Lasers in Medical Science

, Volume 27, Issue 3, pp 661–673 | Cite as

Efficacy of Er:YAG laser in the treatment of chronic periodontitis: systematic review and meta-analysis

  • Fabrizio SgolastraEmail author
  • Ambra Petrucci
  • Roberto Gatto
  • Annalisa Monaco
Review Article


Scaling root planing (SRP) has been proven efficacious as the traditional treatment approach for chronic periodontitis. However, important limitations such as difficult access in deep pockets, grooves, and furcations have led to the development of new therapeutic strategies. The erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser is one of the most promising laser types for periodontal therapy. Its efficacy in radicular debris removal and root smoothing has been proven in vitro. However, the clinical effectiveness of the Er:YAG laser remains controversial. The aim of the present systematic review was to systemically assess the scientific evidence for the effectiveness of Er:YAG laser compared to SRP in the treatment of chronic periodontitis. Electronic database searches of MEDLINE, Cochrane Controlled Clinical Trial Register, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, CINAHL, Science Direct, ISI Web of Science, and SCOPUS were performed, as well as hand-searching of relevant journals through December 23, 2010. Quality assessment was made according to the CONSORT guidelines. The systematic review was performed according to the QUOROM statement and Cochrane Collaboration recommendations. Meta-analyses of the clinical attachment level gain, probing depth reduction, and changes in gingival recession were performed using weighted mean differences for continuous data with 95% confidence intervals, nested in a random effect model. No statistically significant differences were found in any of the investigated clinical parameters among the five random controlled trials (RCTs) entered into the study, indicating that there was no evidence of effectiveness. However, significant heterogeneity, a high risk of bias in three of the five included studies, and methodological shortcomings indicate that the results should be considered with caution. Future long-term, well-designed RCTs are needed to assess the scientific evidence of Er:YAG laser efficacy as an alternative treatment strategy to SRP.


