Periodontal treatment with an Er:YAG laser compared to ultrasonic instrumentation: a pilot study

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

Lasers are increasingly utilized in the non-surgical treatment of periodontal disease. The aim of the present systematic review with meta-analysis was to investigate the combination use of Nd:YAG and Er:YAG laser therapy in the treatment of severe periodontitis. A systematic review of the literature including searches in PubMed/Medline, Cochrane Library, Google Scholar, and Grey Literature databases, as well as manual searches, was performed until November 1, 2021. Only studies a combination of lasers during non-surgical treatment of pockets ≥ 6mm were included. The eligibility criteria for meta-analysis comprised randomized controlled trials (RCTs) comparing the use of combination laser therapy with/without adjunctive mechanical for the non-surgical management of periodontitis. From 57 initial articles, 6 full-text articles were assessed for eligibility. Two studies were excluded, one study was not a randomized clinical trial (case series), and one study was an in vitro study. Four RCTs were included in the meta-analysis. It was shown that combination of Nd:YAG and Er:YAG may be beneficial for non-surgical periodontal therapy with an additional average reduction in pocket depth and clinical attachment level reported at 1.01 and 0.77 mm respectively when compared to controls. The findings suggest that the combination of Nd:YAG and Er:YAG lasers may lead to additional clinical improvements compared to nonsurgical treatment alone. Future research is needed to substantiate these findings and optimize clinical guidelines including more specific laser protocols. Preliminary data suggest favorable outcomes following the combination of Nd:YAG and Er:YAG lasers for non-surgical periodontal therapy.

Erbium lasers in non-surgical periodontal therapy: an umbrella review and evidence gap map analysis

The literature on the efficacy of erbium lasers for nonsurgical periodontal therapy is inconsistent. The objective of the umbrella review was to collate the information available in the systematic reviews to provide a comprehensive synthesis of clinical and patient reported outcomes following the use of erbium lasers for non-surgical periodontal therapy. An electronic database search was carried out, and systematic reviews/meta-analyses which assessed the efficacy of erbium lasers as monotherapy or as an adjunct to scaling and root planing were included. The methodological quality and reporting quality of the included studies were assessed. 15 Systematic reviews/meta-analyses were obtained after title, abstract, and full text search. The meta-analyses data revealed a clinical attachment level gain, reduction in probing pocket depth at 1 and 3-month follow-up, and no additional benefit at ≥ 6-month follow-up in the erbium laser group. The evidence gap map revealed lack of clinical outcome data at > 6-month follow-up and dearth in studies assessing patient reported outcome measures and adverse events. Erbium lasers may provide short-term clinical benefits, and further studies with standardized laser parameters evaluating long-term follow-up, patient-reported outcome measures, and adverse events are needed.

The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future

Periodontal diseases comprise a group of globally prevalent, chronic oral inflammatory conditions caused by microbial dysbiosis and the host immune response. These diseases specifically affect the tooth-supporting tissues (i.e., the periodontium) but are also known to contribute to systemic inflammation. If left untreated, periodontal diseases can ultimately progress to tooth loss, lead to compromised oral function, and negatively impact the overall quality of life. Therefore, it is important for the clinician to accurately diagnose these diseases both early and accurately chairside. Currently, the staging and grading of periodontal diseases are based on recording medical and dental histories, thorough oral examination, and multiple clinical and radiographic analyses of the periodontium. There have been numerous attempts to improve, automate, and digitize the collection of this information with varied success. Recent studies focused on the subgingival microbiome and the host immune response suggest there is an untapped potential for non-invasive oral sampling to assist clinicians in the chairside diagnosis and, potentially, prognosis. Here, we review the available toolkit available for diagnosing periodontal diseases, discuss commercially available options, and highlight the need for collaborative research initiatives and state-of-the-art technology development across disciplines to overcome the challenges of rapid periodontal disease diagnosis.

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.

Adjunctive laser or antimicrobial photodynamic therapy to non-surgical mechanical instrumentation in patients with untreated periodontitis: A systematic review and meta-analysis

AIM

To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non-surgical mechanical instrumentation alone in untreated periodontitis patients.

MATERIALS AND METHODS

Two focused questions were addressed using the Population, Intervention, Comparison and Outcome criteria as follows: in patients with untreated periodontitis, (a) does laser application provide adjunctive effects on probing pocket depth (PPD) changes compared with non-surgical instrumentation alone? and (b) does application of aPDT provide adjunctive effects on PPD changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Results of the meta-analysis are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines.

