Abstract
The objective of this study was to evaluate the clinical attachment level (CAL) gain of Er:YAG, Er,Cr; YSGG, Nd:YAG; and diode laser (DL) as monotherapy or adjunctive to scaling and root planing (SRP) of chronic periodontitis by network meta-analysis (NMA). Randomized controlled clinical trials (RCTs) about lasers applied in SRP of chronic periodontitis were searched from PubMed, Cochrane Library, Web of Science, Ovid, Science Direct, Wan Fang, and China National Knowledge Infrastructure (CNKI) databases up to September 2018 and from references of selected full-texts and related reviews. Standard mean differences and 95% confidence intervals were counted for CAL gain. The random effects NMA were performed in STATA software. There were 25 RCTs about CAL gain at 3 and/or 6 months after lasers were applied in SRP. No inconsistency was detected. Er:YAG as monotherapy gained significantly more CAL at 3 months than did SRP; no significant differences were detected among other comparisons. In terms of CAL gain at 3 months, the ranking result from best to worst was as follows: Er:YAG as monotherapy, DL adjunctive to SRP, Er:YAG adjunctive to SRP, Er,Cr;YSGG as monotherapy, Nd:YAG adjunctive to SRP, and SRP. In terms of CAL gain at 6 months, the ranking result from best to worst was as follows: DL adjunctive to SRP, Nd:YAG adjunctive to SRP, SRP, Er:YAG adjunctive to SRP, and Er:YAG as monotherapy. Laser-assisted periodontal treatment could be superior to SRP alone and could serve as a good adjunctive treatment tool.
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References
Thornton-Evans G, Eke P, Wei L et al (2013) Periodontitis among adults aged ≥ 30 years: United States, 2009-2010. MMWR Suppl 62:129–135
Holtfreter B, Kocher T, Hoffmann T, Desvarieux M, Micheelis W (2010) Prevalence of periodontal disease and treatment demands based on a German dental survey (DMS IV). J Clin Periodontol 37:211–219
Sun HY, Jiang H, Du MQ et al (2018) The prevalence and associated factors of periodontal disease among 35 to 44-year-old Chinese adults in the 4th national oral health survey. Chin J Dent Res 21(4):241–247
Al-Falaki R, Cronshaw M, Parker S (2016) The adjunctive use of the erbium, chromium: yttrium scandium gallium garnet laser in closed flap periodontal therapy. A Retrospective Cohort Study. Open Dent J 10(1):298–307
Berakdar M, Callaway A, Eddin MF, Roß A, Willershausen B (2012) Comparison between scaling-root-planing (SRP) and SRP/photodynamic therapy: six-month study. Head Face Med 8:12
John MT, Michalowicz BS, Kotsakis GA, Chu H (2017) Network meta-analysis of studies included in the clinical practice guideline on the nonsurgical treatment of chronic periodontitis. J Clin Periodontol 44(6):603–611
Giannelli M, Formigli L, Lorenzini L, Bani D (2015) Efficacy of combined photoablative-photodynamic diode laser therapy adjunctive to scaling and root planing in periodontitis: randomized split-mouth trial with 4-year follow-up. Photomed Laser Surg 33(9):473–480
Sgolastra F, Severino M, Petrucci A, Gatto R, Monaco A (2014) Nd:YAG laser as an adjunctive treatment to nonsurgical periodontal therapy: a meta-analysis. Lasers Med Sci 29(3):887–895
Mills MP, Rosen PS, Chambrone L et al (2018) American Academy of Periodontology best evidence consensus statement on the efficacy of laser therapy used alone or as an adjunct to non-surgical and surgical treatment of periodontitis and peri-implant diseases. J Periodontol 89:737–742
Jensen J, Lulic M, Heitz-Mayfield LJA, Joss A, Lang NP (2010) Nd:YAG (1064 nm) laser for the treatment of chronic periodontitis: a pilot study. J Investig Clin Dent 1:16–22
Chambrone L, Ramos UD, Reynolds MA (2018) Infrared lasers for the treatment of moderate to severe periodontitis: an American Academy of Periodontology best evidence review. J Periodontol 89:743–765
Mizutani K, Aoki A, Coluzzi D et al (2016) Lasers in minimally invasive periodontal and peri-implant therapy. Periodontol 2000(71):185–212
Sanz M, Teughels W (2008) Innovations in non-surgical periodontal therapy: consensus report of the sixth European workshop on periodontology. J Clin Periodontol 35(8):3–7
