DIODE LASER AS AN ADJUNCT TO SCALING AND ROOT PLANING IN THE MANAGEMENT OF CHRONIC
PERIODONTITIS -A SPLIT MOUTH STUDY.
A Dissertation submitted to
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY CHENNAI - 600032
In partial fulfilment for the degree of MASTER OF DENTAL SURGERY
BRANCH – II
DEPARTMENT OF PERIODONTOLOGY AND IMPLANTOLOGY
2017 – 2020
CERTIFICATE
This is to certify that the Dissertation entitled “TO EVALUATE THE EFFICACY OF SOFT TISSUE DIODE LASER AS AN ADJUNCT TO SCALING AND ROOT PLANING IN THE MANAGEMENT OF CHRONIC PERIODONTITIS – A SPLIT MOUTH STUDY " is a bonafide work done by Dr. B.RADHIKA, Post Graduate student (2017 -2020) in the Department of PERIODONTOLOGY and IMPLANTOLOGY, Madha Dental College
& Hospital -Chennai-69 under the direct guidance and supervision in partial fulfilment of regulation laid down by The Tamil Nadu Dr.M.G.R Medical University, Guindy, Chennai -32 for Masters of Dental Sur gery, Periodontology and Implantology (Branch II) Degree Examination.
Guided By
Dr.J.SELVAKUMAR MDS., Professor and Head
Department of Periodontology & Implantology Madha Dental College & Hospital,
Chennai - 600 069
ENDORSEMENT BY HEAD OF THE DEPARTMENT /HEAD OF THE INSTITUTION
This is to certify that the Dissertation entitled “TO EVALUATE THE EFFICACY OF SOFT TISSUE DIODE LASER AS AN ADJUNCT TO SCALING AND ROOT PLANING IN THE MANAGEMENT OF CHRONIC PERIODONTITIS – A SPLIT MOUTH STUDY” is a bonafide work done by Dr. B.RADHIKA, Post Graduate student (2017 -2020) in the Department of Periodontology &
Implantology, under the guidance of Dr.J.SELVAKUMAR MDS., Professor and HOD, Department of Periodontology & Implantology, Madha Dental College and Hospital, Chennai – 600 069.
Dr.J.SELVAKUMAR MDS., Professor and Head,
Department of Periodontology
& Implantology
Madha Dental College & Hospital, Kundrathur, Chennai -600069.
Dr.M.C.SAINATH M D S , M B A , P G D C R . ,
Principal
Madha Dental College & Hospital, Kundrathur, Chennai -600069.
DECLARATION OF THE CANDIDATE
I, Dr.B.RADHIKA hereby declare that this dissertation titled “TO EVALUATE THE EFFICACY OF SOFT TISSUE DIODE LASER AS AN ADJUNCT TO SCALING AND ROOT PLANING IN THE MANAGEMENT OF CHRONIC PERIODONTITIS – A SPLIT MOUTH STUDY” is a bonafide and genuine research work carried out by me under the guidance of Dr.J.SELVAKUMAR MDS., Professor and HOD, Department of Periodontology & Implantology, Madha Dental College and Hospital, Chennai -600069.
Dr.B.RADHIKA Post Graduate Student,
Department of Periodontology & Implantology, Madha Dental College and Hospital,
Kundrathur, Chennai.
This agreement herein after the “Agreement” is entered into on this da y --- bet ween the Madha Dent al C oll ege and Hos pital repres ent ed b y it s Prin cipal having address at M adha Dent al Coll ege and Hospital , C hennai – 600 069, (Herei n aft er referred t o as, „t he college‟)
And Dr.J .SELVAKUMAR, M.D.S., aged 47 years working as Professor and HOD in Depart ment of Periodontol ogy and Im pl ant ology at the Madha Dental C oll ege and Hospit al, Chennai – 600 069 having residence addre ss at 52, Annamal ai nagar, Ist street, metupal ai yam ,Chennai -33, Tamil Nadu ( Herein after referred to as t he
„Prinicipal Author‟),
And Dr. B.RADHI KA , aged 27 years currentl y st ud yi ng as Pos t Graduate stud ent i n Departm ent of Periodontology and Implant ology, Madha Dent al Col lege and Hospit al, C hennai – 600 069 (Herei n aft er referred to as the „PG/Research student and Co -Author‟).
