lasers and nonsurgical periodontal therapy.

by:UMeasure     2020-06-13
Bottom line lasers are becoming more and more popular in dental hygiene practices.
Although traditional scaling and root planing (SRP)and daily self-
Patient care has been shown to be effective in reducing inflammation and depth of detection, as well as in increasing clinical adhesion, challenges associated with deeper pockets, root morphology and inaccessible areas reduce the likelihood of healing after non-surgical periodontal therapy (NSPT).
To overcome these limitations, the use of assistive devices such as antibacterial drugs and lasers is advocated.
The laser can be used as a separate therapy or as an adjunct to the SRP during the initial periodontal treatment, surgery or periodontal maintenance treatment;
However, this paper discusses their use as an auxiliary tool for nspt srp.
Several types of laser for treatment of periodontal and peripheral
Implant disease: diode laser (DLs)(809 to 980 nm), Nd:YAG (1064 nm)
, Er: YAG and Er, Cr: YSGG (
2940 and 2780 nm, respectively)and the C[O. sub. 2]laser (10,600 nm). (1)
In the NSPT, laser treatment is advocated to remove the wound, also known as soft tissue scraping, and to perform a sterilization effect in the periodontal bag.
Unlike other treatment procedures used by dental hygienists and dentists, the use of lasers does not have a standard accepted agreement.
In general, the performance of a given laser depends on the depth of its absorption or penetration of the tissue, and the absorption depends on the wavelength. (2)
The penetration depth of diodes and Nd: YAG lasers is large, while Er: YAG, Er, Cr: YSGG and C [O. sub. 2]
Surface penetration.
One exception to this general rule is photodynamic therapy (PDT)diode laser (660 to 810 nm), a low-
The power laser used only for antibacterial purposes is used in combination with photosensitizers;
Therefore, PDT is not involved in this paper.
In addition, the results presented in this paper do not apply to laser-
Assist in the new attachment procedure (LANAP)
The use of the Nd: YAG laser, as it is a specific agreement registered by a company, requires a full year of training and retains only clearer surgical procedures for dentists or dental specialists. (2)
Laser therapy, also known as periodontal light therapy, is used with SRP in NSPT and is the focus of this article.
The study discussed in this paper aims to evaluate the effectiveness of diodes and Nd: The YAG laser is used with SRP, as they have the potential to perform soft tissue scraping and reduce the periodontal pathogens in the periodontal bag. (2)
Neither of these types of lasers is used for calculus removal.
Based on the results of the two studies, the following conclusions can be drawn: * clinicians need to distinguish between the various types of lasers used in the NSPT, and consider each type of evidence in evaluating the effectiveness of laser therapy or light therapy.
* System-based review and meta-
Analysis of Slot et al, auxiliary use of the most commonly used diode lasers (809 to 980 nm)
As an auxiliary means of traditional mechanical treatment, periodontal treatment is questionable.
* Evidence of meta-analysis by Sgolastra and others
The analysis shows that due to the reduction of PD and GCF, Nd: yag srp has potential benefits in addition to SRP;
However, the number of studies that met the inclusion criteria was small and there was a risk of bias in the inclusion study, which led to the conclusion that there was not enough evidence to support the effectiveness of Nd: YAG assisted SRP.
* The results of these two studies support the 2015 systematic review and meta-
A panel of experts convened by the Scientific Affairs Committee of the American Dental Association conducted and published an analysis of non-surgical treatment of chronic periodontal disease through scaling and root surface leveling. (3)
* Low level of evidence supporting non-evidencePDT DL (809 to 980 nm)
Based on a small gain in CAL (0. 21mm)
Compared to the use of PDT alone, although ADA found moderate levels of evidence to support the use of pdt dl with pho toagent (0.
CAL gain 53mm).
Again, non-
Pdt dl studied by Slot et al.
Attention should be paid to DL used with PDT light agent.
* Although the ND: YAG laser produces 0.
