Skip to main content

Advertisement

SpringerLink
Log in

Treatment of severe periodontitis with a laser and light-emitting diode (LED) procedure adjunctive to scaling and root planing: a double-blind, randomized, single-center, split-mouth clinical trial investigating its efficacy and patient-reported outcomes at 1 year

  • Original Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

Broad methodological heterogeneity makes the literature on the clinical effects of laser treatment in periodontitis, both as monotherapy and adjunct to non-surgical therapy, which is difficult to interpret. The present split-mouth study was performed: (i) to determine the efficacy and safety of a photoablative-photodynamic diode laser therapy, including antiseptic LED irradiation, in adjunct to scaling and root planing (iPAPD+SRP) vs. sham-treatment+SRP for the treatment of diffuse severe periodontitis and (ii) to estimate the patient-reported outcomes. Twenty-four patients with severe periodontitis were treated with iPAPD+SRP or sham-treatment+SRP. iPAPD+SRP consisted of the following: (1) intra-/extra-pocket de-epithelization with photoablative λ 810 nm laser, (2) disinfection with λ 405 nm LED, (3) SRP, and (4) 10 weekly antiseptic/anti-inflammatory photodynamic treatments with λ 635 nm laser and 0.1% toluidine blue as photosensitizer. Clinical and cytofluorescent periodontal markers and patient-reported results were analyzed. At 1-year follow-up, both groups showed a significant reduction of several severity markers of periodontitis, namely probing depth (PD) and bleeding on probing (BoP), as well as of bacteria, polymorphonuclear cells, erythrocytes and damaged epithelial cells in exfoliative samples, as compared with day 0. The quadrants subjected to iPAPD+SRP showed significantly better values of these parameters as well as of clinical attachment level (CAL) as compared with those undergoing sham-treatment+SRP. The patients’ perceived pain/discomfort, and overall liking was also in favor of the iPAPD+SRP treatment. This study confirms the efficacy of combined phototherapy in adjunct to SRP which had emerged from previous clinical trials, extending its field of application to severe periodontitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sima C, Glogauer M (2013) Macrophage subsets and osteoimmunology: tuning of the immunological recognition and effector systems that maintain alveolar bone. Periodontol 2000(63):80–101

    Article  Google Scholar 

  2. Tonetti MS, Jepsen S, Jin L, Otomo-Corgel J (2017) Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: a call for global action. J Clin Periodontol 44:456–462

    Article  PubMed  Google Scholar 

  3. Rhemrev GE, Timmerman MF, Veldkamp I, Van Winkelhoff AJ, Van der Velden U (2006) Immediate effect of instrumentation on the subgingival microflora in deep inflamed pockets under strict plaque control. J Clin Periodontol 33:42–48

    Article  PubMed  CAS  Google Scholar 

  4. Dentino A, Lee S, Mailhot J, Hefti AF (2013) Principles of periodontology. Periodontol 2000(61):16–53

    Article  Google Scholar 

  5. Mombelli A, Schmid B, Rutar A, Lang NP (2000) Persistence patterns of Porphyromonas gingivalis, Prevotella intermedia/nigrescens, and Actinobacillus actinomyetemcomitans after mechanical therapy of periodontal disease. J Periodontol 71:14–21

    Article  PubMed  CAS  Google Scholar 

  6. Adriaens PA, De Boever JA, Loesche WJ (1988) Bacterial invasion in root cementum and radicular dentin of periodontally diseased teeth in humans. A reservoir of periodontopathic bacteria. J Periodontol 59:222–230

    Article  PubMed  CAS  Google Scholar 

  7. Tribble GD, Lamont RJ (2010) Bacterial invasion of epithelial cells and spreading in periodontal tissue. Periodontol 2000(52):68–83

    Article  Google Scholar 

  8. Silva N, Abusleme L, Bravo D, Dutzan N, Garcia-Sesnich J, Vernal R, Hernández M, Gamonal J (2015) Host response mechanisms in periodontal diseases. J Appl Oral Sci 23:329–355

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Wang HL (2000) Greenwell H (2001) surgical periodontal therapy. Periodontol 25:89–99

    Article  Google Scholar 

  10. Mailoa J, Lin GH, Khoshkam V, MacEachern M, Chan HL, Wang HL (2015) Long-term effect of four surgical periodontal therapies and one non-surgical therapy: a systematic review and meta-analysis. J Periodontol 86:1150–1158

    Article  PubMed  Google Scholar 

  11. Hung HC, Douglass CW (2002) Meta-analysis of the effect of scaling and root planing, surgical treatment and antibiotic therapies on periodontal probing depth and attachment loss. J Clin Periodontol 29:975–986

    Article  PubMed  Google Scholar 

  12. Heitz-Mayfield LJ, Trombelli L, Heitz F, Needleman I, Moles D (2002) A systematic review of the effect of surgical debridement vs non-surgical debridement for the treatment of chronic periodontitis. J Clin Periodontol 29:92–102