Whereas the PG/ R esearch st udent as part of his curri culum undert akes to res earch on “TO EVALUATE THE EFFICACY OF SOF T TISSUE DIODE LASE R AS AN ADJUNCT TO SCALI NG AND ROOT PL ANING I N THE TREAT ME NT O F CHRO NI C PERIO DONTITIS - A S PLIT MOUTH STUDY ” for whi ch purpose the P G/ Principal Author shall act as princi pal author at the college shall provide t he requis ite i nfrast ruct u re bas ed on avail abilit y and als o provi de facilit y to the P G/ R es earch student as to the extent possible as a Co -Author.
Whereas t he parti es , b y t his agreem ent have m utuall y agreed t o the various i ssues including i n parti cul ar t he cop yri ght and confidenti alit y issues t hat ari se in t his regard.
Now thi s agreem ent witness ed as foll ows:
1. The parties agree t hat all the R es earch materi al and ownership therein shall becom e the vested ri ght of t he coll ege, i ncluding in parti cul ar all the cop yri ght i n the lit erat ure incl uding the stud y, research and all other rel at ed papers.
2. To the extent t hat t he coll ege has the l egal ri ght to do go, shal l grant to li cence or as si gn the cop yri ght do vest ed wit h it for m edi cal and/or comm ercial usage of i nt erest ed persons/ entiti es subj ect to a reas onabl e t erms/ conditi ons including ro yalt y as deem ed b y the coll ege.
3. The ro yalt y so recei ved b y t he coll ege shall be shared equall y b y all the three parti es .
4. The PG/ Res earch st udent and PG/Pri nci pal Author s hall under no circumst ances deal with the cop yri ght , Confi denti al i nformation and know – how – generat ed duri ng t he course of research/st ud y in an y manner whats oever, whil e s hall sol e west with the col lege.
5. The P G student and Co -investi gator undert ake not to di vul ge (or) cause to be divul ged an y of t he Confidential i nformati on or, know – how to an yone in an y m anner whatsoever and for an y purpos e without t he express writ ten consent of the coll ege.
6. All expens es pert aining to the res earch s hall be decided upon b y t he Principal inves ti gat or/ Co -investi gator or borne sol e b y t he PG student (P rincipal -invest i gator)
7. The coll ege shall provi de all i nfrast ructure and access faciliti es withi n and i n other institutes t o t he extent possible. This includes pati ent int eractions, introductor y let ters, recomm endation lett ers and such ot her acts requires in t his regard.
8. The Co -Investi gator shall suit abl y guide t he Student Ri ght from sel ection of the R es earch Topi c and Area till it s com pleti on.
However the sel ecti on and conduct of res earch, topic and area of research b y the student researcher under gui dance from t he C o - Invest i gator shall be subj ect to the pri or approval, recom mendati ons
for the purpose.
9. It is agreed t hat as regards other aspects not covered under this agreem ent , but which pertain to the research undert aken b y t he P G student , under the guidance from the Co -Investi gat or, t he decisi on of t he coll ege m a y be bindi ng and final.
10.If an y dis put e aris es as to the mat ters relat ed or connect ed t o thi s agreem ent herei n, it shall be referred t o arbit ration in accordance with the provisions of the Arbit ration and Concili ation Act, 1996.
In witnes s whereof t he parti es hereinabove m entioned have on this da y month and year herei n above m enti oned s et their hands to this agreem ent in the presence of the following two witness es .
College repres ent ed b y it s
Principal PG Student
St udent Gui de Witnes ses
1.
2.
I thank God Al mi ght y, whos e imm ense grace has been suffi ci ent in all as pect s in every circum st ance encount ered. He guided and hel ped me t hroughout m y life i n ever y endeavour and for that I am grat eful.
I woul d li ke to t ake im mens e pl easure to t hank al l thos e who have gui ded m e all t hroughout m y post graduat e curri culum.
At the outs et, I woul d like to thank our founder of M adha group of academi c ins titut ions Li on. Dr. S.PETER, our m anagi ng di rect or, Mr. AJ AY KUM AR, and our vi ce chai rperson M rs. MERC Y FLORENCE, M adha Dental Col lege and Hospital for providi ng m e with an opport unit y to pursue post -graduati on i n the s peci alt y of periodont ology and i mplantol ogy in t heir est eemed i nstitution.
