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1
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Fiegler-Rudol J, Grzech-Leśniak Z, Tkaczyk M, Grzech-Leśniak K, Zawilska A, Wiench R. Enhancing Root Canal Disinfection with Er:YAG Laser: A Systematic Review. Dent J (Basel) 2025; 13:101. [PMID: 40136729 PMCID: PMC11941447 DOI: 10.3390/dj13030101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 02/21/2025] [Accepted: 02/25/2025] [Indexed: 03/27/2025] Open
Abstract
Background: The quest for minimally invasive disinfection in endodontics has led to using Erbium:Yttrium-Aluminum-Garnet (Er:YAG) lasers. Conventional approaches may leave bacterial reservoirs in complex canal anatomies. Er:YAG's strong water absorption generates photoacoustic streaming, improving smear layer removal with lower thermal risk than other laser systems. Methods: This systematic review followed PRISMA 2020 guidelines. Database searches (PubMed/MEDLINE, Embase, Scopus, Cochrane Library) identified studies (2015-2025) on Er:YAG laser-assisted root canal disinfection. Fifteen articles met the inclusion criteria: antibacterial efficacy, biofilm disruption, or smear layer removal. Data on laser settings, irrigants, and outcomes were extracted. The risk of bias was assessed using a ten-item checklist, based on guidelines from the Cochrane Handbook for Systematic Reviews of Interventions. Results: All studies found Er:YAG laser activation significantly improved root canal disinfection over conventional or ultrasonic methods. Photon-induced photoacoustic streaming (PIPS) and shock wave-enhanced emission photoacoustic streaming (SWEEPS) yielded superior bacterial reduction, especially apically, and enabled lower sodium hypochlorite concentrations without sacrificing efficacy. Some research indicated reduced post-operative discomfort. However, protocols, laser parameters, and outcome measures varied, limiting direct comparisons and emphasizing the need for more standardized, long-term clinical trials. Conclusions: Er:YAG laser-assisted irrigation appears highly effective in biofilm disruption and smear layer removal, supporting deeper irrigant penetration. While findings are promising, further standardized research is needed to solidify guidelines and confirm Er:YAG lasers' long-term clinical benefits.
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Affiliation(s)
- Jakub Fiegler-Rudol
- Department of Periodontal and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.T.); (R.W.)
| | | | - Marcin Tkaczyk
- Department of Periodontal and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.T.); (R.W.)
| | - Kinga Grzech-Leśniak
- Dental Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Anna Zawilska
- Department of Conservative Dentistry and Endodontics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Rafał Wiench
- Department of Periodontal and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.T.); (R.W.)
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2
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Gufran K, Alqahtani AS, Alasqah M, Alsakr A, Alkharaan H, Ghurmallah Alzahrani H, Almutairi A. Effect of Er: YAG laser therapy in non-surgical periodontal treatment: an umbrella review. BMC Oral Health 2024; 24:1347. [PMID: 39548487 PMCID: PMC11566196 DOI: 10.1186/s12903-024-05120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 10/28/2024] [Indexed: 11/18/2024] Open
Abstract
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.
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Affiliation(s)
- Khalid Gufran
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, 11942, Saudi Arabia.
| | - Abdullah Saad Alqahtani
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, 11942, Saudi Arabia
| | - Mohammed Alasqah
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, 11942, Saudi Arabia
| | - Abdulaziz Alsakr
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, 11942, Saudi Arabia
| | - Hassan Alkharaan
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, 11942, Saudi Arabia
| | - Hanadi Ghurmallah Alzahrani
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, 11942, Saudi Arabia
| | - Abdullah Almutairi
- Department of Periodontology and Implant Dentistry, College of Dentistry, Qassim University, Buraydah, Saudi Arabia
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3
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Harris DM, Sulewski JG. Photoinactivation and Photoablation of Porphyromonas gingivalis. Pathogens 2023; 12:1160. [PMID: 37764967 PMCID: PMC10535405 DOI: 10.3390/pathogens12091160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
Several types of phototherapy target human pathogens and Porphyromonas gingivitis (Pg) in particular. The various approaches can be organized into five different treatment modes sorted by different power densities, interaction times, effective wavelengths and mechanisms of action. Mode 1: antimicrobial ultraviolet (aUV); mode 2: antimicrobial blue light (aBL); mode 3: antimicrobial selective photothermolysis (aSP); mode 4: antimicrobial vaporization; mode 5: antimicrobial photodynamic therapy (aPDT). This report reviews the literature to identify for each mode (a) the putative molecular mechanism of action; (b) the effective wavelength range and penetration depth; (c) selectivity; (d) in vitro outcomes; and (e) clinical trial/study outcomes as these elements apply to Porphyromonas gingivalis (Pg). The characteristics of each mode influence how each is translated into the clinic.
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Affiliation(s)
- David M. Harris
- Bio-Medical Consultants, Inc., Canandaigua, NY 14424, USA
- Department of Periodontics, Rutgers School of Dental Medicine, Newark, NJ 07103, USA
| | - John G. Sulewski
- Institute for Advanced Dental Technologies, Huntington Woods, MI 48070, USA
- Millennium Dental Technologies, Inc., Cerritos, CA 90703, USA
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4
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AlZoubi IA. An Overview of the Systematic Evidence on the Adjunctive Use of Laser Therapy in Non-surgical Periodontal Treatment. Cureus 2023; 15:e44268. [PMID: 37772214 PMCID: PMC10529468 DOI: 10.7759/cureus.44268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
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.
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Affiliation(s)
- Ibrahim A AlZoubi
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Al Jouf, SAU
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5
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FAGGION CLOVISMARIANO. COMBINATION OF Nd:YAG AND Er:YAG LASERS MIGHT IMPROVE PERIODONTAL PROBING DEPTHS AND CLINICAL ATTACHMENT LEVELS, BUT THE LEVEL OF EVIDENCE IS VERY WEAK. J Evid Based Dent Pract 2022; 22:101753. [DOI: 10.1016/j.jebdp.2022.101753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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6
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Sayar F, Hashemi S, Chiniforush N, Seyed Jafari E, Jandaghi A. Effects of diode and erbium lasers as an adjunct to scaling and root planing on clinical and immunological parameters in non-surgical periodontal treatment: a split-mouth randomized controlled clinical trial-"effects of lasers on immunological parameters". Lasers Med Sci 2022; 37:3021-3030. [PMID: 35718807 DOI: 10.1007/s10103-022-03596-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
This study evaluated the effects of diode and erbium lasers, as an adjunct to scaling and root planing (SRP), on clinical and immunological parameters in non-surgical periodontal therapy. In this split-mouth randomized controlled clinical trial, 17 participants with at least one periodontally involved tooth in each quadrant received oral hygiene instruction and full-mouth SRP. At baseline, probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and full-mouth plaque index (FMPI) were measured, and gingival crevicular fluid (GCF) sampling was performed. Next, one random quadrant in each participant received 940 nm diode laser (1 W, continuous-wave), and another quadrant received 2780 nm Er,Cr:YSGG laser (1.5 W, 30 Hz) irradiation. The GCF levels of interleukin (IL)-10 and matrix metalloproteinase (MMP)-13 were measured at baseline, and after 2 and 6 months using ELISA. The clinical parameters were also measured. Data were analyzed by repeated measures ANOVA. Significant clinical improvement was noted in all groups (P < 0.05). CAL in the control group was higher at 6 months than 2 months. The increase in IL-10 in erbium group was significantly greater than that in other groups (P < 0.001). The MMP-13 level was significantly lower in laser groups with greater reduction in erbium group (P < 0.001). Application of 940 nm diode and 2780 nm Er,Cr:YSGG lasers as an adjunct to SRP significantly decreased the GCF level of MMP-13, with no significant clinical advantage over SRP monotherapy. Application of 2780 nm Er,Cr:YSGG laser in addition to SRP increased the GCF level of IL-10.Trial registration numbers: IRCT20140318017053N11 and IRCT20140318017053N9.
