Lasers in periodontal therapy

About 50 years ago, lasers started to be used in periodontal treatment following evidence that wounds produced in animals healed more quickly after being irradiated with low‐intensity lasers. Increased production of growth factors, stimulated mainly by red and infrared lasers, may participate in this process by influencing the behavior of various types of cells. High‐intensity lasers have been used as an alternative to nonsurgical periodontal therapy in root biomodification and to reduce dentin hypersensivity; low‐intensity lasers are frequently employed to improve tissue repair in regenerative procedures and in antimicrobial photodynamic therapy. Despite the abundance of promising data on the advantages of their use, there is still controversy regarding the real benefits of lasers and antimicrobial photodynamic therapy in periodontal and peri‐implant treatment. A huge variation in the parameters of laser application among studies makes comparisons very difficult. An overview of the current concepts and findings on lasers in periodontal therapy is presented with emphasis on data collected from Latin‐American researchers.     

Effectiveness of Laser Application for Periodontal Surgical Therapy: Systematic Review and Meta‐Analysis

Background: Evidence has shown some improved clinical outcomes and morbidity reduction with the use of lasers for non‐surgical periodontal therapy due to ablation, vaporization, hemostasis, and field sterilization. The purpose of this systematic review is to evaluate and compare studies involving lasers as monotherapy or adjunctive to surgical periodontal treatment. Methods: Electronic and manual searches were conducted by two independent reviewers in several databases for articles written in English up to December 2014. Articles were included in this review if they reported outcomes of surgical periodontal therapy with and without the use of lasers. The primary outcome was probing depth (PD), and secondary outcomes were measured changes in clinical factors such as clinical attachment level (CAL) and gingival recession (GR). For the comparative studies included, the pooled weighted mean difference (WMD) and 95% confidence interval (CI) of each variable were calculated using random‐effects meta‐analysis. Results: Eight and nine articles were included in the quantitative and qualitative analyses, respectively. Although low‐to‐moderate risk of bias was detected, high heterogeneity among studies was found. In flap surgery with or without laser treatment, there was no statistically significant difference in primary outcome. Similarly, in guided tissue regeneration (GTR)/enamel matrix derivative (EMD) with and without laser treatment, the WMD of PD was negligible; however, the GTR/EMD group showed better outcomes (P = 0.005) than the laser group. Regarding the secondary outcomes, in the flap surgery group, the WMD of CAL gain was 1.34 mm, and the WMD of GR was ?0.24 mm; no significant difference was detected between groups. In GTR/EMD with and without laser treatment, the WMD of CAL gain was 0.10 mm and the WMD of recession was ?0.18 mm; again, no significant difference was detected between groups. Conclusions: The available evidence is insufficient to support the effectiveness of dental lasers as an adjunct to resective or regenerative surgical periodontal therapy. However, precautions must be exercised when interpreting the results of this study because of the small sample size and high heterogeneity among studies.     

Lasers in minimally invasive periodontal and peri‐implant therapy

Laser therapy has the potential to be an effective, minimally invasive procedure in periodontal therapy. The aim of the present review was to survey the relevant literature on the clinical application of lasers as a minimally invasive treatment for periodontitis and peri‐implant disease. Currently, there are a large number of published clinical studies and case reports that evaluate the adjunctive use of diode, carbon dioxide, neodymium‐doped yttrium aluminium garnet (Nd:YAG), erbium‐doped yttrium aluminium garnet (Er:YAG) and erbium, chromium‐doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) lasers or antimicrobial photodynamic therapy for nonsurgical and minimally invasive surgical treatment of periodontal pockets. These procedures are expected not only to control inflammation but also to provide biostimulation effects with photonic energy. Recent meta‐analyses did not show statistically significant differences in pocket reduction and clinical attachment gain compared with mechanical debridement alone, although limited positive effects of adjunctive laser therapy were reported. At present, systematic literature approaches suggest that more evidence‐based studies need to be performed to support the integration of various laser therapies into the treatment of periodontal and peri‐implant diseases. The disparity between previous statistical analyses and individual successful clinical outcomes of laser applications might reveal the necessity of developing optimal laser‐treatment modalities of different wavelengths and better‐defined indications for each protocol.     

