Behandlung des überempfindlichen Zahnhalses - Konventionelle und innovative Therapiemethoden - ein aktueller Status

Zusammenfassung

In der vorliegenden Übersicht werden grundlegende Theorien zur Schmerzsymptomatik bei freiliegenden Zahnhälsen beschrieben. Anerkannte Möglichkeiten der Desensibilisierung durch topische Applikationen werden zusammenfassend vorgestellt. Laserapplikationen werden im Sinne einer Gesamtübersicht dargestellt und bewertet. Topische Applikationen führen in der Regel zu einer temporären Besserung der Symptome, weshalb sie in regelmäßigen Abständen wiederholt werden müssen. Mit Lasern werden je nach Bestrahlungsparametern unterschiedliche Effekte erzielt; hierzu zählen analgetische Effekte sowie morphologische Veränderungen im Dentin. Klinische Studien belegen die Evidenz verschiedener Laseranwendungsmöglichkeiten in Bezug auf Effektivität und Sicherheit. Dabei richtet sich der Fokus in jüngster Zeit vor allem auf Kombinationsbehandlungen (Laser/topische Applikationen), die dauerhafte Effekte versprechen.

The present review describes basic theories of pain symptoms and genesis concerning exposed root surfaces. Generally accepted methods of desensitisation with topical applications are discussed and laser applications are described. Usually topical applications have temporary effects, so they have to be applied repeatedly and periodically. Laser applications can cause nerve analgesia and morphological changes of the dentinal structure. Clinical studies supply the evidence of different laser applications concerning effectiveness and safety. Actually the combined application of laser light and topical substances are of great interest, promising long term efficacy.

Schlüsselwörter

Hypersensibilität - Dentin - Laser - Fluoride - Schmerzreiz - Adhäsivsysteme - Analgesie

Key words

Hypersensibility - Dentine - Laser - Fluoride - Pain Stimulus - Adhesive Systems - Analgesia

