• Journal of Periodontal and Implant Science
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• v.53 no.3
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• pp.173-183
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• 2023

Purpose: Treatment for periodontitis has evolved over the years as new technologies have become available. Currently, lasers seem attractive as a treatment modality, but their effectiveness needs to be verified. The purpose of this project was to evaluate Laser Assisted New Attachment Procedure^® (LANAP^®) surgery as a single treatment modality. Methods: As part of a mandatory training program for periodontists and other dentists, 22 consecutive patients diagnosed with moderate to severe periodontitis (probing depth [PD] up to 11 mm) were treated with the LANAP^® surgical approach using a 1064-nm Nd:YAG laser as part of a multi-step protocol. Following single-session active therapy, they were entered into a maintenance program. Their clinical status was re-evaluated at 12-18 months following surgery. Results: All 22 patients completed the 12- to 18-month follow-up. PD, clinical attachment level, and furcation (FURC) showed substantial improvement. Recession was minimal (mean, 0.1 mm), while 93.5% of PD measurements were 3 mm or less at re-evaluation. Furthermore, 40% of grade 2 FURC closed clinically. Conclusions: Within the limits of this case series, LANAP^® was found to be an effective, minimally invasive, laser surgical therapy for moderate to advanced periodontitis.

• Journal of Periodontal and Implant Science
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• v.32 no.2
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• pp.303-314
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• 2002

This study was performed to evaluate the usability of Er:YAG laser for periodontal therapy. Forty dental root slabs ($5{\times}5{\times}2mm^3$) were prepared from human periodontally diseased extracted teeth and grouped into 4 groups: 1) control (root planing only), 2) root planing and irradiated with laser at 30mJ, 3) root planing and irradiated with laser at 60mJ, and 4) root planing and irradiated with laser at 100mJ. The root slabs were embedded in resin block before laser treatment. Er:YAG laser was irradiated under water irrigation with the tip held perpendicular to the root surface in contact mode. After Er:YAG laser irradiation or planing on the root surface, morphological changes have been observed under SEM, and the micro-hardness and Ca/P ratio were compared. 1. In the Control group, the root surface showed the directional change caused by root planing instrumentation, and the presence of smear layer, and no exposure of dentinal tubule was observed. Laser irradiated group showed surface changes with rough dentin surface of niche and depression and dentinal tubule exposure by the elimination of smear layer. 2. The micro-hardness of root surface in the laser irradiated group was higher than the control group. The higher energy output was applied, the higher micro-hardness on root surface was resulted. 3. The higher energy output was applied, the higher Ca/P ratio was observed. The higher Ca/P ratio in 60mJ group and 100mJ group was statistically significantly compared to the control group and the 30mJ group. These results suggest that Er:YAG laser irradiation on the periodontally diseased root surface could remove smear layer and increase the micro-hardness on root surface and Ca/P ratio which contribute to enhance the acid resistance of periodontally treated root surface.

• Journal of Periodontal and Implant Science
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• v.52 no.1
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• pp.77-87
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• 2022

Purpose: This pilot study assessed the immediate in vivo effect of high peak pulse power neodymium-doped yttrium aluminum garnet (Nd:YAG) laser monotherapy on selected red/orange complex periodontal pathogens in deep human periodontal pockets. Methods: Twelve adults with severe periodontitis were treated with the Laser-Assisted New Attachment Procedure (LANAP®) surgical protocol, wherein a free-running, digitally pulsed, Nd:YAG dental laser was used as the initial therapeutic step before mechanical root debridement. Using a flexible optical fiber in a handpiece, Nd:YAG laser energy, at a density of 196 J/cm² and a high peak pulse power of 1,333 W/pulse, was directed parallel to untreated tooth root surfaces in sequential coronal-apical passes to clinical periodontal probing depths, for a total applied energy dose of approximately 8-12 joules per millimeter of periodontal probing depth at each periodontal site. Subgingival biofilm specimens were collected from each patient before and immediately after Nd:YAG laser monotherapy from periodontal pockets exhibiting ≥6 mm probing depths and bleeding on probing. Selected red/orange complex periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Fusobacterium nucleatum, Parvimonas micra, and Campylobacter species) were quantified in the subgingival samples using established anaerobic culture techniques. Results: All immediate post-treatment subgingival biofilm specimens continued to yield microbial growth after Nd:YAG laser monotherapy. The mean levels of total cultivable red/orange complex periodontal pathogens per patient significantly decreased from 12.0% pretreatment to 4.9% (a 59.2% decrease) immediately after Nd:YAG laser monotherapy, with 3 (25%) patients rendered culture-negative for all evaluated red/orange complex periodontal pathogens. Conclusions: High peak pulse power Nd:YAG laser monotherapy, used as the initial step in the LANAP® surgical protocol on mature subgingival biofilms, immediately induced significant reductions of nearly 60% in the mean total cultivable red/orange complex periodontal pathogen proportions per patient prior to mechanical root instrumentation and the rest of the LANAP® surgical protocol.

