Revue belge de medecine dentaire最新文献

Since their appearance in 1960, lasers have been considered useful light sources for medical applications. Laser light is monochromatic, the bundle is parallel and can be directed and focussed, as a result of which very high energy densities can be achieved. Several applications in dentistry have been investigated over the past decades. This article describes the physics behind lasers, the characteristics of the laser beam and overviews the laser wavelengths currently used in dentistry. The different interactions between the laser beam and the target are explained.

In 1999, the Haute Autorité de Santé (HAS) issued recommendations on the follow-up in France of diabetic patients. It recommends at least an annual dental examination with special attention on the periodontal environment. The results of studies suggest that recommendations on the monitoring of oral diabetes are few or not implemented. In this work, we sought to evaluate the application of the recommendations of the HAS for patients with diabetes and in particular the recommendations on oral follow-up, from a cross-sectional survey using questionnaires to dentists (CD), general practitioners (MG) and diabetic patients in the region of Pays de la Loire. The results of this cross-sectional study shows that the requirements for monitoring oral health of these patients are poorly known and therefore far from being massively applied by health professionals. Our study revealed a lack of knowledge among health professionals, in monitoring oral diabetic patients. The causal association between diabetes and periodontal diseases are now well established; the dentist should be more involved in the medical team during the monitoring of diabetic patients. His role involves the prevention and care oral disease early. The patient information is the first step of prevention and care that it should be issued in any consultation with a dentist and relayed by the associations of diabetic's patients who should also be better informed.

Smoking habits have a negative impact on general health and are detrimendous for teeth, dental implants, periodontal and peri-implant tissues. In this paper, however, a critical note is placed based on a comparison of the current evidence based knowledge with scientifically sound communications dating 1946. It seems that not only science has turned its own conclusions upside down but also health care workers and dentists have changed their opinion regarding smokers enormously. Some reflection and relativism should be taken into account when dentists are planning dental care in smoking patients.

Reports of cases of ONJ are significantly increased during the last five years as a iatrogenic complication of therapy with bisphosphonates (BPT). The aim of this work is to present the advantages of surgery using Er:YAG laser for treatment of ONJ. Er:YAG laser can gradually reach the healthy bone without causing any heating damage of tissues. This device results very versatile and gives the possibility of choose among different surgical techniques depending by the case (e.g.: vaporization or ostectomy). Moreover, different studies have demonstrated the presence of both bactericidal and biomodulating effect on bone and surrounding tissues, with biostimulation of microcirculation and neoangiogenesis. Seventeen sites of ONJ, classified according to the staging system developed by Ruggiero and observed in 12 patients with multiple myeloma (9 patients), bone metastases (2 patients) and osteoporosis (1 patient), were treated with Er:YAG laser (Fidelis Plus, Fotona-Slovenia). Laser device was used in non-contact or near-contact way (VSP, 300 m3 30 Hz, Fluence 60 J/cm2) on 17 sites (4 Stage I and 13 Stage II) on 3 different types of surgery: sequestrectomy + debridement, sequestrectomy + corticotomy and vaporization. For an average follow-up of 9 months (SD +/- 6 months), complete healing of ONJ (Stage 0) was obtained for 13 sites (76.5%) and resolution of symptoms was obtained (Stage 1) for 3 sites (17.5%). For one site at Stage II (6%), recovery was obtained but this result was not maintained over 3 months. Positive results were independent by the anatomical area (mandible or maxilla), primary disease (osteoporosis, multiple myelomas or metastasis) and discontinuation of BPT before surgery. Er:YAG laser (2940 nm), in our experience, represents a valid therapeutic option for ONJ-BP related, especially in early stages of the disease.

Vestibular deepening for maxillary edentulous patients is mainly indicated once instability cannot be reached due to important bone resorption. Vestibular deepening with CO2 super-pulsed laser enhance, in a bloodless environment, sustentation as well retention of those full dentures in good operative conditions as compared with conventional techniques.

