Periodontal Disease

Photomed Laser Surg. 2016 Nov 17. [Epub ahead of print]

Role of Low-Level Laser Therapy as an Adjunct to Initial Periodontal Treatment in Type 2 Diabetic Patients: A Split-Mouth, Randomized, Controlled Clinical Trial.

Demirturk-Gocgun O1, Baser U1, Aykol-Sahin G2, Dinccag N3, Issever H4, Yalcin F1.

Author information

  • 11 Department of Periodontology, Faculty of Dentistry, Istanbul University , Istanbul, Turkey .
  • 22 Department of Periodontology, Faculty of Dentistry, Okan University , Istanbul, Turkey .
  • 33 Division of Diabetes, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .
  • 44 Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .

Abstract

OBJECTIVE:

In this split-mouth clinical trial, we evaluated the clinical benefits of low-level laser therapy (LLLT) as an adjunct to nonsurgical periodontal treatment in patients with type 2 diabetes mellitus (DM).

BACKGROUND DATA:

The impaired wound healing seen in diabetic patients may affect the results of periodontal treatment and may require an additional approach.

MATERIALS AND METHODS:

In total, 22 chronic periodontitis patients with type 2 DM were included. Applying a split-mouth design, two quadrants were treated with only scaling and root planing (SRP) as the control and those in the other two were treated with SRP + LLLT as the test sites in each patient. An 808?nm GaAlAs diode laser was performed in the test sites at the energy density of 4.46 J/cm2 on days 1, 2, and 7 after SRP. Plaque index (PI), probing depth (PD), bleeding on probing (BOP), and clinical attachment level were measured at baseline and again at 1 and 3 months after treatment. Deep periodontal pockets (PD 4mm) were evaluated separately.

RESULTS:

Test sites showed significant improvement in PI and BOP in deep pockets at the 1-month follow-up period (p<0.001 and <0.001, respectively), whereas no difference was found between the control and the test sites in other periodontal parameters.

CONCLUSIONS:

LLLT during periodontal treatment offered minimal short-term additional benefit in deep pocket healing in patients with type 2 DM.

Lasers Med Sci. 2016 Jan;31(1):187-96. doi: 10.1007/s10103-015-1836-0. Epub 2015 Nov 12.

Antimicrobial photodynamic therapy in the treatment of aggressive periodontitis: a systematic review and meta-analysis.

Souza E1, Medeiros AC2, Gurgel BC3, Sarmento C4.

Author information

  • 1Drug Development Laboratory, Paraiba State University, Rua Baraúnas 351, Campina Grande, PB, 58429-500, Brazil. emanuelodonto_1988@hotmail.com.
  • 2Drug Development Laboratory, Paraiba State University, Rua Baraúnas 351, Campina Grande, PB, 58429-500, Brazil.
  • 3Department of Dentistry, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
  • 4Department of Dentistry, Federal University of Pernambuco, Recife, PE, Brazil.

Abstract

The aim of this systematic review was to investigate whether the use of antimicrobial photodynamic therapy (aPDT) as an adjuvant to scaling and root planning (SRP) yields better results than SRP alone or associated with systemic antibiotics in the treatment of aggressive periodontitis (AgP). A meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statements and Cochrane Collaboration recommendations. The search for relevant studies (earliest record to January 2015) was carried out in seven databases, followed by a manual search. Methodological quality assessment of the studies selected was based on an analysis of the risk of bias. At each time point of follow-up, the existence of significant differences (p?<?0.05) in clinical attachment level (CAL) gain and probing depth (PD) reduction (primary outcomes) between groups was assessed with RevMan software 5.0. Heterogeneity between studies was assessed by the Higgin test (I (2)). Four randomized controlled trials (RCTs) satisfied the eligibility criteria of this review. Only one study was found to have a low risk of bias. There were no significant differences in PD reduction (mean difference 0.33, 95 % confidence interval -0.32 to 0.98, p?=?0.32) and CAL gain (mean difference 0.20, 95 % confidence interval -0.41 to 0.81, p?=?0.53) between the test and control interventions. At present, therefore, when compared to SRP alone or associated with systemic antibiotics, the evidence suggests that the association of aPDT?+?SRP is of no additional benefit in the nonsurgical treatment of AgP.

Medicine (Baltimore). 2015 Oct;94(42):e1724.

Periodontal Treatment Elevates Carotid Wall Shear Stress in the Medium Term.

