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S. Stübinger et al. (eds.)Lasers in Oral and Maxillofacial Surgerydoi.org/10.1007/978-3-030-29604-9_8
8. Deep Lasers on Hard Tissue and Laser Prevention in Oral Health
The use of deep lasers on hard dental tissues to treat dental hypersensitivity and prevention by sealing with laser integrated procedures. Hypersensitivity is a common problem for many patients in our offices, and management is quite complex. Deep lasers such as Nd:YAG and diode laser can be used, with different techniques and different clinical approaches in our daily practice. The importance of using chromophore and desensitized chemical products, in addition to laser beam, seems to be strongly recommended. Results on clinical studies and medium-term evaluation show that these procedures are safe, efficient, and time-saving in expert hands.
Nd:YAGDiode laserDental hypersensitivityLaser sealingPDT
8.1 Laser and Hypersensitivity
Dental hypersensitivity (DH) , defined as “a short sharp pain arising from physical or chemical stimuli which cannot be ascribed to dental pathologies” in 2003 by the Canadian Advisory Board, is a highly relevant and widespread problem among dental patients. Such pain, often described as short and sharp, can be ascribed to thermal stimuli, mechanical contacts, osmotic variations (e.g., drying of the surface of exposed dentine), or chemical stimulations (e.g., sugary or acid foods). According to the hydrodynamic theory already expounded at the beginning of the last century by Brannstrom, these stimuli would create a movement of the intratubular fluid that would stretch the nerve fibers within the processes of the odontoblasts contained in them.
Exposed dentine is often due to periodontal disease and is particularly related to gum recession in thin gingival biotypes, while it becomes a matter of resective periodontal surgery in patients undergoing such procedures for the maintenance of the health of the periodontium. It is estimated that between 60% and 98% of patients are affected by periodontal disease with a loss of teeth, and undergoing resective therapies present varying degrees of dentine hypersensitivity.
Other situations that can be correlated to DH are the loss of dental tissue in the cervical region due to abrasions caused by mechanical traumas (e.g., incorrect brushing) or abfractions often found in patients affected by chewing parafunctions. Less common are pathologies linked to odontogenesis (e.g., amelogenesis imperfecta) or erosions due to chemical traumas (e.g., patients with eating disorders such as anorexia and/or bulimia).
For these reasons, nowadays, numerous systems are used with a view to obliterating the dentine tubules themselves so as to eliminate the movement of fluid and the consequent algic symptoms demonstrated by the affected teeth.
Following one of the various treatment protocols mentioned in previous studies, it is first of all important to identify and, where possible, to eliminate the root cause of DH. In the second place, chemical products such as KNO3 and KCl are used in order to relieve the pain. If these preventive and curative measures should not produce satisfactory results, it is necessary to proceed with the obliteration of the dentine tubules.
There are numerous techniques proposed for this procedure including the following:
Gingival closing: using the techniques of mucus-gingival surgery, the exposed dentine is corrected by repositioning the gingival margin.
Adhesive systems: the enamel-dentine adhesive systems seem to be relatively effective in tubular obliteration.
Chemical sclerosis: chemical products with the capacity to form weak links with the dental substratum are applied topically to the exposed surface. Some examples are CaOH2, fluoride, and HAp-based varnish and pastes.
Integrated laser techniques called LITS: Laser integrated tubular sclerosis.
The light of the laser by transmitting energy under the form of photons (photonic energy) makes it possible, according to the characteristics of the laser itself, to have a direct effect on the exposed dentine or to activate an appropriately treated desensitizing chemical product.
8.1.1 Nd:YAG Laser: LITS Technique
The Nd:YAG laser is considered a high-energy laser in that the modality of the ray properly called a pulsate or super pulsate allows the built-up energy to be emitted in very high quantities (peak power of very high pulsations) in an extremely short time (short pulse duration). This binomial of energy and exposure time allows the wavelength to alter irreversibly the irradiated dentine surface without however transmitting the heat produced to the deep tissue and in particular to the pulp tissue which is extremely sensitive to rise in temperature.
Delicate washing of the surface with a rotating toothbrush.
Application of the graphite on the surface to be treated.
Application of the laser (Nd:YAG 0.5 W; 10 Hz; fiber 300 μ) with the fiber at an angle of around 45° in relation to the tooth.
Pause of 30 s (the time for thermal relaxation).
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