Journal of Investigative and Clinical Dentistry (2010), 1, 16–22
ORIGINAL ARTICLE Periodontology
Nd:YAG (1064 nm) laser for the treatment of chronic periodontitis: a pilot study Jørgen Jensen1, Martina Lulic2, Lisa J.A. Heitz-Mayfield2,3, Andreas Joss1 & Niklaus P. Lang1,2 1 School of Dental Medicine, University of Berne, Berne, Switzerland 2 Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, China 3 Faculty of Dentistry, Sydney University, Sydney, New South Wales, Australia
Keywords chronic periodontitis, gingivectomy, microbiological effect, neodymium: yttrium–aluminum–garnet laser, treatment. Correspondence Prof. Niklaus P. Lang, Prince Philip Dental Hospital, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong, China. Tel: +852-2859-0526 Fax: +852-2559-9013 Email: [email protected] Received 20 November 2009; accepted 14 February 2010. doi: 10.1111/j.2041-1626.2010.00009.x
Abstract Aim: To evaluate the clinical and microbiological effects of neodymium: yttrium–aluminum–garnet laser therapy as an adjunct to scaling and root planing during the hygienic phase. Methods: In eight patients, sites with a mean probing pocket depth (PPD) of ‡5 mm were treated by either scaling and root planing (n = 28) (control) or by scaling and root planing and adjunctive laser therapy (n = 28) (power: 5 W). Re-evaluation was at 4–6 weeks. Thereafter, remaining pockets (mean PPD ‡5 mm) were eliminated by either laser surgery (power: 7 W) or gingivectomy (control). Results: At baseline, the mean PPD of sites originally presenting with a mean PPD ‡4 mm were 4.69 and 4.73 mm in the test and control sites, respectively. Six months following surgery, there was a similar average mean PPD reduction in the test (1.18 mm, P < 0.01) and control sites (1.35 mm, P < 0.01). Also, the reduction in bleeding on probing in both groups was statistically significant (P < 0.01, paired t-tests). No statistically-significant differences between the test and control sites were found for any clinical or microbiological parameters at baseline, after initial, and 3 or 6 months’ post-surgical therapy. Conclusion: During the hygienic phase, neodymium: yttrium–aluminum– garnet (1064 nm) laser treatment yielded no superiority in clinical efficacy compared to conventional debridement. Laser gingivectomy resulted in similar treatment outcomes (mean PPD and bleeding on probing reduction), as did conventional gingivectomy.
Introduction Since the development of lasers in the early 1960s,1,2 attempts have been made to identify appropriate clinical applications in both medicine and dentistry. One of the major obstacles encountered has been the thermal side-effects produced of various laser systems. The neodymium: yttrium–aluminum–garnet (Nd:YAG) laser is adaptable to a pulsed delivery aimed at reducing the amount of heat generated. In periodontal treatment, the Nd:YAG laser has been used alone for calculus removal,3,4 in conjunction with scaling and root planing (SRP)5,6 for soft tissue surgery,7 and for 16
the reduction of dentinal hypersensitivity.8 Furthermore, it has been suggested that the Nd:YAG laser is capable of reducing the bacterial load in periodontal pockets.6,9,10 The goal of periodontal treatment is to reduce the amount of soft and mineralized biofilm deposits to a level compatible with the maintenance of periodontal health. In order to facilitate the subgingival debridement of deep pockets, surgical techniques, such as gingivectomy and various flap procedures, have been advocated. Studies have demonstrated that successful periodontal therapy can be achieved following adequate surgical debridement and the institution of supportive periodontal therapy, irrespective of the surgical procedure applied.11,12 ª 2010 Blackwell Publishing Asia Pty Ltd