Noraian KW, Cobb CM (2018) The efficacy of laser therapy: commentary on the American Academy of Periodontology best evidence consensus meeting. J Periodontol 89:804–806
Zhao Y, Yin Y, Tao L, Nie P, Tang Y, Zhu M (2014) Er:YAG laser versus scaling and root planing as alternative or adjuvant for chronic periodontitis treatment: a systematic review. J Clin Periodontol 41(11):1069–1079
Sgolastra F, Severino M, Gatto R, Monaco A (2013) Effectiveness of diode laser as adjunctive therapy to scaling root planing in the treatment of chronic periodontitis: a meta-analysis. Lasers Med Sci 28(5):1393–1402
Cheng Y, Chen JW, Ge MK, Zhou ZY, Yin X, Zou SJ (2015) Efficacy of adjunctive laser in non-surgical periodontal treatment: a systematic review and meta-analysis. Lasers Med Sci 31(1):1–13
Leucht S, Chaimani A, Cipriani AS, Davis JM, Furukawa TA, Salanti G (2016) Network meta-analyses should be the highest level of evidence in treatment guidelines. Eur Arch Psychiatry Clin Neurosci 266(6):477–480
Hutton B, Salanti G, Caldwell DM et al (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162(11):777–784
Schlosser RW, Koul R, Costello J (2007) Asking well-built questions for evidence-based practice in augmentative and alternative communication. J Commun Disord 40(3):225–238
Higgins JPT, Altman DG, Gøtzsche PC et al (2011) The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. Br Med J 343(7829):889–893
Soo L, Leichter JW, Windle J et al (2012) A comparison of Er:YAG laser and mechanical debridement for the non-surgical treatment of chronic periodontitis: a randomized, prospective clinical study. J Clin Periodontol 39(6):537–545
Cui JY, Dong FS, Li SJ, Li CN, Wu MX (2017) The curative effects of twinlight laser treatment on chronic periodontitis. J Pract Stomatol 33(6):807–811
Crespi R, Capparè P, Toscanelli I, Gherlone E, Romanos GE (2007) Effects of Er:YAG laser compared to ultrasonic scaler in periodontal treatment: a 2-year follow-up Split-mouth clinical study. J Periodontol 78(7):1195–1200
Malali E, Kadir T, Noyan U (2012) Er:YAG lasers versus ultrasonic and hand instruments in periodontal therapy: clinical parameters, intracrevicular micro-organism and leukocyte counts. Photomed Laser Surg 30(9):543–550
Grzech-Lesniak K, Sculean A, Gaspirc B (2018) Laser reduction of specific microorganisms in the periodontal pocket using Er:YAG and Nd:YAG lasers: a randomized controlled clinical study. Lasers Med Sci 33(7):1461–1470
Wang Y, Li WW, Shi L, Zhang FQ, Zheng S (2017) Comparison of clinical parameters, microbiological effects and calprotectin counts in gingival crevicular fluid between Er:YAG laser and conventional periodontal therapies: a split-mouth, single-blinded, randomized controlled trial. Medicine (Baltimore) 96(51):e9367
Lopes BMV, Theodoro LH, Melo RF, de Thompson GMA, Marcantonio RAC (2010) Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with erbium:YAG laser and scaling and root planing. J Periodontol 81(5):682–691
Yilmaz S, Kut B, Gursoy H, Kuru BE, Noyan U, Kadir T (2012) Er:YAG laser versus systemic metronidazole as an adjunct to nonsurgical periodontal therapy: a clinical and microbiological study. Photomed Laser Surg 30(6):325–330
Wu KY, Xu CJ, Chi YT, Sun XJ, Wang HF, Wang MM (2017) Detection of Dickkopf-1 and alkaline phosphatase activity in gingival crevicular fluid from chronic periodontitis with Er:YAG laser as an adjunctive treatment. Shanghai Kou Qiang Yi Xue 26(3):285–289
Yılmaz S, Algan S, Gursoy H, Noyan U, Kuru BE, Kadir T (2013) Evaluation of the clinical and antimicrobial effects of the Er:YAG laser or topical gaseous ozone as adjuncts to initial periodontal therapy. Photomed Laser Surg 31(6):293–298
Sanz-Sánchez I, Ortiz-Vigón A, Matos R, Herrera D, Sanz M (2015) Clinical efficacy of subgingival debridement with adjunctive erbium: yttrium-aluminum-garnet laser treatment in patients with chronic periodontitis: a randomized clinical trial. J Periodontol 86(4):527–535
Chen M (2017) Clinical efficacy of Er:YAG laser as adjunctive therapy of chronic periodontitis. MMJC 17(11):59–61
