Efficacy of the Er,Cr:YSGG Laser Application Versus the Conventional Method in Periodontal Flap Surgery: A Split-Mouth Randomized Control Trial Er,Cr:YSGG Laser Application in Periodontal Flap Surgery
Journal of Lasers in Medical Sciences,
Vol. 13 (2022),
10 January 2022
,
Page e4
Abstract
Introduction: The Er,Cr: YSGG laser has a suitable wavelength for the ablation of both hard and soft tissues of the periodontium and can be considered a potential tool in periodontal surgeries. The current study aimed at evaluating the application of this laser versus conventional instruments in periodontal pocket reduction flap surgery.
Methods: Eight patients requiring periodontal surgery were included. Using a split-mouth study design, two posterior sextants of a dental arch were randomly allocated into either a test group, open flap debridement periodontal surgery using the Er,Cr:YSGG laser, or a control group using the conventional method. Laser parameter settings of a 2780 nm wavelength, H mode (60 µs pulse duration), 25-50 Hz, 2-3.5 W output powers, and Air-20%, Water-60-80% were applied and adjusted individually for each step of the flap surgery procedure. Baseline, 1-3 month measurements of plaque index, Gingival Index, gingival recession, probing depth, and clinical attachment level were recorded for comparisons. Data were analyzed by a linear model for correlated data using the generalized estimating equations method and the least significant difference.
Results: In both treatment groups, reductions in PI and GI were observed in the 3-month follow-up period. These indices were significantly lower in the laser-treated sides compared to the conventional group (P<0.05). The Mean PD and CAL were lower at 1 month and 3 months compared to the baseline in both groups (P<0.05). However, these parameters were not statistically different in the treatment groups during these follow-up timelines. An increase in GR was observed from the baseline to 1 month and 3 months with less recession in the laser-treated sides (P=0.016).
Conclusion: Based on the results of the present study, the Er,Cr:YSGG laser-assisted periodontal flap surgery resulted in similar treatment outcomes to the conventional method and may be considered a safe and effective treatment modality
- Laser; Surgical flap; Periodontitis; Randomized controlled trial
How to Cite
References
Kinane DF, Stathopoulou PG, Papapanou PN. Periodontal diseases. Nat Rev Dis Primers. 2017;3:17038. doi:10.1038/nrdp.2017.38.
Taniguchi Y, Aoki A, Mizutani K, Izumi Y. Application of the Characteristics of Er: YAG Laser in Periodontal Therapy. Nippon Laser Igakkaishi. 2016;37(1):43-51. doi:10.2530/jslsm.jslsm-37_0006.
Aoki A, Mizutani K, Taniguchi Y, Komaki M, Ejiri K, Mikami R, et al. Periodontal pocket therapy using Er:YAG laser: systematic review of literature and introduction of a new treatment procedure. Nippon Laser Igakkaishi. 2017;38(2):167-178. doi:10.2530/jslsm.jslsm-38_0025.
Cobb CM. Clinical significance of non‐surgical periodontal therapy: an evidence‐based perspective of scaling and root planing. J Clin Periodontol. 2002;29(s2):22-32. doi:10.1034/j.1600-051X.29.s2.4.x
Ramfjord SP. Present status of the modified widman flap procedure. J Periodontol. 1977;48(9):558-565. doi:10.1902/jop.1977.48.9.558.
Ramfjord SP, Nissle RR. The Modified Widman Flap. J Periodontol. 1974;45(8):601-607. doi:10.1902/jop.1974.45.8.2.601.
Gaspirc B, Skaleric U. Clinical evaluation of periodontal surgical treatment with an Er:YAG laser: 5‐year results. J Periodontol. 2007;78(10):1864-71. doi:10.1902/jop.2007.070054.
Stavropoulos A, Bertl K, Spineli LM, Sculean A, Cortellini P, Tonetti M. Medium- and long-term clinical benefits of periodontal regenerative/reconstructive procedures in intrabony defects: Systematic review and network meta-analysis of randomized controlled clinical studies. J Clin Periodontol. 2021;48(3):410-430. doi:10.1111/jcpe.13409.
Mailoa J, Lin GH, Khoshkam V, MacEachern M, Chan HL, Wang HL. Long-Term Effect of Four Surgical Periodontal Therapies and One Non-Surgical Therapy: A Systematic Review and Meta-Analysis. J Periodontol. Oct 2015;86(10):1150-8. doi:10.1902/jop.2015.150159.
