BREAktHROuGH

®
ell
a n t i b a c t e r i a l
BREAktHROuGH
®
in
Photo Dynamic Therapy (PDT).
.C.
®
+
Kills Germs
+
No Pain
+
No Antibiotics
+
No Discomfort
+
Destroys ALL
Bacteria
+
10
ba
Simply Rinse Away
Laser
FOX
EmunDo® + FOX Laser
info-leaflet
www.arclaser.de
A.R.C. Laser
April 2012
More than 75% of adults1 suffer from periodontitis (PD)
and other bacterial infections of the gums or the oral cavity.
In addition to the eventual loss of teeth, doctors and dentists believe that inflamed gums for an extended period of
time may be associated with systemic diseases. Attempts
to mechanically clean the bleeding gums may lead to the
transfer of bacteria in the mouth into the bloodstream (bacteremia) potentially causing the bacteria to spread throughout the body, resulting in cerebrovascual diseases
Due to stress on the immune system, the risk of diseases
of the arteria carotis, heart attacks, arthritis, diabetes and
premature births are rising. Therefore, PD bacteria is more
harmful than smoking, obesity or high cholesterol levels2. 
This brochure will explain
• What is Photo Dynamic Therapy (PDT)?
• How does it work?
• Question & Answer (Q&A)
• Features and Benefits
• Clinical Applications
• EmunDo® Therapy
2
Healthy teeth –
healthy patients
If the bacterial count in the gingival pockets is extremely high, then the PDtherapy is problematic because the mechanical cleaning and the curettage
are no longer sufficient to stop the inflammation.
A.R.C. Laser developed EmunDo®, a new innovative dye for photo dynamic
therapy (PDT). Now it is possible to reduce or totally avoid the use of antibiotics – and eliminate all of the associated health risks – for patients with
periodontitis. Independent of antibiotic resistance, EmunDo® selectively destroys the relevant PD-germs, especially the AA-Complex³
The pathogens that arise during PD are the same in peri-implantitis. Due to
the rise in the number of implants, there has been a dramatic increase in the
number of reported cases; therefore, dentists and researchers are looking
for an effective therapy. Since the implant is difficult to clean without compromising the surface, it is necessary to do so before the dental abutment is
covered and the connective tissue of the mucosa surrounding the implant is
decreasing. EmunDo® provides an alternative to fight the bacterial inflammation and to save the implants.
The mechanism of action:
Upon irradiation with the FOX Laser, the EmunDo® dye generates singlet
oxygen. The Gram-positive and Gram-negative bacteria can not survive is
this oxygen rich environment.
1) Initiative Parodontitisfreies Deutschland http://www.parodontitisfreies-deutschland.de/
2) Moïse Desvarieux, et. al.: Epidemiology:Periodontal Microbiota and Carotid Intima-Media
Thickness: The Oral Infections and Vascular Disease Epidemiology Study (INVEST), Circulation.
2005;111:576-582, doi:10.1161/01.CIR.0000154582.37101.15
3)T.K. Boehm, S.G. Ciancio; Diode laser activated indocyanine green selectively kills bacteria.
J Int Acad Periodontol. 2011 Jul ;13 (2):58-63 21913603
3
Photodynamic
breakthrough
Photodynamischer
Durchbruch
What is photo dynamic therapy (PDT)?
PDT von A.R.C. 810
ri
ell
®
bakte
greiche
r kransunder
antibakteriell
HealthyZähne
teeth ––
Gesunde
healthy
patients
gesunder Mensch
®
PDT
eraten wir
Patienteninformation
A.R.C.
Ihres Zahnarztes
recognized that certain dyes in combination with light can be destructive to specific cells in the presence
of oxygen. He called this discovery
“photodynamic reaction”. In recent
years, especially since the late 70s,
clinical studies have been conducted
to determine how this reaction can be
utilized for treatment of various diseases. Ultimately, these findings have
become part of the history of modern
medicine under the name of „photo
dynamic therapy“.
What light sources are used and
are they harmful?
®
© A.R.C. Laser
r A.R.C Laser GmbH
217 79 -0
217 79 99
.de
de
l
von
photo dynamic therapy
nm
Photo dynamic therapy (PDT) was
originally
a treatment method for skin
Gesundheit beginnt im Mund!
diseases. It has proven itself as a particularly useful therapy for treating the
primary stages of skin cancer. Over
the past 10 years, a number of new
applications have been discovered.
