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İnce Kuka G, Gürsoy H. Root surface roughness evaluation following application of different periodontal instruments and Er:YAG laser: A profilometry and SEM study. Lasers Med Sci 2024; 39:98. [PMID: 38583109 PMCID: PMC10999381 DOI: 10.1007/s10103-024-04025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/13/2024] [Indexed: 04/08/2024]
Abstract
AIM The aim of the present study was to evaluate the efficacy of 30°-angled Er:YAG laser tip and different periodontal instruments on root surface roughness and morphology in vitro. METHODS Eighteen bovine teeth root without carious lesion were decoronated from the cementoenamel junction and seperated longitidunally. A total of 36 obtained blocks were mounted in resin blocks and polished with silicon carbide papers under water irrigation. These blocks were randomly assigned into 3 treatment groups. In Group 1, 30°-angled Er:YAG laser (2.94 μm) tip was applied onto the blocks with a 20 Hz, 120 mJ energy output under water irrigation for 20 s. In Groups 2 and 3, the same treatment was applied to the blocks with new generation ultrasonic tip and conventional curette apico-coronally for 20 s with a sweeping motion. Surface roughness and morphology were evaluated before and after instrumentation with a profilometer and SEM, respectively. RESULTS After instrumentation, profilometric analysis revealed significantly higher roughness values compared to baseline in all treatment groups(p < 0.05). Laser group revealed the roughest surface morphology followed by conventional curette and new generation ultrasonic tip treatment groups (p < 0.05). In SEM analysis, irregular surfaces and crater defects were seen more frequently in the laser group. CONCLUSION Results of the study showed that the use of new generation ultrasonic tip was associated with smoother surface morphology compared to 30°-angled Er-YAG laser tip and conventional curette. Further in vitro and in vivo studies with an increased sample size are necessary to support the present study findings.
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Affiliation(s)
- Gizem İnce Kuka
- Department of Periodontology, Hamidiye Dental Faculty, University of Health Sciences, Istanbul, Turkey.
| | - Hare Gürsoy
- Department of Periodontology, Hamidiye Dental Faculty, University of Health Sciences, Istanbul, Turkey
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2
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The Efficiency of Photodynamic Therapy in the Bacterial Decontamination of Periodontal Pockets and Its Impact on the Patient. Diagnostics (Basel) 2022; 12:diagnostics12123026. [PMID: 36553035 PMCID: PMC9776409 DOI: 10.3390/diagnostics12123026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Research in the field of periodontal disease continues to focus on disease-associated microorganisms, as the microbial plaque and the host immune responses are considered to be important causative factors, that are highly responsible for the progression of this disease. The purpose of this article is to compare the reduction in the number of specific periodontopathogens in two test groups according to different therapeutic approaches in periodontal disease and to show possible differences. This article is based on a prospective clinical study involving eighteen subjects with forty-four average periodontal pockets assigned to study groups treated by two different methods, SRP and SRP followed by a single PDT application. Efficiency in removing specific bacterial species was evaluated by PCR testing, at baseline and immediately after treatment. The hypothesis that using SRP + aPDT results in an increased decontamination potential was confirmed statistically, when all five specific bacterial pathogens were investigated together. When the pathogens were considered separately, two of the five microorganisms tested were significantly lower in the SRP + PDT group (p < 0.00), and important germ counts reductions were also observed for the other three. There is also a statistically significant relation between the pain at 48 h postoperatively and the type of treatment the patients received, as resulted from the Questionnaire Form. Our results demonstrate that aPDT, as an adjunctive treatment to conservative mechanical cleaning of root surfaces at sites affected by periodontitis, represents an effective tool in terms of reducing specific periodontopathogen germs.