Carallo C1, Franceschi MS, Tripolino C, Iovane C, Catalano S, Giudice A, Crispino A, Figliuzzi M, Irace C, Fortunato L, Gnasso A.
Author information
1From the Department of Chemical Engineering, Imperial College London, London, United Kingdom (CC, SC); Department of Clinical and Experimental Medicine, Institute of Dentistry, “Magna Graecia” University (MSDF, CI, AG, AC, MF, LF); and Department of Clinical and Experimental Medicine, Metabolic Disease Unit, “Magna Graecia” University, Catanzaro, Italy (CC, MSDF, CT, CI, AG).
Abstract
Periodontal disease is associated with endothelial dysfunction of the brachial artery and hemodynamic alterations of the common carotid artery. Periodontal therapy improves endothelial function. It is not known if it is able also to improve the hemodynamics of the carotid artery. The aim of the current study was to evaluate the efficacy of 2 different periodontal treatments on carotid hemodynamics: scaling and root planing (SRP) alone or together with low-level laser therapy (LLLT). Forty patients were recruited and randomly treated with SRP (n=20) or SRP + LLLT (n=20). Periodontal indices (plaque, gingival, and probing depth indices) were measured before and 5 months after treatment. Blood viscosity, common carotid wall shear stress, circumferential wall tension, and Peterson elastic modulus were evaluated before, soon after and 5 months after treatment. It was found that the periodontal indices improved in both groups, but significantly more so for SRP + LLLT than for SRP (decrease in gingival index 69.3% versus 45.4%, respectively, P=0.04). In the SRP + LLLT group, after a transient reduction by 5% immediately after therapy, shear stress increased by 11% after 5 months. In SRP only group, however, shear stress variations were less marked. No significant changes were found for the other hemodynamic parameters in either of the groups. Periodontal disease treatment by SRP + LLLT can therefore be said to improve common carotid wall shear stress. This suggests a possible mechanism by which the treatment of periodontal disease has beneficial effects on the cardiovascular system.
J Periodontal Implant Sci. 2014 Dec;44(6):280-7. doi: 10.5051/jpis.2014.44.6.280. Epub 2014 Dec 31.

Effects of adjunctive daily phototherapy on chronic periodontitis: a randomized single-blind controlled trial.

Jung GU1, Kim JW2, Kim SJ2, Pang EK3.

Author information

  • 1Department of Periodontology, Ewha Womans University Mokdong Hospital, Seoul, Korea.
  • 2Department of Oral and Maxillofacial Surgery, Ewha Womans University Medical Center, Seoul, Korea.
  • 3Department of Periodontology, Ewha Womans University Mokdong Hospital, Seoul, Korea. ; Department of Periodontology, Ewha Womans University Graduate School of Medicine, Seoul, Korea.

Abstract

PURPOSE:

The purpose of this randomized single-blind controlled trial was to elucidate the clinical and antimicrobial effects of daily phototherapy (PT) as an adjunct to scaling and root planing (SRP) in patients with chronic periodontitis.

METHODS:

The study was conducted from December 2013 to May 2014 at Ewha Womans University Mokdong Hospital, Seoul, Korea. Forty-one patients with mild to moderate chronic periodontitis were randomly divided into two therapeutic groups in a 1:1 ratio: SRP+PT and SRP (control) groups. All participants underwent full-mouth SRP. PT was performed thrice a day for a month by using electric toothbrushes with embedded light-emitting diodes. Plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing were assessed before (baseline) and four weeks after (follow-up) the treatment. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Parvimonas micra, Campylobacter rectus, Eikenella corrodens, Streptococcus mutans, and Streptococcus sobrinus levels were detected by a real-time polymerase chain reaction at the same points in time.

RESULTS:

The clinical parameters improved in both the groups. At the follow-up assessment, PPD was significantly decreased in the SRP+PT group (P=0.00). Further, PPD and CAL showed significantly greater changes in the SRP+PT group than in the SRP group (PPD, P=0.03; CAL, P=0.04). P. gingivalis and T. forsythia levels decreased in this group, but no significant intergroup differences were noted.

CONCLUSIONS:

Adjunctive PT seems to have clinical benefits, but evidence of its antimicrobial effects is not sufficient. Long-term studies are necessary to develop the most effective PT protocol and compare the effectiveness of PT with and without exogenous photosensitizers.

Gen Dent.  2012 Nov-Dec;60(6):540-3.

Five-year retrospective study of laser-assisted periodontal therapy.

Kusek ER, Kusek AJ, Kusek EA.

Source

University of South Dakota Hygiene School, Vermillion, SD, USA.

Abstract

This article outlines a five-year retrospective study involving a diode dental laser used on periodontally infected teeth. The present study utilized a specific protocol: scaling and root planing, light ultrasonic scaling, and the use of a diode laser. In 80% of cases, pocket depth of 3 mm or less was maintained.

Diabetes Technol Ther.  2012 Sep;14(9):799-803.

Low-level lasers as an adjunct in periodontal therapy in patients with diabetes mellitus.

Obradovic R, Kesic L, Mihailovi? D, Jovanovic G, Antic S, Brkic Z.

Source

1 Department of Periodontology and Oral Medicine, University of Niš , Niš, Serbia .

Abstract

Abstract Background: Diabetes mellitus (DM) increases the risk of periodontitis, and severe periodontitis often coexists with severe DM. The proposed dual pathway of tissue destruction suggests that control of chronic periodontal infection and gingival inflammation is essential for achieving long-term control of DM. The purpose this study is to evaluate the effects of low-level laser therapy (LLLT) by exfoliative cytology in patients with DM and gingival inflammation.

Subjects and Methods: Three hundred patients were divided in three equal groups: Group 1 consisted of patients with periodontitis and type 1 DM, Group 2 of patients with periodontitis and type 2 DM, and Group 3 of patients with periodontitis (control group). After oral examination, smears were taken from gingival tissue, and afterward all of the patients received oral hygiene instructions, removal of dental plaque, and full-mouth scaling and root planing. A split-mouth design was applied; on the right side of jaws GaAlAs LLLT (670?nm, 5?mW, 14?min/day) (model Mils 94; Optica Laser, Sofia, Bulgaria) was applied for five consecutive days. After the therapy was completed, smears from both sides of jaws were taken. The morphometric analysis was done using the National Institutes of Health Image software program and a model NU2 microscope (Carl Zeiss, Jena, Germany).

