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J Clin Periodontol 2002; 29: 211–215 Copyright C Munksgaard 2002 Printed in Denmark . All rights reserved Frank Schwarz1, Nicole Arweiler2,
Thomas Georg3 and Elmar Reich2
Desensitizing effects of an Er:YAG 1DepartmentofOralandMaxillofacial Surgery, Ludwig Maximilians University,Munich, Germany; 2Department of Periodontology and Conservative Dentistry,University of Saarland, Homburg, Germany;3Institute of Medical Biometrics, Epidemiology and Medical Informatics, University ofSaarland, Homburg, Germany Schwarz F, Arweiler N, Georg T, Reich E: Desensitizing effects of anEr:YAG laser on hypersensitive dentine. A controlled, prospective clinical study.
J Clin Periodontol 2002; 29: 211–215. C Munksgaard, 2002.
Abstract
Aim: The aim of the present study was to evaluate and compare the desensitizing
effects of an Er:YAG laser (KEY IIA, KaVo, Germany) and Dentin ProtectorA
(Vivadent, Germany) on cervically exposed hypersensitive dentine.
Method: A group of 30 patients showing a total of 104 contralateral pairs of
hypersensitive and caries-free teeth was selected and randomly allocated in a split-
mouth design to either (1) Er:YAG laser (80 mJ/pulse, 3 Hz), or (2) the appli-
cation of Dentin ProtectorA (polyurethane-isocyanate 22.5%; methylenechloride
77.5%) whereat one pair served as an untreated control in each patient. The
degree of sensitivity to a thermal stimulus was determined qualitatively with an
evaporative stimulus defined as a 3-s air blast at a distance of 2 mm from each
site to be tested. A qualitative registration of the degree of discomfort was
determined according to an arbitrary pain scale in 4 degrees. Recordings were
assessed before treatment, immediately after, 1 week, 2 and 6 months after treat-
ment by 1 blinded examiner.
Results: Both treatment forms resulted in significant improvements of discomfort
immediately after and 1 week post treatment. After 2 months, the discomfort
in the Dentin ProtectorA group increased up to 65% of the baseline score and
even up to 90% after 6 months, whereas the effect of the laser remained at the
same level that was achieved immediately after treatment. The differences im-
mediately after, 1 week, 2 and 6 months post treatment between both groups were
statistically high significant (pр0.001; respectively). Compared to the untreated
control group, both treatment forms resulted in a significant reduction of dis-
comfort at each follow-up examination.
laser; dentine hypersensitivity; polyurethane- Conclusion: It was concluded that desensitizing of hypersensitive dentine with an
Er:YAG laser is effective and the maintenance of the positive result was moreprolonged than with Dentin ProtectorA.
theory’’, movements of fluid within ex- Flynn et al. 1985, Scherman & Jacobs- sodium fluoride, are also effective (Ged- en 1992). So far, there is relatively little or solution resulted in positive desensit- 1990). According to the ‘‘hydrodynamic various laser systems are discussed for a ide) lasers are limited due to their ther- tivity treatment whilst on the trial.
ness & Löe 1964) was recorded on the Study design
an untreated control in each patient.
Treatments
and even 20,000 ¿ greater than the and left sides. All patients were treated rectly result in a decrease of dentine hy- persensitivity. In this context, the appli- pulse, and a repetition rate of 3 Hz with Oral hygiene
structions given by the manufacturer.
ficial layers of the dentinal fluid. How- tern. All contralateral teeth received an Clinical measurements
hypersensitive teeth served as a control.
The degree of sensitivity to a evaporative Material and Methods
onds cold air blast (temperature range of Subject selection
19–20 æC) at a distance of 2 mm from the site to be tested. Sensitivity was assessed four degrees (Table 1). During testing the Statistical analysis
clinical parameters were calculated.
Table 1. Pain scale to assess the degree of surfaces. Criteria for exclusion from the ing to the distribution of the data, non- study were: (a) carious lesions on the se- lected or neighbouring teeth, (b) any de- and parametric tests (Student paired t- sensitizing therapy on the selected teeth during the last 6 months, (c) cervical fill- ings on the selected teeth. Other reasons of pр0.05 were accepted as statistically for exclusion were a history of allergy to Desensitizing effects of an Er:YAG laser Table 2. Mean degree of discomfort and standard deviation in all groups over 6 months (nΩ ductions of discomfort were unalteredeven 6 months following the initial The stars indicate statistically significant differences between groups (Wilcoxon signed ranks test) (n.s. pу0.05, * pр0.05, ** pр0.01, *** pр0.001).
tine hypersensitivity, whereas the use oflasers has often been propagated for thisindication. In previous clinical studies it Table 3. Mean gingival recessions (∫SD) in all groups over 6 months (nΩ30 patients) has been demonstrated that the pulsedNd:YAG laser is also an effective tool in reducing dentine hypersensitivity to cold air stimuli. It produced an immediate ef- Harper & Midda 1992, Gelskey et al.