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3
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Gong H, Li M. Short-Term Efficacy of Er:YAG Laser and Nd:YAG Laser Combined Therapy on Periodontitis. Photobiomodul Photomed Laser Surg 2022; 40:580-588. [DOI: 10.1089/photob.2022.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Huiyan Gong
- Department of Stomatology, Second Hospital of Jilin University, Changchun, Jilin, China
| | - Meihua Li
- Department of Stomatology, Second Hospital of Jilin University, Changchun, Jilin, China
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4
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Jia L, Jia J, Wu M, Li T, Zhao C, Shi H, Zhang X. Probing depth reduction of laser application in periodontal therapy: a network meta-analysis. Lasers Med Sci 2022; 37:1217-1226. [PMID: 34327566 DOI: 10.1007/s10103-021-03376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
The aim was to systematically evaluate the probing depth (PD) reduction of lasers in scaling and root planing (SRP) of chronic periodontitis by network meta-analysis (NMA). Randomized controlled clinical trials (RCTs) were searched through electronic-search and hand-search up to January 2020. Standard mean different (SMD) and 95% confidence interval (CI) were counted for PD reduction. The random-effects NMA were performed using mvmeta routine in STATA software (version 13). This NMA analysed seven periodontal treatments through 37 RCTs. No inconsistency was detected. Compared with mechanical SRP, significant differences were in favour of diode laser (DL) as adjunct at 3 months (SMD = 0.61; 95% CI range: 0.27-0.96) and Nd:YAG as adjunct (SMD = 0.29; 95% CI range: 0.03-0.55), Er,Cr:YSGG as monotherapy (SMD = 0.37; 95% CI range: 0.04-0.71) and Er,Cr:YSGG as adjunct (SMD = 0.53; 95% CI range: 0.23-0.84) at 6 months after treatment. Compared with Er:YAG as monotherapy, significant differences were in favour of DL as adjunct at 6 months (SMD = 0.51; 95% CI range: 0.07-0.95) after treatment. In terms of PD reduction at 3-month follow-up, the ranking result from best to worst was Nd:YAG as adjunct, DL as adjunct, Er:YAG as adjunct, Er,Cr:YSGG as monotherapy, Er:YAG as monotherapy and mechanical SRP. In terms of PD reduction at 6-month follow-up, the ranking result was DL as adjunct, Nd:YAG as adjunct, Er:YAG as adjunct, Er,Cr:YSGG as adjunct, Er:YAG as monotherapy, Er,Cr:YSGG as monotherapy and mechanical SRP. Laser-assisted periodontal treatment has better PD reduction.
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Affiliation(s)
- Liying Jia
- Department of Preventive Dentistry, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Jinhai Jia
- Outpatient Clinic, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Mingxuan Wu
- Department of Periodontal Dentistry, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Tao Li
- Department of Preventive Dentistry, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Caiyun Zhao
- Department of Pediatric Dentistry, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Hong Shi
- Department of Pediatric Dentistry, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China.
| | - Xiaolin Zhang
- Department of Epidemiology and Statistics, Hebei Province Key Laboratory of Environment and Human Health, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China.
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5
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Erbium lasers in non-surgical periodontal therapy: an umbrella review and evidence gap map analysis. Lasers Med Sci 2022; 37:103-120. [PMID: 35029727 DOI: 10.1007/s10103-022-03504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
The literature on the efficacy of erbium lasers for nonsurgical periodontal therapy is inconsistent. The objective of the umbrella review was to collate the information available in the systematic reviews to provide a comprehensive synthesis of clinical and patient reported outcomes following the use of erbium lasers for non-surgical periodontal therapy. An electronic database search was carried out, and systematic reviews/meta-analyses which assessed the efficacy of erbium lasers as monotherapy or as an adjunct to scaling and root planing were included. The methodological quality and reporting quality of the included studies were assessed. 15 Systematic reviews/meta-analyses were obtained after title, abstract, and full text search. The meta-analyses data revealed a clinical attachment level gain, reduction in probing pocket depth at 1 and 3-month follow-up, and no additional benefit at ≥ 6-month follow-up in the erbium laser group. The evidence gap map revealed lack of clinical outcome data at > 6-month follow-up and dearth in studies assessing patient reported outcome measures and adverse events. Erbium lasers may provide short-term clinical benefits, and further studies with standardized laser parameters evaluating long-term follow-up, patient-reported outcome measures, and adverse events are needed.
