Treatment with Nd:YAG Laser Irradiation Combined with Sodium Hypochlorite or Hydrogen Peroxide Irrigation on Periodontal Pathogens: An In Vitro Study

Systemic inflammatory markers following adjunctive Nd:YAG (1064 nm) laser irradiation to step 2 of periodontal therapy: a 12-month, randomized, controlled trial

OBJECTIVES

The aim of this study was to investigate whether the use of adjunctive Nd:YAG (1064 nm) laser irradiation to full-mouth scaling and root planing (FM-SRP) may offer additional benefit in the systemic inflammatory status of the patient, as depicted in a variety of systemic biomarkers over FM-SRP alone, up to 12 months after treatment.

MATERIALS AND METHODS

A total of 60 otherwise healthy stage III/IV periodontal patients were equally distributed in 3 groups. The control group received FM-SRP. In laser A group, 1 week after FM-SRP, Nd:YAG laser irradiation was delivered in periodontal pockets with PD ≥ 4 mm using specific settings (3 W, 150 mJ, 20 Hz, 100 μs). In laser B group Nd:YAG laser irradiation was delivered twice, 1 week after FM-SRP and 1 week later with different settings compared to laser A (2 W, 200 mJ, 10 Hz, 100 μs).

RESULTS

A significant reduction (p = 0.038) of IL-1β serum levels at the 6-month time point was observed for laser A group. IL-6 was found statistically significantly increased (p = 0.011) in the control group at the 6-week time point, whereas no difference was reported for the laser-treated groups (laser A, laser B).

CONCLUSIONS

The adjunctive use of Nd:YAG laser irradiation, prevented from IL-6 increase after FM-SRP, 6 weeks after treatment. Similarly, Nd:YAG laser irradiation (3 W, 150 mJ, 20 Hz,100 μs) was associated with significantly lower IL-1β levels, 6 months post-operatively.

CLINICAL RELEVANCE

Additional Nd:YAG laser application to FM-SRP may provide a potential beneficial effect on systemic inflammation.

TRIAL REGISTRATION NUMBER

ISRCTN26692900.

REGISTRATION DATE

09/06/2022.

Adjunctive Nd:YAG laser irradiation in the treatment of stage III/IV periodontitis: a 12-month, randomized, controlled trial

OBJECTIVES

The aim of this study was to evaluate the clinical efficacy of the adjunctive use of Nd:YAG laser (1064 nm) to full-mouth scaling and root planning (FMS), in stage III/IV periodontitis patients.

MATERIALS AND METHODS

Sixty stage III/IV periodontitis patients were randomly assigned to three groups. The control group received FMS, laser 1 group received combined FMS/single Nd:YAG laser irradiation (3 W, 150 mJ, 20 Hz,100 μs), and laser 2 group received combined FMS/double Nd:YAG laser irradiation with 1-week interval (2.0 W, 200 mJ, 10 Hz, 100 μs). PD, CAL, FMPS, GI, FMBS, and GR were evaluated at baseline, 6 weeks, 3, 6, and 12 months after treatment. Patient-reported outcomes were evaluated 1 week after treatment.

RESULTS

A significant improvement (p < 0.001) for all clinical parameters was observed during the entire study period, with the exception of mean CAL gain for the laser 2 group at 12 months. The percentage of pockets ≤ 4 mm was significantly higher compared to baseline for all groups throughout the study, with no inter-group differences at any time point. Patient-reported analgesic consumption was higher for laser 1 group.

CONCLUSIONS

The adjunctive use of Nd:YAG laser irradiation was similarly effective to FMS alone, during the entire study period. A slightly higher, though not statistically significant improvement was reported for PD at 6 and 12 months after a single post-FMS application of Nd:YAG laser for pocket epithelium removal and coagulation.

CLINICAL RELEVANCE

Additional Nd:YAG laser application for sulcular epithelium removal and coagulation may provide minor long-term improvements compared to FMS or laser irradiation for pocket disinfection and detoxification.

