Erbium:YAG laser compared to scaling and root planing in periodontal treatment A controlled, prospective clinical study

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ErbiumYAG laser compared to scaling and root
planing in periodontal treatmentA controlled,
prospective clinical study

Frank Schwarz¹, Anton Sculean², Thomas Georg²
and Elmar Reich²
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¹ Department of Oral and Maxillofacial Surgery
Ludwig Maximilians University Munich,
Germany ² Department of Periodontology and
Conservative Dentistry, University of Saarland
Homburg, Germany

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Background

• The ErYAG laser is expected to be useful in
  medical and dental applications because its
  emission wavelenght (2.94 µm) is highly absorbed
  by water

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Background

• ErYAG lasers have shown their capacity in
  removing plaque and calculus present on
  periodontally diseased root surfaces in vitro and
  in vivo (Aoki et al. 1994, Folwaczny et al. 2000,
  Schwarz et al. 2001)

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Background
Study Time Group PPD (0) PPD (1) CAL (0) CAL (1)
Watanabe et al. J Clin Laser Med Surg 1996 4 Weeks Laser 5.6 2.0 2.6 0.9 - -
Jepsen at al. J Dent Res (Abstr) 2000 3 Months Laser SRP 3.9 0.8 3.9 0.8 2.9 ? 0.6 2.9 ? 0.6 Gain Gain 0.3 ? 0.2 0.4 ? 0.3
Schwarz et al. Parodontologie 2000 6 Months Laser 4.7 0.7 3.1 0.6 6.1 1.1 4.6 1.0
Schwarz et al. J Periodontol 2001 6 Months Laser SRP 4.9 0.7 5.0 0.6 2.9 0.6 3.4 0.7 6.3 1.1 6.5 1.0 4.4 1.0 5.5 1.0
Schwarz et al. J Clin Periodontol (in press) 12 Months Laser SRP Laser 5.2 0.8 5.0 0.7 3.2 0.8 3.3 0.7 6.9 1.0 6.6 1.1 5.3 1.0 5.0 0.7
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Objectives

• The aim of the present study was to assess the
  clinical effectiveness of an ErYAG laser when
  compared to well established procedures such as
  scaling and root planing

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Material and Methods

• 20 patients (age 28 to 79 years)
• advanced periodontal disease
• a total of 34 maxillary and 21 mandibular pairs
  of contralateral single- and multi- rooted teeth
• good oral hygiene
• no systemic diseases
• treatment according to a split-mouth design

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Material and Methods

• For 4 weeks before treatment all patients were
  enrolled in a hygiene program and received oral
  hygiene instructions at 2 to 4 appointments as
  well as professional tooth cleaning according to
  individual needs
• A supragingival professional tooth cleaning was
  performed at baseline as well as 3, 6 and 12
  months after treatment

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Treatment of test group

• KEY II (KaVo, Biberach, Germany)
• handpiece 2056
• fiber tips of 0.5 x 1.65 and 0.5 x 1.1
• energy level 160 mJ/pulse at 10 pps
• water irrigation
• treatment from coronal to apical in parallel
  paths
• inclination of the fiber tip of 15-20 to root
  surface (Folwaczny et al. 2001)
• treatment under local anesthesia

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• CLINICAL PICTURE
• HANDPIECE 2056

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Background
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Treatment of control group

• scaling and root planing (SRP)
• Gracey curettes (Hu-Friedy, Chicago, USA)
• no. 1/2, 3/4, 7/8, 11/12, 13/14
• treatment under local anesthesia

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Treatment time
Single rooted teeth Multi rooted teeth
Laser 5 minutes 10 minutes
SRP 9 minutes 15 minutes
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Clinical measurements

• plaque index (PI) (Silness Löe 1964)
• gingival index (GI) (Löe Silness 1963)
• bleeding on probing (BOP)
• probing pocket depth (PPD)
• gingival recessions (GR)
• clinical attachment level (CAL)

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Microbiological evaluation

• subgingival plaque samples
• analysed using darkfield microscopy for the
  presence of
• cocci
• non motile rods
• motile rods
• Spirochetes
• (Listgarten Helldén 1978)

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Assessments

• recordings of clinical indices were assessed
  before treatment, 3, 6 and 12 months after
  treatment
• one calibrated and blinded examiner
• statistical analysis by paired t-test
  (n.s. non significant p?0.05
  p?0.01 p?0.001)

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Results (PI/ GI/ BOP)
Index Baseline ( SD) 3 Months ( SD) P 6 Months ( SD) P 12 Months ( SD) P
PI Laser SRP P Value 1.0 ? 0.6 1.0 ? 0.6 n.s. 0.7 ? 0.4 0.5 ? 0.5 n.s. 0.7 ? 0.4 0.7 ? 0.5 n.s. 0.6 ? 0.4 0.7 ? 0.5 n.s.
GI Laser SRP P Value 1.9 ? 0.6 1.9 ? 0.6 n.s. 0.5 ? 0.6 0.7 ? 0.8 n.s. 0.3 ? 0.6 0.4 ? 0.8 n.s. 0.4 ? 0.3 0.5 ? 0.7 n.s.
BOP Laser SRP P Value 56 52 n.s. 17 22 13 23 14 26
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Results (PPD/ GR/ CAL)
Index Baseline ( SD) 3 Months ( SD) P 6 Months ( SD) P 12 Months ( SD) P
PPD Laser SRP P Value 4.9 0.7 5.0 0.6 n.s. 3.5 0.6 3.8 0.7 2.9 0.6 3.4 0.7 3.0 0.8 3.5 1.3
GR Laser SRP P Value 1.4 0.8 1.5 0.8 n.s. 1.5 0.7 1.9 0.8 n.s. 1.5 0.7 2.0 0.8 n.s. 1.5 0.7 2.1 0.7 n.s.
CAL Laser SRP P Value 6.3 1.1 6.5 1.0 n.s. 5.1 1.0 5.6 1.1 4.4 1.0 5.5 1.0 4.5 1.3 5.6 1.4
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Distribution of bacteria (Laser)
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Distribution of bacteria (SRP)
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Conclusion

• The results of the present study indicate that
  non-surgical periodontal treatment with an ErYAG
  laser is an alternative to scaling and root
  planing with hand instruments