RESULTS

Out of 1,202 records, 10 articles for adjunctive laser and 8 for adjunctive aPDT were included. With respect to PPD changes, 1 meta-analysis including 2 articles (total n = 42; split-mouth design) failed to identify a statistically significant difference (WMD = 0.35 mm; 95%CI: -0.04/0.73; p = .08) in favour of adjunctive aPDT (wavelength range 650-700 nm). In terms of adjunctive laser application, a high variability of clinical outcomes at 6 months was noted. Two articles included patient-reported outcomes and 10 reported on the presence/absence of harms/adverse effects.

CONCLUSIONS

Available evidence on adjunctive therapy with lasers and aPDT is limited by (a) the low number of controlled studies and (b) the heterogeneity of study designs. Patient-reported benefits remain to be demonstrated.

Clinical and Immunological Effects of Er,Cr:YSGG Laser in Nonsurgical Periodontal Treatment: A Randomized Clinical Trial

Objective: The aim of this study was to compare the clinical and immunological results of nonsurgical periodontal treatment with or without the erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser. Background data: As lasers have begun to be used in dentistry, the Er,Cr:YSGG laser has started to attract attention in the field of periodontology. Materials and methods: Fifty-nine nonsmoking patients with advanced chronic periodontitis were randomly allocated to a test group (full-mouth ultrasonic supra- and subgingival debridement+Er,Cr:YSGG laser application) and a control group (full-mouth ultrasonic supra- and subgingival debridement+root planing with Gracey curettes). The laser parameters were set as follows: 1.5 W output power, pulse mode H (pulse duration of 140 μs), pulse frequency of 20 Hz, and an air-water spray ratio of 10% air and 15% water. The instrumentation was performed until the operator felt that the root surfaces were adequately debrided. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index, interleukin-1 beta (IL-1β), matrix metalloproteinase-8 (MMP-8), tissue inhibitor metalloproteinase-1 (TIMP-1), and MMP-8/TIMP-1 levels in gingival crevicular fluid were evaluated at baseline, 6 weeks, and 3 months postoperatively. Results: There were statistically significant differences in PD, which was our primary outcome, and BOP between the groups at both examinations [p < 0.001 and p < 0.001 (for PD) and p = 0.048 and p < 0.001 (for BOP), respectively], in favor of the laser group. However, there were no significant differences among groups at any time for CAL gain (p = 563 and p = 369, respectively). No significant differences in MMP-8, TIMP-1, and MMP-8/TIMP-1 levels were detected among groups. There was a statistically significant difference for IL-1β levels among groups at 3-month evaluations in favor of the laser group. Conclusions: Using the Er,Cr:YSGG laser instead of hand instruments in nonsurgical periodontal treatment has shown additional improvements in terms of pocket reduction and gingival bleeding compared with traditional nonsurgical therapy.

Photonic Therapy in Periodontal Diseases an Overview with Appraisal of the Literature and Reasoned Treatment Recommendations

Recent reviews and meta-analyses of the literature over the past quarter-century have failed to provide enough evidence to prove or disprove the actual utility of photonic therapy in periodontitis, alone or adjunctive to conventional approaches. This apparent paradox has been explained by the many physical, molecular, biological, anatomical, and technical variables of photonic treatments, which can differ in light-emitting devices (laser or LED), wavelengths, irradiation power and modes, clinical objectives, follow-up times, disease grading, and assessment methods. This multi-faceted, controversial scenario has led practitioners to underestimate the actual potential of photonic therapy in periodontal diseases. In this critical appraisal of the literature, we have briefly summarized the main photonic therapies and instruments used in Periodontology, highlighting their main characteristics and limitations. Then, we have tried to identify and discuss the key methodological issues which can have an impact on the outcome of photonic therapies. Our main goal was to identify the best parameters, settings, and methodologies to perform effective periodontal photonic treatments and to extrapolate some recommendations for clinical use. Should these recommendations find a consensus among periodontologists and be adopted in future clinical studies, they will hopefully contribute to dissipate the present confusion and uncertainty on this complex matter.

In vitro and clinical evaluation of optical coherence tomography for the detection of subgingival calculus and root cementum

This study evaluated the effectiveness of swept-source optical coherence tomography (ss-OCT) for detecting calculus and root cementum during periodontal therapy. Optical coherence tomography (OCT) images were taken before and after removal of subgingival calculus from extracted teeth and compared with non-decalcified histological sections. Porcine gingival sheets of various thicknesses were applied to the root surfaces of extracted teeth with calculus and OCT images were taken. OCT images were also taken before and after scaling and root planing (SRP) in human patients. In vitro, calculus was clearly detected as a white-gray amorphous structure on the root surface, which disappeared after removal. Cementum was identified as a thin, dark-gray layer. The calculus could not be clearly observed when soft tissues were present on the root surface. Clinically, supragingival calculus and cementum could be detected clearly with OCT, and subgingival calculus in the buccal cervical area of the anterior and premolar teeth was identified, which disappeared after SRP. Digital processing of the original OCT images was useful for clarifying the calculus. In conclusion, ss-OCT showed potential as a periodontal diagnostic tool for detecting cementum and subgingival calculus, although the practical applications of subgingival imaging remain limited.

