Bactericidal effect of erbium YAG laser on periodontopathic bacteria

Current status of Er:YAG laser in periodontal surgery

Lasers have numerous advantageous tissue interactions such as ablation or vaporization, hemostasis, bacterial killing, as well as biological effects, which induce various beneficial therapeutic effects and biological responses in the tissues. Thus, lasers are considered an effective and suitable device for treating a variety of inflammatory and infectious conditions of periodontal disease. Among various laser systems, the Er:YAG laser, which can be effectively and safely used in both soft and hard tissues with minimal thermal side effects, has been attracting much attention in periodontal therapy. This laser can effectively and precisely debride the diseased root surface including calculus removal, ablate diseased connective tissues within the bone defects, and stimulate the irradiated surrounding periodontal tissues during surgery, resulting in favorable wound healing as well as regeneration of periodontal tissues. The safe and effective performance of Er:YAG laser-assisted periodontal surgery has been reported with comparable and occasionally superior clinical outcomes compared to conventional surgery. This article explains the characteristics of the Er:YAG laser and introduces its applications in periodontal surgery including conventional flap surgery, regenerative surgery, and flapless surgery, based on scientific evidence from currently available basic and clinical studies as well as cases reports.

Effect of Er: YAG laser therapy in non-surgical periodontal treatment: an umbrella review

AIM

The current umbrella review aimed to summarize the effect of erbium-doped yttrium aluminum garnet (Er: YAG) laser adjunct with the conventional non-surgical periodontal treatment which was evidenced from available systematic reviews.

METHODS

An extensive literature search was piloted by two independent reviewers in the PubMed, Scopus, Science Direct, and Google Scholar databases. The search was limited to the English language from 2011 to 2023 years. The methodological quality of systematic reviews 2 (AMSTAR 2) guideline was followed to evaluate the risk of bias for the selected studies. Cohen's kappa statistic was implemented to evaluate the level of agreement to assess the risk of bias in the selected studies.

RESULTS

A total of 472 studies were initially identified. After removing the duplicates and screening, a total of four studies were selected for the current overview. Based on the quality assessment tool, each study scored as high, moderate, low, and critically low-quality study following AMSTAR 2 tool. Inter-rater reliability by Cohen's Kappa statistics showed near-perfect agreement (0.95) between the two reviewers.

CONCLUSION

Even though weak evidence of effectiveness was observed for Er: YAG laser application in non-surgical periodontal treatment, the clinical benefits are still lacking.

Therapeutic solutions for anterior restorations in disabled patients: Systematic review and case report

INTRODUCTION

Treating anterior restorations is a real challenge for a dentist and conventional protocols are not always applicable. The aim of this study is to determine different therapeutic to conducting anterior restorations in disabled people.

CASE REPORT

We begin by presenting the case of a 23-year-old, handicapped man, who was brought in consultation to compensate for the loss of the left upper central incisor (#21).

MATERIALS AND METHODS

We then performed a systematic literature review in December 2022, in accordance with the PRISMA guidelines. The publications, on three databases, dealing with dental treatments on disabled people were selected whether they were clinical studies or case reports.

RESULTS

In the end, 14 publications were included. Most of the treatments described in the studies (n = 10; 71.43%) concern people aged under 19. The patients present different types of handicaps with various degrees of severity and the oral diseases described are as heterogeneous as the handicaps retrieved.

DISCUSSION

It is therefore difficult to make common treatment recommendations for all these variable profiles and situations. Most of patients in this study are very young, so there is a need for preventive and therapeutic care as earlier as possible, to preserve the vitality of their teeth and dental occlusion.

High-Power Laser Application for Immediate Implant Placement in Infected Sites: A Systematic Review

Objective: The purpose of this study was to review the literatures regarding the treatment outcomes of applying laser to the infected sites in immediate implant placement. The review tended to primarily target a question: does applying high-power laser have any positive effect on infected sites in immediate implant placement? Background: Although immediate placement of dental implants has been referred to as a predictable and successful procedure, it is prone to the presence of infection that interferes with the healing process, and triggers the failure of implants. Materials and methods: A thorough electronic database search was conducted on PubMed/Medline, Embase, Web of Science, Google Scholar, and the Cochrane library in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two writers worked separately on screening the eligible studies, assessing whether there was a risk of bias, and extracting the required data. Results: Five out of the 60 studies nominated by the database search matched the inclusion criteria. The studies were carried out on a total of 192 patients with 296 implants in all. Ultimately, the study focused on 245 implants whose infected bed had been already decontaminated and prepared with the help of the high-intensity laser, used either alone or in combination with other approaches before implantation. With only nine failures, the implants inserted in infected and irradiated areas had a 96.3% overall survival rate. Conclusions: Taking the limitations of the review into account, the authors arrived at the conclusion that high-power laser irradiation can be beneficial for immediate implant placement in infected sites.

Er:YAG laser-assisted comprehensive periodontal pocket therapy for residual periodontal pocket treatment: A randomized controlled clinical trial

BACKGROUND

This study evaluated the effectiveness of a novel pocket therapy (Er:YAG laser-assisted comprehensive periodontal pocket therapy [Er-LCPT]) for residual pocket treatment, compared with conventional mechanical treatment alone, in a randomized controlled clinical trial.

METHODS

Two sites in 18 patients having residual periodontal pockets of ≥5 mm depth, extant following initial active therapy, or during supportive therapy, were randomized into two groups in a split mouth design: the control group received scaling and root planing (SRP) by curette, and the test group received Er-LCPT using curette and laser. With Er-LCPT, after root debridement, inflamed connective tissue on the inner gingival surface and on the bone surface/within extant bone defects was thoroughly debrided. Furthermore, removal of proximate oral epithelium and coagulation of the blood clot in the pocket entrance were performed with laser. Clinical parameters were evaluated, before and after treatment, through 12 months.

RESULTS

Both groups showed significant improvements in clinical parameters. With Er-LCPT, pocket debridement was thoroughly and safely performed, without any adverse side effects and complications, and favorable healing was observed in most of the cases. At 12 months, Er-LCPT demonstrated significantly higher probing pocket depth reduction (2.78 mm vs. 1.89 mm on average; p = 0.012, Wilcoxon signed-rank test), clinical attachment gain (1.67 mm vs. 1.06 mm; p = 0.004) as primary outcomes, and reduced BOP value (0.89 vs. 0.56; p = 0.031), compared with SRP alone.

CONCLUSION

The results of this study indicate that Er-LCPT is more effective for residual pocket treatment, compared with SRP alone.