M y sincere and heartfelt thanks to Dr. M.C.S AINATH, M DS., our Principal , Madha Dent al Coll ege and Hos pit al, Chennai -600069, for his conti nuous and enorm ous support i n allowing me to conduct t his stud y and for his constant encouragement and advi ce during m y t ough phase in curri culum.
From the core of m y heart I express m y heart felt gratit ude and indebt edness to Dr. J . SELVA KUMAR, MDS, Head of the department, Departm ent of Peri odontol ogy and Im plantol ogy, f or hi s
him for all the s upport provi ded throughout the peri od of thi s stud y and m y post-graduation cours e and to bring this diss ertat ion to a success ful compl eti on.
I would like to express m y utm ost grat itude to m y Dr. N.
GOWTHAM KUM AR MDS, P rofess or, Departm ent of Periodontology and Implantol ogy, Madha Dent al Col l ege and Hos pit al, Chennai - 600069, for helpi ng me wit h his valuable and tim el y sugge stions and encouragem ent .
I owe m y t hanks to Dr. C .S.KR IS HNAN, MDS, P rofess or, departm ent of peri odontol ogy and im plantology, M adha Dent al Coll ege and Hospital , C hennai -600069, for hel ping me with for his ti mel y suggesti ons and unt i ring support throughout t he stud y. I thank him for bei ng so hel pful t hroughout m y post -graduati on course.
I woul d like to express m y utmost gratit ude to Dr.PAR TH IB AN MDS ,R eader, Department of P eri odontol ogy and Im pl ant ology, Madha Dental Coll ege and Hospital , C hennai -600069, for helping me wit h his val uable and tim el y suggestions and encouragem ent .
Dr. GOWR I S HANKAR, MDS , Senior Lecturer, Departm ent of Peri odontol ogy and Implantol ogy, Madha Dent al Coll ege and Hospital, Chennai -600069 for the innovati ve ideas, tim el y suggestions, tremendous help and unti ring su pport t hroughout the st ud y. I thank them for being so helpful throughout m y post -graduation course.
INDHU, MDS., S enior Lect urer, Department of Periodontology and Im pl ant ology, M adha Dent al C oll ege an d Hospit al , Chennai -600069, for helping me with his valuable and tim el y suggesti ons and encouragem ent .
It gives m e imm ens e pleas ure t o convey m y grat itude to t he chai rman of t he Et hical C ommitt ee and Revi ew board – Dean Dr.
Gaj endran M BBS, M D., and Medica l Superi nt endent Dr.Thani kachal am MS,MCH( pl asti c)., Madha Medi cal C oll ege and Hos pital for gi ving m e permiss ion and hel pi ng m e with this st udy.
I am obli ged to Dr. R ahila for carryi ng out the st atist ical anal ys is for m y st udy.
I t hank all non -t eaching s taff of the departm ent for t hei r assi stance and servi ce rendered duri ng m y post -graduation cours e.
I dedi cate t his s tud y to m y Father M r. A. BAS KARAN, M other Mrs. B. TAM IL S ELV I, m y Father i n law N. S ANKAR AN and m y Mother in l aw K.S KANTHIMATH I and m y Sist er B. LAVANYA and m y Brother B. VIGNESH for their unconditional love and concern and for thei r m oral support.
I als o dedicat e this stud y to m y speci al famil y m embers V.
TH IYAGARAJAN, M. GURUNATHAN, K.S. P OORN IM A, T.S HR I AKS HAYA,G. PRANAV, T.S HR I V ISHNUR AJAN .
I al so dedicat e thi s stud y t o m y well wishers Dr. K. VIJ AY VENKATES H, Dr. P .L.R AV ISHANKAR , Dr. M. RAJ U LA KEV IN, Dr.S R AJ ARAJ ESHWAR I , Dr. S. LAKSHM I PR IYANKA and Dr.
S.ATHAVAN
I als o dedicat e this stud y to m y Husband K.S S IDDHARTHAN for hi s unconditional affection, concern and for hi s moral support .
I take this opport unit y to express m y gratitude to m y fri ends, coll eagues , juniors for thei r valuable hel p and suggesti ons t hroughout this diss ertat ion.
I s eek the bl es sing of the al mi ght y God without whose benevol ence of t he dissert ation woul d not have been poss ibl e.