Laser reduction of specific microorganisms in the periodontal pocket using Er:YAG and Nd:YAG lasers: a randomized controlled clinical study

The objective of this study was to evaluate the microbiological and clinical outcomes following nonsurgical treatment by either scaling and root planing, combination of Nd:YAG and Er:YAG lasers, or by Er:YAG laser treatment alone. The study involved 60 patients with generalized chronic periodontitis, randomly assigned into one of three treatment groups of 20 patients. The first group received scaling and root planing by hand instruments (SRP group), the second group received Er:YAG laser treatment alone (Er group), and the third group received combined treatment with Nd:YAG and Er:YAG lasers (NdErNd group). Microbiological samples, taken from the periodontal pockets at baseline and 6 months after treatments, were assessed with PET Plus tests. The combined NdErNd laser (93.0%), followed closely by Er:YAG laser (84.9%), treatment resulted in the highest reduction of all bacteria count after 6 months, whereas SRP (46.2%) failed to reduce Treponema denticola, Peptostreptococcus micros, and Capnocytophaga gingivalis. Full-mouth plaque and bleeding on probing scores dropped after 6 months and were the lowest in both laser groups. The combination of NdErNd resulted in higher probing pocket depth reduction and gain of clinical attachment level (1.99 ± 0.23 mm) compared to SRP (0.86 ± 0.13 mm) or Er:YAG laser alone (0.93 ± 0.20 mm) in 4-6 mm-deep pockets. Within their limits, the present results provide support for the combination of Nd:YAG and Er:YAG lasers to additionally improve the microbiological and clinical outcomes of nonsurgical periodontal therapy in patients with moderate to severe chronic periodontitis.

Comparison of clinical parameters, microbiological effects and calprotectin counts in gingival crevicular fluid between Er: YAG laser and conventional periodontal therapies: A split-mouth, single-blinded, randomized controlled trial

BACKGROUND

The erbium-doped yttrium, aluminum, and garnet (Er:YAG) laser is thought to be the most promising laser for periodontal treatment; however, its application is still under consideration. The aim of this study was to compare Er:YAG laser monotherapy with conventional scaling and root planing (SRP) for chronic periodontitis using clinical parameters, the detection rate of periodontal pathogens, and the calprotectin level in gingival crevicular fluid.

METHODS

Twenty-seven participants with moderate-to-advanced chronic periodontitis were included. In a split-mouth design, the 2 half-mouths of each participant were randomly assigned to Er:YAG laser or SRP (combination of ultrasonic and manual instruments) treatment. Clinical parameters were recorded at baseline, 6 weeks, and 3 and 6 months after treatment. At the same time points, gingival crevicular fluid was collected to analyze the detection rate of 6 periodontal pathogens by polymerase chain reaction and the levels of calprotectin by enzyme-linked immunosorbent assay.

RESULTS

Both treatment groups showed significant reductions in probing depth (PD), bleeding index (BI), and clinical attachment level (CAL) from baseline to 6 months. For sites with 4 mm ≤ PD ≤ 6 mm at baseline, SRP resulted in a greater reduction in PD and CAL than Er:YAG laser treatment, and the difference remained at 6 months post-treatment (P = .01 and P < .01, respectively). For sites with PD ≥7 mm at baseline, the clinical parameters showed similar results between the 2 groups. SRP resulted in a lower detection rate of Porphyromonas gingivalis at 6 months post-treatment. The levels of calprotectin were significantly decreased from baseline to 6 months in both groups, without a significant difference between the groups.

CONCLUSION

For mild pockets, conventional SRP may still be the preferred choice. For deep pockets, Er:YAG laser treatment could be an effective alternative. Studies are needed to explore more advanced instruments and new application methods for the Er:YAG laser for periodontal treatment in deep pockets.

Combined application of Er:YAG and Nd:YAG lasers in treatment of chronic periodontitis. A split-mouth, single-blind, randomized controlled trial

BACKGROUND

The aim of the present study was to compare the effectiveness of combined Er:YAG and Nd:YAG laser therapy to that of scaling and root planing with hand instruments in non-surgical treatment of chronic periodontitis.