Surgical Treatment of Peri-Implantitis Using a Combined Nd: YAG and Er: YAG Laser Approach: Investigation of Clinical and Bone Loss Biomarkers

The current study aimed to investigate the effect of the combined Nd-Er: YAG laser on the surgical treatment of peri-implantitis by evaluating clinical markers and biomarkers of bone loss (RANKL/OPG). Twenty (20) patients having at least 1 implant diagnosed with peri-implantitis were randomly assigned to two groups for surgical treatment. In the test group (n = 10), Er: YAG laser was used for granulation tissue removal and implant surface decontamination, while Nd: YAG laser was employed for deep tissue decontamination and biomodulation. In the control group (n = 10), an access flap was applied, and mechanical instrumentation of the implant surface was performed by using titanium curettes. The following clinical parameters were evaluated at baseline and six months after treatment: Full-mouth Plaque Score (FMPS), Probing Pocket Depth (PPD), Probing Attachment Levels (PAL), recession (REC), and Bleeding on probing (BoP). Peri-implant crevicular fluid (PICF) was collected at baseline and six months for the evaluation of soluble RANKL and OPG utilizing enzyme-linked immunosorbent assay (ELISA). Baseline clinical values were similar for both groups, with no statistical differences between them. The study results indicated statistically significant improvements in the clinical parameters during the 6-month observation period in both groups. More specifically, PPD, PAL, and REC were improved in the test and control groups with no differences in the between-groups comparisons. However, a greater reduction in the BoP-positive sites was noted for the laser group (Mean change 22.05 ± 33.92 vs. 55.00 ± 30.48, p = 0.037). The baseline and six-month comparisons of sRANKL and OPG revealed no statistically significant differences between the two groups. The combined Nd: YAG—Er: YAG laser surgical therapy of peri-implantitis seemed to lead to more favorable improvements in regard to bleeding on probing six months after treatment compared to the conventional mechanical decontamination of the implant surface. None of the methods was found superior in the modification of bone loss biomarkers (RANKL, OPG) six months after treatment.

Comparative evaluation of combined efficacy of methylene blue mediated antimicrobial photodynamic therapy (a-PDT) using 660 nm diode laser versus Erbium-chromium-yttrium-scandium-gallium-garnet (Er, Cr: YSGG) laser as an adjunct to scaling and root planing on clinical parameters in supportive periodontal therapy: A randomized split-mouth trial

AIM

The aim of this study was to evaluate combined efficacy of methylene blue mediated antimicrobial photodynamic therapy (a-PDT) using 660 nm diode laser versus Er, Cr: YSGG laser as an adjunct to scaling and root planing on improving the Probing depth (PD), Clinical attachment level (CAL), Plaque Index (PI) and Gingival Index (GI).clinical parameters in Supportive periodontal therapy.

MATERIALS AND METHOD

In this split-mouth, double-blind, randomized controlled trial, we compared a-PDT versus Er,Cr:YSGG as an adjunct to scaling and root planning (SRP) with SRP alone in Supportive periodontal therapy. A total of 36 subjected were enrolled. In each patient, two quadrants constituted the control group (Group I - Scaling and root planing SRP alone), one site in other quadrant constituted the test group 1 (Group II - SRP followed by application of Er, Cr: YSGG laser), and another site in different quadrant constituted the test group 2 (Group III - SRP followed by antimicrobial Photodynamic therapy using diode laser). The diode laser was operated at a peak power of 70 mW using a 0.6 mm diameter fiber-optic tip. Each site was irradiated with a power density of 28 mW/cm², for 10 s, thus delivering a total energy of 16.72 J/cm² per tooth. Whereas, the Er,Cr:YSGG laser's parameters were set to 1 W of power, 10% air, and 15% water. The same procedure was repeated at 1st, 2nd and 3rd week for both the laser therapies. Plaque index (PI), Gingival index (GI), Probing depth (PD,) and Clinical attachment level (CAL) were measured by a single examiner at baseline and 3 months follow up. Inter group analysis of the parameters were done using One-way ANOVA and pairwise comparison was carried out by Tukey's post hoc test. Intra group analysis was performed using Students's paired t test. Statistical significance was set to p < 0.05.

RESULTS

There were no significant differences between participants for clinical parameters at baseline. PI, GI PD, and CAL significantly improved at 3 months follow up compared to baseline in both the study groups (Group II - SRP + Er,Cr:YSGG, Group III - SRP + a-PDT) with P < 0.05. Adjunctive use of Er,Cr:YSGG laser with SRP showed better clinical outcomes than a-PDT with SRP.

CONCLUSION

Nonsurgical periodontal therapy of chronic periodontitis using Er, Cr: YSGG, and a-PDT as an adjunct to SRP was significantly more effective than SRP alone in reducing PD, CAL, GI, and PI at 3 months follow up. Adjunctive use of Er,Cr:YSGG laser with SRP showed better clinical outcomes than a-PDT with SRP. However, the long-term positive benefits of the laser therapies are yet unknown and more research with longer follow-ups are required.

Efficacy of Er:YAG laser for the peri-implantitis treatment and microbiological changes: a randomized controlled trial

The aims of this study were to identify the microbiological changes in the periodontal pockets following an Er:YAG laser (ERL) irradiation and mechanical debridement to compare the effectiveness of ERL irradiation to mechanical debridement for peri-implantitis treatment through randomized controlled trials. Twenty-three patients with peri-implantitis lesions were treated in either a test group, ERL set at energy level of 100 mJ/pulse, frequency of 10 Hz, pulse duration was 100 µs, and irradiated by three passages, or a control group, with mechanical debridement using an ultrasonic scaler. An examiner measured the following clinical parameters at different stages (a baseline and at 3- and 6-month post-treatment): probing depth (PD), bleeding on probing (BOP), marginal bone loss (MBL), and anaerobic bacteria counts. Linear regression, with generalized estimation equations, was used to compare the clinical parameters and anaerobic bacterial counts at different stages and between groups. The anaerobic bacterial counts significantly decreased within the control group during the follow-ups. At the 6-month follow-up, both groups showed a significant reduction in PD (test group: mean difference of 0.84 mm; control group: mean difference of 0.41 mm), and the test group showed a significantly higher PD reduction on the buccal site (1.31 mm) compared to that of the control group (0.25 mm). Both ERL and mechanical debridement treatments led to significant improvements in PD. When mechanical debridement therapy was used, significant anaerobic bacterial count reductions were observed. Future treatment of peri-implantitis should involve a combination of both of these therapies.

A comparison of human dental pulp stem cell activity cultured on sandblasted titanium discs decontaminated with Er:YAG laser and air-powder abrasion: an in vitro study

Decontamination of implant surfaces is important to the treatment of peri-implantitis. Er:YAG laser and air-powder abrasion system are regarded as the most effective means of decontamination of implant surfaces. The aim of this in vitro study was to compare the activity of human dental pulp stem cells (hDPSCs) cultured on decontaminated sandblasted titanium discs using Er:YAG laser irradiation and air-powder abrasion. Forty-five titanium discs were contaminated with Escherichia coli (E. coli) bacteria and fifteen titanium discs served as sterile control groups. Thirty contaminated titanium discs were decontaminated with Er:YAG laser or air-powder abrasion system and fifteen contaminated discs were used as contaminated control group. Afterwards, hDPSCs were seeded on all sixty experimental titanium discs. The effects of two decontamination tools on hDPSCs viability were evaluated by MTT assay. Alkaline phosphatase (ALP) activity assay, quantitative real-time PCR analysis and alizarin red staining method were performed to assess hDPSCs osteogenic differentiation. Scanning microscope electron (SEM) was also used to evaluate the effects of two different decontaminated methods on cellular morphology. Our study showed that decontamination using Er:YAG laser caused maximum cell viability. However, the ALP activity was not different in laser and air-abrasion groups. The significant expression of an osteoblastic marker and stronger Alizarin red staining were observed in laser irradiation groups. In addition, SEM observation indicated that grown cells were more stretched and more filopodia in Er:YAG-treated discs. In the present study, Er:YAG laser and air-powder abrasion improved the activity of the cells cultured on the decontaminated titanium discs. However, in comparison with air-powder abrasion, Er:YAG laser was more effective.

