Lasers are making an impact in the world of dentistry. Lasers are mainly used in dentistry for soft tissue therapies, whitening, and periodontal therapies.
The most common type of laser used in dentistry is the diode laser. Diode lasers is a solid-state laser, such as, as bar code scanner. Indications for lasers include hemostasis, sulcular debridement, gingivectomy, implant recovery, excisional/incisional biopsies, precise tissue cutting, frenectomies, troughing, operculectomy, etc. However, laser hygiene procedures include, laser bacterial reduction, pocket decontamination, treatment for aphthous ulcers and herpes labialis, teeth whitening, and root surface desensitization. The use of lasers in adjunct to scaling and root planing (SRP) is to decontaminate the epithelium within a pocket and reduce bacteria in periodontal pockets.
SRP is needed with laser therapy because laser therapy does not remove calculus. Laser debridement, laser decontamination, biostimulation, and guided tissue regeneration are all laser assisted periodontal therapy. Biosimulation uses light to speed, enhance, and promote healing. It increases circulation, collagen formation, fibroblastic activity, and osteoblastic activity. Laser therapy will help with healing in patients with periodontitis. Periodontitis is a multifactorial inflammatory disease of periodontal tissues usually caused by extension of bacterial infection into subgingiva, which leads to the connective tissue destruction and alveolar bone loss.
The essential objective of periodontal treatment is to decrease or eliminate the responsible periopathogens, by means of removing bacterial deposits from the tooth surface (Birang, Shahaboui, Kiani, Shadmehr, & Naghsh, 2015). Scaling and root planing is mechanical debridement for treatment of inflammation of the periodontium. Lasers are beneficial in dental hygiene for many reasons.
Lasers reduce bacteria of pockets that result in periodontal disease and to promote healing. Not only do lasers help promote healing in the periodontal pocket but can also speed up the healing process of aphthous ulcers. Laser therapy is also used for root surface desensitization and teeth whitening. Overall, patient comfort is increased by the use of lasers. Although laser therapy can be beneficial it is contraindicated for patients whom are pregnant, are immunosuppressed, and cancer patients. There are also some concerns with laser safety, including eye injuries, skin injuries, environmental hazards, combustion hazards, laser plume and electrical hazards.
Each laser needs their own set of safety glasses, glasses that work on one laser will not work on another that has a different wavelength. Thermal burns are rare with lasers, but they can cause reddening, blistering, and charring of the skin if penetrated. Potential inhalation of airborne hazardous materials that may be released as a result of laser therapy may cause respiratory hazards (Sushma, Saba, Sadaf, & Zainab, 2018). A chemical is released with all soft tissue surgery’s that can be an environmental hazard as well.
Finally, lasers can also be a fire/electrical hazard as well. All personal that operate lasers need to be properly trained and take the proper safety measures. There have been many studies on if lasers, specifically the diode laser, are beneficial in adjunct to a scaling and root plaining and treatment for periodontitis. The benefits vary from study to study.
For instance, one study showed that laser therapy increased pocket depth reduction and greater gain in CAL in patients with diabetes. Ten patients were used for this specific study. The ages ranged from 30-60 years in age. All patients had moderate chronic periodontitis, controlled type 2 diabetes (only on medications for diabetes), and had probing depths greater than 5mm.
The study measured gingival index, plaque index, bleeding index, pocket depth, and clinical attachment level. Measurements were recorded before laser therapy and 3 weeks after. All patients would receive debridement using ultrasonic scaler, mechanical instruments including Gracey curettes, and local anesthetic. Each patient received treatment using a split mouth design, two quadrants were used in each group.
Group 1 would be a controlled group receiving SRP treatment alone. Group II was receiving SRP and laser treatment together. Both debridement’s were performed on the same day.
The results showed a decrease in plaque index (showed on graph), gingival index, bleeding index, pocket depth (showed on graph), and gain in clinical attachment loss (shown on graph). It can be concluded that laser therapy in adjunct with SRP offers additional benefits in periodontal therapy compared to SRP alone, especially in systemically compromised patients. Numerous studies have found that diode laser exhibits anti-inflammatory action with an improved periodontal wound healing in systemically compromised patients, especially in diabetes (Elavarasu, Suthanthiran, Thangavelu, Mohandas, Selvaraj, & Saravanan, 2015). Studies have also shown that patients with diabetes are at a higher risk to have periodontal disease. Therefore, according to this study laser treatment is in fact beneficial. Another study also showed significant improvement when laser therapy was used in addition to SRP.
