DrBicuspid Article
Study: Diode laser treatment improves SRP results
By Rabia Mughal, Contributing Editor
December
10, 2012 -- Diode lasers can significantly improve clinical parameters when
used as an adjunct to scaling and root planing (SRP)
during periodontal treatment, according to a new study in Lasers in Medical
Science (November 16, 2012).
Laser
treatment has been expected to serve as an alternative or adjunctive treatment
to conventional mechanical therapy in periodontology
due to several advantages: ablation of tissues together with effective hemostasis, removal of calculus and granulation tissue, and
bacterial reduction in periodontal pockets, explained study author Mehmet Saglam, PhD, a faculty
member at the department of periodontology at İzmir Kâtip Çelebi University in İzmir,
Turkey, in a DrBicuspid.com interview.
To see
whether a diode laser will enhance SRP treatment outcomes, Saglam
and his colleagues conducted a randomized, controlled six-month clinical trial
using a parallel design. They looked at 30 patients (18 men, 12 women) with
chronic periodontitis who were referred for
periodontal treatment at the department of periodontology
at the Faculty of Dentistry of Selçuk University
between January 2010 and July 2010.
We observed satisfactory results ... but
there is no guarantee to achieve satisfactory results every time.
Mehmet Saglam, PhD
Study
participants had at least 14 teeth with at least two teeth with 5 mm or greater
probing depth at each quadrant. They were randomly assigned to two groups: one
group (n = 15) served as the control and received only SRP, while the test
group received SRP followed by diode laser treatment.
Exclusion
criteria for the study included any periodontal treatment received during the
past year, systemic diseases that could influence the outcome of the therapy,
pregnancy, smoking, immunosuppressive chemotherapy, and use of antibiotics and
anti-inflammatory drugs for the last six months.
Supragingival scaling was performed for each patient in all groups using
hand instruments and ultrasonic devices. Full-mouth subgingival SRP under local
anesthesia was performed in a single appointment for each patient in all groups
using an ultrasonic scaler and hand instruments. SRP
and diode laser therapy was performed in the same visit. All treatments were
performed under local anesthesia.
Laser
treatment was performed by using a 940-nm indium-gallium-aluminum phosphate (InGaAIP) diode laser. Plaque index, gingival index,
bleeding on probing, probing depth, and clinical attachment level were measured
at baseline and at one, three, and six months after treatment.
The
gingival crevicular fluid levels of interleukin-1
beta (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), matrix
metalloproteinase-1 (MMP-1), matrix metalloproteinase-8 (MMP-8), and tissue
inhibitor matrix metalloproteinase-1 (TIMP-1) were analyzed by enzyme-linked immunosorbent assay.
Here are
some of the key results:
"The
literature does not show any standard procedures regarding energy, modes of
irradiation, and time taken for bacterial reduction in the periodontal
pocket," Saglam explained. "You can observe
different results due to type of laser device (Er:YAG,
Er:YSGG, Nd:YAG, CO2 laser, and diode),
modes of irradiation, application time, diameter of laser fiber tip, and using
cooling system."
He and
his colleagues used a diode laser (power: 1.5 W, pulse interval: 20 msec, pulse length: 20 msec, 20
s/cm2, 15 Joules/cm2) for decontamination of the
periodontal pocket and once with the root planing
procedure, he added.
"In
some periodontal diseases, you can't achieve the results that you hope," Saglam said. "Inaccessible areas for hand instruments
in the mouth, specific periodontal microorganisms which can invade gingival
tissues and lead to reinfection of periodontal
pocket, and the presence of resistant bacteria to some antibiotics in
periodontal pocket are some reasons of failure in nonsurgical
periodontal treatment."
Correct
selection of the dental laser device, modes of irradiation, application time,
the diameter of the laser fiber tip, and frequency of application may help the
clinicians to get better results in treating periodontal disease, he added.
"We
observed satisfactory results by using diode laser," Saglam
concluded. "But there is no guarantee to achieve satisfactory results in
every time. We need more evidence to use dental lasers effectively in the
treatment of periodontitis."