Subjective intensity of pain during supportive periodontal treatment using a sonic scaler or an...

Subjective intensity of pain duringsupportive periodontal treatmentusing a sonic scaler oran Er:YAG laser

Braun A, Jepsen S, Deimling D, Ratka-Kruger P. Subjective intensity of pain duringsupportive periodontal treatment using a sonic scaler or an Er:YAG laser. J ClinPeriodontol 2010; 37: 340–345. doi: 10.1111/j.1600-051X.2010.01536.x

AbstractObjective: To assess the subjective intensities of pain during supportive periodontaltreatment using a sonic scaler or an Er:YAG laser.

Material and Methods: Forty patients with two residual periodontal pocketsfollowing conventional periodontal therapy were treated using a sonic scaler and anEr:YAG laser in a split-mouth design. A visual analogue scale was used for painassessment directly after each treatment procedure. Additionally, pain was recordedduring the treatment of 11 patients at intervals of 0.5 s using an inter-modal intensitycomparison.

Results: Pain assessment during treatment showed that laser treatment (median painscore: 0.71 U, maximum: 9.94 U, minimum: 0 U) caused less pain than the sonicdevice (median pain score: 2.17 U, maximum: 11.26 U, minimum: 0 U) (po0.05) withno difference in the treatment time (p40.05). These results could be confirmed by thevisual analogue scale: pain scores assessed after laser treatment (median: 1 U,maximum: 7 U, minimum: 0 U) were lower than those after sonic instrumentation(median: 3.5 U, maximum: 7.5 U, minimum: 0 U) (po0.05).

Conclusions: Using an Er:YAG laser during supportive periodontal treatment, painfulsensations can be reduced compared with sonic scaler instrumentation.

Key words: inter-modal intensity comparison;pain assessment; supportive periodontaltreatment; ultrasonic instrumentation; visualanalogue scale

Accepted for publication 10 December 2009

The primary goal of periodontal therapyregimens is infection control by removalof supra- and subgingival plaque andcalculus and prevention of recoloniza-tion of periodontal pockets by patho-genic bacteria. The importance of aregular periodontal care has been shownin several studies (Axelsson & Lindhe1981, Lindhe & Nyman 1984, Kaldahlet al. 1996). Thus, supportive perio-

dontal care (SPC) must be regarded asan integral part of overall periodontalmanagement (American Academy ofPeriodontology 2000, Cohen 2003) forpreserving the clinical improvementsgained by previous periodontal treat-ment procedures and to avoid furthertissue destruction (Axelsson et al. 1991).The overall aims of SPC can be sum-marized as follows: (I) to prevent therecurrence and progression of perio-dontal disease in patients who havepreviously been treated for gingivitis,periodontitis or peri-implantitis; (II) toprevent or reduce the incidence of toothloss by monitoring the dentition and anyprosthetic replacements of the naturalteeth; and (III) to increase the probabil-

ity of locating and treating, in a timelymanner, other diseases and conditionsfound in the oral cavity (Committee onResearch, Science and Technology ofthe American Academy of Perio-dontology 1998). At present, there areseveral therapy regimens such as power-driven, hand or laser instrumentation toachieve these aims. However, all theseregimens should be well accepted by thepatients to enhance the patient’s com-pliance and possibly improve the prog-nosis of SPC. The compliance withdental treatment procedures is affectedby many factors, including self-destruc-tive behaviour, fear, economic factors,health beliefs, stressful events in theirlives and perceived dentist indifference

Andreas Braun1, Søren Jepsen1,Daniela Deimling2 andPetra Ratka-Kruger2

1Department of Periodontology, Operative

and Preventive Dentistry, University Dental

Clinic Bonn, Bonn, Germany; 2Department of

Operative Dentistry and Periodontology,

University Dental Clinic Freiburg, Freiburg,

Germany

Conflict of interest and source offunding statement

The authors declare that they have noconflict of interests.The study was self-funded by the authorsand their institutions.

J Clin Periodontol 2010; 37: 340–345 doi: 10.1111/j.1600-051X.2010.01536.x

340 r 2010 John Wiley & Sons A/S

(Wilson 1998). Thus, the ability to deli-ver dental care with a minimum ofpatient discomfort should be an essentialpart of a clinician’s skills to avoid adecline of compliance.

