Morphological Alterations of Periodontal Pocket Epithelium Following Nd:YAG Laser Irradiation

Abstract

The SEM and histologic findings demonstrated the feasibility of ablating pocket epithelium with an Nd:YAG laser irradiation using parameters of 2 W of power (200 mJ, 10 pps). Furthermore, the presence or absence of clinical inflammation appeared to have an impact on the degree of laser-mediated epithelial ablation.

Efficacy of non-surgical periodontal therapy with adjunct Nd:YAG laser therapy in the treatment of periodontal inflammation among patients with and without type 2 diabetes mellitus: A short-term pilot study

“…Although it is exigent to provide a precise justification for the improvement of periodontal status on the test-sites compared to control sites; however, the partial removal of the pocket epithelial lining may be an essential contributing factor. In vivo study, Ting et al [23] investigated morphologic alterations in the periodontal pocket epithelium (with or without clinical inflammation) following the use of Nd:YAG laser therapy. Scanning electron microscopic results showed that in sites with PD P 4 mm, complete removal of the epithelium occurred whereas epithelium persisted in the uninflamed sites following whose extent and degree were increasing, was observed in the inflamed portion following Nd:YAG laser therapy [23].…”

“…In vivo study, Ting et al [23] investigated morphologic alterations in the periodontal pocket epithelium (with or without clinical inflammation) following the use of Nd:YAG laser therapy. Scanning electron microscopic results showed that in sites with PD P 4 mm, complete removal of the epithelium occurred whereas epithelium persisted in the uninflamed sites following whose extent and degree were increasing, was observed in the inflamed portion following Nd:YAG laser therapy [23]. In the present study, periodontal parameters were comparable among the test-sites and control-sites among patients in groups 1 and 2 after 3-months of treatment.…”

Lasers and the treatment of periodontitis: the essence and the noise

“…Ting et al. procured soft‐tissue biopsies immediately post‐treatment with the Nd:YAG laser and, based on light microscopy, reported removal of all inflamed pocket epithelium without damage to subjacent connective tissues. Also, epithelium overlying noninflamed pocket areas was left intact.…”

“…Of the remaining eight studies, four demonstrated no significant difference between control and test groups ; two favored the adjunctive use of the laser with scaling and root planing ; and one showed a significant reduction in the levels of 18 different species of bacteria following use of the laser adjunctive to a local antibiotic vs. the laser alone ; and in one study the scaling and root planing group produced a significant reduction in the number of bacterial colony‐forming units vs. baseline levels . Overall, one must conclude that the laser, at best, may be equivalent to scaling and root planing and has no added clinical benefit regarding reduction in subgingival microbial loads. There is no evidence that the Nd:YAG laser used as a monotherapy or adjunctive to scaling and root planing, is capable of “sterilizing” a periodontal pocket (Table ). Currently, there is no consistent significant evidence showing that use of the Nd:YAG laser in the treatment of chronic periodontitis has a beneficial impact on the levels of inflammatory cytokines. There is limited evidence showing that the Nd:YAG laser, at relatively low power settings, is capable of removing inflamed pocket epithelium without damage to subjacent connective tissues .…”

“…Indeed, it has been suggested that the Nd:YAG laser may offer significant clinical benefits as an adjunct to scaling and root planing in the nonsurgical treatment of periodontitis (186). For example, the laser purportedly is effective at selective killing of brown/black pigmentproducing bacteria in subgingival sites (166,230,243) and producing an overall reduction in bacterial load (16,18,62,130,140,259,337,369), neutralizing endotoxins (16), ablating inflamed periodontal pocket epithelium (i.e. through laser-mediated curettage) (18,130,134,186,(287)(288)(289)(290)369) and biologically closing the treated periodontal pocket by creation of a fibrin seal which, in turn, may facilitate reattachment to a previously diseased root surface (284,395).…”