Periodontal and peri‐implant wound healing following laser therapy

Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO₂, neodymium‐doped yttrium‐aluminium‐garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft‐tissue management. With development of the erbium‐doped yttrium‐aluminium‐garnet (Er:YAG) and erbium, chromium‐doped yttrium‐scandium‐gallium‐garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft‐tissue management to hard‐tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri‐implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti‐inflammatory agents, phototherapy using lasers and light‐emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low‐ and high‐level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri‐implant diseases. This article discusses the outcomes of laser therapy in soft‐tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri‐implant treatment, focusing on postoperative wound healing of periodontal and peri‐implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.     

Clinical Effects of Potassium–Titanyl–Phosphate Laser and Photodynamic Therapy on Outcomes of Treatment of Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: The main objective of periodontal treatment is to control infection and thereby curb disease progression. Recent studies have demonstrated that adjunctive treatment procedures, such as laser irradiation or photodynamic therapy (PDT), may provide some additional benefit in the treatment of chronic periodontitis (CP). The aim of this randomized controlled trial is to clinically evaluate and compare the clinical effects of potassium–titanyl–phosphate (KTP) laser and PDT on outcomes of CP treatment. Methods: Twenty‐four patients with untreated CP were treated using a split‐mouth study design in which the teeth in each quadrant were randomly treated by scaling and root planing (SRP) alone (group A), PDT followed by SRP (group B), or KTP laser followed by SRP (group C). The periodontal pockets were exposed to a KTP laser with the following parameters: 0.8 W output power, 50 milliseconds time on/50 milliseconds time off, 30 seconds per irradiation at 532 nm and 11.7 J/cm² fluence, with a flexible fiberoptic tip with a diameter of 200 µm. The selected pockets were probed with a pressure‐controlled probe, guided by stents. Clinical periodontal parameters assessed included plaque index, gingival index, bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL), which were recorded at baseline and at 6 months after therapy. Results: Statistical analysis demonstrated no differences between groups at baseline for all parameters (P >0.05). All treatments yielded significant improvements in terms of BOP and PD decrease and CAL gain compared to baseline values (P <0.05). Group C showed a greater reduction in PD compared to the other groups (P <0.05). In addition, group C showed a greater CAL gain compared to the other groups (P <0.05). Conclusion: In patients with CP, clinical outcomes from conventional periodontal treatment of deeper pockets can be improved by using adjunctive KTP laser.     

Adjunctive Non‐Surgical Therapy of Inflamed Periodontal Pockets During Maintenance Therapy Using Diode Laser: A Randomized Clinical Trial

Background: Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin‐1β (IL‐1β) in patients receiving regular periodontal maintenance therapy. Methods: This single‐masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥5 mm with bleeding on probing (BOP). Fifty‐six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty‐eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL‐1β levels were measured immediately before treatment (baseline) and 3 months after treatment. Results: Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL‐1β levels between SRP + L and SRP alone were not statistically significant. Conclusion: In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥5 mm PD.     