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Affiliation(s)
- Ferena Sayar
- Department of Periodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | | | - Nasim Chiniforush
- Laser Research Center of Dentistry, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Ehsan Seyed Jafari
- Department of Biotechnology, College of Sciences, University of Tehran, Tehran, Iran
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7
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Sethasathien P, Tantivitayakul P, Teparat-Burana T. The effect of Er,Cr:YSGG laser on periodontopathic bacteria elimination: an in vitro study. Lasers Med Sci 2022; 37:2763-2771. [PMID: 35652988 DOI: 10.1007/s10103-022-03573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
In vitro bacterial elimination using the erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser against periodontopathic bacteria was investigated. Bacterial suspensions of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were spread on agar plates and the Er,Cr:YSGG laser was applied at 40 mJ pulse energy for durations of 30 s, 60 s, and 90 s. The agar plates were incubated, and growth inhibition zones were assessed. Optimal laser irradiation durations to achieve maximal bacterial elimination were evaluated using laser ablation on the bacterial colonies. The remaining viable bacteria were determined by the colony-forming unit (CFU) counting method. Growth inhibition zones were observed at all irradiation durations for both A. actinomycetemcomitans and P. gingivalis. Mean logarithmic values of CFU/ml after bacterial colony irradiation for 0 s (control), 12 s × 1 lap, 24 s × 1 lap, 48 s × 1 lap, and 24 s × 2 laps were 8.82 ± 0.35, 7.31 ± 0.94, 6.32 ± 0.61, 3.17 ± 2.90, and 0.00, respectively, for A. actinomycetemcomitans and 9.83 ± 0.50, 9.42 ± 0.11, 6.90 ± 1.60, 2.33 ± 3.19, and 0.00 for P. gingivalis. Significant differences were found between the control group and the two irradiated groups 48 s × 1 lap and 24 s × 2 laps (p < 0.05), and also between irradiated groups 12 s × 1 lap and 24 s × 2 laps (p < 0.05). An Er,Cr:YSGG laser with power setting 1.5 W and 30 Hz frequency showed potential for bacterial elimination against A. actinomycetemcomitans and P. gingivalis in vitro. Significant bacterial elimination (> 99.99%) was observed after 48 s of irradiation.
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Affiliation(s)
| | - Pornpen Tantivitayakul
- Department of Oral Microbiology, Faculty of Dentistry, Mahidol University, Yothi, Bangkok, 10400, Thailand
| | - Thitiwan Teparat-Burana
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Yothi, Bangkok, 10400, Thailand.
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8
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Lavu V, Kumar D, Krishnakumar D, Maheshkumar A, Agarwal A, Kirubakaran R, Muthu MS. Erbium lasers in non-surgical periodontal therapy: an umbrella review and evidence gap map analysis. Lasers Med Sci 2022; 37:103-120. [PMID: 35029727 DOI: 10.1007/s10103-022-03504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Vamsi Lavu
- Department of Periodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Divya Kumar
- Department of Periodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Dhanadivya Krishnakumar
- Department of Periodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | | - Amit Agarwal
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Richard Kirubakaran
- Prof. B.V Moses Center for Evidence Informed Health Care and Health Policy, Tamil Nadu, India
| | - M S Muthu
- Department of Pediatric and Preventive Dentistry, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
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9
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Lin T, Yu CC, Liu CM, Hsieh PL, Liao YW, Yu CH, Chen CJ. Er:YAG laser promotes proliferation and wound healing capacity of human periodontal ligament fibroblasts through Galectin-7 induction. J Formos Med Assoc 2021; 120:388-394. [DOI: 10.1016/j.jfma.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022] Open
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10
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Jia L, Jia J, Xie M, Zhang X, Li T, Shi L, Shi H, Zhang X. Clinical attachment level gain of lasers in scaling and root planing of chronic periodontitis: a network meta-analysis of randomized controlled clinical trials. Lasers Med Sci 2020; 35:473-485. [PMID: 31691054 DOI: 10.1007/s10103-019-02875-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
The objective of this study was to evaluate the clinical attachment level (CAL) gain of Er:YAG, Er,Cr; YSGG, Nd:YAG; and diode laser (DL) as monotherapy or adjunctive to scaling and root planing (SRP) of chronic periodontitis by network meta-analysis (NMA). Randomized controlled clinical trials (RCTs) about lasers applied in SRP of chronic periodontitis were searched from PubMed, Cochrane Library, Web of Science, Ovid, Science Direct, Wan Fang, and China National Knowledge Infrastructure (CNKI) databases up to September 2018 and from references of selected full-texts and related reviews. Standard mean differences and 95% confidence intervals were counted for CAL gain. The random effects NMA were performed in STATA software. There were 25 RCTs about CAL gain at 3 and/or 6 months after lasers were applied in SRP. No inconsistency was detected. Er:YAG as monotherapy gained significantly more CAL at 3 months than did SRP; no significant differences were detected among other comparisons. In terms of CAL gain at 3 months, the ranking result from best to worst was as follows: Er:YAG as monotherapy, DL adjunctive to SRP, Er:YAG adjunctive to SRP, Er,Cr;YSGG as monotherapy, Nd:YAG adjunctive to SRP, and SRP. In terms of CAL gain at 6 months, the ranking result from best to worst was as follows: DL adjunctive to SRP, Nd:YAG adjunctive to SRP, SRP, Er:YAG adjunctive to SRP, and Er:YAG as monotherapy. Laser-assisted periodontal treatment could be superior to SRP alone and could serve as a good adjunctive treatment tool.
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Affiliation(s)
- Liying Jia
- Department of Pediatric Dentistry, School and Hospital of Stomatology & Hebei Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Jinhai Jia
- Outpatient Clinic, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Meng Xie
- Department of Pediatric Dentistry, School and Hospital of Stomatology & Hebei Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Xiaoxiao Zhang
- Department of Dentistry, Children's Hospital of Hebei Province, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Ting Li
- Department of Pathology, School and Hospital of Stomatology & Hebei Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Linan Shi
- Department of Pediatric Dentistry, School and Hospital of Stomatology & Hebei Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Hong Shi
- Department of Pediatric Dentistry, School and Hospital of Stomatology & Hebei Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China.
| | - Xiaolin Zhang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, Hebei, 050017, People's Republic of China.