Place: Chennai Nam e: Dr. B. R adhika
Dat e: Signature:
A S A N A D J U N C T T O S C A L I N G A N D R O O T P L A N I N G I N T H E M A N A G E M E N T O F C H R O N I C P E R I O D O N T I T I S - A S P L I T M O U T H S T U D Y
ABSTRACT
BACKGRO UND: Chroni c periodontit is is an infectious dis eas e resulti ng in inflam m ation of the supporti ve ti ssues of t he t eet h with the progres sive att achment l oss and bone loss. Thus , an ess enti al com ponent of therap y i s t o eli minat e t he etiologi cal pat hogens. This has been tradi tionall y accompl ished t hrough m echani cal m eans (SRP ) scaling and root planing in non -s urgi cal t reatm ent m odalit y for chronic periodonti tis.
AI M: To evaluat e t he effi cac y of soft ti ssue diode laser as an adjunct to s caling and root planing foll owi ng non-surgi cal t reatment modal it y in the cli nical param et ers of adult pati ent s wit h chronic peri odontitis .
MATE RI ALS AND METHO DOL GY: A tot al 30 s ys temi call y health y subj ects di agnos ed with chroni c periodontitis were randoml y ass i gned in two groups ;
GROUP I (SRP): SR P alone done
GROUP II (SRP L): Las ers was us ed as an adjunct to s caling and root planing.
Bas eline dat a, incl uding pl aque index (P I), gingival i ndex (G I), probing pocket depth (PPD) and rel ati ve clini cal att achm ent l evel (rC AL) were recorde d before t he treatm ent and 1s t,3r d and 6t h months aft er t he treatm ent .
index (P I), gi ngival index (GI). The laser group showed onl y si gni fi cant probing pocket depth and cli nical att achm ent gai n aft er t he treatm ent.
CONCLUS ION:
The results of this stud y show si gni fi cant di fference in PPD bet ween GROUP I (SRP) and GR OUP II (SRP L) at 6months interval from bas eline.
The res ults of this stud y show si gnifi cant difference in CAL bet ween GROUP I (SRP) and GR OUP II (SRP L) at 6months interval from bas eline.
There was si gni f i cant di fference i n P I and GI i n bot h t he groups from bas eli ne to 6 m onths follow up.
However, there was no si gni fi cant di fference in P I and G I bet ween both groups I and II at 6 mont hs interval.
KE YWO RDS : chronic periodontiti s, scaling and root planing, s oft tissue diode l as er.
TABLE OF CONTENT
S.No TITLE Page No
1. INTRODUCTI ON 1
2. AI M AND OBJE CT IVES 4
3. REVIE W O F LITE RAT URE 5
4. MATE RI ALS AND METHO D S 34
5. STATISTI CAL ANALYSIS 43
6.
PRO FORMA AND CASE PHOTO GRAPHS.
44
7. RESULTS 51
8. DISCUSSIO N 66
9. CONCLUS ION 71
10. BIBLIO GRAPHY 73
11. ANNEXURES 83
LIST OF ABBREVIATIONS
SRP SCALING AND R OOT P LANING
LASER LIGHT AMP LIF IC ATION BY S TIM U LATED EMISS ION OF R ADIAT ION
P I P LAQUE INDEX
GI GING IVAL INDEX
BOP BLEED ING ON PR OB ING
CAL C LIN IC AL ATTACHMENT LEVEL
PPD PROBING POC KET DEPTH
SD STANDARD DEV IATION
1
INTRODUCTION
Periodontitis, a biofilm induced chronic inflamma tory disease leads to the destruction of the periodontium.1 The tissue damage is mediated by destructive host immune responses orchestrated by a group of periodontal pathogens in subgingival plaque.
Chronic periodontitis is “an infectious disease resulting in inflammation within the supporting tissues of the teet h, progressive attachment loss, and bone loss.”2
Chronic periodontitis is the prevalent form of periodontitis, and it is slowly progressing inflammatory disease. However, systemic and environmental factors (e.g., diabetes mellitus, smoking) may modify th e host immune response to biofilm so that periodontal destruction tends to be more progressive in nature.
Although chronic periodontitis is frequently observed in adults, it can occur in adolescents in response to chronic local factors accumulation.
