erbium:yag laser compared to scaling and root planing in periodontal treatment a controlled,...
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Erbium:YAG laser compared Erbium:YAG laser compared to scaling and root planing to scaling and root planing
in periodontal treatmentin periodontal treatment
A controlled, prospective clinical studyA controlled, prospective clinical study
Frank Schwarz*¹, Anton Sculean², Thomas Georg² and Elmar Reich²
¹ Department of Oral and Maxillofacial Surgery Ludwig Maximilians University Munich, Germany
² Department of Periodontology and Conservative Dentistry, University of Saarland Homburg, Germany
Background:Background:
The Er:YAG laser is expected to be useful in The Er:YAG laser is expected to be useful in
medical and dental applications because its medical and dental applications because its
emission wavelenght (2.94 µm) is highly emission wavelenght (2.94 µm) is highly
absorbed by waterabsorbed by water
Background:Background:
Er:YAG lasers have shown their capacity in Er:YAG lasers have shown their capacity in
removing plaque and calculus present on removing plaque and calculus present on
periodontally diseased root surfaces periodontally diseased root surfaces in vitroin vitro
and and in vivoin vivo (Aoki et al. 1994, Folwaczny et (Aoki et al. 1994, Folwaczny et
al. 2000, Schwarz et al. 2001)al. 2000, Schwarz et al. 2001)
Background:Background:StudyStudy TimeTime GroupGroup PPD (0)PPD (0) PPD (1)PPD (1) CAL (0)CAL (0) CAL (1)CAL (1)
Watanabe et al.Watanabe et al.
J Clin Laser Med Surg 1996J Clin Laser Med Surg 1996
4 Weeks4 Weeks LaserLaser 5.6 ± 2.05.6 ± 2.0 2.6 2.6 ± 0.9± 0.9 -- --
Jepsen at al.Jepsen at al.
J Dent Res (Abstr) 2000J Dent Res (Abstr) 2000
3 Months3 Months LaserLaserSRPSRP
3.9 3.9 ± 0.8± 0.83.9 ± 0.83.9 ± 0.8
2.9 2.9 0.60.6
2.9 2.9 0.60.6
Gain:Gain:Gain:Gain:
0.3 0.3 0.20.2
0.4 0.4 0.30.3
Schwarz et al.Schwarz et al.
Parodontologie 2000Parodontologie 20006 Months6 Months LaserLaser 4.7 4.7 ± 0.7± 0.7 3.1 ± 0.63.1 ± 0.6 6.1 ± 1.16.1 ± 1.1 4.6 ± 1.04.6 ± 1.0
Schwarz et al.Schwarz et al.
J Periodontol 2001J Periodontol 20016 Months6 Months LaserLaser
SRPSRP4.9 4.9 ± 0.7± 0.75.0 ± 0.65.0 ± 0.6
2.9 2.9 ± 0.6± 0.63.4 ± 0.73.4 ± 0.7
6.3 6.3 ± 1.1± 1.16.5 ± 1.06.5 ± 1.0
4.4 4.4 ± 1.0± 1.05.5 ± 1.05.5 ± 1.0
Schwarz et al.Schwarz et al.