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11
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Xu J, Bandyopadhyay D, Salehabadi SM, Michalowicz B, Chakraborty B. SMARTp: A SMART design for nonsurgical treatments of chronic periodontitis with spatially referenced and nonrandomly missing skewed outcomes. Biom J 2019; 62:282-310. [PMID: 31531896 DOI: 10.1002/bimj.201900027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 11/06/2022]
Abstract
This paper proposes dynamic treatment regimes (DTRs) as effective individualized treatment strategies for managing chronic periodontitis. The proposed DTRs are studied via SMARTp-a two-stage sequential multiple assignment randomized trial (SMART) design. For this design, we propose a statistical analysis plan and a novel cluster-level sample size calculation method that factors in typical features of periodontal responses such as non-Gaussianity, spatial clustering, and nonrandom missingness. Here, each patient is viewed as a cluster, and a tooth within a patient's mouth is viewed as an individual unit inside the cluster, with the tooth-level covariance structure described by a conditionally autoregressive structure. To accommodate possible skewness and tail behavior, the tooth-level clinical attachment level (CAL) response is assumed to be skew-t, with the nonrandomly missing structure captured via a shared parameter model corresponding to the missingness indicator. The proposed method considers mean comparison for the regimes with or without sharing an initial treatment, where the expected values and corresponding variances or covariance for the sample means of a pair of DTRs are derived by the inverse probability weighting and method of moments. Simulation studies are conducted to investigate the finite-sample performance of the proposed sample size formulas under a variety of outcome-generating scenarios. An R package SMARTp implementing our sample size formula is available at the Comprehensive R Archive Network for free download.
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Affiliation(s)
- Jing Xu
- Centre for Quantitative Medicine and Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Cancer Data Science, Children's Medical Research Institute, The University of Sydney, Westmead, NSW, Australia
| | | | | | - Bryan Michalowicz
- Como Dental Specialty Center, HealthPartners Institute, Bloomington, MN, USA
| | - Bibhas Chakraborty
- Centre for Quantitative Medicine and Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Department of Statistics and Applied Probability, National University of Singapore, Singapore.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
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12
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Klepper KL, Chun YP, Cochran D, Chen S, McGuff HS, Mealey BL. Impact of Er:YAG laser on wound healing following nonsurgical therapy: A pilot study. Clin Exp Dent Res 2019; 5:250-258. [PMID: 31249706 PMCID: PMC6585580 DOI: 10.1002/cre2.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/18/2019] [Indexed: 12/02/2022] Open
Abstract
The purpose is to examine early wound healing through histological analysis by characterizing connective tissue distribution and organization in the treated periodontium following nonsurgical therapy. Periodontal disease is a multifactorial pathological process that leads to the loss of the surrounding periodontium. Traditional periodontal therapies have proven beneficial in halting the progression of disease. The aim of this study is to investigate early wound healing in periodontal patients following hand/ultrasonic instrumentation alone, erbium-doped yttrium aluminum garnet laser instrumentation alone, or a combination of hand/ultrasonic instrumentation and Er:YAG laser instrumentation for the nonsurgical treatment of periodontitis by histologic evaluation. Twenty-one patients were randomized to receive nonsurgical therapy for the treatment of chronic periodontitis with three modalities prior to surgical therapy. Baseline clinical measurements were obtained prior to treatment. Wound healing was assessed by obtaining an otherwise discarded tissue sample following nonsurgical therapy of the selected study site. Samples were obtained at 2 or 6 weeks following initial therapy with a step-back incision and fixated for histological and immunohistochemical analysis. There were minimal between-group differences in the amount of collagen distribution when analyzing the Mallory-Heidenhain Azan trichrome, Picrosirus Red stain, and proliferating cell nuclear antigen at both time points. Descriptive analysis of baseline measurements showed no differences in probing depth change, bleeding on probing, and clinical attachment level following initial therapy between the three treatment groups at 2 or 6 weeks. Each treatment modality was effective in treating moderate to severe chronic periodontitis; however, the results of this study are inconclusive regarding superiority of any one treatment approach from a histologic and immunohistochemical perspective. Based on this assessment, there was increased fibroblast proliferation and collagen maturation between the 2- and 6-week time point after treatment in all treatment groups, with few apparent differences between treatment groups. This pilot study qualitatively evaluated early wound healing in periodontal patients following non surgical therapy with various treatment modalities. When comparing descriptive outcomes of Er:YAG laser therapy and hand/ultrasonic instrumentation there were minimal differences in collagen distribution and density between groups. The evaluated modalities were each effective treating periodontal patients with non surgical therapy.
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Affiliation(s)
- Kandice L. Klepper
- Department of PeriodonticsUT Health San AntonioSan AntonioTexasUSA
- Department of Cell Systems and AnatomyUT Health San AntonioSan AntonioTexasUSA
| | - Yong‐Hee Patricia Chun
- Department of PeriodonticsUT Health San AntonioSan AntonioTexasUSA
- Department of Cell Systems and AnatomyUT Health San AntonioSan AntonioTexasUSA
| | - David Cochran
- Department of PeriodonticsUT Health San AntonioSan AntonioTexasUSA
- Department of Cell Systems and AnatomyUT Health San AntonioSan AntonioTexasUSA
| | - Shuo Chen
- Department of Developmental DentistryUT Health San AntonioSan AntonioTexasUSA
| | - Howard S. McGuff
- Department of Biomedical SciencesUT Health San AntonioSan AntonioTexasUSA
| | - Brian L. Mealey
- Department of PeriodonticsUT Health San AntonioSan AntonioTexasUSA
- Department of Cell Systems and AnatomyUT Health San AntonioSan AntonioTexasUSA
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13
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Zhou X, Lin M, Zhang D, Song Y, Wang Z. Efficacy of Er:
YAG
laser on periodontitis as an adjunctive non‐surgical treatment: A split‐mouth randomized controlled study. J Clin Periodontol 2019; 46:539-547. [PMID: 31069833 DOI: 10.1111/jcpe.13107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/03/2019] [Accepted: 03/26/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Xuan Zhou
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
| | - Mei Lin
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
| | - Dongxue Zhang
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
| | - Yiqing Song
- Department of Epidemiology Richard M. Fairbanks School of Public Health Indiana University Indianapolis Indiana USA
| | - Zuomin Wang
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
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Clinical and Microbiological Effects of the Use of Erbium: Yttrium–Aluminum–Garnet Laser on Chronic Periodontitis in Addition to Nonsurgical Periodontal Treatment: A Randomized Clinical Trial—6 Months Follow-Up. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:182-190. [DOI: 10.1089/photob.2018.4510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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15
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Laser reduction of specific microorganisms in the periodontal pocket using Er:YAG and Nd:YAG lasers: a randomized controlled clinical study. Lasers Med Sci 2018; 33:1461-1470. [PMID: 29766330 DOI: 10.1007/s10103-018-2491-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/21/2018] [Indexed: 12/13/2022]
Abstract
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.