J. Jensen et al.
The aim of this study was to evaluate the clinical and microbiological effects of Nd:YAG laser therapy as an adjunct SRP during the hygienic phase, and subsequently, to compare the effects of laser gingivectomy to conventional scalpel gingivectomy in the treatment of chronic periodontitis. Materials and methods Patients The study was approved by the ethical committee of the Canton of Berne, Switzerland (KEK 156/1999), and signed, informed consent was obtained from all the participants. Eight patients (4 females), aged between 32 and 57 years (mean age 44 years), with chronic periodontitis, were recruited for this pilot study. Inclusion criteria were: (a) one or more teeth with a mean probing pocket depth (PPD) of ‡5 mm in at least two quadrants and (b) age >21 years. Patients were excluded if they were heavy smokers (smoked ‡20 cigarettes/day), pregnant, or had received systemic or local antibiotic therapy within the last 6 months. The patient sample for this pilot study was based on previous results from surgical studies performed at the Department of Periodontology and Fixed Prosthodontics, University of Berne School of Dental Medicine, Berne, Switzerland. No power calculation was performed as there were no data available for a direct comparison of the laser versus conventional therapy. Study design A split mouth design, with one test and control quadrant in each patient, was used. Baseline measurements included full mouth plaque score (FMPS)13 and full mouth bleeding scores (FMBS),14 and PPD measurements at the teeth in the two experimental quadrants. In addition, microbial samples were taken from the two deepest sites within the test and control quadrants. Following patient recruitment and baseline measurements, two experimental quadrants in each patient were randomly assigned as a test and a control quadrant by a person not aware of the study design (dental assistant). Randomization was performed using sealed envelopes coded for the treatment of numbered quadrants by test and control procedures. The seal was broken immediately before the clinical procedures were executed. The clinical procedures were exclusively performed by one periodontist specialist (LJAH-M). Initial therapy During initial therapy, all patients received oral hygiene instructions and full mouth SRP using hand instruments ª 2010 Blackwell Publishing Asia Pty Ltd
Nd:YAG laser for periodontal treatment
only. In addition, the test quadrant was treated with the Nd:YAG Genius Laser (Mølsgaard Dental, Copenhagen, Denmark). The optic fiber was inserted into the pocket in parallel alignment with the root surface and moved around the root surface. According to the manufacturer’s recommendations, the laser settings for initial therapy were selected: a power of 5 W, water spray 7, air spray 3, pulse frequency 50 Hz, and pulse duration of 250 ms. Laser treatment was performed for 30 s per site. Re-evaluation 4–6 weeks after initial therapy was performed, and teeth with remaining pockets of PPD of ‡5 mm in the test and control quadrants received further periodontal treatment aimed at pocket reduction. A minimum standard of oral hygiene of FMPS of
ORIGINAL ARTICLE Periodontology
Nd:YAG (1064 nm) laser for the treatment of chronic periodontitis: a pilot study Jørgen Jensen1, Martina Lulic2, Lisa J.A. Heitz-Mayfield2,3, Andreas Joss1 & Niklaus P. Lang1,2 1 School of Dental Medicine, University of Berne, Berne, Switzerland 2 Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, China 3 Faculty of Dentistry, Sydney University, Sydney, New South Wales, Australia
Keywords chronic periodontitis, gingivectomy, microbiological effect, neodymium: yttrium–aluminum–garnet laser, treatment. Correspondence Prof. Niklaus P. Lang, Prince Philip Dental Hospital, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong, China. Tel: +852-2859-0526 Fax: +852-2559-9013 Email: [email protected] Received 20 November 2009; accepted 14 February 2010. doi: 10.1111/j.2041-1626.2010.00009.x
Abstract Aim: To evaluate the clinical and microbiological effects of neodymium: yttrium–aluminum–garnet laser therapy as an adjunct to scaling and root planing during the hygienic phase. Methods: In eight patients, sites with a mean probing pocket depth (PPD) of ‡5 mm were treated by either scaling and root planing (n = 28) (control) or by scaling and root planing and adjunctive laser therapy (n = 28) (power: 5 W). Re-evaluation was at 4–6 weeks. Thereafter, remaining pockets (mean PPD ‡5 mm) were eliminated by either laser surgery (power: 7 W) or gingivectomy (control). Results: At baseline, the mean PPD of sites originally presenting with a mean PPD ‡4 mm were 4.69 and 4.73 mm in the test and control sites, respectively. Six months following surgery, there was a similar average mean PPD reduction in the test (1.18 mm, P < 0.01) and control sites (1.35 mm, P < 0.01). Also, the reduction in bleeding on probing in both groups was statistically significant (P < 0.01, paired t-tests). No statistically-significant differences between the test and control sites were found for any clinical or microbiological parameters at baseline, after initial, and 3 or 6 months’ post-surgical therapy. Conclusion: During the hygienic phase, neodymium: yttrium–aluminum– garnet (1064 nm) laser treatment yielded no superiority in clinical efficacy compared to conventional debridement. Laser gingivectomy resulted in similar treatment outcomes (mean PPD and bleeding on probing reduction), as did conventional gingivectomy.
