Skip to main content

Advertisement

SpringerLink
Log in

Effectiveness of diode laser as adjunctive therapy to scaling root planning in the treatment of chronic periodontitis: a meta-analysis

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

Abstract

To investigate whether the adjunctive use of diode laser provides additional benefits to scaling root planning alone in patients with chronic periodontitis, a meta-analysis was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement and the Cochrane Collaboration. A literature search was performed on seven databases, followed by a manual search. Weighted mean differences and 95 % confidence intervals were calculated for the clinical attachment level, probing depth, and changes in the plaque and gingival indices. The I 2 test was used for interstudy heterogeneity. Visual asymmetry inspection of the funnel plot, Egger’s regression test, and the trim-and-fill method were used to investigate publication bias. All outcomes were evaluated at 6 months. No significant differences were observed for any investigated outcome of interest. No evidence of heterogeneity or publication bias was detected. These findings suggested that the use of diode laser as an adjunctive therapy to conventional nonsurgical periodontal therapy did not provide additional clinical benefit. However, given that few studies were included in the analysis, and that three of the five included studies had a high risk of bias, the results should be interpreted with caution. Important issues that remain to be clarified include the influence of smoking on clinical outcomes, the effectiveness of adjunctive diode laser on microbiological outcomes, and the occurrence of adverse events. Future long-term well-designed parallel randomized clinical trials are required to assess the effectiveness of the adjunctive use of diode laser, as well as the appropriate dosimetry and laser settings.

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
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Darveau RP, Tanner A, Page RC (1997) The microbial challenge in periodontitis. Periodontol 2000 14:12–32

    Article  PubMed  CAS  Google Scholar 

  2. Teles RP, Haffajee AD, Socransky SS (2006) Microbiological goals of periodontal therapy. Periodontol 2000 42:180–218

    Article  PubMed  Google Scholar 

  3. Takasaki AA, Aoki A, Mizutani K, Schwarz F, Sculean A, Wang CY, Koshy G, Romanos G, Ishikawa I, Izumi Y (2009) Application of antimicrobial photodynamic therapy in periodontal and peri-implant diseases. Periodontol 2000 51:109–140

    Article  PubMed  Google Scholar 

  4. Aoki A, Sasaki KM, Watanabe H, Ishikawa I (2004) Lasers in nonsurgical periodontal therapy. Periodontol 2000 36:59–97

    Article  PubMed  Google Scholar 

  5. Adriaens PA, Adriaens LM (2004) Effects of nonsurgical periodontal therapy on hard and soft tissues. Periodontol 2000 36:121–145

    Article  PubMed  Google Scholar 

  6. Adriaens PA, Edwards CA, DeBoever JA, Loesche WJ (1988) Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth. J Periodontol 59:493–503

    Article  PubMed  CAS  Google Scholar 

  7. Matia JI, Bissada NF, Maybury JE, Ricchetti P (1986) Efficiency of scaling of the molar furcation area with and without surgical access. Int J Periodontics Restorative Dent 6:24–35

    PubMed  CAS  Google Scholar 

  8. Sherman PR, Hutchens LH, Jewson LG, Moriarty JM, Greco GW, McFall WT (1990) The effectiveness of subgingival scaling and root planing. I. Clinical detection of residual calculus. J Periodontol 61:3–8

    Article  PubMed  CAS  Google Scholar 

  9. Cobb CM (1996) Non-surgical pocket therapy. Ann Periodontol 1:443–490

    Article  PubMed  CAS  Google Scholar 

  10. Renvert S, Wilkstrom M, Dahlen G, Slots J, Egelberg J (1990) Effect of root debridement on the elimination of Actinobacillus actinomycetemcomitans and Bacteroides gingivalis from periodontal pockets. J Clin Periodontol 17:345–350

    Article  PubMed  CAS  Google Scholar 

  11. Sbordone L, Ramaglia L, Gulleta E, Iacono Y (1990) Recolonization of the subgingival microflora after scaling and root planning in human periodontitis. J Periodontol 61:579–584