J Clin Periodontol (in press)J Clin Periodontol (in press)12 Months12 Months Laser + SRPLaser + SRP
LaserLaser5.2 ± 0.85.2 ± 0.85.0 ± 0.75.0 ± 0.7
3.2 ± 0.83.2 ± 0.83.3 ± 0.73.3 ± 0.7
6.9 ± 1.06.9 ± 1.06.6 ± 1.16.6 ± 1.1
5.3 ± 1.05.3 ± 1.05.0 ± 0.75.0 ± 0.7
Objectives:Objectives:
The aim of the present study was to assess The aim of the present study was to assess
the clinical effectiveness of an Er:YAG laser the clinical effectiveness of an Er:YAG laser
when compared to well established when compared to well established
procedures such as scaling and root planingprocedures such as scaling and root planing
Material and Methods:Material and Methods:
20 patients (age: 28 to 79 years) 20 patients (age: 28 to 79 years) advanced periodontal diseaseadvanced periodontal diseasea total of 34 maxillary and 21 mandibular a total of 34 maxillary and 21 mandibular pairs of contralateral single- and multi- pairs of contralateral single- and multi- rooted teethrooted teethgood oral hygienegood oral hygieneno systemic diseasesno systemic diseasestreatment according to a split-mouth designtreatment according to a split-mouth design
Material and Methods:Material and Methods:
For 4 weeks before treatment all patients For 4 weeks before treatment all patients were enrolled in a hygiene program and were enrolled in a hygiene program and received oral hygiene instructions at 2 to 4 received oral hygiene instructions at 2 to 4 appointments as well as professional tooth appointments as well as professional tooth cleaning according to individual needscleaning according to individual needs
A supragingival professional tooth cleaning A supragingival professional tooth cleaning was performed at baseline as well as 3, 6 and was performed at baseline as well as 3, 6 and 12 months after treatment12 months after treatment
Treatment of test group:Treatment of test group:
KEY IIKEY II®® (KaVo, Biberach, Germany) (KaVo, Biberach, Germany)handpiece 2056handpiece 2056fiber tips of 0.5 x 1.65 and 0.5 x 1.1fiber tips of 0.5 x 1.65 and 0.5 x 1.1energy level 160 mJ/pulse at 10 ppsenergy level 160 mJ/pulse at 10 ppswater irrigationwater irrigationtreatment from coronal to apical in parallel treatment from coronal to apical in parallel pathspathsinclination of the fiber tip of 15-20inclination of the fiber tip of 15-20° to root ° to root surface (Folwaczny et al. 2001)surface (Folwaczny et al. 2001)treatment under local anesthesiatreatment under local anesthesia
Treatment of control group:Treatment of control group:
scaling and root planing (SRP)scaling and root planing (SRP)
Gracey curettes (Hu-Friedy, Chicago, USA) Gracey curettes (Hu-Friedy, Chicago, USA)
no. 1/2, 3/4, 7/8, 11/12, 13/14no. 1/2, 3/4, 7/8, 11/12, 13/14
treatment under local anesthesiatreatment under local anesthesia
Treatment time:Treatment time:
Single rooted teethSingle rooted teeth Multi rooted teethMulti rooted teeth
LaserLaser 5 minutes5 minutes 10 minutes10 minutes
SRPSRP 9 minutes9 minutes 15 minutes15 minutes
Clinical measurements:Clinical measurements:
plaque index (PI) (Silness & Löe 1964)plaque index (PI) (Silness & Löe 1964)
gingival index (GI) (Löe & Silness 1963)gingival index (GI) (Löe & Silness 1963)
bleeding on probing (BOP)bleeding on probing (BOP)
probing pocket depth (PPD)probing pocket depth (PPD)
gingival recessions (GR)gingival recessions (GR)
clinical attachment level (CAL)clinical attachment level (CAL)
Microbiological evaluation:Microbiological evaluation:
subgingival plaque samplessubgingival plaque samples
analysed using darkfield microscopy for the analysed using darkfield microscopy for the
presence of:presence of:
– coccicocci
– non motile rodsnon motile rods
– motile rodsmotile rods
– SpirochetesSpirochetes
((Listgarten & Helldén 1978Listgarten & Helldén 1978))
Assessments:Assessments:
recordings of clinical indices were assessed recordings of clinical indices were assessed
before treatment, 3, 6 and 12 months after before treatment, 3, 6 and 12 months after
treatment treatment
one calibrated and blinded examinerone calibrated and blinded examiner
statistical analysis by paired statistical analysis by paired tt-test -test (n.s. = non significant; * (n.s. = non significant; * pp0.05; ** 0.05; ** pp0.01; *** 0.01; *** pp0.001)0.001)
IndexIndex Baseline Baseline (± SD)(± SD)
3 Months 3 Months (± SD)(± SD)
PP 6 Months 6 Months (± SD)(± SD)
PP 12 Months 12 Months (± SD)(± SD)
PP
PIPI LaserLaser SRPSRP PP Value Value
1.0 1.0 0.6 0.61.0 1.0 0.6 0.6
n.s.n.s.
