ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Laser Use Reduces Post-Endodontic Re-Treatment Pain and Neuropeptide Production in Patients with Symptomatic Apical Periodontitis
Clinical Question In patients being endodontically re-treated for symptoms associated with persistent symptomatic apical periodontitis, does the use of a 1440 nm Nd:YAG laser in conjunction with conventional retreatment, compared with conventional endodontic retreatment alone, reduce patient-perceived pain and pain-related neuropeptides more effectively?
Clinical Bottom Line The use of a 1440 nm Nd: YAG laser in the canals of previously endodontically treated teeth shows a significant reduction in pain on percussion, post RCT re-treat. There is also a marked reduction in the concentration of pain mediators in the intracanal exudate.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24331986Yoo/201440 patients, previously RCT-initiatedRandomized Controlled Trial
Key resultsAfter randomizing a total of 40 patients into the laser group (L) and the conventional group (C), it was determined that applying a 1440 nm Nd:YAG laser fiberoptic tip 3mm from working length in a clean and dried canal showed better results of pain management in retreatment cases and also yielded greater decreases in the concentrations of pain neuropeptides SP, CGRP, and MMP-8. A Wilcoxon signed rank sum test showed that having additional laser application significantly reduced spontaneous pain, pain on percussion, and levels of SP, CGRP, and MMP-8 (P<0.5) while conventional RCT alone only significantly reduces degree of pain on percussion and the levels of CGRP and MMP-8 levels (P<0.5).
Evidence Search “lasers in endodontics” [MeSH]
Comments on
The Evidence
Yoo and cohort took into consideration several confounding variables when selecting the study population and removed patients from the pool who had significant contributory medical histories, sinus tracts and swellings, as well as no known use of systemic antibiotics or analgesics within two weeks of enrollment into the study. The team had a systematic, reproducible approach to testing for percussion sensitivity pre- and post-laser treatment and tried to reduce the placebo effect by mimicking laser application in the C group. The study had a 100% follow up response and none of the patients had to use any form of “escape” medication (ibuprofen/arginine) in between treatment testing. The use of a visual analog scale (VAS) to assess pain, both spontaneous and related to percussion, was employed. Further clinical studies need to be performed to determine the effectiveness in a more general and larger patient population. It would also be of interest to determine if the laser is equally effective in primary endodontic treatment pain control.
Applicability Applicable to all clinicians performing conventional endodontic retreatment procedures. The study indicates that using a ND;YAG laser reduces post-operative pain in some retreatment cases.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Fiber-optic tip, Nd:YAG laser, VAS, neuropeptides, pain
ID# 2756
Date of submission: 07/21/2014spacer
E-mail shauna.d.jones@ucdenver.edu
Author Shauna Jones
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ethelyn Thomason, DMD
Faculty mentor/Co-author e-mail ethelyn.thomasonlarsen@ucdenver.edu
Basic Science Rationale
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