Aoki A, Sasaki KM, Watanabe H, Ishikawa I. Lasers in nonsurgical periodontal therapy. Periodontol 2000. 2004;36:59-97. doi:10.1111/j.1600-0757.2004.03679.x.
Schwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker J. Clinical evaluation of an Er:YAG laser combined with scaling and root planing for non‐surgical periodontal treatment: A controlled, prospective clinical study. J Clin Periodontol. 2003;30(1):26-34. doi:10.1034/j.1600-051x.2003.300105.x.
Cobb CM. Lasers and the treatment of periodontitis: the essence and the noise. Periodontol 2000. 2017;75(1):205-295. doi:10.1111/prd.12137.
Harashima T, Kinoshita JI, Kimura Y, Brugnera Jr A, Zanin F, Pecora JD, et al. Morphological comparative study on ablation of dental hard tissues at cavity preparation by Er:YAG and Er,Cr:YSGG lasers. Photomed Laser Surg. 2005;23(1):52-55. doi:10.1089/pho.2005.23.52.
Ishikawa I, Aoki A, Takasaki AA, Mizutani K, Sasaki KM, Izumi Y. Application of lasers in periodontics: true innovation or myth? Periodontol 2000. 2009;50:90-126. doi:10.1111/j.1600-0757.2008.00283.x.
Mizutani K, Aoki A, Coluzzi D, Yukna R, Wang CY, Pavlic V, et al. Lasers in minimally invasive periodontal and peri-implant therapy. Periodontol 2000. 2016;71(1):185-212. doi:10.1111/prd.12123.
Agoob Alfergany M, Nasher R, Gutknecht N. Calculus Removal and Root Surface Roughness When Using the Er:YAG or Er,Cr:YSGG Laser Compared with Conventional Instrumentation Method: A Literature Review. Photobiomodul Photomed Laser Surg. Apr 2019;37(4):197-226. doi:10.1089/photob.2018.4465.
Ge L, Zhang Y, Shu R. Er,Cr:YSGG Laser Application for the Treatment of Periodontal Furcation Involvements. Photomed Laser Surg. 2017;35(2):92-97. doi:10.1089/pho.2016.4145.
Ting CC, Fukuda M, Watanabe T, Aoki T, Sanaoka A, Noguchi T. Effects of Er,Cr: SGG laser irradiation on the root surface: morphologic analysis and efficiency of calculus removal. J Periodontol. 2007;78(11):2156-2164. doi:10.1902/jop.2007.070160.
Noori ZT, Fekrazad R, Eslami B, Etemadi A, Khosravi S, Mir M. Comparing the effects of root surface scaling with ultrasound instruments and Er,Cr:YSGG laser. Lasers Med Sci. 2008;23(3):283-287. doi:10.1007/s10103-007-0480-8.
Gutknecht N, Van Betteray C, Ozturan S, Vanweersch L, Franzen R. Laser supported reduction of specific microorganisms in the periodontal pocket with the aid of an Er,Cr:YSGG laser: a pilot study. Scie World J. 2015;2015:450258. doi:10.1155/2015/450258.
Gupta M, Lamba AK, Verma M, Faraz F, Tandon S, Chawla K, et al. Comparison of periodontal open flap debridement versus closed debridement with Er,Cr:YSGG laser. Aust Dent J. 2013;58(1):41-49. doi:10.1111/adj.12021.
Sezen D, Hatipoğlu M, Üstün K. Evaluation of the clinical and biochemical efficacy of erbium, chromium:ytrium-scandium-gallium-garnet (ER,CR:YSGG) laser treatment in periodontitis. Lasers Med Sci. 2020;35(7):1567-1575. doi:10.1007/s10103-020-02990-8.
Li MM, Jia JH, Wu MX, Zhao CY, Jia LY, Shi H, et al. Clinical effectiveness of Er,Cr:YSGG lasers in non-surgical treatment of chronic periodontitis: a meta-analysis of randomized controlled trials. Lasers Med Sci. Jun 2021;36(4):889-901. doi:10.1007/s10103-020-03156-2.
Ekworapoj P, Sidhu SK, McCabe JF. Effect of different power parameters of Er,Cr:YSGG laser on human dentine. Lasers Med Sci. 2007;22(3):175-182. doi:10.1007/s10103-006-0426-6.