The basic concept of PDT is to enrich the specific light sensitive photosensitizers in or on the areas to be
EmunDo® + FOX Laser
treated.
Infected or harmful cells can be selectively isolated and destroyed by irradiation of the photosensitizer using
of an appropriate wavelength of light.
Applying this same medical approach,
not only can tumor cells be destroyed
but also unwanted bacteria.
02.11.2011 18:01:30
When was photo dynamic therapy
invented?
Since the beginning of the 20th
century, the scientific advantages of
light irradiation in conjunction with a
photosensitizer like EmunDo® were
known in the treatment of skin related
diseases. Nearly 100 years ago Hermann von Tappeiner, head of pharmacology at the University of Munich,
4
The EmunDo® dye is activated using a
laser light wavelength of 810 nm. The
laser light is so low in energy that the
healthy tissue surrounding the treatment area is not affected. In fact, similar laser light energy is used for biostimulation treatments (low-level laser
therapy, LLLT) for a wound healing effect. Therefore, this treatment has the
added advantage of achieving excellent cosmetic results with minimal risk
of scarring.
Is EmunDo® toxic?
The tricarbocyanine dye in EmunDo®
contains inIndocyanine green (ICG,
MW775), which has been extensively tested for biocompatibility (e.g. in
ophthalmology as a contrast agent).
In addition, since 1956, it has been
widely used to measure blood flow
through various organs to determine
the cardiac output, the cardiac ejection fraction and liver function diagnostics1.
EmunDo® is an iodine free dye; therefore, it is compatible with allergy sufferers.
Unlike inflamed tissue where the surface roughness promotes the attachment of ICG molecules, the molecular size of the ICG is so large that it
will not accumulate in healthy tissue;
hence making this treatment tissue
selective!
Applications in the dental practice
a nUntilt now,
i b the
a success
c t e ofr periodoni a l
titis treatment primarily depended
upon antibiotic therapy and patient
compliance. For years, researchers
have been looking for a long term,
more predictable alternative.
PDT is a scientifically proven, nonsurgical therapy which effectively
treats periodontal disease and simultaneously prevents the serious sequelae that can occur2. In addition, it
is a welcome alternative treatment for
peri-implantitis to save the implant (to
maintain the protective function of the
mucosa).
FOX Diode Laser
A large number of applications are
possible in your dental practice with
the usage of FOX diode laser. For
example, the diode laser is a useful
tool for soft tissue surgery (eg, exposure of implants, frenectomy) and
endodontitis.
EmunDo® + FOX Laser
0%
ntieriell
Photodynamic
breakthrough
Photodynamischer
Durchbruch
Clinical testing verifies efficacy against aggressive PD-germs
PDT von A.R.C. 810
nm
• AA-Complex: Aggregatibacter actinomycetans with a resistance against
Clindamycin/ Metronidazol
amount
• Red complex: Porphyromonas gingivalis and others
before
vor
der
PDT
®
• Germ-complexes orange or orange
associated
antibakteriell
a n t i b a c t e r i a l
after der
nach
PDT
Singlet oxygen directly affects the cell
walls. Also, bacteria with thicker cell walls
are directly destroyed by the singlet oxygen or by the absorption through the Ca++
canals.
®
Why is it desirable to not prescribe
antibiotics?
P DTheT German
v o State
n Ministry
A . R of. C
.
Health
in Niedersachsen (Lower Saxony)
stated3:
“In recent years, mainly in industrialized nations, the number of antibiotic
®
resistant bacterial pathogens grew
alarmingly. According to the Euro-
AARED
ORANGE ORANGE GREEN
associated
pean Centre for Disease Prevention
and Control (ECDC report 2007), the
development of bacterial resistance
to antibiotics is currently one of the
most important health problems in
Europe. The World Health Organization and the European Union demand
their members to be vigilant and to
develop effective countermeasures to
raise awareness in both the scientific
and social community. Due to this issue on 11/18/2008 the „Antibiotic
day“ was introduced in Europe. Antibiotic resistance was also the theme
of World Health Day 2011 (on April
7th 2011). [...]
