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Making Use of Lasers in Periodontal Treatment: A

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Article in Photomedicine and Laser Surgery · June 2017

DOI: 10.1089/pho.2017.4323

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 Photomedicine and Laser Surgery
Volume XX, Number XX, 2017
ª Mary Ann Liebert, Inc.
Pp. 1–2
DOI: 10.1089/pho.2017.4323
Making Use of Lasers in Periodontal Treatment:
A New Gold Standard?
Kinga Grzech-Leśniak, PhD, DDS
Downloaded from online.liebertpub.com by Dr Aldo Brugnera Junior on 09/27/17. For personal use only.
W hat is the role of laser in the periodontal field?
Should it become a necessary element in the treatment
protocol in periodontal patients? Looking at periodontitis, the
most common chronic inflammatory disease seen in humans,
I propose laser be considered a new gold standard in peri-
odontal treatment. Severe periodontitis is one of the world’s
most prevalent conditions, and if untreated, it affects not only
general health but also lowers the quality of life and may lead
to social exclusion—people with chronic periodontitis often
have worse chances on a job market and commonly experi-
ence social or professional discrimination. It cannot be em-
Photomedicine and Laser Surgery
phasized enough that dentists need to recognize the severity
of the periodontal disease and adopt a holistic approach that
puts patients and their good at the center.
In the past several decades, there has been extensive de-
velopment of periodontal treatment. However, although
considerable progress has been made in this area, we are still
looking for therapy modalities that are safe, efficient, patient
centered, and, last but not least, cost-effective. For more
than 50 years, the dental community has looked at lasers and
their expediency for the treatment of various dental condi-
tions. The application of lasers has been recognized as an
adjunctive or alternative approach in periodontal and peri-
implant therapy. I am convinced that the time has come to
make laser therapy a new gold standard—a necessary step in
protocol of periodontal pocket treatment. The unique char-
acteristics of laser technology, such as ablation, hemostasis,
bactericidal and detoxification effect, as well as promotion
of tissue regeneration and wound healing make it possible to
treat soft and hard tissues in a manner that is beyond the
scope of conventional techniques.1
The established traditional gold standard in periodontal
treatment is ultrasound and hand instrumentation. However,
evidence has demonstrated that mechanical debridement alone,
such as scaling and root planing (SRP), may not be sufficient to
eradicate the periodontal pathogens; therefore, adjunctive use
of systemic antibiotics is recommended for the treatment of
aggressive or severe chronic periodontitis. Clinical improve-
ments, particularly the reduction of deep pockets, from the
adjunctive antibiotic therapy are meaningful in that it can re-
duce the need of surgical therapy after SRP. However, sub-
gingival bacteria exist in biofilm, not as single cells, and as such
are more difficult to eliminate with antibiotics. There is general
agreement that antibiotics affect general health—they disrupt
the healthy equilibrium in the intestinal tract, and thus can
Oral Surgery Department, Medical University, Wroclaw, Poland.
1
Guest Editorial
affect host defense mechanisms and the functioning of the
immune system. It cannot be overstated that clinicians be
cautious and selective in applying the adjunctive antibiotic
therapy because of a multiplicity of possible side effects of
systemic antibiotics, including allergic reactions, drug inter-
actions, and bacterial resistance. World Health Organization
has long been educating and warning of the growing problem of
antibiotic resistance, caused by overprescribing, patients not
finishing their treatment, overuse of antibiotics in livestock and
fish farming, poor infection control in hospitals, lack of hy-
giene, and poor sanitation. Lack of new antibiotics is especially
worrying—there has not been a new one in three decades,
whereas there are new diseases and super bugs developing
all the time.
Antibiotic resistance has become a serious public health
issue in recent years with high economic and social costs. It
prolongs the healing and thus the treatment, contributes to
higher mortality, increases the economic costs of medical care
as it requires more expensive drugs, and thus increases burden
on the health system. Dentists can contribute to solving these
problems by selective, rather than routine, use of antibiotics,
and by developing treatment protocols that are minimally
invasive, safe, and efficient, such as laser therapy. Gutknecht
et al.2 showed that laser treatment is a new effective way of
treating periodontitis without antibiotics, and emphasized that
even if it helps to avoid loading human systems with anti-
microbials only in some cases, it is already a positive step.
Research shows how periodontal health influences general
health. Periodontitis is associated with most chronic inflam-
matory diseases of ageing, including atherogenic cardiovascular
disease, stroke, type 2 diabetes, rheumatoid arthritis, chronic
kidney disease, obesity, and chronic obstructive pulmonary
disease.3 The costs of treatment of combined chronic inflam-
matory diseases, including periodontal diseases, are so high that