MATERIAL AND METHODS

Twenty-five systemically healthy patients with chronic periodontitis were selected for this study. The quadrants were randomly allocated in a split-mouth design to either combined Er:YAG (160 mJ/pulse, 10 Hz) and Nd:YAG laser (100 mJ/pulse, 20 Hz) therapy (test group) or scaling and root planing alone (control group). At baseline, 1 month and 3 months after treatment, plaque index, gingival index, probing depth, clinical attachment level and bleeding on probing (%), were recorded and gingival crevicular fluid and subgingival plaque samples were taken. The gingival crevicular fluid levels of interleukin-1β and tumor necrosis factor-α were analyzed by enzyme-linked immunosorbent assay. Quantitative analysis of red complex bacteria was performed using quantitative real-time polymerase chain reaction.

RESULTS

The clinical parameters had significantly improved for both groups after treatment. There were statistically significant differences in probing depth and clinical attachment level between the test and control groups only for deep pockets (≥7 mm) (P<.05). No significant differences between the two groups were observed for the biochemical and microbiological parameters at any time points (P>.05).

CONCLUSIONS

The present study suggests that a combined course of Er:YAG and Nd:YAG laser therapy may be beneficial particularly in inaccessible areas such as deep pockets on a short-term basis. Further, well-designed studies are required to assess the effectiveness of the combination of these lasers.

Periodontal and peri-implant wound healing following laser therapy

Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO2 , neodymium-doped yttrium-aluminium-garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft-tissue management. With development of the erbium-doped yttrium-aluminium-garnet (Er:YAG) and erbium, chromium-doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft-tissue management to hard-tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri-implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti-inflammatory agents, phototherapy using lasers and light-emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low- and high-level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri-implant diseases. This article discusses the outcomes of laser therapy in soft-tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri-implant treatment, focusing on postoperative wound healing of periodontal and peri-implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.

Energy output reduction and surface alteration of quartz tips following Er:YAG laser contact irradiation on soft and hard tissues in vitro

Though the Er:YAG laser (ErL) has been used in periodontal therapy, the irradiated tip damage has not been studied in detail. In this study, the change in the energy output, surface morphology, and temperature of quartz tips was evaluated following contact irradiation. Soft tissue, calculus on extracted human teeth, and porcine bone were irradiated by ErL for 60 min at 14.2 or 28.3 J/cm(2)/pulse and 20 Hz with or without water spray. The energy output ratio declined the most in the calculus group, followed by the bone and soft tissue groups with and/or without water spray. Carbon contamination was detected in all groups, and contamination by P, Ca, and/or other inorganic elements was observed in the calculus and bone groups. The rate of energy output reduction and the degree of surface alteration/contamination is variously influenced by the targeting tissue, temperature elevation of the tip and water spray.

Current concepts in the use of lasers in periodontal and implant dentistry

Lasers have various periodontal applications including calculus removal (Er: YAG, Er, Cr: YSGG lasers); soft tissue excision, incision and ablation; decontamination of root and implant surfaces; biostimulation; bacteria reduction; and osseous surgery. This paper reviews some of the major opportunities for using lasers in periodontal and implant specialty practices. The literature relating to the use of lasers for removal of the pocket epithelium, root conditioning, bacterial reduction and decontamination of infected implant surfaces is discussed, and a summary of the advantages and disadvantages of using lasers for periodontal treatment is provided.

Laser assisted periodontics: A review of the literature

Over the years, the use of the laser within health field and more particularly dentistry has been increasing and improving. The application of laser in the periodontal treatment takes part of a non-surgical and surgical approaches, is used for the decontamination of periodontal pockets due to its bactericidal effect, and the removal of granulation tissues, inflamed and diseased epithelium lining, bacterial deposits and subgingival calculus. However in spite of all the marketing surrounding, the use of laser highlighting its beneficial effect, the capacity of laser to replace the conventional treatment for chronic periodontitis is still debatable. In fact there is no evidence that any laser system adds substantial clinical value above conventional treatments of chronic periodontitis. Some studies showed a significant positive effect on clinical attachment level gain and probing depth reduction. In the other hand, several articles demonstrated no evidence of the superior effectiveness of laser therapy compared to root planing and scaling. Our aims is to review the literature on the capacity of erbium:Yttrium-aluminum-garnet and neodymium:Yttrium-aluminium-garnet laser to either replace or complete conventional mechanical/surgical periodontal treatments.