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6
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Gurpegui Abud D, Shariff JA, Linden E, Kang PY. 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. J Periodontol 2021; 93:493-503. [PMID: 34286867 DOI: 10.1002/jper.21-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Daniela Gurpegui Abud
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, New York.,Periodontics, Touro College of Dental Medicine at New York Medical College, Hawthorne, New York
| | - Jaffer A Shariff
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, New York.,Periodontics, Touro College of Dental Medicine at New York Medical College, Hawthorne, New York
| | - Eric Linden
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, New York
| | - Philip Y Kang
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, New York
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7
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Zhu J, Wei R, Lv X, Qu C. Efficacy of a combined Er:YAG laser and Nd:YAG laser in non-surgical treatment for severe periodontitis. Lasers Med Sci 2021; 37:1095-1100. [PMID: 34125321 PMCID: PMC8202041 DOI: 10.1007/s10103-021-03357-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/07/2021] [Indexed: 12/05/2022]
Abstract
Severe periodontitis is challenging to treat. The aim of this study was to evaluate the efficacy of a combined Er:YAG laser (ERL) and Nd:YAG laser (NDL) in non-surgical treatment for severe periodontitis. One week after supragingival scaling, 32 systemically healthy patients with stage III or IV periodontitis were randomly divided into a control group (16 subjects) and a test group (16 subjects). The control group was treated by scaling and root planning (SRP) with ultrasonic equipment and manual instruments, and the test group was treated by SRP as well as ERL and NDL. Before treatment, the following clinical parameters were recorded at baseline: debris index (DI), probing depth (PD), clinical attachment level (CAL), and percentage of bleeding on probing (BOP %). Two months after therapy, the clinical parameters were recorded again, and the results between the groups were compared. All clinical parameters were significantly improved in both groups after therapy. For moderately deep periodontal pockets (4 mm ≤ PD ≤ 6 mm), the gains in CAL were greater in the test group (1.17 ± 1.47 mm) than in the control group (0.46 ± 2.78 mm), while no significant difference was found for PD reductions after therapy between the two groups. For deep periodontal pockets (PD > 6 mm), the differences in all of the clinical parameters were similar between the test group and the control group. In this short-term study, ERL and NDL radiation exhibited potential advantages in improving the clinical attachment level compared to conventional SRP in the non-surgical treatment of severe periodontitis.
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Affiliation(s)
- Jie Zhu
- Department of Stomatology, Peking University International Hospital, Shengmingyuan road, Changping District, Beijing, 102206, China.
| | - Rong Wei
- Department of Stomatology, Peking University International Hospital, Shengmingyuan road, Changping District, Beijing, 102206, China
| | - Xiaodan Lv
- Department of Stomatology, Peking University International Hospital, Shengmingyuan road, Changping District, Beijing, 102206, China.,Department of Stomatology, Shijiazhuang Second Hospital, Shijiazhuang, China
| | - Chunna Qu
- Department of Stomatology, Peking University International Hospital, Shengmingyuan road, Changping District, Beijing, 102206, China
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8
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Lin Z, Strauss FJ, Lang NP, Sculean A, Salvi GE, Stähli A. Efficacy of laser monotherapy or non-surgical mechanical instrumentation in the management of untreated periodontitis patients. A systematic review and meta-analysis. Clin Oral Investig 2020; 25:375-391. [PMID: 33170372 PMCID: PMC7819921 DOI: 10.1007/s00784-020-03584-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/11/2020] [Indexed: 01/16/2023]
Abstract
Objective To evaluate and compare the effects of laser monotherapy with non-surgical mechanical instrumentation alone in untreated periodontitis patients. Materials and methods A focused question was formulated based on the Population, Intervention, Comparison, Outcome, and Study design criteria (PICOS): in patients with untreated periodontitis, does laser mono-therapy provide adjunctive effects on pocket probing depth (PPD) changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. The results of the meta-analyses are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines. Results The search yielded 1268 records, out of which 8 articles could be included. With respect to PPD changes, a meta-analysis including 5 articles (n = 148) failed to identify statistically significant differences in favor of laser monotherapy for PPD change (WMD = 0.14 mm; 95% CI: − 0.04/0.32; z = 1.51; p = 0.132) nor for clinical attachment level (CAL) (WMD = 0.04 mm; 95% CI: − 0.35/0.42; z = 0.19; p = 0.850). Data on cost-effectiveness are lacking. One study reported patient-related outcome measures (PROMS). Conclusions In untreated periodontitis patients, laser monotherapy does not yield superior clinical benefits compared with non-surgical mechanical instrumentation alone. Clinical relevance In untreated periodontitis patients, mechanical instrumentation with hand and/or ultrasonic instruments remains the standard of care.