Cao Y, Wu WL, Xue YQ, Sun WB (2018) Efficacy observation of Nd:YAG and Er:YAG laser for the treatment of severe periodontitis. Stomatology 38(6):514–517
Yin YL, Xu CM, Wu YF, Zhao L (2017) Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with Nd:YAG laser and scaling and root planning. Hua Xi Kou Qiang Yi Xue Za Zhi 35(6):618–624
Guan WQ, Wang XY, Yang B (2010) Effects of Nd:YAG laser treatment on recovery of periodontal pockets and clinical attachment level of chronic periodontitis patients. J Pract Stomatol 3(4):231–232,235
Sun P, Wang W, Liu ZX (2016) The clinical effect of Nd:YAG laser in the treatment of moderate and severe chronic periodontitis. Gen J Stomatol 3(7):86–88
Eltas A, Orbak R (2012) Clinical effects of Nd:YAG laser applications during nonsurgical periodontal treatment in smoking and nonsmoking patients with chronic periodontitis. Photomed Laser Surg 30(7):360–366
Chen MH, Wang LM (2016) Effect of Er,Cr:YSGG laser on the treatment of chronic periodontitis: a short-term evaluation. Stomatology 36(1):64–67
Ge LH, Shu R (2014) Clinical application of periodontal initial treatment with Er,Cr:YSGG laser for patients with chronic periodontitis. J Oral Sci Res 30(3):235–237
Ge LH, Zhang YX, Shu R (2017) Er,Cr:YSGG laser application for the treatment of periodontal furcation involvements. Photomed Laser Surg 35(2):92–97
Srikanth K, Chandra RV, Reddy AA, Reddy BH, Reddy C, Naveen A (2015) Effect of a single session of antimicrobial photodynamic therapy using indocyanine green in the treatment of chronic periodontitis: a randomized controlled pilot trial. Quintessence Int 46(5):391–400
Jose KA, Ambooken M, Mathew JJ, Issac AV, Kunju AP, Parameshwaran RA (2016) Management of chronic periodontitis using chlorhexidine chip and diode laser-a clinical study. J Clin Diagn Res 10(4):76–80
Ustün K, Erciyas K, Sezer U et al (2014) Clinical and biochemical effects of 810 nm diode laser as an adjunct to periodontal therapy: a randomized split-mouth clinical trial. Photomed Laser Surg 32(2):61–66
Saglam M, Kantarci A, Dundar N, Hakki SS (2014) Clinical and biochemical effects of diode laser as an adjunct to nonsurgical treatment of chronic periodontitis: a randomized, controlled clinical trial. Lasers Med Sci 29(1):37–46
Zhang LJ, Shi J, Guo JH, Zhang N (2018) Clinical evaluation of diode laser assisted treatment of chronic periodontitis. J Pract Stomatol 34(3):404–440
Borrell LN, Papapanou PN (2005) Analytical epidemiology of periodontitis. J Clin Periodontol 32(s6):132–158
Imrey PB, Chilton NW, Pihlstrom BL et al (1994) Proposed guidelines for American Dental Association acceptance of products for professional, non-surgical treatment of adult periodontitis. J Periodontal Res 29(5):348–360
Sağlam M, Köseoğlu S, Taşdemir İ, Yilmaz HE, Savran L, Sutcu R (2017) Combined application of Er:YAG and Nd:YAG lasers in treatment of chronic periodontitis. A split-mouth, single-blind, randomized controlled trial. J Periodontal Res 52(5):853–862
Slot DE, Jorritsma KH, Cobb CM, Van der Weijden FA (2014) The effect of the thermal diode laser (wavelength 808-980nm) in non-surgical periodontal therapy: a systematic review and meta-analysis. J Clin Periodontol 41(7):681–692
Birang R, Shahaboui M, Kiani S, Shadmehr E, Naghsh N (2015) Effect of nonsurgical periodontal treatment combined with diode laser or photodynamic therapy on chronic periodontitis: a randomized controlled Split-mouth clinical trial. Lasers Med Sci 6(3):112–119
Dukić W, Bago I, Aurer A, Roguljic M (2013) Clinical effectiveness of diode laser therapy as an adjunct to non-surgical periodontal treatment: a randomized clinical study. J Periodontol 84(8):1111–1117
Bassir SH, Moslemi N, Jamali R et al (2013) Photoactivated disinfection using light-emitting diode as an adjunct in the management of chronic periodontitis: a pilot double-blind split-mouth randomized clinical trial. J Clin Periodontol 40(1):65–72
Gündoğar H, Şenyurt SZ, Erciyas K et al (2016) The effect of low-level laser therapy on non-surgical periodontal treatment: a randomized controlled, single-blind, split-mouth clinical trial. Lasers Med Sci 31(9):1767–1773
