Volume 2 - Issue 4 (Aug-Oct) Download Pdf - IJMD

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Review ArticleTreatmentSome of the treatment modalities that includeapplication to exposed dentinal tubules of resins,oxalate salts, isobutyl cyanoacrylate, fluoridereleasingresins or varnishes 8,9. Use of potassium containingdentifrices, fluoride containing medicaments and10% strontium chloride were partially effective inreducing dentinal hypersensitivity. 10,11 Recentlyremineralizing pastes like calcium sodiumphosphosilicate bioactive glass, amorphous calciumphosphate, and Pro-Argin Technology containingarginine, an amino acid that binds to the negativecharged dentin surface and attracts calcium richlayer from the saliva. 12,13NEWER TREATMENT A different treatmentmodality for reducing dentinal hypersensitivityinvolves the use of laser technologyThe rationale for laser induced reduction indentinal hypersensitivity is based on two possiblemechanisms that differ greatly from each other. Thefirst mechanism implies the direct effect of laserirradiation on the electric activity of nerve fiberswithin the dental pulp, whereas the second involvesmodification of the tubular structure of the dentinby melting and fusing of the hard tissue or smearlayer and subsequent sealing of the dentinal tubules.Among the different lasers used, desensitizingmechanism is distinct for each emitted wavelength;success rates reported differ according to laserdevice, irradiation parameters (adequate wavelength, power density, wave mode, frequency ofpulses, and number of irradiation repetitions) andinvestigation methods used to assess dentinal pain.The lasers used for the treatment of dentinalhypersensitivity may be divided into two groups:1. Low output power lasers (Heluium-neon andgallium/aluminum/arsenide (diode)2. middle output power lasers (Nd;YAG and carbondioide CO2)Matsumoto et al in 1985 introduced first diode laserfor the management of dentinal hypersensitivity. 17They applied an out applied an output power of30mW in a continuous wave irradiation mode for0.5to a3 minutes and reported treatment effectivenessranging from 85% to 100. The investigatorsconsidered that the analgesic effect was related todepressed nerve transmission caused by the diodelaser irradiation blocking the depolarization ofC-fiber afferents. Moritz et al 18 used a CO 2laserwith an output of 0.5 W for 5 seconds. Treatmenteffectiveness of 59%-100% was reported.Senda et al 19 were the first to apply the helium neonlaser in treating dentinal hypersensitivity. They usedan output power of only 6mW, which does not affectthe morphology of the enamel or dentin surface butallows a small fraction of the energy to reach thepulp tissue. It was reported that the effectiveness ofthis treatment ranges from 5.2% to 100%.Matsumoto et al 20 used a CO 2laser with an outputpower of 0.5 Win a continuous wave mode andan irradiation time of 5 seconds to treat dentinhypersensitivity. Treatment effectiveness rangedfrom 85% to 100%.Renton –Harper and midda 21 conducted a clinicaltrial on 30 patients to evaluate the efficacy of the Nd:YAG laser in reducing dentinal hypersensitivity.They reported it was 90% effective and themechanism is occluding or narrowing of the dentinaltubules. Direct nerve analgesia and suppressiveeffect achieved by blocking the depolarization of Adelta and C fibres.Stabhikz et al 22 investigated the effects of excimerlasers onexposed dentinal tubules of extractedhuman teeth and found melting of dentin and closureof exposed dentinal tubules. Main advantage ofexcimer lasers is safe and minimal thermal damageto the surrounding tissues.Wan-Hong Lan et al(2009) 14 conducted a study toevaluate the effectiveness of the Nd:YAG laser inthe treatment of dentin hypersensitivity. Thirtysubjects participated were followed for 3 months.The Nd:YAG laser treatment reduced dentinhypersensitivity to air by 65% and to mechanicalstimulus by 72% over 3 months. In conclusion,the Nd:YAG laser can be used to reduce dentinhypersensitivity without detrimental pulpal effectsIpci et al 15 conducted a study to evaluate and comparethe efficacy of CO 2and Er:YAG lasers alone andin combination with topical sodium fluoride inthe management of dentin hypersensitivity. Theyconcluded that both the CO 2and Er:YAG lasershave promising potential for the treatment ofdentine hypersensitivity. Zhang C et al 16 evaluatedthe combined occluding effect of sodium fluoridevarnish and Nd:YAG laser irradiation on human570Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 4, August-October 2012
Review Articledentinal tubules under SEM. Over 90% of thedentinal tubule orifices were occluded by sodiumfluoride varnish combined with Nd:YAG laser.A recent study conducted in our department ofconservative dentistry and endodontics, RMDCH, tocompare between CO 2and Nd:YAG laser irradiationfor their sealing ability on human dentinal tubuleswhen treated with and without fluoride varnish usingScanning Electron Microscopy. 23 It was concludedthat compared to conventional fluoridation or laserirradiation in the treatment of dentin hypersensitivity,CO 2lasers in combination with Fluoride varnishappear to show better efficacy than either treatmentmodality alone.FIG. 3Combined occluding effect of fluoridevarnish and Nd:YAG laser irradiation onhuman dentinal tubules ( X2500)FIG. 1Control specimen showed exposed dentinaltubule orifices. (X 2500)FIG. 4Combined occluding effect of fluoridevarnish and CO2 laser irradiation onhuman dentinal tubules (X2500)FIG. 2Fluoride varnished group showed smoothsurface, and almost all of the dentinal tubuleorifices were occluded. (X 2500)FIG. 5Nd:YAG lased specimen showed partialocclusion of dentinal tubules. (x 2500)Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 4, August-October 2012 571
Page 1 and 2: From the Editor's DeskFROM THE EDIT
Page 3 and 4: Reliability o f Lo w e r Lip Li n e
Page 5 and 6: DiscussionOriginal ResearchIn curre
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Page 9 and 10: COMPARISON OF FRICTIONAL RESISTANCE
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Page 16 and 17: Review Articlediagnostic biomarkers
Page 18 and 19: eview articleCo n c e p t o f Short
Page 20 and 21: Review Articleincreased when unilat
Page 22 and 23: Review Articledimensionally accurat
Page 24 and 25: Review Articleassociated with incre
Page 26 and 27: Review Articleunderstanding of the
Page 30 and 31: Review ArticleFIG. 6CO 2lased speci
Page 32 and 33: Review Articlesite of a different s
Page 34 and 35: Review ArticleReferences :1. Predic
Page 36 and 37: A Case Reportcranium, diminished bi
Page 38 and 39: A Case Reportpreauricular hair disp
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Page 42 and 43: A Case ReportCLINICAL PHOTOGRAPHS:F
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Page 55 and 56: A Case Report15. Freilich MA, Karma

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