Further information about Antibiotic resistance
can be found:
http://www.cdc.gov/drugresistance/index.html
ESAC, ein Projekt zur Überwachung und Monitoring der Antibiotikagabe in der EU: http://app.esac.
ua.ac.be/public/
Europäisches Zentrum für die Prävention und die
Kontrolle von Krankheiten: http://ecdc.europa.eu
Europäische Gesellschaft für klinische Mikrobiologie und Infektionskrankheiten: www.eucast.org/
Centers for Disease Control and Prevention (USA)
http://www.cdc.gov/drugresistance/index.html
European Antimicrobial Resistance Surveillance
Network (EARS-Net)
www.ecdc.europa.eu/en/activities/surveillance/
EARS-Net/Pages/index.aspx
Photodynamic
breakthrough
Photodynamischer
Durchbruch
Primary features of EmunDo® therapy
EmunDo® + FOX Laser
PDT von A.R.C. 810
nm
The germicidal effects can be achieved without antibiotics
++All of the bacteria will be de-
stroyed, regardless of the Gram
stain, whether it is Gram-posi®
tive / -negative bacteria, as well
a n t i as
b Gram-variable
a k t e r i e land
l Gramundetermined species.
++As a result of the germicidal effect,
no antibiotics are necessary;
therefore, potential problems with
existing antibiotic resistance or resistance formation can be avoided!
a n t i b a c t e r i a l
EmunDo® + FOX Laser
Laboratory tests prove
the destruction of e.g.:
Staphylococcus aureus
(MRSA, ORSA, VISA, VRSA)
Escherichia coli
Enterococcus faecalis
and E. Faecium
Streptococcus pneumoniae
Reduce the need to
® use antibiotics and avoid the risk of developing
antibiotic resistance
P D T Faster
v o n and
A .better
R . C healing
.
through biostimulation
Gingival pockets close germ free
Klebsiella pneumoniae
Pseudomonas aeruginosa
Proteus mirabilis
Klebsiella ocaenae
®
1
2
3
R.M.-Szeimies et al.; Photochemotherapie kutaner Aids-assoziierter Kaposi-Sarkome mit Indocyaningrün und Laserlicht Der
Hautarzt, Volume 52, Number 4, 322-326, DOI: 10.1007/s001050051315
P.Meisel, T.Kocher; Photo dynamic therapy for periodontal diseases: State of the art Journal of Photochemistry and Photobiology
B: Biology; Volume 79, Issue 2, 13 May 2005, Pages 159-170
http://www.nlga.niedersachsen.de/portal/live.php?navigation_id=6599&article_id=19418&_psmand=20; Datum: 1.10.2011
100%
antibacterial
5
l
Photodynamic
breakthrough
Photodynamischer
Durchbruch
EmunDo® is a very gentle therapy
PDT von A.R.C. 810
photo dynamic therapy
nm
®
antibakteriell
a n t i b a c t e r i a l
There is no thermal effect with the laser
light activation so there is no risk of thermal injury to tissue.
There is no glazing of the dentin because
the laser irradiation is applied at low power.
®
PDT
von
PDT assists the dentist with scaling & root
planing because the concrements are
loosened by the therapy, making cleaning
easier
A.R.C.
The treatment is quick and easy with minimal patient discomfort.
®
The FOX laser simply induces a photochemical reaction similar to photosynthesis
++Once PDT destroys the biofilm
and the germs, the patient looses
less root material during aggressive, mechanical cleaning resulting
in less dentine hypersensitivity.
++PDT makes it possible to target
difficult to access areas such as
furcations and ®
deep invaginations,
EmunDo
+ FOX
Laser
which
are very difficult
to clean
mechanically.
++Treating bleeding pockets is more
++No waiting period: the dye can be
irradiated immediately.
++PDT therapy is compatible for
ally in the inflamed tissue. Poorly
cleaned areas can be shown to
the patient to educate them on
problem areas and to promote
better oral hygiene.
-- Furthermore, alternative solu-
tions do not last long enough in
theEmunDo
pockets in order
to take
effect
®
+ FOX
Laser
on the germs. The solutions are
washed out by e.g. the saliva.
patients prone to iodine allergy
++In addition to performing PDT with
EmunDo®, the 810 nm wavelength
can also be used for other soft tissue applications.
Features and benefits of PDT:
++The dye accumulates preferenti-
tissue pockets. The penetration
depth of chemical disinfectants is
only about 100 microns versus the
diode laser which penetrates more
than 1,000 microns into tissue!
clinically effective than only relying upon better oral hygiene from
patients.
