Change in clinical indices following laser or scalpel treatment for periodontitis: A split-mouth, randomized, multi-center trial

Abstract

Data are presented from a multi-center, prospective, longitudinal, clinical trial comparing four different treatments for periodontitis, (1) the LANAP™ protocol utilizing a FR pulsed-Nd:YAG laser; (2) flap surgery using the Modified Widman technique (MWF); (3) traditional scaling and root planing (SRP); and (4) coronal debridement (CD). Each treatment was randomized to a different quadrant. Fifty-one (54) subjects were recruited at five centers that included both private practice and university-based investigators. At 6-months and 12 months post-treatment the LANAP™ protocol and MWF yielded equivalent results based on changes in probing depths. The major difference observed between the two procedures was that patients reported significantly greater comfort following the LANAP™ procedure than following the MWF (P<0.001). There was greater reduction in bleeding in the LANAP™ quadrant than in the other three at both 6 and 12 months. Improvements following SRP were better than expected at 6 months and continued to improve, providing outcomes that were equivalent to both LANAP™ and MWF at 12 months. The improvement in the SRP quadrants suggests the hypothesis that an aspect of the LANAP™ protocol generated a significant, positive and unanticipated systemic (or trans-oral) effect on sub-gingival wound healing.

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

“… The only published randomized controlled trial involving LANAP ® compared the laser therapy with modified Widman flap surgery, scaling and root planing alone and supragingival scaling, and reported that the laser surgery was equal to the modified Widman flap surgery procedure with respect to reductions in probing depth and bleeding on probing. The results also showed the laser therapy to be only 0.2 mm better than scaling and root planing alone for probing depth reduction (Table ). Although LANAP ® is marketed as a protocol that promotes bone regeneration in periodontitis defects, there was no mention of bone regeneration in the published results. The average difference in probing depth reduction for LANAP ® ‐treated sites vs. scaling and root planing only, for the five studies presenting such data (Table ), was 0.56 mm for pockets of 3–6 mm and 0.24 mm for pockets of > 6 mm (Table ).…”

“…Furthermore, it should be noted that two other studies did not report on tooth/site selection and may have involved only single‐rooted teeth. Lastly, the one major randomized controlled trial did not report gains or loss in clinical attachment level. Given these flaws in experimental design, a judgement of clinical significance becomes an exercise in futility. Only one of six published studies in the LANAP ® series presented data concerning reductions in bleeding on probing .…”

“…Lasers, when used for various soft-tissue procedures, can provide distinct advantages over the traditional scalpel, such as easy ablation of small volumes of tissue, hemostasis (which, in turn, offers better visualization of the surgical field), sterilization of the incision or target surface area and less post-treatment tissue edema and swelling. For many procedures use of the laser can be considered a minimally invasive technique, resulting in less discomfort than traditional approaches (16,18,65,66,168). Furthermore, lasers may have biostimulatory effects (i.e.…”

“…Currently, the rationale for laser periodontal therapy is presented in more sophisticated language but basically rests on several suppositions: (i) there is substantial clinical benefit from laser-mediated subgingival curettage (16,130,230,293,341); (ii) lasers used as a monotherapy or adjunctive to scaling and root planing produce a significant reduction in subgingival bacterial loads (16,56,186,230,273); (iii) specific laser wavelengths show a predilection for brown/black pigmented anaerobic gram-negative bacteria that are prime pathogens in periodontitis (e.g. Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Prevotella melaninogenica and "Bacteroides" species) (82,126,183,354,355); (iv) specific laser wavelengths used alone or adjunctive to scaling and root planing are effective at reducing levels of inflammation and inflammatory mediators and promote a better healing response than scaling and root planing alone (24,267,268,273); (v) lasers are effective at detoxifying root surfaces exposed to the periodontal pocket environment (16,230); (vi) lasers may be an alternative for patients wishing to avoid surgical therapy (168,312); and (vii) given the appropriate wavelength and protocol it may be possible to regenerate lost tissues of the periodontium (i.e. cementum, periodontal ligament and supporting alveolar bone) (260,395).…”

“…Results from a multicenter, prospective, longitudinal, clinical trial conducted at five treatment centers were published in 2014 (168). In this clinical trial, each treatment was randomized to a different quadrant of 51 subjects with advanced chronic periodontitis and a minimum of four sites per quadrant with probing depth ≥ 5 mm and two sites with probing depth ≥ 7 mm.…”