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Scanning Electron Microscopy Evaluation of Root Surfaces After Instrumentation With Two Piezoelectric Devices. J Craniofac Surg 2018; 29:988-991. [PMID: 29485561 DOI: 10.1097/scs.0000000000004364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Scanning electron microscopy evaluation of root surfaces after ultrasonic instrumentation was performed with 2 different metallic tips on piezoelectric devices. Fresh extracted teeth were collected for experimental observation and randomly divided into 2 groups: Test Group, where the root surfaces were treated using an iron, rough, double nano-structural coated (T-Black), corindone-treated tip, and Control Group where the root surfaces were treated with a conventional iron smooth tip. A scanning electronic microscope analysis was performed and the surface roughness and the amount of residual debris were evaluated. Descriptive and inferential statistics were performed. Twenty specimens were analyzed, 10 per group and a total of 21.4 × 10 μm has been observed. On treated area percentage of debris after ultrasonic scaling in Test Group was 1.9 ± 1.8%, while in Control Group it was 5.7 ± 4.3%. Within the limits of the study, it seems that the efficacy of the novel iron, rough, double nano-structural coated (T-Black), corindone-treated structure tip showed greater performance in terms of root surface debridement than the conventional iron smooth tip. The possibility to use a single tool (ultrasonic device with a specific tip) for the root planing procedure within the nonsurgical mechanical therapy may represent a significant advantage for the clinicians. The tested novel tip seems to be able to show the requested ideal characteristics. However, further clinical studies are needed to demonstrate the in vitro results.
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Wang Y, Li W, Shi L, Zhang F, Zheng S. 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. Medicine (Baltimore) 2017; 96:e9367. [PMID: 29390529 PMCID: PMC5758231 DOI: 10.1097/md.0000000000009367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
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.
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Affiliation(s)
- Yue Wang
- Department of Periodontology
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University
| | - Weiwei Li
- Department of Periodontology
- Department of Stomatology, Beijing Chongwen Hospital of Stomatology, Beijing, China
| | - Li Shi
- Department of Periodontology
| | | | - Sun Zheng
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University
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Seo SH, Han I, Lee HS, Choi JJ, Choi EH, Kim KN, Park G, Kim KM. Antibacterial activity and effect on gingival cells of microwave-pulsed non-thermal atmospheric pressure plasma in artificial saliva. Sci Rep 2017; 7:8395. [PMID: 28827766 PMCID: PMC5567204 DOI: 10.1038/s41598-017-08725-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/17/2017] [Indexed: 11/09/2022] Open
Abstract
Although various oral pathogens are inactivated by non-thermal atmospheric pressure plasma (NTAPP), the in vivo effects of NTAPP are poorly understood. The first aim of this study was to examine the antibacterial activity of microwave-pulsed NTAPP against Staphylococcus aureus in artificial saliva to mimic oral environmental conditions. The second aim was to determine the influence of microwave-pulsed NTAPP on human gingival fibroblasts (HGFs). The microwave-pulsed NTAPP reduced bacterial viability (as measured by colony forming units [CFU]) to a greater extent in artificial saliva than in saline. Extending the post-treatment incubation time increased bacterial inactivation in artificial saliva compared to saline. HGFs viability was unaffected by microwave-pulsed NTAPP for bacterial inactivation. Rather, HGFs proliferation increased after a 5-min microwave-pulsed NTAPP. Less tumor necrosis factor alpha was released by microwave-pulsed NTAPP-treated HGFs stimulated with lipopolysaccharide (LPS) than by untreated, LPS-stimulated HGFs; thus, plasma appeared to suppress the inflammatory response. Our study suggests that microwave-pulsed NTAPP may have stronger in vivo antibacterial activity than in vitro activity, and that microwave-pulsed NTAPP may have the additional advantage of suppressing gingival inflammatory responses.
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Affiliation(s)
- Sang-Hee Seo
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry, Seoul, 03722, Korea.,BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, 03722, Korea
| | - Ihn Han
- Plasma Bioscience Research Center, Kwangwoon University, Seoul, 01897, Korea
| | - Han Seol Lee
- Plasma Bioscience Research Center, Kwangwoon University, Seoul, 01897, Korea
| | - Jin Joo Choi
- Plasma Bioscience Research Center, Kwangwoon University, Seoul, 01897, Korea
| | - Eun Ha Choi
- Plasma Bioscience Research Center, Kwangwoon University, Seoul, 01897, Korea
| | - Kyoung-Nam Kim
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry, Seoul, 03722, Korea.,BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, 03722, Korea
| | - Gyungsoon Park
- Plasma Bioscience Research Center, Kwangwoon University, Seoul, 01897, Korea.
| | - Kwang-Mahn Kim
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry, Seoul, 03722, Korea. .,BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, 03722, Korea.
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19
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Cobb CM. Lasers and the treatment of periodontitis: the essence and the noise. Periodontol 2000 2017; 75:205-295. [DOI: 10.1111/prd.12137] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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20
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Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki AA, Romanos GE, Taniguchi Y, Sasaki KM, Zeredo JL, Koshy G, Coluzzi DJ, White JM, Abiko Y, Ishikawa I, Izumi Y. Periodontal and peri-implant wound healing following laser therapy. Periodontol 2000 2017; 68:217-69. [PMID: 25867988 DOI: 10.1111/prd.12080] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 12/18/2022]
Abstract
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.
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Birang R, Yaghini J, Nasri N, Noordeh N, Iranmanesh P, Saeidi A, Naghsh N. Comparison of Er:YAG Laser and Ultrasonic Scaler in the Treatment of Moderate Chronic Periodontitis: A Randomized Clinical Trial. J Lasers Med Sci 2017; 8:51-55. [PMID: 28912945 DOI: 10.15171/jlms.2017.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Periodontitis is an inflammatory periodontal disease that leads to tooth loss. Recently laser has been introduced as an alternative treatment for periodontitis. The aim of the present study was to compare the effect of Erbium-doped Yttrium Aluminum Garnet (Er:YAG) laser with ultrasonic scaler in patients with moderate chronic periodontitis. Methods: In this randomized single-blind clinical trial, 27 patients with moderate chronic periodontitis were selected. One quadrant of the patients was treated by Er:YAG laser and the other one by ultrasonic scaler. Clinical parameters, including periodontal pocket depth (PPD), papillary bleeding index (PBI) and clinical attachment level (CAL) were measured before, as well as 6 and 12 weeks after treatment. Data were analyzed by SPSS 20 software using Friedman test, paired t test, independent t test and Mann-Whitney test. The significance level was set at 0.05. Results: The means of clinical parameters in both groups were significantly improved in the first and second follow-ups (P < 0.001). Although the means of PPD, PBI and CAL were slightly higher in the laser group than in the ultrasonic group, the differences were not statistically significant between these two groups (P > 0.05). Conclusion: Although both ultrasonic scaler and Er:YAG laser could effectively improve clinical periodontal parameters, the results did not reveal the superiority of Er:YAG laser over ultrasonic scaler or vice versa.