Laser Er:YAG Chronic periodontitis Meta-analysis 


  1. 1.
    Derdilopoulou FV, Nonhoff J, Neumann K, Kielbassa AM (2007) Microbiological findings after periodontal therapy using curettes, Er:YAG laser, sonic, and ultrasonic scalers. J Clin Periodontol 34:588–598PubMedCrossRefGoogle Scholar
  2. 2.
    O’Leary TJ (1986) The impact of research on scaling and root planing. J Periodontol 52:69–75CrossRefGoogle Scholar
  3. 3.
    Axelsson P, Lindhe J, Nystrom B (1991) On the prevention of caries and periodontal disease. Results of 15-year longitudinal study in adults. J Clin Periodontol 18:182–189PubMedCrossRefGoogle Scholar
  4. 4.
    Tunkel J, Heinecke A, Flemmig TF (2002) A systematic review of efficacy of machine-driven and manual subgingival debridement in the treatment of chronic periodontitis. J Clin Periodontol 29(suppl 3):72–81PubMedCrossRefGoogle Scholar
  5. 5.
    Walmsley AD, Lea SC, Landini G, Moses AJ (2008) Advances in power driven pocket/root instrumentation. J Clin Periodontol 35(suppl 8):22–28PubMedCrossRefGoogle Scholar
  6. 6.
    Bower RC (1979) Furcation morphology relative to periodontal treatment. Furcation root surface anatomy. J Periodontol 50:366–374PubMedCrossRefGoogle Scholar
  7. 7.
    Cobb CM (1996) Non-surgical pocket therapy: mechanical. Ann Periodontol 1:443–490PubMedCrossRefGoogle Scholar
  8. 8.
    Crespi R, Barone A, Covani U (2005) Histologic evaluation of three methods of periodontal root surface treatment in humans. J Periodontol 76:476–481PubMedCrossRefGoogle Scholar
  9. 9.
    Copulos TA, Low SB, Walker CB, Trebilcock YY, Hefti AF (1993) Comparative analysis between a modified ultrasonic tip and hand instruments on clinical parameters of periodontal disease. J Periodontol 64:694–700PubMedCrossRefGoogle Scholar
  10. 10.
    Holbrook WP, Muir KF, Macphee IT, Ross PW (1978) Bacteriological investigation of the aerosol from ultrasonic scalers. Br Dent J 144:245–247PubMedCrossRefGoogle Scholar
  11. 11.
    Aoki A, Sasaki KM, Watanabe H, Ishikawa I (2004) Lasers in nonsurgical periodontal therapy. Periodontol 2000 36:59–97PubMedCrossRefGoogle Scholar
  12. 12.
    Ando Y, Aoki A, Watanabe H, Ishikawa I (1996) Bactericidal effect of erbium YAG laser on periodontopathic bacteria. Lasers Surg Med 19:190–200PubMedCrossRefGoogle Scholar
  13. 13.
    Folwaczny M, Mehl A, Aggstaller H, Hickel R (2002) Antimicrobial effects of 2.94 micron Er:YAG laser radiation on root surfaces: an in vitro study. J Clin Periodontol 29:73–78PubMedCrossRefGoogle Scholar
  14. 14.
    Chanthaboury R, Irinakis T (2005) The use of lasers for periodontal debridement: marketing tool or proven therapy? J Can Dent Assoc 71:653–658PubMedGoogle Scholar
  15. 15.
    Rotundo R, Nieri M, Cairo F, Franceschi D, Mervelt J, Bonaccini D, Esposito M, Pini-Prato G (2010) Lack of adjunctive benefit of Er:YAG laser in non-surgical periodontal treatment: a randomized split-mouth clinical trial. J Clin Periodontol 37:526–533PubMedCrossRefGoogle Scholar
  16. 16.
    Fujii T, Baehni PC, Kawai O, Kwawkami T, Matsuda K, Kowashi Y (1998) Scanning electron microscopic study of the effects of Er:YAG laser on root cementum. J Periodontol 69:1283–1290PubMedCrossRefGoogle Scholar
  17. 17.
    Cozean C, Arcoria CJ, Pelagalli J, Powell L (1997) Dentistry for the 21st century? Er:YAG laser for teeth. J Am Dent Assoc 128:1080–1087PubMedGoogle Scholar
  18. 18.
    Eberhard J, Ehlers H, Falk W, Acil Y, Albers HK, Jepsen S (2003) Efficacy of subgingival calculus removal with Er:YAG laser compared to mechanical debridement: an in situ study. J Clin Periodontol 30:511–518PubMedCrossRefGoogle Scholar
  19. 19.
    Crespi R, Barone A, Covani U (2006) Er:YAG laser scaling of diseased root surfaces: a histologic study. J Periodontol 77:218–222PubMedCrossRefGoogle Scholar
  20. 20.
    Frentzen M, Braun A, Aniol D (2002) Er:YAG laser scaling of diseased root surfaces. J Periodontol 73:524–530PubMedCrossRefGoogle Scholar
  21. 21.
    Folwaczny M, Benner KU, Flasskamp B, Mehl A, Hickel R (2003) Effects of 2.94 mm Er:YAG laser radiation on root surfaces treated in situ: a histological study. J Periodontol 74:360–365PubMedCrossRefGoogle Scholar
  22. 22.
    Folwaczny M, Thiele L, Mehl A, Hickel R (2001) The effect of working tip angulation on root substance removal using Er:YAG laser radiation: An in vitro study. J Clin Periodontol 28:220–226PubMedCrossRefGoogle Scholar
  23. 23.
    Crespi R, Cappare 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 78:1195–1200PubMedCrossRefGoogle Scholar
  24. 24.
    Schwarz F, Sculean A, Georg T, Reich E (2001) Periodontal treatment with an Er:YAG laser compared to scaling and root planing. A controlled study. J Periodontol 72:361–367PubMedCrossRefGoogle Scholar
  25. 25.
    Sculean A, Schwarz F, Berakdar M, Romanos GE, Arweiler N, Becker J (2004) Periodontal treatment with an Er:YAG laser compared to ultrasonic instrumentation: a pilot study. J Periodontol 75:966–973PubMedCrossRefGoogle Scholar
  26. 26.
    Schwarz F, Aoki A, Becker J, Sculean A (2008) Laser application in non-surgical periodontal therapy: a systematic review. J Clin Periodontol 35(suppl 8):29–44PubMedCrossRefGoogle Scholar
  27. 27.
    Sanz M, Teughels W (2008) Innovations in non-surgical periodontal therapy: consensus report of the Sixth European Workshop on Periodontology. J Clin Periodontol 35(suppl 8):3–7PubMedCrossRefGoogle Scholar
  28. 28.
    Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 354:1896–1900PubMedCrossRefGoogle Scholar
  29. 29.
    Higgins JPT, Green S, eds. (2009) Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.2. The Cochrane Collaboration. Available at: Accessed September December 2, 2010
  30. 30.
