haven’t had the time to really look into it deeply.
Like that rfw guy, I’ve seen selected cases of bone regeneration simply from root planing (the ‘unusual’ case). So seeing a case here and there with apparent bone regeneration with Bob’s laser isn’t enough to get me to buy one — yet. And I WISH I wasn’t so damned busy so that I could investigate it more, ’cause I just have the feeling that it may be a major deal. Like I said, someday.
Rod
(Edited by Rod at 1:19 pm on Mar. 23, 2003)
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