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Affiliation(s)
- Reza Birang
- Department of Periodontology, Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jaber Yaghini
- Department of Periodontology, Dental Implants Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Naeimeh Nasri
- Departments of Oral and Maxillofacial Radiology, School of Dentistry, Isfahan University of Medical Science, Isfahan, Iran
| | - Nasim Noordeh
- Dental Student's Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pedram Iranmanesh
- Department of Endodontics, School of Dentistry, Isfahan University of Medical Science, Isfahan, Iran
| | - Alireza Saeidi
- Dental Student's Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Naghsh
- Department of Periodontology, Dental Implants Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Kundalić J, University of Niš, Faculty of Medicine, PhD student, Niš, Serbia, Pavlović D, Jevtović-Stoimenov T, Cvetković T, Obradović R, Kesić L, Pejčić A, Kundalić B, Stošić N. OXIDATIVE STRESS IN THE PATHOGENESIS OF PERIODONTAL DISEASE. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Al-Falaki R, Hughes F, Wadia R, Eastman C, Kontogiorgos E, Low S. The Effect of an Er,Cr:YSGG Laser in the Management of Intrabony Defects Associated with Chronic Periodontitis Using Minimally Invasive Closed Flap Surgery. A Case Series. Laser Ther 2016; 25:131-139. [PMID: 27721565 DOI: 10.5978/islsm.16-or-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aims: This is an extended case series of patients treated with an Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser as an adjunct to scaling for the management of intrabony defects. Materials & methods: 46 patients with 79 angular intrabony defects associated with pocket depths of >5mm, and a mean age of 53 ± 9 years presenting with chronic periodontitis were included in the analysis. All patients underwent a localized minimally invasive closed flap surgery utilizing Er,Cr:YSGG laser therapy. Final radiographs and pocket depths were compared to pretreatment measurements with a time period of 8 ± 3 months. Results: Treatment resulted in significant overall pocket depth reduction. The mean pre-op probing depth was 8.1 ± 1.9mm, reducing to 2.4 ± 0.9mm post-treatment. Bony infill of the defects was visible radiographically and there was an increase in overall radiographic coronal osseous height compared to a pre-treatment baseline. Radiographs of 15 of the defects were available for further measurements after >12 months, and showed in these sites there was a significant reduction in intrabony defect depth, but no change in suprabony bone height. 9 of the 15 sites showed 50% or more, bony infill of the intrabony defect. Conclusions: The results demonstrate that the utilization of an Er,Cr:YSGG laser in a closed flap approach with chronic periodontitis may be of significant clinical benefit. Further studies using this laser surgical protocol are required to test these observations in well-designed randomized controlled trials.
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Affiliation(s)
| | - Francis Hughes
- Dept of Periodontology, Kings College London Dental Institute, University of London
| | - Reena Wadia
- Dept of Periodontology, Kings College London Dental Institute, University of London
| | - Christie Eastman
- Department of Periodontology, University of Florida, College of Dentistry
| | - Elias Kontogiorgos
- Department of Restorative Sciences, Baylor College of Dentistry, Texas A&M University
| | - Samuel Low
- Department of Periodontology, University of Florida, College of Dentistry
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24
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Al-Falaki R, Cronshaw M, Parker S. The Adjunctive Use of the Erbium, Chromium: Yttrium Scandium Gallium Garnet Laser in Closed Flap Periodontal Therapy. A Retrospective Cohort Study. Open Dent J 2016; 10:298-307. [PMID: 27350796 PMCID: PMC4906144 DOI: 10.2174/1874210601610010298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 01/28/2023] Open
Abstract
Objectives: The current periodontal literature has been inconsistent in finding an added advantage to using lasers in periodontal therapy. The aim of this study was to compare treatment outcomes following root surface instrumentation alone (NL group), or with adjunctive use of Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser (L group). Material and Methods: Patients diagnosed with generalized chronic periodontitis, having a minimum of 1 year follow up were selected by a blinded party for inclusion in a retrospective analysis from patients treated prior to and after integration of laser in a single clinic setting. Probing depths (PD) of all sites ≥5 mm and full mouth bleeding scores were analyzed. Further analysis was carried out on the treatment outcomes of only the molar teeth and of pockets >6mm. Results: 53 patients were included (25 NL,28 L). There was no significant difference between baseline PDs (NL=6.19mm, L=6.27mm, range 5-11mm). The mean PD after one year was 2.83mm (NL) 2.45mm (L), with the mean PD reductions being 3.35mm (NL) and 3.82mm (L) (p<0.002). The mean PD reduction for the molars were 3.32mm (NL) and 3.86mm (L) (p< 0.007), and for ≥7mm group were 4.75mm (NL) compared to 5.14mm (L) (p< 0.009). There was significantly less bleeding on probing in the laser group after one year (p<0.001) Conclusion: Both treatment modalities were effective in treating chronic periodontitis, but the added use of laser may have advantages, particularly in molar tooth sites and deeper pockets. Further research with RCTs is needed to test this hypothesis further.
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Affiliation(s)
- Rana Al-Falaki
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
| | - Mark Cronshaw
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
| | - Steven Parker
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
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25
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Cobb CM. Commentary: Is There Clinical Benefit From Using a Diode or Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Periodontitis? J Periodontol 2016; 87:1117-31. [PMID: 27181116 DOI: 10.1902/jop.2016.160134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Despite a quarter of a century of laser research, there is a persistent debate regarding the efficacy of dental lasers in the treatment of periodontitis or periodontal maintenance therapy. There are many claims and much hyperbole surrounding the use of lasers, either as a monotherapy or adjunctive to scaling and root planing, to treat periodontitis. There is little evidence that using a diode or neodymium:yttrium-aluminum-garnet laser adds clinical value over and above conventional non-surgical or surgical periodontal treatment. There is a significant need for better designed human clinical trials. Data from such trials should be analyzed according to initial probing depth and characteristics of the treated sites, such as non-molar, molar flat surfaces, and molar furcations, and evaluated for long-term post-treatment results.