Literatur

• 1 Absi EG, Addy M, Adams D. Dentine hypersensitivity. A study of the patency of dentinal tubules in sensitive and non-sensitive cervical dentine.  J Clin Periodontol. 1987;  14 280-284
• 2 Addy M. Tooth brushing, tooth wear and dentine hypersensitivity - are they associated?.  Int Dent J. 2005;  55 261-267
• 3 Addy M, Mostafa P. Dentin hypersensitivity II. Effects produced by the uptake in vitro of toothpastes onto dentine.  J Oral Rehabil. 1989;  16 35-48
• 4 Addy M, Mostafa P, Absi EG, Adams D. Cervical dentine hypersensitivity: Etiology and management with particular reference to dentifrices. In: Hypersensitive Dentin: Origin and Management. NH Rowe, Ed. University or Michigan Press, Ann Arbor 1985: 43-64
• 5 Al-Sabbagh M, Andreana S, Ciancio SG. Dentinal hypersensitivity: review of aetiology, differential diagnosis, prevalence, and mechanism.  J Int Acad Periodontol. 2004;  6 8-12
• 6 Arrastia AMA, Machida T, Wilder-Smith P, Matsumoto K. Comparative study on the thermal effects of 4 semiconductor lasers on the enamel and pulp chamber of a human tooth.  Lasers Surg Med. 1994;  15 116-118
• 7 Bal J, Kundalgurki S. Tooth sensitivity prevention and treatment.  Oral Health. 1999;  89 33-41
• 8 Brannstrom M, Johnson G, Nordenvall KJ. Transmission and control of dentinal pain: resin impregnation for the desensitization of dentin.  J Am Dent Assoc. 1979;  99 612-618
• 9 Bonin P, Biovin R, Poulard J. Dentinal permeability of the dog canine after exposure of a cervical cavity to the beam of a CO₂ laser.  J Endod. 1991;  17 116-118
• 10 Botzenhart UU, Braun A, van H Benthem, Frentzen M. Effects of Diode-laser (809 nm) in the Treatment of Dentin Hypersensitivity - An in Vitro Study.  LaserZahnheilkunde. 2006;  2 85-173
• 11 Byers MR. Development of sensory innervation in dentin.  J Comp Neurol. 1980;  191 413-427
• 12 Chabanski MB, Gilliam DG, Bulman JS, Newman HN. Clinical evaluation of patients self reporting cervical dentinal sensitivity (CDS).  J Dent Res. 1995;  74 882
• 13 Chabanski MB, Gillam DG, Bulman JS, Newman HN. Clinical evaluation of cervical dentine sensitivity in a population of patients referred to a specialist periodontology department: a pilot study.  J Oral Rehabil. 2007;  24 666-672
• 14 Charvat J, Soremark R, Li J, Vacek J. Titaniumtetrafluoride for treatment of hypersensitive dentin.  Swed Dent J. 1995;  19 41-46
• 15 Christensen GJ. Desensitization of cervical tooth structure.  J Am Dent Assoc. 1998;  129 765-766
• 16 Coleton S. Sensitivity and laser treatment.  J Am Dent Assoc. 1998;  129 1200-1204
• 17 Collaert B, Fischer C. Dentine hypersensitivity: a review.  Endod Dent Traumatol. 1991;  7 145-152
• 18 Corona SA, Nascimento TN, Cartirse AB, Lizarelli RF, Dinelli W, Palma-Dipp RG. Clinical evaluation of low-level laser therapy and fluoride varnish for treating cervical dentinal hypersensitivity.  J Oral Rehabil. 2003;  30 1183-1189
• 19 Cuenin MF, Scheidt MJ, O'Neal RB, Strong SL, Pashley DH, Horner JA, Dyke TE Van. An in vitro study on dentin sensitivity. The relation of dentin sensitivity and the patency of dentin tubules.  J Periodontol. 1991;  62 668-673
• 20 Davidson DF, Suzuki M. The Gluma bonding system: a clinical evaluation of its various components for the treatment of hypersensitive root dentin.  J Can Dent Assoc. 2007;  63 38-41
• 21 Dondi G dall'Orologio, Malferrari S. Desensitizing effects of Gluma and Gluma 2000 on hypersensitive dentin.  Am J Dent. 1993;  6 283-286
• 22 Dondi G dall'Orologio, Lorenzi R, Anselmi M. Dentin desensitizing effects of Gluma alternate, Health-Dent Desensitizer and Scotchbond Multi-Purpose.  Am J Dent. 1999;  12 103-106
• 23 Dowell P, Addy M. Dentine hypersensitivity - a review. Aetiology, symptoms and theories of pain production.  J Clin Periodontol. 1983;  10 341-350
• 24 Earl J, Wood D, Milne S. An Investigation of the Use of Bio-Materials to Occlude Dentinal Tubules; Electron Microscopy and Analysis Group and the Nanoscale Physics and Technology Group Conference. Zahnmedizin Report 2005: 17-18
• 25 Featherstone JDB, Nelson DGA. Laser effects on dental hard tissue.  Adv Dent Res. 1987;  1 21-26