The intensities of painful sensationsduring supra- and subgingival perio-dontal treatment can be affected usingdifferent power-driven devices and sca-ler tip styles (Braun et al. 2003, 2007,Hoffman et al. 2005, Walmsley et al.2008). Especially, a linear oscillatingdevice is well tolerated by patients andcan be used without local anaesthesia(Guentsch & Preshaw 2008). Compar-ing ultrasonic and hand instrumentationin periodontally involved teeth, it couldbe shown that the linear oscillatingdevice caused less painful sensationsthan hand instruments (Braun et al.2003). In a recent consensus report oninnovations in non-surgical periodontaltherapy, it was stated that there is a needfor studies to address patient-centredoutcomes such as treatment discomfort,etc. (Sanz & Teughels 2008).

Laser treatment procedures areexpected to serve as an alternative oran adjunctive treatment to conventional,mechanical periodontal therapy. At pre-sent, there is insufficient evidence tosupport the clinical application of eitherCO2, Nd:YAG, Nd:YAP or differentdiode laser wavelengths in non-surgicalperiodontal treatment. However, Er:YAGlaser application compared with mech-anical debridement resulted in similarclinical outcomes, both in the short andin the long term (up to 24 months), inpatients with chronic periodontitis(Schwarz et al. 2008). It was concludedthat the Er:YAG laser might be anappropriate treatment procedure for thenon-surgical and supportive therapy ofchronic periodontitis. Evaluating painscores with a visual analogue scale(VAS) immediately after Er:YAG lasertreatment in SPC, the degree of treat-ment discomfort scored significantlylower for the laser than for the ultrasonictreatment modality (Tomasi et al. 2006).

At present, studies conducted so farhave not evaluated subjective pain inten-sities caused by sonic treatment duringSPC. Moreover, there are no data onsonic treatment compared with the useof an Er:YAG laser. Thus, the aim of thestudy was to compare subjective painsensations during subgingival root sur-face instrumentation using a sonic and alaser device, testing the hypothesis ofEr:YAG laser treatment causing lesspain sensations during subgingival SPC.

Material and Methods

Forty patients with chronic periodontitis(19 female, 21 male, mean age:55.3 � 10.0 years, all non-smokers),each presenting with two residual perio-dontal pockets at two teeth [probingdepth �5 mm and bleeding on probing(BOP) (1) or probing depth �6 mm andBOP(1/�)] after completed conven-tional periodontal therapy with no sub-or supragingival calculus clinicallyobservable, were treated using a sonicscaler (Sonicflex 3000 L, KaVo, Biber-ach, Germany) (Fig. 1) and an Er:YAGlaser (KEY Laser 3, KaVo) in a split-mouth multicentre study design. Theparticipating centres were (I) Depart-ment of Periodontology, Operative andPreventive Dentistry, University DentalClinic Bonn and (II) Department ofOperative Dentistry and Periodonto-logy, University Dental Clinic Freiburg.The sonic device was turned to powersetting ‘‘1’’ with the slim-line shapedperiodontal insert No. 60. According tothe manufacturer, the maximum ampli-tude of oscillation was 120mm at6.5 kHz for the level ‘‘1’’ power setting(DIN EN ISO 1506:2000-07). The sca-ler tip shows a predominantly ellipsoidoscillation pattern. The Er:YAG laser(KEY Laser 3) was operated with the2061 handpiece and the 1.65 lightwedge with an energy setting of120 mJ at the laser panel, representingan effective energy of 86 mJ at theworking tip. The pulse repetition ratewas 10 Hz with a continuous water flowand the fluorescence feedback systemswitched off, as otherwise the laserwould only have been activated if cal-culus was detected.

The endpoint of treatment was time-dependent. As the patients presentedafter complete periodontal debridement,

the teeth under study had clinicallyjudged clean root surfaces. Therefore,the aim of the therapy was to remove thesubgingival biofilm. The treatment timewas set to 20 s per diseased root surfaceto achieve biofilm removal. The wholecircumference of the tooth was dividedinto six root surfaces, resulting in amaximum treatment time of 2 min. pertooth.

