A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted...
Transcript of A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted...
![Page 1: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/1.jpg)
ALD 2015KNOWLEDGE | EXPERIENCE | APPLICATION
A Hygienist’s Step-by Step Guide to Non-surgical Laser Assisted
Periodontal Care
Jeanette K Miranda, RDH BSDHMary Lynn Smith, RDH
Friday, February 20, 15
![Page 2: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/2.jpg)
ALD 2015KNOWLEDGE | EXPERIENCE | APPLICATION
Disclosure:
Jeanette Miranda and Mary Lynn Smith have no commercial relationships.
Friday, February 20, 15
![Page 3: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/3.jpg)
A Hygienist’s Step-by Step Guide to Non-surgical Laser Assisted
Periodontal CareJeanette K Miranda, RDH BSDHMary Lynn Smith, RDH
Friday, February 20, 15
![Page 4: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/4.jpg)
✦ Identify stages of periodontal disease
✦ Treatment planning appropriately
✦ Case study
✦ Resolution: supportive care vs continued therapy
✦ Case documentation
Objectives:
Friday, February 20, 15
![Page 5: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/5.jpg)
Identify the DiseaseGingivitis4mm+ pseudopocketsBleeding, swelling, tenderness
Periodontitis4mm+ pockets with bonelossBleeding, swelling, tenderness
Friday, February 20, 15
![Page 6: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/6.jpg)
Treatment Planning
Friday, February 20, 15
![Page 7: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/7.jpg)
Healthy No Pockets No Laser Treatment
Gingivitis Bleeding Pockets LBR-1 appointment(Laser bacterial reduction)
Early Perio 3-4 mm Pockets LBR-1 appointment
Moderate Perio 5-6 mm Pockets LAPT-2/3 appointments(Laser assisted perio therapy)
Advanced Perio 6+ mm Pockets LAPT-3+ appointments
Treatment Planning
Friday, February 20, 15
![Page 8: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/8.jpg)
Multiple vs Single Laser sessions
Multiple Sessions✦ Chronic wounds cleared of
biofilm at 7 day intervals✦ Deep pockets-extends the
time of optimal environment for healing
✦ Repeated biostimulation✦ Allows continued coaching
the patient in daily biofilm management
Single Session✦ Minimal inflammation and
pocketing doesn’t need repeated visits
✦ Convenient for scheduling
GREATER AMOUNT OF DISEASE AND DESTRUCTION
HEALTHIER PATIENT BEING TREATED EARLIER
Friday, February 20, 15
![Page 9: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/9.jpg)
Indications for Laser Use• Creating a favorable environment for healing
• Enhance the body’s natural healing response by reducing the microbial and inflammatory challenges
• Deactivating bacteria in tissue wall and crevicular fluid RDH is working at low settings: nonsurgical 50°C vs. surgical at 100°C
Friday, February 20, 15
![Page 10: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/10.jpg)
Difficult Case Study
Friday, February 20, 15
![Page 11: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/11.jpg)
Panorex
Friday, February 20, 15
![Page 12: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/12.jpg)
Bitewing X-rays
Friday, February 20, 15
![Page 13: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/13.jpg)
Patient Background & Hygiene Diagnosis • Patient background:- 60 year old Caucasian Female- No dental complaints- History of acid reflux
• Hygiene diagnosis:- Severe generalized chronic periodontitis with good
prognosis for #5,9,10,11,15,19 and 26- Sever generalized chronic periodontits with guarded
prognosis for #3,4,12,20,27,28,29,30 and 31
Friday, February 20, 15
![Page 14: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/14.jpg)
Periodontal Treatment Plan• Active Phase SRP 2-2 hour appointments• Active Phase LAPT 2-1 hour appointments,
7-10 days apart• Evaluation in 3 months
Friday, February 20, 15
![Page 15: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/15.jpg)
LAPT• Review procedures and sign consent forms• Apply topical/local anesthetic• Use ultrasonic scaler• Use laser• Decontamination• Tissue coagulation• Biostimulation• Apply Vitamin E oil• Post op instructions
Friday, February 20, 15
![Page 16: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/16.jpg)
Initiate fiber
Check CleaveMeasure and Cleave Fiber
Preparing Fiber
Friday, February 20, 15
![Page 17: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/17.jpg)
Immediate post-opUltrasonic
LaserTopical anesthetic
Friday, February 20, 15
![Page 18: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/18.jpg)
Evaluation✦Supportive recare ✦Further active treatment✦Referral
Friday, February 20, 15
![Page 19: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/19.jpg)
Evaluation CriteriaSupportive Care✦Improvement noted ✦Continued inflammation present✦Continue biofilm management coaching✦Can the appointment needs be accomplished in the
appointment time?
