Non-surgical periodontal treatment of peri-implant diseases with the adjunctive use of diode laser: preliminary clinical study.

Peri-implant diseases present in two forms: peri-implant mucositis and peri-implantitis. The prevalence of peri-implant complications is significantly rising. The aim of this study was to compare conventional treatment of inflamed peri-implant tissues with conventional treatment together with diode laser application. Twenty-seven patients (age 36 to 67, 15 women and 12 men, 12 smokers and 15 non-smokers) requiring treatment for mucositis or peri-implantitis were taken into account for this preliminary study. Plaque index (PI), pocket depth (PD), and bleeding on probing (BoP) were recorded at baseline evaluation. Patients in control group (CG) received conventional non-surgical periodontal treatment. Patients in test group received conventional non-surgical periodontal treatment together with diode laser application (810 nm, 30 s, 1 W, 50 Hz, t on = 100 ms, t off = 100 ms, energy density = 24.87 J/cm(2)). Paired t test was used to evaluate the difference in repeated measurements of considered indexes at T 0 and T 1 (1 year) in both groups. A total of 606 sites were taken into account in the test group (TG) and 144 in the CG. PD mean variation in the TG was 2.66 mm ± 1.07, while mean PD variation in the CG was 0.94 ± 1.13 mm. Paired t testing of the variation in PD in CG and TG revealed a statistically significant difference between the two groups (p < 0.0001). A reduction of pathological sites from 89 % (T 0) to 14.35 % (T 1) was achieved in the TG, while reduction obtained in the CG was from 75.69 % (T 0) to 50 % (T 1); BoP scores at time T 1 had fallen below 5 % in the TG and decreased to 59.7 %, in the CG. Within the limitations of this study, diode laser seems to be an additional valuable tool for peri-implant disease treatment.

Ten-Year Nonsurgical Periodontal Treatment Protocol with Adjunctive Use of Diode Laser Monitoring Clinical Outcomes in ≥ 6 mm Pockets: A Retrospective Controlled Case Series.

The clinical effects of treatment with 808- and 980-nm diode lasers as an adjunct to a uniform and consistent nonsurgical periodontal treatment protocol (NSPTP) for initial probing pockets ≥ 6 mm with a 10-year follow-up were evaluated. In total, 24 patients (16 test cases and 8 control cases) were treated with the NSPTP. The control group (CG) was treated only with nonsurgical conventional therapy, while the test group (TG) received treatment with thermal diode lasers (wavelength of 808 or 980 nm). All patients had recall visits every 3 months and were reevaluated at 1 year after NSPTP. Following the 1-year follow-up, patients were monitored at 4-month intervals for the remaining 9 years. In total, 646 teeth (433 in TG [124 multirooted teeth and 309 single-rooted teeth] and 213 in CG [64 multirooted teeth and 149 single-rooted teeth]) were included. The initial probing pocket depth (PPD) in single-rooted teeth from TG patients decreased from an average of 6.7 mm to 3.3 mm after 1 year, and to 2.3 mm after 10 years. The mean increase in clinical attachment level (CAL) was 3.8 mm. The initial PPD of single-rooted teeth in CG patients decreased from an average of 6.4 mm at baseline to 4 mm after 1 year and 3.3 mm after 10 years. The mean increase in CAL was 2.5 mm in CG. In the TG, the PPDs of multirooted teeth decreased from 6.2 mm to 3.3 mm after 1 year, where they remained stable for 10 years. The mean increase in CAL was 2.2 mm in this group. In the CG, the PPDs for multirooted teeth decreased from 7 mm to 5.8 mm after 1 year and were 5.1 mm after 10 years. The mean increase in CAL was 1.9 mm. The TG had significantly better clinical parameters than the CG, including reduced tooth loss. Compared to conventional debridement alone, the use of thermal diode lasers with NSPTP improves PPD and increases CAL in periodontal pockets ≥ 6 mm over the long term.

Three Years of a Nonsurgical Periodontal Treatment Protocol to Observe Clinical Outcomes in ≥ 6-mm Pockets: A Retrospective Case Series.

A total of 25 patients were treated with a nonsurgical periodontal treatment protocol (NSPTP) consisting of four appointments (three within 1 week and one approximately 30 days later). Nonsurgical periodontal instrumentation was implemented, with the adjunctive use of thermal diode lasers (wavelength of 808 or 980 nm). The patients were scheduled for recall visits every 3 months and reevaluated 1 year post-NSPTP. They were subsequently monitored at 4-month intervals for the remaining 2-year follow-up maintenance period. In total, 698 teeth (210 multirooted and 488 single-rooted) were included in the study. The mean bleeding on probing was 43% at baseline and decreased to 12% at 12 months and to 8% at 3 years. The initial ≥ 6-mm probing pocket depth (PPD) in single-rooted teeth decreased from 6.2 mm at baseline to a mean of 1.8 mm at 12 months and remained at 1.8 mm at 3 years, with a mean clinical attachment level (CAL) gain of 4.4 mm. In multirooted teeth, the PPD decreased from 6.7 mm to a mean of 3.9 mm at 12 months and 3.6 mm at 3 years, with a mean CAL gain of 2.9 mm. The mean overall recession was 0.3 mm at baseline, 0.1 mm at 1 year, and 0.3 mm at the 3-year follow-up. In the short-term followup period, uniform and consistent implementation of the NSPTP used here with adjunctive use of thermal diode lasers seemed to convey therapeutic benefits, stable periodontal soft tissue levels, and satisfactory esthetics in patients with moderate to severe chronic periodontitis. The present protocol is relevant as a treatment option for medically compromised patients, those who refuse or delay surgical treatment, or those who present with other limitations.

Systematic review of the adjunctive use of diode and Nd:YAG lasers for nonsurgical periodontal instrumentation.

OBJECTIVE: The aims of this study were (1) to conduct a literature search and systematically evaluate the additional therapeutic effects of pulsed Nd:YAG or diode laser use in patients with periodontitis, (2) to assess evidence supporting the additional benefit of laser-mediated periodontal treatment in conjunction with scaling and root planning (SRP) (not as monotherapy), and (3) to interpret the evidence presented in retrieved publications. BACKGROUND DATA: Opinions about the additional use of diode lasers in the nonsurgical treatment of plaque-induced periodontal lesions are conflicting. The April 2011 American Academy of Periodontology's "Statement on the Efficacy of Lasers in the Non-Surgical Treatment of Inflammatory Periodontal Disease" asserted that the use of a laser as monotherapy or in addition to nonsurgical periodontal instrumentation conveyed no advantage. METHODS: After initial screening, 23/77 potentially relevant articles and abstracts identified through electronic and manual searches of the MEDLINE(®)/PubMed database and the Cochrane Central Register of Controlled Trials (1990-2012) were included in this review. RESULTS: A meta-analysis could be performed. The results indicate that Nd:YAG or diode laser, used in an adjunctive capacity to SRP, may provide some additional benefit, in 6 month studies, compared with mechanical debridement. CONCLUSIONS: The results show the adjunctive benefits that diode laser treatment can provide when it is used as an adjunct to nonsurgical periodontal treatment in adults with chronic periodontitis. Further long-term, well-designed, parallel randomized clinical trials are needed to assess the effectiveness of the adjunctive use of the diode laser, as well as the appropriate dosimetry and laser settings.