The Application of Antimicrobial Photodynamic Therapy (aPDT) in the Treatment of Peri-Implantitis

Background

This literature review evaluates the mechanisms and efficacy of different types of antimicrobial photodynamic therapy (aPDT) for treating peri-implantitis by reviewing existing experimental studies to provide guidance for the clinical application of antibacterial photodynamic therapy (aPDT) in oral implants.

Materials and Methods

From February 2001 to February 2021, we have collected 152 randomized controlled trials of aPDT for peri-implantitis by searching the experimental studies and clinical trials published in PubMed, Embase, Web of Science, and Google Scholar databases via online search. After screening the retrieved literature, we finally selected 10 statistically significant literature for evaluation and review.

Results

Compared with the traditional nonsurgical treatment of peri-implantitis, the aPDT was superior to the traditional mechanical irrigation treatment group in terms of periodontal indexes PD, BOP, PLI, and postoperative effect, and the difference was statistically significant (P < 0.05). Furthermore, the combination of the aPDT and other treatments shows the synergistic antibacterial effect, signifying better clinical effect in many aspects (P < 0.05). In these 10 papers, by comparing the probe depth (PD), bleeding on probing (BOP), synosteosis, and periodontal pathogenic bacteria detection, etc., obtained after treating peri-implantitis by application of the antimicrobial photodynamic therapy, and using the SPSS data analysis software for statistical data processing, we found that the antimicrobial photodynamic therapy combined with other periodontal treatments has a more prominent postoperative effect. Meanwhile, the antibacterial photodynamic therapy with targeted action of photosensitizer has strong specificity to some bacteria, while the synthetic photosensitize for antibacterial photodynamic therapy can show good inactivation effect on broad-spectrum periodontal anaerobes without side effect.

Conclusion

The experimental studies and clinical data of antibacterial photodynamic therapy for treating peri-implantitis show a good postoperative treatment effect. In addition, it did not develop resistance due to the use of antibiotic drugs. Owing to multiple advantages from combining antibacterial photodynamic therapy and other treatments, it is applicable for clinical treatment.

Laser Decontamination and LED Photobiomodulation Promote Bone Regeneration and Wound Healing by Secondary Intention, in Alveolar Ridge Preservation-Clinical and Radiographic Evaluation: A Pilot Experience

Background: Tooth loss reduces crestal bone with important resorption of alveolar dimensions, reducing the possibility of placing implants after wounds healing. Objective: The goal of this pilot experience was to consider, in alveolar ridge preservation, the regenerative and decontaminating potential of oxygen high-level laser therapy (OHLLT), a high-frequency and high-power diode laser combined with hydrogen peroxide 10 volumes 3%, and to evaluate wound closure during the 14-21 days after surgery. Methods: For this study we selected 15 patients (age range from 30 to 70 years old) who underwent alveolar ridge preservation (three patients were treated in the anterior maxilla, 12 in the mandibular jaw, with molars and premolars involved). A clinical and radiographic examination was performed at baseline. In this pilot experience, after the extractions, the sockets were treated with photodynamic therapy without dye (OHLLT/SiOxyL+ protocol) to decontaminate the area that was treated, combined with allografts, Osteobiol, granulometry 25, Platelet-Rich Fibrin and collagen membranes, Biogide/Geistlich. Photobiomodulation (PBM) sessions with ATP38 were made for the first 4 months every 2 weeks. Clinical evaluations were performed at 14, 21, 90, and 240 days. Radiographic evaluations with cone beam computed tomography (CBCT) were performed at 240 days, before the second surgery. Two hundred seventy days after the first surgery, a new surgical treatment was made with the same concepts adopted in the first surgery, to place implants. Results: All alveolar ridge preservation surgeries were successful, with minimal bone resorption after 9 months. Closure of gingival tissue healed by secondary intention was achieved after 14 days for all patients, except one, who showed wound closure after 21 days. Conclusions: This pilot experience showed that this technique allowed to obtain new bone and wound healing by secondary intention in treated sites and to place implants in all patients, without other bone augmentation techniques, thanks to extracellular matrix induced by photodynamic laser therapy on grafts materials and to PBM made each 2 weeks for the first 4 months postsurgery. The study was conducted according to the guidelines of the Ethics Committee of the School of Medicine and Surgery at the Milano Bicocca University (protocol n. 11/17), and derived from the approval of Italian National Institute of Health (ISS), protocol 30 July 2007-0040488.

Effect of diode laser combined with minocycline hydrochloride in nonsurgical periodontal therapy: a randomized clinical trial

Background

This study aimed to assess the effect of diode laser combined with minocycline hydrochloride in conventional nonsurgical periodontal therapy.

Methods

Ninety-two patients and 1206 teeth were included in this study. The patients were diagnosed moderate or severe periodontal diseases with the presence of teeth in at least 3 quadrants in the oral cavity. Each patient’s quadrants were randomly divided into three treatment groups as following, Control group: scaling and root planning (SRP); Experimental group 1 (Exp 1): SRP + minocycline hydrochloride; Experimental group 2 (Exp 2): SRP + 809 nm diode laser + minocycline hydrochloride. The minocycline in Exp 1 and Exp 2 was applied once per week, for 4 weeks. Clinical examinations including periodontal probing depth (PD), clinical attachment level (CAL) and bleeding index (BI), and the secretion of inflammatory factor (tumor necrosis factor, TNF-α) was detected by ELISA before and 3, 6 months after the treatments. The differences among these groups were assessed by One-Way ANOVA and Kruskal–Wallis test. P-value < 0.05 was considered significant.

Results

All the periodontal indexes (PD, CAL and BI) were improved after each treatment and the secretion of TNF-α was reduced for all three groups. In patients with deep periodontal pockets, Exp 2 showed significant improvements in all indexes comparison with Con group and Exp group 1.

Conclusions

The synergistic effect of SRP and 809 nm diode laser combined with minocycline hydrochloride could play an efficient and reliable effect in the nonsurgical periodontal treatment approach.

Trial registration The clinical trial was retrospectively registered in chictr.org.cn with registration ChiCTR2100051708 (01/10/2021).

Adjunctive Er:YAG laser in non-surgical periodontal therapy of patients with inadequately controlled type 2 diabetes mellitus: A split-mouth randomized controlled study

BACKGROUND AND OBJECTIVE

Limited studies are available comparing the outcomes of non-surgical periodontal therapy (NSPT) with or without adjunctive Er:YAG laser (ERL) in patients with type 2 diabetes mellitus (T2DM). This study evaluated the effects of ERL adjunctive NSPT on single-rooted teeth of inadequately controlled T2DM patients with periodontitis.