Lasers in periodontics: a review of the literature

BACKGROUND: Despite the large number of publications, there is still controversy among clinicians regarding the application of dental lasers to the treatment of chronic periodontitis. The purpose of this review is to analyze the peer-reviewed research literature to determine the state of the science concerning the application of lasers to common oral soft tissue problems, root surface detoxification, and the treatment of chronic periodontitis. METHODS: A comprehensive computer-based search combined the following databases into one search: Medline, Current Contents, and the Cumulated Index of Nursing and Allied Health. This search also used key words. In addition, hand searches were done for several journals not cataloged in the databases, and the reference lists from published articles were checked. All articles were considered individually to eliminate non-peer-reviewed articles, those dealing with commercial laser technology, and those considered by the author to be purely opinion articles, leaving 278 possible articles. RESULTS: There is a considerable conflict in results for both laboratory studies and clinical trials, even when using the same laser wavelength. A meaningful comparison between various clinical studies or between laser and conventional therapy is difficult at best and likely impossible at the present. Reasons for this dilemma are several, such as different laser wavelengths; wide variations in laser parameters; insufficient reporting of parameters that, in turn, does not allow calculation of energy density; differences in experimental design, lack of proper controls, and differences in severity of disease and treatment protocols; and measurement of different clinical endpoints. CONCLUSIONS: Based on this review of the literature, there is a great need to develop an evidence-based approach to the use of lasers for the treatment of chronic periodontitis. Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. Current evidence does suggest that use of the Nd:YAG or Er:YAG wavelengths for treatment of chronic periodontitis may be equivalent to scaling and root planing (SRP) with respect to reduction in probing depth and subgingival bacterial populations. However, if gain in clinical attachment level is considered the gold standard for non-surgical periodontal therapy, then the evidence supporting laser-mediated periodontal treatment over traditional therapy is minimal at best. Lastly, there is limited evidence suggesting that lasers used in an adjunctive capacity to SRP may provide some additional benefit.     

Commentary: Is There Clinical Benefit From Using a Diode or Neodymium:Yttrium‐Aluminum‐Garnet Laser in the Treatment of Periodontitis?

Despite a quarter of a century of laser research, there is a persistent debate regarding the efficacy of dental lasers in the treatment of periodontitis or periodontal maintenance therapy. There are many claims and much hyperbole surrounding the use of lasers, either as a monotherapy or adjunctive to scaling and root planing, to treat periodontitis. There is little evidence that using a diode or neodymium:yttrium‐aluminum‐garnet laser adds clinical value over and above conventional non‐surgical or surgical periodontal treatment. There is a significant need for better designed human clinical trials. Data from such trials should be analyzed according to initial probing depth and characteristics of the treated sites, such as non‐molar, molar flat surfaces, and molar furcations, and evaluated for long‐term post‐treatment results.     

Infrared lasers for the treatment of moderate to severe periodontitis: An American Academy of Periodontology best evidence review

1 Background

This systematic review assesses the efficacy of infrared laser therapy used alone or as an adjunct to nonsurgical or surgical periodontal therapy, on clinical and patient‐centered outcomes in patients with periodontitis.

2 Methods

Randomized clinical trials (RCTs) with a follow‐up duration ≥3 months that evaluated root surface debridement (i.e., scaling and root debridement with or without surgical access) to laser therapy alone or laser therapy plus root surface debridement for the treatment of adult patients (≥18 years old) with moderate to severe aggressive or chronic periodontitis were considered eligible for inclusion. The MEDLINE, EMBASE and CENTRAL databases were searched for articles published up to and including March 2016. Random effects meta‐analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences (MDs) with their associated 95% confidence intervals (CIs). Additionally, summaries are presented of the included RCTs, critical remarks of the literature and evidence quality rating/strength of recommendation of laser procedures.

3 Results

Of the 475 potentially eligible articles, 28 were included in the review. Individual study outcomes and seven sets of meta‐analysis (1 for the nonsurgical treatment of AgP and 9 for nonsurgical and surgical treatment of CP) showed a benefit of laser therapy in improving clinical attachment level (CAL) and probing depth (PD). However, the comparative differences in clinical outcomes were modest (< 1 mm) and the level of certainty for different therapies was considered low‐to‐moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the Strength of Clinical Recommendations of laser therapies were considered weak or based on expert opinion.

4 Conclusions

In patients with moderate to severe periodontitis, the nonsurgical treatment of AgP and CP by SRP plus infrared diode laser, and the surgical treatment of CP by Er:YAG laser therapy alone may promote statistically significant improvements in PD and CAL. However, these gains are relatively small (< 1 mm) and provide modest clinical relevance compared with SRP alone.     