The sequence of the different treat-ment devices was randomly assignedusing computer-generated random num-ber table: considering the tooth sequenceupper right last molar to upper left lastmolar and lower left last molar to lowerright last molar, the first diseased toothin this sequence was assigned to thefirstly randomly determined treatmentdevice, leaving the remaining tooth tobe treated with the other device. Bothsonic and laser therapy in one patientwere performed by the same operator,allowing an intra-experimental compar-ison of the values. Test and control siteswere treated at the same visit.

With respect to the clinical effective-ness of the two investigated treatmentsat baseline and 3 months after treatment,the BOP frequency was evaluated bya blinded investigator who was notinvolved in the treatment of the patients.BOP was assessed for the two teethunder study separately by gentle probingof the gingival sulcus with a PCP UNC15 periodontal probe. Bleeding pointswere assessed 30 s after probing.

The study was performed withoutusing any local anaesthetics, as no parti-cipant asked for it. However, everyparticipant was aware that local anaes-thetics would have been provided in thecase of unbearable pain or at the sub-ject’s option.

In all forty patients, the subjectiveintensities of pain were assessed with aVAS ranging from 0, representing nopain or discomfort, to 10, representingmaximum pain and discomfort, evaluat-ing the overall pain perception for thetreatment. Additionally, in elevenpatients, pain was recorded during thetreatment procedure at intervals of 0.5 susing an inter-modal intensity compar-ison according to a previously publishedstudy design (Braun et al. 2003, 2007):the patient held the bulb of a manometer(Speidel and Keller, Jungingen, Ger-many) in his left hand with the outputmonitored by a computer (Fig. 2). Thepatient was asked to set the pressure ofhis hand in proportion to the perceivedintensities of pain. Thus, it was possible

Fig. 1. Slim-line-styled sonic scaler tip usedin the study. The device was operated withpower setting ‘‘1’’, resulting in a maximumoscillation amplitude of 120mm at 6.5 kHz.

Pain during supportive treatment 341

r 2010 John Wiley & Sons A/S

to monitor each single painful percep-tion peak during the treatment interval.Additionally, treatment time wasrecorded to assess differences withrespect to the treatment device used.

All patients had been informed aboutthe study and had given their informedconsent. The study was conducted in fullaccordance with the declared ethicalprinciples (World Medical AssociationDeclaration of Helsinki, version VI,2002) and had been approved by thelocal Ethic’s Committee (referencenumber: 198/05).

A power analysis was performedbefore the study. Therefore, the effectsize was set to 0.8 according to Cohen(1988). For an a-error of 0.05 and apower of 0.8, a sample size of 40 subjectswas calculated. For statistical analysis,normal distribution of the values wasassessed using the Shapiro–Wilk test.As not all data were normally distributed,values for pain perception and the BOPindex at baseline and after 3 months wereanalysed using a non-parametric test(Wilcoxon). The Mann–Whitney testwas used to evaluate differences between

BOP values in the two treatment groups.Evaluating the correlation between thetwo different methods for pain assess-ment, cross tabulation tables of the VASreadings and overall mean values of handpressure over time and the respectivePearson’s correlation coefficients werecomputed. Differences were consideredas statistically signicant at po0.05.

Results

In the present study, no participant everasked for a local anaesthesia, althoughall subjects were told that local anaes-thetics would have been provided in thecase of unbearable pain or at the sub-ject’s option. Pain scores could beshown to be dependent on the treatmentdevice used. The inter-modal intensitycomparison during treatment showedthat the Er:YAG laser treatment (medianpain score: 0.71 U, maximum: 9.94 U,minimum: 0 U) caused less pain than theconventional ultrasonic scaler (medianpain score: 2.17 U, maximum: 11.26 U,minimum 0 U) (po0.05) (Fig. 3).Assessing the occurrence of pain sensa-tions over time, it could be demon-strated that pain did not occur con-stantly (Fig. 4). Subjective pain peakscould be observed both in the laser andin the ultrasonic group, reaching com-parable intensity levels. These resultscould be confirmed by VAS measure-ments after therapy: treatment with thelaser device (median pain score: 1 U,maximum: 7 U, min: 0 U) caused statis-tically significantly less pain thanpower-driven instrumentation (medianpain score: 3.5 U, maximum: 7.5 U,

Fig. 2. PC-based device to record pain intensities during the treatment procedure at intervalsof 0.5 s using an inter-modal intensity comparison.

pain

ass

essm

ent [

U]

laser treatment sonic treatment

Fig. 3. Pain assessment using the inter-mod-al intensity comparison in 11 patients for thetwo different treatment devices evaluated inthe present study. Significantly lower painscores were obtained for laser treatment(po0.05). Box plots show the median, firstand third quartiles, minimum and maximumvalues (whiskers). Outliers are marked asdata points and asterisks.