Results: Investigated parameters were significantly lower after therapy compared with values before therapy. After therapy on the side subjected to LLLT, there was no significantly difference between patients with DM and the control group.

Conclusions: It can be concluded that LLLT as an adjunct in periodontal therapy reduces gingival inflammation in patients with DM and periodontitis.

Rom J Morphol Embryol.  2012;53(1):111-6.

Healing process and laser therapy in the superficial periodontium: a histological study.

Mâru S, Amlinei C, Tatarciuc M, Rotaru M, Potârnichie O, Liliac L, Cruntu ID.

Source

Department of Periodontology, Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iassy, Romania.

Abstract

AIM:

To evaluate the efficiency of laser therapy in healing, regeneration and repair processes located in the superficial periodontium after gingivectomy procedures.

MATERIALS AND METHODS:

The study group consisted of 38 patients without any systemic diseases presenting with gingival hypertrophy developed exclusively within the clinical context of gingivitis and/or periodontitis. All patients were included in the study based on their informed consent. All patients required several surgical interventions at the level of the superficial periodontium. Subgroup 1 (17 patients) was treated only through gingivectomy procedures. For subgroup 2 (21 patients), the gingivectomy was associated with laser therapy, applied every day for seven days. Gingival mucosa fragments were taken on day 1 (curative gingivectomy) and on day 21 (clinical control and corrective gingivectomy), and routinely processed for the microscopic exam, using Hematoxylin-Eosin and special stains (trichrome Szekely and Periodic Acid-Schiff).

RESULTS AND DISCUSSION:

The comparison between the morphological pictures characterizing the healing process associated or not with laser therapy, allowed the identification of some features supporting the benefits of laser therapy. We believe that the decrease in the inflammatory infiltrate located in the lamina propria is the critical morphological trait for the control of a healing process as near to restitutio ad integrum as possible. The diminished number of lymphocytes and macrophages will implicitly determine a lower production of chemical mediators interfering with the sequences of the healing process.

CONCLUSIONS:

The morphological differences identified at the gingival epithelium level and subjacent lamina propria support the value of laser therapy, stimulating an improved healing of the damaged tissues.

Lasers Med Sci. 2012 Jun 15. [Epub ahead of print]

Effect of 635 nm irradiation on high glucose-boosted inflammatory responses in LPS-induced MC3T3-E1 cells.

Kwon H, Lim W, Kim J, Jeon S, Kim S, Karna S, Cha H, Kim O, Choi H.

Source

Department of Oral Pathology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Bug-Gu, Gwangju, 500-757, South Korea.

Abstract

Hyperglycemia occurs in patients with poorly controlled diabetes mellitus and contributes to bone resorption and increased susceptibility to bacterial infections. Hyperglycemia can incite low-grade inflammation that can contribute to the resorption of bone, especially the periodontal bone. The increased susceptibility to periodontal infections can contribute to bone resorption through the activation of osteoclasts. In this study, the osteoblastic, clonal cell line, MC3T3-E1, was used in an in vitro model of hyperglycemia and lipopolysaccharide-induced reactive oxygen species generation to determine the potential anti-inflammatory effect of 635 nm light-emitting diode (LED) irradiation or whether 635 nm LED irradiation can be a potential anti-inflammatory treatment. LED irradiation of MC3T3-E1 cells stimulated with lipopolysaccharide in a high glucose-containing medium decreased the level of cyclooxygenase gene and protein expression and reduced the level of prostaglandin E2 expression by decreasing the amount of reactive oxygen species generation. LED irradiation also inhibited the osteoclastogenesis in MC3T3-E1 cells by regulating the receptor activator of nuclear factor kappa-B ligand and osteoprotegerin. These findings reveal the mechanisms which are important in the pathogenesis of diabetic periodontitis and highlight the beneficial effects of 635 nm LED irradiation in reducing the adverse effects of diabetic periodontitis.

Lasers Med Sci.  2012 May 1. [Epub ahead of print]

Short-term clinical and osteoimmunological effects of scaling and root planing complemented by simple or repeated laser phototherapy in chronic periodontitis.

Calderín S, García-Núñez JA, Gómez C.

Source

Departamento de Estomatología III, Facultad de Odontología, UCM, Madrid, Spain.