Laser therapy for treatment of peri‐implant mucositis and peri‐implantitis: An American Academy of Periodontology best evidence review

1 Background

Peri‐implant diseases are prevalent, with numerous therapies studied in an attempt to combat this condition. The present review aims to systematically evaluate the effectiveness of laser therapy with non‐surgical or surgical therapy in managing peri‐implant mucositis and peri‐implantitis.

2 Methods

An electronic search of three databases and a hand search of peer‐reviewed journals for relevant articles published (in English) from January 1980 to June 2016 were performed. Human clinical trials of ≥ 10 patients with peri‐implant diseases, treated with surgical or non‐surgical approaches and laser therapy, and a follow‐up period of ≥ 6 months, were included. Random‐effects meta‐analyses were performed to analyze weighted mean difference (WMD) and confidence interval for the recorded variables according to PRISMA guidelines. Risk of bias assessment was also performed for randomized controlled trials included.

3 Results

From 22 articles selected, 11 were included in the meta‐analyses. The outcomes of using lasers as a monotherapy could not be evaluated since no controlled studies were identified. Therefore, all reported results were the outcomes of applying lasers as an adjunct to surgical/non‐surgical treatment. For the non‐surgical approach, WMD of probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI), marginal bone level (MBL) and recession (REC) was 0.15 mm (P = 0.50), ?0.10 mm (P = 0.32), 21.08% (P = 0.02), ?0.07 (P = 0.002), ?0.22 mm (P = 0.04) and ?0.11 mm (P = 0.34), respectively. For the surgical approach with a long‐term follow up, WMD of PD, CAL, BOP, and PI was 0.45 mm (P = 0.11), 0.22 mm (P = 0.56), 7.26% (P = 0.76) and ?0.09 (P = 0.84), respectively.

4 Conclusions

Current evidence shows laser therapy in combination with surgical/non‐surgical therapy provided minimal benefit in PD reduction, CAL gain, amount of REC improvement, and PI reduction in the treatment of peri‐implant diseases. Lasers when used as an adjunct to non‐surgical therapy might result in more BOP reduction in the short term. However, current evidence allowed for analysis of only Er:YAG, CO₂, and diode lasers. Studies on others failed to have controlled evidence supporting their evaluation.     

Antimicrobial photodynamic therapy for the treatment of periodontitis and peri‐implantitis: An American Academy of Periodontology best evidence review

1 Background

This systematic review evaluates the efficacy of antimicrobial photodynamic therapy (aPDT), as an adjunct to non‐surgical or surgical therapy, on clinical and patient‐centered outcomes in patients with periodontitis or peri‐implantitis.

2 Methods

Randomized controlled trials (RCTs) with a follow‐up duration ≥ 3 months that evaluated mechanical root/implant surface debridement (i.e., scaling and root planing [SRP] or implant surface scaling [ISS]) versus SRP or ISS plus aPDT for the treatment of adult patients (≥ 18 years old) with moderate‐to‐severe chronic (CP)/aggressive periodontitis (AgP) or peri‐implantitis, respectively, were considered eligible for inclusion. The MEDLINE, EMBASE, and CENTRAL databases were searched for articles published up to and including March 2017. Random‐effects meta‐analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences with their associated 95% confidence intervals. Additionally, summaries are presented of the included RCTs, critical remarks of the literature, and evidence quality rating/strength of recommendation of laser procedures.

3 Results

Of 729 potentially eligible articles, 28 papers (26 studies) were included in the review. Individual study outcomes and four sets of meta‐analysis showed potential statistical significant benefit of aPDT in improving clinical attachment level (CAL) (non‐surgical treatment of AgP) and probing depth (PD) (non‐surgical treatment of AgP and CP). However, the comparative differences in clinical outcomes were modest (< 1 mm), and the level of certainty for different therapies was considered low‐to‐moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the strengths of clinical recommendations of aPDT were guided by the expert opinion.

4 Conclusions

aPDT may provide similar clinical improvements in PD and CAL when compared with conventional periodontal therapy for both periodontitis and peri‐implantitis patients. The restricted base of evidence for some treatment approaches and conditions precludes additional conclusions.     