-- Despite its germicidal effect, use
of the bactericidal gas “ozone”
has only a limited affect against
relevant PD-germs: AA, Pg, Tf, Pm
inside the biofilm1.
-- Cleansing solutions are not as
effective as EmunDo® because
they do not penetrate into the
-- In addition, local indicated ‚chips‘
have only a limited effect on the
relevant germs AA and Pg2.
++The application is so easy it can
be delegated to the support staff
(see treatment plan).
++This is the best treatment option
for anyone who has a positive
aMMP-8 test.
1
K. Huth, et al.: Effectiveness of ozone against periodontal pathogenic microorganisms; European Journal of Oral Sciences; Volume
119, Issue 3, pages 204–210, June 2011
2
3
27 (2000) 116–119
cal diagnosis. Treatment of
Porphyromonas gingivalis and Actinobacillus actinomycetemco-
6
G. Schenk, et al.:Lack of antimicrobial effect on periodontopathic
bacteria by ultrasonic and sonic scalers in vitro, J. Clin. Periodontol.
A. Mombelli, et al.: Local antibiotic therapy guided by microbiologi4
L. Vitkov, et al: Bacterial adhesion to sulcular epithelium in periodon-
mitans persisting after mechanical therapy, J. Clin. Periodontol. 29
titis, FEMS Microbiol. Lett. 211 (2002) 239–246n to sulcular epitheli-
(2002) 743–749
um in periodontitis, FEMS Microbiol. Lett. 211 (2002) 239–246
Photodynamic
breakthrough
Photodynamischer
Durchbruch
Principle characteristics of EmunDo® therapy
PDT von A.R.C. 810
nm
photo dynamic therapy
®
antibakteriell
PDT
a n t i b a c t e r i a l
Germicidal Effect
®
without Antibiotics
von
A.R.C.
®
Inflamed areas are dyed
and concrements are loosened
++All of the bacteria will be de-
++Because of the germicidal ef-
stroyed, regardless of the Gram
stain, including Gram-positive
/ -negative bacteria, as well as
Gram-variable and Gram-undetermined species.
fect, no antibiotics are necessary,
therefore potential problems with
existing antibiotic resistance or resistance formation is avoided!
Ph
ot
of
Inflamed
tissue is easy
to remove with
Bare Fiber
Transgingivaland Bulb
irradiation
effect because it accumulates only
in the inflamed areas.
++Furthermore, the bacteria con-
tained in plaque or biofilm is less
affected by antibiotics, because
they are shielded by the organic
matrix
in the film
®3 and may be
EmunDo
+ FOX Laser
absorbed by or adhere to the tooth
and epithel cells4.
ffect
ic e
am
yn
od
Selective c
o
inflamed lour
are in
as g
EmunDo® + FOX Laser
++EmunDo® has a selective, localized
Wide field of
application
A
ct
iva
tio
nw
0n
1
8
ith the FOX
m
7
Photodynamic
breakthrough
Photodynamischer
Durchbruch
Bacterial affects on the periodontium
PDT von A.R.C. 810
nm
®
antibakteriell
a n t i b a c t e r i a l
®
PDT
von
A.R.C.
®
Gingivitis
periodontitis
peri-implantitis
Periodontitis
l
EmunDo® + FOX Laser
Bacterial inflammation in periodontal pockets, leads
to bleeding gums, pocket formation, reformation of
gums with loosening and eventual loss of teeth. Furthermore, scientific evidence indicates that there is an
®
increased risk of infection
developing
in FOX
the restLaser
of the
EmunDo
+
body, eventually resulting in vascular diseases in the
heart and arteries.
Advantages of EmunDo® therapy
Gingivitis and periodontitis:
Leads to bone degradation and the loss of teeth
8
EmunDo® therapy is safe and effective for removing all harmful bacteria. By comparison, mechanical
cleaning is unable to reach and remove bacteria from
all areas. Other laser based therapies are not clinically effective on all types of germs. If any method
does not remove all of the bacteria, harmful bacteria
will quickly repopulate the area. EmunDo® therapy
helps to prevent the spread of bacteria to potentially
infect the body.
