Lasers in Periodontics: A Review of the Literature

Abstract

Background: Despite the large number of publications, there is still controversy among clinicians regarding the application of dental lasers to the treatment of chronic periodontitis. The purpose of this review is to analyze the peer-reviewed research literature to determine the state of the science concerning the application of lasers to common oral soft tissue problems, root surface detoxification, and the treatment of chronic periodontitis.Methods: A comprehensive computer-based search combined the following databases into one search: Medline, Current Contents, and the Cumulated Index of Nursing and Allied Health. This search also used key words. In addition, hand searches were done for several journals not cataloged in the databases, and the reference lists from published articles were checked. All articles were considered individually to eliminate non-peer-reviewed articles, those dealing with commercial laser technology, and those considered by the author to be purely opinion articles, leaving 278 possible articles.Results: There is a considerable conflict in results for both laboratory studies and clinical trials, even when using the same laser wavelength. A meaningful comparison between various clinical studies or between laser and conventional therapy is difficult at best and likely impossible at the present. Reasons for this dilemma are several, such as different laser wavelengths; wide variations in laser parameters; insufficient reporting of parameters that, in turn, does not allow calculation of energy density; differences in experimental design, lack of proper controls, and differences in severity of disease and treatment protocols; and measurement of different clinical endpoints.Conclusions: Based on this review of the literature, there is a great need to develop an evidence-based approach to the use of lasers for the treatment of chronic periodontitis. Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. Current evidence does suggest that use of the Nd:YAG or Er:YAG wavelengths for treatment of chronic periodontitis may be equivalent to scaling and root planing (SRP) with respect to reduction in probing depth and subgingival bacterial populations. However, if gain in clinical attachment level is considered the gold standard for non-surgical periodontal therapy, then the evidence supporting laser-mediated periodontal treatment over traditional therapy is minimal at best. Lastly, there is limited evidence suggesting that lasers used in an adjunctive capacity to SRP may provide some additional benefit.

Evaluation of Effectiveness of Photodynamic Therapy With Low-level Diode Laser in Nonsurgical Treatment of Peri-implantitis

“…21,22 This laser has a superb hemostatic effect and can be applied for cutting and coagulating gingiva and mucosa. 23 In addition, this laser can contact the implant surface without melting, cracking or making it concave. 1 Therefore, the aim of the present study was to evaluate the clinical and microbiological effects of the use of EmunDo dye as a photosensitizer, in association with the applications of 810-nm diode laser beams and to compare it with the application of laser alone for the treatment of peri-implantitis.…”

Modern Approach to the Identification and Elimination of Periodontal Infection

“…For these reasons, laser therapy, which uses the photo-thermal effect to fight bacterial infection, is strongly recommended as a new therapeutic option and supplementary method to classical treatment approaches. Periodontal disease can be treated with laser therapy at any stage [22].…”

Antibacterial effect of using the Er:YAG laser or Er,Cr:YSGG laser compared to conventional instrumentation method—a literature review

“…This thin, initial biofilm has been almost always present on the tooth surface as it forms immediately after cleaning [2]. An initial few layers (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) of the biofilm consist mostly gram-positive cocci bacteria, followed by some gram-positive rods and filaments, and a very small amount of gram-negative cocci. The gram-positive cocci species involved in this conditioning layer include, but are not limited to, S t re p t o c o c c u s m u t a n s , S t r e p t o c o c c u s m i t i s , Streptococcus sanguis, Streptococcus oralis, Rothia dentocariosa, and Staphylococcus epidermidis.…”

“…It was found in previous study that there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. Current evidence does suggest that use of the Nd:YAG or Er:YAG wavelengths for treatment of chronic periodontitis may be equivalent to SRP with respect to reduction in PD and subgingival bacterial populations [4]. The aim of this review was to evaluate the effectiveness of using Er:YAG laser or Er,Cr:YSGG laser on the reduction of bacteria causing the periodontal disease in comparison to that with the hand, sonic, or ultrasonic scaling devices.…”