Efficacy+of+Lasers

An advantage of lasers are bacteriocidal effects. The ErbiumYAGlaser is among a group of lasers for dental application that can effectively be used on hard and soft tissue. This laser has been shown to reduce bacteria following 6 and 12 months after its usage.
 * 1. Er:YAG Lasers can be used as an adjunct to scaling and root planning to reduce activity of bacteria. KT4**

Studies have demonstrated that Er:YAG lasers are ineffective in eliminating all pathogens in the periodontal pocket. In one study lasers were compared to hand scaling, Er:YAG, and ultrasonic scalers and the bacterial count in the periodontal pocket was evaluated after the intervention. The results concluded that lasers were as effective as the other methods in reducing the bacterial count of P. intermedia, P. gingivalis, T. forsynthia, and T. denticola. However, Aa was not eradicated by the laser and ultrasonic scaler. This demonstrates that the bacterialcidal effects of lasers are not effective for all the periodontal pathogens in the pocket. Also this proofs that lasers can be as effective as other methods of intervention in eliminating pathogens.
 * 2. Er:YAG Lasers have no effect in eliminating all periodontal pathogens when compared to other methods**. **MC#3**

Usage of lasers is making it's way into the dental office. The usage of lasers is to eradicate the bacteria that is present in the periodontal pocket. With the usage of lasers as an adjunct to traditional scaling and root planing clinicians see a decrease in bleeding on probing as well as papilla bleeding index. Therefore concluding that the SRP combined with lasers provides added benefits to the patient.
 * 3. Lasers used as an adjunct to scaling and root planing show a reduction in BOP LM # 11**

Lasers have been used in dentistry since 1994 to treat a number of dental problems, such as tooth decay, gum disease, biopsy or lesion removal, teeth whitening, and reduction in hypersensitivity.
 * 4. The use of dental lasers can reduce dental sensitivity. RK 7**

__Tooth decay__: Lasers are used to remove decay within a tooth and prepare the surrounding enamel for the filling Lasers are also used to cure a filling. __Gum disease__: Lasers are used to reshape gums and remove bacteria during root canal procedures. __Biopsy or lesion remova__l: Lasers can be used to remove a small piece of tissue so that it can be examined for cancer. Lasers are also used to remove lesions in the mouth; and relieve the pain of canker sores. __Teeth whitening__: Lasers are used to speed up the in-office teeth whitening procedures. A peroxide bleaching solution, applied to the tooth surface, is activated by laser energy, which speeds up of the whitening process.

The effectiveness of lasers in reducing dental hypersensitivity was evaluated through studies that compared the use of laser therapy to placebo laser therapy. In addition the study reviewed literature to determine the safety of receiving laser treatment. A detailed search of literature was performed in order to find randomized studies containing placebo-controlled clinical trials which measured the effectiveness of reducing dental hypersensitivity with lasers. Three studies were found, all of which supported the use of lasers in reducing hypersensitivity. However it was noted that there was not a significant difference between the placebo group and the laser group. When addressing the safety of lasers the research found no side effects, adverse reactions, or pulp damage at the settings used in the studies.

Reference Sgolastra, F, Gatto, R, & Monaco, A. (2011). Effectiveness of laser in dentinal hypersensitivity treatment: a systematic review. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed

5. The erbium laser's efficacy compared to SRP was no greater than supragingival scaling only. AP12
The use of Er:YAG laser was compared to the supragingival debridement, SRP+Er:YAG, and SRP groups. There was no difference between the Er:YAG and supragingival groups in gaining attachment. The SRP and SRP+Er:YAG groups were equal in attachment gain and had greater gains than the Er:YAG and supragingival groups.

