Periodontal treatment with a low-level diode laser: clinical findings

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Periodontal witha low-level treatment findings diodelaser:Clinical Nikola DDS,MS,PhD. Snezana Angelov, Pesevska, DDs,MS,PhD. MariaNakova, DD5,M5,PhD lckoGjorgoski, PhD. Kirolvanovski, DDS,MS,PhD. Dragana Angelova, DDS' OliverHoffmann, DDS,MS Sebastiano Andreana, DDS Thisstudyassessed theeffects of low-level laser in treatment g R Pi n) p a ti ents c om binat ion wit hs c a l i nagn dro o tp l a n i n(S w i th periodontitis. periodontitis Sixtysubjects withchronic advanced (n = 20)after groups wereassigned randomly to threetreatment gingiv calli n i c p rs . uA c ollec t ing aa l ra m e teGro p re c e i ved SRP on quadrant perdayforfourconsecutive a single onthefifth days; day,allquadrants wererescaled, Group B received thesame treatment asGroup A, followed bylaser application forfivedays. G r oup C r ec eiv e thdes a me tre a tmeanstGro u B p b u tth el aser wasad m i n i s tefo t r eat m ent rerda to taol f 1 0d a y sF. o rG roups B andC,a low- l e vdeilo d el a s e(6 r 3 0 -6 7 n0 m)w a su s ed. The

is a chronic, dental lleriodontitis Rl"que-induced inf ammatorv |/ I diseaseof the tissuesthat support teeth, a condition that leads to a gradual loss of connective tissue

pl aque gi ngi val i ndex, i ndex, andsul cul bl areedi ng i ndex w ere recorded foral lgroups. parameters, Forallclinical allthreegroups reported statistically (p< 0.005) significant differences compared to baseline data. Compared A, Groups to Group BandC showed statistically parameters. improvement forallclinical significant These findings suggest thata low-level diodelaser canhavea beneficial effect for periodontitis. treating inflammatory chronic advanced Received: 26,2008 September Accepted: November 10,2008

bacteria.22Red spectrum laser light

Materials andmethods

used under specific conditions can acceleratewound healing.r3It has

Sixty generally healthy subjects were enrolled in this clinical study.

been reported that laser-enhanced

Patients were excluded from this study if they were smokers,had fewer than 20 teeth, had uncon-

attachment and alveolar bone. Dentists have a plethora of surgical

biostimulation producesmetabolic changeswithin the host cells, which results in faster cell division, rapid

and nonsurgical modalities for

matrix production, and cell move-

trolled diabetes,had infectious diseases,had used antibiotics in the

treating infammatory periodontal diseases.rThe efficacy of subgingival scaling and root planing (SRP)

ment.2'rOne additional feature of

last three months. needed antibiotic

laser application is its abiliry to

prophylaxis, had used anticoagu-

de-epithelialize the periodontal The carbon dioxide laser pocket.2a-26

lants, or had any diseasesknown to impair healing. All 60 participants had been diagnosed previously with

has been demonstrated in numerous clinical studies.2-5 In recent years, numerous in uitro and in uiuo studies have been conducted concerning laserapplications in dentistry, especiallyin the field of

has been shown to eliminate sulcular and gingival (external) epithelium without disturbing the underlying Few controlled connective tissue.2a-26 studies have enrolled adequate

chronic advanced periodontitis and SRP was already planned. After an initial screeningand collection of clinical parametersat baseline,patients were randomly

periodontology; these studies have included a diverse range of laser sys-

numbers of human subjectsand

tems.6-2r'Whentreating infammatory periodontal diseases,lasersmay

helium-neon laserbiostimulation for

assignedto three treatment groups (n = 20). The clinical parameters

treatment of periodontal disease. This prospective randomized clini-

used for this study were the plaque index (PI), the gingival index (GI),

cal study sought to evaluate how low-level laser treatment (LLLT),

and the sulcular bleeding index (SBI;.27'28 All patients received

laser therapy, in combination

in combination with SRB affected

with scaling, supports healing of

patients with chronic advanced

treatment from an experienced periodontist (SP).Clinical indices

periodontal pockets by eliminating

periodontitis.

were assessedby two previously

2009 September/October

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contribute to the bacterial reduction in periodontal pockets. Moritz et al reported that diode

510

evaluated the beneficial effects of

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r calibrated periodontists (KI, MN) in a blinded manner. Group A received SRP on a single quadrant per day for four consecutive days. On the fifth day, all quadrants were rescaled. Following the same time schedule,Group

T a b l e1 . C l i n i c aP l l ( r S D )f o l l o w i n g S R Pa n d a d j u n c tl a s e rt r e a t m e n t .