• 26 Fejerskov O, Josephsen K, Joost M Larsen, Thylstrup A. Cytological feature of rat ameloblasts following long-erm fluoride exposure.  Caries Res. 1980;  14 181-182
• 27 Fischer C, Fischer RG, Wennberg A. Prevalence and distribution of cervical dentine hypersensitivity in a population in Rio de Janeiro.  J Dent. 1992;  20 272-276
• 28 Gangarosa LP. Sr. Current strategies for dentist-applied treatment in the management of hypersensitive dentin.  Arch Oral Biol. 1994;  39 101-106
• 29 Gelsky SC, White JM, Pruthi VK. The effectiveness of the Nd:YAG laser in the treatment of dental hypersensitivity.  J Can Dent Assoc. 1993;  59 377-386
• 30 Gerschman JA, Ruben J, Gerbart-Eaglenont J. Low level laser therapy for dentinal tooth hypersensitivity.  Aust Dent J. 1994;  39 353-357
• 31 Gilliam DG, Khan N, Mordan NJ, Barber PM. Scanning electron microscopy (SEM) investigation of selected desensitizing agents in the dentine disc model.  Endod Dent Traumatol. 1999;  15 198-204
• 32 Gilliam DG, Newman HN, Bulman JS, Davies EH. Dentfrice abrasitivity and cervical dentinal hypersensitivity.  J Periodontol. 1992;  63 7-12
• 33 Gilliam DG, Newman HN, Davies EH, Bulman JS, Troullos ES, Curro FA. Clinical evaluation of ferric oxalate in relieving dentine hypersensitivity.  J Oral Rehabil. 2004;  31 245-250
• 34 Gilliam DG, Mordan NJ, Newman HN. The Dentin Disc surface: a plausible model for dentin physiology and dentin sensitivity evaluation.  Adv Dent Res. 2007;  11 487-501
• 35 Griffiths BM, Watson TF, Sherriff M. The influence of dentine bonding systems and their handling characteristics on the morphology and micropermeability of the dentine adhesive interface.  J Dent. 1999;  27 63-67
• 36 Gutknecht N, Moritz A, Dercks HW, Lampert F. Treatment of hypersensitive teeth using neodymium:yttrium-aluminum-garnet lasers: a comparison of the use of various settings in an in vivo study.  J Clin Laser Med Surg. 2007;  15 171-174
• 37 Hiatt WH, Johansen E. Root preparation I. Obturation of dentinal tubules in treatment of root hypersensitivity.  J Periodontol. 1972;  43 373-380
• 38 Jarvis D, Bruce M MacIver, Tanelian DL. Electrophysiologic recording and thermodynamic modelling demonstrate that helium-neon laser irridation does not affect peripheral A - or C-fiber nociceptors.  Pain. 1990;  43 235-242
• 39 Johnson G, Brannström M. The sensitivity of dentine. Changes in relation to condition at exposed tubules aperture.  Acta Odontol Scand. 1974;  32 28-29
• 40 Keller U. Laser in der Zahnmedizin-Indikationen und klinische Perspektiven.  Zahnärztliche Praxis. 1993;  2 38-43
• 41 Kerns DG, Scheidt MJ, Pashley DH, Horner JA, Strong SL, Dyke TE van. Dentinal tubule occlusion and root hypersensitivity.  J Periodontol. 1991;  62 421-428
• 42 Kielbassa AM, Attin T, Hellwig E, Schade-Brittinger C. In vivo study on the effectiveness of a lacquer containing CaF2/NaF in treating dentine hypersensitivity.  Clin Oral Investig. 2007;  12 95-99
• 43 Kielbassa AM, König J, Plagmann H-C, Raab W, Reich E, Stein A, Weinert W, Willershausen B, Zimmer S. Schmerzempfindliche Zähne - Ergebnisse einer Konsensuskonferenz.  Das Deutsche Zahnärzteblatt. 2001;  110
• 44 Kimura Y, Takebayashi H, Iwase T, Nara Y, Marioka T. The enhancement of transforming growth factor- activity by helium-neon laser on wound healing in rats.  Laser Life Sci. 1993;  5 209-217
• 45 Kimura Y, Iwase T, Marioka T, Wilder-Smith T. Possible platelet-derived growth factor involvement on helium-neon laser stimulated wound healing in rats.  Lasers Life Sci. 2007;  7 267-284
• 46 Kimura Y, Wilder-Smith P, Krasieva TB, Liaw L-HL, Matsumoto K. Effects of CO₂ laser on human dentin: a confocal laser scanning microscopic study.  Laser Life Sci. 1998;  8 1-12
• 47 Kimura Y, Wilder-Smith P, Yonaga K, Matsumoto K. Treatment of dentine hypersensitivity by lasers: a review.  J Clin Periodontol. 2000;  27 715-721
• 48 Kimura Y, Wilder-Smith P, Matsumoto K. Laser in endodontics: a review.  Int Endod J. 2000;  33 173-185
• 49 Kodaka T, Kuroiwa M, Kuroiwa M, Okumura J, Mori R, Hirasawa S, Kobori M.  Effects of brushing with a dentifrice for sensitive teeth on tubule occlusion and abrasion of dentin.  J Electron Microsc. 2001;  50 57-64