METHODS

Twenty-two inadequately controlled T2DM participants with periodontitis were recruited. Adopting a double-blinded split-mouth design and under block randomization, we investigated the effects of ERL in calculus removal then degranulation mode, or a sham treatment, adjunct NSPT, which included two visits of full-mouth root surface debridement delivered within 4-10 days, to test or control single-rooted teeth (Wuxi Stomatology Hospital, trial 2017-016). We followed periodontal parameters (plaque %, bleeding on probing [BOP] %, probing pocket depth [PPD], probing attachment level [PAL]) and selected systemic parameters (fasting plasma glucose [FPG], glycosylated hemoglobin [HbA1c%], high sensitivity C-reactive protein) at baseline, one, three, and six months after periodontal treatment.

RESULTS

The study was completed as planned. Periodontal parameters, FPG and HbA1c% of the 22 participants appeared significantly improved at six months (p < 0.001). The 44 ERL treated, compared to 44 sham treated single-rooted teeth exhibited significant improvement in BOP, mean PPD, and mean PAL at various postoperative follow-up time points (effect size ≥0.44; p < 0.001). No adverse event was reported.

CONCLUSION

Periodontal treatment outcomes in the T2DM patients with inadequate glycemic control were better in the single-rooted teeth received ERL adjunct NSPT. Further studies are warranted to confirm the observations reported in this short-term clinical study.

Erbium-doped: yttrium-aluminum-garnet (Er:YAG) versus scaling and root planing for the treatment of periodontal disease: A single-blinded split-mouth randomized clinical trial

BACKGROUND

This randomized, controlled clinical trial aimed to compare the differences in periodontal clinical outcomes, duration of the procedure, and patient's experience between conventional scaling and root planing and erbium-doped: yttrium-aluminum-garnet (Er:YAG) in the treatment of generalized moderate to severe chronic periodontitis or generalized Stages II or III, and Grade B periodontitis based on the Centers for Disease Control (CDC), American Academy of Periodontology (AAP), and European Federation of Periodontology (EFP) definitions.

METHODS

Thirty subjects were initially recruited. In a split-mouth fashion, right and left sides were randomly allocated into two treatment arms: conventional scaling and root planing (C-SRP) versus laser-assisted scaling and root planing (L-SRP). A blinded examiner recorded clinical measurements at baseline and 3 months. Duration of the procedure was also recorded for each visit, and the patient's experience was assessed with a questionnaire at baseline, 1, and 3 months.

RESULTS

The final sample consisted of 26 subjects. Both treatments resulted in overall improvement, but no significant differences were found between modalities for clinical attachment gain or probing depth reduction. The duration of the procedure was approximately half for L-SRP, and postoperative sensitivity was greater in C-SRP.

CONCLUSIONS

The low-energy protocol with Er:YAG (50 mJ) used for the non-surgical treatment of moderate-severe chronic or Stage II-III, Grade B periodontitis performed in this study population was a treatment modality that yielded similar clinical improvements when compared to conventional scaling and root planing.

Short-term improvement of clinical parameters and microbial diversity in periodontitis patients following Indocyanine green-based antimicrobial photodynamic therapy: A randomized single-blind split-mouth cohort

BACKGROUND

Indocyanine green-mediated photodynamic therapy is effective against chronic periodontitis. Here, we evaluated the efficiency of indocyanine green-based adjunctive antimicrobial photodynamic therapy in non-surgical treatment of chronic periodontitis patients.

METHODS

Fifty-six periodontally involved teeth of 20 patients were treated with "scaling and root planing" (control group) or "scaling and root planing with indocyanine green-based (perio-green, 0.1 mg/ml) antimicrobial photodynamic therapy" (test group) using a split-mouth design. We performed clinical assessment of probing depth, gingival recession, clinical attachment loss, and other indices, while plaque samples were collected for microbiome analysis.

RESULTS

At baseline, periodontal depth and clinical attachment loss were significantly higher in the test group (p < 0.05), and at 1-month post-treatment, we observed a significant favorable reduction of both periodontal depth and clinical attachment loss in test and control sites, with lower means maintained at 3 months (p = 0.01 and p = 0.000, respectively). Additionally, analysis of variance showed significant improvements in periodontal depth and clinical attachment loss in the indocyanine green-antimicrobial photodynamic therapy group (p = 0.001), although not for clinical attachment loss in controls (p = 0.102). Moreover, a significant reduction was observed in test sites for bleeding on probing and residual pocket post-therapy (p = 0.04 and p = 0.0001 respectively). Furthermore, microbiome analysis identified Porphyromonons gingivalis, Treponema, and Tannerella in all samples with favorable changes in test sites (p = 0.07).

CONCLUSION

We observed a significant reduction in periodontal clinical parameters (periodontal depth and clinical attachment loss) in chronic periodontitis patients treated with antimicrobial photodynamic therapy as an adjunctive procedure to conventional scaling and root planing. This improvement was associated with periodontal pathogen reduction and increase in the healthy subgingival microbiome.

Clinical effectiveness of Er,Cr:YSGG lasers in non-surgical treatment of chronic periodontitis: a meta-analysis of randomized controlled trials

The meta-analysis aimed to systematically evaluate all the available pieces of evidence concerning the clinical effectiveness of Er,Cr:YSGG lasers (erbium, chromium, yttrium scandium gallium garnet laser) in the non-surgical treatment of patients with chronic periodontitis, and provide guidance for clinicians about the application of Er,Cr:YSGG lasers during the process of non-surgical periodontal treatments. The meta-analysis was conducted with data extracted from 16 randomized controlled clinical trials (RCTs) that compare Er,Cr:YSGG lasers adjunct/substitute to scaling and root planing (SRP) with SRP alone for the treatment of chronic periodontitis published in English or Chinese from January 2000 to January 2020. The weighted mean differences (WMDs) and 95% confidence intervals (CIs) were counted for probing depth (PD) reduction, clinical attachment level (CAL) gain, and visual analogue scale (VAS) score. Heterogeneity of each study was evaluated with the Q test. The publication bias was measured using Begg's adjusted rank correlation test. Sixteen RCTs with 606 patients were included in the meta-analysis. There were statistically significant differences between Er,Cr:YSGG lasers adjunct/substitute to SRP and SRP alone in the PD reduction at 1-month follow-up (WMD = ‑ 0.35, 95% CI [- 0.63, ‑ 0.07], P = 0.013), 3-month follow-up (WMD = - 0.342, 95% CI [- 0.552, - 0.132], P = 0.001), CAL gain at 3-month follow-up (WMD = - 0.17, 95% CI [- 0.31, 0.03], P = 0.017), and VAS score (WMD = - 2.395, 95% CI [- 3.327, - 1.464], P = 0.000) immediately after treatment. There were no significant differences of PD reduction and CAL change at 6-month follow-up. The present meta-analysis indicated that Er,Cr:YSGG lasers provided additional effectiveness in PD reduction and CAL gain at short-term follow-ups and there was less pain compared with SRP alone.

