The Effect of Diode Laser as an Adjunct to Periodontal Treatment on Clinical Periodontal Parameters and Halitosis: A Randomized Controlled Clinical Trial
Abstract:Conclusion:The present study indicates that compared to SRP solely, adjunctive applications of a 940-nm diode laser with SRP showed lower bleeding on probing and halitosis levels.
“…In seven articles, the use of local anaesthesia in conjunction with periodontal treatment was reported (Dereci et al, ; Eltas & Orbak, ; Euzebio Alves et al, ; Hatipoglu et al, ; Kamma et al, ; Matarese et al, ; Üstün et al, ); in one article, local anaesthesia was reported to be delivered if needed (Rotundo et al, ) whereas lack of information with respect to the use of local anaesthesia was observed in two articles (Dilsiz et al, ; Kelbauskiene et al, ).…”
Section: Resultsmentioning
confidence: 99%
“…The characteristics of the 10 articles evaluating the adjunctive use of laser are summarized in Table 2 (Dereci, Hatipoglu, Sindel, Tozoglu, & Üstün, 2016;Dilsiz, Canakci, & Aydin, 2013;Eltas & Orbak, 2012a;Euzebio Alves et al, 2013;Hatipoglu et al, 2017;Kamma, Vasdekis, & Romanos, 2009;Kelbauskiene, Baseviciene, Goharkhay, Moritz, & Machiulskiene, 2011;Matarese, Ramaglia, Cicciu, Cordasco, & Isola, 2017;Rotundo et al, 2010;Üstün, Hatipoglu, Daltaban, Felek, & Firat, 2018).…”
Section: Description Of Included Studiesmentioning
confidence: 99%
“…The percentage of females ranged from 33% to 67% and of males from 33% to 66%, respectively. Smokers were reported in 3 articles (Eltas & Orbak, 2012a;Kamma et al, 2009;Rotundo et al, 2010); smokers were excluded in 6 articles (Dilsiz et al, 2013;Euzebio Alves et al, 2013;Hatipoglu et al, 2017;Kelbauskiene et al, 2011;Matarese et al, 2017;Üstün et al, 2018). Two articles reported on patients diagnosed with aggressive periodontitis (Kamma et al, 2009;Matarese et al, 2017), 7 articles on patients diagnosed with chronic periodontitis (Dereci et al, 2016;Dilsiz et al, 2013;Eltas & Orbak, 2012a;Euzebio Alves et al, 2013;Hatipoglu et al, 2017;Rotundo et al, 2010;Üstün et al, 2018), and periodontal diagnosis was not reported in 1 article (Kelbauskiene et al, 2011).…”
Aim: To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non-surgical mechanical instrumentation alone in untreated periodontitis patients. Materials and Methods: Two focused questions were addressed using the Population, Intervention, Comparison and Outcome criteria as follows: in patients with untreated periodontitis, (a) does laser application provide adjunctive effects on probing pocket depth (PPD) changes compared with non-surgical instrumentation alone? and (b) does application of aPDT provide adjunctive effects on PPD changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Results of the meta-analysis are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines. Results: Out of 1,202 records, 10 articles for adjunctive laser and 8 for adjunctive aPDT were included. With respect to PPD changes, 1 meta-analysis including 2 articles (total n = 42; split-mouth design) failed to identify a statistically significant difference (WMD = 0.35 mm; 95%CI: −0.04/0.73; p = .08) in favour of adjunctive aPDT (wavelength range 650-700 nm). In terms of adjunctive laser application, a high variability of clinical outcomes at 6 months was noted. Two articles included patient-reported outcomes and 10 reported on the presence/absence of harms/adverse effects. Conclusions: Available evidence on adjunctive therapy with lasers and aPDT is limited by (a) the low number of controlled studies and (b) the heterogeneity of study designs. Patient-reported benefits remain to be demonstrated.