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Affiliation(s)
- Zhikai Lin
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.,Department of Periodontology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Franz J Strauss
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Department of Conservative Dentistry Faculty of Dentistry , University of Chile , Santiago, Chile
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
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9
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Erbil D, Nazaroglu K, Baser U, İssever H, Mese S, İsik AG. Clinical and Immunological Effects of Er,Cr:YSGG Laser in Nonsurgical Periodontal Treatment: A Randomized Clinical Trial. Photobiomodul Photomed Laser Surg 2020; 38:316-322. [PMID: 32427555 DOI: 10.1089/photob.2019.4748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: The aim of this study was to compare the clinical and immunological results of nonsurgical periodontal treatment with or without the erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser. Background data: As lasers have begun to be used in dentistry, the Er,Cr:YSGG laser has started to attract attention in the field of periodontology. Materials and methods: Fifty-nine nonsmoking patients with advanced chronic periodontitis were randomly allocated to a test group (full-mouth ultrasonic supra- and subgingival debridement+Er,Cr:YSGG laser application) and a control group (full-mouth ultrasonic supra- and subgingival debridement+root planing with Gracey curettes). The laser parameters were set as follows: 1.5 W output power, pulse mode H (pulse duration of 140 μs), pulse frequency of 20 Hz, and an air-water spray ratio of 10% air and 15% water. The instrumentation was performed until the operator felt that the root surfaces were adequately debrided. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index, interleukin-1 beta (IL-1β), matrix metalloproteinase-8 (MMP-8), tissue inhibitor metalloproteinase-1 (TIMP-1), and MMP-8/TIMP-1 levels in gingival crevicular fluid were evaluated at baseline, 6 weeks, and 3 months postoperatively. Results: There were statistically significant differences in PD, which was our primary outcome, and BOP between the groups at both examinations [p < 0.001 and p < 0.001 (for PD) and p = 0.048 and p < 0.001 (for BOP), respectively], in favor of the laser group. However, there were no significant differences among groups at any time for CAL gain (p = 563 and p = 369, respectively). No significant differences in MMP-8, TIMP-1, and MMP-8/TIMP-1 levels were detected among groups. There was a statistically significant difference for IL-1β levels among groups at 3-month evaluations in favor of the laser group. Conclusions: Using the Er,Cr:YSGG laser instead of hand instruments in nonsurgical periodontal treatment has shown additional improvements in terms of pocket reduction and gingival bleeding compared with traditional nonsurgical therapy.
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Affiliation(s)
- Deniz Erbil
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | | | - Ulku Baser
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Halim İssever
- Department of Public Health, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevim Mese
- Department of Virology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysen G İsik
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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10
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Clinical attachment level gain of lasers in scaling and root planing of chronic periodontitis: a network meta-analysis of randomized controlled clinical trials. Lasers Med Sci 2019; 35:473-485. [DOI: 10.1007/s10103-019-02875-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
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11
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Photonic Therapy in Periodontal Diseases an Overview with Appraisal of the Literature and Reasoned Treatment Recommendations. Int J Mol Sci 2019; 20:ijms20194741. [PMID: 31554277 PMCID: PMC6801906 DOI: 10.3390/ijms20194741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/13/2019] [Accepted: 09/21/2019] [Indexed: 12/26/2022] Open
Abstract
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.
