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Bone Splintering Following Laser Surgery

05/02/2007

Question:

I had laser surgery 10 months ago for periodontitis disease. Since Feb 07, I have been having small pieces of bone come through on the right side. I asked my dentist and he said that I have extremely large tori and does not know why it is splintering like it is, because he did not use the laser in the area the bone is splintering.

Is this common? I plan to have surgery next month for the removal of the tori. Is this a good move? It is extremely painful when the bone pokes thru the gum and irritates the tongue, until I can get that piece of bone out. Any other suggestions besides surgery? Thanks.

Answer:

From the information you are providing, I do not know if the laser surgery is the cause of the bone splintering at this time. Torus or Tori (plural) is/are benign bone growths that occur in certain areas of the mouth, usually on both sides, predominantly on the tongue side of the lower jaw. Most of the time they start growing without causing any symptoms or discomfort. The removal is a relatively simple procedure; if this torus is bothering you, it would be good to remove it. I have included a recent review of all the evidence available for the use of lasers for the treatment of periodontitis.

American Academy of Periodontology Commissioned Review Lasers in Periodontics: Review of the Literature.

By Dr. Charles Cobb

Background: Despite the large number of publications, there is still controversy among clinicians regarding the application of dental lasers to the treatment of chronic periodontitis. The purpose of this review is to analyze the peer-reviewed research literature to determine the state of the science concerning the application of lasers to common oral soft tissue problems, root surface detoxification, and the treatment of chronic periodontitis.

Methods: A comprehensive computer-based search combined the following databases into one search: Medline, Current Contents, and the Cumulated Index of Nursing and Allied Health. This search also used key words. In addition, hand searches were done for several journals not cataloged in the databases, and the reference lists from published articles were checked. All articles were considered individually to eliminate non-peer-reviewed articles, those dealing with commercial laser technology, and those considered by the author to be purely opinion articles, leaving 278 possible articles.

Results: There is a considerable conflict in results for both laboratory studies and clinical trials, even when using the same laser wavelength. A meaningful comparison between various clinical studies or between laser and conventional therapy is difficult at best and likely impossible at the present. Reasons for this dilemma are several, such as different laser wavelengths; wide variations in laser parameters; insufficient reporting of parameters that, in turn, does not allow calculation of energy density; differences in experimental design, lack of proper controls, and differences in severity of disease and treatment protocols; and measurement of different clinical endpoints.

Conclusions: Based on this review of the literature, there is a great need to develop an evidence-based approach to the use of lasers for the treatment of chronic periodontitis. Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. Current evidence does suggest that use of the Nd:YAGor Er:YAG wavelengths for treatment of chronic periodontitis may be equivalent to scaling and root planing (SRP) with respect to reduction in probing depth and subgingival bacterial populations. However, if gain in clinical attachment level is considered the gold standard for non-surgical periodontal therapy, then the evidence supporting laser-mediated periodontal treatment over traditional therapy is minimal at best. Lastly, there is limited evidence suggesting that lasers used in an adjunctive capacity to SRP may provide some additional benefit.

Reference: Journal of Periodontology 2006;(April)77:545-564.

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Response by:

Jose I Arauz-Dutari, DMD Jose I Arauz-Dutari, DMD
Formerly, Assistant Professor of Periodontics
School of Dental Medicine
Case Western Reserve University