    Article  PubMed  CAS  Google Scholar 

  12. Silveira PC, Streck EL, Pinho RA (2007) Evaluation of mitochondrial respiratory chain activity in wound healing by low-level laser therapy. J Photochem Photobiol B 86:279–282

    Article  PubMed  CAS  Google Scholar 

  13. Hawkins D, Abrahamse H (2006) Effect of multiple exposures of low-level laser therapy on the cellular responses of wounded human skin fibroblasts. Photomed Laser Surg 24:705–714

    Article  PubMed  CAS  Google Scholar 

  14. Harris DM, Yessik M (2004) Therapeutic ratio quantifies laser antisepsis: ablation of Porphyromonas gingivalis with dental lasers. Laser Surg Med 35:206–213

    Article  Google Scholar 

  15. Caruso U, Nastri L, Piccolomini R, d’Ercole S, Mazza C, Guida L (2008) Use of diode laser 980 nm as adjunctive therapy in the treatment of chronic periodontitis. A randomized controlled clinical trial. New Microbiol 31:513–518

    PubMed  Google Scholar 

  16. de Paula EC, de Freitas PM, Esteves-Oliveira M, Aranha AC, Ramalho KM, Simões A, Bello-Silva MS, Tunér J (2010) Laser phototherapy in the treatment of periodontal disease. A review. Lasers Med Sci 25:781–792

    Article  Google Scholar 

  17. Schwarz F, Aoki A, Becker J, Sculean A (2008) Laser application in non-surgical periodontal therapy: a systematic review. J Clin Periodontol 35(8 Suppl):29–44

    Article  PubMed  Google Scholar 

  18. American Academy of Periodontology (2011) American academy of periodontology statement on the efficacy of lasers in the non-surgical treatment of inflammatory periodontal disease. J Periodontol 82:513–514

    Article  Google Scholar 

  19. Higgins JPT, Green S, (eds) (2009) Cochrane handbook for systematic reviews of interventions, version 5.1. The Cochrane Collaboration. Available at: http://www.cochrane-handbook.org. Accessed 1 March 2012

  20. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269

    Article  PubMed  Google Scholar 

  21. Landis JR, Koch GG (1997) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363–374

    Article  Google Scholar 

  22. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  PubMed  CAS  Google Scholar 

  23. 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 134:657–662

    Article  PubMed  CAS  Google Scholar 

  24. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  PubMed  CAS  Google Scholar 

  25. Sterne JA, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54:1046–1055

    Article  PubMed  CAS  Google Scholar 

  26. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  PubMed  CAS  Google Scholar 

  27. Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455–463

    Article  PubMed  CAS  Google Scholar 

  28. Euzebio Alves VT, de Andrade AK, Toaliar JM, Conde MC, Zezell DM, Cai S, Pannuti CM, De Micheli G (2012) Clinical and microbiological evaluation of high intensity diode laser adjutant to non-surgical periodontal treatment: a 6-month clinical trial. Clin Oral Invest (in press)

  29. Giannelli M, D B, 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 

  30. Obradović R, Kesić L, Mihailović D, Antić S, Jovanović G, Petrović A, Peševska S (2012) A histological evaluation of a low-level laser therapy as an adjunct to periodontal therapy in patients with diabetes mellitus. Lasers Med Sci (in press)

  31. Makhlouf M, Dahaba MM, Tunér J, Eissa SA, Harhash TA (2012) Effect of adjunctive low level laser therapy (LLLT) on nonsurgical treatment of chronic periodontitis. Photomed Laser Surg 30:160–166

    Article  PubMed  CAS  Google Scholar 

  32. Giannopoulou C, Cappuyns I, Cancela J, Cionca N, Mombelli A (2012) Effect of photodynamic therapy, diode laser and deep scaling on cytokine and acute-phase protein levels in gingival crevicular fluid of residual periodontal pockets. J Periodontol (in press)

  33. Cappuyns I, Cionca N, Wick P, Giannopoulou C, Mombelli A (2012) Treatment of residual pockets with photodynamic therapy, diode laser, or deep scaling. A randomized, split-mouth controlled clinical trial. Lasers Med Sci (in press)