Abstract

The aim of this study was to evaluate the clinical, anti-inflammatory, and osteoimmunological benefits of the single (PT) and repeated laser phototherapy (rPT) as an adjunctive treatment of inflamed periodontal tissue. Twenty-seven patients with chronic periodontitis were randomly divided into three groups of nine patients each in order to undergo scaling and root planing (SRP), SRP followed by one session of adjunctive PT (Day 1; SRP?+?PT), or SRP followed by adjunctive repeated PT five times in 2 weeks (Days 1, 2, 4, 7, and 11; SRP?+?rPT). For phototherapy session, a diode laser (??=?670 nm, 200 mW, 60 s/tooth) was applied into the sulcus. Clinical parameters, including full-mouth plaque score, full-mouth bleeding score, probing pocket depth, and clinical attachment level were recorded. Samples of gingival crevicular fluid (GCF) were taken at baseline, 4, and 8 weeks after treatment. Interleukin 1beta (IL-1?), tumor necrosis factor alpha (TNF-?), receptor activator of nuclear factor ?? ligand (RANKL), and osteoprotegerin (OPG) levels in the collected GCF were measured. PT used in a single or repeated doses, does not produce a significant reduction in the clinical parameters essayed (p?>?0.05). Levels of IL-1? in GCF were significantly reduced in SRP?+?PT and SRP?+?rPT groups compared with the SRP group (p?<?0.05). However, the SRP?+?rPT group showed a significant reduction of pro-inflammatory cytokine TNF-? and RANKL/OPG ratio at 4 weeks post-treatment compared with the SRP?+?PT and SRP groups (p?<?0.05). SRP?+?PT group also showed a significant reduction in TNF-? and RANKL/OPG ratio at 8 weeks post-treatment compared with the SRP group (p?<?0.05). PT exerts a biostimulative effect on the periodontal tissue. Multiple sessions of PT showed a faster and greater tendency to reduce proinflammatory mediators and RANKL/OPG ratio.

Lasers Med Sci. 2010 Nov;25(6):781-92. Epub 2010 Jul 17.

Laser phototherapy in the treatment of periodontal disease. A review.

de Paula Eduardo C, de Freitas PM, Esteves-Oliveira M, Aranha AC, Ramalho KM, Simões A, Bello-Silva MS, Tunér J.

Special Laboratory of Lasers in Dentistry (LELO), Department of Restorative Dentistry, School of Dentistry, University of São Paulo, 227 Cidade Universitária, São Paulo, SP, Brazil. cpeduard@usp.br

Abstract

Many studies in the literature address the effect of low-power lasers in the management of pathologies related to periodontal tissues. Due to the lack of standardized information and the absence of a consensus, this review presents the current status of laser phototherapy (LPT) in periodontics and discusses its benefits and limits in the treatment of periodontal disease. The literature was searched for reviews and original research articles relating to LPT and periodontal disease. The articles were selected using either electronic search engines or manual tracing of the references cited in key papers. The literature search retrieved references on wound and bone healing, analgesia, hypersensitivity, inflammatory process and antimicrobial photodynamic therapy. Each topic is individually addressed in this review. The current literature suggests that LPT is effective in modulating different periodontal disease aspects in vitro, in animals, and in simple clinical models. Further development of this therapy is now dependent on new clinical trials with more complex study designs.

J Clin Periodontol. 2009 Aug;36(8):650-60. Epub 2009 Jun 10.

Immediate efficacy of diode laser application in the treatment of dentine hypersensitivity in periodontal maintenance patients: a randomized clinical trial.

Sicilia A, Cuesta-Frechoso S, Suárez A, Angulo J, Pordomingo A, De Juan P.

Clinica Sicilia, Oviedo, Spain. asicilia@clinicasicilia.com

BACKGROUND: To evaluate the immediate efficacy in the reduction of dentine hypersensitivity (DH) when applying an 810 nm diode laser (DL), and a 10% potassium nitrate bioadhesive gel (NK10%).

MATERIAL AND METHODS: Forty-five consecutive periodontal maintenance patients of both sexes, with a DH >or= 2 on the verbal rating scale (VRS) in one or more teeth, were randomly allocated into three equal groups: 15 patients received DL and placebo gel; 15 patients were tested with a placebo laser and NK10%; and the remaining 15 received a placebo laser and placebo gel. The DH was evaluated at the start of the study, 15 and 30 min. after the laser application, and on days 2, 4, 7, 14, 30 and 60 by a blind examiner.

RESULTS: After 15 min., observations showed a reduction in DH after an evaporative stimulus (ES) of 36.9% (0.86), three times greater than that of the control group (0.23) (p=0.008). After 14 days, this effect was even greater [DL 71.7% (1.67)/NK10% 36.3% (1.73)/control 28.1% (0.73); p=0.004], and lasted until day 60 [65.7% (1.53)/30.4% (0.73)/25.8% (0.67); p=0.01].

CONCLUSIONS: The DL and NK10% gel were proven effective in the treatment of DH. A significantly greater immediate response was observed with DL.

Photomed Laser Surg. 2009 Jan 16. [Epub ahead of print]

The Effect of Diode Laser (980 nm) Treatment on Aggressive Periodontitis: Evaluation of Microbial and Clinical Parameters.

Kamma JJ, Vasdekis VG, Romanos GE.

Private Dental Clinic of Periodontics, Piraeus, Athens, Greece.

Abstract Objective: The aim was to compare the effect of scaling and root planing (SRP) alone, diode laser treatment (LAS) alone, and SRP combined with LAS (SRP + LAS) on clinical and microbial parameters in patients with aggressive periodontitis.

Materials and Methods: Thirty patients with aggressive periodontitis were assessed for plaque, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Four plaque samples were randomly obtained, one from each quadrant that was randomly assigned to SRP alone, SRP + LAS, LAS alone, and control (CRL). A 980-nm diode laser was used in continuous mode at 2 W power. Plaque samples were collected 2 wk, 12 wk, and 6 mo post-treatment. The levels of Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, Treponema denticola, and total bacterial load (TBL) were evaluated using ssrRNA probes.