Patient-reported outcomes of laser-assisted pain control following non-surgical and surgical periodontal therapy: A systematic review and meta-analysis

Adjunctive use of laser devices as high reactive-level laser/light therapy (HLLT) or photobiomodulation therapy (PBMT) for periodontal therapy is known to be more effective on suppressing pain than conventional therapy, however, there are no systematic reviews addressed its effectiveness. This systematic review and meta-analysis aim to investigate the following clinical question (CQ): does adjunctive use of lasers with conventional therapy suppress the pain associated with periodontal treatment? A systematic and extensive literature search was performed to summarize the currently available knowledge to answer the CQ using the PubMed, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) conducted before June 2020. Bias risk was assessed using the Cochrane tool for the risk of bias evaluation. A meta-analysis was performed on quantitative evaluation of pain control based on patient-reported outcomes. After an independent screening of 165 initial records, ten RCTs were included. Six of them focused on surgical procedures and the others on non-surgical periodontal pocket therapy. The protocols of HLLT, PBMT, and combination with HLLT and PBMT were employed in five, four and one RCTs, respectively. Following the assessment of bias risk, it is revealed that all RCTs had methodological weaknesses regarding the blinding of key personnel, although other bias risk factors were not evident. Meta-analysis showed that HLLT using erbium lasers significantly reduced the patient-reported pain immediately after treatment (two RCTs, p < 0.0001), while PBMT using diode lasers significantly reduced pain 2-7 days after treatment (two RCTs, p < 0.0001 to p = 0.03). The presented systematic review and meta-analysis suggest that the alternative use of HLLT using erbium lasers to conventional instrumentation can significantly suppress postoperative pain and that intraoperative or postoperative PBMT using diode lasers combined with periodontal surgery can significantly reduce postoperative pain. However, the evidence is still insufficient and more well-designed RCTs are required.

Comparative Evaluation of the Effects of CO2 and Er:YAG Lasers on Smear Layer Removal and Blood Cell Attachment to Tooth Root Surfaces

Introduction: The tooth root surfaces are modified by different agents for better removal of the smear layer, the formation of fibrin clots, and the attachment of blood cells. This in vitro study compared the removal of the smear layer, the formation of fibrin clots and the attachment of blood cells after exposing periodontally compromised root surfaces to ER:YAG and CO₂ laser beams. Methods: Eighteen dentin block samples were prepared from freshly extracted periodontally compromised teeth that were deemed hopeless, and they were divided into 3 groups: exposed to Er:YAG laser beams, exposed to CO₂ laser beams, and the control group. The samples were evaluated using scanning electron microscopy and micrographs were taken. Smear layer removal and blood cell attachment were scored. Data were analyzed using Kruskal-Wallis and MannWhitney tests. Results: In the Er:YAG laser group, the smear layer was removed completely. In the specimens exposed to blood, better fibrin clot formation and blood cell attachment were observed in the Er:YAG laser group. In the CO₂ laser group, the smear layer was also removed; however, there were no significant differences between the CO₂ laser and control groups in fibrin clot formation and blood cell attachment. Conclusion: The application of the Er:YAG laser to the root dentin appears to result in the formation of a suitable surface for fibrin clot formation and blood cell attachment. Further clinical studies are necessary to support these results.

Er:YAG Laser Irradiation Reduces Microbial Viability When Used in Combination with Irrigation with Sodium Hypochlorite, Chlorhexidine, and Hydrogen Peroxide

The erbium-doped yttrium aluminum garnet (Er:YAG) laser is used to treat periodontal disease; however, its effectiveness at killing oral bacteria is not well known. Furthermore, the compounding effect of the combination of a laser treatment and irrigation methods with antimicrobials on bacterial viability is yet to be determined. The purpose of this in vitro study was to evaluate the effect of the Er:YAG laser with irrigation using chlorhexidine (CHX), hydrogen peroxide (H₂O₂), or sodium hypochlorite (NaOCl) on the viability of oral bacteria. Three bacterial species were used in our study: Streptococcus gordonii, Fusobacterium nucleatum, and Porphyromonas gingivalis. Bacteria were grown in an anaerobic chamber in brain heart infusion broth and incubated at 37 °C. Bacterial samples with an OD of 0.5 were irradiated with the Er:YAG laser at 2940 nm using a 400-µm Varian tip. The experiment was repeated four times using these parameters: 40 mJ, 40 Hz, and 1.6 W for 20 seconds with the 300 µs short pulse duration in contact mode. Treatment groups consisted of the following: (1) no treatment, (2) 0.5% H₂O₂ alone, (3) 0.5% NaOCl alone, (4) 0.03% CHX alone, (5) Er:YAG irradiation alone, (6) Er:YAG irradiation with 0.5% H₂O₂, (7) Er:YAG irradiation with 0.5% NaOCl, and (8) Er:YAG irradiation with 0.03% CHX. Microbial viability was determined through plating and colony counts and calculated into CFU/ml. Statistical analysis was done using a two-tailed paired t-test. The use of the Er:YAG laser alone failed to show statistically significant antibacterial activity against any of bacteria. The most effective mono-treatment with irrigation solutions for all three bacteria were 0.5% H₂O₂ and 0.5% NaOCl (p < 0.001 for each solution). Irrigation with 0.03% CHX was most effective against F. nucleatum (p < 0.01) and less against P. gingivalis and S. gordonii and showed the least antibacterial action alone but improved significantly in combination therapy (p < 0.05). The combined treatment with the Er:YAG showed the greatest and most significant improvement in the reduction of bacterial viability compared to any other treatment group (p < 0.05 for each combined treatment). Irradiation with the Er:YAG laser with the addition of 0.5% H₂O₂, 0.5% NaOCl, or 0.03% CHX under a short working time (20 s) resulted in a significant reduction of bacterial viability for all three bacterial species compared with any single treatment option. The combination of irradiation with the Er:YAG laser with the addition of 0.5% H₂O₂, 0.5% NaOCl, or 0.03% CHX resulted in a larger reduction of bacterial survival when compared to monotherapies with antimicrobial solutions or laser. The combination of the Er:YAG laser with a low concentration irrigant solution of 0.5% H₂O₂, 0.5% NaOCl, or 0.03% CHX could be an effective treatment protocol for the reduction of periodontal pathogens and thus suitable treatment for non-surgical periodontal therapy.

Photonic Therapy in Periodontal Diseases an Overview with Appraisal of the Literature and Reasoned Treatment Recommendations

Recent reviews and meta-analyses of the literature over the past quarter-century have failed to provide enough evidence to prove or disprove the actual utility of photonic therapy in periodontitis, alone or adjunctive to conventional approaches. This apparent paradox has been explained by the many physical, molecular, biological, anatomical, and technical variables of photonic treatments, which can differ in light-emitting devices (laser or LED), wavelengths, irradiation power and modes, clinical objectives, follow-up times, disease grading, and assessment methods. This multi-faceted, controversial scenario has led practitioners to underestimate the actual potential of photonic therapy in periodontal diseases. In this critical appraisal of the literature, we have briefly summarized the main photonic therapies and instruments used in Periodontology, highlighting their main characteristics and limitations. Then, we have tried to identify and discuss the key methodological issues which can have an impact on the outcome of photonic therapies. Our main goal was to identify the best parameters, settings, and methodologies to perform effective periodontal photonic treatments and to extrapolate some recommendations for clinical use. Should these recommendations find a consensus among periodontologists and be adopted in future clinical studies, they will hopefully contribute to dissipate the present confusion and uncertainty on this complex matter.

