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ePaper created 2017-03-17, 12:41:55 | version 1.38.0
| research Fig. 30a Fig. 30b Fig. 30c Fig. 31 Fig. 32 Fig. 30a: The pocket depth on 23 d and 26 mp. Fig. 30b: X-ray of 23. Fig. 30c: X-ray of 26, all images from 18 March 2008. Fig. 31: The bacterial situation in the pockets, 28 April 2008. The main responsible bacteria for the pockets is Aa. Fig. 32: All pathologic bacteria eliminated by tPDT. Analysing date of bacteria pocket probe: 8 October 2008. Er:YAG laser could not improve the conventional peri- odontal treatments.40 As we know that the field of laser adjunctive ther- apy in periodontics or other fields is very young in dentistry and is not integrated in the general educa- tion of dentists, we must assume that many laser ap- plications perhaps do not respect the biophysical background of the different laser wavelengths. Too much venous blood in the pocket absorbs the laser energy for lasers with wavelength from excimer laser to the diode laser of 940 nm. Hotspots at the fibre end overheat the irradiated tissues very fast and too much energy or energy densities with lasers in the middle infrared can harm subgingival tooth surface or alve- olar bone. And we clinicians know that for physical reasons a parallel access to the subgingival area during a closed periodontal treatment with our laser handpieces is very, very difficult. For this reason the author thinks that settings of 160 mJ, 10 Hz in subgin- gival, closed working can be dangerous ablating too much health dentine too fast. However, we were able to demonstrate with the presented cases that very good clinical results can be reached safely with set- tings close above the ablation threshold of the hard tissue. And in the author’s opinion, it is a pity that the industry has not yet produced slightly angulated sap- phires for the handpieces. This would allow easier and safer access to the subgingival root surface. A parallel laser beam to the root dentine of the Er:YAG or Er,Cr:YSGG laser would minimise the risk for our pa- tients. Whatever the sellers of laser devices do prom- ise during a sales pitch, in this context the laser user may always be reminded of the fundamental principle in medical ethics “primum non nocere”. It is absolutely necessary to sensitise laser practi- tioners to respect the properties of the different laser wavelengths on the one hand and on the other hand to correctly assess the optical properties of the irra- diated tissue. In our cases, we observed no uncom- fortable side effects after treatment and the wound healing was much faster than when done only with SRP and curettage with conventional instruments like 16 laser 1 2017