In addition to the local immune response caused by the dental biofilm, periodontitis may also be associated with several systemic disorders and defined syndromes. In most cases, patients with systemic diseases that lead to impaired host immunity may also show p eriodontal destruction.
2 Nonsurgical periodontal therapy has been proven to be an effective treatment for patients with chronic periodontitis and remains the “gold standard” modality for periodontal treatment.3 Scaling is the process by which plaque and calculus are removed from the supragingival and subgingival tooth surfaces. Root planing is the process by which residual embedded calculus and portions of cementum are removed from the roots to produce smooth, h ard, clean surface.4 The primary objective of scaling and root planing is to restore gingival health by completely removing elements that provoke gingival inflammation from the tooth surface. The conventional nonsurgical therapy is done by debridement of t he root surfaces on a quadrant basis with 1 -2-weeks intervals. This time interval may result in recolonization by the bacteria of the instrumented pockets and impair healing; the main etiology is being intraoral translocation of bacteria (i.e. one niche to another).5 This lead to the concept of application of laser to prevent reinfection of the previously treated sites by from untreated pockets or any other intraoral reservoir.
Light Amplification by Stimulated Emission of Radiation (LASER) is a coherent, collimated, unidirectional and monochromatic light which has been classified, according to their wavelength. Nowadays, lasers are widely used in periodontics which has a wavelength of 810 -980 nm and it is used in both non-surgical and minor surgical peri odontal treatments like frenectomy,
3 gingivectomy, gingivoplasty, de -epithelization of reflected flaps, gingival depigmentation and nonsurgical periodontal treatments like pre-procedural disinfection, scaling and root planing, subgingival curettage, sulcula r debridement, and decontamination.6 The biofil m within the necrotic tissue of the pocket wall is eliminated by laser decontamination. Laser decontamination uses very low power settings and it does not cut the tissues rather decontaminates it.
A relativel y new treatment modality, application of laser, has a significant impact on periodontal practice. Therefore, this study is designed to evaluate the clinical outcomes by evaluating the efficacy of soft tissue diode laser as an adjunct to scaling and root planing in chronic periodontitis patients.
4
AIM AND OBJECTIVES
AIM
This study aims to evaluate the efficacy of soft tissue diode laser as an adjunct to scaling and root planing in the management of chronic periodontitis.
OBJECTIVE
The objective of the study is:
To determine the efficacy of scaling and root planing (SRP) in the management of chronic periodontitis.
To determine the efficacy of soft tissue diode laser as an adjunct to scaling and root planing (SRP) in the management of chronic periodontitis.
To check and compare the possible improvement of the periodontal indices in two groups of patients with periodontal disease: the first group undergone with the treatment of SRP alone, the second group undergone to the treatment of S RP with the addition of laser therapy.
To check and compare the pocket depth (PD) and clinical attachment level (CAL) in two groups of patients with periodontal disease: the first group undergone with the treatment of SRP alone, the second group undergone to the treatment of SRP with the addition of laser therapy.
5
REVIEW OF LITERATURE
Periodontal disease, the condition results from inflammation of the supporting structures of teeth in response to chronic infections caused by various periodontopathic bacteria. In late 1800, periodontitis or alveolar pyorrhoea was known as Rigg’s disease, which was named after an American dentist, John M.
Rigg’s.7
Flemming TF (1999) defined periodontitis “as an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss and bone loss”.2
Chronic periodontitis is considered a site -specific disease which is characterized by local inflammation, pocket formation, attachment loss, and bone loss are the consequences of direct exposure to the subgingival plaque (biofilm). As the result of this local effect, pocket formation and attachment loss, as well as bone loss, may occur on one surface of a tooth, whereas other surfaces maintain normal attachment level. As a resul t of the site -specific nature, the number of teeth involved with clinical attachment loss is classified chronic periodontitis into the following types:
Localized chronic periodontitis: less than 30% of the site show attachment and bone loss.
Generalized ch ronic periodontitis: 30% or more of the sites show attachment and bone loss.
6 During chronic periodontitis, the local inflammatory response may lead to different patterns of bone loss, including vertical (angular) and horizontal bone destruction. Although v ertical bone loss is associated with intrabony/ infrabony pocket formation, horizontal bone loss is usually associated with suprabony (supra - alveolar) pockets
The severity of periodontal destruction that occurs as a result of chronic periodontitis is generally considered as a function of time in combination with systemic disorders that impair or enhance host immune responses. With increasing age, attachment loss and bone loss become more prevalent and more severe as a result of an accumulation of destr uction. Disease severity may be described as mild, moderate and severe based on the amount of clinical attachment loss:
Mild chronic periodontitis: when no more than 1 -2 mm of clinical attachment loss has occurred.
