A Comparision of conventional and laser assisted desensitization techniques for treating dentinal hypersensitivity

Abstract

The study's objective was to assess the effectiveness of conventional and laser-assisted desensitization in treating dentinal hypersensitivity (DH). Twenty patients were divided into experimental and control groups. Following scaling, patients in the control group were instructed to utilize desensitization paste; however, after comprehensive scaling, patients in the experimental group received treatment with the erbium, chromium, yttrium, scandium, gallium garnet (Er, Cr: YSGG) laser. Before laser emission, the visual analog scale (VAS) score was obtained for both groups. Postoperative VAS scores were recorded right away, 1 week and 1 month later for the test group, and 1 week and 1 month later for the control group, following the use of desensitizing paste. In comparison to the control group, the Er, Cr: YSGG laser treatment had a substantially higher desensitizing impact right away, according to the data. The variances in the mean VAS scores between baseline and all time periods after treatment for the test group were statistically significant. At any subsequent assessment, there were no discernible variations in plaque index between the test and control groups. The Er, Cr: YSGG laser is found to be more effective than the control group in treating DH within the confines of this investigation.

INTRODUCTION

When exposed to tactile, electrical, thermal, osmotic, chemical, and mechanical stimuli, the exposed dentin of people with dentinal hypersensitivity (DH) experiences a brief, acute pain.[1] The development of DH was effectively explained by tooth wear mechanisms as attrition, erosion, and abrasion.[2] Other factors that have been linked to an increased risk of DH include caries, brushing-related abrasion, malocclusion, abnormal habits, old age, gum diseases, and orthodontic and restorative treatments.[3]

The hydrodynamic theory of sensitivity is the most widely accepted explanation describing the mechanism of DH.[4] Dentinal tubules contain fluids that respond to various stimuli by flowing inward or outward, activating sensory nerves at the dentin–pulp interface, in accordance with this notion. Therefore, any substance or technique that stops or reduces the movement of fluid reduces DH.

Mucogingival surgery, pulpectomy, resin application, lasers, topical desensitizing medications, and desensitizing toothpaste are some of the therapy options for DH.[5] Lasers are one of the most promising novel desensitization methods. Numerous lasers, including erbium-doped yttrium, neodymium-doped yttrium, aluminum, and garnet (Nd: YAG), helium-neon, and YAG (erbium: yttrium aluminum garnet [Er: YAG]), gallium–aluminum–arsenide, and carbon dioxide (CO₂), exhibit desensitizing effects.[6] Dentine melting and recrystallization, which plugs or occludes dentinal tubules, is the most widely accepted theory explaining how laser irradiation affects dentine.[7] Nd: YAG and CO₂ lasers have a limited role in the treatment of DH because of their thermal side effects.[7,8] Thermomechanicl ablation and high absorption of the wavelengths 2.94 and 2.78 nm of Er: YAG, chromium-doped: yttrium garnet made these lasers more effective in dental applications.[9] Erbium lasers with yttrium aluminum garnet were proved to be effective in DH.[10]

Belal and Yassin in 2014 concluded in a study that CO₂ and Er: YAG lasers can effectively lower DH.[11] However, there is a paucity of evidence on the clinical consequences of treatments by using erbium, chromium, yttrium, scandium, gallium garnet (Er, Cr: YSGG) laser, to our knowledge.[12] The purpose of this study is to assess the effectiveness of conventional and laser-assisted desensitization in treating DH. The study's null hypothesis was that there was no difference in how DH was managed between the two groups.

MATERIALS AND METHODS

The Department of Periodontics and Implantology, Saveetha Dental College and Hospitals, Chennai, carried out this investigation. For this trial, a total of 30 individuals were enrolled. Group 1 were cases (n = 15) which were treated by laser and Group 2 were controls (n = 15) which were treated by desensitizing paste, within the age group of 1–36 years, out of which 16 were males and 14 were females. Randomization was done using coin flip techniques. Single blinding (patient alone) was done to reduce the patient-related bias. The study was presented to institutional ethical and scientific committee and got approved.

Approval number was IHEC/SDC/PERIO-2005/22/422.

The study setting requires one or more opposite pairs of hypersensitive teeth. Criteria that do not fall in this study setting were pregnant women and people undergoing any active desensitization therapy for the past 6 months, any systemic disorders, and any analgesic usage should not be considered for this study.

Laser protocol

Range or degree of sensitivity analysis was done with air blast to the buccal side of the tooth at the distance of 1 cm in 90° 3 s per each mode. Sensitivity was assessed for every patient with the use of a 10-cm visual analog scale (VAS). All the parameters and operators remain the same to achieve uniform air pressure.

Sensitive teeth in Group 1 were treated using an Er, Cr: YSGG laser at 2780 nm in noncontact mode with a MZ6 sapphire tip in the hard tissue mode (Waterlase MD, Biolase).[11,13,14] Desensitization paste (potassium nitrate 5% w/w in dental paste, monofluorophosphate 0.7% w/w) was given to Group 2 patients, which was commercially marketed as RR Thermoseal. Subjects were instructed to apply it to all surfaces of their teeth, wait 5 min, and then clean their teeth. Postoperative VAS scores were recorded immediately for Group 1 and after 1 week and 4 weeks for Group 2.

