Lasers in periodontics: a review of the literature

BACKGROUND: Despite the large number of publications, there is still controversy among clinicians regarding the application of dental lasers to the treatment of chronic periodontitis. The purpose of this review is to analyze the peer-reviewed research literature to determine the state of the science concerning the application of lasers to common oral soft tissue problems, root surface detoxification, and the treatment of chronic periodontitis. METHODS: A comprehensive computer-based search combined the following databases into one search: Medline, Current Contents, and the Cumulated Index of Nursing and Allied Health. This search also used key words. In addition, hand searches were done for several journals not cataloged in the databases, and the reference lists from published articles were checked. All articles were considered individually to eliminate non-peer-reviewed articles, those dealing with commercial laser technology, and those considered by the author to be purely opinion articles, leaving 278 possible articles. RESULTS: There is a considerable conflict in results for both laboratory studies and clinical trials, even when using the same laser wavelength. A meaningful comparison between various clinical studies or between laser and conventional therapy is difficult at best and likely impossible at the present. Reasons for this dilemma are several, such as different laser wavelengths; wide variations in laser parameters; insufficient reporting of parameters that, in turn, does not allow calculation of energy density; differences in experimental design, lack of proper controls, and differences in severity of disease and treatment protocols; and measurement of different clinical endpoints. CONCLUSIONS: Based on this review of the literature, there is a great need to develop an evidence-based approach to the use of lasers for the treatment of chronic periodontitis. Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. Current evidence does suggest that use of the Nd:YAG or Er:YAG wavelengths for treatment of chronic periodontitis may be equivalent to scaling and root planing (SRP) with respect to reduction in probing depth and subgingival bacterial populations. However, if gain in clinical attachment level is considered the gold standard for non-surgical periodontal therapy, then the evidence supporting laser-mediated periodontal treatment over traditional therapy is minimal at best. Lastly, there is limited evidence suggesting that lasers used in an adjunctive capacity to SRP may provide some additional benefit.     

Laser assisted periodontics: A review of the literature

Over the years, the use of the laser within health field and more particularly dentistry has been increasing and improving. The application of laser in the periodontal treatment takes part of a non-surgical and surgical approaches, is used for the decontamination of periodontal pockets due to its bactericidal effect, and the removal of granulation tissues, inflamed and diseased epithelium lining, bacterial deposits and subgingival calculus. However in spite of all the marketing surrounding, the use of laser highlighting its beneficial effect, the capacity of laser to replace the conventional treatment for chronic periodontitis is still debatable. In fact there is no evidence that any laser system adds substantial clinical value above conventional treatments of chronic periodontitis. Some studies showed a significant positive effect on clinical attachment level gain and probing depth reduction. In the other hand, several articles demonstrated no evidence of the superior effectiveness of laser therapy compared to root planing and scaling. Our aims is to review the literature on the capacity of erbium:Yttrium-aluminum-garnet and neodymium:Yttrium-aluminium-garnet laser to either replace or complete conventional mechanical/surgical periodontal treatments.     

Interrelationships between orthodontics and periodontics.

At the present time, periodontists have no evidence to indicate that orthodontic treatment in the child will either enhance or detract from the periodontal health of the patient or that it will increase or decrease the longevity of the teeth. Many periodontists believe that much orthodontic treatment is undertaken on an esthetic or empirical basis. Proper emphasis on plaque control procedures prior to initial banding, altered and reinforced during the entire period of orthodontic treatment, may well minimize the inflammatory lesion often found during therapy. Gingival, periodontal, and mucogingival problems should be treated as soon as they are diagnosed. Limiting our orthodontic objectives in adult patients because of the possibility of inducing supporting alveolar bone loss and other problems that did not previously exist may be a worthwhile compromise. Orthodontic movement in periodontally healthy adults, and especially in those with periodontally involved teeth, constitutes a problem distinct from routine orthodontics. When periodontal disease has already produced significant destruction of supporting tissue and secondary occlusal trauma is a complicating factor, orthodontic treatment may possibly serve as another mode of treatment to reestablish the correct occlusal plane and alter bony deformities. Various methods can be used to try and place teeth into better bone. One should make certain that teeth are being moved into a greater volume of bone. The bite plane is of great value in allowing continuous eruption of the teeth and their supporting structures and in eliminating additional trauma by enabling the teeth to move into their correct cusp-fossa relationships unimpeded by the inclined planes of the opposing teeth. Since little is known about the interrelationships between orthodontic treatment and periodontal health and disease, there is still a great deal to learn. In spite of this lack of knowledge, the general practitioners and the various specialists of dentistry, each seeking a rationale for his preventive and therapeutic procedures, subject the patient to treatment based on concepts of the occlusion which have yet to be corroborated. In addition to the need for research in this field, a common language between the periodontist and the orthodontist must be established to eliminate the existing communications barrier. Once basic principles can be determined, elucidated, and applied correctly, the movement of teeth in periodontal cases will be limited only by the imagination of the operator.     