Matarese G, Ramaglia L, Cicciù M et al (2017) The effects of diode laser therapy as an adjunct to scaling and root planing in the treatment of aggressive periodontitis: a 1-year randomized controlled clinical trial. Photomed Laser Surg 35(12):702–709
Lui J, Corbet EF, Jin L (2011) Combined photodynamic and low-level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis. J Periodontal Res 46:89–96
Aykol G, Baser U, Maden I et al (2011) The effect of low-level laser therapy as an adjunct to non-surgical periodontal treatment. J Periodontol 82(3):481–488
Alves VTE, Andrade AKPD, Toaliar JM et al (2013) Clinical and microbiological evaluation of high intensity diode laser adjutant to non-surgical periodontal treatment: a 6-month clinical trial. Clin Oral Investig 17(1):87–95
Sgolastra F, Petrucci A, Gatto R, Monaco A (2012) Efficacy of Er:YAG laser in the treatment of chronic periodontitis: systematic review and meta-analysis. Lasers Med Sci 27(3):661–673
Rotundo R, Nieri M, Cairo F et al (2010) Lack of adjunctive benefit of Er:YAG laser in non-surgical periodontal treatment: a randomized split-mouth clinical trial. J Clin Periodontol 37(6):526–533
Qu CN, Kang J, Zhang YL, Luan QX (2016) Application of Er,Cr:YSGG laser in non-surgical treatment of chronic periodontitis. Beijing J Stomatol 24(1):21–24
Mummolo S, Marchetti E, Di MS, Scorzetti L, Marzo G (2008) Aggressive periodontitis: laser Nd:YAG treatment versus conventional surgical therapy. Eur J Paediatr Dent 9(2):88–92
Kranendonk AA, van der Reijden WA, van Winkelhoff AJ, van der Weijden GA (2010) The bactericidal effect of a genius Nd:YAG laser. Int J Dent Hyg 8(1):63–67
Qadri T, Poddani P, Javed F, Tuner J, Gustafsson A (2010) A short-term evaluation of Nd:YAG laser as an adjunct to scaling and root planing in the treatment of periodontal inflammation. J Periodontol 81(8):1161–1166
Smiley CJ, Tracy SL, Abt E et al (2015) Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc 146(7):525–535
Zhao XD, Liu JB, Zhang C, Pan YM (2016) Effectiveness of Nd:YAG laser with non-surgical periodontal therapy on improvement of periodontitis: meta-analysis. Shanghai Kou Qiang Yi Xue 25(2):248–253
Ma L, Zhang XL, Ma Z et al (2018) Clinical effectiveness of Er:YAG lasers adjunct to scaling and root planing in non-surgical treatment of chronic periodontitis: a meta-analysis of randomized controlled trials. Med Sci Monit 24:7090–7099
Han X, Ding F, Lv YL, Duan XQ, Liu Y, Xuan W (2011) Clinical observation on application of Nd:YAG laser to reduce periodontal scaling pain. Chin J Geriatr Dent 9(5):279–281 291
Israel M, Cobb CM, Rossmann JA, Spencer P (1997) The effects of CO2, Nd:YAG and Er:YAG lasers with and without surface coolant on tooth root surfaces. An in vitro study. J Clin Periodontol 24(9 Pt 1):595–602
Schwarz F, Sculean A, Berakdar M, Szathmari L, Georg T, Becker J (2003) In vivo and in vitro effects of an Er:YAG laser, a GaAlAs diode laser, and scaling and root planing on periodontally diseased root surfaces: a comparative histologic study. Lasers Surg Med 32(5):359–366
Jansen JP, Fleurence R, Devine B et al (2011) Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health 14(4):417–428
Sathorn C, Parashos P, Messer H (2007) Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysis. Int Endod J 40:2–10
Johnson GK, Guthmiller JM (2007) The impact of cigarette smoking on periodontal disease and treatment. Periodontol 200044:178–194
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This study was supported by the Hospital of Stomatology Hebei Medical University.
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The study was approved by the Research Ethics Committee of Hospital of Stomatology, Hebei Medical University. This was a network meta-analysis which not required an informed consent.
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Jia, L., Jia, J., Xie, M. et al. Clinical attachment level gain of lasers in scaling and root planing of chronic periodontitis: a network meta-analysis of randomized controlled clinical trials. Lasers Med Sci 35, 473–485 (2020). https://doi.org/10.1007/s10103-019-02875-5
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DOI: https://doi.org/10.1007/s10103-019-02875-5