Group A (0,74) 2.36 1.2(0.4).

Baseline Aftertreatment

B Group C Group (0.74) (0.74) 2.36 2.36 (0.44).t 0.71 (0.61) . t 0.77

B received the same treatment as

* Statistically to combined baseline data difference compared significant t Statistically to Group A significant difference compared

Group A plus laser application once a day for five days once SRP was completed. Group C followed the same protocol as Group B, except that the laser treatment was

T a b l e2 . C l i n i c aG l l ( t S D )f o l l o w i n g S R Pa n d a d j u n c tl a s e rt r e a t m e n t .

administered once a day for 10 consecutive days. All subjects followed standardized oral hygiene instructions during the length of the study and care was taken to achieve an adequate level of self-administered oral hygiene before the start of

Group A (0.s1) 2.43 (0.46). 1.07

Baseline Aftertreatment

B Group (0.s1) 2,43 (0.4q.r 0.77

Group C (0 . sl) 2.43 0.5(0. 65) . t

- Statistically baseline data difference compared to combined significant t Statistically to Group A significant difference compared

treatment. For Groups B and C, the tip of a low-level diode laser (630-670 nm) was applied vertically to the long

T a b l e3 . C l i n i c a5l B l( t S D )f o l l o w i n g S R Pa n d a d j u n c tl a s e rt r e a t m e n t .

axis of the tooth in all interdental spacesfor 15 secondsin continuous mode on both facial and lingual

Baseline

surfaces,with a light contact on the tissue.At each visit, laser treatment was performed on all oral sites

Group A 2.21(0.43) 0.61(0.72Y

Aftertreatment

B Group 2.21(0.43) (0.44).t 0.23

C Group 2,21(0.43) (0.36) . 1 0.14

. Statistically data compared to combined baseline significant difference t Statistically A significant difference compared to Group

for approximately 16 minutes per mouth (4 minutes per quadrant) so that at each visit, patients in Groups B and C receivedlaser energy equal to I J/cm2. Clinical parameters (PI, GI, and SBI) were

decreasecompared to Group A. All three groups showed a

shown to contribute significantly to bacterial reduction in periodontd

significant decreasein GI and

obtained again from the subjects at the conclusion of treatment.

SBI compared to the combined pre-treatment value (seeTables

Conversely, Radvar er pockets.2e'3o a/ demonstrated that SRP can yield

Pairwise statistical analysiswas conducted (/ < 0.05).

2 and 3). h addition, Groups B

Results For all three groups, the results from the PI analysis are presented in Table 1. All three groups demonstrated a statistically significant decreasein PI following periodontal treatment, compared to the combined data of all participants before treatment. Groups B and C displayed a significantly higher PI

bemer clinical results than laser treatment alone.'il A 1995 study by Finkbeiner reported that an argon

and C demonstrated a significant difference in terms of the amount that these indices decreasedwhen compared to Group A.

