Are lasers useful in the treatment of periodontitis?

Watch Dental Video about Using Lasers in Periodontitis Treatment

First of all – up to now there has been no clear advantage and/or indication demonstrated for the treatment of periodontitis.

Many patients have high expectations for a laser treatment of periodontitis but up to now there are no scientifically assured indications in this respect.

Research is showing developments which may be of practical interest in future for periodontics, e.g. the selective erosion of scale with special laser systems or laser-supported fluoridisation of exposed root upper surfaces but in practice no treatment has yet been carried out.

In addition the exposure of lasers in clinics is not without problems. Laser light, whether direct, reflected or scattered can be dangerous to the eyes. Whilst light from CO2 and Er:YAG lasers can mainly damage the corneas due to the limited depth of penetration, infrared or visible lasers pose a much greater danger to the deeper parts of the eye. The use of dental lasers without specific protection glasses for the patient, dental team and onlookers at each session would be very irresponsible. This would apply to all wavelengths and uses of lasers.

Periodontal illnesses such as chronic widespread periodontitis for example are amongst the most widespread illnesses of the gums in adults. For most of the different illnesses there are scientifically founded courses of treatment which when applied carefully offer high rates of success and all this without lasers. In almost all cases long-lasting, active collaboration by the patient and continuing interest from the treater is necessary. The desire for simpler and more effective treatment alternatives, whilst understandable, is the probable source of this ‘laser hype’.

Laser Treatment

Laser Treatment

Lasers can be used to cut or remove soft tissues. The advantages of using laser include a blood-free operating area with a clear view and a reduction of the spread of bacteria, the latter has been postulated but hard data is still lacking. Further possible uses in periodontics are limited to cutting of the mucus membranes in surgical interventions as well as abrading or remodelling measures on the gums.

Lasers are hardly useful in classical flap operations. Due to the lack of control over the effective depth of the laser beam, irreversible damage to hard dental tissue or alveolar bone may result from an unintended exposure to the laser beam. The so-called coagulation necrosis to the edges of the wound can lead to a lengthening of the healing process, the extent of which depends on the type of laser used and the application technique. Sometimes sutures or bandaging are not possible due to the coagulation on the surface in small interventions.

It is not possible to achieve the desired removal of scale or other calculus when cleaning the upper surface of the root – known as scaling - under clinical conditions with the selection of current types of laser available (argon, ion, diode, Nd:YAG, Ho:YAG, CO2). Such attempted use would lead to widespread necroses in the root cement and dentine. For excimer and modified Alexandrite lasers there are only experimental studies. Results with lasers with beams in the 3 μm range (e.g. Er:YAG) seem to be very promising.

Histological studies confirm that with these tools an ongoing cleaning without injury of the upper root surface is possible. The upper root surfaces do however appear to be rather raw afterwards. Early clinical studies show that after non-surgical periodontitis therapy with an Er:YAG laser over a period of up to two years the connection of the gum to the tooth can be maintained and that the scaling is comparable to conventional methods.

Periodontology

Periodontology

When it comes to the removal of bacteria in the area of the gum pocket, which plays a central role in the treatment of periodontitis, no significant difference between optical fibre lasering of the pocket as opposed to a classical periodontitis treatment/care can be demonstrated. The antimicrobial effect of laser energy is based in most cases on the effects of heat. In this respect there’s a particular potential risk in fibre-optic pocket lasering, since the laser beams are distributed without visible control onto very variably absorbent surfaces (scale, calculus, epithelium, desmodont, root cement and bone).

Only a temporary reduction of the microflora has been confirmed by microbiological observation in clinical studies. Misuse of the laser poses a great potential danger of, amongst others, damage to dental nerves, burns of the gums or laser-induced inflammation of the bones.

Lasers are being recommended more and more often for so-called bio-stimulation and for aftercare after periodontological treatment as well as for the promotion of healing of wounds. One can understand the underlying attempt at positively influencing biological processes, such as healing wounds with laser light. In contrast to other uses of lasers the laser beams applied, like those of laser pointers, for example, do not change the tissues concerned.

Based on numerous double blind studies it can be said with certainty that laser bio-stimulation has no substantial effect and that any therapeutic effects appear to be placebo-effects.

Click here to see the video: Periodontology

 

This post is also available in: German

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