Diode Laser as an Adjunctive Treatment for Peri-implant Mucositis: A Systematic Review and Meta-analysis

The early detection and management of peri-implant mucositis may help in reducing inflammatory parameters and arrest disease progression to peri-implantitis. The potential therapeutic benefits of different adjunctive therapies, such as the diode laser, are still not completely understood. The objective of this systematic review and meta-analyses was to assess the outcomes of using diode laser on the management of peri-implant mucositis in terms of changes in periodontal parameters. Electronic databases were searched to identify randomised controlled trials (RCTs) that compared the combined use of mechanical debridement and diode laser with mechanical debridement alone. A specific risk-of-bias tool was used to assess the risk of bias. Data were analysed using a statistical software programme. In total, 149 studies were found. A meta-analysis of 3 RCTs showed no statistically significant differences in probing pocket depths (mean difference [MD], ?0.36; 95% confidence interval [CI], ?0.88 to 0.16; P = .18) or bleeding on probing (MD, ?0.71; 95% CI, 1.58–0.16; P = .11) between the 2 groups at 3 months. In the management of peri-implant mucositis, the combined use of diode laser and mechanical debridement did not provide any additional clinical advantage over mechanical debridement alone. Long-term, well-designed RCTs are still needed.     

Effects of Er:YAG laser on periodontal therapy

The use of the laser in dentistry has been widening due to its increasing use in surgery and medicine. In the field of periodontology, the most commonly used lasers have been CO2 and Nd:YAG lasers. According to the last reviews reporting the use of lasers in periodontal therapy, these lasers were considered unsuitable for dental treatment, due to various shortcomings, such as the carbonization and severe thermal damages caused on the target and surrounding tissues, and therefore their use has been confined to soft tissue procedures. Technological advances and improvements have increased the choices of the available laser systems. Among them, Er:YAG lasers seem to be of promising use. The Er:YAG laser is a solid-state crystal laser operating in the infrared wavelength (2,940 nm). Due to its high absorbability in water and hydroxyapatite, several studies have shown the effectiveness of this laser for both hard and soft tissue ablation, and its bactericidal effects with less or even no pain under clinical applications. The variety of the potential applications for this laser has been studied and the interest about its use in dental practice has increased among practitioners. This review includes studies regarding the use of Er:YAG laser on hard tissue procedures, such as calculus removal and osseous surgery as well as soft tissue management, like gingivectomy, gingival curettage and melanin removal.     

Combined photodynamic and low‐level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis

Lui J, Corbet EF, Jin L. Combined photodynamic and low‐level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis. J Periodont Res 2011; 46: 89–96. © 2010 John Wiley & Sons A/S Background and Objective: In recent years, there has been a growing interest in the use of dental lasers for treatment of periodontal diseases. The purpose of this short‐term clinical trial was to evaluate the effects of a combination of photodynamic therapy with low‐level laser therapy as an adjunct to nonsurgical treatment of chronic periodontitis. Material and Methods: Twenty‐four nonsmoking adults with untreated chronic periodontitis were randomly assigned in a split‐mouth design to receive scaling and root debridement with or without one course of adjunctive photodynamic therapy and low‐level laser therapy within 5 d. Plaque, bleeding on probing, probing depth and gingival recession were recorded at baseline, 1 and 3 mo after the treatment. Gingival crevicular fluid was collected for assay of interleukin‐1β levels at baseline, 1 wk and 1 mo. Results: The test teeth achieved greater reductions in the percentage of sites with bleeding on probing and in mean probing depth at 1 mo compared with the control teeth (p < 0.05). A significant decrease in gingival crevicular fluid volume was observed in both groups at 1 wk (p < 0.001), with a further decrease at 1 mo in the test sites (p < 0.05). The test sites showed a greater reduction of interleukin‐1β levels in gingival crevicular fluid at 1 wk than the control sites (p < 0.05). No significant differences in periodontal parameters were found between the test and control teeth at 3 mo. Conclusions: The present study suggests that a combined course of photodynamic therapy with low‐level laser therapy could be a beneficial adjunct to nonsurgical treatment of chronic periodontitis on a short‐term basis. Further studies are required to assess the long‐term effectiveness of the combination of photodynamic therapy with low‐level laser therapy as an adjunct in nonsurgical treatment of periodontitis.     

