Management of Early Periodontitis using Lasers

INTRODUCTION - A periodontal disease starts when the bacteria, (often found in plaque), infect the areas around the teeth and form the hardened substance called calculus. This leads to the inflammation of gingiva and affects both the tooth and underlying jawbone (called as Periodontitis).

The initial therapy for this condition involves the removal of plaque and calculus, termed as periodontal curettage/debridement. However, the bacteria are not removed by this procedure and thus periodontitis recurs chronically. Hence, the conventional form of periodontal curettage is longer advice as per the periodontal consensus. 

This would entail the use of laser technology to kill the bacterial colonies which is not possible with the use of conventional method and to promote healing of the diseased gum and teeth. LASER CURETTAGE/DEBRIDEMENT is an effective way to remove colonies of different bacteria thriving in small pockets located at the base of teeth. 

SURGICAL PROCEDURE - The Laser Curettage/Debridement procedure is divided into following 3 steps: -

1.Measure the pocket depth (using a periodontal probe)

2.Scaling and root planing

3.Use of laser for Curettage/Debridement 

The presented case shows inflammed gingiva with accumulation of calculus depicting chronic periodontitis. Laser Curettage/Debridement has been done in this case following the first two steps mentioned above. 

The third step is use of laser for Curettage/Debridement: - After applying topical anaesthesia, S1 POON Laser 980nm wavelength was used at a power setting of 1-Watt in continuous wave mode. The tip used here is 300-micron tip (initiated). 

Firstly, laser tip is inserted into the pocket 2mm short of the pocket depth facing towards the pocket lining epithelium. Using a continuous movement of the laser tip, the complete pocket lining epithelium is then removed not exceeding total laser irradiation time of 20 seconds. 

An overview by Douglas N in 2002 presented a review of the literature and a synopsis of the current scientific consensus regarding laser curettage, its effectiveness, its potential for collateral damage, and the scientific standards that apply. Elavarasu S et al 2015 reported that when laser curettage was used as adjunct to SRP more reduction in Periodontal Depth and Clinical Attachment Level was seen.

CONCLUSION - Diode lasers have emerged as a promising and effective tool in modern minimally invasive dentistry and have been proved successful for the treatment of periodontal pockets.

REFERENCE - Douglas N Dederich. Laser curettage: an overview. Compend Contin Educ Dent 2002 Nov;23(11A):1097-103 and Elavarasu S et al. LASER curettage as adjunct to SRP, compared to SRP alone, in patients with periodontitis and controlled type 2 diabetes mellitus: A comparative clinical study. J Pharm Bioallied Sci. 2015 Aug; 7(Suppl 2): S636–S642.

Preoperative View with Red Inflammed Lower Gingiva (Case Courtesy – Dr. Sana Farista)

Postoperative View with Non-Inflammed Lower Gingiva (Case Courtesy – Dr. Sana Farista)

- Dr Aditi Chaudhary

MDS Periodontist 

Divas in Laser