Christeena Abraham1, Sankari M.2
1Post Graduate Student, Department of Periodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
2Professor, Department of Periodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
In the history of science, the invention of laser has attracted the attention of a lot of people. Maiman, in the year 1960, introduced “light amplification by stimulated emission of radiation” (LASER) making use of Einstein’s theory on stimulated emission. Laser helps to remove the microorganisms and diseased soft tissue and it also stimulates wound healing. However, the clinical value and awareness of the advantages of their use is limited. Food and drug administration have granted their approval. There are different types of lasers that are used in dentistry. Some of them being Diode, Er: YAG (Erbium: Yttrium-Aluminium-Garnet), Argon, Carbon dioxide, Nd: YAG (Neodium: Yttrium-Aluminium-Garnet). Lasers can be used in the field of periodontics for soft tissue crown lengthening procedure, depigmentation, curettage, frenectomy, operculectomy, soft tissue ablation, mechanical debridement of subgingival root surface and treatment of periodontal pockets. Lasers are also used in other fields of dentistry such as restorative and for acquiring biopsies. The present study was a questionnaire based study assessing the knowledge, attitude and practice of lasers among periodontists in India. A cross sectional study was carried out using a research based questionnaire. The questionnaire consisted of 24 questions. It was filled by 45 periodontists in India. The questions were based on assessment of knowledge, attitude and practice. The percentage of knowledge was 65.6%, attitude was 82.1% and practice was 54.5%.
After Maiman made the first laser device in 1960, Dr. Leon Goldman used laser on his brother who was a dentist, he used ruby laser for crazing of enamel and found that it was painless1. It was first introduced in 1977 by Lentz et al in maxillofacial surgery2. Laser light is a collimated beam which is coherent and monochromatic3. There are different types of lasers that are used in dentistry. Some of them being Diode, Er: YAG (Erbium: Yttrium-Aluminium-Garnet), Argon, Carbon dioxide, Nd: YAG (Neodium: Yttrium-Aluminium-Garnet).
The use of lasers in dentistry first started in restorative dentistry where it was used to remove caries. Laser has also been incorporated in setting/curing system of restorative materials. Lasers have also been used to acquire biopsies and to control the spread of lesions, both pathological and non-pathological lesions. Tooth whitening has become easier and much quicker with the use of lasers. In the recent years, subgingival root surfaces are being mechanically debrided and the treatment of periodontal pockets are being done with the use of lasers4. There are other various areas where lasers are used in periodontics like soft tissue crown lengthening procedure, frenectomy, operculectomy, soft tissue recontouring, removal of large masses of tissue, haemostasis, soft tissue ablation, curettage, depigmentation, bactericidal effects in the pockets5.
The use of lasers is becoming more common in clinical dentistry. Various types of lasers are used as an alternative to mechanical scaling and root planing6. Low-level laser therapy generates light of a single wavelength, thus it is a light source treatment. They do not cause cutting or ablation of the tissue. Gallium aluminium arsenide infrared semiconductor (gallium-aluminium-arsenide), gallium arsenide, and helium-neon lasers come under the low-level laser therapy (LLLT). LLLT has been used in a variety of ways in periodontics such as pain reduction after surgical and non-surgical procedures and in assisting wound healing3. The prototype for Nd: YAG laser was developed by Snitzer in 1962. Lasers have also been used to carry out surgical laser assisted new attachment procedures (LANAP)7,8. The load of Porphyromonasgingivalis and Prevotellaintermedia was shown to reduce initially with the use of an Nd: YAG laser9.
The present study was a questionnaire based study assessing the knowledge, attitude and practice of lasers among periodontists in India.
MATERIALS AND METHODS:
A cross sectional study was carried out using a research based questionnaire. This questionnaire consisted of 24 questions. It was circulated through internet. The questionnaire was filled by 45 periodontists in India. The questions were divided on the basis of knowledge, attitude and practice.