  34. Aykol G, Baser U, Maden I, Kazak Z, Onan U, Tanrikulu-Kucuk S, Ademoglu E, Issever H, Yalcin F (2011) The effect of low-level laser therapy as an adjunct to non-surgical periodontal treatment. J Periodontol 82:481–488

    Article  PubMed  Google Scholar 

  35. 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

    Article  PubMed  CAS  Google Scholar 

  36. Mayahara K, Yamaguchi A, Sakaguchi M, Igarashi Y, Shimizu N (2010) Effect of Ga-Al-As laser irradiation on COX-2 and cPLA2-alpha expression in compressed human periodontal ligament cells. Lasers Surg Med 42:489–493

    Article  PubMed  Google Scholar 

  37. de Micheli G, de Andrade AK, Alves VT, Seto M, Pannuti CM, Cai S (2011) Efficacy of high intensity diode laser as an adjunct to non-surgical periodontal treatment: a randomized controlled trial. Lasers Med Sci 26:43–48

    Article  PubMed  Google Scholar 

  38. Cobb CM, Low SB, Coluzzi DJ (2010) Lasers and the treatment of chronic periodontitis. Dent Clin North Am 54:35–53

    Article  PubMed  Google Scholar 

  39. Pejcic A, Kojovic D, Kesic L, Obradovic R (2010) The effects of low level laser irradiation on gingival inflammation. Photomed Laser Surg 28:69–74

    Article  PubMed  Google Scholar 

  40. Angelov N, Pesevska S, Nakova M, Gjorgoski I, Ivanovski K, Angelova D, Hoffmann O, Andreana S (2009) Periodontal treatment with a low-level diode laser: clinical findings. Gen Dent 57:510–513

    PubMed  Google Scholar 

  41. Lin J, Bi L, Wang L, Song Y, Ma W, Jensen S, Cao D (2011) Gingival curettage study comparing a laser treatment to hand instruments. Lasers Med Sci 26:7–11

    Article  PubMed  CAS  Google Scholar 

  42. Karlsson MR, Diogo Löfgren CI, Jansson HM (2008) The effect of laser therapy as an adjunct to non-surgical periodontal treatment in subjects with chronic periodontitis: a systematic review. J Periodontol 79:2021–2028

    Article  PubMed  Google Scholar 

  43. Lai SM, Zee KY, Lai MK, Corbet EF (2009) Clinical and radiographic investigation of the adjunctive effects of a low-power He–Ne laser in the treatment of moderate to advanced periodontal disease: a pilot study. Photomed Laser Surg 27:287–293

    Article  PubMed  CAS  Google Scholar 

  44. Ribeiro IW, Sbrana MC, Esper LA, Almeida AL (2008) Evaluation of the effect of the GaAlAs laser on subgingival scaling and root planing. Photomed Laser Surg 26:387–391

    Article  PubMed  Google Scholar 

  45. Assaf M, Yilmaz S, Kuru B, Ipci SD, Noyun U, Kadir T (2007) Effect of the diode laser on bacteremia associated with dental ultrasonic scaling: a clinical and microbiological study. Photomed Laser Surg 25:250–256

    Article  PubMed  Google Scholar 

  46. Nonhoff J, Derdilopoulou F, Neumann K, Kielbassa AM (2006) A quadrant-design trial of four therapeutic modalities in chronic moderate periodontitis. Schweiz Monatsschr Zahnmed 116:484–492

    PubMed  Google Scholar 

  47. Castro GL, Gallas M, Núñez IR, Borrajo JL, Varela LG (2006) Histological evaluation of the use of diode laser as an adjunct to traditional periodontal treatment. Photomed Laser Surg 24:64–68

    Article  PubMed  Google Scholar 

  48. Kreisler M, Al Haj H, D’Hoedt B (2005) Clinical efficacy of semiconductor laser application as an adjunct to conventional scaling and root planning. Lasers Surg Med 37:350–355

    Article  PubMed  Google Scholar 

  49. Chanthaboury R, Irinakis T (2005) The use of lasers for periodontal debridement: marketing tool or proven therapy? J Can Dent Assoc 71:653–658