0.7 0.7 0.4 0.40.5 0.5 0.5 0.5
n.s.n.s.
****
0.7 0.7 0.4 0.40.7 0.7 0.5 0.5
n.s.n.s.
****
0.6 0.6 0.4 0.40.7 0.7 0.5 0.5
n.s.n.s.
****
GIGI LaserLaser SRPSRP PP Value Value
1.9 1.9 0.6 0.61.9 1.9 0.6 0.6
n.s.n.s.
0.5 0.5 0.6 0.60.7 0.7 0.8 0.8
n.s.n.s.
************
0.3 0.3 0.6 0.60.4 0.4 0.8 0.8
n.s.n.s.
************
0.4 0.4 0.3 0.30.5 0.5 0.7 0.7
n.s.n.s.
************
BOPBOP LaserLaser SRPSRP PP Value Value
56 %56 %52 %52 %n.s.n.s.
17 %17 %22 %22 %
**
************
13 %13 %23 %23 %
**
************
14 %14 %26 %26 %
****
************
Results (PI/ GI/ BOP):Results (PI/ GI/ BOP):
Results (PPD/ GR/ CAL):Results (PPD/ GR/ CAL):IndexIndex Baseline Baseline
(± SD)(± SD)3 Months 3 Months
(± SD)(± SD)PP 6 Months6 Months
(± SD)(± SD)PP 12 Months 12 Months
(± SD)(± SD)PP
PPDPPD LaserLaser SRPSRP PP Value Value
4.9 ± 0.74.9 ± 0.75.0 ± 0.65.0 ± 0.6
n.s.n.s.
3.5 ± 0.63.5 ± 0.63.8 ± 0.73.8 ± 0.7
**
************
2.9 ± 0.62.9 ± 0.63.4 ± 0.73.4 ± 0.7
******
************
3.0 ± 0.83.0 ± 0.83.5 ± 1.33.5 ± 1.3
******
************
GRGR LaserLaser SRPSRP PP Value Value
1.4 ± 0.81.4 ± 0.81.5 ± 0.81.5 ± 0.8
n.s.n.s.
1.5 ± 0.71.5 ± 0.71.9 ± 0.81.9 ± 0.8
****
n.s.n.s.******
1.5 ± 0.71.5 ± 0.72.0 ± 0.82.0 ± 0.8
******
n.s.n.s.******
1.5 ± 0.71.5 ± 0.72.1 ± 0.72.1 ± 0.7
******
n.s.n.s.******
CALCAL LaserLaser SRPSRP PP Value Value
6.3 ± 1.16.3 ± 1.16.5 ± 1.06.5 ± 1.0
n.s.n.s.
5.1 ± 1.05.1 ± 1.05.6 ± 1.15.6 ± 1.1
****
************
4.4 ± 1.04.4 ± 1.05.5 ± 1.05.5 ± 1.0
******
************
4.5 ± 1.34.5 ± 1.35.6 ± 1.45.6 ± 1.4
******
************
Distribution of bacteria (Laser):Distribution of bacteria (Laser):
0%
5%
10%
15%
20%
25%
30%
35%
40%
cocci non-motile rods motile rods spirochetes
Laser Baseline
Laser 3 Months
Laser 6 Months
Laser 12 Months
Distribution of bacteria (SRP):Distribution of bacteria (SRP):
0%
5%
10%
15%
20%
25%
30%
35%
40%
cocci non-motile rods motile rods spirochetes
SRP Baseline
SRP 3 Months
SRP 6 Months
SRP 12 Months
Conclusion:Conclusion:
The results of the present study indicate The results of the present study indicate
that non-surgical periodontal treatment that non-surgical periodontal treatment
with an Er:YAG laser is an alternative to with an Er:YAG laser is an alternative to
scaling and root planing with hand scaling and root planing with hand
instrumentsinstruments