A 54-year-old Caucasian female presented with Type II periodontal disease (generalized 4 mm to 5 mm pockets) of unknown duration (Figure 1). All areas were charted, probed using a probe (CPITN-E probe), and treatment planned for scaling and root planing with utilization of laser in diseased areas. One manageable treatment section of scaling and root planing was conducted using 1 carpule of 2 percent lidocaine (Septocaine 1:100,000) infiltrated into the surrounding tissue. Traditional root planing and scaling were performed prior to the lasing procedure to allow improved pocket access for the fiber. A 400-micron fiber was applied directly to the diseased pocket using a light touch. Laser-assisted periodontal curettage using a diode laser at a setting of 0.6 watts in continuous wave mode in conjunction with root planing and scaling procedures were then performed.

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Figure 2

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Treatment began at the gingival margin holding the fiber parallel to the tooth and slightly angled toward the diseased tissues using a deliberate, erasure-like, crosshatching motion. The fiber tip was inspected frequently to remove accumulated tissue on a 2 x 2 gauze. Typically, each pocket had a 30- to 40-second lasing treatment time, which varied depending on type of tissue and severity of disease. The procedure was evaluated as complete by evidence of a new wound site with bleeding or fresh bleed (Figure 2).

Postoperative instructions included warm saltwater rinses twice daily and an extra-soft-bristle toothbrush to be used at next brush session. (Figure 6 demonstrates postoperative healing after one month.) Healing was assessed at a one-month recare visit where tissues appeared firm, pink, and slightly stippled. Patient was evaluated at future recare visits, and full probing was performed. Any remaining pockets over 3 mm with hemorrhage would require further lasing. In this specific case, no relasing was required.

Written by Lori Trost, DMD and Karen Kaiser, RDH