Fig. 4. Pain scores during laser and sonic treatment. Pain values (U) show the mean values ofinter-modal intensity comparisons for 11 patients under study. Pain peaks could be observedboth in the laser and in the ultrasonic group, reaching comparable intensity levels.

342 Braun et al.


minimum: 0 U) (po0.05) (Fig. 5). Eval-uating the readings of the two differentmethods for pain assessment, a signifi-cant positive correlation could be foundbetween the VAS and the overall meanpain values of hand pressure over timefor both the laser (Pearson’s r: 0.856,po0.05) and the sonic treatment (Pear-son’s r: 0.665, po0.05). The treatmenttime did not differ in the laser (mediantime: 92 s, maximum: 117 s, min: 81 s)and the ultrasonic group (median time:90 s, maximum: 119 s, min: 80 s)(po0.05) (Fig. 6).

Values for the BOP frequency did notshow statistically significant differencesbetween the laser (86.1%) and thesonic group (83.3%) (p40.05). After 3months, the frequency values de-

creased significantly within both groups(po0.05), with no difference betweenthe laser (50.0%) and the sonic (50.0%)treatment (p40.05).

Discussion

Subjective pain intensities during sup-portive periodontal treatment with theEr:YAG laser and the sonic device dif-fered statistically significantly: patientsperceived less pain during laser instru-mentation of the root surface. Regardingthe treatment time for the devices understudy, there was no difference in thelaser and the sonic group. Thus, thenumber of periodontally involved rootsurfaces should have been equally dis-tributed in the two groups, as the treat-ment time was set to 20 s per surface.

In the present study, painful sensa-tions were assessed during and after twodifferent treatment procedures. As inter-and intra-individual differences in painsensation could not be excluded, theevaluation was designed as a split-mouth study. Therefore, inter-individualdifferences in pain perception affectedthe two treatment groups in the sameway. As a consequence, the statisticalanalysis was performed using a pairednon-parametric test, considering thepossibility of inter-individual differ-ences in pain perception. With respectto intra-individual pain sensations,the sequence of the different treatmentdevices was randomly assigned usinga computer-generated random numbertable.

Comparing a sonic and an ultrasonicscaler regarding painful sensations bymeans of a VAS during prophylaxistreatment, no difference could beobserved between these two treatmentmodalities (Kocher et al. 2005b). Focus-ing on pain associated with periodontalmaintenance therapy, no differencecould be demonstrated, comparing thepiezoelectric Vectort device and a con-ventional ultrasonic device at a reducedpower setting (Kocher et al. 2005a). Theauthors used a VAS to evaluate subjec-tive pain perception in this study. How-ever, this kind of pain assessment allowsonly a retrospective description of pre-viously perceived painful sensations, sothat short high peaks of pain may berecorded imprecisely (Huskisson 1983,Tammaro et al. 2000). Therefore, in thepresent study, pain was recorded alongwith the SPC treatment procedure usingan inter-modal intensity comparison to

increase the precision of pain assess-ment. Thus, it was possible to correlateevery single painful sensation to theexact treatment time (Braun et al.2003). Consequently, this procedurehas to be considered more precise inpain assessment, as a VAS does notinclude time as a variable. Evaluatingnot a whole treatment procedure butonly a single possibly painful sensationlike periodontal probing with different-sized instruments (Hassan et al. 2005),the use of a VAS appears to be appro-priate for pain assessment as the prob-ing procedure represents a temporallydefined pain sensation. In the presentstudy, pain should be evaluated duringthe whole SPC treatment procedure. Asa consequence, values of the well-estab-lished VAS were amended by the inter-modal intensity comparison with handpressure. A manometer for hand pres-sure assessment is a device describedpreviously for inter-modal intensitycomparisons (Stevens 1970, Braun etal. 2003). It was possible to set thepressure of a subject’s hand in propor-tion to the intensity of light (Stevens1970). In further studies, the intensitiesof heat, weight, cold, vibration andsound were evaluated using a man-ometer (Stevens 1975). A recent studyevaluated pain intensities by an inter-modal intensity comparison with a man-ometer during supragingival calculusremoval at the mandibular front teeth.Using slim-line-styled ultrasonic scalertips, painful sensations were found to bereduced compared with conventionalultrasonic devices (Braun et al. 2007).