Schwarz F, Aoki A, Becker J, Sculean A. Laser application in non-surgical periodontal therapy: a systematic review. J Clin Periodontol. 2008;35 (8 Suppl):29-44. doi:10.1111/j.1600-051X.2008.01259.x
Almehdi A, Aoki A, Ichinose S, Taniguchi Y, Sasaki KM, Ejiri K, et al. Histological and SEM analysis of root cementum following irradiation with Er:YAG and CO2 lasers. Lasers Med Sci. 2013;28(1):203-213. doi:10.1007/s10103-012-1110-7.
Pavone C, Scardueli CR, De Oliveira GJPL, Cerri PS, Marcantonio Junior E, Marcantonio RAC. Effects of an Er,Cr:YSGG laser on bone regeneration in critical-sized calvarial defects of rats exposed to inhalation of cigarette smoke. Photobiomodul Photomed Laser Surg. 2019;37(8):500-507. doi:10.1089/photob.2018.4546.
Wang X, Zhang C, Matsumoto K. In vivo study of the healing processes that occur in the jaws of rabbits following perforation by an Er,Cr:YSGG laser. Lasers Med Sci. 2005;20(1):21-27. doi:10.1007/s10103-005-0329-y.
Perussi LR, Pavone C, de Oliveira GJPL, Cerri PS, Marcantonio RAC. Effects of the Er,Cr:YSGG laser on bone and soft tissue in a rat model. Lasers Med Sci. 2012;27(1):95-102. doi:10.1007/s10103-011-0920-3.
Clem D, Heard R, McGuire M, Scheyer ET, Richardson C, Toback G, et al. Comparison of Er,Cr:YSGG laser to minimally invasive surgical technique in the treatment of intrabony defects: Six-month results of a multicenter, randomized, controlled study. J Periodontol. 2021;92(4):496-506. doi:10.1002/jper.20-0028.
Rossmann JA, Israel M. Laser de-epithelialization for enhanced guided tissue regeneration. A paradigm shift? Dent Clin North Am. 2000;44(4):793-809.
Romanos G. Current concepts in the use of lasers in periodontal and implant dentistry. J Indian Soc Periodontol. 2015;19(5):490-4. doi:10.4103/0972-124x.153471.
Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki AA, et al. Periodontal and peri-implant wound healing following laser therapy. Periodontol 2000. 2015;68(1):217-69. doi:10.1111/prd.12080.
Sperandio FF, Meneguzzo DT, Ferreira LS, Da Ana PA, Azevedo LH, de Sousa SC. Different air-water spray regulations affect the healing of Er,Cr:YSGG laser incisions. Lasers Med Sci. 2011;26(2):257-265. doi:10.1007/s10103-010-0849-y.
Wang X, Ishizaki NT, Suzuki N, Kimura Y, Matsumoto K. Morphological changes of bovine mandibular bone irradiated by Er,Cr:YSGG laser: an in vitro study. J Clin Laser Med Surg. 2002;20(5):245-250. doi:10.1089/10445470260420740.
Ryu SW, Lee SH, Yoon HJ. A comparative histological and immunohistochemical study of wound healing following incision with a scalpel, CO2 laser or Er,Cr:YSGG laser in the guinea pig oral mucosa. Acta Odontol Scand. 2012;70(6):448-54. doi:10.3109/00016357.2011.635598.
Watanabe H, Ishikawa I, Suzuki M, Hasegawa K. Clinical assessments of the erbium:YAG laser for soft tissue surgery and scaling. J Clin Laser Med Surg. 1996;14(2):67-75. doi:10.1089/clm.1996.14.67.
Schwarz F, Sculean A, Georg T, Reich E. Periodontal treatment with an Er:YAG laser compared to scaling and root planing. A controlled clinical study. J Periodontol. 2001;72(3):361-367. doi:10.1902/jop.2001.72.3.361.
Schwarz F, Sculean A, Georg T, Reich E, Becker J. Periodontal treatment with an Er: YAG laser compared to scaling and root planing. A controlled clinical study. J Periodontol. 2001;72(3):590-596. doi:10.1902/jop.2001.72.3.361.
Schwarz F, Sculean A, Berakdar M, Georg T, Reich E. Clinical evaluation of an Er:YAG laser combined with scaling and root planing for non-surgical periodontal treatment: A controlled, prospective clinical study. J Clin Periodontol. 2003;30(1):26-34. doi:10.1034/j.1600-051x.2003.300105.x.