Statistical analysis

The data were all expressed as means with standard deviations, and SPSS version 23.0 for Windows was used. The statistical significance of age, gender, and DH was evaluated using the Chi-square test. Paired t-tests were used to assess statistical significance for preoperative, immediate, and postoperative results. All the tests done for the current study were statistically significant, that is, P < 0.05. 85% of G power was calculated using power analysis.

RESULTS

The 1-month trial period was completed by all 30 subjects. No consequences and negative effects or allergic reactions were noticed. The mean differences between the genders was mentioned in the Figure 1 and Table 1. The mean VAS ratings for the therapies at various time points are displayed in Figure 2 and Table 2. Paired t-test was done between baseline and postoperative VAS scores at different time intervals within two groups showing P < 0.05, which shows that there is a statistical difference between groups and within groups. Within-group anova was one method used, and the results were statistically significant.

Figure 1.

Bar graph depicts the differences in mean values of male and females at baseline, immediate postoperative, after 1 week, after 4 weeks in Group 1

Table 1.

Basic demographic details of the subjects

Parameters	Group I	Group II
Mean±SD	26.0±5.657	28.45±6.128
Age	18-35	18-35
Gender (male/female)	8/7	8/7

SD: Standard deviation

Figure 2.

Bar graph depicts the differences in mean values of VAS scores male and females at baseline, after 1 week, after 4 weeks in Group 2, VAS: Visual analog scale

Table 2.

The mean values of both groups in different time intervals such as preoperative, immediate postoperative, after 1 week, and after 4 weeks

Groups	Baseline	Immediate postoperative	After 1 week	After 4 weeks
Group 1	7.02±1.82	1.47±1.08	1.35±1.02	1.07±1.52
Group 2	6.89±1.5	-	2.51±1.05	2.90±1.72

DISCUSSION

According to Absi EG, the optimum treatment for DH should be effective, endure for longer lengths of time, be simple to administer, not hurt, and leave teeth stained.[15]

Tubular occlusion and blocking of nerve activity are the basic ways to prevent or cure DH.[16] In 1985, laser therapy was originally proposed as a viable treatment for DH.[17] The mechanism by which lasers work is by occluding the dentinal tubules by partial melting when exposed to low-intensity lasers.[10,17] Depending on the density, wavelength and optical characteristics of the laser to thr targeted tissues various reactions will take place.[18]

Systematic review done by Sgolastra et al. reported that laser therapy can relieve pain; however, the evidence for this was only for a weak.[19] The study by Kimura y et al. found that laser light modifies sensory axon ends, alters permeability, and interferes with the sodium pump mechanism.[20] Ladalardo et al. observed that the diode laser treatment for DH had an immediate analgesic effect. According to the previous study, the laser stimulation results in a photobiomodulation effect that raises cellular metabolic activity of odontoblasts and prevents the tertiary dentine.[21]

It has been indicated that Er, Cr: YSGG lasers are useful for both soft tissue surgery and hard tissue reduction. On the other hand, little is known about how lasers affect DH. The Er, Cr: YSGG laser has been discovered to be effective against DH with just one application, according to the research done by Yilmaz et al.[22]

Based on a short-term clinical evaluation in a study by Aranhaet al., Er: YAG and Er, Cr: YSGG lasers compared to DH, Er, Cr: YSGG lasers with a power setting of 0.25 W demonstrated the best outcomes.[23] Previous studies conducted on the lasers explained that laser desensitization is effective against DH, but some studies do not compare the test group with the control group.[24] To overcome such limitations, the present case–control study has been conducted. The control group was advised to use desensitizing paste which is commercially available as RR Thermoseal (potassium nitrate 5% w/w in tooth paste, monofluorophosphate 0.7% w/w) twice daily.[24,25] Er, Cr: YSGG laser exposure for the test group has been completed. As determined by the VAS score, the results indicated that laser desensitization is more efficient at lowering DH. Conventional methods of desensitization were also effective in reducing DH, but the results were poor when compared with lasers.

The present study shows that there is reduction of DH in both groups. Laser desensitization shows better reduction compared to conventional methods which are immediate and less time consuming. Postoperatively, after 4 weeks, there is not much difference in the mean values in Group 1 compared to Group 2. However, the conventional method shows that there is an increase in the VAS scores postoperatively after 4 weeks compared to postoperative 1 week, which means that it is not that effective after a few weeks. The mean VAS scores of two groups are given in Figure 3.

Figure 3.

Bar graph depicts the differences in mean values of VAS scores at different treatment intervals comparing both groups. Group 1: Laser desensitization, Group 2: Desensitization paste, VAS: Visual analog scale

Limitations

The major limitation of this study was 4-week follow-up, small sample size, and no parallel observation with different types of lasers.

Future scope

Future scope for this present study as an effective treatment modality for DH can be achieved by overcoming the limitations of the study.

CONCLUSION

According to the current study, Er, Cr: YSGG lasers are more efficient than conventional methods at reducing DH (desensitization paste). For a more thorough analysis, additional research with a bigger sample size and long-term follow-up must be conducted.

Financial support and sponsorship

The present study is supported by Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University.

Conflicts of interest

There are no conflicts of interest.