Another inter-modal matching deviceis the so-called ‘‘finger span’’: twometal arms were taped to the thumband index finger of the subject. Thedistance of these two arms was mea-sured using a potentiometer and set inrelation to the subjective intensities ofpain (Franzen & Berkley 1975).

The recording of evoked potentials isanother possibility for detecting tooth-related painful sensations in humans(Braun et al. 2000). In the present study,this method was not applicable as boththe laser irradiation and the sonic vibra-tion do not represent an exact tempo-rally defined and reproducible peri-pheral stimulus, so that characteristicdental potentials are not distinguishablefrom the spontaneous activity of thecortex. Er:YAG laser irradiation forperiodontal debridement showed only aminimal root cementum removal com-pared with conventional scaling and root

Fig. 6. Treatment time with the laser andsonic device for the 11 patients, with painassessment by inter-modal intensity compar-ison. Time did not differ in the two groups(p40.05). Box plots show the median, firstand third quartiles, minimum and maximumvalues (whiskers). Outliers are marked asdata points and asterisks.

Fig. 5. Pain assessment using the visualanalogue scale in 40 patients for the twodifferent treatment devices evaluated in thepresent study. Significantly lower painscores were obtained after laser treatment(po0.05). Box plots show the median, firstand third quartiles, minimum and maximumvalues (whiskers). Outliers are marked asdata points and asterisks.



planing, with 73.2% of the root dentinebeing completely denuded from thecementum (Eberhard et al. 2003). Parti-cularly during supportive periodontaltreatment, the primary goal is not calcu-lus removal, as the amount of miner-alized deposits on the root surfaceshould have been removed previously.Thus, SPC aims to remove a periopatho-genic biofilm without affecting soundhard tissues of the root surface. It couldbe shown that removal of hard tissuescan be decreased using an ultrasonicdevice compared with conventionalhand instrumentation of the root surface(Braun et al. 2005), and tooth surfacesare debrided as thoroughly as with con-ventional instruments (Braun et al.2006), but it could also be demonstratedthat the aggressiveness of magnetostric-tive and piezoelectric ultrasonic devicesto root substance is significantly influ-enced by the scaler tip designs (Jepsenet al. 2004). A recently published studycould show that the microbiologicaleffects of hand instruments, Er:YAGlaser, sonic and ultrasonic scalers inpatients with chronic periodontitisresulted in a comparable reduction ofthe evaluated periodontal pathogens,and bacterial increase was only partiallydifferent 6 months post-operatively(Derdilopoulou et al. 2007). As a con-sequence, the use of an Er:YAG laserand a sonic device can also be suggestedfor SPC treatment procedures. Addition-ally, the fibroblast attachment to perio-dontally diseased root surfaces treatedwith an Er:YAG laser device isincreased compared with ultrasonicroot instrumentation (Crespi et al.2006).

In the present study, the authorswanted to focus on pain perception.Periodontal treatment procedures areusually correlated with painful sensa-tions. However, only a few studiesdeal with this important aspect of perio-dontology or present only minor infor-mation, not attracting an appropriateamount of attention. On the otherhand, the procedures used for perio-dontal supportive treatment have beenevaluated for this purpose before. Sonicor ultrasonic scalers seem to be similarlyeffective as manual debridement regard-ing clinical attachment gain, probingpocket depth reduction and BOP reduc-tion (Tunkel et al. 2002, Suvan 2005). Itcould be demonstrated that Er:YAGlaser treatment in SPC showed similareffects on clinical and microbiologicalparameters as ultrasonic instrumentation

(Tomasi et al. 2006). The only differ-ence was less treatment discomfort inthe laser group. These results are inaccordance with those of the presentstudy. It could also be demonstratedthat laser treatment showed less painfulsensations, with similar results for thereduction of BOP.