• Journal of Periodontal and Implant Science
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• v.24 no.2
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• pp.283-302
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• 1994

Gingivectomy has been utilized as a therapeutic method to remove diseased periodontal pocket wall in order to aid in root planing. Although chemical agents and electrosurgery has been used in addition to the conventional method of using surgical blades, difficulties in controling the depth of chemical penetration and effectively regenerating the gingival tissue as well as the slow wound healing has been pointed out as shortcomings of these methods. This study was designed to assess the effect of Aloe vera on wound healing of gingivectomy sites created by $CO_2$ laser on palatal gingiva of maxillary molar region of white rats. Those sites treated by surgical blades were designated as control, by $CO_2$ laser as Experimental group I, by surgical blades in addition to topical application of Aloe vera as Experimental group II, and by $CO_2$ laser and Aloe vera application as Experimental group III. Animals were sacrificed at 2 days, 3 days, 1 week, 2 weeks and 3 weeks postoperatively, and the specimens were histologically analyzed. The results were as follows : 1. Resorption of blood clots were observed in the control at 3rd day, followed by the rest of the experimental groups at 1 week postoperatively. 2. Persistent inflammation was observed up to 1 week in the control and Experimental group II and III, and until the 2nd week in Experimental group I. 3. Granulation tissue was observed up to 1 week in the control, and 2 weeks in the rest of the groups. 4. Epithelization started on the 2nd day. The control showed the most rapid epithelization, and the process was completed by the 2nd week in all groups. 5. Experimental group II and III, which were treated with Aloe vera, showed similar healing patterns to the control and Experimental group I.

• Journal of Periodontal and Implant Science
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• v.23 no.3
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• pp.564-576
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• 1993

The purpose of this study was to evaluate the effects of Nd:YAG laser treatment on removal of smear layer and exposure of dentinal tubules. The experimental specimens were obtained from root planed surface of 30 human teeth which were extracted due to severe periodontal disease. The specimens were assigned randomly of three groups: root planed group, Tetracycline HCl(100mg/ml, 5min) group, and Nd:YAG laser ($Laser-35^{TM}$, U.S.A. 5 seconds )group. Nd:YAG laser group was divided into 4 subgroups according to 3.0W, 3.5W, 4.0W, 4.5W of power. The surface change of specimens were evaluated by scanning electron microscopy. The number of exposed dentinal tubules and percentage of area occupied by dentinal tubule orifices per unit area between each group was statistically analyzed by paired Student t-test. The results were as follows: 1. By root planing only, dentinal tubule was not exposed, but scale-like smear layer and parallel instrument tracks were resulted. 2. Tetracycline HCl treated surfaces exhibited the small number of partially exposed dentinal tubules with long orifices. The number($3.80{\pm}0.79$) of exposed dentinal tubules on Tetracycline HCl group was significantly less than that in laser groups above 3.5W of power(P<0.001), and the percentage ($0.68{\pm}0.19$) of area occufied by dentinal tubule orifices per unit area($192\;{\mu}m^2$) was significantly lower than that of any laser group(P<0.001). 3. The laser group irradiated with 4.5W of power showed both the most number($10.60{\pm}0.97$) of exposed dentinal tubules among the experimental groups, and the highest percentage($3.75{\pm}0.55\;%$) of area occupied by dentinal tubule orifices. 4. Energy Surge during laser pulsing and overlapping passes of the fiber resulted in melted and resolidified surface textures with lava-like appearance.