Friday, February 20, 15
![Page 20: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/20.jpg)
Evaluation Criteria
Retreatment✦If pockets 5mm+ with bleeding persist✦More than can be addressed with 1 hr✦Are Laser Decontamination appts required
This may be difficult to determine and recommend
Friday, February 20, 15
![Page 21: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/21.jpg)
EvaluationCriteriaReferral(Out of hygiene chair)
Approximately at 1 yr following laser therapy if a deep pocket persists with BOP
Clinician’s judgement
Friday, February 20, 15
![Page 22: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/22.jpg)
Periodontal Assessment: 4 Weeks
Friday, February 20, 15
![Page 23: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/23.jpg)
Periodontal Assessment: 3 Months
Friday, February 20, 15
![Page 24: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/24.jpg)
Initial Probe 5mm Three month Post op Probe 3mm
Friday, February 20, 15
![Page 25: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/25.jpg)
Photo Documentation
✦Pre-op general*✦Pre-op probe✦Operative with laser in place✦Post-op immediate*
* suggested minimum photos Friday, February 20, 15
![Page 26: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/26.jpg)
✦Post-op 1 week✦Post-op with probe
-12 wk appts -6, 9, 12 months
Photo Documentation
Friday, February 20, 15
![Page 27: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/27.jpg)
Written Documentation• Signed consent form for laser treatment and photography• Type of laser and wavelength• Tip/Fiber size• Continuous or pulsed emission mode• Settings used for all steps• Total wattage/time• Use of ultrasonic scaler• Use of topical or local anesthetic• Use of Methylene Blue Dye• Use of Vitamin E oil• Post op instructions given
Friday, February 20, 15
![Page 28: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/28.jpg)
5-1-2008 Updated HH. Pt signed LAPT consent form.
LAPT provided on all 5mm pockets on teeth (#3,4,12,13,28,29,30,31)
Used 810 nm diode laser/400 micron tip/safety glasses/HVE.
Used ultrasonic scaler.
Decontamination-0.5-0.9 W CW with initiated tip, 15 to 30 seconds per site. Very slight tissue interaction.
Tissue coagulation -0.5 W CW for 10 seconds per site
Biostimulation 1.5 W PW 30/30 30 seconds per site. Vit E oil.
Gave post-op instructions. Photos taken. Total time 10 min 248 J
NV: 1 wk re-treat LAPT
Written Documentation
Friday, February 20, 15
![Page 29: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/29.jpg)
2-14-2014 Periodontal Therapy UR
Pt presented...Objectives of treatment reviewed. Administered anesthetic...OHI...
Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.
Bacterial reduction of pockets with CO2 superpulsed laser 10.6 micron wavelength at Level 5, 50 Hz, for an average power of 2.1 W, pulsed wave mode, 100 mm handpiece, perio insert with tip giving a 400 micron spot size. Energy applied for 30 sec or less within the sulcus per tooth.
Laser glasses were worn. No adverse reactions. Post Op instructions given.
Written Documentation
Friday, February 20, 15
![Page 30: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/30.jpg)
...the more you LEARN, the you more you USE your laser...
and help others improve their oral health.
Friday, February 20, 15
![Page 31: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/31.jpg)
Reasons for Pursuing Advanced Proficiency In depth learning on specific wavelength. Adds to what was already learned in general laser knowledge of the standard proficiencyIncreased laser knowledgePrestige and recognition of advanced education by peersBetter clinician using a laserAttended more conferences to learn moreAdvanced education--Beyond MINIMAL knowledgeObligated to expand your knowledge in order to treat patients to the highest standard of careUpdates the laser user on the latest information for the best applications possibleBackground for teaching other laser courses, such as an introductory course. It is a prerequisite to becoming an ALD recognized course provider to offer a standard proficiency certification. Personal satisfaction of highest level of testing completed.Legal purposes--prove your education level if neededDeeper understanding of physics, fundamentals, safety, etc.Learning experience to compile the details of a case and defend the procedure rationale verbally as well as written.Connecting with a mentor with open dialogue of learning through specific cases and laser applications
Friday, February 20, 15
![Page 32: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/32.jpg)
Reasons for Pursuing Advanced Proficiency
Broader knowledge base of lasersSafety for allCredentials show patients knowledge of advanced technology and treatmentUnderstand the how and the why of laser application for the specific procedures needed in the case studyUnderstanding the laser parameters and adjustments to solve issues for the patientPreparing clinical cases requires detail but also promotes objectivity.Continued learning and progressing in one’s career, energizing rather than drainingSelf esteem and confidence builderShows advancement in one’s clinical expertiseConnecting with an elite and excellent international organization and experiencing a reciprocal commitment.Prerequisite to ALD Mastership honorA mean’s of sharing ones clinical casesTo improve communications with patients and educate them on advantages of laser-assisted procedure. “An educated patient is a more compliant patient”
Friday, February 20, 15
![Page 33: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/33.jpg)
ALD Hygienists are all about
Lending a Helping Hand
Friday, February 20, 15
![Page 34: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/34.jpg)
YOU ARE INVITED
Friday, February 20, 15
![Page 35: A Hygienist’s Step-by Step Guide to Non-surgical Laser ... · to Non-surgical Laser Assisted Periodontal Care ... Teeth # 2-8 debrided definitively with manual and ultrasonic instrumentation.](https://reader030.fdocuments.in/reader030/viewer/2022040810/5e518113008d0a4d894965c1/html5/thumbnails/35.jpg)
BEGIN YOUR ADVANCED
PROFICIENCY2016
Friday, February 20, 15