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12
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Zhou X, Lin M, Zhang D, Song Y, Wang Z. Efficacy of Er:
YAG
laser on periodontitis as an adjunctive non‐surgical treatment: A split‐mouth randomized controlled study. J Clin Periodontol 2019; 46:539-547. [PMID: 31069833 DOI: 10.1111/jcpe.13107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/03/2019] [Accepted: 03/26/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Xuan Zhou
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
| | - Mei Lin
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
| | - Dongxue Zhang
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
| | - Yiqing Song
- Department of Epidemiology Richard M. Fairbanks School of Public Health Indiana University Indianapolis Indiana USA
| | - Zuomin Wang
- Department of Stomatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
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13
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Clinical and Microbiological Effects of the Use of Erbium: Yttrium–Aluminum–Garnet Laser on Chronic Periodontitis in Addition to Nonsurgical Periodontal Treatment: A Randomized Clinical Trial—6 Months Follow-Up. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:182-190. [DOI: 10.1089/photob.2018.4510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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14
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Sumra N, Kulshrestha R, Umale V, Chandurkar K. Lasers in non-surgical periodontal treatment – a review. J COSMET LASER THER 2018; 21:255-261. [DOI: 10.1080/14764172.2018.1525744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nida Sumra
- Consulting Periodontist, Private Practice, Mumbai, India
| | | | - Vinay Umale
- Senior Lecturer, Department of Orthodontics, Yogita Dental College, Khed Maharashtra, India
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15
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Wang Y, Li W, Shi L, Zhang F, Zheng S. Comparison of clinical parameters, microbiological effects and calprotectin counts in gingival crevicular fluid between Er: YAG laser and conventional periodontal therapies: A split-mouth, single-blinded, randomized controlled trial. Medicine (Baltimore) 2017; 96:e9367. [PMID: 29390529 PMCID: PMC5758231 DOI: 10.1097/md.0000000000009367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The erbium-doped yttrium, aluminum, and garnet (Er:YAG) laser is thought to be the most promising laser for periodontal treatment; however, its application is still under consideration. The aim of this study was to compare Er:YAG laser monotherapy with conventional scaling and root planing (SRP) for chronic periodontitis using clinical parameters, the detection rate of periodontal pathogens, and the calprotectin level in gingival crevicular fluid. METHODS Twenty-seven participants with moderate-to-advanced chronic periodontitis were included. In a split-mouth design, the 2 half-mouths of each participant were randomly assigned to Er:YAG laser or SRP (combination of ultrasonic and manual instruments) treatment. Clinical parameters were recorded at baseline, 6 weeks, and 3 and 6 months after treatment. At the same time points, gingival crevicular fluid was collected to analyze the detection rate of 6 periodontal pathogens by polymerase chain reaction and the levels of calprotectin by enzyme-linked immunosorbent assay. RESULTS Both treatment groups showed significant reductions in probing depth (PD), bleeding index (BI), and clinical attachment level (CAL) from baseline to 6 months. For sites with 4 mm ≤ PD ≤ 6 mm at baseline, SRP resulted in a greater reduction in PD and CAL than Er:YAG laser treatment, and the difference remained at 6 months post-treatment (P = .01 and P < .01, respectively). For sites with PD ≥7 mm at baseline, the clinical parameters showed similar results between the 2 groups. SRP resulted in a lower detection rate of Porphyromonas gingivalis at 6 months post-treatment. The levels of calprotectin were significantly decreased from baseline to 6 months in both groups, without a significant difference between the groups. CONCLUSION For mild pockets, conventional SRP may still be the preferred choice. For deep pockets, Er:YAG laser treatment could be an effective alternative. Studies are needed to explore more advanced instruments and new application methods for the Er:YAG laser for periodontal treatment in deep pockets.
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Affiliation(s)
- Yue Wang
- Department of Periodontology
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University
| | - Weiwei Li
- Department of Periodontology
- Department of Stomatology, Beijing Chongwen Hospital of Stomatology, Beijing, China
| | - Li Shi
- Department of Periodontology
| | | | - Sun Zheng
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University
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16
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Cobb CM. Lasers and the treatment of periodontitis: the essence and the noise. Periodontol 2000 2017; 75:205-295. [DOI: 10.1111/prd.12137] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Sağlam M, Köseoğlu S, Taşdemir I, Erbak Yılmaz H, Savran L, Sütçü R. Combined application of Er:YAG and Nd:YAG lasers in treatment of chronic periodontitis. A split-mouth, single-blind, randomized controlled trial. J Periodontal Res 2017; 52:853-862. [PMID: 28332191 DOI: 10.1111/jre.12454] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2017] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- M Sağlam
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - S Köseoğlu
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - I Taşdemir
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - H Erbak Yılmaz
- Department of Medical Biochemistry, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - L Savran
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - R Sütçü
- 9242/1 Street, Apartment No: 5, Karabağlar, Izmir, Turkey
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18
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Birang R, Yaghini J, Nasri N, Noordeh N, Iranmanesh P, Saeidi A, Naghsh N. Comparison of Er:YAG Laser and Ultrasonic Scaler in the Treatment of Moderate Chronic Periodontitis: A Randomized Clinical Trial. J Lasers Med Sci 2017; 8:51-55. [PMID: 28912945 DOI: 10.15171/jlms.2017.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Periodontitis is an inflammatory periodontal disease that leads to tooth loss. Recently laser has been introduced as an alternative treatment for periodontitis. The aim of the present study was to compare the effect of Erbium-doped Yttrium Aluminum Garnet (Er:YAG) laser with ultrasonic scaler in patients with moderate chronic periodontitis. Methods: In this randomized single-blind clinical trial, 27 patients with moderate chronic periodontitis were selected. One quadrant of the patients was treated by Er:YAG laser and the other one by ultrasonic scaler. Clinical parameters, including periodontal pocket depth (PPD), papillary bleeding index (PBI) and clinical attachment level (CAL) were measured before, as well as 6 and 12 weeks after treatment. Data were analyzed by SPSS 20 software using Friedman test, paired t test, independent t test and Mann-Whitney test. The significance level was set at 0.05. Results: The means of clinical parameters in both groups were significantly improved in the first and second follow-ups (P < 0.001). Although the means of PPD, PBI and CAL were slightly higher in the laser group than in the ultrasonic group, the differences were not statistically significant between these two groups (P > 0.05). Conclusion: Although both ultrasonic scaler and Er:YAG laser could effectively improve clinical periodontal parameters, the results did not reveal the superiority of Er:YAG laser over ultrasonic scaler or vice versa.
