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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 7  |  Issue : 1  |  Page : 27-29

Clinical evaluation of conventional and laser tooth preparation using visual analogue scale


Department of Conservative Dentistry and Endodontics, MARDC, Pune, Maharashtra, India

Date of Web Publication19-Sep-2013

Correspondence Address:
Vighnesh Dixit
Department of Conservative Dentistry and Endodontics, MARDC, Azam Campus, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-2868.118444

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  Abstract 

Context: Use of lasers in painless contemporary restorative dentistry. Aims: To assess the extent of painless perception using lasers for tooth preparation based on visual analogue scale (VAS). To compare conventional and laser tooth preparation using VAS scale. Settings and Design: Adult patients reporting to the Department of Conservative Dentistry were selected. Fotona fidelis make for ER:YAG laser was used at preset laser settings for enamel and dentin removal with combination of air-water spray. Materials and Methods: Standardized class I tooth preparation for composite restorations were selected for individuals requiring treatment for teeth with similar enamel/dentinal configuration, that is, contralateral in the same individual. Carbide burs-SS White #245 were used for all preparations. Identical tooth preparations were carried out by the same operator for both the teeth using conventional high speed on one side and ER:YAG laser at noncontact mode on the other side. Fotona fidelis make was used at preset laser settings for enamel and dentin removal with combination of air-water spray. The patient was required to provide score according to the VAS scale. Statistical Analysis Used: Kruskal-Wallis test. Results: The median of pain while preparing tooth by conventional method is the highest in patient (8) and the smallest in ER:YAG laser (1). The P value is very small (less than the common alpha-level of 0.05), the test is significant. Thus, it is concluded that the method of tooth preparation does affect the pain perception. Conclusions: The statistical analysis of these findings comprehensively prove that laser tooth preparation is much more painless, hence comfortable for the patient, only the economics prove to be a deterrent in its widespread usage.

Keywords: Erbium:yttrium-aluminum-garnet lasers, pain perception, visual analogue scale


How to cite this article:
Dixit V, Dixit M, Hegde V, Sathe S, Jadhav S. Clinical evaluation of conventional and laser tooth preparation using visual analogue scale. J Dent Lasers 2013;7:27-9

How to cite this URL:
Dixit V, Dixit M, Hegde V, Sathe S, Jadhav S. Clinical evaluation of conventional and laser tooth preparation using visual analogue scale. J Dent Lasers [serial online] 2013 [cited 2017 Mar 29];7:27-9. Available from: http://www.jdentlasers.org/text.asp?2013/7/1/27/118444


  Introduction Top


Preservation of natural tooth structure is the primary goal of conservative and preventive dentistry. Minimal tooth preparation should be achieved efficiently, painlessly, and with adequate control. Fear of dentistry and dental procedures has been attributed to the noise of air turbines in conventional dental settings; erbium:yttrium-aluminum-garnet (ER:YAG) lasers have posed a suitable alternative for the same, painlessly.

Hence, it was decided to assess the comfort and efficiency perceived by patients with comparison of both modalities for tooth preparation. [1],[2]

Few controlled clinical trials have been mentioned in the available literature, so the need to establish the same was conceived.


  Materials and Methods Top


The study was carried out in the Department of Conservative Dentistry; the protocol was approved by the appropriate authority. Written informed consent was obtained from all study subjects after the procedures were explained to them (format attached).

Standardized class I tooth preparation for composite restorations were selected for individuals requiring treatment for teeth with similar enamel/dentinal configuration, that is, contralateral in the same individual. Carbide burs-SS White #245 were used for all preparations.

Identical tooth preparations were carried out by the same operator for both the teeth using conventional high speed on one side and ER:YAG laser at noncontact mode on the other side. Fotona fidelis make was used at preset laser settings for enamel and dentin removal with combination of air-water spray.

The patient was required to provide score according to the VAS scale by the same associate, who was unaware of the modality used for tooth preparation.

Following is the pain scale used in the study [Figure 1].
Figure 1: Vas-pain scale

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The various responses were compiled and subjected to statistical analysis.


  Results Top


Statistical report [Table 1].
Table 1: Statistical report

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Mean score:

  • Conventional tooth preparation: 7.4
  • Laser tooth preparation: 1.




Kruskal-Wallis test

The median of pain while preparing tooth by conventional method is the highest in patient (8) and the smallest in ER:YAG laser (1).

The P value is very small (less than the common alpha level of 0.05), the test is significant. Thus, it is concluded that the method of tooth preparation does affect the pain perception.


  Discussion Top


With the emphasis on conservation of tooth structure, there has been a drive towards the usage of minute tools for tooth preparation especially for dental restorative composites. This has been popularized and has impact on the emphasis of treatment rendered.

