nemoci-sympt/ZUBNI/laserove-cisteni-zubu/indikace
- More than 20 cleared indications for use for dental lasers in the United States [1]
- Pokud jsem to dobře pochopila a hledala dost dlouho, tak žádná oněch idikací dle ADA není laserové čištění zubů
Aid in the Diagnosis of Caries
- Laser fluorescence may be a useful in the detection of early enamel caries
- The level of energy used in this application poses
- Little risk to the patient
- Offers potential benefits
- One product available commercially in the United States is based on this laser technology
- Using a diode laser at 655-nm wavelength [1]
Laser-Assisted New Attachment Procedure (LANAP)
- A 2007 publication - advanced chronic periodontitis
- Traditional mechanical therapy vs.
- Traditional mechanical therapy + two intrasulcular applications of Nd: YAG
- Removing the sulcular epithelium
- “seal” the pocket
- Histology was performed on 6 pairs of single-rooted teeth at 3 months
- Laser-treated pockets tended to show greater
- Probing depth reductions
- Clinical attachment gains
- Lasered teeth showed
- Evidence of new cementum
- 5 of the 6 control teeth showed a long junctional epithelial attachment
- LANAP can be associated with
- Cementum-mediated new connective-tissue attachment
- Apparent periodontal regeneration
- Of diseased root surfaces in humans [1]
- Dentists should note that this study provides
- no more than pilot validation for this treatment concept
- Study was not blinded
- Sample size was small
- Pre-treatment notches in the teeth were difficult to place
- Hard to know exactly where they were placed
- Are difficult to clearly detect on histological specimens [1]
- Advanced periodontal destruction initially present in these 6 test teeth
- Make it difficult to extrapolate these results to cases of early and moderate chronic periodontitis (nebo dokonce na zdravé zuby !!! )
- Where the anatomic environment, laser energy distribution and clinical outcome may differ substantially [1]
- It is also unclear what laser-based “sealing” of a treated periodontal sulcus is
- If real, what benefits it might provide
- Additional clinical data from properly designed clinical trials with adequate sample sizes are still required
- Before it can be known to what extent LANAP is safe and effective across the spectrum of patients with chronic periodontitis
- The Council therefore cautions clinicians to weigh the available evidence for LANAP [1]
Takže co v tom čtu selským rozumem
- Laserem zničí epitel mezi dásní a zubem, včetně bakterií a zánětlivých buněk (překážka zhojení jakékoliv rány) - možná i lehce naruší sklovinu nebo už ani v téhle úrovni asi ani není a odhalený nejspíš i laserem lehce narušený povrch dentinu (to vše si domýšlím) je asi dobrý stimul k tomu, aby se z těchto tkání začaly uvolňovat různé růstové faktory a spustil se tak proces hojení - mezi laserem narušenou dásní a dentinem ( kostní hmotou zubu) - formou vzniku vaziva - podobně jako v kůži jizva - tedy jako jakákoliv jizva kekoliv v těle, kde rána zasahuje pod bazální membránu epitelu
- Dokážu si představit, že účinek laseru bude zvyšovat preciznost celé kyretáže, která sama o sobě pouze mechanicky asi neumí tak dokonale zničit prorostlý epitel a přisedlé bakterie na všech místech, kde překáží tvorbě a přisedání vaziva ke kosti aj.
- Tohle by mohla tedy být výhodná indikace
- Ale stojím o podobný zásah ve vyšší části zubu, pokud chci odstranit jenom pigmentový zubní kámen ze skoloviny ?
- To už od toho laseru očekávám dost jiné vlastnosti...
Laser Root Planing
- Erbium lasers show potential for effective root debridement.
- Er:YAG laser has been shown, in vitro, to
- Remove calculus
- Negate endotoxin [1]
- Clinical data also exist that suggest the Er:YAG laser can result in
- A superior calculated clinical attachment gain
- Compared with mechanical scaling and root planing alone
- The Council views such developments as encouraging.
- Additional well-designed comparative studies would be helpful to clinicians in confirming these results. [1]
Laser Wound Healing
- Low-powered lasers to improve wound healing have been noted for many years but the reported results have been mixed.
- Risk of thermal damage from low-powered lasers appears minimal, the Council considers the application of laser energy purely for the purpose of improved wound healing to be controversial and not well supported by clinical studies. [1]
Reduction of Bacteria Level
- Lasers, as a group, have inconsistently demonstrated the ability to reduce microorganisms within a periodontal pocket.
- It appears from the literature that mechanical root debridement remains a priority to attain improvements in clinical attachment levels.
- Limited new data suggest that clinical outcomes may be enhanced by the adjunctive use (following root debridement) of a bactericidal irrigant activated by a cold laser [1]
Sulcular Debridement (Curettage)
- When used as an adjunct to
- Meticulous root planing
- Mechanical or chemical curettage
- Intentional removal of the epithelial lining of the sulcus
- Offers no consistent benefit beyond scaling and root planing alone with respect to gain of the periodontal attachment
- Curettage was deemed several years ago to be of no known clinical value
- Accordingly, the ADA code for curettage was omitted from the CDT-4 code listing
- There is little convincing clinical evidence that adjunctive laser curettage produces a result superior to adjunctive mechanical or chemical curettage, or even scaling and root planing alone
- Current evidence suggests that therapies intended to arrest and control periodontitis depend primarily on effective root debridement [1]