Photodynamic
breakthrough
Photodynamischer
Durchbruch
PDT von A.R.C. 810
nm
photo dynamic therapy
®
antibakteriell
a n t i b a c t e r i a l
®
PDT
von
A.R.C.
®
loosening
of
implants
loss
of
implants!
Peri-implantitis
EmunDo® + FOX Laser
Bacterial infection around an implant could lead to its
loss. The primary goal is the complete removal of the
microbial contamination. The germs are similar to those
in periodontitis, thus peri-implantitis could be avoided if
®
the risk of infection could
be eliminated
to implant
EmunDo
+prior
FOX
Laser
placement. Patients with periodontitis are not suitable
candidates for implants. Since germs colonize the
rough surface of the implant, which is not covered by
tissue, the use of oral antibiotics is ineffective.
Advantages of treatment with EmunDo®
Peri-implantitis:
Leads to bone decomposition and loss of the implant
PDT has the ability to treat exposed areas
without any thermal effect.
9
Photodynamic
breakthrough
Photodynamischer
Durchbruch
EmunDo® is a very gentle therapy
PDT von A.R.C. 810
nm
photo dynamic therapy
®
antibakteriell
®
PDT
von
A.R.C.
Treatment procedure with EmunDo® of
a full mouth – periodontitis
a n t i b a c t e r i a l
In general, the PA method is very similar to a conventional treatment, except that the EmunDo® ensures sterility of the pockets
and allows easier curettage by loosening the plaque layer. Prior to
the first EmunDo® session, a standard professional dental cleaning is performed.
1. Mix the EmunDo® dye
1
®
Accessories
2. Apply the green EmunDo® dye to the teeth and the adjacent
gums.
2
EmunDo®hand piece
l
Bulb Fiber
Bare Fiber
EmunDo® + FOX Laser
10
APPLYING the EmunDo® dye
EmunDo® + FOX Laser
Photodynamic
breakthrough
Photodynamischer
Durchbruch
PDT von A.R.C. 810
nm
LASER PERIO CARE
No pain or discomfort during laser
activation.
®
. 3. Laser
irradiation can be performed immediately.
The photodynamic process is initiated in the dye
(ACTIVATION) using a low power setting, hence
without heat. Highly reactive singlet oxygen is produced which achieves a germicidal effect without
patient discomfort.
3
antibakteriell
® using three differ4. EmunDo® therapy is performed
ent hand pieces, starting with the large irradiation
EmunDo hand piece. Change to the smaller bulb
tip fiber to activate all dyed regions. Finish by using
the bare fiber for deepithelisation.
PDT
von
a n t i b a c t e r i a l
A.R.C.
®
ACTIVATION of EmunDo®
4
5. Upon completion, simply rinse out the mouth to
remove remaining dye. NOTE: The dye is completely bio-compatible and will not be absorbed.
6. The mechanical removal of concrements (Scaling
and Root Planing) is now easier, due the loosening effects of PDT on the plaque.
DEEPITHELISATION
EmunDo + FOX Laser
EmunDo® + FOX Laser
®
EmunDo®
Transgingival
Bulb
Parallel-handpiece at
200 mW (300 mW)
cw; point at the
papilla and irradiate*
for:
Bulb-fiber for
shadowed areas, which
can not be activated by
transgingival irridation:
at 200 mW cw, starting
from the bottom of a
pocket, moving
coronally
Deepithelisation
Bare-fiber
at 300 mW pulsing
with 10/10 ms;
Proceed steadily to
remove inflamed
tissue and biofilm
irridate for 8-10s / Molar
depending on patient*
* Times for one-sided irridation per tooth,
two times per tooth
SRP
Scaling & Root Planing after the first session
11
FOX
HIGH POWER LASER
now for
Photo Dynamic Therapy (PDT).
APPLICATIONS
h Endodontics
h Periodontology
h Surgery
h Implantology
h Biostimulation
h Bleaching
h PDT – EmunDo®
ADvANTAgeS
h
Store Treatment Protocols
h
h
easy to use
Touch Screen Display
Photodynamic
breakthrough
cher
uch
A.R.C. Laser GmbH
Bessemerstraße 14
90411 Nürnberg
Deutschland
Germany
C. 810
 0911 2 17 79 -0
0911 2 17 79 99
nm
[email protected]
www.arclaser.de
®
riell
a n t i b a c t e r i a l
www.arclaser.de