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Clinical attachment level gain of lasers in scaling and root planing of chronic periodontitis: a network meta-analysis of randomized controlled clinical trials

  • Liying Jia
  • Jinhai Jia
  • Meng Xie
  • Xiaoxiao Zhang
  • Ting Li
  • Linan Shi
  • Hong ShiEmail author
  • Xiaolin ZhangEmail author
Original Article

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.

Keywords

Lasers Chronic periodontitis Scaling and root planing Network meta-analysis 

Notes

Funding information

This study was supported by the Hospital of Stomatology Hebei Medical University.

Compliance with ethical standards

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.

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Thornton-Evans G, Eke P, Wei L et al (2013) Periodontitis among adults aged ≥ 30 years: United States, 2009-2010. MMWR Suppl 62:129–135PubMedGoogle Scholar
  2. 2.
    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 37:211–219PubMedCrossRefGoogle Scholar
  3. 3.
    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):241–247PubMedGoogle Scholar
  4. 4.
    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):298–307PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    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 8:12PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    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):603–611PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    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):473–480PubMedCrossRefGoogle Scholar
  8. 8.
    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):887–895PubMedCrossRefGoogle Scholar
  9. 9.
    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 89:737–742PubMedCrossRefGoogle Scholar
  10. 10.
    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 1:16–22PubMedCrossRefGoogle Scholar
  11. 11.
    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 89:743–765PubMedGoogle Scholar
  12. 12.
    Mizutani K, Aoki A, Coluzzi D et al (2016) Lasers in minimally invasive periodontal and peri-implant therapy. Periodontol 2000(71):185–212CrossRefGoogle Scholar
  13. 13.
    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):3–7PubMedCrossRefGoogle Scholar
  14. 14.
    Noraian KW, Cobb CM (2018) The efficacy of laser therapy: commentary on the American Academy of Periodontology best evidence consensus meeting. J Periodontol 89:804–806PubMedCrossRefGoogle Scholar
  15. 15.
    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):1069–1079PubMedCrossRefGoogle Scholar
  16. 16.
    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):1393–1402PubMedCrossRefGoogle Scholar
  17. 17.
    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):1–13Google Scholar
  18. 18.
    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):477–480PubMedCrossRefGoogle Scholar
  19. 19.
    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):777–784CrossRefGoogle Scholar
  20. 20.
    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):225–238PubMedCrossRefGoogle Scholar
  21. 21.
    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):889–893Google Scholar
  22. 22.
    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):537–545PubMedCrossRefGoogle Scholar
  23. 23.
    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):807–811Google Scholar
  24. 24.
    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):1195–1200PubMedCrossRefGoogle Scholar
  25. 25.
    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):543–550PubMedCrossRefGoogle Scholar
  26. 26.
    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):1461–1470PubMedCrossRefGoogle Scholar
  27. 27.
    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):e9367CrossRefGoogle Scholar
  28. 28.
    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):682–691PubMedCrossRefGoogle Scholar
  29. 29.
    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):325–330PubMedCrossRefGoogle Scholar
  30. 30.
    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):285–289PubMedGoogle Scholar
  31. 31.
    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):293–298PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    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):527–535PubMedCrossRefGoogle Scholar
  33. 33.
    Chen M (2017) Clinical efficacy of Er:YAG laser as adjunctive therapy of chronic periodontitis. MMJC 17(11):59–61Google Scholar
  34. 34.
    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):514–517Google Scholar
  35. 35.
    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):618–624Google Scholar
  36. 36.
    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):231–232,235Google Scholar
  37. 37.
    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):86–88Google Scholar
  38. 38.
    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):360–366PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Chen MH, Wang LM (2016) Effect of Er,Cr:YSGG laser on the treatment of chronic periodontitis: a short-term evaluation. Stomatology 36(1):64–67Google Scholar
  40. 40.
    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):235–237Google Scholar
  41. 41.
    Ge LH, Zhang YX, Shu R (2017) Er,Cr:YSGG laser application for the treatment of periodontal furcation involvements. Photomed Laser Surg 35(2):92–97PubMedCrossRefGoogle Scholar
  42. 42.
    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):391–400PubMedGoogle Scholar
  43. 43.
    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):76–80Google Scholar
  44. 44.
    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):61–66PubMedCrossRefGoogle Scholar
  45. 45.
    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):37–46PubMedCrossRefGoogle Scholar
  46. 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):404–440Google Scholar
  47. 47.
    Borrell LN, Papapanou PN (2005) Analytical epidemiology of periodontitis. J Clin Periodontol 32(s6):132–158PubMedCrossRefGoogle Scholar
  48. 48.
    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):348–360PubMedCrossRefGoogle Scholar
  49. 49.
    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):853–862PubMedCrossRefGoogle Scholar
  50. 50.
    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):681–692PubMedCrossRefGoogle Scholar
  51. 51.
    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):112–119CrossRefGoogle Scholar
  52. 52.
    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):1111–1117PubMedCrossRefGoogle Scholar
  53. 53.
    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):65–72PubMedCrossRefGoogle Scholar
  54. 54.
    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):1767–1773PubMedCrossRefGoogle Scholar
  55. 55.
    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):702–709PubMedCrossRefGoogle Scholar
  56. 56.
    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 46:89–96PubMedCrossRefGoogle Scholar
  57. 57.
    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):481–488PubMedCrossRefGoogle Scholar
  58. 58.
    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):87–95CrossRefGoogle Scholar
  59. 59.
    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):661–673PubMedCrossRefGoogle Scholar
  60. 60.
    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):526–533PubMedCrossRefGoogle Scholar
  61. 61.
    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):21–24Google Scholar
  62. 62.
    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):88–92PubMedGoogle Scholar
  63. 63.
    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):63–67PubMedCrossRefGoogle Scholar
  64. 64.
    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):1161–1166PubMedCrossRefGoogle Scholar
  65. 65.
    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):525–535PubMedCrossRefGoogle Scholar
  66. 66.
    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):248–253PubMedGoogle Scholar
  67. 67.
    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 24:7090–7099PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    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 291Google Scholar
  69. 69.
    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):595–602PubMedCrossRefGoogle Scholar
  70. 70.
    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):359–366PubMedCrossRefGoogle Scholar
  71. 71.
    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):417–428PubMedCrossRefGoogle Scholar
  72. 72.
    Sathorn C, Parashos P, Messer H (2007) Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysis. Int Endod J 40:2–10PubMedCrossRefGoogle Scholar
  73. 73.
    Johnson GK, Guthmiller JM (2007) The impact of cigarette smoking on periodontal disease and treatment. Periodontol 200044:178–194CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Pediatric Dentistry, School and Hospital of Stomatology & Hebei Key Laboratory of StomatologyHebei Medical UniversityShijiazhuangPeople’s Republic of China
  2. 2.Outpatient ClinicHebei Medical UniversityShijiazhuangPeople’s Republic of China
  3. 3.Department of Dentistry, Children’s Hospital of Hebei ProvinceHebei Medical UniversityShijiazhuangPeople’s Republic of China
  4. 4.Department of Pathology, School and Hospital of Stomatology & Hebei Key Laboratory of StomatologyHebei Medical UniversityShijiazhuangPeople’s Republic of China
  5. 5.Department of Epidemiology and Statistics, School of Public Health, Hebei Province Key Laboratory of Environment and Human HealthHebei Medical UniversityShijiazhuangPeople’s Republic of China

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