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Affiliation(s)
- Charles M Cobb
- Department of Periodontics, University of Missouri-Kansas City, Kansas City, MO
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26
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Martin-Cabezas R, Davideau JL, Tenenbaum H, Huck O. Clinical efficacy of probiotics as an adjunctive therapy to non-surgical periodontal treatment of chronic periodontitis: a systematic review and meta-analysis. J Clin Periodontol 2016; 43:520-30. [PMID: 26970230 DOI: 10.1111/jcpe.12545] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 12/18/2022]
Abstract
FOCUSED QUESTION What is the clinical influence of probiotics as an adjunctive therapy of scaling and root planing (SRP) when compared with SRP alone or in combination with placebo in the treatment of chronic periodontitis (CP). METHODS Electronic databases were searched up to July 2015. Randomized controlled trials (RCTs) comparing SRP + probiotic versusSRP were included. PPD reduction and CAL gain were selected as primary outcome variables. RESULTS Independent screening resulted in four eligible publications for the systematic review and three were included in the meta-analysis. Meta-analysis showed a statistically significant CAL gain (-0.42 mm, p = 0.002) and bleeding on probing (BOP) reduction (-14.66, p = 0.003) for SRP + probiotic treatment versusSRP at short-term. Only a tendency (p = 0.06) has been observed in terms of overall PPD reduction, whereas results were significant when stratified for moderate (-0.18, p = 0.001) and deep pockets (-0.67, p < 0.001). CONCLUSION Within the limitations of this study, the findings of this meta-analysis seem to support the adjunctive use of L. reuteri to SRP in CP treatment at short-term, especially in deep pockets. Heterogeneity and limited available data may reduce the impact of these conclusions. Future long-term RCTs evaluating the clinical efficacy of adjunctive probiotics to SRP are needed.
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Affiliation(s)
- Rodrigo Martin-Cabezas
- Department of Periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France
| | - Jean-Luc Davideau
- Department of Periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France.,INSERM 1109 "Osteoarticular & Dental Regenerative Nanomedicine", Strasbourg, France
| | - Henri Tenenbaum
- Department of Periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France.,INSERM 1109 "Osteoarticular & Dental Regenerative Nanomedicine", Strasbourg, France
| | - Olivier Huck
- Department of Periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France.,INSERM 1109 "Osteoarticular & Dental Regenerative Nanomedicine", Strasbourg, France
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Freire MO, Devaraj A, Young A, Navarro JB, Downey JS, Chen C, Bakaletz LO, Zadeh HH, Goodman SD. A bacterial-biofilm-induced oral osteolytic infection can be successfully treated by immuno-targeting an extracellular nucleoid-associated protein. Mol Oral Microbiol 2016; 32:74-88. [PMID: 26931773 DOI: 10.1111/omi.12155] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 02/06/2023]
Abstract
Periodontal disease exemplifies a chronic and recurrent infection with a necessary biofilm component. Mucosal inflammation is a hallmark response of the host seen in chronic diseases, such as colitis, gingivitis, and periodontitis (and the related disorder peri-implantitis). We have taken advantage of our recently developed rat model of human peri-implantitis that recapitulates osteolysis, the requirement of biofilm formation, and the perpetuation of the bona fide disease state, to test a new therapeutic modality with two novel components. First we used hyperimmune antiserum directed against the DNABII family of proteins, now known to be a critical component of the extracellular matrix of bacterial biofilms. Second we delivered the antiserum as cargo in biodegradable microspheres to the site of the biofilm infection. We demonstrated that delivery of a single dose of anti-DNABII in poly(lactic-co-glycolic acid) (PLGA) microspheres induced significant resolution of experimental peri-implantitis, including marked reduction of inflammation. These data support the continued development of a DNABII protein-targeted therapeutic for peri-implantitis and other chronic inflammatory pathologies of the oral cavity in animals and humans.
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Affiliation(s)
- M O Freire
- Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, MA, USA.,Department of Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - A Devaraj
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
| | - A Young
- Division of Periodontology, Diagnostic Sciences & Dental Hygiene Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - J B Navarro
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
| | - J S Downey
- Division of Periodontology, Diagnostic Sciences & Dental Hygiene Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - C Chen
- Division of Periodontology, Diagnostic Sciences & Dental Hygiene Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - L O Bakaletz
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
| | - H H Zadeh
- Division of Periodontology, Diagnostic Sciences & Dental Hygiene Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.,Laboratory for Immunoregulation and Tissue Engineering (LITE), University of Southern California, Los Angeles, CA, USA
| | - S D Goodman
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
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Mizutani K, Aoki A, Coluzzi D, Yukna R, Wang CY, Pavlic V, Izumi Y. Lasers in minimally invasive periodontal and peri-implant therapy. Periodontol 2000 2016; 71:185-212. [DOI: 10.1111/prd.12123] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 12/28/2022]
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29
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Behdin S, Monje A, Lin GH, Edwards B, Othman A, Wang HL. Effectiveness of Laser Application for Periodontal Surgical Therapy: Systematic Review and Meta-Analysis. J Periodontol 2015; 86:1352-63. [DOI: 10.1902/jop.2015.150212] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Bouhout Y, Gonçalves RB. Laser assisted periodontics: A review of the literature. World J Stomatol 2015; 4:129-136. [DOI: 10.5321/wjs.v4.i4.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 06/29/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
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.
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Sanz-Sánchez I, Ortiz-Vigón A, Herrera D, Sanz M. Microbiological effects and recolonization patterns after adjunctive subgingival debridement with Er:YAG laser. Clin Oral Investig 2015; 20:1253-61. [PMID: 26419675 DOI: 10.1007/s00784-015-1617-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study was to assess the microbiological effects and recolonization patterns after non-surgical periodontal treatment protocol based on the adjunctive use of erbium-doped yttrium aluminium garnet (Er:YAG) laser. MATERIAL AND METHODS Patients diagnosed with chronic periodontitis were randomly assigned to two different treatment protocols: test, full-mouth subgingival ultrasonic instrumentation followed by Er-YAG laser application 1 week later to sites with initial probing pocket depth ≥4.5 mm; and control, full-mouth ultrasonic subgingival instrumentation within 1 week. Clinical (at sampled sites) and microbiological (culture-based) parameters were recorded at baseline and 3 and 12 months. Microbiological variables included total counts, frequency of detection, proportions and counts of target species. RESULTS Results from 19 test and 21 control patients were compared. Minor changes were observed for total colony-forming units, with no differences between groups. For the frequency of detection, a limited and similar impact in both groups was observed for the most prevalent (over 80 %) periodontal pathogens (Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum). For proportions, reductions in P. gingivalis occurred at 3 months, both in the test and control groups (from 16.3 to 10 % and 16 to 14.8 %, respectively), although these differences were not statistically significant. At 12 months, the test group showed a statistically significant greater reduction in probing depth for the sampled sites. CONCLUSIONS The adjunctive use of Er:YAG laser when compared with conventional ultrasonic debridement did not provide a microbiological added benefit. CLINICAL RELEVANCE Even though some clinical benefits with the adjunctive laser application were identified when comparing both treatment protocols, there were no differences in microbiological outcomes or in the bacterial recolonization patterns.