Er:YAG laser versus scaling and root planing as alternative or adjuvant for chronic periodontitis treatment: a systematic review

AIM

To perform a systematic review to evaluate the erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser versus scaling and root planing (SRP) as alternative or adjuvant for chronic periodontitis treatment.

MATERIAL AND METHODS

We performed a literature search using six electronic databases and completed by manual searches up to July 2013. We conducted a meta-analysis as well as heterogeneity, sensitivity, subgroup and power analyses to clarify and validate the pooled results. The 3-, 6- and 12-month clinical outcomes were evaluated.

RESULTS

Twelve eligible randomized clinical trials were finally included. Our meta-analysis showed that Er:YAG laser resulted in similar clinical improvements as SRP 3 months postoperatively. For subgroups by laser level, quality of trials and fluorescence feedback device, the results remained consistent. The 6- and 12-month observations between Er:YaG laser and SRP demonstrated no difference but inconclusive, due to large heterogeneity. The advantage of Er:YAG laser adjuvant to SRP for periodontitis treatment was not significant.

CONCLUSIONS

This systematic review indicated that the clinical efficacy of Er:YAG laser was similar to SRP 3 months postoperatively. The clinical benefits of Er:YAG laser as adjuvant to SRP was still lacking. Since Er:YAG laser has certain advantages, it could be expected to be a novel short-term alternative choice for chronic periodontitis.

Effects of root surface debridement using Er:YAG laser versus ultrasonic scaling - a SEM study

OBJECTIVE

Despite promising results of Er:YAG laser in periodontal debridement, to date there is no consensus about the ideal settings for clinical use. This experimental clinical trial aimed to determine the effects of debridement using Er:YAG laser and to compare with ultrasonic treatment.

MATERIALS AND METHODS

Sixty-four teeth were divided into two in vivo and in vitro subgroups. Each tooth received ultrasonic treatment on one side and Er:YAG laser debridement at either 60, 100, 160 or 250 mJ pulse(-1) and at 10 Hz on the other side on a random basis. All samples were morphologically analyzed afterwards under scanning electron microscope for surface changes and dentinal tubules exposure. Treatment duration (d) was also recorded.

RESULTS

Laser debridement produced an irregular, rough and flaky surface free of carbonization or meltdown while ultrasound produced a relatively smoother surface. The number of exposed dentinal tubules (n) followed an energy-dependent trend. The number of exposed tubules among the in vivo laser groups was n 60 mJ = n 100 mJ < n 160 mJ < n 250 mJ (P < 0.001). Also 160 and 250 mJ lasers led to significantly more dentinal exposure than ultrasound under in vivo condition. Within the in vitro laser groups, dentinal tubules exposure was n 60 mJ < n 100 mJ < n 160 mJ < n 250 mJ (P ≤ 0.0015). Furthermore, in vitro laser treatments at 100, 160 and 250 mJ led to significantly more dentinal denudation than ultrasound. Treatment duration (d) for the in vivo groups was d 60 mJ > d 100 mJ > d Ultrasound = d 160 mJ > d 250 mJ (P ≤ 0.046), while for the in vitro groups it was d 60 mJ > d 100 mJ = d Ultrasound = d 160 mJ >d 250 mJ (P ≤ 0.046).

CONCLUSIONS

Due to excessive treatment duration and surface damage, Er:YAG laser debridement at 60 and 250 mJ pulse(-1), respectively, is not appropriate for clinical use. Although laser debridement at 100 and 160 mJ pulse(-1) seems more suitable for clinical application, compared to ultrasound the former is more time-consuming and the latter is more aggressive. Using a feedback device or lower pulse energies are recommended when using laser in closed field.

Anti-infective therapy with an Er:YAG laser: influence on peri-implant healing

In addition to conventional treatment modalities (mechanical and chemical), the use of lasers has been increasingly proposed for the treatment of periodontal and peri-implant infections (i.e., cleaning and detoxification of implant surfaces). Preliminary results from basic studies have pointed to the high potential of the Erbium-doped: Yttrium, Aluminum and Garnet (Er:YAG) laser. Furthermore, preliminary clinical data indicate that treatment with this kind of laser may positively influence peri-implant healing. The aim of this research update is to evaluate, based on the currently available evidence, the use of an Er:YAG laser for the treatment of peri-implant infections and to indicate its potential as a new treatment modality.

Er:YAG laser in the treatment of periodontal sites with recurring chronic inflammation: a 12-month randomized, controlled clinical trial

AIM

The objective of this randomized, controlled clinical trial was to compare the clinical and microbiological effects of pocket debridement using erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser with conventional debridement in maintenance patients.