Evidence-based practice of periodontics

Evidence-based practice involves complex and conscientious decision making based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognizes that care is individualized and ever-changing and involves uncertainties and probabilities. The specialty of periodontics has abundant high-level evidence upon which treatment decisions can be determined. This paper offers a brief commentary and overview of the available evidence commonly used in the private practice of periodontics.     

Interrelationship between periodontics and adult orthodontics

Abstract. The purpose of this review article is to provide the dental practitioner with an understanding of the interrelationship between periodontics and orthodontics in adults. Specific areas reviewed are how periodontal tissue reacts to orthodontic forces, influence of tooth movement on the periodontium, effect of circumferential supracrestal fiberotomy in preventing orthodontic relapse, effect of orthodontic bands on the periodontium, specific microbiology associated with orthodontic bands, mucogingival considerations and time relationship between orthodontic and periodontal therapy. In addition, the relationship between orthodontics and implant restorations (e.g., using dental implants as orthodontic anchorage) will be discussed.     

Reciprocal relationships between orthodontics and periodontics in esthetic treatments

The objective of this article is to review various unsightly periodontal defects and the treatments that have previously been used to eliminate them in order to establish guidelines for future therapy. The inter-relationship between orthodontic and periodontal disciplines is well established and needs no defense here. Periodontal tissues change throughout life and the same is true for the smile. The periodontium is an essential component of the appearance of the face as well as the lips. These are dynamic esthetic criteria while the gingiva and the static character of the dentition also contribute to the character of an individual's smile. In order to conduct orthodontic therapy most effectively it is essential that orthodontists and periodontists utilize a coordinated approach. From the beginning, they must establish an etiological diagnosis of any esthetic defects that will insure that their joint therapy is conducted appropriately and at the proper moment.     

The effectiveness of computer-aided learning in teaching orthodontics: a review of the literature.

INTRODUCTION: The purposes of this review were to evaluate the effectiveness of computer-aided learning (CAL) in orthodontic education, to make evidence-based recommendations for the use of CAL in orthodontics, and to develop guidelines for conducting comparative trials to evaluate CAL as a mode of learning in orthodontic education. METHODS: Medline, the Cochrane Library Database, ERIC, CINAHL, LISA, Psycinfo, and IPA were searched for randomized controlled trials evaluating the effectiveness of CAL in orthodontics. Outcome measures included objectively measured posttest scores on multiple choice, written, or oral tests; performance on a clinical procedure or clinical interview; time spent on CAL programs to learn the material presented; and responses to questionnaires conveying participants' attitudes toward various modes of learning. RESULTS: Four randomized controlled trials comparing CAL with conventional teaching fulfilled the inclusion criteria and met the cutoff quality assessment checklist (QAC) score of > or = 8. Each study was assessed for quality by 2 independent reviewers. The validity and strength of the selected studies were assessed by using a QAC for an educational intervention. CONCLUSIONS: The controlled trials of CAL in orthodontics that met our QAC cutoff score of 8 were split, with 2 showing that CAL enjoyed a significant advantage over conventional teaching, 1 showing no difference, and 1 showing that the conventional tutorial method was better. More high-quality trials evaluating the effectiveness of CAL in orthodontics are needed. CAL programs in orthodontics elicit mostly positive responses and attitudes from students toward learning.     

Ultrasonic instrumentation versus hand instrumentation in periodontics. A review of the literature

The working mechanism and the correct use of ultrasonic devices is discussed. Comparative efficiency of ultrasonic and hand instrumentation is evaluated for the removal of subgingival plaque and calculus, for the effect on root surfaces and for the ability in removing endotoxins. Possible side effects of the ultrasonic vibrations on the tooth structures and periodontal tissues, the incidence of bacteremias and the spreading of oral infections via aerosols are stated. Particular attention is given to the clinical results of both instrumentation technics and the necessity of root planing. One can conclude, that ultrasonics present an alternative and/or a supply for hand instruments, provided that a selective and careful use is taken into account.     

Compliance. A review of the literature with possible applications to periodontics

This paper begins with a review of the literature on compliance. The medical literature suggests that patients with chronic illnesses tend to comply poorly, especially if the disease is not perceived by the patient as particularly threatening. The dental literature covers two principal areas: compliance with oral hygiene regimens and utilization of dental care by the public. These works show that most patients surveyed do not clean their teeth as they have been instructed, and most do not receive routine dental care. The reasons for this noncompliance are highly variable but include lack of pertinent information, fear, economics, and the patient's perception of lack of compassion on the part of the dental therapist. In periodontics the majority of studies have focused on the effectiveness of patient oral hygiene along with its modification and on maintenance therapy. Other work in the periodontal literature is discussed in light of the widespread noncompliance shown by our patients. A number of studies have been undertaken on how best to improve compliance. In general, it has been found that patients comply better when they are informed and positively reinforced, and when barriers to treatment are reduced. Suggestions are made for improving compliance in the periodontal office and for tailoring therapy to predicted compliance levels.     

