Rajiv Gandhi University of Health Sciences, Karnataka
Bangalore
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / Name Of The Candidate And Address(In Block Letters)
/ Dr. MANDAR KATE.
POST GRADUATE STUDENT DEPARTMENT OF PERIODONTICS COORG INSTITUTE OF DENTAL SCIENCES
VIRAJPET
2 / Name of the Institution / COORG INSTITUTE OF DENTAL SCIENCES
3 / Course of study and Subject / MASTER OF DENTAL SURGERY, PERIODONTICS - BRANCH II
4 / Date of admission of Course / 30-05-2013
5 / Title of the Topic
A PROSPECTIVE, SPLIT MOUTH TRIAL COMPARING THE EFFICIENCY OF ER:YAG LASER DEBRIDEMENT VERSUS CONVENTIONAL SCALING AND ROOT PLANING IN PATIENTS WITH CHRONIC PERIODONTITIS. A SCANNING ELECTRON MICROSCOPY & MICROBIAL STUDY.
6. Brief Resume of the intended work:
Need for the study:
Periodontitis is defined as an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of specific microorganisms resulting in progressive destruction of the periodontal ligament and alveolar bone with pocket formation, recession or both. 1
Scaling is the process by which plaque and calculus are removed from both supragingival and subgingival tooth surfaces. 2
Root planing is the process by which plaque and calculus are removed from the roots to produce a smooth, hard, clean surface. 2
Advanced periodontal disease in humans is characterized by the presence of inflammatory lesions leading to loss of periodontal attachment to the tooth. Oral bacteria play a pivotal role in the etiology of gingivitis and periodontitis. Hence plaque control, scaling and root planing, as well as consequent maintenance with regular recall intervals may delay or even arrest periodontal progression. 3
The Er:YAG laser was proposed as an alternative/adjunct to mechanical scaling and root planing when early feasibility studies demonstrated that it has the ability to remove hard deposits from the root surface . 4
Currently, the standard of care in root surface debridement is scaling and root planing (SRP) using a combination of powered scalers and hand instruments, but there are limitations to mechanical debridement, like,
1. Subgingival calculus may be left behind on proximal surfaces, in deep sites, root concavities and furcation area.
2. Deep pockets may be difficult to access
3. Formation of smear layer.
The advantages of using laser debridement with an Er:YAG laser, as reported in the literature, are its strong bactericidal and detoxification activity , its ability to remove deposits from inaccessible areas and debride the root surface with minimal removal of tooth substance, its ability to ablate without producing a smear layer and its ability to remove smear layers and cementum bound endotoxin. It is also been shown that Er:YAG laser has the potential of removing micro organisms from the soft tissue wall of periodontal pocket. 4
Hence the study is planned to evaluate the efficiency of Er:YAG laser in the treatment of chronic periodontitis.
6.1 Review of literature:
- Aoki et al., Adriaens & Adriaens, reported Ultrasonic scaling produces
deep grooves on the root surface whereas substantial amounts of cementum and dentine
are removed with each stroke of a curette. The same study also states the Er:YAG laser’s
ability to debride the root surface with minimal removal of tooth substance.
- Eberhard J, Ehlers H, Falk W, Acil Y, Albers H-K, Jepsen S, demonstrated the ability of Er:YAG laser to remove hard deposits from the root surface.
- Folwaczny et al. , reported that Er:YAG laser has strong bactericidal and
detoxification activity.
- Schwarz et al., Eberhard et al. reported that, Er:YAG lasers can be used to
remove calculus and, Walsh & Cummings, Aoki et al., Ishikawa et al. reported that ,due
to their high absorption in water, provide the ability to completely ablate calculus from
periodontally diseased areas without causing thermal side effects to the root.
- Yamaguchi et al., Folwaczny et al., reported that this laser has been assumed not
only to eliminate bacteria but also to inactivate bacterial toxins diffused in the root
cementum without producing a smear layer.
- Maruyama H, Aoki A, Sasaki KM, et al, reported that Er:YAG laser showed a
significant difference in efficiency of calculus removal compared with the Er,Cr:YSGG
laser. Aoki A, Miura M, Akiyama F, et al., reported that Er:YAG laser is able to
effectively remove subgingival calculus from the root surface.
6.2 Objective of the study:
1) To compare and evaluate the efficiency of Erbium YAG lasers on root surface and pocket wall debridement to conventional scaling and root planing.
2) To compare and evaluate the efficiency of Erbium YAG lasers and scaling and root planing on residual microorganisms in the treatment of patients with chronic periodontitis.
3) To compare surface characteristics on the root surface following the two procedures.
7 / Materials And Methods:
7.1 Source of data
Patients reporting to the Out Patients Department of Periodontics in Coorg Institute of Dental Sciences, Virajpet, Karnataka.
Inclusion criteria
· Age group: 35 yrs to 55 yrs.