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Affiliation(s)
- Ignacio Sanz-Sánchez
- Postgraduate Clinic in Periodontology, Faculty of Odontology, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N., 28040, Madrid, Spain.
| | - Alberto Ortiz-Vigón
- Postgraduate Clinic in Periodontology, Faculty of Odontology, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N., 28040, Madrid, Spain
| | - David Herrera
- Postgraduate Clinic in Periodontology, Faculty of Odontology, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N., 28040, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Postgraduate Clinic in Periodontology, Faculty of Odontology, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N., 28040, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
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Alzoman HA, Diab HM. Effect of gallium aluminium arsenide diode laser therapy on Porphyromonas gingivalis in chronic periodontitis: a randomized controlled trial. Int J Dent Hyg 2015; 14:261-266. [PMID: 26250477 DOI: 10.1111/idh.12169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this randomized, controlled trial was to evaluate the effects of 685-nm gallium aluminium arsenide (GaAlAs) diode laser therapy (1.6 J cm-2 ) as an adjunct to scaling and root planing in the treatment of chronic periodontitis. METHODS Thirty-two patients aged 35-60 years old who had chronic periodontitis met the eligibility criteria. They were randomly assigned to two equal groups: scaling and root planing were performed in the SRP group, while scaling, root planing and laser irradiation of periodontal pockets were performed in the SRP + DL group. Subgingival plaque samples were subjected to polymerase chain reaction (PCR) to detect P. gingivalis-colonized sites, and common clinical indices were evaluated before and 2 months after treatment. Clinical examination included gingival index (GI), plaque index (PI), probing depth (PD), clinical attachment level (CAL) and gingival bleeding index (GBI), all of which were recorded. RESULTS Data from 30 patients [19 women and 11 men; mean age, 48.4 (5.4) years old] were analysed. There were statistically significant improvements in GI, PD, CAL and GBI for the SRP + DL group compared to SRP group but no significant difference in PI between the groups. Additionally, the percentage of P. gingivalis-positive sites in the SRP + DL group decreased from 80% (12/15) to 20% (3/15) after laser irradiation (P < 0.05). No significant changes were noted in the SRP group. CONCLUSION GaAlAs diode laser irradiation of diseased periodontal pockets at 685 nm and 1.6 J cm-2 seemed to be an effective adjuvant to mechanical instrumentation to treat chronic periodontitis.
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Affiliation(s)
- H A Alzoman
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
| | - H M Diab
- Department of Periodontology, Faculty of Dentistry, Tanta University, Tanta, Egypt.,Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
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Sanz-Sánchez I, Ortiz-Vigón A, Matos R, Herrera D, Sanz M. Clinical Efficacy of Subgingival Debridement With Adjunctive Erbium:Yttrium-Aluminum-Garnet Laser Treatment in Patients With Chronic Periodontitis: A Randomized Clinical Trial. J Periodontol 2015; 86:527-35. [DOI: 10.1902/jop.2014.140258] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lavu V, Sundaram S, Sabarish R, Rao SR. Root Surface Bio-modification with Erbium Lasers- A Myth or a Reality?? Open Dent J 2015; 9:79-86. [PMID: 25713635 PMCID: PMC4333616 DOI: 10.2174/1874210601509010079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/03/2014] [Accepted: 12/10/2014] [Indexed: 12/19/2022] Open
Abstract
The objective of this literature review was to critically review the evidence available in the literature regarding the expediency of erbium family of lasers for root bio modification as a part of periodontal therapy. The literature search was performed on the Pubmed using MeSH words such as "lasers/therapeutic use, scaling, dental calculus, tooth root/anatomy and histology, ultrasonic therapy". The studies were screened and were grouped as follows: those evaluating a) efficacy for calculus removal with the Erbium family of laser b) root surface changes following Er YAG and Er Cr YSGG application c) comparative studies of the Er YAG, Er Cr YSGG lasers versus conventional methods of root surface modification d) Bio compatibility of root surface following Erbium laser treatment e) Studies on the combined efficacy of laser root modification with conventional methods towards root surface bio-modification f) Studies on effectiveness of root surface bio-modification prior to root coverage procedures. In conclusion, the erbium family has a proven anti-bacterial action, predictable calculus removal, minimal root substance removal, and appears to favor cell attachment. The Erbium family of lasers appears to be a useful adjunct for the management of periodontal disease.
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Affiliation(s)
- Vamsi Lavu
- Department of Periodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Tamil Nadu, Chennai, India
| | - Subramoniam Sundaram
- Department of Periodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Tamil Nadu, Chennai, India
| | - Ram Sabarish
- Department of Periodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Tamil Nadu, Chennai, India
| | - Suresh Ranga Rao
- Department of Periodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Tamil Nadu, Chennai, India
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Bhansali RS. Non-surgical periodontal therapy: An update on current evidence. World J Stomatol 2014; 3:38-51. [DOI: 10.5321/wjs.v3.i4.38] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/06/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
Periodontal disease is an inflammatory condition that involves a complex interaction between pathogenic bacteria, environmental and acquired factors and host related factors. Till recently periodontal treatment was directed primarily towards reduction of bacterial load by subgingival debridement of root surfaces and modification of environmental risk factors. The current paradigm of periodontal disease stresses greater role of host-mediated inflammatory response in tissue destruction characteristic of periodontal disease. Various therapeutic modalities have been developed adjuvant to mechanical periodontal therapy. The use of laser and photodynamic therapy show great promise but their effectiveness has still not been conclusively proven. Chemotherapeutic agents, either systemic and local antimicrobials or host modulating drugs, played pivotal role in better and more predictable management of periodontal disease. The present review focuses on the best available evidence, for the current management of the chronic periodontal patients, gathered from systematic reviews and meta-analysis of mechanical non surgical periodontal therapy (NSPT) (subgingival debridement, laser therapy and photodynamic therapy) and the adjunctive chemotherapeutic approaches such as systematic and local antibiotics and antiseptics, subgingival pocket irrigation and host modulation therapies. The review also attempts to briefly introduce future developments in some of these modalities. At the end, the review summarizes the analysis of the current evidence that suggests that thorough subgingival debridement remains the mainstay of NSPT and that adjunct use of chemotherapeutic agents may offer better management of clinical parameters in periodontitis patients.
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Zhao Y, Yin Y, Tao L, Nie P, Tang Y, Zhu M. Er:YAG laser versus scaling and root planing as alternative or adjuvant for chronic periodontitis treatment: a systematic review. J Clin Periodontol 2014; 41:1069-79. [PMID: 25164559 DOI: 10.1111/jcpe.12304] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Yanhui Zhao
- Department of Oral and Cranio-Maxillofacial Science, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
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Belal MH, Watanabe H. Comparative Study on Morphologic Changes and Cell Attachment of Periodontitis-Affected Root Surfaces Following Conditioning with CO2and Er:YAG Laser Irradiations. Photomed Laser Surg 2014; 32:553-60. [DOI: 10.1089/pho.2014.3769] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Mahmoud Helmy Belal
- Department of Oral Medicine, Periodontology & Oral Diagnosis, Faculty of Oral & Dental Medicine, Fayoum University, Bahaariy Region, Al-Fayoum, Egypt
| | - Hisashi Watanabe
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
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38
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Heitz-Mayfield LJA, Lang NP. Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts. Periodontol 2000 2014; 62:218-31. [PMID: 23574468 DOI: 10.1111/prd.12008] [Citation(s) in RCA: 212] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This review aims to highlight concepts relating to nonsurgical and surgical periodontal therapy, which have been learned and unlearned over the past few decades. A number of treatment procedures, such as gingival curettage and aggressive removal of contaminated root cementum, have been unlearned. Advances in technology have resulted in the introduction of a range of new methods for use in nonsurgical periodontal therapy, including machine-driven instruments, lasers, antimicrobial photodynamic therapy and local antimicrobial-delivery devices. However, these methods have not been shown to offer significant benefits over and above nonsurgical debridement using hand instruments. The method of debridement is therefore largely dependent on the preferences of the operator and the patient. Recent evidence indicates that specific systemic antimicrobials may be indicated for use as adjuncts to nonsurgical debridement in patients with advanced disease. Full-mouth disinfection protocols have been proven to be a relevant treatment option. We have learned that while nonsurgical and surgical methods result in similar long-term treatment outcomes, surgical therapy results in greater probing-depth reduction and clinical attachment gain in initially deep pockets. The surgical technique chosen seems to have limited influence upon changes in clinical attachment gain. What has not changed is the importance of thorough mechanical debridement and optimal plaque control for successful nonsurgical and surgical periodontal therapy.