    Article  PubMed  Google Scholar 

  13. Novak MJ, Albather HM, Close JM (2008) Redefining the biologic width in severe, generalized, chronic periodontitis: implications for therapy. J Periodontol 79:1864–1869

    Article  PubMed  Google Scholar 

  14. Ramfjord SP, Caffesse RG, Morrison EC, Hill RW, Kerry GJ, Appleberry EA, Nissle RR, Stults DL (1987) 4 modalities of periodontal treatment compared over 5 years. J Clin Periodontol 14:445–452

    Article  PubMed  CAS  Google Scholar 

  15. Quirynen M, Teughels W, De Soete M, van Steenberghe D (2002) Topical antiseptics and antibiotics in the initial therapy of chronic adult periodontitis: microbiological aspects. Periodontol 2000 28:72–90

    Article  PubMed  Google Scholar 

  16. Sanz M, Teughels W, Group A of European Workshop on Periodontology (2008) Innovations in non-surgical periodontal therapy: consensus report of the Sixth European Workshop on Periodontology. J Clin Periodontol 35:3–7

    Article  PubMed  CAS  Google Scholar 

  17. Gursoy H, Ozcakir-Tomruk C, Tanalp J, Yilmaz S (2013) Photodynamic therapy in dentistry: a literature review. Clin Oral Investig 17:1113–1125

    Article  PubMed  Google Scholar 

  18. Schwarz F, Aoki A, Becker J, Sculean A (2008) Laser application in non-surgical periodontal therapy: a systematic review. J Clin Periodontol 35:29–44

    Article  PubMed  Google Scholar 

  19. Mizutani K, Aoki A, Coluzzi D, Yukna R, Wang CY, Pavlic V (2000) Izumi Y (2016) lasers in minimally invasive periodontal and peri-implant therapy. Periodontol 71:185–212

    Article  Google Scholar 

  20. Giannelli M, Formigli L, Lorenzini L, Bani D (2012) Combined photoablative and photodynamic diode laser therapy as an adjunct to non-surgical periodontal treatment: a randomized split-mouth clinical trial. J Clin Periodontol 39:962–970

    Article  PubMed  Google Scholar 

  21. Braun A, Dehn C, Krause F, Jepsen S (2008) Short-term clinical effects of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial. J Clin Periodontol 35:877–884

    Article  PubMed  CAS  Google Scholar 

  22. Moreira AL, Novaes AB Jr, Grisi MF, Taba M Jr, Souza SL, Palioto DB, de Oliveira PG, Casati MZ, Casarin RC, Messora MR (2015) Antimicrobial photodynamic therapy as an adjunct to non-surgical treatment of aggressive periodontitis: a split-mouth randomized controlled trial. J Periodontol 86:376–386

    Article  PubMed  CAS  Google Scholar 

  23. Soukos NS, Som S, Abernethy AD, Ruggiero K, Dunham J, Lee C, Doukas AG, Goodson JM (2005) Phototargeting oral black-pigmented bacteria. Antimicrob Agents Chemother 49:1391–1396

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Cobb CM (2017) Lasers and the treatment of periodontitis: the essence and the noise. Periodontol 2000(75):205–295

    Article  Google Scholar 

  25. 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 29:37–46

    Article  PubMed  Google Scholar 

  26. Pourabbas R, Kashefimehr A, Rahmanpour N, Babaloo Z, Kishen A, Tenenbaum HC, Azarpazhooh A (2014) Effects of photodynamic therapy on clinical and gingival crevicular fluid inflammatory biomarkers in chronic periodontitis: a split-mouth randomized clinical trial. J Periodontol 85:1222–1229

    Article  PubMed  CAS  Google Scholar 

  27. Akram Z, Hyder T, Al-Hamoudi N, Binshabaib MS, Alharthi SS, Hanif A (2017) Efficacy of photodynamic therapy versus antibiotics as an adjunct to scaling and root planing in the treatment of periodontitis: a systematic review and meta-analysis. Photodiagn Photodyn Ther 19:86–92

    Article  CAS  Google Scholar 

  28. 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 33:473–480

    Article  PubMed  Google Scholar 

  29. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, Lamb SE, Dixon-Woods M, McCulloch P, Wyatt JC, Chan AW, Michie S (2014) Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Brit Med J 7:348–360

    Google Scholar 

  30. Lesaffre E, Garcia Zattera MJ, Redmond C, Huber H, Needleman I (2007) Reported methodological quality of split-mouth studies. J Clin Periodontol 34:756–761

    Article  PubMed  Google Scholar 

  31. Hujoel PP, Loesche WJ (1990) Efficiency of split-mouth designs. J Clin Periodontol 17:722–728

    Article  PubMed  CAS  Google Scholar 

  32. Derman SH, Lowden CE, Hellmich M, Noack MJ (2014) Influence of intra-pocket anesthesia gel on treatment outcome in periodontal patients: a randomized controlled trial. J Clin Periodontol 41:481–488

