Disinfection Potential of 980 nm Diode Laser and Hydrogen Peroxide (3%) in “Critical Probing Depths” Periodontal Pockets: Retrospective Study

Abstract

A successful treatment of periodontitis depends largely on the successful elimination of the periodontopathogens during non-surgical and surgical mechanical debridement. In this retrospective study, data collection was conducted from 2017 to 2021. The retrospective study included 128 patients with 128 sites of localized periodontitis with pocket depths > 5 mm. The included data were based on sites that received conventional mechanical debridement followed by different adjunctive approaches. In total, 30 patients did not receive any additional treatment (SRP group), 30 patients received SRP + 980 nm diode laser irradiation only (SRP + laser), 30 patients received SRP + 3% hydrogen peroxide irrigation (SRP + H2O2) only and 30 patients received a combined treatment of 3% hydrogen peroxide and 980 nm diode laser irradiation (SRP + H2O2 + laser). Total bacterial counts (TBC) in the periodontal pocket collected for all participants before treatment, immediately after treatment, 6 weeks after treatment, 12 weeks after treatment and 6 months after treatment were statistically analyzed and compared. When the laser was used, irradiation parameters were 10 μsec/pulse duration, 10 kHz, pick power of 10 W, average power of 1 W, irradiation time of one minute with inward and outward movements, and fiber diameter of 320 μm. The irradiation was repeated 3 times/pocket. When hydrogen peroxide was used, the irrigation was conducted for one minute and repeated 3 times. The maximum reduction in TBC was obtained when SRP was coupled with 3% H2O2 irrigation followed by 980 nm diode laser irradiation. After six months of follow-up, a significant reduction in TBC was obtained for the group of SRP + H2O2 + laser when compared to all the other groups, from 7.27 × 107 before intervention to 3.21 × 107 after six months. All three approaches to SRP showed a significant reduction in TBC immediately after treatment. Values were 3.52 × 107, 4.01 × 106, 9.58 × 106, 1.98 × 106 for SRP alone, SRP + diode, SRP + H2O2 and SRP + H2O2 + diode laser, respectively. At 6 months, we saw no significant difference between SRP + laser and SRP + H2O2 with 4.01 × 107 and 4.32 × 107, respectively. This retrospective study reveals that after SRP, irrigation with 3% hydrogen peroxide and irradiation with a 980 nm diode laser within specific treatment protocol can be used as an additional approach to conventional SRP to increase the disinfection of the periodontal pockets > 5 mm.

Sodium Hypochlorite and Diode Laser in Non-Surgical Treatment of Periodontitis: Clinical and Bacteriological Study with Real Time Polymerase Chain Reaction (PCR)

“…The heat and photo-disruptive energy can reach deep areas that the conventional mechanical debridement cannot [ 32 , 33 , 34 ]. For instance, this might have increased the disinfection of the epithelial junction, the connective tissue and the periodontal ligaments [ 19 , 32 , 33 , 34 ]. In addition, the 980 nm wavelength is in the near infrared light that was shown to be able to directly kill pigmented bacteria that contain protoporphyrin IX such as Aggregatibacter actinomycetemcomitans [ 35 ].…”

“…The most widely used irrigation solution in periodontal therapy remains chlorhexidine; however, other irrigation solutions were proposed and investigated such as hydrogen peroxide (generally 3%), povidone-iodine, fluoride mouthwash and others. In this context, El Mobadder et al [ 19 ] showed in a retrospective study, including 128 sites of localized periodontitis, that the use of 3% of hydron peroxide coupled with irradiation with a 980 nm diode laser can provide a significant reduction in the TBC of periodontal pockets that are greater than 5 mm. However, El Mobadder et al [ 19 ] did not assess the bacterial count of the specific periodonto-pathogens; thus, their suggested protocol might not be as effective on the red complex as it was on the total bacteria present in the deep periodontal pockets.…”

“…In this context, El Mobadder et al [ 19 ] showed in a retrospective study, including 128 sites of localized periodontitis, that the use of 3% of hydron peroxide coupled with irradiation with a 980 nm diode laser can provide a significant reduction in the TBC of periodontal pockets that are greater than 5 mm. However, El Mobadder et al [ 19 ] did not assess the bacterial count of the specific periodonto-pathogens; thus, their suggested protocol might not be as effective on the red complex as it was on the total bacteria present in the deep periodontal pockets. On the other hand, Grzech-Lesniak showed in a randomized clinical and microbiological study that multiple applications of aPDT using toluidine blue 0.1% as a photosensitizer can be an effective additional approach to the SRP during maintenance sessions for patients with periodontitis [ 48 ].…”

“…Scaling and root planing (SRP) alone offer mechanical debridement of calculus and biofilm by direct contact of hard and soft tissues which can be considered a limitation in deep pockets and/or in some challenging to reach anatomical areas. To compensate for the limitations of the non-surgical treatment, additional approaches were suggested in the literature such as the use of antibiotics [ 18 ], disinfection solutions [ 19 ], antimicrobial peptides [ 20 ], probiotics [ 21 , 22 ], laser irradiation [ 19 , 23 , 24 ] and photodynamic therapy [ 25 , 26 ]. In this context, sodium hypochlorite (NaOCl) [ 27 ] and a diode laser [ 28 ] are proposed as an additional approach for SRP in the non-surgical treatment of periodontitis [ 27 , 28 ].…”

“…NaOCl presents a broad antimicrobial activity with a high dissolving effect on necrotic tissue and fast bactericidal action that has been known for many years [ 29 ]. Laser irradiation, if used adequately, might significantly increase the disinfection of deep periodontal pockets as its energy penetrates in depth, increasing the disinfection of the periodontium [ 19 , 23 , 30 ]. Moreover, some studies of root canal therapy suggest that the combination of a diode laser and NaOCl can increase the disinfection of the root canal system by causing a direct heating of NaOCl leading to an increase in its activity [ 31 ].…”