laser resulted in periodontal reduction of pocket depth ranging from

Discussion Although the clinicd application of

probing was reducedby 75o/o;however, the study presented no data from control groups and all pockets

lasersin the ueatment of periodon-

were scaled and root planed prior to

titis is well-documented, previous studies have not always produced

laser treatment.32 Using a diode laser to treat infammatory periodontitis has

similar results. The Nd:YAG laser in combination with SRP has been

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1.6-3.3 mm, while bleeding on

been describedin the literature.rs're

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2009 September/October

511

Lasnn Tne RApy Periodontal treatmentwith a diodelaser

In a recent study, LLLI was shown to be an effective adjuvant to con-

may be due to the antimicrobial

ventional periodontitis treatment

low-level laser irradiation reported previously.r8These results contradict

and anti-infammatory effect of

in immunosuppressedrats.33Conversely, Ribeiro et al demonstrated

a2005 study that reported no significant differences in PI, GI,

that using the diode laser as a supplement to subgingival SRP did not

bleeding on probing, or the sulcus fuid flow rate in patients who

provide any apparent clinical benefit for teeth with shallow to moderate

treatment of inflammatory periodontitis is a safe clinical procedure that can be utilized as an adjunct to conventional SRP.

Conclusion LLLI

in combination with SRP in patients with periodontitis can significantly improve the clinical

pockets.3aA 2005 lirerature review

received laser therapy as an adjunct to SRP treatment.3sHowever, that

reported possible beneficial effects

study reported a greater reduction in

parameters indicative of the infammatory state of periodontal tissues.

of laser therapy, including in uitro

tooth mobiliry and probing depths,

Although mechanical debridement

stimulation of fibroblasts, in uiuo reduction of periodontal pathogens,

which was attributed to the deepithelialization of the periodontal

remains the mainstay of periodontal

and a decreasein infammatory mediators.35

pockets enhancing the connective tissueattachment.3s

of low-level lasersmay represent a valuable additional tool when the

A2002 study byPereira et al

Vithin

the limitations of the

diseasetreatment, the adjunctive use

goal of treatment is improvement of the gingival response.

reported that LLLT stimulates fibroblast proliferation without

present study's design, it is important to note that the immediate

impairing procollagen synthesis.36 As a result, low-level laserspre-

statistically significant reduction of gingival parameters may result from

Authorinformation

dominandy are used to enhance cell activiry and improve inflammatory outcomes. Recently, Igic

more than one factor. Compared

Department of Periodontics, Loma Linda University School of Dentistry

et al reported that LLLT used in

period of observation, which sug-

in Loma Linda, California, where Dr. Hoffrnann is an associateprofes-

addition to conventional treatment helped to resolve chronic gingivitis in children.3TAdditional studies are necessaryto determine the clinical

geststhat prolonged administration of oral hygiene might have played

sor and Dr. Andreana is a professor. Dr. Pesevskais assistantprofessor,

a role in reducing the gingival

Department of Ord Pathology, University Sts. Cyril and Methodius, Skopje, Macedonia, where Dr. Nakova is a professor; Dr. Gjorgoski

to Group A, the data for Groups B and C were collected after a longer

relevanceof these findings. The present study sought to

Paramerers. The literature has demonstrated that LLLI has a direct role in soft

evaluate the gingival infammatory responseand possible dental plaque

tissue healing. A2009 study by Al'Watban et al showed that diabetic

reduction following treatment with

rats receiving LLLI demonstrated a marked improvement in burn

SRP and LLLT. The results of this study showed an immediate decrease in the evaluated clinical indices (PI, GI, and SBI) after periodontal therapy that included SRP and lowlevel diode laser irradiation. These decreasessuggestthat the low-level

healing.3ePosten et al indicated that LLLT has been shown to stimulate soft tissue wound healing; however, larger scaleclinical studies that correlate cellular effects and biologic processesare needed.ao

laser may have a beneficial effect

Further researchis needed to

when used to treat infammatory

determine whether the improved

chronic advanced periodontitis.

clinical parameters in this study are

The groups that received laser irradiation demonstrated improve-

due to bacterial reduction in the

ment in all observed clinical

periodontal pockets and to determine which immunological aspects

indices compared to the group

of the infammatory responseare

that received SRP alone. The

affected by low-level laser irradia-

significant reducrion in the clinical indices in the laser-treatedgroups

a low-level diode laser for the

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don. The authors believe that using

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Dr. Angelov is an associateprofessor,

is a professor,Institute of Biology, Faculty of Natural Sciencesand Mathematics; and Dr. Ivanovski is an assistantprofessor,Department of Oral Pathology and Periodontology.

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