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ePaper created 2017-03-17, 12:41:55 | version 1.38.0
| research Fig. 4 Fig. 4: Development of the clinical 2.1 The conventional treatment protocol pocket depth. From the left: 4 January 2012, 12 November 2012 and 24 April 2014. The patient had to pass an oral hygiene phase prior to pocket treatment, followed by a first pocket treat- ment session, including: – Splinting the tooth with wire and traditional or acrylic and glass fibre reinforced composites (ever- Stick®). – Elimination of the pockets cause or causes, e.g. · endo/perio laesions begin endodontic treat- ment, · occlusal traumata eliminate pre-contacts or · hyperbalances etc., food impaction (FI) close the gap with recon- structive methods, foreign bodies remove them, · · no attached gingiva if periodontal treatment is successful free gingival graft (FGG), · special pathogen bacteria like Aa decontami- nation by laser light. – SRP under local anaesthesia. In up to three or four following sessions, the con- ventional treatment always consists of only ultra- sonic cleaning of the treated pockets to remove any plaque formation without anaesthesia and finishing of the conservative therapies (endodontic treatment, fillings, occlusion, FGG, etc.). The therapy of deep pockets greater than 9 mm de- mands at least three, oftentimes four laser applica- tions in time intervals between four to ten days. During the whole treatment period, when common prophy- lactic actions in the treated area are impossible or con- tra productive, the patients have to rinse their mouth with 0.2 % Chlorhexidine (CHX) solution.The healing of the periodontally treated area with correctly applied Fig. 5: Radiological situation of bone regeneration. From the left: 4 January 2012, 12 November 2012 and 24 April 2014. Fig. 5 08 laser 1 2017 laser therapy is almost painless for the patient, fast and without any uncomfortable side effects. To understand why the local application of laser energy is able to replace antibiotics and to substitute augmentation procedures in many cases, it is indis- pensable to know the biophysical background of the therapeutic effects of the different laser wave- lengths. Antibiotics must be applied only when the general health state demands antibiosis and augmen- tation procedures are needed in aesthetically very sensitive areas. 2.2 The laser treatment protocol 2.2.1 The first laser treatment session follows directly after the conventional SRP under anaesthesia. The cu- rettage is not done by conventional instruments, but by laser irradiation of an Er:YAG laser for two reasons: – The laser in the middle infrared region stimulates bone growth factors.21 – The soft tissue is removed by the laser in a sterile way because of its ablation mechanism and disin- fects the remaining soft and hard tissues.18 If we do a closed curettage of a very deep pocket of 10 mm and more pocket depth with an Er:YAG laser, it is impossible that during such irradiation the water spray gets inside of the deep pocket. The water spray has only a cooling effect from outside. Therefore, the tissue water in the pocket must be sufficient to provide an ab- sorption of the energy solely in water. This can be safely achieved by special settings and a special technique of application. Our setting for closed pocket curettage with the Er:YAG Laser (LiteTouch, Syneron) are: – fluence < 10 J/cm2 – energy on the device display: 50 mJ