TRIAL REGISTRATION

ISRCTN26692900. Registration date: 09/06/2022.

The In Vitro Effect of Laser Irradiation (Er:YAG and CO2) and Chemical Reagents (Hydrogen Peroxide, Sodium Hypochlorite, Chlorhexidine, or Sodium Fluoride) Alone or in Combination on Reducing Root Caries Bacteria

(1) Lasers have been used for the treatment of dentinal hypersensitivity and bacterial reductions in periodontology. The purpose of this in vitro study was to evaluate the effect of Carbon Dioxide (CO₂) and Erbium-doped Yttrium Aluminum Garnet (Er:YAG) lasers with chlorhexidine (CHX), hydrogen peroxide (H₂O₂), sodium hypochlorite (NaOCl), or sodium fluoride (NaF) on the viability of oral bacteria associated with root caries. (2) Streptococcus mutans, Streptococcus sanguinis, and Enterococcus faecalis were grown in Brain Heart Infusion (BHI) broth, diluted to an OD660 of 0.5, and treated with antiseptics with or without simultaneous irradiation with the Er:YAG and CO₂ lasers for 30 s repeated three times. The treatment groups consisted of 1: no treatment, 2: 0.5% H₂O₂ alone, 3: 0.5% NaOCl alone, 4: 0.12% CHX alone, 5: 2% NaF alone, 6: laser alone, 7: laser with 0.5% H₂O₂, 8: laser with 0.5% NaOCl, 9: laser with 0.12% CHX, and 10: laser with 2% NaF for both lasers. The microbial viability was determined through plating and viable colonies were counted, converted into CFU/mL, and transformed into log form. The statistical analysis was performed using a two-tailed paired t-test. (3) The use of CO₂ and Er:YAG lasers alone failed to show statistically significant antibacterial activity against any of the bacteria. The only effective monotreatment was CHX for S. mutans. The combined treatment of 0.5% NaOCl with Er:YAG produced the greatest reduction in overall viability. (4) The combination of the Er:YAG laser with 0.5% NaOCl resulted in the largest reduction in bacterial survival when compared to monotherapies with antimicrobial solutions or lasers.

Effectiveness of lasers and aPDT in elimination of intraoral halitosis: a systematic review based on clinical trials

In recent years, there has been increasing interest in research showing positive results in antimicrobial photodynamic therapy (aPDT) and laser therapy (LT) in dentistry. The authors of this review tried to answer the question: “Is the effectiveness of lasers and aPDT in the elimination of intraoral halitosis possible?” For this purpose, the electronic database of PubMed and Cochrane Library were searched until September 2021 using a combination of different keywords: (bad breath OR fetor ex ore OR halitosis OR oral malodor) AND (laser OR PDT OR PACT OR photodynamic inactivation OR photodynamic therapy OR photodynamic antimicrobial chemotherapy). Initially, 83 studies were identified. A total of 9 articles were qualified after the application of the eligibility criteria. Eight works concerned aPDT treatment, and only one dedicated to the Er,Cr:YSGG laser. A significant reduction in halitosis occurred immediately after both LT and aPDT. The review found the confirmation of the effectiveness of laser therapy in reducing the number of volatile sulfur compounds (VSC) and the amount of anaerobic bacteria responsible for VSC formation. In most studies, a positive effect was observed for a 1-week follow-up. Laser therapy (aPDT, Er,Cr:YSGG) effectively eliminates microorganisms that produce volatile compounds and can effectively eliminate bad breath for the longer period of time than traditional methods of combatting this ailment.