Diode Laser as an Adjunct to Kirkland Flap Surgery-A Randomized Split-Mouth Clinical and Microbiological Study

Background: Mechanical methods of periodontal therapy alone may fail to eliminate the tissue-invasive pathogenic flora; therefore, considerable attention has been given to adjunctive antimicrobial measures. Objective: The aim of this study was to investigate and compare the clinical and microbiological effects of diode laser (DL) as an adjunct to Kirkland flap surgery versus Kirkland flap surgery alone for the treatment of generalized chronic periodontitis. Materials and methods: A total of 20 patients with generalized chronic periodontitis with probing pocket depth ≥5 mm after phase I therapy were included in this split-mouth study. Two contralateral quadrants of each patient were randomly assigned to either test or control group. Control group was treated with Kirkland flap surgery alone, whereas test group was treated with DL as an adjunct to Kirkland flap surgery. Periodontal parameters were recorded, and subgingival plaque samples were collected from both the control and test groups at baseline and third and sixth month. The plaque samples were then analyzed for red complex organisms using quantitative real-time polymerase chain reaction. Results: Compared with baseline, both treatments showed an improvement in periodontal parameters at the third and sixth month. However, test group produced a significant improvement in plaque index (1.039 ± 0.069 vs. 1.392 ± 0.17, p < 0.001), bleeding on probing (16.512 ± 5.982 vs. 37.051 ± 7.459, p < 0.001), probing pocket depth (1.727 ± 0.39 vs. 3.016 ± 0.47, p < 0.001), and clinical attachment level (2.054 ± 0.524 vs. 3.354 ± 0.728, p < 0.001) at third and sixth month compared with the control group. Moreover, in the test group, levels of red complex bacteria were significantly reduced at third and sixth month compared with the control group. Conclusions: DL as an adjunct to Kirkland flap surgery has resulted in a greater reduction in clinical and microbiological parameters compared with Kirkland flap surgery alone, thereby offering additional benefit in treating generalized chronic periodontitis patients.

Effectiveness of an erbium-doped: yttrium, aluminum and garnet laser for treatment of peri-implant disease: Clinical, microbiological, and biochemical marker analyses

Background

The effectiveness of an erbium-doped: yttrium, aluminum and garnet (Er: YAG) laser (EYL) for the treatment of peri-implant disease (PID) remains unclear. The aim of this study was to compare non-surgical EYL therapy for PID with locally delivered minocycline hydrochloride (MC) ointment therapy by evaluating clinical, microbiological, and biochemical markers.

Material and Methods

Thirty-seven patients with PID were randomly assigned to either the EYL group (n = 18) or the MC group (n = 19). The clinical, microbiological, and biochemical markers at baseline and at 1 and 3 months after treatment were compared between the two groups. Subgingival plaque and peri-implant crevicular fluid (PICF) were collected from the diseased pockets.

Results

In the EYL group, probing pocket depth (PPD) was significantly decreased after treatment when compared with baseline. On the other hand, in the MC group, there was no significant decrease in PPD after treatment. Specific bacteria associated with PID were not determined. The counts of both Gram-positive and -negative species did not significantly decrease in the EYL group at 3 months after treatment. In the MC group, the counts of almost all bacterial species were significantly decreased after treatment. Biochemical marker analysis of PICF revealed significantly lower levels of metalloproteinase (MMP)-9 in the EYL group, as compared with the MC group at 3 months after treatment (p= 0.009).

Conclusions

Non-surgical therapy with an EYL for PID was clinically effective, with decreased MMP-9 levels in PICF, which may lead to reduced peri-implant tissue destruction. Key words:Er: YAG laser; peri-implant disease; biomarker; peri-implant crevicular fluid.

Clinical Effectiveness of Er: YAG Lasers Adjunct to Scaling and Root Planing in Non-Surgical Treatment of Chronic Periodontitis: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND Er: YAG lasers (ERLs) show suitable characteristics for scaling and root planing, but previous studies have drawn conflicting conclusions. This meta-analysis aimed to systematically appraise the available evidence concerning the effectiveness of ERLs as an adjunct to scaling and root planing (SRP) for non-surgical periodontal treatment. MATERIAL AND METHODS Randomized controlled trials (RCTs) comparing ERLs+SRP with SRP alone for the treatment of chronic periodontitis were searched in 9 electronic biomedical databases up to January 2018. The weighted mean differences (WMDs) and 95% confidence intervals (CIs) were counted for probing depth (PD) reduction, clinical attachment level (CAL) gain, and visual analog scale (VAS) score. Heterogeneity was evaluated with the I² statistic for interstudy comparisons and the χ²-based Q statistic for intra-study comparisons. Sensitivity analysis was conducted by switching to a random or fixed effect model based on the heterogeneity. Publication bias was measured by Begg's test. RESULTS Ten related RCTs met the inclusion criteria. There were statistically significant differences in the assessed clinical parameters at the three-month follow-up: PD reduction (WMD=0.32, 95%CI range from 0.14 to 0.51, p<0.001; p=0.003, I²=69.7%); CAL gain (WMD=0.31, 95%CI range from 0.22 to 0.40, p<0.001; p=0.209, I²=28.8%); and VAS scores (WMD=-1.38, 95%CI range from -2.45 to -0.31, p<0.001; p=0.182, I²=44%). There were no significant differences at the six- and twelve-month follow-ups. Sensitivity analysis revealed that the results were consistent. No evidence of publication bias was detected. CONCLUSIONS This systematic analysis demonstrated that ERLs+SRP provides additional short-term effectiveness and that patients experience less pain compared to SRP. There were no significant differences at the medium-term and long-term follow-ups. Long-term well-designed RCTs are required.

Efficacy of removal of cariogenic bacteria and carious dentin by ablation using different modes of Er:YAG lasers

The primary objective of this in vitro study was to evaluate the efficiency of removal of cariogenic bacteria and carious dentin by ablation using two lasers: fluorescence-feedback controlled (FFC) Er:YAG laser and different pulses of Er:YAG laser based on variable square pulse technology (VSPt). The secondary objective was to measure the temperature during laser ablation of carious tissue. Seventy-two extracted human molars were used in this study. Sixty teeth with carious dentin were randomly divided into four experimental groups according to the treatment for caries removal: group 1: 400 µs (FFC group); group 2: super short pulse (SSP group, 50 µs pulse); group 3: medium short pulse (MSP group, 100 µs pulse); group 4: short pulse (SP group, 300 µs pulse) and one positive control group with no treatment. Twelve teeth without carious lesion were used as a negative control group. After caries removal, swabs were taken with cotton pellets and real-time PCR analysis was performed. During caries ablation, a thermal infrared camera was used to measure the temperature changes. In all experimental groups, specimens were free of bacterial contamination after the treatment. In the SSP, MSP and SP groups, temperatures measured during caries ablation were significantly higher compared to temperatures in the FFC group (P<0.001). In this in vitro study, laser treatment for removal of carious dentin and cariogenic bacteria was an efficient treatment modality without causing excessive temperatures that might adversely affect pulp vitality.

