Combination of Nd:YAG and Er:YAG lasers in non-surgical periodontal therapy: a systematic review of randomized clinical studies

Effect of Er: YAG laser therapy in non-surgical periodontal treatment: an umbrella review

AIM

The current umbrella review aimed to summarize the effect of erbium-doped yttrium aluminum garnet (Er: YAG) laser adjunct with the conventional non-surgical periodontal treatment which was evidenced from available systematic reviews.

METHODS

An extensive literature search was piloted by two independent reviewers in the PubMed, Scopus, Science Direct, and Google Scholar databases. The search was limited to the English language from 2011 to 2023 years. The methodological quality of systematic reviews 2 (AMSTAR 2) guideline was followed to evaluate the risk of bias for the selected studies. Cohen's kappa statistic was implemented to evaluate the level of agreement to assess the risk of bias in the selected studies.

RESULTS

A total of 472 studies were initially identified. After removing the duplicates and screening, a total of four studies were selected for the current overview. Based on the quality assessment tool, each study scored as high, moderate, low, and critically low-quality study following AMSTAR 2 tool. Inter-rater reliability by Cohen's Kappa statistics showed near-perfect agreement (0.95) between the two reviewers.

CONCLUSION

Even though weak evidence of effectiveness was observed for Er: YAG laser application in non-surgical periodontal treatment, the clinical benefits are still lacking.

Matrix Metalloproteinase 9 (MMP-9) and Interleukin-8 (IL-8) in Gingival Crevicular Fluid after Minimally Invasive Periodontal Surgery with or without Er:YAG and Nd:YAG Laser Application

BACKGROUND

This study aimed to evaluate alterations in the concentrations of matrix metalloproteinase-9 (MMP-9) and interleukin-8 (IL-8) within gingival crevicular fluid (GCF) extracted from the intrabony periodontal defect site before and after minimally invasive regenerative surgery, with or without supplemental laser application. The surgical procedure was performed using the modified minimally invasive surgical technique (M-MIST).

METHODS

Thirty-eight patients, each presenting with a single vertical defect, were randomly assigned to either the test (M-MIST + Er:YAG + Nd:YAG) or the control group (M-MIST). IL-8 and MMP-9 levels (primary outcomes of the study) were assessed prior to therapy, after 2 and 4 weeks, and 6 months following the surgical procedure by means of dedicated ELISA kits.

RESULTS

Both procedures were clinically effective as evidenced by probing depth (PD) reduction and clinical attachment level (CAL) gain at the 6-month follow-up. No statistical differences were observed in the levels of MMP-9 and IL-8 between the groups at any time point assessed. The changes in the level of MMP-9 and IL-8 over time were not statistically significant in any group. IL-8 was positively correlated with MMP-9 in the control group throughout the study and in the test group 2 weeks and 6 months post-op.

CONCLUSIONS

Within the limitations of this study, the additional application of Er:YAG + Nd:YAG lasers alongside the M-MIST procedure did not enhance the clinical and biochemical treatment outcomes compared to M-MIST alone.

Assessment of the Efficacy of Photobiomodulation (PBM) Therapy in Periodontal Treatment: A Longitudinal Study

Objective

The intention of this longstanding study was to assess the effectiveness of photobiomodulation (PBM) therapy as a complementary periodontal therapy method.

Methods

Fifty patients with periodontal disease were recruited and randomly randomized to receive either PBM therapy (n = 50) or traditional periodontal management (n = 50) as the control group. Periodontal parameters were measured at baseline and 3 and 6 months after management, including gingival index, probing depth, and clinical attachment level. Statistical analysis was applied.

Results

At follow-up intervals, both the PBM management group and the control group showed significant improvements in periodontal markers. The PBM therapy group confirmed a higher degree of improvement than the control group, with statistically significant variations between the groups at 3 and 6 months post management (P < 0.05).

Conclusion

In summary, PBM therapy outperforms traditional management techniques in terms of improving periodontal metrics. The incorporation of PBM therapy as an additional therapeutic method for the management of periodontal disease into clinical practice is supported by these findings. To improve management procedures and clarify the longstanding impacts of PBM therapy on periodontal tissue regeneration and clinical results, more investigation is necessary.