1993, Gutknecht et al. 1997). It was pre-sumed that dentine may be fused during The stars indicate statistically significant differences between groups (paired t-test) (n.s.
pу0.05, * pр0.05, ** pр0.01, *** pр0.001).
Harper & Midda 1992, Gelskey et al.
1993). Similar results have also beenfound with the CO2 laser (Moritz et al.
Table 4. Mean plaque index (∫SD) in all groups over 6 months (nΩ30 patients) 1996). Its effectiveness is probably due to ments of fluid in the tubules, fusing the elimination of dentine hypersensitivity.
In this context it is important to mention The stars indicate statistically significant differences between groups (paired t-test) (n.s.
pу0.05, * pр0.05, ** pр0.01, *** pр0.001).
tubular diameters that are significantlywider (2¿) than those of non-sensitiveteeth, so it would appear that treatment detrimental pulpal effects or allergic re- focused at decreasing the radius is a pre- tings of 80 mJ/pulse at 3 Hz, used in the present study, are lower than the ablation groups (pу0.05; respectively) (Table 3).
in all groups with progressive reductions (pу0.05; respectively) (Table 4).
insoluble salts in the exposed tubules are responsible for an obturation of the den- Discussion
after, 1 week, 2 and 6 months post treat- The results of the present clinical trial tivity of teeth. The pain threshold of the cally high significant (pр0.01; respec- nerve fibers seems to be lowered in pres- son & Brannström 1974, Olgart et al.
comfort throughout the study period.
1974). In this context it is important to torA. The results especially illustrate ef- frei waren ausgewa¨hlt und nach einem Zu- d’incomfort a e´te´ de´termine´ suivant une fallsprinzip einem Splitmouth-Design zuge- e´chelle de douleur arbitraire de 4 degre´s. Les (Ando et al. 1996, Hibst et al. 1996).
enregistrements ont e´te´ effectue´s avant le traitement, imme´diatement apre`s ainsi qu’u- Dentin ProtectorA (Polyurethan-Isocyanate ne semaine, 2 et 6 mois apre`s le traitement und ein Paar bei jedem Patienten diente als Re´sultats: Les deux types de traitement se
sont accompagne´s d’une diminutionde l’in- keitsgrad bezu¨glich eines thermischen Stimu- confort imme´diatement apre`s et 1 semaine ate, as the active substance, has not yet lus wurde qualitativ bestimmt, indem jede apre`s le traitement. Apre`s 2 mois, l’inconfort Stelle aus 2 mm Entfernung mit einem Luft- dans le groupe Dentin ProtecorA atteignait ably lead to the creation of a peripheral bla¨ser fu¨r 3 Sekunden getrocknet wurde. Ent- 65% du score initial et meˆme 90% apre`s 6 intrinsic barrier within the lumen of the sprechend einer Schmerzskala mit Einteilung mois tandis que l’effet obtenu par le laser de- dentinal tubules. In this context the re- nach vier Graden wurde eine qualitative Be- meurait au meˆme niveau que celui atteint jus- urteilung des Grades der Beeintra¨chtigung te apre`s le traitement. Les diffe´rences imme´- diates, 1 semaine, 2 et 6 mois apre`s le traite- Behandlung, direkt anschließend, sowie eine ment entre les deux groupes e´taient tre`s significatives (pр0.001). Compare´es au grou- handlung durch einen bezu¨glich der Therapie pe controˆle non-traite´, les deux traitements able for the penetration of the resin-ad- re´sultaient en une re´duction significative de Ergebnisse: Direkt nach der Behandlung und
l’inconfort lors de chaque examen.
Conclusion: La de´sensibilisation dentinaire
lungsarten eine signifikante Verbesserung der avec le laser Er:YAG est efficace et le main- Beeintra¨chtigung zur Folge. Nach zwei Mo- tien de son re´sultat positif plus prolonge´ naten erho¨hte sich in der Dentin ProtextorA- Gruppe die Beeintra¨chtigung auf Werte bis removal of this peripheral intrinsic bar- zu 65% der Ausgangswerte und sogar auf bis References
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