Compared to the individual SRP, the attachment was increased by 41mm and the overall level of certainty of the evidence was lower.
Only three studies can be included in the meta-study
Risk of analysis and deviation from moderate to high.
* In addition, these system reviews and meta-
Analysis, and systematic review and meta-analysis by the ADA Science Team
Analysis, support about laser in non-
Surgical treatment of inflammatory periodontal diseases published by the American periodontal society, in part, states that there is little evidence to support the use of laser for Subgum cleaning as a supplement to the SRP. (4)
Jorde, Jorritsma KH, Cobb CM, Van der Vidon FA.
The role of a thermal diode laser (wavelength 808-980nm)in non-
Surgical periodontal therapy: systematic review and meta-presentationanalysis.
J. Clin periodontal tissue2014; 41(7):681-692.
Focus problem: what is the auxiliary effect of diode laser (DL)following non-
Periodontal surgery (SRP)
In the initial stage of periodontal treatment, the clinical parameters of periodontal disease?
Materials and Methods: MEDLINE-
The central control trial Register and The EMBASE database were retrieved as of September 2013.
Probe pocket depth (PPD)
And loss of clinical attachment (CAL)
Was selected as a result variable.
In addition, plaque points (PS)
Bleeding score (BS)
Gum Index (GI)
Measures considered to be fruitful.
The data is extracted, one yuan. analysis (MA)
Execute in the appropriate place.
Results: 416 unique papers were independently screened and 9 qualified publications were obtained.
MA evaluating PPD, CAL, PS did not show significant results.
For the result parameters GI and BS, the only meaning of supporting DL-assisted use was observed.
Conclusion: collective evidence on the auxiliary use of DL and SRP suggests that the effect provided by the combined treatment is comparable to the effect of using DL alone.
This is for PPD and CAL.
A large amount of evidence considering DL-assisted use is considered to be \"moderate\" to changes in PPD and CAL \".
With regard to BS, the results showed a small but significant effect in favor of DL, however, the clinical relevance of this difference remains a problem.
This systematic review questioned the auxiliary use of DL and traditional mechanical treatment patterns in patients with periodontal disease.
In this article, Slot et al. Reported a systematic review and meta-
Analysis to evaluate the effect of diode laser (
DL, 809 to 980 nm)
In the initial non-surgical periodontal treatment, as an adjunct to the SRP, it is used to evaluate the parameters of the periodontal and periodontal disease in the periodontal patients.
A systematic review is a study designed to answer specific, focused research questions through comprehensive collection and evaluation of published studies.
All pre-compliant studies
According to the precise method, the established criteria for systematically determining, evaluating and summarizing the evidence at the highest level. Meta-
The analysis adds an additional step by counting the results of the combined partial or full inclusion of the study.
Studies that are statistically similar enough to be combined, integrated, and analyzed, as data are generated from one study.
Systematic review or meta-for research issues with treatment or prevention strategies-
Analysis of Randomized Clinical Trials (RCTs)
Considered to be the highest level of available evidence.
As shown in the summary, only 9 of the 419 studies reviewed were included in the systematic review and meta-
Analysis based on quality and 8 criteria included.
Only randomized controlled trials comparing periodontitis with srp dl alone were included.
In addition, only studies considered to be at low risk of bias are included.
Split was used in seven studies
The oral sides that received each intervention were Randomized Oral study designs, 2 with parallel designs, and patients were randomly assigned to different treatment groups.
A separate analysis of the two designs showed no significant difference.
Due to insufficient reporting of details of tobacco use, the impact of some studies, including smokers, could not be analyzed.
A small number of studies (
However, of the 5 studies that reported these results, only 1 showed a significant reduction in bacterial load supporting dl srp.
Bleeding score (BS)
Gum inflammation (GI)
However, the advantages of dl srp are small compared to SRP, but statistically significant.
These indicators represent the disease.
The extent to which this difference in means representing the outcome of the two therapies is-5. 34%;
The authors therefore question the clinical significance of this difference.