Why is there a lack of evidence regarding errors and complications in periodontal and implant therapy?

The occurrence of errors, complications, and adverse effects may occur as a consequence of single or multiple events related to the clinician and/or patient. Apparently, the amount of dental literature on these undesirable outcomes has not been as prolific as that obtained for conventional primary periodontal outcome measures. This review explores the potential reasons for the lack of studies reporting on errors and complications in periodontal and implant therapy, as well as other noteworthy methodological aspects, to enlighten their impact on the selection of the best (or most appropriate) “gold standard” periodontal/implant-related treatment options, and on the overall decision-making process. The following points were addressed: (a) the importance of reporting errors and complications in clinical research; (b) the adequate reporting of errors and complications in periodontology and dental implantology; and (c) efficacy trials vs effectiveness studies and their impact on the assessment and report of periodontal and implant treatment-related risks and complications.     

Clinical Outcomes of Using Lasers for Peri‐Implantitis Surface Detoxification: A Systematic Review and Meta‐Analysis

The aim of this systematic review is to compare the clinical outcomes of lasers with other commonly applied detoxification methods for treating peri‐implantitis. An electronic search of four databases and a hand search of peer‐reviewed journals for relevant articles were conducted. Comparative human clinical trials and case series with ≥6 months of follow‐up in ≥10 patients with peri‐implantitis treated with lasers were included. Additionally, animal studies applying lasers for treating peri‐implantitis were also included. The included studies had to report probing depth (PD) reduction after the therapy. Results: Seven human prospective clinical trials and two animal studies were included. In four and three human studies, lasers were accompanied with surgical and non‐surgical treatments, respectively. The meta‐analyses showed an overall weighted mean difference of 0.00 mm (95% confidence interval = ?0.18 to 0.19 mm) PD reduction between the laser and conventional treatment groups (P = 0.98) for non‐surgical intervention. In animal studies, laser‐treated rough‐surface implants had a higher percentage of bone‐to‐implant contact than smooth‐surface implants. In a short‐term follow‐up, lasers resulted in similar PD reduction when compared with conventional implant surface decontamination methods.     

Salivary microbial levels in relation to periodontal status and caries development

Iwano Y, Sugano N, Matsumoto K, Nishihara R, Iizuka T, Yoshinuma N, Ito K. Salivary microbial levels in relation to periodontal status and caries development. J Periodont Res 2010; 45: 165–169. © 2010 John Wiley & Sons A/S Background and Objective: Although an inverse relationship between caries and periodontal disease has been suggested, some studies have reported a positive correlation between periodontal disease and the decayed, missing and filled teeth (DMF) index. The aim of the present study was to examine the relationship between caries and periodontal disease. Material and Methods: We assessed the clinical parameters and salivary levels of Porphyromonas gingivalis and Streptococcus mutans using real‐time polymerase chain reaction in 40 subjects with varying degrees of caries and periodontal disease. Results: The salivary levels of S. mutans were significantly higher in the periodontally healthy group than in the periodontitis group. The salivary levels of P. gingivalis were significantly higher in the caries‐free group than in the periodontally healthy group with caries. The salivary levels of S. mutans were significantly increased after the initial periodontal treatment. Conclusions: This study showed that an inverse relationship exists between periodontitis and caries in terms of the clinical and bacteriological findings.     

