Effects of Root Debridement With Hand Curettes and Er:YAG Laser on Chemical Properties and Ultrastructure of Periodontally-Diseased Root Surfaces Using Spectroscopy and Scanning Electron Microscopy

Comparative Analysis of Er:YAG and Er,Cr:YSGG Lasers on Root Debridement and Cell Attachment Versus Conventional Instrumentation Methods: A Scoping Review

Effective subgingival debridement is essential for periodontal therapy. Subgingival debridement techniques induce morphological changes that influence healing. While hand instruments and ultrasonic scalers are the gold standard, erbium lasers offer potential advantages in biocompatibility and healing. This scoping review compares the effectiveness of erbium lasers (Er,Cr:YSGG (erbium, chromium-doped yttrium-scandium-gallium-garnet) and Er:YAG (erbium-doped yttrium-aluminum-garnet)) and conventional debridement methods in calculus removal, root surface topography, and cellular attachment following root debridement, based on in vitro studies. A systematic search was conducted in PubMed and Google Scholar for English-language articles published between 2014 and 2024. Studies evaluating erbium lasers compared to conventional debridement methods were included. A total of 1224 studies were initially identified from two databases: PubMed and Google Scholar. Following the eligibility assessment, 15 in vitro studies were analyzed. All methods effectively achieved subgingival instrumentation; additionally, erbium lasers produced smear layer-free surfaces with increased porosity, which may facilitate fibroblast attachment. However, laser-treated surfaces exhibited greater roughness and crater formation compared to conventional methods, with higher energy levels contributing to thermal damage. While some studies reported residual calculus on laser-treated surfaces, others demonstrated enhanced calculus removal and minimal root substance loss. Cell attachment studies indicated that Er:YAG lasers promoted fibroblast viability and proliferation, whereas high-energy Er,Cr:YSGG applications had variable effects on biocompatibility. Erbium lasers present a promising alternative to conventional debridement methods, improving smear layer removal and cell adhesion. However, variations in laser parameters impact treatment outcomes, emphasizing the need for standardized protocols. Further in vivo and clinical studies are required to validate their long-term effectiveness in periodontal therapy.

Efficacy of ultrasonics and Er,Cr:YSGG laser on root surface calculus removal: A comparative in vitro field emission scanning electron microscope study

Background

Scaling and root planing (SRP) is an inevitable primary step in non-surgical periodontal therapy. Debridement carried out with manual instruments and ultrasonics results in the removal of tooth structure. Current research revolves around laser as an efficient adjunct to SRP. This study evaluated and compared the effectiveness of root surface calculus removal between ultrasonics and Er,Cr:YSGG laser.

Methods

Twenty-eight single-rooted teeth extracted due to periodontal disease were selected for the study. The specimens were randomly assigned to two groups (n=14). Group I underwent ultrasonic instrumentation using a piezo ultrasonic scaler, and group II was subjected to laser instrumentation using Er,Cr:YSGG laser (Waterlase). The specimens were processed, fixed, viewed under a field emission scanning electron microscope and evaluated using the remaining calculus index (RCI) and loss of tooth substance index (LTSI).

Results

Ultrasonics-treated specimens revealed more remaining calculus (1.57±0.65) and lost tooth substance (1.71±0.61) compared to the Er,Cr:YSGG laser-treated specimens, with significantly lower RCI (0.71±0.61) and LTSI (1.00±0.56). There was a statistically significant difference (P<0.05) in the efficacy of root surface calculus removal between the two groups.

Conclusion

Compared to ultrasonics, Er,Cr:YSGG laser demonstrated superior results by causing precise removal of root surface calculus without significantly affecting tooth structure and aiding in new attachment.

Efficacy of laser monotherapy or non-surgical mechanical instrumentation in the management of untreated periodontitis patients. A systematic review and meta-analysis

OBJECTIVE

To evaluate and compare the effects of laser monotherapy with non-surgical mechanical instrumentation alone in untreated periodontitis patients.

MATERIALS AND METHODS

A focused question was formulated based on the Population, Intervention, Comparison, Outcome, and Study design criteria (PICOS): in patients with untreated periodontitis, does laser mono-therapy provide adjunctive effects on pocket probing depth (PPD) changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. The results of the meta-analyses are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines.

RESULTS

The search yielded 1268 records, out of which 8 articles could be included. With respect to PPD changes, a meta-analysis including 5 articles (n = 148) failed to identify statistically significant differences in favor of laser monotherapy for PPD change (WMD = 0.14 mm; 95% CI: - 0.04/0.32; z = 1.51; p = 0.132) nor for clinical attachment level (CAL) (WMD = 0.04 mm; 95% CI: - 0.35/0.42; z = 0.19; p = 0.850). Data on cost-effectiveness are lacking. One study reported patient-related outcome measures (PROMS).

CONCLUSIONS

In untreated periodontitis patients, laser monotherapy does not yield superior clinical benefits compared with non-surgical mechanical instrumentation alone.

CLINICAL RELEVANCE

In untreated periodontitis patients, mechanical instrumentation with hand and/or ultrasonic instruments remains the standard of care.

Profilometric Analysis of Periodontally Diseased Root Surfaces After Application of Different Instrumentation Tools: An In Vitro Study

Objective: The topography of the root surface plays an important role in plaque accumulation, cell adhesion, and periodontal healing. The aim of this study is to profilometrically evaluate the root surface changes following the instrumentation using different tools. Methods: Forty dentin blocks of buccal and lingual root surfaces were obtained from 20 single-rooted periodontally diseased hopeless teeth and randomly divided into 4 groups. Each group was subjected to different root instrumentation tools such as stainless steel (SS) Gracey curette (Group 1); titanium nitride (TIN) Gracey curette (Group 2); ultrasonic piezoelectric device with a special tip designed for root surfaces (H3) (Group 3); and Er:YAG laser (Er:YAG tip) chisel (Group 4). A calibrated clinician instrumented all surfaces in each group. The root surfaces were profilometrically evaluated before and after instrumentations. Results: There were no statistical differences between the initial roughness levels of the groups. TIN curettes revealed the most prominent effect on smoothing the surface, whereas the Er:YAG tip showed the highest roughness in comparison with the other root surface instrumentation tools. Conclusions: Considering the importance of root surface roughness after treatment for the success of periodontal therapy, the TIN curette was the most periodontally appealing tool followed by H3, SS curette, and Er:YAG tip.