Optimizing visualization and ergonomics. - Academy of Laser Dentistry

JOUR NAL OF LASER DENTIS TRY | 2007 VOL 15, NO. 3
144
CLINICAL CASE
Nd:YAG Laser Use in Treatment of
Moderate Chronic Periodontitis
Mary Lynn Smith, RDH, McPherson, Kansas
J Laser Dent 2007;15(3):144-150
SYNOPSIS
This case report describes the use of an Nd:YAG laser as an integral
component of the initial treatment of periodontal disease.
PRETREATMENT
A. Diagnostic Tests
1. Full Clinical Description
A healthy 47-year-old Hispanic male
presented for examination. His chief
complaint was the dark spot at the
gingival margin of tooth #9 and
limited chewing efficiency (Figure 1).
His last dental visit was 6 months
prior for an emergency extraction of
tooth #19. He had never had any
type of dental hygiene appointment.
The patient speaks Spanish predominately,
and communication was
accomplished by the dentist translating
information at specific times
in each appointment.
During the initial hygiene
appointment, the health history was
reviewed and tissues were visually
screened for signs of oral cancer.
Comprehensive restorative, periodontal,
and radiographic exams
were completed. Micro-ultrasonic
scaling, biofilm removal, and coronal
polishing were performed. The
patient was educated concerning his
oral health and probable progression
of untreated disease.
The patient was taking no
medications and had no known allergies.
He was missing nine teeth: #1,
16, 17, 19, 20, 25, 26, 30, and 32.
Decay was noted on teeth #3, 15, and
18. Significant fractures were noted
on tooth #18 as well. The occlusion
was Angle’s classification I with
normal TMJ function. Supragingival
calculus and gingival inflammation
indicated possible periodontal
disease. Complete periodontal
charting revealed periodontal
probing depths of 2-7 mm. Areas of
recession exposing 1 to 4 mm of root
surface were
present.
Furcations and
mobility were
also noted on the
molars.
2. Radiographic
Examination
A full-mouth
series with 4
vertical bitewings
and 14
periapical films
was taken to
further evaluate
bone loss and
carious lesions
(Figure 2).
Decay was
noted on teeth
#3 and 18.
Decay on #15
was not detected
radiographically.
There was
moderate gener-
Figure 2: Full-mouth film series taken at
initial visit Figure 3: Initial periodontal probing chart
Figure 1: Preoperative full-smile photograph
of patient at presentation
alized horizontal bone loss with areas
of severe vertical bone loss on posterior
teeth. Areas of particular concern were
teeth #2, 15, 18, and 31. These teeth
were diagnosed as hopeless due to the
periodontal involvement and/or decay
present and were scheduled for extraction.
Generalized moderate-to-heavy
calculus was noted on the radiographs.
Smith