• 50 Kumar NG, Melita DS. Short-term assessment of the Nd:YAG laser with and without sodium fluoride varnish in the treatment of dentin hypersensitivity - a clinical and scanning electron microscopy study.  J Periodontol. 2005;  76 1140-1147
• 51 Lan WH, Liu H-C. Treatment of dentine hypersensitivity by Nd:YAG laser.  J Clin Laser Med Surg. 1996;  14 89-92
• 52 Lan WH, Liu H-C, Lin CP. The combined occluding effect of sodium fluoride varnish and Nd:YAG laser irradiation on human dentinal tubules.  J Endod. 1999;  25 424-426
• 53 Lan WH, Lee BS, Liu H-C, Lin C-P. Morphologic study of Nd:YAG laser usage in treatment of dentinal hypersensitivity.  J Endod. 2004;  30 131-134
• 54 Liu H-C, Lin C-P, Lan W-H. Sealing depth of Nd:YAG laser on human dentinal tubules.  J Endod. 2007;  23 691-693
• 55 Marini I, Checchi L, Vecchiet F, Spiazzi L. Intraoral fluoride releasing device: a new clinical therapy for dentine sensitivity.  J Periodontol. 2000;  71 90-95
• 56 Markowitz K. Tooth sensitivity: mechanisms and management.  Compendium. 1993;  14 1032-1046
• 57 Marsilio AL, Rodrigues JR, Borges AB. Effect of the clinical application of the GaAlAs laser in the treatment of dentine hypersensitivity.  J Clin Laser Med Surg. 2003;  21 291-296
• 58 Matsumoto K, Funai H, Shirasuka T, Wakabayashi H. Effects of Nd:YAG-laser in treatment of cervical hypersensitive dentine.  Jpn J Conserv Dent. 1985;  28 760-765
• 59 Matsumoto K, Funai H, Wakabayashi H, Oyama T. Study on the treatment of hypersensitive dentine by GaAlAs laser diode.  Jpn J Conserv Dent. 1985;  28 766-771
• 60 Matsumoto K, Nakamura Y, Wakabayashi H. A clinical study on the hypersensitive dentine by 60 mW GaAlAs semiconductor laser.  Showg Univ Dent Soc. 1990;  10 446-449
• 61 Moritz A, Gutknecht N, Schoop U, Goharkhay K, Ebrahim D, Wernisch J, Sperr W. The advantage of CO₂-treated dental necks in comparison with a standard method: Result of an in vivo study.  J Clin Laser Med Surg. 1996;  14 27-32
• 62 Moritz A, Gutknecht N, Schoop U, Goharkhay K, Aoid H, Teichenbach P, Lothaller MA, Wernisch J, Sperr W. Long term effects of CO₂ laser irradiation on treatment of hypersensitive dental necks: Result of an in vivo study.  J Clin Laser Med Surg. 1998;  16 211-215
• 63 Moritz A, Beer F, Goharkhay K, Schoop U, Strassl M, Verheyen P, Walsh LJ, Wernisch J, Wintner E. Orale Lasertherapie.  Quintessenz, Berlin. 2006;  1 377-405
• 64 Morris MF, Davis RD, Richardson BW. Clinical efficacy of two dentin desensitizing agents.  Am J Dent. 1999;  12 72-76
• 65 Murray LE, Roberts AJ. The prevalence of self-reported hypersensitive teeth. Hypersensitive dentine.  Arch Oral Biol. 1994;  39 129S
• 66 Opdam NJ, Roeters FJ, Verdonschot EH. Adaptation and radiographic evaluation of four adhesive systems.  J Dent. 2007;  25 391-397
• 67 Orchardson R, Peacock HM, Whitters CJ. Effect of pulsed Nd:YAG laser radiation on action potential conduction in isolated mammalian spinal nerves.  Lasers Surg Med. 2007;  21 142-148
• 68 Panduric V, Knezevic A, Tarle Z, Sutalo J. The efficiency of dentine adhesives in treating non-caries cervical lesions.  J Oral Rehabil. 2001;  28 1168-1174
• 69 Pashley DH, Leibach JG, Horner JA. The effects of brushing NaF/kaolin/glycerine paste on detin permeability.  J Periodontol. 1987;  58 19-23
• 70 Pashley EL, Horner JA, Liu M, Kim S, Pashley DH. Effects of CO₂-laser energy on dentin permeability.  J Endod. 1992;  18 257-262
• 71 Pashley DH, Carvalho RM. Dentin permeability and adhesion.  J Dent. 2007;  25 355-372
• 72 Rees JS. The prevalence of dentine hypersensitivity in general dental practice in the UK.  J Clin Periodontol. 2000;  27 860-865
• 73 Renggli HH. Hypersensible Zähne - nicht nur bei Älteren ein Problem.  Prophylaxedialog. 2000;  2 3-4
• 74 Renton-Harper P, Midda M. Nd:YAG laser treatment of dentin hypersensibility.  Br Dent J. 1992;  172 13-16
• 75 Rochkind S, Nissan M, Razon N, Schwartz M, Bartal A. Electrophysiological effect of HeNe laser on normal and injured sciatic nerve in the rat.  Acta Neurochir. 1986;  83 125-130
