Efficacy of laser monotherapy or non-surgical mechanical instrumentation in the management of untreated periodontitis patients. A systematic review and meta-analysis

Abstract

Objective To evaluate and compare the effects of laser monotherapy with non-surgical mechanical instrumentation alone in untreated periodontitis patients. Materials and methods A focused question was formulated based on the Population, Intervention, Comparison, Outcome, and Study design criteria (PICOS): in patients with untreated periodontitis, does laser mono-therapy provide adjunctive effects on pocket probing depth (PPD) changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. The results of the meta-analyses are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines. Results The search yielded 1268 records, out of which 8 articles could be included. With respect to PPD changes, a meta-analysis including 5 articles (n = 148) failed to identify statistically significant differences in favor of laser monotherapy for PPD change (WMD = 0.14 mm; 95% CI: − 0.04/0.32; z = 1.51; p = 0.132) nor for clinical attachment level (CAL) (WMD = 0.04 mm; 95% CI: − 0.35/0.42; z = 0.19; p = 0.850). Data on cost-effectiveness are lacking. One study reported patient-related outcome measures (PROMS). Conclusions In untreated periodontitis patients, laser monotherapy does not yield superior clinical benefits compared with non-surgical mechanical instrumentation alone. Clinical relevance In untreated periodontitis patients, mechanical instrumentation with hand and/or ultrasonic instruments remains the standard of care.

The Use of Lasers in Dental Materials: A Review

“…In terms of non-surgical periodontal treatment, laser use aims mainly in root surface detoxification. A recent systematic review and meta-analysis showed that in untreated periodontitis patients, laser monotherapy leads to similar clinical improvement to conventional non-surgical periodontal treatment alone [ 29 ], which is in agreement with earlier reviews [ 27 , 34 ]. Systematic reviews on untreated periodontitis failed to show further clinical benefits with the addition of laser treatment to conventional non-surgical periodontal treatment [ 27 , 28 , 30 ].…”

“…Lasers are used in most areas of clinical dentistry and their use is steadily increasing. Their application includes caries detection, caries removal, dental cavity preparation, dentine hypersensitivity management, tooth bleaching, photodynamic therapy, excisional biopsy, aphthous ulcers management, frenectomy, vestibuloplasty, removal of irritation fibroma, removal of hyperplastic tissues, haemangioma, exposure of impacted teeth, gingivectomy and gingivoplasty, apicoectomy, an adjunct to endodontic treatment [ 19 ], gingival melanin hyperpigmentation removal [ 20 , 21 , 22 ], non-surgical periodontal treatment of untreated periodontitis [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ] and treatment of peri-implant diseases [ 31 , 32 , 33 ]. In terms of endodontic treatment, lasers are used for post-chemomechanical preparation to reduce the remaining bacterial load either by direct irradiation of the canal walls or by laser assisted irrigation via erbium laser group.…”

The preventive care of medication-related osteonecrosis of the jaw (MRONJ): a position paper by Italian experts for dental hygienists

“…If it is decided to treat MRONJ conservatively, the dental hygienist (on the advice of the dentist) could play a central role in all bio-stimulation procedures. These may be performed using ozone-generating instruments or laser therapy [2,[65][66][67][68][69][70][71][72]. The application of ozone therapy deploys various aids and methods (e.g.…”

“…low level laser therapy, LLLT) would seem to be effective in increasing the organic bone matrix in the proximity of the lesion, in stimulating the growth of blood and lymph vessels inside and outside the gum line and in reducing pain and possibly also the size of adjacent bone exposure. And this is in addition to its characteristics of being a safe, minimally invasive and well-tolerated technique [68][69][70][71][72]. Many authors have reported clinical success in the treatment of MRONJ with LLLT, deploying different wavelengths and different parameters [73,74].…”

Efficacy of Er:YAG laser irradiation for decontamination and its effect on biocompatibility of different titanium surfaces

“…Erbium-doped yttrium–aluminum–garnet (Er:YAG) laser irradiation has been suggested to be a better treatment option for implant surface decontamination to control peri-implantitis because of its numerous advantages, including dental calculus removal, high bactericidal activity, excellent tissue ablation, and promoting of new bone formation [ 6 ]. Er:YAG laser has been extensively investigated for applications in clinical treatment of peri-implantitis either independently or in combination with other techniques, showing favorable outcomes [ 7 ]. However, there is no consensus on the optimal Er:YAG laser irradiation parameters for debridement of microstructured surfaces of titanium implants, particularly at a high pulse repetition rate [ 8 ].…”