Impact of Adjunctive Diode Laser Application to Non-Surgical Periodontal Therapy on Clinical, Microbiological and Immunological Outcomes in Management of Chronic Periodontitis: A Systematic Review of Human Randomized Controlled Clinical Trials

Abstract

Background Due to the limitations of scaling and root planing (SRP) in chronic periodontitis (CP) management, research has been focused on utilising additional therapies to enhance conventional treatment methods. The present systematic review is aimed to appraise the accessible scientific evidence of in vivo human studies to establish the effectiveness of adjunctive diode (λ 808- λ 980nm) laser treatment to SRP in CP. Methodology This systematic review was conducted following the PRISMA statement guidelines. The review protocol is registered in PROSPERO (CRD 42021227695). The search strategies were based on structured electronic and manual (with appropriate keywords) and were conducted to collect the applicable published data on RCTs studies (in vivo human), spanning over ten years between August 2010 and August 2020. The articles were selected to address the following research focus question: “Does diode laser (λ 808- λ 980nm) therapy have superior effects as an adjunct to SPR, compared to SRP alone, in terms of clinical or microbiological or immunological profiles in the management of CP?” Results Fifteen articles met the eligibility criteria and are included in this review. A wide range of discrepancies and inconsistencies were shown in the outcomes of the laser and SPR treatment modality, compared to SRP alone. The data on standardised study protocol, optimal laser parameters and outcome measurements were inconclusive, and a high risk of bias in the majority of the studies observed, which are crucial in establishing a homogenous and reproducible protocol. Conclusion In light of the confined evidence-based data and critical evaluation of this systematic review, the efficacy of adjunctive diode laser treatment ranging between 808 and 980nm to SRP remains debatable. The observational quality of the present systematic review was emphasised after scrutinising the available data, and an attempt to propose a laser protocol for future RCTs consideration was a great challenge due to an absence of clear and standardised recommendations in delivering a reliable laser protocol which can be replicable by future investigators. RCTs with robust methodology are warranted.

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“…Inside the periodontal pocket for non-surgical therapy, we use a diode near-infrared laser with a wavelength between 800nm-980nm for coagulating gingivae (epithelial ablation inside the pocket) as an adjunct to SRP. Additionally, it results in complete removal of the inflamed epithelium and decreases the amount of pro-inflammatory agents [9,12,[28][29][30][31][32][33][34][35][36]. Appropriate laser wavelengths, with suitable protocols, probably can improve the periodontal status for a more extended period and likely limit the use of antibiotics.…”

“…To obtain this, we have to follow specific rules leading to the optimal absorption of laser light by the target tissue and choose the laser wavelength, emission mode, time of exposure, distance from the tip, its angulation towards the surface, and tissue composition and given thickness. In Periodontitis, the heat generated by the laser beam can additionally deactivate some bacterial enzymes leading to their apoptosis via photothermal effect [26,36,40,46,47]. In addition, the inflamed socket soft tissue can be debrided induced by laser beam coagulation at 60ᵒ Celsius; in this process, the blood vessels and lymphatic connections can be coagulated to enable healing.…”

“…Lack of bleeding proves the stability of the periodontal tissues. In the presence of pockets >4mm with concomitant bleeding in the maintenance phase examination, there is a risk of further loss of connective tissue attachment [14,25,32,36,42,45,59].…”

Application and Research Progress of Laser in Periodontal Disease

“…The rationale behind it is that: different parts of calculus, plaque, and hard tissues have different fluorescent emission properties when subjected to irradiation with a 655 nm diode laser. 38,39,40 Root biomodification: a lot of studies are done to determine the degree of effectiveness of using lasers in bacterial reduction and detoxifying root surfaces. 41,42 Low-level laser therapy:…”

Utilization of Laser Wavelengths in Periodontitis and Periimplantitis

“…You are reducing the volume of Aggregatibacter actinomycetemcomitans (A.a) (periodontal pocket violet complex) and Porphyromonas gingivalis (P.g) (redcomplex), which can easily penetrate the gingival epithelium without damaging the underlying connective tissues (bactericidal activity), which are the primary pathogens in Periodontitis. In soft tissue, you can also expect postoperative pain relief with the quasi Photobiomodulation (PBM) effect [21,26,36].…”