Effect of Nonsurgical Periodontal Treatment Combined With Diode Laser or Photodynamic Therapy on Chronic Periodontitis: A Randomized Controlled Split-Mouth Clinical Trial
Journal of Lasers in Medical Sciences,
Vol. 6 No. 3 (2015),
30 June 2015
,
Page 112-119
Abstract
Introduction: The optimum removal of bacteria and their toxins from periodontal pockets is not always obtained by conventional mechanical debridement. Adjunctive therapies may improve tissue healing through detoxification and bactericidal effects. The purpose of the present study was to evaluate the impact of adjunctive laser therapy (LT) and photodynamic therapy (PDT) on patients with chronic periodontitis.
Methods: Twenty patients with at least three quadrants involved and each of them presenting pockets 4-8 mm deep were included in the study. Periodontal treatment comprising scaling and root planning (SRP) was accomplished for the whole mouth. Applying a split-mouth design, each quadrant was randomly treated with SRP alone (group A), SRP with LT (group B), and SRP with PDT (group C). The clinical indices were measured at baseline 6 weeks and 3 months after treatment. Microbiological samples were taken and evaluated at baseline and 3-month follow-up.
Results: All groups showed statistically significant improvements in terms of clinical attachment level (CAL) gain, periodontal pocket depth (PPD) reduction, papilla bleeding index and microbial count compared to baseline (P < .05). The results showed more significant improvement in the 6-week evaluation in terms of CAL in groups B and C than in group A (P < .05). Group B also revealed a greater reduction in PPD than the other treatment modalities (P < .05).
Conclusion: The obtained data suggested that adjunctive LT and PDT have significant short-term benefits in the treatment of chronic periodontitis. Furthermore, LT showed minimal additional advantages compared to PDT.
- Periodontitis
- chronic
- Diode laser
- Photodynamic therapy
- Photosensitizing agent
How to Cite
References
Andersen R, Loebel N, Hammond D, Wilson M. Treatment of periodontal disease by photodisinfection compared to scaling and root planing. J Clin Dent. 2007;18(2):34-38.
Renvert S, Dahlen G, Wikstrom M. Treatment of periodontal disease based on microbiological diagnosis. Relation between microbiological and clinical parameters during 5 years. J Periodontol. 1996;67(6):562-571. doi:10.1902/jop.1996.67.6.562.
Sbordone L, Ramaglia L, Gulletta E, Iacono V. Recolonization of the subgingival microflora after scaling and root planing in human periodontitis. J Periodontol. 1990;61(9):579-584. doi:10.1902/ jop.1990.61.9.579.
Teles RP, Haffajee AD, Socransky SS. Microbiological goals of periodontal therapy. Periodontol. 2000. 2006;42:180-218.
Cobb CM. Non-surgical pocket therapy: mechanical. Ann Periodontol. 1996;1(1):443-490. doi:10.1902/ annals.1996.1.1.443.
Soukos NS, Goodson JM. Photodynamic therapy in the control of oral biofilms. Periodontol 2000. 2011;55(1):143-166. doi:10.1111/j.1600- 0757.2010.00346.x.
Adriaens PA, Adriaens LM. Effects of nonsurgical periodontal therapy on hard and soft tissues. Periodontol 2000. 2004;36:121-145. doi:10.1111/ j.1600-0757.2004.03676.x.
Chaves ES, Jeffcoat MK, Ryerson CC, Snyder B. Persistent bacterial colonization of Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans in periodontitis and its association with alveolar bone loss after 6 months of therapy. J Clin Periodontol. 2000;27(12):897-903.
Stabholz A, Nicholas AA, Zimmerman GJ, Wikesjo UM. Clinical and antimicrobial effects of a single episode of subgingival irrigation with tetracycline HCl or chlorhexidine in deep periodontal pockets. J Clin Periodontol. 1998;25(10):794-800.
Feres M, Haffajee AD, Goncalves C, et al. Systemic doxycycline administration in the treatment of periodontal infections (II). Effect on antibiotic resistance of subgingival species. J Clin Periodontol. 1999;26(12):784-792.