    PubMed  Google Scholar 

  50. Kiernicka M, Owczarek B, Gałkowska E, Wysokińska-Miszczuk J (2004) Comparison of the effectiveness of the conservative treatment of the periodontal pockets with or without the use of laser biostimulation. Ann Univ Mariae Curie Sklodowska Med 59:488–494

    PubMed  Google Scholar 

  51. Qadri T, Miranda L, Tunér J, Gustafsson A (2005) The short-term effects of low-level lasers as adjunct therapy in the treatment of periodontal inflammation. J Clin Periodontol 32:714–719

    Article  PubMed  CAS  Google Scholar 

  52. Borrajo JL, Varela LG, Castro GL, Rodríguez-Nuñez I, Torreira MG (2004) Diode laser (980 nm) as adjunct to scaling and root planning. Photomed Laser Surg 22:509–512

    Article  PubMed  Google Scholar 

  53. Rafetto N (2004) Lasers for initial periodontal therapy. Dent Clin North Am 48:923–936

    Article  Google Scholar 

  54. 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 planning on periodontally diseased root surfaces: a comparative histologic study. Lasers Surg Med 32:359–366

    Article  PubMed  Google Scholar 

  55. Sjöström L, Friskopp J (2002) Laser treatment as an adjunct to debridement of periodontal pockets. Swed Dent J 26:51–57

    PubMed  Google Scholar 

  56. Yilmaz S, Kuru B, Kuru L, Noyan U, Argun D, Kadir T (2002) Effect of gallium arsenide diode laser on human periodontal disease: a microbiological and clinical study. Lasers Surg Med 30:60–66

    Article  PubMed  Google Scholar 

  57. Moritz A, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J, Sperr W (1998) Treatment of periodontal pockets with a diode laser. Lasers Surg Med 22:302–311

    Article  PubMed  CAS  Google Scholar 

  58. Walsh LJ (1997) The current status of low level laser therapy in dentistry. Part 2. Hard tissue applications. Aust Dent J 42:302–306

    Article  PubMed  CAS  Google Scholar 

  59. Rossmann JA, Cobb CM (1995) Lasers in periodontal therapy. Periodontol 2000 9:150–164

    Article  PubMed  CAS  Google Scholar 

  60. Rydén H, Persson L, Preber H, Bergström J (1994) Effect of low level energy laser irradiation on gingival inflammation. Swed Dent J 18:35–41

    PubMed  Google Scholar 

  61. Silness J, Löe H (1964) Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:112–135

    Article  Google Scholar 

  62. Loe H, Silness J (1963) Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 21:533–551

    PubMed  Google Scholar 

  63. Tunér J, Hode L (1998) It’s all in the parameters: a critical analysis of some well-known negative studies on low-level laser therapy. J Clin Laser Med Surg 16:245–248

    PubMed  Google Scholar 

  64. McGuire MK, Nunn ME (1996) Prognosis versus actual outcome. III. The effectiveness of clinical parameters in accurately predicting tooth survival. J Periodontol 67:666–674

    Article  PubMed  CAS  Google Scholar 

  65. Grossi SG, Zambon J, Machtei EE, Schifferle R, Andreana S, Genco RJ, Cummins D, Harrap G (1997) Effects of smoking and smoking cessation on healing after mechanical periodontal therapy. J Am Dent Assoc 128:599–607

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  67. Hujoel PP, De Rouen TA (1992) Validity issues in split-mouth trials. J Clin Periodontol 19:625–627

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Health Sciences, University of L’Aquila, San Salvatore 1, Building Delta 6, 67100, L’Aquila, Italy

    Fabrizio Sgolastra, Marco Severino, Roberto Gatto & Annalisa Monaco

Authors
  1. Fabrizio Sgolastra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Severino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto Gatto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Annalisa Monaco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabrizio Sgolastra.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sgolastra, F., Severino, M., Gatto, R. et al. Effectiveness of diode laser as adjunctive therapy to scaling root planning in the treatment of chronic periodontitis: a meta-analysis. Lasers Med Sci 28, 1393–1402 (2013). https://doi.org/10.1007/s10103-012-1181-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10103-012-1181-5

Keywords

Search

Navigation