    Landis JR, Koch GG (1997) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363–374CrossRefGoogle Scholar
  31. 31.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  32. 32.
    Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med 134:657–662PubMedGoogle Scholar
  33. 33.
    Rosner B (2000) Fundamentals of biostatistics. Duxbury Press, Pacific Grove, pp 135–138Google Scholar
  34. 34.
    Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127:820–826PubMedGoogle Scholar
  35. 35.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRefGoogle Scholar
  36. 36.
    Sterne JA, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54:1046–1055PubMedCrossRefGoogle Scholar
  37. 37.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRefGoogle Scholar
  38. 38.
    Duval S, Tweedie R (2000) Trim and fill: a simple funnelplot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455–463PubMedCrossRefGoogle Scholar
  39. 39.
    Gursoy-Mert H, Altan-Koran M, Noyan U, Kadir T, Cologlu S, Yilmaz S (2010) Evaluation of the effectiveness of Er:YAG laser and conventional periodontal treatment in a patient with acute streptococcal gingivitis: a 2-year follow-up. Photomed Laser Surg 28:841–845PubMedCrossRefGoogle Scholar
  40. 40.
    Braun A, Jepsen S, Deimling D, Ratka-Krüger P (2010) Subjective intensity of pain during supportive periodontal treatment using a sonic scaler or an Er:YAG laser. J Clin Periodontol 37:340–345PubMedCrossRefGoogle Scholar
  41. 41.
    Lopes BM, Theodoro LH, Melo RF, Thompson GM, Marcantonio RA (2010) Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with erbium:YAG laser and scaling and root planing. J Periodontol 81:682–691PubMedCrossRefGoogle Scholar
  42. 42.
    Gómez C, Bisheimer M, Costela A, García-Moreno I, García A, García JA (2009) Evaluation of the effects of Er:YAG and Nd:YAG lasers and ultrasonic instrumentation on root surfaces. Photomed Laser Surg 27:43–48PubMedCrossRefGoogle Scholar
  43. 43.
    Lopes BM, Marcantonio RA, Thompson GM, Neves LH, Theodoro LH (2008) Short-term clinical and immunologic effects of scaling and root planing with Er:YAG laser in chronic periodontitis. J Periodontol 79:1158–1167PubMedCrossRefGoogle Scholar
  44. 44.
    Ishikawa I, Aoki A, Takasaki AA (2008) Clinical application of erbium:YAG laser in periodontology. J Int Acad Periodontol 10:22–30PubMedGoogle Scholar
  45. 45.
    Moghare Abed A, Tawakkoli M, Dehchenari MA, Gutknecht N, Mir M (2007) A comparative SEM study between hand instrument and Er:YAG laser scaling and root planing. Lasers Med Sci 22:25–29PubMedCrossRefGoogle Scholar
  46. 46.
    Cobb CM (2006) Lasers in periodontics: a review of the literature. J Periodontol 77:545–564PubMedCrossRefGoogle Scholar
  47. 47.
    Tomasi C, Schander K, Dahlén G, Wennström JL (2006) Short-term clinical and microbiologic effects of pocket debridement with an Er:YAG laser during periodontal maintenance. J Periodontol 77:111–118PubMedCrossRefGoogle Scholar
  48. 48.
    Schwarz F, Bieling K, Venghaus S, Sculean A, Jepsen S, Becker J (2006) Influence of fluorescence-controlled Er:YAG laser radiation, the Vector system and hand instruments on periodontally diseased root surfaces in vivo. J Clin Periodontol 33:200–208PubMedCrossRefGoogle Scholar
  49. 49.
    Crespi R, Barone A, Covani U (2005) Effect of Er:YAG laser on diseased root surfaces: an in vivo study. J Periodontol 76:1386–1390PubMedCrossRefGoogle Scholar
  50. 50.
    Van As G (2004) Erbium lasers in dentistry. Dent Clin North Am 48:1017–1059PubMedCrossRefGoogle Scholar
  51. 51.
    Ishikawa I, Aoki A, Takasaki AA (2004) Potential applications of Erbium:YAG laser in periodontics. J Periodontal Res 39:275–285PubMedCrossRefGoogle Scholar
  52. 52.
    Schwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker J (2003) Periodontal treatment with an Er:YAG laser or scaling and root planing. A 2-year follow-up split-mouth study. J Periodontol 74:590–596PubMedCrossRefGoogle Scholar
  53. 53.
    Schwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker J (2003) Clinical evaluation of an Er:YAG laser combined with scaling and root planing for non-surgical periodontal treatment. A controlled, prospective clinical study. J Clin Periodontol 30:26–34PubMedCrossRefGoogle Scholar
  54. 54.
    Ishikawa I, Sasaki KM, Aoki A, Watanabe H (2003) Effects of Er:YAG laser on periodontal therapy. J Int Acad Periodontol 5:23–28PubMedGoogle Scholar
  55. 55.
    Research, Science and Therapy Committee of the American Academy of Periodontology (2002) Lasers in periodontics. J Periodontol 73:1231–1239CrossRefGoogle Scholar
  56. 56.
    Lioubavina-Hack N (2002) Lasers in dentistry. 5. The use of lasers in periodontology. Ned Tijdschr Tandheelkd 109:286–292PubMedGoogle Scholar
  57. 57.
    Folwaczny M, Mehl A, Haffner C, Benz C, Hickel R (2000) Root substance removal with Er:YAG laser radiation at different parameters using a new delivery system. J Periodontol 71:147–155PubMedCrossRefGoogle Scholar
  58. 58.
    Watanabe H, Ishikawa I, Suzuki M, Hasegawa K (1996) Clinical assessments of the erbium:YAG laser for soft tissue surgery and scaling. J Clin Laser Med Surg 14:67–75PubMedGoogle Scholar
  59. 59.
    Hujoel PP, Loesche WJ (1990) Efficiency of split-mouth designs. J Clin Periodontol 17:722–728PubMedCrossRefGoogle Scholar
  60. 60.
    Hujoel PP, De Rouen TA (1992) Validity issues in split-mouth trials. J Clin Periodontol 19:625–627PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd 2011

Authors and Affiliations

  • Fabrizio Sgolastra
    • 1
    Email author
  • Ambra Petrucci
    • 1
  • Roberto Gatto
    • 1
  • Annalisa Monaco
    • 1
  1. 1.Department of Health SciencesUniversity of L’AquilaL’AquilaItaly

Personalised recommendations