The present study indicates that theuse of an Er:YAG laser during suppor-tive periodontal treatment reduces pain-ful sensations compared with sonicscaler instrumentation. Considering theoverall aim to deliver dental care withminimum patient discomfort, it thusmight be possible to increase thepatient’s compliance during periodontalsupportive therapy.

Acknowledgement

We acknowledge KaVo Dental GmbHfor providing the laser wedges and sonicinsert tips.

References

American Academy of Periodontology. (2000)

Parameter on periodontal maintenance. Jour-

nal of Periodontology 71 (Suppl. 5), 849–

850.

Axelsson, P. & Lindhe, J. (1981) The signifi-

cance of maintenance care in the treatment of

periodontal disease. Journal of Clinical

Periodontology 8, 281–294.

Axelsson, P., Lindhe, J. & Nystrom, B. (1991)

On the prevention of caries and periodontal

disease. Results of a 15-year longitudinal

study in adults. Journal of Clinical Perio-

dontology 18, 182–189.

Braun, A., Jepsen, S. & Krause, F. (2007)

Subjective intensity of pain during ultrasonic

supragingival calculus removal. Journal of

Clinical Periodontology 34, 668–672.

Braun, A., Krause, F., Frentzen, M. & Jepsen, S.

(2005) Removal of root substance with the

Vector-system compared to conventional

debridement in vitro. Journal of Clinical


Braun, A., Krause, F., Hartschen, V., Falk, W.

& Jepsen, S. (2006) Efficiency of the Vec-

tort-system compared with conventional

subgingival debridement in vitro and in

vivo. Journal of Clinical Periodontology 33,

568–574.

Braun, A., Krause, F., Nolden, R. & Frentzen,

M. (2003) Subjective intensity of pain during

the treatment of periodontal lesions with the

Vectort-system. Journal of Periodontal

Research 38, 135–140.

Braun, A., Rodel, R. & Nolden, R. (2000)

Objectification of somatosensory sensations

of teeth using evoked potentials. Deutsche

Zahnarztliche Zeitschrift 55, 401–403.

Cohen, J. (1988) Statistical Power Analysis for

the Behavioral Sciences, 2nd edition. Hills-

dale, NJ: Lawrence Erlbaum Associates.

Cohen, R. E. (2003) Position paper – perio-

dontal maintenance. Research, science and

therapy committee of the American academy

of periodontology. Journal of Periodontology

74, 1395–1401.

Committee on Research, Science and Therapy

of the American Academy of Periodontology.

(1998) Supportive periodontal therapy. Jour-

nal of Periodontology 69, 502–506.

Crespi, R., Romanos, G. E., Cassinelli, C. &

Gherlone, E. (2006) Effects of Er:YAG laser

and ultrasonic treatment on fibroblast attach-

ment to root surfaces: an in vitro study.

Journal of Periodontology 77, 1217–1222.

Derdilopoulou, F. V., Nonhoff, J., Neumann, K.

& Kielbassa, A. M. (2007) Microbiological

findings after periodontal therapy using cur-

ettes, Er:YAG laser, sonic, and ultrasonic

scalers. Journal of Clinical Periodontology

34, 588–598.

Eberhard, J., Ehlers, H., Falk, W., Acil, Y.,

Albers, H. K. & Jepsen, S. (2003) Efficacy of

subgingival calculus removal with Er:YAG

laser compared to mechanical debridement:

an in situ study. Journal of Clinical Perio-


Franzen, O. & Berkley, M. (1975) Apparent

contrast as a function of modulation depth

and spatial frequency: a comparison between

perceptual and electrophysiological mea-

sures. Vision Research 15, 655–660.

Guentsch, A. & Preshaw, P. M. (2008) The use

of a linear oscillating device in periodontal

treatment: a review. Journal of Clinical


Hassan, M. A., Bogle, G., Quishenbery, M.,

Stephens, D., Riggs, M. & Egelberg, J.

(2005) Pain experienced by patients during

periodontal recall examination using thinner

versus thicker probes. Journal of Perio-


Hoffman, A., Marshall, R. I. & Bartold, P. M.

(2005) Use of the Vector scaling unit in

supportive periodontal therapy: a subjective

patient evaluation. Journal of Clinical Perio-

dontology 32, 1089–1093.