Sodium Hypochlorite and Diode Laser in Non-Surgical Treatment of Periodontitis: Clinical and Bacteriological Study with Real Time Polymerase Chain Reaction (PCR)

Increasing the disinfection during non-surgical treatment of periodontitis is primordial. This study assesses the effectiveness of sodium hypochlorite and a 980 nm diode laser in non-surgical treatment of periodontitis. Thirty sites of localized periodontitis with a probing pocket depth (PPD) of ≥ 6 mm were included. Fifteen underwent scaling root planing (SRP group) and 15 underwent SRP + 0.5% NaOCl and a 980 nm diode laser (study group). A biological molecular test and real time polymerase chain reaction (RT-PCR) were performed before (T0) and after intervention (T1). Total bacterial count and counts of Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia, Peptostreptococcus micros, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, Eubacterium nodatum, Capnocytophaga gingivalis were assessed. Plaque index (PI), bleeding on probing (BOP), gingival recession (GR), PPD and clinical attachment loss (CAL) were evaluated at T0, and 3 and 6 months after. Study group showed a statistically significant reduction of TBC (5.66 × 10⁸ CFU/mL) compared to SRP (6.2 × 10⁹ CFU/mL). Both groups showed a statistically significant reduction of Treponema denticola, Tannerella forsythia, Prevotella intermedia, Peptostrep. (micromonas) micros and Fusobacterium nucleatum; however, a significant reduction of Eubacterium nodatum and Capnocytophaga gingivalis was observed in the study group. At T6, both groups had a statistically significant reduction of PI, BOP, GR, PD and CAL. The study group showed more GR compared to SRP and a significant reduction of PD (4.03 mm ± 0.49) compared to SRP (5.28 mm ± 0.67). This study reveals that NaOCl and a diode laser are effective as an adjunctive to the non-surgical treatment of periodontitis.

Disinfection Potential of 980 nm Diode Laser and Hydrogen Peroxide (3%) in "Critical Probing Depths" Periodontal Pockets: Retrospective Study

A successful treatment of periodontitis depends largely on the successful elimination of the periodontopathogens during non-surgical and surgical mechanical debridement. In this retrospective study, data collection was conducted from 2017 to 2021. The retrospective study included 128 patients with 128 sites of localized periodontitis with pocket depths > 5 mm. The included data were based on sites that received conventional mechanical debridement followed by different adjunctive approaches. In total, 30 patients did not receive any additional treatment (SRP group), 30 patients received SRP + 980 nm diode laser irradiation only (SRP + laser), 30 patients received SRP + 3% hydrogen peroxide irrigation (SRP + H2O2) only and 30 patients received a combined treatment of 3% hydrogen peroxide and 980 nm diode laser irradiation (SRP + H2O2 + laser). Total bacterial counts (TBC) in the periodontal pocket collected for all participants before treatment, immediately after treatment, 6 weeks after treatment, 12 weeks after treatment and 6 months after treatment were statistically analyzed and compared. When the laser was used, irradiation parameters were 10 μsec/pulse duration, 10 kHz, pick power of 10 W, average power of 1 W, irradiation time of one minute with inward and outward movements, and fiber diameter of 320 μm. The irradiation was repeated 3 times/pocket. When hydrogen peroxide was used, the irrigation was conducted for one minute and repeated 3 times. The maximum reduction in TBC was obtained when SRP was coupled with 3% H2O2 irrigation followed by 980 nm diode laser irradiation. After six months of follow-up, a significant reduction in TBC was obtained for the group of SRP + H2O2 + laser when compared to all the other groups, from 7.27 × 107 before intervention to 3.21 × 107 after six months. All three approaches to SRP showed a significant reduction in TBC immediately after treatment. Values were 3.52 × 107, 4.01 × 106, 9.58 × 106, 1.98 × 106 for SRP alone, SRP + diode, SRP + H2O2 and SRP + H2O2 + diode laser, respectively. At 6 months, we saw no significant difference between SRP + laser and SRP + H2O2 with 4.01 × 107 and 4.32 × 107, respectively. This retrospective study reveals that after SRP, irrigation with 3% hydrogen peroxide and irradiation with a 980 nm diode laser within specific treatment protocol can be used as an additional approach to conventional SRP to increase the disinfection of the periodontal pockets > 5 mm.