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Periodontics

Does deep periodontal pocket disinfection with a soft tissue diode laser work?

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The following question was submitted by a practising dentist: What clinical evidence is available for the efficacy of deep periodontal pocket disinfection with a soft tissue diode laser? What protocols are proven and recommended in terms of frequency of treatment?

JCDA Editorial Consultant Dr. Debora Matthews of Dalhousie University provided this initial response for consideration: 

There are two issues related to this question. The first is, does a soft tissue diode laser disinfect periodontal pockets (pocket disinfection therapy, or PDT)? The more important question, however, is whether diode lasers provide any additional clinical benefit over traditional scaling and root planing (Because this is really the goal –we don’t just want to get rid of the pathogenic bacteria, but we want the pockets to shrink and attachment levels to increase).

There is good evidence that diode lasers, with or without photoactivation, will reduce bacterial levels. However, the evidence is limited as to whether this actually results in more clinically significant changes in periodontal health than standard non-surgical debridement.

There are few studies published on humans and most are of short-term duration (3 months or less). They all show that the results are either similar in terms of improving attachment levels or pocket depths, or if there is an advantage for lasers, the amount is clinically meaningless (i.e. less than 1 mm). The American Academy of Periodontology published a position statement on the efficacy of lasers in the non-surgical treatment of inflammatory periodontal disease in 2011.

Follow-up: Readers are invited to comment on this initial response and provide further insights by posting in the comment box which you will find by clicking on “Leave a reply” below. Comments come directly to me for approval prior to posting.  You are welcome to remain anonymous. We will never post your email address in any response. John

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3 Comments

  1. Elaine Orpe October 4, 2012

    I have a follow-up question. Is there less bacteremia with laser diode versus conventional SRP? I believe that there is at least one study that found this to be so. If so, could laser disinfection be considered for patients for whom bacteremia is a risk? Could it relieve the need for antibiotic prophylaxis for such patients?

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  2. Debora October 10, 2012

    Good question! While this does make some sense, I could not find any clinical trials that measured levels of bacteremia – only local levels of bacteria. Even so, the evidence is not consistent. There are a couple of studies that show a greater reduction in the levels of bacteria in periodontal pockets with photodynamic therapy (PDT), but most show no difference between PDT and scaling and root planing. And although there are risks with prescribing antibiotics, lasers are not without risks either.

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  3. Elaine October 10, 2012

    These are the papers I found – certainly not enough for a consensus. The first study is more applicable but I believe that the second study just used a buccal incision on the hamster animal model.

    Effect of the diode laser on bacteremia associated with dental ultrasonic scaling: a clinical and microbiological study.
    Assaf M, Yilmaz S, Kuru B, Ipci SD, Noyun U, Kadir T.

    Bacteremia following laser and conventional surgery in hamsters.
    Kaminer R, Liebow C, Margarone JE 3rd, Zambon JJ.
    SourceSchool of Dental Medicine, State University of New York, Buffalo 14214.

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