Olsvik B, Tenover FC. Tetracycline resistance in periodontal pathogens. Clin Infect Dis. 1993;16(suppl 4):S310-S313.
Moritz A, Gutknecht N, Schoop U, Goharkhay K, Doertbudak O, Sperr W. Irradiation of infected root canals with a diode laser in vivo: results of microbiological examinations. Lasers Surg Med. 1997;21(3):221-226.
Mester E, Spiry T, Szende B, Tota JG. Effect of laser rays on wound healing. Am J Surg. 1971;122(4):532- 535.
Moritz A, Schoop U, Goharkhay K, et al. Treatment of periodontal pockets with a diode laser. Lasers Surg Med. 1998;22(5):302-311.
Pfitzner A, Sigusch BW, Albrecht V, Glockmann E. Killing of periodontopathogenic bacteria by photodynamic therapy. J Periodontol. 2004;75(10):1343-1349.
Hughes F. Color atlas of dental medicine: Periodontology. Br Dent J. 2005;198(10):655-655.
Harris DM, Yessik M. Therapeutic ratio quantifies laser antisepsis: ablation of Porphyromonas gingivalis with dental lasers. Lasers Surg Med. 2004;35(3):206- 213. doi:10.1002/lsm.20086
Konopka K, Goslinski T. Photodynamic therapy in dentistry. J Dent Res. 2007;86(8):694-707.
Von Tappeiner H, Jodlbauer A. On the effect of photodynamic (fluorescent) substances on protozoa and enzymes (in German). Deutsch Arch Klin Medizin. 1904(39):427-487.
Moan J, Berg K. The photodegradation of porphyrins in cells can be used to estimate the lifetime of singlet oxygen. Photochem Photobiol. 1991;53(4):549-553.
Ehrenberg B, Gross E, Nitzan Y, Malik Z. Electric depolarization of photosensitized cells: lipid vs. protein alterations. Biochim Biophys Acta. 1993;1151(2):257-264.
Soukos NS, Mulholland SE, Socransky SS, Doukas AG. Photodestruction of human dental plaque bacteria: enhancement of the photodynamic effect by photomechanical waves in an oral biofilm model. Lasers Surg Med. 2003;33(3):161-168. doi:10.1002/ lsm.10208.
Nastri L, Donnarumma G, Porzio C, et al. Effects of toluidine blue-mediated photodynamic therapy on periopathogens and periodontal biofilm: in vitro evaluation. Int J Immunopathol Pharmacol. 2010;23(4):1125-1132.
Zanin ICJ, Brugnera AJ. Terapia fotodinâmica no tratamento da doença periodontal. Perionews. 2007;1:79-85.
Prates RA, Yamada AM, Jr., Suzuki LC, et al. Bactericidal effect of malachite green and red laser on Actinobacillus actinomycetemcomitans. J Photochem Photobiol B. 2007;86(1):70-76. doi:10.1016/j. jphotobiol.2006.07.010.
Qin Y, Luan X, Bi L, et al. Toluidine blue-mediated photoinactivation of periodontal pathogens from supragingival plaques. Lasers Med Sci. 2008;23(1):49- 54. doi:10.1007/s10103-007-0454-x.
Christodoulides N, Nikolidakis D, Chondros P, et al. Photodynamic therapy as an adjunct to non-surgical periodontal treatment: a randomized, controlled clinical trial. J Periodontol. 2008;79(9):1638-1644. doi:10.1902/jop.2008.070652
Giannelli M, Formigli L, Lorenzini L, Bani D. Combined photoablative and photodynamic diode laser therapy as an adjunct to non-surgical periodontal treatment: a randomized split-mouth clinical trial. J Clin Periodontol. 2012;39(10):962-970. doi:10.1111/j.1600-051X.2012.01925.x.
Caruso U, Nastri L, Piccolomini R, d’Ercole S, Mazza C, Guida L. Use of diode laser 980 nm as adjunctive therapy in the treatment of chronic periodontitis. A randomized controlled clinical trial. New Microbiol. 2008;31(4):513-518.
De Micheli G, de Andrade AK, Alves VT, Seto M, Pannuti CM, Cai S. Efficacy of high intensity diode laser as an adjunct to non-surgical periodontal treatment: a randomized controlled trial. Lasers Med Sci. 2011;26(1):43-48.