Long‐Term Evaluation of Periodontal Parameters and Implant Outcomes in Periodontally Compromised Patients: A Systematic Review

Background : The aim of this systematic review is to evaluate the long‐term outcomes of patients with periodontitis submitted to periodontal therapy/maintenance and implant placement. Methods: Studies reporting clinical and/or long‐term implant outcomes from partially edentulous patients with periodontitis who were treated and followed periodontal maintenance for ≥5 years were considered eligible for the review. Screening of the articles, data extraction, and quality assessment were conducted independently and in duplicate. Results: Search of MEDLINE, EMBASE, and CENTRAL databases resulted in 959 papers, and of them 931 were excluded after title/abstract assessment. The full texts of 28 potentially eligible publications were screened, but only 10 studies met inclusion criteria. Most of the included studies (77.8%) presented a medium/high methodologic quality. The results demonstrated that patients with a diagnosis of periodontitis had satisfactory implant outcomes. Implant survival was high (92.1%) within studies reporting 10 years of follow‐up. Parameters related to probing depth, clinical attachment level, and bone loss around teeth increased the occurrence of peri‐implantitis and implant loss. Non‐attendance to periodontal maintenance and smoking habits were also associated with less favorable implant outcomes. Conclusions: This systematic review confirmed that implant therapy can be successfully used in patients with a diagnosis of periodontitis who underwent proper therapy and regular periodontal maintenance. Residual pockets, non‐attendance to the periodontal maintenance program, and smoking were considered to be negative factors for the long‐term implant outcomes.     

Effect of Nd: YAG laser irradiation on the treatment of oral malodour associated with chronic periodontitis

AIM: To investigate, using a randomised-controlled, single clinical trial whether treating periodontitis with non-surgical periodontal treatment procedures and laser applications can decrease the effect of oral malodour and compare the effectiveness of the different therapies. METHODS: Sixty patients suffering from chronic periodontitis and complaining of oral malodour were included in the study. The parameters measured included organoleptic scoring, volatile sulphur compound (VSC) levels, gingival index, plaque index, probing depth and clinical attachment levels before and after the different treatment procedures (oral hygiene instructions, scaling-root planing-SRP and subgingival Nd: YAG laser irradiation). RESULTS: There were significant relationships between oral malodour and the specific periodontal parameters. For all patients, there were statistically significant (p < 0.05) decreases in the clinical index scores and VSC values after all treatments. Although the VSC values decreased in all groups after treatment, laser treatment alone did not cause as large decreases as that achieved by SRP and SRP + laser irradiation. CONCLUSION: The results confirmed that in the population studied, oral malodour levels were significantly reduced after treating chronic periodontitis. The data indicated a possible adjunctive role for Nd: YAG lasers in periodontal therapy and treatment of oral malodour.     

A Systematic Review and Meta-analysis of Clinical,Immunological, and Microbiological Shift in Periodontitis After Nonsurgical Periodontal Therapy With Adjunctive Use of Probiotics

ObjectivesThere is a lack of evidence regarding long-term effects of probiotics as adjuncts to nonsurgical periodontal therapy (NSPT) in the management of periodontitis. Therefore, this systematic review aimed to evaluate the clinical, microbiological, and immunological outcomes of probiotics applied as an adjunct to NSPT with at least 3 months of follow-up.MethodsElectronic searches of 5 databases were performed. Clinical trials that compared the adjunctive use of probiotics in NSPT with NSPT alone, reporting clinical or immunological or microbiological outcomes, were selected. The primary clinical outcome variables were clinical attachment level (CAL) and probing pocket depth (PPD). Meta-analyses were conducted to evaluate the efficacy of probiotics over different longitudinal intervals.ResultsTen randomized controlled trials were included, and high heterogeneity in methods was noted. Meta-analysis revealed CAL gain, and PPD reduction in the probiotics group was significant at 3 months and 12 months, but no significant difference was noted at 6 months and 9 months. There was no significant difference in periodontal pathogen levels between groups at 3 months. Immunological data were not sufficient for quantitative analysis. Ancillary sensitivity analysis indicated a subset of studies with severe mean baseline PPD (≥5 mm) at baseline showed significant and more CAL gain and PPD reduction at 3 months, with probiotics administration of 2-4 weeks.ConclusionHeterogenous evidence implied a long-term clinical benefit of probiotics as an adjunct to NSPT. Outcomes may be impacted by baseline disease severity. Limited microbiological and immunological data precluded any conclusive findings. Current evidence is insufficient to formulate clinical recommendations.