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Affiliation(s)
- Reza Birang
- Department of Periodontology, Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jaber Yaghini
- Department of Periodontology, Dental Implants Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Naeimeh Nasri
- Departments of Oral and Maxillofacial Radiology, School of Dentistry, Isfahan University of Medical Science, Isfahan, Iran
| | - Nasim Noordeh
- Dental Student's Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pedram Iranmanesh
- Department of Endodontics, School of Dentistry, Isfahan University of Medical Science, Isfahan, Iran
| | - Alireza Saeidi
- Dental Student's Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Naghsh
- Department of Periodontology, Dental Implants Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Hatipoğlu M, Barutcigil Ç, Harorlı OT, Ulug B. Effect of the lasers used in periodontal therapy on the surfaces of restorative materials. SCANNING 2016; 38:227-233. [PMID: 26340579 DOI: 10.1002/sca.21264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/12/2015] [Accepted: 08/21/2015] [Indexed: 06/05/2023]
Abstract
The present study aimed to reveal potential damage of the lasers, which are used as an alternative to manual instruments in periodontal therapy, might cause to the surface of restorative materials. Four different restorative materials were used: a glass-ionomer cement (GIC), a flowable composite (FC), a universal composite (UC) and an amalgam. Ten cylindrical samples (8 mm × 2 mm) were prepared for each restorative material. Two laser systems were used in subgingival curettage mode; an 940 nm diode laser (Epic Biolase, Irvine, CA) and an Er,Cr:YSGG laser (Waterlase iPlus, Biolase, Irvine, CA). After laser irradiation, roughness of the sample surfaces was measured using a profilometer. Additionally, atomic force microscopy (AFM) and scanning electron microscopy (SEM) analyses were performed to evaluate the morphology and surface deformations of the restorative materials and surfaces. The laser irradiation did not affect the surface roughness of any restorative materials relative to that of the control group (p > 0.05) except for the Er,Cr:YSGG treatment on GIC (p < 0.05). SEM and AFM images verified the results of the surface roughness tests. Within the limitations of the present study, it was demonstrated that Er,Cr:YSGG and diode lasers, aside from the Er;Cr:YSGG treatment on GIC, caused no harmful surface effects on adjacent restorative materials. SCANNING 38:227-233, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Mükerrem Hatipoğlu
- Department of Periodontology, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Çağatay Barutcigil
- Department of Restorative Dentistry, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Osman Tolga Harorlı
- Department of Restorative Dentistry, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Bülent Ulug
- Department of Physics, Faculty of Science, Akdeniz University, Antalya, Turkey
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20
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Milne TJ, Coates DE, Leichter JW, Soo L, Williams SM, Seymour GJ, Cullinan MP. Periodontopathogen levels following the use of an Er:YAG laser in the treatment of chronic periodontitis. Aust Dent J 2016; 61:35-44. [DOI: 10.1111/adj.12306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 12/23/2022]
Affiliation(s)
- TJ Milne
- Sir John Walsh Research Institute; School of Dentistry; University of Otago; Dunedin New Zealand
| | - DE Coates
- Sir John Walsh Research Institute; School of Dentistry; University of Otago; Dunedin New Zealand
| | - JW Leichter
- Sir John Walsh Research Institute; School of Dentistry; University of Otago; Dunedin New Zealand
| | - L Soo
- Sir John Walsh Research Institute; School of Dentistry; University of Otago; Dunedin New Zealand
| | - SM Williams
- Preventive and Social Medicine; Dunedin School of Medicine; University of Otago; Dunedin New Zealand
| | - GJ Seymour
- Sir John Walsh Research Institute; School of Dentistry; University of Otago; Dunedin New Zealand
| | - MP Cullinan