we need to look for efficient ways to reduce them and ensure
improvement of general health. Cost-based results suggest that
laser periodontal therapy has the potential to be an effective,
minimally invasive, and safe treatment modality. Laser tech-
nology contributes to greater patient safety without producing
irreversible changes and results in less postoperative pain and
fewer complications. In their editorial, Brugnera Junior and
Bagnato point out an important advantage of phototherapy—
a possibility of numerous applications with no side effects.4
Photodynamic therapy—light-induced inactivation of toxic
microorganisms—is a novel therapeutic approach that best
 2 GRZECH-LEŚNIAK
exemplifies how safe and efficient laser technology is in
the treatment of periodontal inflammation. Eradication
of periopathogens using photodynamic therapy is defined
as antimicrobial photodynamic therapy (aPDT), photody-
namic antimicrobial chemotherapy, or photodynamic dis-
infection. Photoinactivation of bacteria is tightly restricted to
the localization of the photosensitizer, ensuring the protection
of distant cells from side effects. Since conventional treat-
ment such as SRP does not completely eliminate periodontal
pathogens, especially in deep periodontal pockets, aPDT
makes an alternative therapeutic strategy. A systematic re-
view and meta-analysis5 reported clinically and statistically
Downloaded from online.liebertpub.com by Dr Aldo Brugnera Junior on 09/27/17. For personal use only.
significant differences between aPDT adjunctive to SRP and
conventional SRP alone in probing depth (PD) reduction.
Photoactive disinfection helps ensure a lasting success of
periodontal treatment as a supportive therapy for clinical
attachment level gain, PD reduction, and is recommended for
the maintenance treatment of residual pockets.
Systematic literature reviews describe the many positive
effects of laser therapy. There are clinical reports of suc-
cessful laser applications in periodontal and peri-implant
diseases. High-power lasers have been especially useful for
periodontal debridement, ablation, vaporization, hemosta-
sis, and disinfection effects as well as biological effects,
such as photobiomodulation. Two procedures merit spe-
Photomedicine and Laser Surgery
cial attention—laser-assisted new attachment procedure
(LANAP) and laser-assisted comprehensive periodontal
pocket therapy (Er-LCTP). Both constitute minimally in-
vasive and effective approaches. Studies show that laser
periodontal debridement is a novel prophylactic treatment to
prevent or minimize transient bacteria with no or minimal root
surface damage. LANAP, a minimally invasive technique
of pocket therapy using Nd:YAG laser, helps achieve new
connective tissue attachment and promotes regeneration of
root surface. Er-LCTP, which uses erbium laser, has been
reported effective in subgingival calculus removal in non-
surgical pocket therapy. Erbium lasers are capable of
ablating subgingival calculus effectively without causing
thermal damage on the root surface, any significant side
effects, and complications. The Er:YAG laser is used both
as an alternative and an adjunct to mechanical therapy for
pocket treatment in clinical practice. In the application of an
Er:YAG laser for surgical debridement, the Er:YAG laser
not only facilitates the debridement procedure in flap sur-
View publication stats
gery but also might be advantageous for tissue repair and
regeneration. Looking at the reported positive effects of
both therapies, it seems a natural step in the development of
minimally invasive, efficient, and safe treatment to combine
both high-power lasers in a single protocol.
Several decades after the introduction of lasers into treat-
ment protocols, we have at our disposal enough evidence that
laser technology constitutes a beneficial adjunct or alterna-
tive therapy. Considering all the established positive effects of
using lasers in periodontal and peri-implant treatment, as
well as promising preliminary results of currently conducted
studies, I would suggest the dental community stick to the old
postulate—‘‘primum non nocere’’ and look at ways to apply
treatment procedures that benefit the patient, ensure best results
and efficacy. Laser technology offers such a possibility and
thus should become a new gold standard in the treatment of
periodontal and peri-implant diseases.
References
1. Mizutani K, Aoki A, Coluzzi D, et al. Lasers in minimally
invasive periodontal and peri-implant therapy. Periodontol
2000 2016;71:185–212.
2. Gutknecht N, Van Betteray C, Ozturan S, Vanweersch L,
Franzen R. Laser supported reduction of specific microor-
ganisms in the periodontal pocket with the aid of an Er,Cr:
YSGG laser: A pilot study. Scientific World Journal 2015;
2015:450258.
3. Slowik J, Wnuk MA, Grzech K, et al. Periodontitis affects
neurological deficit in acute stroke. J Neurol Sci 2010;297:
82–84.
4. Brugnera Junior A, Bagnato VS. Biophotonics and the life
sciences. Photomed Laser Surg 2015;33:531–532.
5. Sgolastra F, Petrucci A, Severino M, Graziani F, Gatto R,
Monaco A. Adjunctive photodynamic therapy to non-surgical
treatment of chronic periodontitis: a systematic review and
meta-analysis. J Clin Periodontol 2013;40:514–526.
Address correspondence to:
Kinga Grzech-Lesniak
Oral Surgery Department
Medical University
Wroclaw
Poland
E-mail: kgl@periocare.pl