Studies have shown that when lasers are used as a adjunct with other periodontal procedures it has shown to decrease pocket depths, BOP, and interleukin-1B in gingival crevicular fluid in patient with chronic periodontitis. A disadvantage to lasers is that when used as a adjunct to scaling and root planing it may have to be repeated at every recare visit in order to keep the bacteria count low in the pocket.
 * 6. Lasers can be used as a adjunct with other periodontal procedures. GE#6**

Studies that have been conducted on the use of Photodynamic therapy to treat chronic periodontitis as an adjunct to SRP are limited. The results of the studies that have been implemented have shown no clinical or statistical differences when compared to SRP alone.
 * 7. Research on lasers is limited, therefore the evidence is weak. MT#18**

In the dental field, lasers have been indicated for many uses. Depending on what treatment is indicated, different types of lasers may be used. The types of lasers used in dentistry include: excimer lasers, gas lasers, diode lasers, and solid-state lasers. Excimer lasers use either argon-fluoride or xenon-chloride as the active medium. According to Carranza, this type of laser is used for "hard tissue ablation" and calculus removal. Gas lasers can use argon, helium-neon, or carbon dioxide as their active medium. These lasers can be used for curing composite, tooth whitening, soft tissue surgery, treatment of dentin hypersensitivity, as well as removal of gingival melanin pigmentation. Diode lasers can use indium-gallium-arsenide-phosphorus, galium-aluminum-arsenide, or galium-arsenide. They can be used for caries and calculus detection, as well as intraoral soft tissue surgery, subgingival curettage, treatment of dentinal hypersensitivity, pulpotomy, and root canal disinfection. Solid-state lasers can use frequency-doubled alexandrite, neodymium:yttrium-aluminum-garnet (Nd:YAG), or erbium including erbium:YAG, erbium:yttrium, and erbium, chromium. These may be used for "selective" removal of plaque and calculus, intraoral soft tissue surgery, subgingival curettage, osseous surgery, treatment of dentin sensitivity, and removal of gingival melanin. Uses of the lasers for hygiene applications still requires more research before it can be deemed effective.
 * 8.** **There are several types of lasers utilized in dentistry, and each has applications it is considered to be more effective for. MW 19**

Currently the research is limited. However we are headed in the direction of lasers being used more frequently. According to perio.org, "at this time there is insufficient evidence to suggest that any specific laser wavelength is superior to the traditional treatment methods of the common periodontal diseases..." WIth a variety of different wavelengths available, (depending on the area being treated), as well as advantages such as the bactericidal effect and hemostasis, lasers will continue to gain popularity as the research expands.
 * 9. The use of lasers in dentistry will expand in the near future, as their efficacy is better shown through research. TL #8**


 * 10.Early Stage of Research SR 14 **

Through clinical research the use of laser therapy has been show to decrease the amount of bacterial load, decrease pocket depths, eliminate calculus, and decrease patient discomfort. However they have not been able to match the efficacy of manual SRP. This has prompted the use of laser as adjunct therapy to increase patient adherence or increase treatment outcome. The use of laser therapy has been increasing in clinical setting with the current data but there is still more research that needs to be done because of questionable data. There are many types of lasers with different uses and applications which may not allow duplication of treatment outcomes. This questionability should limit the use of laser therapy in clinical setting until these issues have been resolved. Laser therapy is at an early stage and it may become an adjunct therapy or initial therapy with more research to support treatment outcomes.

11. **Several potential risks associated with clinical use of lasers. LL#9** Some of the potential risks mentioned in Carranza regarding the clinical use in were excessive tissue destruction by direct ablation and thermal side effects. Carranza did not specify which particular laser, but in the in an article by Caruso et al. (2008) specified that the Nd: YAG wa laser not useful for dental hard tissues due to its thermal side effects on the pulp and alveolar bone. In addition, Carranza also mentioned thermal injury to the root surface, gingival tissue, pulp, and bone. Another possible risks was the destruction of the attachment apparatus at the base of the pocket and excessive ablation of root surface and gingival tissue within the periodontal pockets. Clinical experience and expertise were defined as one of the important factors needed to perform the technique.

Among the current lasers available, high-power lasers such as CO2, Nd:YAG, and diode lasers can be used in periodontics. Because of their soft tissue abalation and hemostatic characteristics, their use has been approved for soft tissue management in periodontal and oral surgery. However, when applied to the hard root surface or alveolar bone, major thermal damage has been reported. This is why their recommended use has been limited to gingivectomy, frenectomy, and similar soft tissue procedures.
 * 12. The use of lasers for periodontal treatment becomes more complex because the periodontium consists of both hard and soft tissue. CE5**