Huskisson, E. C. (1983) Visual analogue scale.

In: Melzack, R. (ed). Pain Measurement and

Assessment, pp. 33–37. New York: Raven

Press.

Jepsen, S., Ayna, M., Hedderich, J. & Eberhard,

J. (2004) Significant influence of scaler tip

design on root substance loss resulting from

ultrasonic scaling: a laserprofilometric in

vitro study. Journal of Clinical Perio-

dontology 31, 1003–1006.

Kaldahl, W. B., Kalkwarf, K. L., Patil, K. D.,

Molvar, M. P. & Dyer, J. K. (1996) Longterm

evaluation of periodontal therapy: incidence

of sites breaking down. Journal of Clinical


Kocher, T., Fanghanel, J., Schwahn, C. &

Ruhling, A. (2005a) A new ultrasonic device

in maintenance therapy: perception pf pain

and clinical efficacy. Journal of Clinical


Kocher, T., Rodemerk, B., Fanghanel, J. &

Meissner, G. (2005b) Pain during prophylaxis

treatment elicited by two power-driven

344 Braun et al.


instruments. Journal of Clinical Perio-


Lindhe, J. & Nyman, S. (1984) Long-term

maintenance of patients treated for advanced

periodontal disease. Journal of Clinical


Sanz, M. & Teughels, W. (2008) Innovations in

non-surgical periodontal therapy. Consensus

Report of the Sixth European Workshop on

Periodontology. Journal of Clinical Perio-

dontology 35 (Suppl. 8), 3–7.

Schwarz, F., Aoki, A., Becker, J. & Sculean, A.

(2008) Laser application in non-surgical

periodontal therapy: a systematic review.

Journal of Clinical Periodontology 35

(Suppl. 8), 29–44.

Stevens, S. S. (1970) Neural events and

the psychophysiological law. Science 170,

1043–1050.

Stevens, S. S. (1975) Psychophysics. New York:

John Wiley.

Suvan, J. E. (2005) Effectiveness of mechanical

nonsurgical pocket therapy. Periodontology

2000 37, 48–71.

Tammaro, S., Wennstrom, J. L. & Bergenholtz,

G. (2000) Root dentin sensitivity following

non-surgical periodontal treatment. Journal

of Clinical Periodontology 27, 690–699.

Tomasi, C., Schander, K., Dahlen, G. & Wenn-

strom, J. L. (2006) Short-term clinical and

microbiologic effects of pocket debridement

with an Er:YAG laser during periodontal

maintenance. Journal of Periodontology 77,

111–118.

Tunkel, J., Heinecke, A. & Flemmig, T. F.

(2002) A systematic review of efficacy of

machine-driven and manual subgingival deb-

ridement in the treatment of chronic perio-

dontitis. Journal of Clinical Periodontology

29, 72–81.

Walmsley, A. D., Lea, S. C., Landini, G. &

Moses, A. J. (2008) Advances in power driven

pocket/root instrumentation. Journal of Clin-

ical Periodontology 35 (Suppl. 8), 22–28.

Wilson, T. G. Jr. (1998) How patient compli-

ance to suggested oral hygiene and mainte-

nance affect periodontal therapy. Dental

Clinics of North America 42, 389–403.

Address:

Andreas Braun

Department of Periodontology, Operative and

Preventive Dentistry

University of Bonn

Welschnonnenstrasse 17

53111 Bonn

Germany

E-mail: [email protected]

Clinical Relevance

Scientific rationale of the study: Par-ticularly with regard to fearful andsensitive patients, a treatment deviceinducing only minor painful sensa-tions would be desirable, in order toenhance the patient’s compliance and

possibly improve the prognosis ofperiodontal care. So far, pain duringsupportive periodontal treatment ispoorly evaluated.Principal findings: By using anEr:YAG laser device for instrumenta-tion of residual periodontal pockets

during supportive periodontal treat-ment, painful sensations can be reducedcompared with sonic scaler treatment.Practical implications: Clinicianscan deliver pain-reduced SPC withan Er:YAG laser and thereby possi-bly improve compliance.



mailto:[email protected]

Subjective intensity of pain during supportive periodontal treatment using a sonic scaler or an...

Documents

Transcript of Subjective intensity of pain during supportive periodontal treatment using a sonic scaler or an...