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ePaper created 2017-03-17, 12:41:55 | version 1.38.0
| research Fig. 19 Fig. 20 Fig. 21 Fig. 22a Fig. 22b Fig. 23a Fig. 23b Fig. 19: Cause of the 11 mm deep pocket distally from 16: FI. becomes very hot and damages the surrounding tis- sue by overheating. Fig. 20: Pocket’s cause restored. Fig. 21: An 11 mm deep pocket, active. Fig. 22a: Eight months later: 6 mm inactive pocket. Fig. 22b: The corresponding X-ray with bone regeneration. Fig. 23a: Two years later: healthy clinical situation. Fig. 23b: Corresponding bite wing. The laser fibre is guided from the pocket bottom to the papilla or the margin of the gum in uniform move- ments and several times during 30 s. This is repeated three times for each pocket. The optical property of non- or less-pigmented tissue allow a deep penetra- tion of the laser light (Fig.1). The expected therapeutic effects will be decontamination of pigmented bacte- ria10,11 and stimulation of bone regeneration and wound healing12,13 without any generation of heat. Di- rectly after the diode laser treatment the pocket un- dergoes tPDT. 2.2.3 The third treatment session for the patient is normally one week after the second session and is identical to the second session with: – ultrasonic cleaning of the pocket – diode laser irradiation – tPDT If necessary, it can be added one week later a fourth session identical to session two and three. 3. Case presentation other laser sessions, a combination of a diode laser at 810 nm and tPDT as described under section 2.2.2. In Figures 4 and 5, the clinical and radiological develop- ment of the pocket on 34 is shown: Complete regen- eration of the alveolar bone. The clinical state is stable until today (2017). Case 2 Patient SA, a 74-year-old woman, came to see us because of a loose bridge in the upper jaw. Incidental findings: 10 mm pocket distolingually from 41, TM 4 and 10 mm pocket circularly 44, TM 4. Pocket’s causes 41: calculus, food impaction, occlusal pre-contacts, and 44: occlusal dysfunction, food impaction, calcu- lus, no attached gingiva on the buccal side. Tooth 41 (Fig. 6) and 44 (Fig. 7) were extremely mobile and could be easily brought into their original situation. They were fixed with wire and composite to the other lower incisors and to 45, respectively. In the same ses- sion, calculus removal, correction of the occlusal dys- function and adding the laser protocol were per- formed. Tooth 44 got an FGG from 45 to 41 three months later. Figures 8 & 9 show the final clinical and radiological situation of 41 and 44 15 months after beginning the pocket treatment. Case 3 Case 1 Patient MU, a 69-year-old man complained on food impaction at tooth 34. The clinical situation showed an occlusal gap between 34 und 35 due to a fractured composite filling. The X-ray showed a 10 mm deep pocket crater distolingually from 34. The treatment of this pocket under local anaesthesia followed the gen- eral periodontal treatment protocol described in point 2.1 with two new composite fillings and 34 and 35 splinted together. The laser protocol was added. This first treatment session was followed by four Patient ED, a 48-year-old woman came into our practice due to fear of losing two upper-front teeth because of their high mobility, teeth 21 and 22, TM4. Tooth 21 on the buccal side featured a periodontal pocket of 11 mm. Pockets’ cause: occlusal dysfunc- tion. All upper front teeth were CO2 positive. Figure 10 shows the clinical periodontal situation and Figure 11 the radiological situation of 21 and 22. Tooth 21 was splinted on the palatal side with a wire and composite to the neighbouring teeth 11 and 22, similar to an or- thodontic retainer. Under anaesthesia, SRP and laser 12 laser 1 2017