    Article  PubMed  CAS  Google Scholar 

  33. Page RC, Eke PI (2007) Case definitions for use in population-based surveillance of periodontitis. J Periodontol 78:1387–1399

    Article  PubMed  Google Scholar 

  34. O'Leary TJ, Drake RB, Naylor JE (1972) The plaque control record. J Periodontol 43:38

    Article  PubMed  CAS  Google Scholar 

  35. Giannelli M, Materassi F, Lorenzini L, Bani D (2017) Management of severe periodontal abscesses using laser/light-emitting diode (LED) procedure adjunctive to scaling & root planing. A case-series study. Clin Adv Periodont March 7(2017):1–10. https://doi.org/10.1902/cap.2017.160090

    Article  Google Scholar 

  36. Santuchi CC, Cortelli JR, Cortelli SC, Cota LO, Fonseca DC, Alencar CO, Costa FO (2016) Scaling and root planing per quadrant versus one-stage full-mouth disinfection: assessment of the impact of chronic periodontitis treatment on quality of life—a clinical randomized, controlled trial. J Periodontol 87:114–123

    Article  PubMed  Google Scholar 

  37. McGuire MK, Scheyer ET, Gwaltney C (2014) Commentary: incorporating patient-reported outcomes in periodontal clinical trials. J Periodontol 85:1313–1319

    Article  PubMed  Google Scholar 

  38. Arany PR, Wilder-Smith P (2016) Special issue on lasers in dentistry. Lasers Surg Med 48:912–914

    Article  PubMed  Google Scholar 

  39. Giannelli M, Bani D, Viti C, Tani A, Lorenzini L, Zecchi-Orlandini S, Formigli L (2012) Comparative evaluation of the effects of different photoablative laser irradiation protocols on the gingiva of periodontopathic patients. Photomed Laser Surg 30:222–230

    Article  PubMed  CAS  Google Scholar 

  40. Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki AA, Romanos GE, Taniguchi Y, Sasaki KM, Zeredo JL, Koshy G, Coluzzi DJ, White JM, Abiko Y, Ishikawa I, Izumi Y (2015) Periodontal and peri-implant wound healing following laser therapy. Periodontol 2000 68:217–269

    Article  PubMed  Google Scholar 

  41. Gillespie JB, Maclean M, Given MJ, Wilson MP, Judd MD, Timoshkin IV, MacGregor SJ (2017) Efficacy of pulsed 405-nm light-emitting diodes for antimicrobial photodynamic inactivation: effects of intensity, frequency, and duty cycle. Photomed Laser Surg 35:150–156

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Giannelli M, Landini G, Materassi F, Chellini F, Antonelli A, Tani A, Nosi D, Zecchi-Orlandini S, Rossolini GM, Bani D (2017) Effects of photodynamic laser and violet-blue led irradiation on Staphylococcus aureus biofilm and Escherichia coli lipopolysaccharide attached to moderately rough titanium surface: in vitro study. Lasers Med Sci 32:857–864

    Article  PubMed  Google Scholar 

  43. Kömerik N, Nakanishi H, MacRobert AJ, Henderson B, Speight P, Wilson M (2003) In vivo killing of Porphyromonas gingivalis by toluidine blue-mediated photosensitization in an animal model. Antimicrob Agents Chemother 47:932–940

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Kimura Y, Wilder-Smith P, Yonaga K, Matsumoto K (2000) Treatment of dentine hypersensitivity by lasers: a review. J Clin Periodontol 27:715–721

    Article  PubMed  CAS  Google Scholar 

  45. Lima TC, Vieira-Barbosa NM, Grasielle de Sá Azevedo C, de Matos FR, Douglas de Oliveira DW, de Oliveira ES, Ramos-Jorge ML, Gonçalves PF, Flecha OD (2017) Oral health-related quality of life before and after treatment of dentin hypersensitivity with cyanoacrylate and laser. J Periodontol 88:166–172

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Odontostomatologic Laser Therapy Center, Via dell’ Olivuzzo 162, 50143, Florence, Italy

    Marco Giannelli, Fabrizio Materassi, Tiziana Fossi & Luca Lorenzini

  2. Department of Experimental and Clinical Medicine, Research Unit of Histology & Embryology, University of Florence, Viale G. Pieraccini 6, 50139, Florence, Italy

    Daniele Bani

Authors
  1. Marco Giannelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabrizio Materassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tiziana Fossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luca Lorenzini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniele Bani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Giannelli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Medical Ethics Committee of the University of Florence, Italy (SPE14126-ASF) and registered at ClinicalTrials.gov (NCT02407379).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Giannelli, M., Materassi, F., Fossi, T. et al. Treatment of severe periodontitis with a laser and light-emitting diode (LED) procedure adjunctive to scaling and root planing: a double-blind, randomized, single-center, split-mouth clinical trial investigating its efficacy and patient-reported outcomes at 1 year. Lasers Med Sci 33, 991–1002 (2018). https://doi.org/10.1007/s10103-018-2441-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10103-018-2441-9

Keywords

Search

Navigation