Introduction Since the development of lasers in the early 1960s,1,2 attempts have been made to identify appropriate clinical applications in both medicine and dentistry. One of the major obstacles encountered has been the thermal side-effects produced of various laser systems. The neodymium: yttrium–aluminum–garnet (Nd:YAG) laser is adaptable to a pulsed delivery aimed at reducing the amount of heat generated. In periodontal treatment, the Nd:YAG laser has been used alone for calculus removal,3,4 in conjunction with scaling and root planing (SRP)5,6 for soft tissue surgery,7 and for 16
the reduction of dentinal hypersensitivity.8 Furthermore, it has been suggested that the Nd:YAG laser is capable of reducing the bacterial load in periodontal pockets.6,9,10 The goal of periodontal treatment is to reduce the amount of soft and mineralized biofilm deposits to a level compatible with the maintenance of periodontal health. In order to facilitate the subgingival debridement of deep pockets, surgical techniques, such as gingivectomy and various flap procedures, have been advocated. Studies have demonstrated that successful periodontal therapy can be achieved following adequate surgical debridement and the institution of supportive periodontal therapy, irrespective of the surgical procedure applied.11,12 ª 2010 Blackwell Publishing Asia Pty Ltd
J. Jensen et al.
The aim of this study was to evaluate the clinical and microbiological effects of Nd:YAG laser therapy as an adjunct SRP during the hygienic phase, and subsequently, to compare the effects of laser gingivectomy to conventional scalpel gingivectomy in the treatment of chronic periodontitis. Materials and methods Patients The study was approved by the ethical committee of the Canton of Berne, Switzerland (KEK 156/1999), and signed, informed consent was obtained from all the participants. Eight patients (4 females), aged between 32 and 57 years (mean age 44 years), with chronic periodontitis, were recruited for this pilot study. Inclusion criteria were: (a) one or more teeth with a mean probing pocket depth (PPD) of ‡5 mm in at least two quadrants and (b) age >21 years. Patients were excluded if they were heavy smokers (smoked ‡20 cigarettes/day), pregnant, or had received systemic or local antibiotic therapy within the last 6 months. The patient sample for this pilot study was based on previous results from surgical studies performed at the Department of Periodontology and Fixed Prosthodontics, University of Berne School of Dental Medicine, Berne, Switzerland. No power calculation was performed as there were no data available for a direct comparison of the laser versus conventional therapy. Study design A split mouth design, with one test and control quadrant in each patient, was used. Baseline measurements included full mouth plaque score (FMPS)13 and full mouth bleeding scores (FMBS),14 and PPD measurements at the teeth in the two experimental quadrants. In addition, microbial samples were taken from the two deepest sites within the test and control quadrants. Following patient recruitment and baseline measurements, two experimental quadrants in each patient were randomly assigned as a test and a control quadrant by a person not aware of the study design (dental assistant). Randomization was performed using sealed envelopes coded for the treatment of numbered quadrants by test and control procedures. The seal was broken immediately before the clinical procedures were executed. The clinical procedures were exclusively performed by one periodontist specialist (LJAH-M). Initial therapy During initial therapy, all patients received oral hygiene instructions and full mouth SRP using hand instruments ª 2010 Blackwell Publishing Asia Pty Ltd
Nd:YAG laser for periodontal treatment
only. In addition, the test quadrant was treated with the Nd:YAG Genius Laser (Mølsgaard Dental, Copenhagen, Denmark). The optic fiber was inserted into the pocket in parallel alignment with the root surface and moved around the root surface. According to the manufacturer’s recommendations, the laser settings for initial therapy were selected: a power of 5 W, water spray 7, air spray 3, pulse frequency 50 Hz, and pulse duration of 250 ms. Laser treatment was performed for 30 s per site. Re-evaluation 4–6 weeks after initial therapy was performed, and teeth with remaining pockets of PPD of ‡5 mm in the test and control quadrants received further periodontal treatment aimed at pocket reduction. A minimum standard of oral hygiene of FMPS of