A way for clinicians to consider statistical and statistical issues
The clinical significance is to treat the latter as a clinical importance.
Dental healers and other health professionals considering the evidence should ask themselves whether the difference between the new and old therapies reported based on the results of the study is sufficient to change their practice?
For this reason, Slot et al. Concluded, based on collective evidence, that it is doubtful to use DL with traditional mechanical treatment patterns for periodontal treatment.
The results of this study support 2015 systematic review and meta-
A panel of experts convened by the Scientific Affairs Committee of the American Dental Association conducted and published an analysis of non-surgical treatment of chronic periodontal disease through scaling and root surface leveling. (3)
The study found that despite moderate levels of evidence supporting the use of pdt dl (0.
CAL gain 53mm)
There is low level of evidence to supportPDT DL (809 to 980 nm)
Based on a small gain in CAL (0. 21 mm)
Only compared to the SRP.
Again, non-
Attention should be paid to the pdt dl studied by Slot et al and the DL used with PDT photosensitizers.
Sgolastra F, Severino mi, Roberto garto of Petrucci, Annalisa mi.
Nd: YAG laser as an auxiliary treatment for basic periodontal therapyanalysis. Lasers Med Sci. 2014; 29:887-895.
Abstract: one yuan
The analysis was carried out to study the scaling of root surface leveling using Nd: YAG laser (SRP)
Compared with the use of SRP alone, it can provide additional benefits for patients with chronic periodontal disease. The meta-
Analysis of PRISMA (
Preferred Reporting Items for system review and Meta-analysis)
Statements and suggestions from the Cochrane collaboration network.
A literature search was performed on seven databases, followed by a manual search.
Calculate the weighted mean difference and 95% confidence interval for clinical attachment level (CAL)
Depth of detection (PD)
Changes in the plaque index (PI)
Gum groove fluid (GCF). Inter-
Study heterogeneity was evaluated by Iodine test and by asymmetric Funnel chart, Egger regression test and trim-and-fill method.
All results were evaluated from baseline to end of follow-upup.
Significant differences in PD and GCF reduction were observed in favor of SRP Nd: YAG;
No significant difference was observed in CAL gain or PI changes.
The discovery of this yuan
The analysis shows that the use of Nd: YAG laser as an auxiliary treatment may bring additional benefits in traditional non-surgical periodontal therapy.
However, all studies included were not at a low risk of bias and only three were included in the meta-studyanalysis.
Therefore, the evidence is insufficient to support the effectiveness of Nd: YAG adjuvant therapy for SRP. Future long-term well-
Parallel randomized clinical trials need to be designed to evaluate the effectiveness of Nd: YAG laser-assisted use.
These tests should also include analysis of microorganisms and adverse events.
This study is a good review.
Design System review and meta-
Analysis was performed to evaluate the application of Nd: YAG laser as an adjunct to SCP in non-surgical periodontal therapy in patients with chronic periodontal disease.
In addition to measuring clinical results, the researchers evaluated the degree of bias in the studies included in the review.
Ten criteria were used in two phases for inclusion and exclusion to determine eligibility for studies included in the system review.
Of the 438 studies assessed, only 3 could be included in the analysis.
All of these studies are low.
Density Nd: YAG laser (1064 nm)
Laser treatment with a fiber tip range of 0. 2 to 0. 6 mm;
However, the contact time, frequency, laser dose and energy settings vary.
Differences in NSPT protocol, variability in the definition of chronic periodontal disease, and the addition of smokers also resulted in heterogeneity of the included data.
The authors determined that the risk of bias in one study was moderate and that the risk of bias in two of the three studies was high.
Included in this review and meta-
Analysis using split-mouth design.
The advantage of this design is to control individual differences between subjects and to allow reduction in the number of subjects in clinical trials without loss of statistical ability. Within-
However, a comparison of patients performed in a split oral design may be affected by differences in the pattern of disease on one side of the mouth and on the other, unless it is randomized or controlled.