Histological evaluation of three techniques for caries removal

A number of concepts and devices have been proposed for caries removal. Among these, the Er:YAG laser is a potential alternative to conventional mechanical treatment. This study compared the effectiveness of the Er:YAG laser with that of low-speed rotary instruments for removal of carious tissue in 26 extracted human molars and premolars with severe decay (i.e., large occlusal or proximal decay but no pulpal contact). The teeth were divided into three groups of eight teeth, and two teeth were used as controls. After sectioning all the teeth through the center of the carious lesion before excavation, each group was randomly assigned to three groups-Er:YAG laser versus tungsten bur, Er:YAG laser versus polymer bur, and polymer bur versus tungsten bur-to evaluate the efficacy of the three techniques. The time required for carious treatment of each half was recorded, and samples were then histologically examined. Mean duration of caries removal did not significantly differ in relation to the technique used. Histological analysis of tooth halves treated with the Er:YAG laser revealed a regular 5-µm-thick stained layer that appeared to be denatured collagen. A smear layer was often detectable in halves treated with carbide burs. A superficial disorganized layer, which was found to be affected dentin, was observed in halves treated with polymer burs. The present findings indicate that the three techniques were clinically and histologically effective in removing the infected dentin layer.(J Oral Sci 58, 583-589, 2016).

Combined application of Er:YAG and Nd:YAG lasers in treatment of chronic periodontitis. A split-mouth, single-blind, randomized controlled trial

BACKGROUND

The aim of the present study was to compare the effectiveness of combined Er:YAG and Nd:YAG laser therapy to that of scaling and root planing with hand instruments in non-surgical treatment of chronic periodontitis.

MATERIAL AND METHODS

Twenty-five systemically healthy patients with chronic periodontitis were selected for this study. The quadrants were randomly allocated in a split-mouth design to either combined Er:YAG (160 mJ/pulse, 10 Hz) and Nd:YAG laser (100 mJ/pulse, 20 Hz) therapy (test group) or scaling and root planing alone (control group). At baseline, 1 month and 3 months after treatment, plaque index, gingival index, probing depth, clinical attachment level and bleeding on probing (%), were recorded and gingival crevicular fluid and subgingival plaque samples were taken. The gingival crevicular fluid levels of interleukin-1β and tumor necrosis factor-α were analyzed by enzyme-linked immunosorbent assay. Quantitative analysis of red complex bacteria was performed using quantitative real-time polymerase chain reaction.

RESULTS

The clinical parameters had significantly improved for both groups after treatment. There were statistically significant differences in probing depth and clinical attachment level between the test and control groups only for deep pockets (≥7 mm) (P<.05). No significant differences between the two groups were observed for the biochemical and microbiological parameters at any time points (P>.05).

CONCLUSIONS

The present study suggests that a combined course of Er:YAG and Nd:YAG laser therapy may be beneficial particularly in inaccessible areas such as deep pockets on a short-term basis. Further, well-designed studies are required to assess the effectiveness of the combination of these lasers.

In Vitro-Activity of Er:YAG Laser in Comparison with other Treatment Modalities on Biofilm Ablation from Implant and Tooth Surfaces

BACKGROUND AND AIM

Bacterial biofilms play a major role in the etiology of periodontal and peri-implant diseases. The aim of the study was to evaluate the removal of bacterial biofilms and attachment of epithelial cells (EC), gingival fibroblasts (GF) and osteoblast-like cells (OC) to dentin and titanium surfaces after Er:YAG laser (Er:YAG) in comparison with other treatment methods.

MATERIAL AND METHODS

Multi-species bacterial biofilms were grown on standardized dentin and titanium specimens with a sand-blasted and acid etched (SLA) surface for 3.5 d. Thereafter, the specimens were placed into artificially-created pockets. The following methods for biofilm removal were used: 1) Gracey (dentin) or titanium curettes (CUR), 2) Er:YAG, 3) photodynamic therapy (PDT) and 4) CUR with adjunctive PDT (CUR/PDT). Colony forming units (CFUs) of the remaining biofilms and attachment of EC, GF and OC were determined. Statistical analysis was performed by means of ANOVA with post-hoc LSD.

RESULTS

All treatment methods decreased statistically significantly (p<0.001) total CFUs in biofilms compared with untreated dentin and titanium surfaces respectively. On dentin, Er:YAG was equally efficient as CUR and PDT but inferior to CUR/PDT (p = 0.005). On titanium, surfaces, the use of Er:YAG resulted in statistically significantly superior biofilm removal compared to the 3 other treatments (each p<0.001). Counts of attached EC, GF and OC were the lowest on untreated contaminated dentin and titanium surfaces each. After CUR/PDT higher EC counts were found on dentin (p = 0.006). On titanium, all decontamination methods statistically significantly increased (p<0.001) the counts of attached EC without differences between groups. Statistically significantly higher counts of GF (p = 0.024) and OC (p<0.001) were observed after Er:YAG decontamination compared with untreated surfaces.

CONCLUSION

Ablation of subgingival biofilms and in particular decontamination of titanium implant surfaces with an Er:YAG laser seem to be a promising approach and warrants further investigations.

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.

Energy output reduction and surface alteration of quartz tips following Er:YAG laser contact irradiation on soft and hard tissues in vitro

Though the Er:YAG laser (ErL) has been used in periodontal therapy, the irradiated tip damage has not been studied in detail. In this study, the change in the energy output, surface morphology, and temperature of quartz tips was evaluated following contact irradiation. Soft tissue, calculus on extracted human teeth, and porcine bone were irradiated by ErL for 60 min at 14.2 or 28.3 J/cm(2)/pulse and 20 Hz with or without water spray. The energy output ratio declined the most in the calculus group, followed by the bone and soft tissue groups with and/or without water spray. Carbon contamination was detected in all groups, and contamination by P, Ca, and/or other inorganic elements was observed in the calculus and bone groups. The rate of energy output reduction and the degree of surface alteration/contamination is variously influenced by the targeting tissue, temperature elevation of the tip and water spray.

Preprosthetic laser assisted mandibular vestibuloplasty

A prosthetic treatment of the edentulous mandible can be very challenging. In cases with inadequate buccal depth, a necessary deepening of the oral vestibule can be achieved by surgically detaching the soft tissue attachments. A preprosthetic vestibuloplasty is usually done surgically by scalpel. With the permanent advancement of laser technology, a laser vestibuloplasty has become a preferred surgical procedure. The aim of this report was to present individuality of a mandible vestibuloplasty performed with Er. YAG laser. A 69-year-old patient was referred to the University Department of oral surgery after several previous unsuccessful attempts to stabilize his lower denture. The intraoral assessment revealed complete mandibular edentulism and a shallow vestibule with sufficient bone height in the anterior region. Since the patient's financial resources precluded dental implants, mandible anterior vestibuloplasty was planned to deepen the vestibule thus increasing the anatomic basis for prosthetic rehabilitation. The vestibuloplasty was performed with Er-Yag Laser (Fotona Fidelis III). The laser ablation started at the mucogingival junction. The soft tissue bands were ablated layer by layer till the desired vestibular depth was achieved. There was no need for suturing. No protective barrier was placed. The postoperative recovery was symptomless, without pain, oedema, or signs of infection. Four weeks after surgery, the healing process was completed and sufficient anterior vestibular depth was gained and maintained. Er.YAG laser assisted vestibuloplasty was a minimally invasive surgical procedure. The fast healing with minimal scarring resulted and a sufficient vestibular depth was gained.