The purpose of this study was to see if adjunctive therapies such as laser therapy and photodynamic therapy, could improve healing in people with chronic periodontitis. Within its limits, the present study demonstrated that adjunctive LT or PDT resulted in more improvement in term of CAL gain compared to SRP alone, only in short-term evaluation. Regarding PPD reduction, adjunctive LT was more efficient than adjunctive PDT or SRP alone (Birang, Shahaboui, Kiani, Shadmehr, & Naghsh, 2015). To come to this conclusion, the study included twenty patients. Each of the patients had three of the four quadrants with pockets varying from 4-8mm and at least 2mm of clinical attachment loss.
This study also used a split mouth design. Group A was treated with SRP alone, group B with SRP and laser therapy, and Group C with photodynamic therapy. Pocket depth, clinical attachment loss, plaque index, and bleeding index was recorded prior to treatment, at 6 weeks, and after 3 months. In order to control the study the patients were taught and practiced home care/OHI over a week before recording first measurements. After 3 months, group B showed the greatest amount of reduction compared to the two other groups.
However, groups B and C showed greater clinical attachment gain than group A at the 6 week check-up, but no difference at 3 months. In this study there was no change in the plaque index showing that plaque biofilm cannot be affected by laser therapy and bleeding was slightly decreased. According to the results, laser therapy is more beneficial than photodynamic therapy and SRP alone. There are some studies that show no significant evidence that lasers are beneficial in adjunct to SRP. The next study included 30 male and female patients aged between 37-63 years, systemically healthy, none-smokers with presence of chronic generalized periodontitis-superficialis or profunda.
Patients were divided into two groups – Group 1 (SRP) and Group 2 (SRP +Diode laser) (Miteva, Peev, & Hristov, 2017). Measurements were taken before treatment, 1.5 month, and 3 months after treatment. These measurements included pocket depths, plaque index, gingival index, clinical attachment level, and gingival margin.
Pocket depths and clinical attachment level both showed improvement for both SRP and diode laser therapy. However, laser therapy did not show significant difference in probing depths and attachment level over SRP alone. This study claims that removal of local stimulating factors and reduction of the severity of inflammation is what benefited the patient and showed these results, not the addition of laser treatment.
Finally, another study supports the claim that the use of diode lasers with SRP treatment do not help micbrobial and inflammatory mediator changes, but did have a significant reduction in pocket depths. The aim of this study was to investigate and compare the clinical, microbial, and inflammatory effects of a diode laser as an adjunct to scaling and root planing (SRP) versus SRP alone for the treatment of generalized aggressive periodontitis (GAgP) (Matarese, Ramaglia, Cicciù, Cordasco, & Isola, 2017). Clinical attachment loss was the primary focus of this study. 31 patients with generalized aggressive periodontitis were used. Only the maxillary teeth were part of the study, the maxillary quadrants were randomly assigned to SRP and laser treatment or SRP alone. The patients were examined regularly for changes over a 1-year period.
At 1 year, SRP+diode laser yielded a significant reduction in some clinical parameters, while microbial and inflammatory mediator changes were not significantly reduced compared to SRP alone (Matarese, Ramaglia, Cicciù, Cordasco, & Isola, 2017). Lasers in dentistry are still new. There is still more research being done about the benefits and risks. Right now, the use of lasers depends on personal, the dentist, and office preference. Lasers are a good way for offices to make more money as well.
A charge can be made when lasers are used for decontamination, aphthous ulcers, teeth whitening. Lasers will be very beneficial for a hygienist. A big topic in a lot of research about lasers includes how lasers are beneficial for hemostasis.
hygienist is responsible for reaching the highest standard of care for each patient. This means that laser therapy could be an alternative if a patient is not seeing results. If laser therapy is not being offered by a hygienist, they are not giving the highest standard of care. Although traditional scaling and root planing (SRP) and daily self-care by the patient have been shown to be effective in reducing inflammation and probing depths and increasing clinical attachment, challenges associated with deeper pockets, root morphology and difficult access areas decrease the likelihood of healing following nonsurgical periodontal therapy (NSPT).
Adjuncts such as antimicrobials and lasers have been advocated to overcome these limitations (Bowen, 2015). Lasers are a good tool to use with traditional mechanical debridement but is not efficient enough to replace it.