MATERIAL & METHODS

Fifteen patients, all smokers, having at least four teeth with residual probing depth (PD) ≥ 5 mm were recruited. Two pockets in two jaw quadrants were randomly assigned to subgingival debridement using an Er:YAG laser (test) or ultrasonic scaler/curette (control) at 3-month intervals. Relative attachment level (RAL), PD, bleeding on probing and dental plaque were recorded at baseline and at 6 and 12 months. Microbiological subgingival samples were taken at the same time points and analysed using a checkerboard DNA-DNA hybridization technique.

RESULTS

A significant decrease in PD took place in both treatments from baseline to 12 months (p < 0.01). In the control, the mean initial PD decreased from 5.4 to 4.0 mm at 12 months. For the test, a similar decrease occurred. No significant between-treatment differences were shown at any time point. The mean RAL showed no overall significant inter- or intra-treatment differences (p > 0.05). No significant between-treatment differences were observed in subgingival microbiological composition or total pathogens.

CONCLUSION

The results failed to support that an Er:YAG laser may be superior to conventional debridement in the treatment of smokers with recurring chronic inflammation. This appears to be the first time that repeated Er-YAG laser instrumentation has been compared with mechanical instrumentation of periodontal sites with recurring chronic inflammation over a clinically relevant time period.

Er:YAG laser treatment in supportive periodontal therapy

OBJECTIVE

To assess clinical and microbiological outcomes of an Er:YAG laser in comparison with sonic debridement in the treatment of persistent periodontal pockets in a prospective randomized controlled multicentre study design.

MATERIAL AND METHODS

A total of 78 patients in supportive periodontal therapy with two residual pockets were included, 58 were available for the whole follow-up period. Root surfaces were instrumented either with a sonic scaler (Sonicflex(®) 2003 L) or with an Er:YAG laser (KEY Laser(®) 3). Clinical attachment levels (CAL), Probing depths (PD), Plaque control record (PCR) and Bleeding on probing (BOP) were assessed at baseline, 13 and 26 weeks after treatment. In addition, microbiological analysis was performed employing a DNA diagnostic test kit (micro-IDent(®) Plus).

RESULTS

Probing depths and CAL were significantly reduced in both groups over time (p < 0.05), without significant differences between the groups (p > 0.05). BOP frequency values decreased significantly within both groups (p < 0.05), with no difference between the laser and the sonic treatment (p > 0.05). PCR frequency values did not change during the observation period (p > 0.05). Microbiological analysis failed to expose any significant difference based on treatment group or period.

CONCLUSION

Employing both sonic and laser treatment procedures during supportive periodontal care, similar clinical and microbiological outcomes can be expected.

Efficacy of Er:YAG laser in the treatment of chronic periodontitis: systematic review and meta-analysis

Scaling root planing (SRP) has been proven efficacious as the traditional treatment approach for chronic periodontitis. However, important limitations such as difficult access in deep pockets, grooves, and furcations have led to the development of new therapeutic strategies. The erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser is one of the most promising laser types for periodontal therapy. Its efficacy in radicular debris removal and root smoothing has been proven in vitro. However, the clinical effectiveness of the Er:YAG laser remains controversial. The aim of the present systematic review was to systemically assess the scientific evidence for the effectiveness of Er:YAG laser compared to SRP in the treatment of chronic periodontitis. Electronic database searches of MEDLINE, Cochrane Controlled Clinical Trial Register, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, CINAHL, Science Direct, ISI Web of Science, and SCOPUS were performed, as well as hand-searching of relevant journals through December 23, 2010. Quality assessment was made according to the CONSORT guidelines. The systematic review was performed according to the QUOROM statement and Cochrane Collaboration recommendations. Meta-analyses of the clinical attachment level gain, probing depth reduction, and changes in gingival recession were performed using weighted mean differences for continuous data with 95% confidence intervals, nested in a random effect model. No statistically significant differences were found in any of the investigated clinical parameters among the five random controlled trials (RCTs) entered into the study, indicating that there was no evidence of effectiveness. However, significant heterogeneity, a high risk of bias in three of the five included studies, and methodological shortcomings indicate that the results should be considered with caution. Future long-term, well-designed RCTs are needed to assess the scientific evidence of Er:YAG laser efficacy as an alternative treatment strategy to SRP.

Laser-induced fluorescence for subgingival calculus detection: scientific rational and clinical application in periodontology

OBJECTIVE

To review the data available on the laser-induced calculus fluorescence phenomenon and the calculus detection devices as well as to determine the clinical relevance of using commercialized calculus detection devices in periodontal treatment.