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Abstract
UNLABELLED Periodontal debridement (PD) remains a gold standard for the treatment of inflammatory periodontitis. BACKGROUND/PURPOSE The evidence base regarding the causal relationship between oral biofilm and the host inflammatory response to the etiology of periodontal disease has substantially increased over the years. What has not changed significantly during that time is the conservative manner in which the disease can be treated with periodontal debridement (PD). Since dental hygienists, in particular, specialize in providing these procedures it is important to evaluate the evidence that supports periodontal debridement as a primary and fundamental treatment modality. METHOD An extensive narrative literature review that included systematic reviews, examined traditional PD, the use of adjuncts to enhance PD and newer PD procedures to determine what are the best practices for achieving optimal clinical outcomes. CONCLUSION Compared to surgical therapy, PD results in maintenance of attachment levels over time, but is not as effective in the initial reduction of probing depths in deep pockets. Sustained release local drug delivery agents have some modest adjunctive effects when used with PD, as do systemic antibiotics in aggressive periodontitis cases. Reported analyses of the long term effects of chemotherapeutic agents usually do not extend beyond a few months to a year. While laser therapy is still under investigation it remains as a potential PD therapy. New instruments being refined to better visualize the root surface either non-surgically or with mini papilla reflection flaps, hold promise for the future when they become more affordable and accessible. Despite the development of new technology, it still appears that periodontal debridement (PD) remains the gold standard for the treatment of inflammatory periodontitis.
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Affiliation(s)
- Connie L Drisko
- GRU & GRHS Leadership Academy (GLA), Georgia Regents University, Augusta, GA 30912, USA.
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Sgolastra F, Severino M, Petrucci A, Gatto R, Monaco A. Nd:YAG laser as an adjunctive treatment to nonsurgical periodontal therapy. Lasers Med Sci 2013; 29:887-95. [DOI: 10.1007/s10103-013-1293-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/25/2013] [Indexed: 02/08/2023]
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Perio DNDC. Periodontal Bone Regeneration and the Er,Cr:YSGG Laser: A Case Report. Open Dent J 2013; 7:16-9. [PMID: 23524914 PMCID: PMC3601343 DOI: 10.2174/1874210601307010016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/08/2012] [Accepted: 11/06/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Traditional methods of regenerating bone in periodontal bone defects have been partially successful and have involved numerous protocols and materials. More recently, it has been proposed that Er,Cr:YSGG laser energy may also be beneficial in the treatment of periodontal pockets, particularly in the regeneration of bone lost due to periodontal disease. CASE DESCRIPTION The purpose of this paper is to present a case report of the Er,Cr:YSGG laser being used to conservatively treat a recalcitrant periodontal pocket in the presence of a periodontal bone defect and that resulted in successful resolution of the pocket and significant radiographic bone fill at the 1 year recall visit. CLINICAL IMPLICATIONS This protocol using the Er,Cr:YSGG laser for the treatment of periodontal loss of attachment and periodontal bone loss may represent a less invasive alternative than traditional open-flap periodontal surgery or the intrasulcular use of other more penetrating laser wavelengths.
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Affiliation(s)
- Douglas N Dederich Cert Perio
- Room 5-531 ECHA, Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 1C9; Canada
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Marchetti E, Monaco A, Procaccini L, Mummolo S, Gatto R, Tetè S, Baldini A, Tecco S, Marzo G. Periodontal disease: the influence of metabolic syndrome. Nutr Metab (Lond) 2012; 9:88. [PMID: 23009606 PMCID: PMC3499456 DOI: 10.1186/1743-7075-9-88] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 08/27/2012] [Indexed: 01/11/2023] Open
Abstract
Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that include obesity, impaired glucose tolerance or diabetes, hyperinsulinemia, hypertension, and dyslipidemia. Recently, more attention has been reserved to the correlation between periodontitis and systemic health. MetS is characterized by oxidative stress, a condition in which the equilibrium between the production and the inactivation of reactive oxygen species (ROS) becomes disrupted. ROS have an essential role in a variety of physiological systems, but under a condition of oxidative stress, they contribute to cellular dysfunction and damage. Oxidative stress may act as a common link to explain the relationship between each component of MetS and periodontitis. All those conditions show increased serum levels of products derived from oxidative damage, promoting a proinflammatory state. Moreover, adipocytokines, produced by the fat cells of fat tissue, might modulate the balance between oxidant and antioxidant activities. An increased caloric intake involves a higher metabolic activity, which results in an increased production of ROS, inducing insulin resistance. At the same time, obese patients require more insulin to maintain blood glucose homeostasis – a state known as hyperinsulinemia, a condition that can evolve into type 2 diabetes. Oxidation products can increase neutrophil adhesion and chemotaxis, thus favoring oxidative damage. Hyperglycemia and an oxidizing state promote the genesis of advanced glycation end-products, which could also be implicated in the degeneration and damage of periodontal tissue. Thus, MetS, the whole of interconnected factors, presents systemic and local manifestations, such as cardiovascular disease and periodontitis, related by a common factor known as oxidative stress.
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Affiliation(s)
- Enrico Marchetti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Annalisa Monaco
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Laura Procaccini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefano Mummolo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roberto Gatto
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefano Tetè
- Department of Oral Science, Nano and Biotechnology, University of Chieti, Chieti, Italy
| | - Alberto Baldini
- Department of Oral Science, University of Tor Vergata, Rome, Italy
| | - Simona Tecco
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Marzo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Sanz I, Alonso B, Carasol M, Herrera D, Sanz M. Nonsurgical Treatment of Periodontitis. J Evid Based Dent Pract 2012; 12:76-86. [DOI: 10.1016/s1532-3382(12)70019-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Krohn-Dale I, Bøe OE, Enersen M, Leknes KN. Er:YAG laser in the treatment of periodontal sites with recurring chronic inflammation: a 12-month randomized, controlled clinical trial. J Clin Periodontol 2012; 39:745-52. [PMID: 22694321 DOI: 10.1111/j.1600-051x.2012.01912.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2012] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Ivar Krohn-Dale
- Department of Clinical Dentistry - Periodontotics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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