Results: Bacterial counts were decreased with all three treatment modalities and they did not reach baseline levels at 6 mo post-treatment. The SRP + LAS group showed statistically significantly lower TBL and bacterial levels of P. gingivalis and T. denticola at 6 mo post-treatment compared to SRP or LAS treatments alone. At the end of the observation period significant differences were observed for PPD and CAL between the SRP + LAS group and both the SRP alone and LAS alone groups. No differences were detected for percentage of plaque and percentage of BOP between any of the treatment groups at 6 mo post-treatment.

Conclusions: Within the limits of this study, diode laser-assisted treatment with SRP showed a superior effect over SRP or LAS alone for certain microbial and clinical parameters in patients with aggressive periodontitis over the 6-mo monitoring period.

Gen Dent. 2009 Sep-Oct;57(5):510-3.

Periodontal treatment with a low-level diode laser: clinical findings.

Angelov N, Pesevska S, Nakova M, Gjorgoski I, Ivanovski K, Angelova D, Hoffmann O, Andreana S.

Department of Periodontics, Loma Linda University School of Dentistry, Loma Linda, CA, USA.

This study assessed the effects of low-level laser treatment in combination with scaling and root planing (SRP) in patients with periodontitis. Sixty subjects with chronic advanced periodontitis were assigned randomly to three treatment groups (n = 20) after collecting gingival clinical parameters. Group A received SRP on a single quadrant per day for four consecutive days; on the fifth day, all quadrants were rescaled. Group B received the same treatment as Group A, followed by laser application for five days. Group C received the same treatment as Group B but the laser treatment was administered for a total of 10 days. For Groups B and C, a low-level diode laser (630 to 670 nm) was used. The plaque index, gingival index, and sulcular bleeding index were recorded for all groups. For all clinical parameters, all three groups reported statistically significant differences (p < 0.005) compared to baseline data. Compared to Group A, Groups B and C showed statistically significant improvement for all clinical parameters. These findings suggest that a low-level diode laser can have a beneficial effect for treating inflammatory chronic advanced periodontitis.

Lasers Med Sci. 2009 May 14. [Epub ahead of print]

Comparison between laser therapy and non-surgical therapy for periodontitis in rats treated with dexamethasone.

Garcia VG, Fernandes LA, de Almeida JM, Bosco AF, Nagata MJ, Martins TM, Okamoto T, Theodoro LH.

Department of Surgery and Integrated Clinic, Division of Periodontics, São Paulo State University (UNESP), Rua Jose Bonifácio 1193, Centro, 16050-300, Araçatuba, SP, Brasil, vg.garcia@uol.com.br.

The aim of this study was to compare low-level laser therapy (LLLT) as adjuvant treatment for induced periodontitis with scaling and root planing (SRP) in dexamethasone-treated rats. One-hundred twenty rats were divided into groups: D group (n = 60), treated with dexamethasone; ND group (n = 60) treated with saline solution. In both groups, periodontal disease was induced by ligature at the left first mandibular molar. After 7 days, the ligature was removed and all animals were subjected to SRP and were divided according to the following treatments: SRP, irrigation with saline solution (SS); SRP + LLLT, SS and laser irradiation (660 nm; 24 J; 0.428 W/cm(2)). Ten animals in each treatment were killed after 7 days, 15 days and 30 days. The radiographic and histometric values were statistically analyzed. In all groups radiographic and histometric analysis showed less bone loss (P < 0.05) in animals treated with SRP + LLLT in all experimental periods. SRP + LLLT was an effective adjuvant conventional treatment for periodontitis in rats treated with dexamethasone.

Arch Immunol Ther Exp (Warsz). 2005 Sep-Oct;53(5):388-98.

Inflammation in periodontal tissues in response to mechanical forces.

Yamaguchi M, Kasai K.

Department of Orthodontics, Nihon University School of Dentistry at Matsudo, Japan. dai@mascat.nihon-u.ac.jp

Orthodontic forces are known to produce mechanical damage and inflammatory reactions in the periodontium and dental pulp, as well as inflammatory mediators, e.g. prostaglandins, interleukin (IL)-1, IL-6, tumor necrosis factor alpha, and receptor activator of nuclear factor kappaB ligand, in the periodontal ligament (PDL) and dental pulp. We have studied the effects of aging on the production of inflammatory mediators in the PDL using in vitro and in vitro methods and found that aging of PDL tissues may be an important factor in the severity of periodontal disease through a higher production of inflammatory mediators in response to mechanical forces. Further, the levels of inflammatory mediators in gingival crevicular fluid, an osmotically mediated inflammatory exudates found in the gingival sulcus, have been shown to be significantly elevated during orthodontic treatment. In order to reduce inflammation, low-level laser therapy has been recently studied in vitro and in vitro by many investigators as a substitute for anti-inflammatory drugs. Clinical and experimental studies have shown that low-level laser irradiation reduces orthodontic post-adjustment inflammation. We believe that orthodontic forces (mechanical forces) may play an important role in periodontal inflammation and that low-level laser therapy may be useful for its inhibition.

J Clin Periodontol. 2005 Jul;32(7):714-9.