METHODS

In vitro or in vivo English publications found on Medline.

RESULTS

In vitro and in vivo studies showed that the devices on the market had a satisfactory detection capacity. Very few studies demonstrated that the erbium:yttrium-aluminium-garnet (Er:YAG) laser debridement, when performed with automatic calculus detection, could lead to improvements at the clinical level, and the outcome was similar to that obtained with conventional treatments.

CONCLUSIONS

Although preliminary data were encouraging, there was a lack of scientific data concerning the calculus detection devices. Therefore, future studies are crucial for determining the clinical relevance of such equipment.

Effect of instrumentation using curettes, piezoelectric ultrasonic scaler and Er,Cr:YSGG laser on the morphology and adhesion of blood components on root surfaces: a SEM study

This study used scanning electron microscopy (SEM) to evaluate the morphology and adhesion of blood components on root surfaces instrumented by curettes, piezoelectric ultrasonic scaler and Er,Cr:YSGG laser. One hundred samples from 25 teeth were divided into 5 groups: 1) Curettes; 2) Piezoelectric ultrasonic scaler; 3) Curettes plus piezoelectric ultrasonic scaler; 4) Er,Cr:YSGG laser; 5) Curettes plus Er,Cr:YSGG laser. Ten samples from each group were used for analysis of root morphology and the other 10 were used for analysis of adhesion of blood components on root surface. The results were analyzed statistically by the Kruskall-Wallis and Mann-Whitney tests with a significance level of 5%. The group treated with curettes showed smoother surfaces when compared to the groups were instrumented with piezoelectric ultrasonic scaler and the Er,Cr:YSGG laser. The surfaces instrumented with piezoelectric ultrasonic scaler and Er,Cr:YSGG laser, alone or in combination with hand scaling and root planing, did not differ significantly (p>0.05) among themselves. No statistically significant differences (p>0.05) among groups were found as to the adhesion of blood components on root surface. Ultrasonic instrumentation and Er,Cr:YSGG irradiation produced rougher root surfaces than the use of curettes, but there were no differences among treatments with respect to the adhesion of blood components.

Root surface biomodification with an Er:YAG laser for the treatment of gingival recession with subepithelial connective tissue grafts

BACKGROUND/AIM

Root surface biomodification has been used to treat gingival recession and periodontitis. The principle for this procedure is that removing the smear layer from the root surfaces exposes collagen fibers, which leads to improved healing. Clinical studies generally have failed to find any improvement in clinical parameters when using such agents. The aim of this study was to evaluate and compare the outcome of gingival recession therapy using the subepithelial connective tissue graft (SCTG) with or without Er:YAG laser application for root surface biomodification.

MATERIALS AND METHODS

Twenty-four teeth in 12 patients with Miller class I and II recession were treated with SCTG with (test group) or without (control group) the application of an Er:YAG laser (2 Hz, 60 mJ/pulse, 40 s, with air spray). Clinical attachment level (CAL), recession depth (RD), recession width (RW), and probing depth (PD) were measured at baseline and 6 months postsurgery.

RESULTS

There were no significant differences between test and control groups (p > 0.05). Postoperatively, significant root coverage, gains in CAL, and highly significant increases in the RW were observed in both groups. For test and control groups, the average root coverage was 80% and 86%, respectively (p > 0.05), and complete root coverage was 75% and 67%, respectively.

CONCLUSIONS

The present study showed that root surface conditioning with an Er:YAG laser does not enhance the results achieved when SCTG was performed alone.

Lack of adjunctive benefit of Er:YAG laser in non-surgical periodontal treatment: a randomized split-mouth clinical trial

AIM

This split-mouth, randomized, clinical trial aimed to evaluate the efficacy of erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser application in non-surgical periodontal treatment.

MATERIALS AND METHODS

A total of 27 patients underwent four modalities of non-surgical therapy: supragingival debridement; scaling and root planing (SRP)+Er:YAG laser; Er:YAG laser; and SRP. Each strategy was randomly assigned and performed in one of the four quadrants. Clinical outcomes were evaluated at 3 and 6 months. Subjective benefits of patients have been evaluated by means of questionnaires.

RESULTS

Six months after therapy, Er:YAG laser showed no statistical difference in clinical attachment gain with respect to supragingival scaling [0.15 mm (95% CI -0.16; 0.46)], while SRP showed a greater attachment gain than the supragingival scaling [0.37 mm (95% CI 0.05; 0.68)]. No difference resulted between Er:YAG laser+SRP and SRP alone [0.05 mm (95% CI -0.25; 0.36)].