Romanos GE, Brink B. Photodynamic therapy in periodontal therapy: microbiological observations from a private practice. Gen Dent. 2010;58(2):e68-73.
Braun A, Dehn C, Krause F, Jepsen S. Short-term clinical effects of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial. J Clin Periodontol. 2008;35(10):877-884. doi:10.1111/j.1600-051X.2008.01303.x.
Wolf HF, Rateitschak KH. Periodontology. Vol 1. Thieme; 2005.
Greenstein G. Periodontal response to mechanical non-surgical therapy: a review. J Periodontol. 1992;63(2):118-130. doi:10.1902/jop.1992.63.2.118.
Borrajo JL, Varela LG, Castro GL, Rodriguez-Nunez I, Torreira MG. Diode laser (980 nm) as adjunct to scaling and root planing. Photomed Laser Surg. 2004;22(6):509-512. doi:10.1089/pho.2004.22.509.
Euzebio Alves VT, de Andrade AK, Toaliar JM, et al. Clinical and microbiological evaluation of high intensity diode laser adjutant to non-surgical periodontal treatment: a 6-month clinical trial. Clin Oral Investig. 2013;17(1):87-95. doi:10.1007/s00784- 012-0703-7.
Balata ML, Andrade LP, Santos DB, et al. Photodynamic therapy associated with full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis: a randomized-controlled clinical trial. J Appl Oral Sci. 2013;21(2):208-214. doi:10.1590/1678-7757201302366.
Birang R, Yaghini J, Adibrad M, Kiany S, Mohammadi Z, Birang E. The Effects of Diode Laser (980 nm Wavelength) and Chlorhexidin Gel in the Treatment of Chronic Periodontitis. J Lasers Med Sci. 2011;2(4):131-138.
Lulic M, Leiggener Gorog I, Salvi GE, Ramseier CA, Mattheos N, Lang NP. One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized-controlled clinical trial. J Clin Periodontol. 2009;36(8):661-666. doi:10.1111/j.1600-051X.2009.01432.x.
Dilsiz A, Canakci V, Aydin T. Clinical effects of potassium-titanyl-phosphate laser and photodynamic therapy on outcomes of treatment of chronic periodontitis: a randomized controlled clinical trial. J Periodontol. 2013;84(3):278-286. doi:10.1902/ jop.2012.120096.
Cappuyns I, Cionca N, Wick P, Giannopoulou C, Mombelli A. Treatment of residual pockets with photodynamic therapy, diode laser, or deep scaling. A randomized, split-mouth controlled clinical trial. Lasers Med Sci. 2012;27(5):979-986. doi:10.1007/ s10103-011-1027-6.
Sgolastra F, Petrucci A, Severino M, Graziani F, Gatto R, Monaco A. Adjunctive photodynamic therapy to non-surgical treatment of chronic periodontitis: a systematic review and meta-analysis. J Clin Periodontol. 2013;40(5):514-526. doi:10.1111/ jcpe.12094.
Wennstrom JL, Heijl L, Lindhe J. Periodontal Surgery: Access Therapy. Bangalore, Karnataka: Blackwell Munksgaard; 2008: 783-822. Clinical Periodontology and Implant dentistry; vol 1.
Lang NP, Joss A, Orsanic T, Gusberti FA, Siegrist BE. Bleeding on probing. A predictor for the progression of periodontal disease? J Clin Periodontol. 1986;13(6):590-596.
Polansky R, Haas M, Heschl A, Wimmer G. Clinical effectiveness of photodynamic therapy in the treatment of periodontitis. J Clin Periodontol. 2009;36(7):575-580.
Dobson J, Wilson M. Sensitization of oral bacteria in biofilms to killing by light from a low-power laser. Arch Oral Biol. 1992;37(11):883-887.
Schwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker J. Periodontal treatment with an Er:YAG laser or scaling and root planing. A 2-year follow-up split-mouth study. J Periodontol. 2003;74(5):590-596. doi:10.1902/jop.2003.74.5.590.
- Abstract Viewed: 1804 times
- PDF Downloaded: 437 times