• Journal of Periodontal and Implant Science
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• v.29 no.3
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• pp.577-594
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• 1999

The major cause of periodontal disease is microorganism in the dental plaque. Gingival sulcular fluid, which is exudate released from the tissue near crevicular epithelium is related with inflammation. The purpose of this study was to evaluate the argon laser efficiency between the clinical index and onset of collagenase of gingival sulcular fluid. Material divided 16 patients into 4 groups. The first control was without treatmemt. The second was with just treatment of argon laser, The third was treated by scaling and root planning and the fourth was treated with both scailing and root planning and argon laser. The level of periocheck test, the index of bleeding, and the depth of periodontal pocket were evaluated from for 128 teeth of 64 anterior teeth and 64 posterior teeth. The results were as follows ; 1. In the score of periocheck test, root planing group(group 3) was significantly reduced more than the group without treatment(group 1) and the argon laser treatment(group 2) for results of 3 days and 7 days. But root planing plus argon laser treatment(group 4) in the 7days after experiment, was significantly reduced than no treatment(group 1) and root planing treatment(group 3)(P<0.05), in the 3 days after experiment, was significantly reduced than root planing(group3)(P<0.05). The score of periocheck test to the root planning group(group 3) were significantly reduced between days1, day3 and day7(P<0.05). Root planning plus argon laser group(group 4) were significantly reduced to 1 or 7days and 3 or 7days(P<0.05). The argon laser group(group 2) didn't show any changes. 2. In the case of sulcus bleeding index, the root planning group(group 3) and root planning plus argon laser group(group 4) were reduced more than without treatment group(group 1)(P<0.05) and sulcus bleeding index in the root planning group(group 3) were reduced more than the argon laser group(group 2)(P<0.05). 3. There wasn't any changes of pocket depth between the control and the experiment group as with experiment periods also.

• Journal of Periodontal and Implant Science
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• v.25 no.3
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• pp.614-622
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• 1995

Root caries is very frequently developed on exposed root surface after periodontal surgical treatment. In order to determine the anti-caries effect of Nd : YAG laser irradiation on periodontally exposed root surface, 40 mandibular molar teeth that had been extracted due to excessive periodontal destruction were used as the experimental teeth. All teeth were treated by the same procedure as conventional periodontal root treatment, ie thorough scaling, root planing and root conditioning with tetracycline HCl(100mg/ml, 5min.). Within middle one third of root, mesial half surface(20) or distal half surface(20) was randomly irradiated at various power of 1.0W, 2.0W, 3.0W and 4.0W for 60 seconds by non-contact(5mm) delivery of a pulsed Nd : YAG laser(EN.EL.EN060, Italy). The microhardness was measured by Vikers microhardness tester(Wilson, USA) at 2mm/second of jog speed under 100gm load. The difference of microhardness between irradiated side and non-irradiated side was statistically analyzed ANOVA and Duncan's method. Following results were obtained ; 1. The microhardness(Knoop hardness number) was significantly higher in laser irradiated surface than non-irradiated surface(p<0.05). 2. There was no significant difference in microhardness between experimental groups classified by different laser power(p>0.1). The results suggest that Nd : YAG laser irradiation on exposed root suface after periodontal therapy may inhibit the root caries development by enhancing surface microhardness.

• Journal of Periodontal and Implant Science
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• v.25 no.3
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• pp.668-678
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• 1995