Reattachment of a Fractured Anterior Tooth Segment With Pulp Exposure via Er:YAG and Nd:YAG Lasers

Introduction:

The reattachment of a dental fragment may be performed for treatment of traumatized anterior teeth, both in cases of simple coronal fracture (enamel and superficial dentin) and in those with complicated coronal fracture (deep dentin with pulp exposure). A major part of this procedure is the adhesion technique, which was described for the first time by Buonocore in 1955. This clinical case demonstrates the use of Er:YAG and Nd:YAG lasers in fragment reattachment of a traumatically fractured anterior tooth with pulp exposure, describes their advantages and highlights the steps involved in their use.

Case Presentation:

A 14-year-old patient who came to our clinic with a traumatic crown fracture of the permanent, right central incisor is described. The patient had preserved the fragment that had broken off into his mouth and it was rebonded to the tooth using lasers (LightWalker device; Fotona, Ljubljana, Slovenia) with the following parameters: Er:YAG, SSP mode; 200 mJ; 10 Hz; quasi-contact tipless handpiece; Nd:YAG, SP mode; 4 W; 40 Hz; 300 μm contact fiber. The whole procedure was performed without the need for anesthesia.

Conclusions:

The patient reported that he did not feel pain or discomfort throughout the intervention. Follow-up visits performed after one, three, six, twelve, and sixteen months demonstrated vitality of the tooth the absence of complications, as well as good esthetic results. Laser technology may be used in the treatment of traumatic anterior teeth injury with advantages in terms of quality of the restoration, esthetic results, and patient comfort.

Er:YAG laser dentistry in special needs patients

OBJECTIVE

Between a quarter and a third of adults with intellectual disability is estimated to have dental anxiety. Unpleasant stimuli, such as the injection of local anaesthesia or the noise and vibration of rotary instruments, may provoke anxiety and subsequent low compliance until the opposition to the treatment. The use of Er:YAG laser in conservative dentistry had a great development in these last years thank to new devices and also to their advantages when compared to the conventional instruments. The aim of this clinical study was to show the advantages of the Er:YAG laser in the conservative treatment of Special Care patients.

METHODS

Four cases are here described to show the Er:YAG laser use in our Unit on special needs patients.

RESULTS AND CONCLUSIONS

Based on the experience gained on conservative laser-assisted treatments performed in a time of 5 years at our Dentistry, Special Needs and Maxillo-Facial Surgery Unit we may affirm that Er:YAG laser may be considered as a good way to improve the cooperation, to reduce anxiety related to rotating instruments and to reach better results with equal or shorter operating times.

Microbiological effects and recolonization patterns after adjunctive subgingival debridement with Er:YAG laser

OBJECTIVES

The objective of this study was to assess the microbiological effects and recolonization patterns after non-surgical periodontal treatment protocol based on the adjunctive use of erbium-doped yttrium aluminium garnet (Er:YAG) laser.

MATERIAL AND METHODS

Patients diagnosed with chronic periodontitis were randomly assigned to two different treatment protocols: test, full-mouth subgingival ultrasonic instrumentation followed by Er-YAG laser application 1 week later to sites with initial probing pocket depth ≥4.5 mm; and control, full-mouth ultrasonic subgingival instrumentation within 1 week. Clinical (at sampled sites) and microbiological (culture-based) parameters were recorded at baseline and 3 and 12 months. Microbiological variables included total counts, frequency of detection, proportions and counts of target species.

RESULTS

Results from 19 test and 21 control patients were compared. Minor changes were observed for total colony-forming units, with no differences between groups. For the frequency of detection, a limited and similar impact in both groups was observed for the most prevalent (over 80 %) periodontal pathogens (Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum). For proportions, reductions in P. gingivalis occurred at 3 months, both in the test and control groups (from 16.3 to 10 % and 16 to 14.8 %, respectively), although these differences were not statistically significant. At 12 months, the test group showed a statistically significant greater reduction in probing depth for the sampled sites.

CONCLUSIONS

The adjunctive use of Er:YAG laser when compared with conventional ultrasonic debridement did not provide a microbiological added benefit.

CLINICAL RELEVANCE

Even though some clinical benefits with the adjunctive laser application were identified when comparing both treatment protocols, there were no differences in microbiological outcomes or in the bacterial recolonization patterns.

Er, Cr:YSGG laser for the treatment of ankyloglossia

Ankyloglossia or tongue-tie is the result of a short and tight lingual frenum causing difficulty in speech, feeding problems in infants due to the limitation of tongue movement. This report presents a case of a 22-year-old female with tongue-tie who complained of difficulty in speech following which she underwent frenectomy procedure with erbium, chromium: yattrium-scandium-gallium-garnet laser without any complications. She was referred to the speech therapist after the procedure.

Caries removal in deciduous teeth using an Er:YAG laser: a randomized split-mouth clinical trial

OBJECTIVES

The aim of the present clinical randomized split-mouth study was to evaluate the effectiveness and efficiency of an Er:YAG laser for caries removal in primary molars, microbiological dentin analysis, and clinical restorations after 1 year in 29 children.

MATERIALS AND METHODS

The children's teeth were randomized into two groups: (I) an Er:YAG laser group and (II) a bur preparation group. The efficiency of the treatments (the time necessary for the removal of carious tissue) was evaluated based on the time spent on caries removal in the deciduous molars. The effectiveness (caries removal capacity) of the caries removal was determined by means of a blind test in which the examiner performed a tactile and visual examination of the dentin. Microbiological analysis was performed by counting the Streptococcus mutans and Lactobacillus sp in the remaining dentin. Clinical analysis of restorations was performed using the USPHS method in combination with photographs of restored teeth, 7 days after the restorative procedure and again after 1 year. All cavities were restored with the Adper Single Bond 2/Filtek Z350 system. The obtained data were analyzed with a significance level of 5 %.

RESULTS

The Er:YAG laser was less effective and had the same efficacy as bur preparation during caries removal at the pulpal wall of deciduous molars. In the surrounding walls, bur preparation was the more effective method. Regardless of the method employed, the affected dentin in the pulpal wall had similar amounts of S. mutans and Lactobacillus sp. The restorations were clinically accepted by the USPHS method over a 1-year period.

CONCLUSION

It can be concluded that caries removal with an Er:YAG laser has no influence on the clinical behavior of restorations.

CLINICAL RELEVANCE

Irradiation with an Er:YAG laser is appropriate for caries removal in primary teeth.