The short-term effects of low-level lasers as adjunct therapy in the treatment of periodontal inflammation.

Qadri T, Miranda L, Tunér J, Gustafsson A.

Department of Periodontology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden. talat.qadri@mbox.lidnet.se

OBJECTIVES: The aim of this split-mouth, double-blind controlled clinical trial was to study the effects of irradiation with low-level lasers as an adjunctive treatment of inflamed gingival tissue.

MATERIALS AND METHODS: Seventeen patients with moderate periodontitis were included. After clinical examination, all teeth were scaled and root planed (SRP). One week after SRP, we took samples of gingival crevicular fluid (GCF) and subgingival plaque. The laser therapy was started 1 week later and continued once a week for 6 weeks. One side of the upper jaw was treated with active laser and the other with a placebo. The test side was treated with two low-level lasers having wavelengths of 635 and 830 nm. The patients then underwent another clinical examination with sampling of GCF and plaque. The GCF samples were analysed for elastase activity, interleukin-1beta (IL-1beta) and metalloproteinase-8 (MMP-8). We examined the subgingival plaque for 12 bacteria using DNA probes.

RESULTS: The clinical variables i.e. probing pocket depth, plaque and gingival indices were reduced more on the laser side than on the placebo one (p<0.01). The decrease in GCF volume was also greater on the laser side, 0, 12 microl, than on the placebo side, 0.05 microl (p=0.01). The total amount of MMP-8 increased on the placebo side but was slightly lower on the laser side (p=0.052). Elastase activity, IL-1beta concentration and the microbiological analyses showed no significant differences between the laser and placebo sides.

CONCLUSION: Additional treatment with low-level lasers reduced periodontal gingival inflammation.

Photomed Laser Surg. 2004 Jun;22(3):177-83.

Removal of epithelium in periodontal pockets following diode (980 nm) laser application in the animal model: an in vitro study.

Romanos GE, Henze M, Banihashemi S, Parsanejad HR, Winckler J, Nentwig GH.

Department of Oral Surgery and Implantology, Dental School (Carolinum), Frankfurt, Germany. Dr.G.E.Romanos@t-online.de

OBJECTIVE: The purpose of this study was to examine the removal of the epithelium in the periodontal pocket using a diode (980 nm) laser in comparison with the conventional techniques in an animal experimental model.

BACKGROUND DATA: The goal of periodontal therapy is to reduce the bacterial deposits in the pockets and to enhance the clinical attachment. Different surgical techniques have been used in the past, which control the epithelial migration and promote the connective tissue formation.

MATERIALS AND METHODS: The buccal pockets of the posterior teeth in 10 freshly sacrificed adult pigs were scaled by three different examiners (with different levels of experience in periodontal surgery) using conventional curettes. The lingual pockets were treated using a diode (980 nm) laser. The laser was used in a continuous wave (c. w.) mode with two different power settings (2 and 4 Watts) with a 300-microm-thick glass fiber. The instrumentation period revealed 15 sec in all of the sites. Soft tissue biopsies of the instrumented sites were removed and examined histologically.

RESULTS: In all of the lased sections, no epithelial remnants were found. The laser with a low power was able to remove the thin pocket epithelium in the same way regardless of the level of surgical experience of the examiner. A high-power setting presented significant damage to the underlying connective tissues. The sites, which were instrumented with the conventional curettes, demonstrated significant epithelial remnants in all of the tissues regardless of the level of periodontal surgical experience.

CONCLUSION: The histological findings presented in this study showed that instrumentation of the soft periodontal tissues with a diode laser (980 nm) leads to a complete epithelial removal in comparison to conventional treatment methods with hand instruments (independent of the clinician’s experience).

Photomed Laser Surg. 2004 Dec;22(6):509-12.

Diode laser (980 nm) as adjunct to scaling and root planing.

Borrajo JL, Varela LG, Castro GL, Rodríguez-Nuñez I, Torreira MG.

Department of Periodontology, School of Dentistry, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Spain.

OBJECTIVE: The aim of this study was to evaluate clinical efficacy of InGaAsP diode laser as adjunct to traditional scaling and root planing.

BACKGROUND DATA: The use of laser is one of the most recent methods in nonsurgical periodontal treatment. Efficacy and side effects of each type of laser treatment have yet to be determined.

METHODS: Thirty patients suffering from moderate periodontal disease have been considered. They were randomly selected to undergo either scaling and root planing with curets, or scaling and root planing combined with InGaAsP laser (980 nm and 2 W). The papilla bleeding index (PBI), bleeding on probing (BOP), and clinical attachment level (CAL) were registered at the beginning and end of treatment.

RESULTS: At the end of treatment, PBI average in the group treated with laser was 0.24 versus 0.43 in the group under conventional treatment (p = 0.014). In the group undergoing scaling and root planing, BOP decrease is 19.55% less (p < 0.0001) than in the group also treated with laser. Nevertheless, CAL differences cannot be considered significant between both groups (p = 0.67).

CONCLUSIONS: Scaling and root planing in combination with laser produce moderate clinical improvement over traditional treatment.

Stomatologiia (Mosk). 2003;82(4):20-4.

[Magnetic laser therapy in the treatment of apical periodontitis]

[Article in Russian]

Giliazetdinova IuA, Vinnichenko AV, Vinnichenko IuA.