The effect of these two treatments can also be transferred from one side of the mouth to the other. A split-
Mouth design should only be used when it is known that this crossover does not exist.
It is speculated that laser treatment lacks effect.
Significant decrease in mean PD was found (0. 55 mm)
The loneliness of the Nd: yag srp Bisang Lanxi party;
However, no significant difference was found in the gain of CAL.
Although no significant differences were observed in PI, the auxiliary use of Nd: YAG significantly reduced the amount of GCF.
GCF is a reflection of inflammation;
Thus, these results may support the ability of laser therapy-assisted SRP to reduce inflammation of periodontal disease, as is the result of comments from slot et al of dl srp, suggesting a difference between GI and bleeding.
All the studies included in the Sgolastra review did not report microbial results, although this claim is often used for laser treatment.
As stated in the summary, the evidence shows that although Nd: YAG junction reduces PD and GCF, suggesting that this approach has potential benefits in addition to SRP, there is insufficient evidence to support auxiliary Nd: effectiveness of YAG for SRP as there are very few studies eligible for inclusion and systematic review and meta-analysis.
This finding is related to 2015 systematic review and meta-
A panel of experts convened by the Scientific Affairs Committee of the American Dental Association conducted and published an analysis of non-surgical treatment of chronic periodontal disease through scaling and root surface leveling. (3)
The ADA review concluded that although the ND: YAG laser caused 0.
Compared to the individual SRP, the attachment was increased by 41mm and the overall level of certainty of the evidence was lower.
The dental practitioner is a prevention professional and is responsible for providing NSPT to meet the treatment needs of patients with periodontal disease.
According to the reported benefits of NSPT treatment, laser treatment using alone or as an adjunct to SRP is becoming more and more popular.
In fact, the evidence provided in these articles suggests that there is not enough evidence to support the use of dl srp or Nd: yag srp compared to the use of DL alone.
Although laser therapy may show some hope in reducing inflammation, the standard protocols used in practice and research are necessary.
Strong parallel studies are required, taking into account the well-established definition of the degree of periodontal disease and the potential impact of smoking on treatment outcomes.
Microbiology results also need to be evaluated based on clinical results.
The purpose of linking research with clinical practice is to provide evidence-based information to clinical dental health workers so that they can make informed decisions about patient treatment and advice.
Each issue will have a different subject area that is very important for clinical dental hygienists, and the bottom line is to translate the findings into clinical applications.
References (1. )
Cobb CM, Low SB, Coluzzi DJ.
Laser therapy and treatment of chronic periodontal disease.
Dental clinics in North America. 2010; 54:35-53. (2. )
Green Wood A, Water Valley K, Schwartz F, etc.
Periodontal and peripheral
Implant healing after laser treatment.
Periodontal tissue 2000. 2015; 68(1):217-69. (3. )
Smiley CJ, Tracy, SL, Abt E, etc.
System Review and yuan
Analysis of the efficacy of scraping and root surface leveling combined or not combined with auxiliary treatment of chronic periodontal disease.
I\'m dent Asch. 2015; 146(7):508-524. (4. )
American College of Dentistry.
Statement on the efficacy of non-laser
Surgical treatment of inflammatory periodontal diseases. J Periodontol. 2011; 82:513-514. Denise M.
Bowen, ms rdh, is an honorary professor of dental hygiene at Idaho State University.
She has served as a consultant to the dental industry and many governments, universities and private organizations and is currently a member of the National Advisory Group of the National Dental Health Research Center of the United StatesS.
She has served as chairman of the Research Committee of the American Association of dental hygienists and chairman of the Research Committee of the Institute of oral health and won the National Dental hygiene excellence award.
Professor Bowen is well known through her published articles and textbook chapters and dynamic continuing education programs related to non-surgical periodontal therapy, preventive oral self-treatment
Education on nursing, research methods and dental hygiene.
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