• 76 Rolla G, Ellingsen JE. Clinical effects and possible mechanisms of action of stannous fluoride.  Int Dent J. 1994;  44 99-105
• 77 Schlüter N, Ganß C, Klimek J. Moderne Erfrischungsgetränke: Gefahr für die Zahnhartsubstanz.  Prophylaxedialog. 2005;  1 14-16
• 78 Schwarz F, Arweiler N, Georg T, Reich E. Desensitizing effects of an Er:YAG laser on hypersensitive dentine.  J Clin Periodontol. 2002;  29 211-215
• 79 Schupbach P, Lutz F, Finger WJ. Closing of dentinal tubules by Gluma desensitizer.  Eur J Oral Sci. 2007;  105 414-421
• 80 Seltzer S, Bender IB. The Dental Pulp. Biologic Considerations in Dental Procedures, 3rd ed. Lippincott, Philadelphia 1984: 78-151
• 81 Senda A, Gomi A, Tani T, Yoshino H, Hara G, Yamaguchi M, Matsumoto T, Marita T, Hasegawa J. A clinical study on „Soft Laser 632”, He-Ne low energy medical laser.  Aichi Gakuin Daigaku Shigakkai Shi. 1985;  23 773-780
• 82 Swift Jr EJ, May Jr KN, Mitchell S. Clinical evaluation of Prime & Bond 2.1 for treating cervical dentin hypersensitivity.  Am J Dent. 2001;  14 13-16
• 83 Suge T, Ishikawa K, Kavasaki A, Yoshiyama M, Asaoka K, Ebisu S. Effects of fluoride on the calcium phosphate precipitation method for dentinal tubule occlusion.  J Dent Res. 1995;  74 1079-1085
• 84 Thompson BK, Meyer R, Singh GB, Mitchell W. Desensitization of exposed root surfaces using a semilunar coronally positioned flap.  Gen Dent. 2000;  48 68-73
• 85 Trash WJ, Jones DL, Dodds WJ. Effect of a fluoride solution on dentinal hypersensitivity.  Am J Dent. 1992;  5 299-296
• 86 Trowbridge H, Silver D. A review of current approaches to office management of tooth hypersensitivity.  Dent Clin North Am. 1990;  34 561-581
• 87 Tung M, Eichmiller FC, Gibson H, Ly AK, Skrtic D, Schumacher GE. Dentin desensitization by in situ formation of calcium phosphate.  J Dent Res. 2007;  76 387
• 88 Watanabe H, Nakamura Y, Wakabayashi H, Matsumoto K. Study on laser transmission through tooth structures by 40 mW Ga-Al-As semiconductor laser.  J Jap Endo Assoc. 1991;  12 40-44
• 89 West NX. Dentine hypersensitivity.  Monogr Oral Sci. 2006;  20 173-189
• 90 West NX, Addy M, Jackson RJ, Ridge DB. Dentine hypersensitivity and the placebo response. A comparison of the effect of strontium acetate, potassium nitrate and fluoride toothpastes.  J Clin Periodontol. 2007;  24 209-215
• 91 Whitters CJ, Hall A, Creanor SL, Moseley H, Gilmour WH, Strang R, Saunders WP, Orchardson R. A clinical study of pulsed Nd:YAG laser-induced pulpal analgesia.  J Dent. 1995;  23 145-150
• 92 Wiegand A, Attin T. Der Einfluss von Mundhygienemaßnahmen auf die Entwicklung erosiver Zahnhartsubstanzdefekte.  Quintessenz. 2004;  7 739-748
• 93 Wilder-Smith P. The soft laser: Therapeutic tool or popular placebo?.  Oral Surg Oral Med Oral Pathol. 1988;  66 654-658
• 94 Yates RJ, Newcombe RG, Addy M. Dentine hypersensitivity: a randomised, double-blind placebo-controlled study of the efficacy of a fluoride-sensitive teeth mouthrinse.  J Clin Periodontol. 2004;  31 885-889
• 95 Yeates R, Owens R, Jackson R, Newcombe RG, Addy M. A splitmouth placebo-controlled study to determine the effect of amorphous calcium phosphate in the treatment of dentin hypersensitivity.  J Clin Periodontol. 1998;  25 687-692
• 96 Yonaga K, Rimura Y, Matsumoto K. Treatment of cervical dentin hypersensitivity by various methods using pulsed Nd:YAG laser.  J Clin Laser Med Surg. 1999;  17 205-210
• 97 Yoshiyama M, Noiri Y, Ozaki K, Uchida A, Ishikawa Y, Ishida H. Transmission electron microscopic characterization of hypersensitive human radicular dentin.  J Dent Res. 1990;  69 1293-1297
• 98 Zennyu K, Inoue M, Konishi M, Minami M, Kumazaki M, Fujii B, Lee CS. Transmission of Nd:YAG laser through human dentin.  J Jpn Soc Laser Dent. 1996;  7 37-45
• 99 Zhang C, Matsumoto K, Kimura Y, Harashima T, Takeda FH, Zhou H. Effects of CO₂ laser in treatment of cervical dentin hypersensitivity.  J Endod. 1988;  24 595-597
• 100 Zhang C, Matsumoto K, Kimura Y, Harashima T, Takeda FH, Zhou H. Effects of CO₂ laser in treatment of cervical dentinal hypersensitivity.  J Endod. 1998;  24 595-597

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