Improving Periodontal Treatment and Maintenance
Maximizing the benefit of a laser-assisted periodontal protocol
Figure 1 | In recent years, technology and science have improved peridontal treatment and long-term outcomes. I use a Picasso diode laser (AMD Lasers, www.amdlasers.com) in a laser-assisted periodontal protocol (LAPT), improving maintenance with custom PerioProtect trays (www.perioprotect.com) using medicaments to eliminate bleeding and reduce pocket depths and inflammation.
For the LAPT protocol, I use the Picasso diode laser with an uninitiated tip (as removed from the package) set at 1.0 W, pulsed at 30/30 m/s and use for 5 seconds per tooth area to reduce bacteria in the sulcus prior to mechanical debridement of the pocket. This reduces the risk of bacteria entering the circulation via the necrotic sulcus lining and improves the effectiveness of LAPT. Ultrasonic scaling is then performed using water or a medicament flowing through the scaler tip to remove all calculus and disrupt the biofilm present within the pocket. To initiate the tip for the next stage, a dark blocking medium (eg, black articulating paper) is applied that in essence concentrates the laser’s energy, heating the tip and allowing the laser to cut tissue and coagulate bleeding. The initiated tip is used following mechanical debridement of the pocket. The diode is set at 0.5 W in a continuous mode for 30 seconds per tooth and/or pocket to selectively remove the diseased epithelium lining and allow healthy tissue to regenerate during healing. The final step was to irrigate the pockets with the ultrasonic unit using chlorhexidine gluconate, a chemotherapeutic agent.
After LAPT, clinicians need solutions to effectively reduce the biofilm and hamper its regrowth. Peroxide is effective in treating sulcular biofilms without the allergic reactions or resistance reported with antibiotics. Efficacy of biofilm elimination with peroxide gel is related to contact time of the gel directly to the biofilm. A minimum of 10 minutes is required for efficacy, and daily use assists in keeping biofilm from reforming. The key to this approach, therefore, is delivering the peroxide gel into the pocket where the biofilm exists and keeping it in contact long enough to be effective.
PerioProtect (www.perioprotect.com) custom trays ensure that medicament is delivered to the depth of each pocket and prevent sulcular fluids from pushing the peroxide gel out of the pocket during the required contact time. When 1.7% peroxide gel is delivered daily with PerioProtect trays, pockets are reduced and gingival bleeding is controlled.
Diode lasers offer distinct advantages over traditional nonsurgical periodontal treatment, helping to control bacteria levels and improve gingival healing. Supplementing that treatment with custom tray delivered medicaments improves long-term outcomes by reducing in biofilm development.
- Color touchscreen and eight customizable presets
- Performs a wide range of surgical, periodontal, and orthodontic procedures
- Safe around metals and implants for implant recovery and peri-implantitis
- Versatile and affordable
- Customizable continuous and pulsed modes
- Ideal for both first-time and expert laser users
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About the Author
Gregori M. Kurtzman, DDS, MAGD, DICOI, has published more than 440 dental articles and is a consultant to multiple dental manufacturers. Dr. Kurtzman is in private practice in Silver Spring, Maryland.