“…In seven articles, the use of local anaesthesia in conjunction with periodontal treatment was reported (Dereci et al, ; Eltas & Orbak, ; Euzebio Alves et al, ; Hatipoglu et al, ; Kamma et al, ; Matarese et al, ; Üstün et al, ); in one article, local anaesthesia was reported to be delivered if needed (Rotundo et al, ) whereas lack of information with respect to the use of local anaesthesia was observed in two articles (Dilsiz et al, ; Kelbauskiene et al, ).…”
Section: Resultsmentioning
confidence: 99%
“…The characteristics of the 10 articles evaluating the adjunctive use of laser are summarized in Table 2 (Dereci, Hatipoglu, Sindel, Tozoglu, & Üstün, 2016;Dilsiz, Canakci, & Aydin, 2013;Eltas & Orbak, 2012a;Euzebio Alves et al, 2013;Hatipoglu et al, 2017;Kamma, Vasdekis, & Romanos, 2009;Kelbauskiene, Baseviciene, Goharkhay, Moritz, & Machiulskiene, 2011;Matarese, Ramaglia, Cicciu, Cordasco, & Isola, 2017;Rotundo et al, 2010;Üstün, Hatipoglu, Daltaban, Felek, & Firat, 2018).…”
Section: Description Of Included Studiesmentioning
confidence: 99%
“…The percentage of females ranged from 33% to 67% and of males from 33% to 66%, respectively. Smokers were reported in 3 articles (Eltas & Orbak, 2012a;Kamma et al, 2009;Rotundo et al, 2010); smokers were excluded in 6 articles (Dilsiz et al, 2013;Euzebio Alves et al, 2013;Hatipoglu et al, 2017;Kelbauskiene et al, 2011;Matarese et al, 2017;Üstün et al, 2018). Two articles reported on patients diagnosed with aggressive periodontitis (Kamma et al, 2009;Matarese et al, 2017), 7 articles on patients diagnosed with chronic periodontitis (Dereci et al, 2016;Dilsiz et al, 2013;Eltas & Orbak, 2012a;Euzebio Alves et al, 2013;Hatipoglu et al, 2017;Rotundo et al, 2010;Üstün et al, 2018), and periodontal diagnosis was not reported in 1 article (Kelbauskiene et al, 2011).…”
Aim: To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non-surgical mechanical instrumentation alone in untreated periodontitis patients. Materials and Methods: Two focused questions were addressed using the Population, Intervention, Comparison and Outcome criteria as follows: in patients with untreated periodontitis, (a) does laser application provide adjunctive effects on probing pocket depth (PPD) changes compared with non-surgical instrumentation alone? and (b) does application of aPDT provide adjunctive effects on PPD changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Results of the meta-analysis are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines. Results: Out of 1,202 records, 10 articles for adjunctive laser and 8 for adjunctive aPDT were included. With respect to PPD changes, 1 meta-analysis including 2 articles (total n = 42; split-mouth design) failed to identify a statistically significant difference (WMD = 0.35 mm; 95%CI: −0.04/0.73; p = .08) in favour of adjunctive aPDT (wavelength range 650-700 nm). In terms of adjunctive laser application, a high variability of clinical outcomes at 6 months was noted. Two articles included patient-reported outcomes and 10 reported on the presence/absence of harms/adverse effects. Conclusions: Available evidence on adjunctive therapy with lasers and aPDT is limited by (a) the low number of controlled studies and (b) the heterogeneity of study designs. Patient-reported benefits remain to be demonstrated.
“…The range of the participant number were as follows: from 11 to 20 in two studies, 45 , 47 from 21 to 50 in eleven studies 42–44 , 46 , 48 , 49 , 51 , 53–56 and from 51 to 60 participants in two studies 50 , 52 ( Table 1 ), whereas the distribution of the subjects’ number according to gender is illustrated in Figure 2 for only 11 of the 15 studies, whereas four studies failed to document the gender of their participants. 45 , 47 , 52 , 56 Figure 2 Illustrates the percentage of the gender distribution according to the number of the recruited subjects.…”
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.
“…4 One common therapy in the treatment of periodontitis is the topical application of antimicrobial therapy and hyaluronic acid. 5,6 Hyaluronic acid (HA) can weaken the bonds of chronic inflammatory tissue cells with the result that they are readily released and replaced through the regeneration of healthy cells. It also produces antimicrobial effects on Aggregatibacter actinomycetemcomitans, Provotela oris, Porphyromonas gingivalis and Staphylococcus aureus.…”
Background: Repair of bone damage represents a fundamental issue in the treatment of periodontitis. The important indicator employed to monitor the bone damage repair process is the number of osteoblast cells. Achatina Fulica snail mucin (SM) contains glycosaminoglycans which have the potential to increase their number. However, the use of SM in dentistry remains limited. Purpose: To determine and prove the effect of SM gel in increasing the number of osteoblasts in rat models suffering from periodontitis. Methods: This study used 36 rat models divided into three groups, namely; a treatment group (T: 20% snail mucin gel, n = 12), a positive-control group (P: hyaluronic acid gel, n = 12) and a negative-control group (N: CMC-Na gel, n = 12). 0.2 ml of all material was applied to a pocket by means of a tuberculin syringe once a day for 14 days. Histologic observations using Haematoxylin-Eosin staining were carried out on days 3, 5, 7 and 14. Data was analyzed by two-way ANOVA followed by a post-hoc LSD. Results: A significant difference existed between the number of osteoblasts in the test groups. The highest number of osteoblasts observed was consistently that in the treatment group. Conclusion: The application of 20% snail mucin gel was effective in enhancing the number of osteoblasts in rats suffering from periodontitis.
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