Unlabelled: Three dogs have been used in this experiment. Class V cavities were made in sixty teeth. A pulpal communication was provoked intentionally in these cavities. Teeth were randomly split in 2 groups (30 teeth for each). On first group, the pulp bleeding was stopped until appearance of coagulum on exposed pulp surfaces by means of CO2 laser irradiation (Output Power: 3 W, Pulse duration: 0.1 sec, frequency: 1 Hz, spot size diameter: 0.3 mm, Energy density: 425 J/cm2). Calcium Dihydroxide was deposited followed by a temporary filling (IRM, Dentsply, De Trey, Germany). In the second group, the calcium Dihydroxide was deposited directly on exposed bleed pulp (conventional technique) followed by the same temporary filling. Ten weeks later, all teeth were extracted and prepared for histological study.

Results: 93% of treated teeth preserved their pulp vitality in the group treated with CO2 laser for direct pulp capping versus 82% in the group treated by conventional technique. The average of the thickness of the dentinal bridge newly formed was 391.5 +/- 33 microm for teeth irradiated with laser and 294.1 +/- 28 microm for teeth treated by conventional technique. The thickness of the dentinal bridge newly formed in teeth treated by means of CO2 laser was 33% more important than in those treated by the conventional technique. Statistical analysis showed a significant difference between the averages of values in all groups (p < 0.05). To conclude, CO2 Laser use in the direct pulp capping increases significantly the percentage of pulp vitality preservation and the thickness of the dentinal bridge newly formed after pulp exposition.

Unlabelled: The aim of our study is to evaluate the efficiency of the Nd:YAG laser in association with graphite for the treatment of dentinal hypersensitivity. 20 patients suffering of different degrees of this affection were involved. The treatment protocol was: cleaning and drying of the dentinal surfaces, evaluation of the level of pain using a graduated scale (after use of an air spray during 3 sec at a distance of 1 cm from the dentinal surfaces), the treated area was smeared with a graphite paste (graphite mixed to physiologic solution), then irradiated with the Nd:YAG laser until complete removal of the graphite (VSP Mode of 140 microsec, 0,25W, 10 Hz, 300 microm diameter fiber, fluence: 35.39 J/cm2), rinsing and drying followed by a second smearing with the graphite, second lasing, rinsing, drying and a new evaluation of the pain immediately after the treatment and one week later.

Results: The means and standard deviations of the level of pain were 7.34 +/- 0.86 before treatment, 3.24 +/- 1.18 immediately after and 2.07 +/- 0.73 one week after. No anesthetic aspect was noticed after treatment. To conclude, our result revealed significant and immediate pain reduction with respect of aesthetics and the natural aspect of the treated teeth. Our protocol is a promising alternative to the treatment of dentinal hypersensitivity.

Many lasers (i.e., different wavelengths) are available today for clinical applications. Not all lasers are to be used for cavity preparation and removal of carious tissues. Erbiumlasers (Er:YAG and Er,Cr:YSGG) are suitable for these purposes (the wavelengths coincide with the highest absorption peaks of water and hydroxyapatite). The advantages during cavity preparation and caries removal are smear layer free cavity walls, selective and localised removal of tooth substance, a restricted need or the absence of anaesthesia, and cavity walls with a higher acid resistance resulting in a better protection against secondary decay. Possible side effects of erbium lasers with water cooling and used with respect for correct power setting are minimal and can be compared with those of rotary instruments. Erbium laser tooth preparation is now one of the options in the minimal invasive approach. The needs for acid etching has been debated for long. At present it has become clear that acid etching is mandatory to obtain a good adhesion and retention with resin composites.

Laser treatment in promoting dental care is present in many areas and disciplines. Modern practice management implies also the introduction of new technology. As there is evidence of the added value for lasers in different disciplines in dentistry practitioners should not be hold back and not wait for patients demanding for this technology for dental treatment.