A new method for the treatment of apical periodontitis, making use of Optodan laser, differs from the known method by more rapid periapical tissue regeneration, which is paralleled by high antiinflammatory effect of magnetic laser therapy at early stages of treatment.

Aust Orthod J. 2002 Mar;18(1):53-63.

Laser irradiation inhibition of open gingival embrasure space after orthodontic treatment.

Meguro D, Yamaguchi M, Kasai K.

Department of Orthodontics, School of Dentistry, Nihon University, Japan. meguro@mascat.nihon-u.ac.jp

The purpose of this study was to investigate the inhibitory effect of low-energy laser irradiation on an incidence of open gingival embrasure space after orthodontic treatment. The patient was a 20-year, 7-month-old Japanese female with an Angle Class I malocclusion and crowding in the mandible. Treatment consisted of extraction of maxillary and mandibular first premolars and use of the Edgewise technique. A Ga-Al-As diode laser was used to irradiate an area of 0.5 cm2 at the labial and lingual gingival papilla between the canines. The time of exposure was 6 minutes for 3 days, carried out between the relevelling and en masse stages of movement. The total energy corresponding to 6 minutes of exposure varied from 1.90 J/cm2. There was no further evidence of open gingival embrasure space, except at the mandibular central incisor. Further: an improvement in the gingival inflammation caused by a periodontal disease was observed, and periodontal pocket depth was maintained. These results suggest that low-energy laser irradiation may inhibit the incidence of open gingival embrasure space after orthodontic treatment.

Eur J Oral Sci. 2000 Feb;108(1):29-34.

Inhibitory effect of low-level laser irradiation on LPS-stimulated prostaglandin E2 production and cyclooxygenase-2 in human gingival fibroblasts.

Sakurai Y, Yamaguchi M, Abiko Y.

Department of Biochemistry, Nihon University School of Dentistry at Matsudo, Chiba, Japan.

It has been reported that lipopolysaccharide (LPS) from periodontal pathogens can penetrate gingival tissues and stimulate the production of prostaglandin E2 (PGE2), which is known as a potent stimulator of inflammation and bone resorption. Although biostimulatory effects of low-level laser irradiation such as anti-inflammatory results have been reported, the physiological mechanism is not yet clarified. The purpose of the present study was to determine the effect of laser irradiation on PGE2 production and cyclooxygenase (COX)-1 and COX-2 gene expression in LPS-challenged human gingival fibroblast (hGF) cells in vitro. hGF cells were prepared from healthy gingival tissues and challenged with LPS, and Ga-Al-As diode laser was irradiated to the hGF cells. The amount of PGE2 released in the culture medium was measured by radioimmunoassay, and mRNA levels were analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). Irradiation with Ga-Al-As diode low-level laser significantly inhibited PGE2 production in a dose-dependent manner, which led to a reduction of COX-2 mRNA levels. In conclusion, low-level laser irradiation inhibited PGE2 by LPS in hGF cells through a reduction of COX-2 mRNA level. The findings suggest that low-level laser irradiation may be of therapeutic benefit against the aggravation of gingivitis and periodontitis by bacterial infection.

Georgian Med News. 2006 May;(134):94-6.

Laser therapy in treatment of generalized parodontitis.

Mdinaradze N.

University “Sakartvelo”, Tbilisi, Georgia.

Laser therapy has a significant place among the treatment methods in stomatology. An experiment was carried out on 48 male white rats with the masses of 150,0-200,0 gr. Parodontitis was simulated by application of ligature around the dental cervix. Morphometric indicators such as diameter of arterioles and capillars Dk (mkm), density of blood vessels distribution VvK, diameter of the zone of peri-capillar diffusion Di (mkm) and intensity of the local blood circulation were taken as the criteria for the effectiveness of treatment. We also conducted microbiological studies of the mucous tunic of the oral cavity. The results gained on the seventh day of treatment equaled to the reference ones. As a result of a combined treatment with medications (3% indometacin ointment, heparin ointment, vitamins, ferments, antibiotics) and laser-beam therapy, the diameter of arterioles and capillaries was increased, or it is to say, the diameter indicator equaled to the reference one, the capillary distribution density V(v)(K) was increased and the diameter of peri-capillar diffusion was also increased. The indicator of the local blood circulation was increased and reached the norm. The analysis of the data gained through research indicates the effeciency of inclusion of laser therapy into the thorough treatment of parodontitis.

Ann Univ Mariae Curie Sklodowska Med. 2004;59(1):488-94.

Comparison of the effectiveness of the conservative treatment of the periodontal pockets with or without the use of laser biostimulation.

Kiernicka M, Owczarek B, Ga?kowska E, Wysoki?ska-Miszczuk J.

Department of Periodontology, Clinic of Dental and Maxillo-Facial Surgery, Skubiszewski Medical University of Lublin.