CONCLUSIONS

The adjunctive use of Er:YAG laser to conventional SRP did not reveal a more effective result than SRP alone. Furthermore, the sites treated with Er:YAG laser showed similar results of the sites treated with supragingival scaling.

In vitro studies of the ablation mechanism of periodontopathic bacteria and decontamination effect on periodontally diseased root surfaces by erbium:yttrium-aluminum-garnet laser

The erbium:yttrium-aluminum-garnet (Er:YAG) laser is now increasingly used in periodontal therapy. The purpose of this study was to investigate the effect of Er:YAG laser irradiation on the morphology of periodontopathic bacteria and to compare the bacterial elimination effect of the laser and the ultrasonic scaler on diseased root surfaces in vitro. Colonies of Porphyromonas gingivalis were exposed to a single-pulse Er:YAG laser at 40 mJ and were examined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Also, 20 pairs of periodontally diseased root surfaces with subgingival calculi of freshly extracted teeth were treated by Er:YAG laser scaling at 40 mJ/pulse (14.2 J/cm(2) per pulse) and 10 Hz with water spray or ultrasonic scaling, or were not treated. The efficiency of each treatment was determined as the area treated per second, and the treated surfaces were examined by SEM. The material scraped from the treated root surfaces was cultured in aerobic and anaerobic conditions, and the numbers of colony forming units (CFUs) were compared. SEM and TEM showed that the Er:YAG laser had easily ablated the bacterial colony, leaving an ablation spot with a crater and the surrounding affected area showing melted branch-like structures. The laser irradiation was as equally effective and efficient as the ultrasonic scaler in performing root surface debridement. The CFUs after laser treatment were significantly fewer than those after ultrasonic scaling in aerobic and anaerobic culture conditions. Er:YAG laser ablates periodontopathic bacteria with thermal vaporization, and its bacterial elimination effect on the diseased root surfaces appears to be superior to that of the ultrasonic scaler.

Lasers and the treatment of chronic periodontitis

For many intraoral soft-tissue surgical procedures the laser has become a desirable and dependable alternative to traditional scalpel surgery. However, the use of dental lasers in periodontal therapy is controversial. This article presents the current peer-reviewed evidence on the use of dental lasers for the treatment of chronic periodontitis.

The effect of laser therapy as an adjunct to non-surgical periodontal treatment in subjects with chronic periodontitis: a systematic review

BACKGROUND

The objective of this study was to systematically review the evidence on the effectiveness of laser therapy as an adjunct to non-surgical periodontal treatment in adults with chronic periodontitis.

METHODS

A search was conducted for randomized controlled trials comparing the outcome of periodontitis with laser as an adjunct to scaling and root planing in the treatment of chronic periodontal disease. The electronic databases, PubMed and Cochrane Central Register of Controlled Trials, were used as data sources. Screening, data abstraction, and quality assessment were conducted independently by three reviewers (MK, HJ, and CDL). The primary outcome measures evaluated were changes in clinical attachment level, probing depth, and bleeding on probing.

RESULTS

The search resulted in 25 abstracts; four randomized controlled clinical trials were included. Four different laser methods were used; consequently, it was impossible to conduct a quantitative data synthesis leading to a meta-analysis. All studies included a limited number of subjects.

CONCLUSIONS

No consistent evidence supports the efficacy of laser treatment as an adjunct to non-surgical periodontal treatment in adults with chronic periodontitis. More randomized controlled clinical trials are needed.

Laser application in non-surgical periodontal therapy: a systematic review

OBJECTIVES

The primary aim was to address the following focused question: What is the clinical effect of laser application compared with mechanical debridement in non-surgical periodontal therapy in patients with chronic periodontitis? A secondary aim was to survey the relevant literature in relation to safety of laser applications.

MATERIAL AND METHODS

Electronic databases of the PubMed and the Cochrane Library were searched and completed by manual searches up to December 2007.

RESULTS

Following screening, 12 publications (11 studies) were eligible for the review. A meta-analysis could not be performed due to the heterogeneity of the studies. The results from a narrative synthesis indicate that Er:YAG laser monotherapy resulted in similar clinical outcomes, both in the short and the long term (up to 24 months), compared with mechanical debridement. There is insufficient evidence to support the clinical application of either CO(2), Nd:YAG, Nd:YAP, or different diode laser wavelengths.

CONCLUSIONS

The Er:YAG laser seems to possess characteristics most suitable for the non-surgical treatment of chronic periodontitis. Research conducted so far has indicated that its safety and effects might be expected to be within the range reported for conventional mechanical debridement. However, the evidence from the evaluated studies is weak.