- Sir John Walsh Research Institute; School of Dentistry; University of Otago; Dunedin New Zealand
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21
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de Oliveira GJPL, Cominotte MA, Beraldo TPP, Sampaio JEC, Marcantonio RAC. A microscopic analysis of the effects of root surface scaling with different power parameters of Er,Cr:YSGG laser. Microsc Res Tech 2015; 78:529-35. [PMID: 25951453 DOI: 10.1002/jemt.22505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 02/19/2015] [Accepted: 03/22/2015] [Indexed: 11/12/2022]
Abstract
The aim of this study was to evaluate the effects of different power parameters of an Erbium, Cromium: Yttrium, Scandium, Gallium, Garnet laser (Er,Cr:YSGG laser) on the morphology, attachment of blood components (ABC), roughness, and wear on irradiated root surfaces. Sixty-five incisive bovine teeth were used in this study, 35 of which were used for the analysis of root surface morphology and ABC. The remaining 30 teeth were used for roughness and root wear analysis. The samples were randomly allocated into seven groups: G1: Er,Cr:YSGG laser, 0.5 W; G2: Er,Cr:YSGG laser, 1.0 W; G3: Er,Cr:YSGG laser, 1.5 W; G4: Er,Cr:YSGG laser, 2.0 W; G5: Er,Cr:YSGG laser, 2.5 W; G6: Er,Cr:YSGG laser, 3.0 W; G7: scaling and root planning (SRP) with manual curettes. The root surfaces irradiated by Er,Cr:YSGG at 1.0 W and scaling with manual curettes presented the highest degrees of ABC. The samples irradiated by the Er,Cr:YSGG laser were rougher than the samples treated by the manual curette, and increasing the laser power parameters caused more root wear and greater roughness on the root surface. The Er,Cr:YSGG laser is safe to use for periodontal treatment, but it is not appropriate to use irradiation greater than 1.0 W for this purpose.
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22
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Sanz-Sánchez I, Ortiz-Vigón A, Matos R, Herrera D, Sanz M. Clinical Efficacy of Subgingival Debridement With Adjunctive Erbium:Yttrium-Aluminum-Garnet Laser Treatment in Patients With Chronic Periodontitis: A Randomized Clinical Trial. J Periodontol 2015; 86:527-35. [DOI: 10.1902/jop.2014.140258] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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23
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Zhao Y, Yin Y, Tao L, Nie P, Tang Y, Zhu M. Er:YAG laser versus scaling and root planing as alternative or adjuvant for chronic periodontitis treatment: a systematic review. J Clin Periodontol 2014; 41:1069-79. [PMID: 25164559 DOI: 10.1111/jcpe.12304] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
AIM To perform a systematic review to evaluate the erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser versus scaling and root planing (SRP) as alternative or adjuvant for chronic periodontitis treatment. MATERIAL AND METHODS We performed a literature search using six electronic databases and completed by manual searches up to July 2013. We conducted a meta-analysis as well as heterogeneity, sensitivity, subgroup and power analyses to clarify and validate the pooled results. The 3-, 6- and 12-month clinical outcomes were evaluated. RESULTS Twelve eligible randomized clinical trials were finally included. Our meta-analysis showed that Er:YAG laser resulted in similar clinical improvements as SRP 3 months postoperatively. For subgroups by laser level, quality of trials and fluorescence feedback device, the results remained consistent. The 6- and 12-month observations between Er:YaG laser and SRP demonstrated no difference but inconclusive, due to large heterogeneity. The advantage of Er:YAG laser adjuvant to SRP for periodontitis treatment was not significant. CONCLUSIONS This systematic review indicated that the clinical efficacy of Er:YAG laser was similar to SRP 3 months postoperatively. The clinical benefits of Er:YAG laser as adjuvant to SRP was still lacking. Since Er:YAG laser has certain advantages, it could be expected to be a novel short-term alternative choice for chronic periodontitis.