Moderate chronic periodontitis: when 3 -4 mm of clinical attachment loss has occurred.
Severe chronic periodontitis: when 5mm or more of clinical attachment loss has occurred.8
ETIOPATHOGENESIS OF PERIODONTITIS
According to Page et al,9 periodontitis is a plaque -induced chronic inflammatory disease that leads to the destruction of the
7 periodontium. The tooth associated biofilm is required but is not sufficient to induce periodontitis, as it is the host inflammatory response to this micro bial challenge that ultimately destroy periodontium.1 0
Socransky SS et al 1 1(1998) studied and identified the periodontal pathogens (Porphyromonas gingivalis, Tanneralla forsythia, Treponema denticolla) that significantly correlated with the periodontal d isease activity.
RATIONALE OF PERIODONTAL THERAPY
According to Ramfjord S1 2 “the goal for all dental treatment, including periodontal therapy is to be achieved and maintain optimal health, function, and aesthetics of the dentition”.
The efficacy of periodontal treatment is made possible by the remarkable healing tendency of the periodontal tissues.
American Academy of Periodontology (2000)1 3 postulated the following therapeutically goals of periodontal therapy:
Eliminate - pain, exudate, gingival in flammation, and bleeding
Reduce periodontal pockets
Eliminate infection
Arrest the destruction of soft tissue and bone
8
Reduce abnormal tooth mobility
Establish optimal occlusal function
Restore tissue destroyed by disease
Re-establish physiologic gingival contour
Prevent reoccurrence of disease
Maintain natural dentition
Periodontal therapy should aim at eliminating the etiological factor, reducing the inflammation of the periodontium, arresting the progression of disease activity, improving the aesthetics and thus creating a better environment for maintaining periodontal health.
American Academy of Periodontology treatment guidelines stated that periodontal health must be achieved in a minimally invasive and cost -effective way. This is often accomplished through non -surgical periodontal therapy.
NON- SURGICAL PERIODONTAL THERAPY (SCALING AND ROOT PLANING)
The primary objective in the treatment of periodontal disease is the removal of bacterial deposits to control the disease progression.
Non-surgical tre atment of such disruptive periodontal disease depends on the abolishing of bacterial deposits to clung to the tooth
9 surface, essentially by mechanical methods; such as scaling and root planing.
Drisko CH1 4 referred non -surgical periodontal therapy as
“cause-related therapy”, “initial therapy” or “phase I therapy” and
“etiotrophic phase”.
American Academy of Periodontology4 (2001) defined scaling
“is the process by which biofilm and calculus are removed fro m both supragingival and subgingival tooth surfaces”
Root planing “is the procedure by which residual embedded calculus and portions of altered cementum are removed from the roots to produce a smooth, hard, clean surface.
Smart et al1 5, used the term per iodontal debridement to describe the instrumentation of tooth with a sonic or ultrasonic scaler. Hence, the term periodontal debridement was used to describe the gentle and thorough instrumentation to remove plaque, endotoxin, and calculus but not cementum . The primary aim of scaling and root planing is to replace gingival health by completely removing elements that provoke gingival inflammation (that is, biofilm, calculus, and endotoxin) from the tooth surface.
10 Instrumentation has been shown to reduce dr amatically the numbers of subgingival micro -organisms. This positive microbial change must be sustained by periodic scaling and root planing performed during supportive periodontal therapy. Although SRP produces huge clinical enhancement in patients with c hronic periodontitis, thorough elimination of bacterial deposits can be hard to achieve.
Indeed, mechanical therapy alone is unable to remove pathogenic bacterial niches in the soft tissue and in the regions that are difficult to reach to periodontal inst ruments (example deep pockets, furcation’s areas, root depressions). And other factors such as pathogenicity and /or resistance of the microorganisms, or even due to systemic conditions which may compromise host response to the mechanical treatment. To ove rwhelm these constrains of traditional mechanical treatment, several adjunctive treatments have been developed such as lasers, photodynamic therapy, antimicrobial therapy, ozone therapy, local drug delivery.