In order to evaluate the therapeutic effect of argon laser irradiation on hypersensitive root, 60 mandibular premolars that had been extracted due to periodontal disease were treated by thorough scaling, root planing and root conditioning with tetracycline HCI(100mg/ml, 5 min.) for induction of hypersensitive root. Within middle one third of root mesial surface(30) or distal surface(30) was randomly irradiated by 0.5W-, 0.75W- and 1.0W-power for 2 minutes argon laser(HGM Inc., USA) with or without topical application of 1.23% acidulated phosphate fluoride gel(Pascal, USA). After all teeth were maintained in 2% methylene blue solution for 48 hours and cross-sectioned through irradiated surface of dried roots, methylene blue stained area was compared between irradiated side and nonirradiated side. Following results were obtained : 1. Methylene blue stained area was significantly less in the laser irradiated group than control group(p<0.05). 2. There was no significant difference in methylene blue stained area between 0.5W-power and 0.75W-power group(p>0.1) and between 0.75W-power and 1.0W-power group(p>0.1), but there was significant difference between 0.5W-power and 1.0W-power group(p<0.05). 3. There was no significant difference in methylene blue stained area between two groups with and without topical application of 0.12% acidulated phosphate fluoride gel(p>0.1). The results suggest that argon laser irradiation on hypersensitive root may reduce the hypersensitivity by obstruction of dentinal tubules.

• Journal of Periodontal and Implant Science
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• v.26 no.1
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• pp.230-243
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• 1996

Root surface exposure due to gingival recession after periodontal surgery, dentin exposure after root planing elicit pain response when exposed to mechanical, heat, chemical or osmotic stimulation. Especially, patients treated with periodontal surgery, show high frequency and there have been reports showing the 1 out of 7 patients have dentin hypersensitivity. There have been many studies on the clinical effects of various materials on the treatment of dentin hypersensitivity. but, none could provide absolute clinical efficacy. In this study, 45 teeth from 30 patients, who had had periodontal surgery and showed dentin hypersensitivity after surgery were chosen for the experimental group and they were illuminated with laser, 15teeth were chosen for the control group and they were not exposed to laser. After this dentin hypersensitivity was elicited by tactile, compressed air, cold water and then, the degree was evaluated using NRS(Numerical Rating Scale). And during LLLT(Low Level Laser Therapy) semiconductor laser using Gallium - Arsenide as a diode was illuminated for 180 seconds at a frequency of 7(500Hz). This therapy was done 10 times, and each time the changes in dentin hypersensitivity was evaluated using NRS. The results were as follows : 1. After treat with LLLT on dentin hypersensitivity due to periodontal surgery, 22.2% showed total loss of dentin hypersensitivity, 60.0% showed loss of tactile dentin hypersensitivity, 48.8% showed loss of compressed air dentin hypersensitivity, 22.2% showed loss of cold water dentin hypersensitivity. 2. As a result of clinical evaluation of dentin hypersensitivity using NRS, there was significant increase in improvement of dentin hypersensitivity in the experimental group compare to the control group(P<0.05). And there was almost no natural loss of dentin hypersensitivity in the control group. 3. In comparison of the stages of evaluation, there was significant difference in between experimental and control group. after the second visit(P<0.05), and the difference increased with each visit.

• International Journal of Oral Biology
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• v.40 no.2
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• pp.103-109
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• 2015

Growing evidence suggests that mitochondrial reactive oxygen species (ROS) are involved in various pain states. This study was performed to investigate whether ROS-induced changes in neuronal excitability in trigeminal subnucleus caudalis are related to ROS generation in mitochondria. Confocal scanning laser microscopy was used to measure ROS-induced fluorescence intensity in live rat trigeminal caudalis slices. The ROS level increased during the perfusion of malate, a mitochondrial substrate, after loading of 2',7'-dichlorofluorescin diacetate ($H_2DCF-DA$), an indicator of the intracellular ROS; the ROS level recovered to the control condition after washout. When pre-treated with phenyl N-tert-butylnitrone (PBN) and 4-hydroxy-2,2,6,6-tetramethylpiperidene-1-oxyl (TEMPOL), malate-induced increase of ROS level was suppressed. To identify the direct relation between elevated ROS levels and mitochondria, we applied the malate after double-loading of $H_2DCF-DA$ and chloromethyl-X-rosamine (CMXRos; MitoTracker Red), which is a mitochondria-specific fluorescent probe. As a result, increase of both intracellular ROS and mitochondrial ROS were observed simultaneously. This study demonstrated that elevated ROS in trigeminal subnucleus caudalis neuron can be induced through mitochondrial-ROS pathway, primarily by the leakage of ROS from the mitochondrial electron transport chain.