Chronic periodontitis:Er:YAG laser may give benefit

Chronic periodontal disease is a common problem worldwide. Recently the use of erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser as an alternative or adjuvant to traditional debridement has been receiving attention. The aim of this review was to compare the effectiveness of (Er:YAG) laser versus scaling and root planing (SRP) as alternative or adjuvant for chronic periodontitis treatment.

Methods

Searches were conducted in PubMed,Embase, the Cochrane controlled trials register, ISI web of science, Science Direct, SCOPUS, This was supplemented with hand searching of major periodontal and laser journals. No language restrictions were applied. Study selection, data abstraction and quality assessment was carried out independently by two reviewers. Randomised controlled trials (RCTs) parallel or split mouth conducted in adults over 18 with a minimum of 3 months follow up were considered. meta-analysis as well as heterogeneity, sensitivity, subgroup and power analyses to clarify and validate the pooled results. Probing depth (PD) and Clinical attachment loss (CAL) were two of the clinical outcomes.

Results

12 RCTs involving 225 patients were included.
2 trials were considered to be of high quality
Er:YAG laser versus SRP as an alternative treatment
- At 3 mths( 8 trials) – Er:YAG laser treatment had similar CAL gains to SRP (WMD = 0.135 mm, 95% CI = -0.486–0.756, pZ = 0.670) and PD reduction (WMD = 0.113 mm, 95% CI = -0.336–0.562, pZ = 0.622)
- At 6 mths( 4 trials) – Significant improvements of PD and CAL were observed in both treatments but there were no significant differences between the two treatment in terms of CAL or PD.
- At 12 months (3 trials) – Comparison of the two treatment modalities demonstrated no statistically significant differences in the improvement of CAL and PD
Er:YAG laser versus SRP as an adjuvant treatment at 3 months ( 4 trials)
- Both of the treatments were equally effective in bringing about successful outcomes in CAL gain postoperatively
- a significant reduction in PD within the laser+ SRP group, compared with the SRP group (WMD = 0.337 mm, 95% CI = 0.191–0.483, pZ < 0.001

Conclusions

The authors concluded

This systematic review indicated that the clinical efficacy of Er:YAG laser was similar to SRP 3 months postoperatively. The clinical benefits of Er:YAG laser as adjuvant to SRP was still lacking. Since Er:YAG laser has certain advantages, it could be expected to be a novel short-term alternative choice for chronic periodontitis.

Commentary

This review has followed a sound methodological approach and restricted their inclusion criteria to RCTs. However the samples size in all the studies is small ranging from 17 to 30 patients. There is also a significant degree of heterogeneity between the studies a point noted by the authors. Consequently the results of this review should be treated with caution and larger high quality studies are needed to further assess the potential of the Er:YAG laser in the management of chronic periodontitis. The findings of this review are similar to previous reviews in this area ( Dental Elf 15^th May 2015 and 26^th April 2013).