Gene therapy in periodontics: a review and future implications

New advancements in gene therapy continue to have a significant impact on dentistry since 1995. At the same time, periodontal disease has attracted the attention of scholars and research scientists as a global concern. With a better understanding of disease progression and new advancement in biological science, gene therapy has emerged to enhance existing therapy and has radically recast approaches to the management of periodontal disease. Since the advent of gene therapy in dentistry, significant progress has been made to control periodontal disease and reconstruct the dentoalveolar apparatus. However, to date, gene therapy methods have not been developed to control periodontal disease due to its multifactorial origin, complex genetic predisposition, and risk associated with it. This review article provides a brief insight into the ever-expanding field of gene therapy and its possible future implication in the field of periodontics. Most of the modalities described in this article are more theoretical and still in infancy stage except for genetically fabricated materials used for regenerative purposes.     

Evidence-based considerations for removable prosthodontic and dental implant occlusion: a literature review

The dental literature is filled with discussions of dental occlusion, occlusal schemes, philosophies, and methods to correct and restore the diseased, worn, or damaged occlusion. Traditionally, these discussions have been empirical in nature and not based on scientific evidence. Due to the empirical nature of the literature, the study of occlusion has been extremely complex and troublesome to both pre- and post-doctoral students. The introduction of osseointegrated implants has further complicated the situation. Dentists may apply the principles of occlusion for the natural dentition directly to implant-supported and retained restorations. Although this may be successful, this rationale may result in overly complex or simplified treatment protocols and outcomes. There is an emerging body of scientific literature related to dental implant therapy that may be useful in formulating treatment protocols and prosthesis designs for implant-supported restorations. This review focuses on some of the "classic" removable prosthodontic literature and the currently available scientific literature involving removable prosthodontic occlusion and dental implant occlusion. The authors reviewed the English peer-reviewed literature prior to 1996 in as comprehensive manner as possible, and material after 1996 was reviewed electronically using MEDLINE. Electronic searches of the literature were performed in MEDLINE using key words-animal studies, case series, clinical trials, cohort studies, complete denture occlusion, dental implant function, dental implant occlusion, dental implant occlusion research, dental implant functional loading, dental implants, dental occlusion, dental occlusion research, denture function, denture occlusion, dentures, implant function, implant functional loading, implant occlusion, occlusion, and removable partial denture occlusion-in various combinations to obtain potential references for review. A total of 5447 English language titles were obtained, many of which were duplicates due to multiple searches. Manual hand searching of the MEDLINE reference list was performed to identify any articles missed in the original search.     

The need and possibility for disinfecting impressions in orthodontics (a review of the literature)]

Reviews the data on a high risk of viral and bacterial infection of dentists in connection with the high prevalence of AIDS and viral hepatitis B and on the possibility of infection of dental patients and the staff by microorganisms transfer on the impressions. Presents the present-day methods and means for disinfection of the impression material. Emphasizes inadequate knowledge of the dentists about the virucidal efficacy and the possibility of the impressions changing their properties in disinfection, which fact results in inaccuracy of the ready articles.     

Evidence-based orthodontics for the 21st century

BACKGROUND: This article examines some of the data-driven advances in clinical orthodontics and how they might influence the decision-making process in the specialty. TYPES OF STUDIES REVIEWED: Nearly 100 years of orthodontic study has focused on two issues: one-phase versus two-phase treatment of Class II malocclusion and extraction versus nonextraction treatment of arch perimeter deficiencies. The author addresses these issues by presenting data from the first randomized clinical trial in orthodontics and from a survey of the current literature. RESULTS: The clinical trial involved subjects who had Class II malocclusion. The researchers who conducted the trial found no difference in the quality of the dental occlusion between the children who had early treatment and those who did not, as judged by both an occlusal index (Peer Assessment Rating scores) and the percentages of the subjects with excellent and less-than-optimal outcomes. Early treatment did not reduce the eventual need for orthognathic surgery. In a separate study, a researcher reported that the maxillary arch perimeter could be increased by 3 to 4 millimeters by using rapid palatal expansion, or RPE, providing space for incisor alignment to resolve crowding. The author concluded that any added benefit of RPE treatment in patients without a crossbite might be "challenging to define." CLINICAL IMPLICATIONS: The challenge facing orthodontists in the 21st century is the need to integrate the accrued scientific evidence into clinical orthodontic practice.     

Evidence-based orthodontics, still a long way to go

Clinical performance can be kept up to date by learning how to practice evidence-based orthodontics, by seeking and appraising evidence-based summaries from the literature and by applying evidence-based strategies to change clinical behaviour. A MEDLINE search over the period 1990-2000 identified 8345 publications on clinical orthodontic subjects. Of these articles 49.5% was published in five specific orthodontic journals, while the others were published in about seventy other journals making it difficult for the clinician to stay current easily. Systematic reviews are an efficient and reliable source of information, but due to a lack of well-designed randomised clinical trials systematic reviews in orthodontics are still rare.