The use of laser therapy as the agent reinforcing conventional treatment of the periodontal diseases becomes more and more common. In the physiotherapy of the periodontal diseases the biostimulating, laser is eagerly used because of its action which accelerates the healing of wounds and also because of its antioedematous, anti-inflammatory and analgesic action. The aim of work was the evaluation of the influence of laser biostimulation on the change of the periodontological pockets depth after the routine conservative periodontological treatment with additional use of laser biostimulation and without it for two groups of pockets: above and below 5 mm. In six patients having periodontitis 613 sites were submitted to the statistic analysis (290 treated conservatively only, including 251 with the depth 2-5 mm and 39 above 5 mm as well as 323 with the use of laser therapy including 297 shallow pockets and 26 deep ones). The initial values of API, SBI, PPD and their changes in the course of the treatment were registered. During each control appointment the patients subjectively estimated periodontal pain occurrence. In both studied groups statistically essential decrease of the evaluated parameters was obtained. Reinforcing the conventional treatment with laser biostimulation shortens its duration and leads to the elimination of pain faster than with the use of conservative treatment only. The changes of the PPD index among the successive examinations were statistically essentially higher in the therapy with the use of laser, especially in relation to deep pockets.

Dent Update. 2004 Nov;31(9):535-8, 541-2, 545-7.

Lasers in periodontology.

Mavrogiannis M, Thomason JM, Seymour RA.

Department of Periodontology, Newcastle upon Tyne School of Dental Sciences, Framlington Place NE2 4BW.

Since the development of the ruby laser by Maiman in 1960, lasers have been widely employed in medicine for a number of years. The purpose of this paper is to summarize potential applications for lasers in dentistry, with special regard to periodontology. This article briefly describes clinical applications of lasers and laser safety. Particularly, the use of a diode laser seems to be promising, especially in already compromised transplant patients, who need to be treated with a technique where the operative and post-operative blood loss, post-operative discomfort and the recurrence of drug-induced gingival overgrowth need to be kept to a minimum or eliminated. Therefore, the use of lasers in periodontology may lead to an alteration in present clinical practice and help to establish the best management strategy because, by maintaining periodontal health, the life quality of patients can be improved.

Lasers Surg Med. 1998;22(5):302-11.

Treatment of periodontal pockets with a diode laser.

Moritz A, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J, Sperr W.

Department of Conservative Dentistry, Dental School of the University of Vienna, Austria.

BACKGROUND AND OBJECTIVE: The aim of this study is to examine the long-term effect of diode laser therapy on periodontal pockets with regard to its bactericidal abilities and the improvement of periodontal condition.

STUDY DESIGN/MATERIALS AND METHODS: Fifty patients were randomly subdivided into two groups (laser-group and control-group) and microbiologic samples were collected. There have been six appointments for 6 months following an exact treatment scheme. After evaluating periodontal indices (bleeding on probing, Quigley-Hein) including pocket depths and instruction of patients in oral hygiene and scaling therapy of all patients, the deepest pockets of each quadrant of the laser-group’s patients were microbiologically examined. Afterwards, all teeth were treated with the diode laser. The control-group received the same treatment but instead of laser therapy were rinsed with H2O2. Each appointment also included a hygienic check-up. After 6 months the final values of the periodontal indices and further microbiologic samples were measured. The total bacterial count as well as specific bacteria, such as Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis, were assessed semiquantitatively.

RESULTS: The bacterial reduction with diode laser therapy was significantly better than in the control group. The index of bleeding on probing improved in 96.9% in the laser-group, whereas only 66.7% in the control group. Pocket depths could be more reduced in the laser group than in the control group.

CONCLUSION: The diode laser reveals a bactericidal effect and helps to reduce inflammation in the periodontal pockets in addition to scaling. The diode laser therapy, in combination with scaling, supports healing of the periodontal pockets through eliminating bacteria.

J Clin Periodontol. 2005 Jul;32(7):714-9.

The short-term effects of low-level lasers as adjunct therapy in the treatment of periodontal inflammation.

Qadri T, Miranda L, Tunér J, Gustafsson A.

Department of Periodontology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden. talat.qadri@mbox.lidnet.se

OBJECTIVES: The aim of this split-mouth, double-blind controlled clinical trial was to study the effects of irradiation with low-level lasers as an adjunctive treatment of inflamed gingival tissue.

MATERIALS AND METHODS: Seventeen patients with moderate periodontitis were included. After clinical examination, all teeth were scaled and root planed (SRP). One week after SRP, we took samples of gingival crevicular fluid (GCF) and subgingival plaque. The laser therapy was started 1 week later and continued once a week for 6 weeks. One side of the upper jaw was treated with active laser and the other with a placebo. The test side was treated with two low-level lasers having wavelengths of 635 and 830 nm. The patients then underwent another clinical examination with sampling of GCF and plaque. The GCF samples were analysed for elastase activity, interleukin-1beta (IL-1beta) and metalloproteinase-8 (MMP-8). We examined the subgingival plaque for 12 bacteria using DNA probes.

RESULTS: The clinical variables i.e. probing pocket depth, plaque and gingival indices were reduced more on the laser side than on the placebo one (p<0.01). The decrease in GCF volume was also greater on the laser side, 0, 12 microl, than on the placebo side, 0.05 microl (p=0.01). The total amount of MMP-8 increased on the placebo side but was slightly lower on the laser side (p=0.052). Elastase activity, IL-1beta concentration and the microbiological analyses showed no significant differences between the laser and placebo sides.

CONCLUSION: Additional treatment with low-level lasers reduced periodontal gingival inflammation.