Al-Falaki R, Hughes F, Wadia R, Eastman C, Kontogiorgos E, Low S. The effect of an Er,Cr:YSGG laser in the management of intrabony defects associated with chronic periodontitis using minimally invasive closed flap surgery. A case series. Laser Ther. 2016;25(2):131-139. doi:10.5978/islsm.16-OR-11.
Hakki SS, Korkusuz P, Berk G, Dundar N, Saglam M, Bozkurt B, et al. Comparison of Er,Cr:YSGG laser and hand instrumentation on the attachment of periodontal ligament fibroblasts to periodontally diseased root surfaces: an in vitro study. J Periodontol. 2010;81(8):1216-1225. doi:10.1902/jop.2010.090715.
Pourzarandian A, Watanabe H, Ruwanpura S, Aoki A, Noguchi K, Ishikawa I. Er:YAG laser irradiation increases prostaglandin E production via the induction of cyclooxygenase-2 mRNA in human gingival fibroblasts. J Periodontal Res. 2005;40(2):182-186. doi:10.1111/j.1600-0765.2005.00789.x.
Blomlöf JP, Blomlöf LB, Lindskog SF. Smear removal and collagen exposure after none-surgical root planing followed by etching with an EDTA gel preparation. J Periodontol. 1996;67(9):841-845. doi:10.1902/jop.1996.67.9.841.
Blomlöf J, Jansson L, Biomlöf L, Lindskog S. Root surface etching at neutral pH promotes periodontal healing. J Clin Periodontol. 1996;23(1):50-55. doi:0.1111/j.1600-051x.1996.tb00504.x.
Desai P, Gutknecht N. Minimally invasive erbium flap (MINIE TM flap)-a retrospective surgical treatment for chronic periodontitis. AMA Arch Intern Med. 2018;2(1):53-62. doi:10.1007/s41547-017-0019-7.
Ciurescu CE, Cosgarea R, Ciurescu D, Gheorghiu A, Popa D, Franzen R, et al. Adjunctive use of InGaAsP and Er,Cr:YSGG lasers in nonsurgical periodontal therapy: a randomized controlled clinical study. Quintessence Int. 2019;50(6): 436-447. doi:10.3290/j.qi.a42508.
Teerakapong A, Chuercharuenwasuchi N, Senarasana P, Chaowaratana S, W. W-a. The comparison of morphologic of periodontitis involved root surfaces after radiated in vitro with Er:YAG and ER,Cr:YSGG lasers. Khon Kaen Dental Journal 2007;10:80-90.
Qu C, Kang J, Luan Q. Effects of Er,Cr:YSGG laser on the root surface of periodontitis and healthy teeth. Beijing Da Xue Xue Bao Yi Xue Ban. 2016;48(1):71-75.
Ando Y, Aoki A, Watanabe H, Ishikawa I. Bactericidal effect of erbium YAG laser on periodontopathic bacteria. Lasers Surg Med. 1996;19(2):190-200. doi:10.1002/(SICI)1096-9101(1996)19:2<190::AID-LSM11>3.0.CO;2-B.
Folwaczny M, Mehl A, Aggstaller H, Hickel R. Antimicrobial effects of 2.94 microm Er:YAG laser radiation on root surfaces: an in vitro study. J Clin Periodontol. 2002;29(1):73-78. doi:10.1034/j.1600-051x.2002.290111.x.
Folwaczny M, Aggstaller H, Mehl A, Hickel R. Removal of bacterial endotoxin from root surface with Er:YAG laser. Am J Dent. 2003;16(1):3-5.
Pié-Sánchez J, España-Tost AJ, Arnabat-Domínguez J, Gay-Escoda C. Comparative study of upper lip frenectomy with the CO2 laser versus the Er,Cr:YSGG laser. Med Oral Patol Oral Cir Bucal. 2012;17(2):e228-32. doi:10.4317/medoral.17373.
Talebi-Ardakani MR, Torshabi M, Karami E, Arbabi E, Esfahrood ZR. In vitro study of Er:YAG and Er,Cr:YSGG laser irradiation on human gingival fibroblast cell line. Acta Medica Iranica. 2016;54(4):251-255.
Rizoiu IM, Eversole LR, Kimmel AI. Effects of an erbium, chromium: yttrium, scandium, gallium, garnet laser on mucocutanous soft tissues. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82(4):386-395. doi:10.1016/s1079-2104(96)80302-7.
- Abstract Viewed: 895 times
- PDF Downloaded: 507 times