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Affiliation(s)
- Yanhui Zhao
- Department of Oral and Cranio-Maxillofacial Science, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
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24
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Miremadi SR, Cosyn J, Schaubroeck D, Lang NP, De Moor RJG, De Bruyn H. Effects of root surface debridement using Er:YAG laser versus ultrasonic scaling - a SEM study. Int J Dent Hyg 2014; 12:273-84. [PMID: 24871380 DOI: 10.1111/idh.12074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Despite promising results of Er:YAG laser in periodontal debridement, to date there is no consensus about the ideal settings for clinical use. This experimental clinical trial aimed to determine the effects of debridement using Er:YAG laser and to compare with ultrasonic treatment. MATERIALS AND METHODS Sixty-four teeth were divided into two in vivo and in vitro subgroups. Each tooth received ultrasonic treatment on one side and Er:YAG laser debridement at either 60, 100, 160 or 250 mJ pulse(-1) and at 10 Hz on the other side on a random basis. All samples were morphologically analyzed afterwards under scanning electron microscope for surface changes and dentinal tubules exposure. Treatment duration (d) was also recorded. RESULTS Laser debridement produced an irregular, rough and flaky surface free of carbonization or meltdown while ultrasound produced a relatively smoother surface. The number of exposed dentinal tubules (n) followed an energy-dependent trend. The number of exposed tubules among the in vivo laser groups was n 60 mJ = n 100 mJ < n 160 mJ < n 250 mJ (P < 0.001). Also 160 and 250 mJ lasers led to significantly more dentinal exposure than ultrasound under in vivo condition. Within the in vitro laser groups, dentinal tubules exposure was n 60 mJ < n 100 mJ < n 160 mJ < n 250 mJ (P ≤ 0.0015). Furthermore, in vitro laser treatments at 100, 160 and 250 mJ led to significantly more dentinal denudation than ultrasound. Treatment duration (d) for the in vivo groups was d 60 mJ > d 100 mJ > d Ultrasound = d 160 mJ > d 250 mJ (P ≤ 0.046), while for the in vitro groups it was d 60 mJ > d 100 mJ = d Ultrasound = d 160 mJ >d 250 mJ (P ≤ 0.046). CONCLUSIONS Due to excessive treatment duration and surface damage, Er:YAG laser debridement at 60 and 250 mJ pulse(-1), respectively, is not appropriate for clinical use. Although laser debridement at 100 and 160 mJ pulse(-1) seems more suitable for clinical application, compared to ultrasound the former is more time-consuming and the latter is more aggressive. Using a feedback device or lower pulse energies are recommended when using laser in closed field.
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Affiliation(s)
- S R Miremadi
- Department of Periodontology, Faculty of Dentistry, Ghent University, Ghent, Belgium
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25
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Bassir SH, Moslemi N, Jamali R, Mashmouly S, Fekrazad R, Chiniforush N, Shamshiri AR, Nowzari H. Photoactivated disinfection using light-emitting diode as an adjunct in the management of chronic periodontitis: a pilot double-blind split-mouth randomized clinical trial. J Clin Periodontol 2012; 40:65-72. [DOI: 10.1111/jcpe.12024] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 08/24/2012] [Accepted: 09/21/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Seyed H. Bassir
- Laser Research Center in Dentistry; Tehran University of Medical Science; Tehran Iran
| | - Neda Moslemi
- Laser Research Center in Dentistry; Advanced Periodontics, School of Dentistry; Tehran University of Medical Science; Tehran Iran
| | - Raika Jamali
- Student's Scientific Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Samira Mashmouly
- Laser Research Center in Dentistry; School of Dentistry; Tehran University of Medical Science; Tehran Iran
| | - Reza Fekrazad
- Laser Research Center in Dentistry; Advanced Periodontics, School of Dentistry; Tehran University of Medical Science; Tehran Iran
| | - Nasim Chiniforush
- Laser Research Center in Dentistry; School of Dentistry; Tehran University of Medical Science; Tehran Iran
| | - Ahmad R. Shamshiri
- Department of Epidemiology and Biostatistics; School of Public Health; Tehran University of Medical Sciences; Tehran Iran
| | - Hessam Nowzari
- Professor of Clinical Dentistry and Director of Advanced Periodontics; Herman Ostrow School of Dentistry; University of Southern California; Los Angeles CA USA
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