The mechanism of tooth preparation with conventional methods is by abrasion; this causes heat generation and pressure is applied to contact the rotating tool with the tooth surface. The lasers for hard tissue cause ablation for removal of the surface tooth structure, erbium lasers have low penetration which can lead to minimal deleterious changes on the tooth, and hence also the perception by the patient. [7],[8],[9],[12]

Lasers provide a suitable means for tooth preparation with adequate control. It has been projected as painless for the patient, hence the clinical trial was carried out to assess and compare the same with conventional, rotary methods. [3],[4] These findings conform with few other studies carried out on adolescent and children. [5],[6],[10],[11],[13],[14]

Another advantage in recommending the noncontact mode is that there is no risk of any contamination of the operative site, when adequate protocol of isolation is followed. Thus, all the concerns regarding transmission of infection in dental procedures is effectively eliminated. This agrees with the concept of treating dental caries as an infectious, microbiological disease, and also the possibility of transfer or residual microbial forms surviving at the dentinal level. The dentinal tubules are area of concern for conventional treatment modalities due to formation of smear layer, which can act as an area of sustenance for microbes.


  Conclusion Top


The statistical analysis of these findings comprehensively prove that laser tooth preparation is much more pain- less, hence comfortable for the patient, only the economics prove to be a deterrent in it's widespread usage.


  Acknowledgment Top


Co-authors and colleagues. Statistician: Mr. Aniruddh Khaddakar, QC Services.

 
  References Top

1.Khatri A, Kalra N. A comparison of two pain scales in the assessment of dental pain in East Delhi children. ISRN Dent 2012;2012:247351.  Back to cited text no. 1
    
2.Williamson A, Hoggart B. Pain: A review of three commonly used pain scales. J Clin Nurs 2005;14:789-804.  Back to cited text no. 2
    
3.Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990;13:227-36.  Back to cited text no. 3
    
4.Rathnam A, Madan N, Madan N. The language of pain: A short study. Contemp Clin Dent 2010;1:142-5.  Back to cited text no. 4
    
5.Gupta V, Chandrasekar T, Ramani P, Anuja. Determining toothache severity in pediatric patients: A study. J Indian Soc Pedod Prev Dent 2006;24:140-3.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.Dilsiz A, Canakci V, Ozdemir A, Kaya Y. Clinical Evaluation of Nd:YAG and 685-nm diode laser therapy for desensitization of teeth with gingival recession. Photomed Laser Surg 2009;27843-8.  Back to cited text no. 6
    
7.De Moor RJ, Delmé KI. Laser-assisted cavity preparation and adhesion to erbium-lased tooth structure: Part 1. Laser-assisted cavity preparation. J Adhes Dent 2009;11:427-38.  Back to cited text no. 7
    
8.De Moor RJ, Delme KI. Laser-assisted cavity preparation and adhesion to erbium-lased tooth structure: Part 2. Present-day adhesion to erbium-lased tooth structure in permanent teeth. J Adhes Dent 2010;12:91-102.  Back to cited text no. 8
[PUBMED]    
9.Delmé K, Meire M, De Bruyne M, Nammour S, De Moor R. Cavity preparation using an Er:YAG laser in the adult dentition. Rev Belge Med Dent (1984) 2009;64:71-80.  Back to cited text no. 9
    
10.Pelagalli J, Gimbel CB, Hansen RT, Swett A, Winn DW 2 nd . Investigational study of the use of Er:YAG laser versus dental drill for caries removal and cavity preparation: Phase I. J Clin Laser Med Surg 1997;15:109-15.  Back to cited text no. 10
    
11.Mosskull Hjertton P, Bågesund M. Er:YAG laser or high-speed bur for cavity preparation in adolescents. Acta Odontol Scand 2013;71:610-5.  Back to cited text no. 11
    
12.Hadley J, Young DA, Eversole LR, Gornbein JA. A laser-powered hydrokinetic system for caries removal and cavity preparation. J Am Dent Assoc 2000;131:777-85.  Back to cited text no. 12
[PUBMED]    
13.Yaman BC, Guray BE, Dorter C, Gomeç Y, Yazıcıoglu O, Erdilek D. Effect of the erbium:yttrium-aluminum-garnet laser or diamond bur cavity preparation on the marginal microleakage of class V cavities restored with different adhesives and composite systems. Lasers Med Sci 2012;27:785-94.  Back to cited text no. 13
    
14.Liu JF, Lai YL, Shu WY, Lee SY. Acceptance and efficiency of Er:YAG laser for cavity preparation in children. Photomed Laser Surg 2006;24:489-93.  Back to cited text no. 14
[PUBMED]    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]


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Abstract
Introduction
Materials and Me...
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