Platelet-Rich Fibrin in Non-Surgical Periodontal Therapy: A Split-Mouth Randomized Controlled Clinical Trial

This clinical trial investigated the efficacy of platelet-rich fibrin (PRF) as an adjunct to conventional scaling and root planing (SRP) in non-surgical periodontal therapy. In a split-mouth randomized controlled trial with 13 patients and 26 periodontal pocket sites, PRF was inserted in test group pockets alongside SRP, while control group pockets received SRP alone. Measurements at baseline and six weeks included probing pocket depths (PPDs), clinical attachment loss (CAL), gingival recession (GR), the plaque index, and the gingivitis index. The wound healing index was assessed at six weeks. The results show statistically significant improvements in the SRP+PRF group compared to SRP alone, demonstrating a better CAL gain (SRP+PRF group: 2.69 ± 0.63; SRP alone group: 4.15 ± 0.69-p-value: 0.001), PPD reduction (SRP+PRF group: 2.62 ± 0.65; SRP alone group: 3.85 ± 0.80-p-value: 0.001), and GR minimization (SRP+PRF group: 0.46 ± 0.62; SRP alone group: 0.81 ± 0.72-p-value: 0.21). The adjunctive use of PRF enhanced healing, reduced pocket depths, decreased tissue morbidity, and minimized gingival recession. This study concludes that PRF placement is effective in 5-6 mm pockets, potentially reducing the number of periodontal treatment sessions needed for pocket closure.

Biofilm removal from Difficult-to-Reach places via secondary cavitation within a constrained geometry mimicking a Periodontal/Peri-Implant pocket

Biofilm removal from the apical region of the periodontal or peri-implant pocket, which is very difficult to achieve with mechanical instruments, is a major unresolved issue in dentistry. Here, we propose the use of photoacoustically induced streaming and secondary cavitation to achieve superior cleaning efficacy in the apical region of the periodontal and peri-implant pocket. We have used a prefabricated narrow wedge system that mimics the consistency of periodontal and peri-implant pockets of both healthy and severely inflamed tissue. We studied the effect of single-pulse modality Er:YAG on Pseudomonas aeruginosa biofilm removal. We used different laser energies, fiber-tip positions, and laser treatment durations. The cleaning process was monitored in real-time with a high-speed camera after each individual laser pulse application. The obtained results suggest that biofilm cleaning efficacy in a difficult-to-reach place in healthy model tissue is directly related to the onset of secondary cavitation bubble formation, which correlates with a significant improvement of biofilm removal from the apical region of the periodontal or peri-implant pocket. In comparison to the healthy tissue model, the laser energy in inflamed tissue model had to be increased to obtain comparable biofilm cleaning efficacy. The advantage of photoacoustic cavitation compared to other methods is that laser-induced cavitation can trigger secondary cavitation at large distances from the point of laser application, which in principle allows biofilm removal at distant locations not reachable with a laser fiber tip or other mechanical instruments.

An Overview of the Systematic Evidence on the Adjunctive Use of Laser Therapy in Non-surgical Periodontal Treatment

This overview aimed to recapitulate the evidence related to laser application in non-surgical periodontal treatment along with conventional periodontal treatment for optimum clinical practice based on the available systematic reviews (SRs). An advanced literature search in the English language was conducted in the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), ScienceDirect, and Scopus databases from January 2000 to October 2022. Two independent reviewers screened all the databases and extracted the data in duplicate. The risk of bias in the selected studies was assessed with the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) guideline for SRs. Cohen's kappa statistics were performed to assess the level of agreement for the assessment of the risk of bias. A total of 556 studies (PubMed = 115, Scopus = 66, ScienceDirect = 298, and MEDLINE = 77) were identified after the initial search using the keywords from different databases. After removing the duplicates and assessing the full manuscripts, a total of 24 studies were selected based on the inclusion criteria for the current overview. A total of three, four, 12, and five systematic reviews were classified as high, moderate, low, and critically low-quality SRs as per the AMSTAR 2 quality assessment tool. Cohen's Kappa statistics showed perfect (𝛋 =1.000) agreement between the two reviewers. Adjunctive laser therapy along with conventional non-surgical periodontal treatment might be effective in short-term treatment outcomes; however, evidence of long-term effects is still lacking.

Efficacy of Periodontal Endoscopy during Subgingival Debridement to Treat Periodontitis: A Systematic Review of Randomized Clinical Trials

This study aims to evaluate the clinical efficacy of periodontal endoscopy (PEND) during subgingival debridement to treat periodontitis. A systematic review of randomized clinical trials (RCTs) was performed. The search strategy included four databases: PubMed, Web of Sciences, Scopus, and Scielo. The initial online exploration generated 228 reports, and 3 RCTs met the selection criteria. These RCTs described a statistically significant decrease in probing depth (PD) in the PEND group compared to controls after 6 and 12 months of follow-up. The improvement in PD was 2.5 mm for PEND and 1.8 mm for the control groups, respectively (p < 0.05). It was also described that the PEND group presented a significantly inferior proportion of PD 7 to 9 mm at 12 months (0.5%) as compared to the control group (1.84%) (p = 0.03). All RCTs noted improvements in clinical attachment level (CAL). It was described as having significant differences in bleeding on probing (BOP) in favor of PEND, with an average reduction of 43% versus 21% in the control groups. Similarly, it was also presented that they were significant differences in plaque indices in favor of PEND. PEND during subgingival debridement to treat periodontitis demonstrated efficacy in reducing PD. Improvement was also observed in CAL and BOP.