· Single rooted teeth.
· Grade III mobility.
· Systemically healthy patients.
Exclusion criteria
· Subjects who are on any medication or were on any medication since the last 6 months.
· Subjects who have undergone treatment in relation to the site within a period of 6 months.
· Diabetic patients
· Subjects with any underlying systemic disease.
· Pregnant/lactating women.
· Subjects consuming tobacco and tobacco products.
7.2 Method of collection of data
A total of 30 single rooted teeth (15 Control and 15 Test) indicated for extraction due to chronic periodontitis will be selected for each group in the study. Samples will be divided into two groups by flipping a coin.
- Group 1(Control): Scaling and Root planing will be done.
- Group 2(Test): Root debridement and lasing of pocket wall using Erbium YAG
Laser will be done.
In control group, after supragingival scaling, the teeth will be isolated and subgingival samples will be collected using absorbent paper point and will be sent for microbiologic analysis. Root planing will be carried out using standard gracey curettes. After root planing subgingival samples will be collected using absorbent paper points and will be sent for microbiologic analysis. The teeth will then be extracted and sent for scanning electron microscope (SEM) analysis.
In test group, supragingival scaling will be done by Er:YAG laser, the teeth will be isolated and subgingival samples will be collected using absorbent paper points and will be sent for microbiologic analysis. Root debridement procedure using Er:YAG laser will be carried out along with lasing of the pocket wall. After root debridement, subgingival samples will be collected using absorbent paper points and will be sent for microbiologic analysis. The teeth will be extracted and will be sent for SEM analysis.
7.3 Does the study require any investigations or interventions to be conducted on the patients or other humans or animals? ( If so please describe briefly)
7.4 Has Ethical clearance been obtained from your institution in case of 7.3?
YES
8. / List Of References:
1. Hinrichs JE, Novak JM. Classification of diseases and conditions affecting the periodontium. 11th Ed Carranza’s Clinical Periodontology for SouthAsia. Chapter4. p. 41.
2. Anna M, Pattison, Gordon L Pattison. Scaling and Root Planing. 10th Ed Carranza’s Clinical Periodontology. Chapter51. p. 774.
3. Socransky,S.S , Haffajee,A.D. Dental Biofilms: Difficult therapeutic targets. Periodontology 2000. 2002; 28:12-55.
4. Soo L, Leichter JW, Windle J, Monteith B, Williams SM, Seymour GJ, Cullinan
MP. A comparison of Er: YAG laser and mechanical debridement for the
nonsurgical treatment of chronic periodontitis: A randomized, prospective
clinical study. J Clin Periodontol 2012; 39: 537–45.
5. Derdilopoulou FV, Nonhoff J, Neumann K, Kielbassa AM. Microbiological findings after periodontal therapy using curettes, Er:YAG laser, sonic, and ultrasonic scalers. J Clin Periodontology 2007; 34: 588–98.
6. Ahmad Moghare Abed, Reza Birang, Ghassem Ansari, Khosro Mostajeran. SEM
Evaluation of Root Surface Roughness Following Scaling Using Er:YAG,
Ultrasonic, and Hand Instruments. Oral Laser Applications 2010; 10: 23-7.
7. Ardavan Etemadi, Mostafa Sadeghi, Fatemeh Mashhadi Abbas, Fahime Razavi,
Akira Aoki, Reza Fekr Azad, Nasim Chiniforush. Comparing Efficiency and
Root Surface Morphology After Scaling with Er:YAG and Er,Cr:YSGG Lasers.
Int J Periodontics Restorative Dent 2013;33:140–4.
8. Crespi R, Cappare P, Toscanelli I, Gherlone E, Romanos GE. Effects of Er:YAG
laser compared to ultrasonic scaler in periodontal treatment: A 2-year follow-up
split- mouth clinical study. J Periodontol 2007;78:1195–200.
9. Maruyama H, Aoki A, Sasaki KM, et al. The effect of chemical and/or
mechanical conditioning on the Er:YAG laser-treated root cementum: Analysis
of surface morphology and periodontal ligament fibroblast attachment. Lasers
Surg Med 2008;40:211–22.
10. Aoki A, Miura M, Akiyama F, et al. In vitro evaluation of Er:YAG laser scaling
of subgingival calculus in comparison with ultrasonic scaling. J Periodontal Res
2000; 35:266–77.
9. / Signature of the Candidate
10. / Remarks of the Guide
11. / Name & Designation of (In block letters)
11.1 Guide
11.2 Signature / Dr B. S. JAGADISH PAI
ASSOCIATE PROFESSOR
11.3 Co- guide (if any)
11.4 Signature
11.5 Head of the Department
11.6 Signature / DR.PADMA R
(PROFESSOR & HOD)
12. / 12.1 Remarks of the chairman & Principal
12.2 Signature / DR. SEQUEIRA PETER SIMON (PRINCIPAL)