It was found that there was adequate knowledge, attitude and practice of lasers among periodontists. However, there could be more improvement in the coming years.
The percentage of knowledge was 65.6%, attitude was 82.1% and practice was 54.5%.
Figure 1: Pie Chart showing percentage of knowledge
Figure 2: Pie Chart showing percentage of attitude
Figure 3: Pie Chart showing percentage of practice
The rate of total knowledge of lasers among periodontists about lasers is 65.6%. According to a study done among general dentists by Bagheri A et al, 94.3% said that they have only heard about laser10.
According to our study, 75% of them stated that they perform less than 10 mucogingival surgeries manually per month and 20.9% of them perform more than 10 mucogingival surgeries per month using lasers. In the coming years, with increased awareness, there could be an increase in this rate.
69.8% of them used diode lasers. 84.1% of periodontists informed their patients about the side effects of the use of laser before performing the treatment. 90.9% of them check their laser equipment regularly.
68.2% of the periodontists think that the cost of the equipment is worth it, which is one of the major factors which shows how interested they are in using laser for treating their patients.
While assesssing the knowledge of the periodontists about lasers, 59.1% of them were aware of the thermal relaxation time. 67.5% of them stated that there is more thermal relaxation time during the pulsed mode. 77.5% of them stated that greater area of tissue is exposed to beam in non contact mode.
54.8% said that the wavelength of diode laser used is 810- 980 nm. The wavelengths of Nd:YAG is 1,064nm, Erbium is 2,790- 2,940nm and Carbon dioxide is 9.3- 10.6 nm. Every wavelength has a predictable specific way of interacting with the tissues and thermal output which is also specific.
While adminstering laser treatment,all of them take necessary precautions like wearing protective eyewear. The human eye can easily get damaged by a laser. The protective eyewear should be worn by the dentist, patient and the assistant.
Water in the tissues absorb long wavelengths (CO2 and Er:YAG), therefore, the tear layer covering the cornea also has the ability to absorb. Interaction between the beam and the tissues occur causing burns as the water is vaporised away. Though not permanent,it can be painful. “Flash blinding” type of injury can be hazardous when it occurs intraoperatively11.
The lasers which are mainly used in soft tissue are diode lasers, Nd: YAG and carbon dioxide. Good coagulation is provided by these lasers. The diode and Nd:YAG is capable of penetrating a few millimeters into the tissue by their laser energy. The laser which gives a very precise cut and which produces excellent coagulation is the carbon dioxide laser which penetrates less than a millimeter. Erbium laser is capable of cutting soft tissue, bone and tooth and they also have affinity for water. Erbium lasers are kind to tissues but it does not provide good hemostasis. This is due to the fact that their penetration into the tissue is only a few microns. Surgical field can be better visualised when a soft tissue laser is used, as they can simultaneously cut and seal. Destruction of aphthous ulcers can be done with like carbon dioxide, diode, Nd: YAG or Er: YAG. To treat periodontal pockets (12), and control gingival bleeding and bacteremia12,13, the first laser to be compared with the scalpel was the Nd: YAG. There was a reduction in the bleeding index scores and probing pocket depth when pulsed Nd:YAG laser was used14. In periodontology, lasers have been used for control of bacteremia15, reduction in the number of bacteria16,17,18,19 and efficient removal of calculus (using Er: YAG lasers)20. Periodontists have to become more knowledgable regarding the use of lasers so that they can do more procedures with it.
CONFLICTS OF INTEREST:
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19. Yaneva B et al. Bactericidal effects of using a fiber-less Er: YAG laser system for treatment of moderate chronic periodontitis: Preliminary results. Quintessence Int 2014;45:489-97
20. Eberhard J et al. Efficacy of subgingival calculus removal with Er: YAG laser compared to mechanical debridement: an in situ study. Journal of clinical periodontology. 2003 Jun;30(6):511-8.
Accepted on 28.09.2018 © RJPT All right reserved
Research J. Pharm. and Tech 2018; 11(12): 5458-5460.