LASERS
Theodore H. Maiman 1 6 (1960) was the first one to invent a laser device based on Albert Einstein’s theory of spontaneous and stimulated emission of radiation”.
11 Goldman L et al1 7, (1961) was the first one to use a laser in the field of dentistry and Ruby laser was the first laser to be used in dentistry.
A laser is a monochromatic, collimated, coherent light. Lasers are classified based on the wavelength as follows:
Among these, the utilization of lasers has been proposed for its bactericidal and detoxification impacts and for its ability to reach sites that conventional mechanical instrumentation can not.
488,514nm Argon
800-830nm AI Gas
810nm Diode
980nm In gas
1064nm Nd:YAG
2780nm Er;Cr:YSGG
2940nm Er:YAG
10600nm CO2
12 Because of its attributes and other known advantages, such as low cost and practicality, that the diode laser has been contrasted with other lasers and has a better biocompatibility.
The diode laser is a soft tissue laser having a wavelength of 810 nm or 910 –980nm. The laser beam aids in soft tissue curettage, sulcular debridement, has a bactericidal effect and without affecting the dental hard tissues. During irradiation a part of the laser energy scatters and penetrates periodontal pockets, stimulating the cells of surrounding tissues. This results in a reduct ion of the inflammatory conditions, increased cell proliferation, improving the periodontal tissue attachment and marked reduction in postoperative pain.
The adjunctive use of lasers with conventional tools may facilitate therapy and have the capacity to improve healing. The diode laser is highly absorbed in haemoglobin and other pigments and is excellent for use in soft tissue surgical procedures.
The review of literature covers the following topic:
Scaling and root planing in the management of chronic periodontitis.
Laser decontamination in the management of chronic periodontitis.
13 Lindhe et al and colleagues (1982) 1 8 demonstrated that in a well - controlled oral hygiene regime, thorough scaling and root planing (SRP) was equally effective when used alone or in combination with the modified Widman procedures in the treatment of advanced periodontitis.
Badersten et al (1984)1 9 in his study to evaluate the effect of non - surgical periodontal therapy either in single or repeated instrumentation, observed a si gnificant reduction in the pocket depth with single instrumentation whereas, no further improvement with repeated instrumentation. Hence, he concluded that the effect of single scaling and root planing depends on the skill of the clinician and revaluation.
Isidor F et al (1984)2 0 in his study to determine the effect of root planing than that of surgical treatment found a significant reduction in probing depth after the one -year duration, but there was no difference after 5 years. In the case of attachment level gain, greater attachment gain by non -surgical periodontal therapy was th ere but after 5 years there was no differences. Hence, he suggested that periodontal surgeries can be prevented by repeated non -surgical periodontal therapy.
Quirynen and colleagues (1995)2 1 introduced the one stage full mouth disinfection which included full mouth scaling and root
14 planing under local anaesthesia using hand and ultrasonic instruments, completed over 2 sessions within 24 hours and adjunctive use of chlorhexidine.
Andreas Moritz et al (1998) 2 2 conducted a study to examine the long-term effect of soft tissue diode laser on periodontal pockets with regards to its bactericidal properties and improvement of periodontal disease. Fifty patients were randomly subdivided into two groups (laser group and control group) and subgingival samples were collected and evaluated for six appointments for six months.
There were a significant bacterial reduction and PPD reduction in the laser group than that of the control group. Hence, they concluded that diode lasers have better bactericidal effect that helps in reducing the inflammation in periodontal pockets.
Cugini M A et al (2000)2 3 in their study evaluated both the microbial and clinical effects of SRP in 32 subjects for 12 months.
Clinical evaluation (BOP, PD, CAL) were recorded before SRP and after SRP at the interval of 3,6,9 and 12 months. Microbiological evaluation was done by collecting subgingival plaque samples at each visit and was analyzed for the presence of levels of 40 subgingival species. There was a significant reduction in BOP and PD and gain in CAL. The prevalence of Porphyromonas gingivalis, Tannerella forsythia, Trepenoma denticola were decreased up to 6 months which remained the same till 12 months. Thus, they found
15 that clinical improvements and reduction in subgingival species occurre d in the first 6 months after SRP and it remained to be the same till 12 months. They also suggested that the maintenance phase is essential in consolidating both clinical and microbiological improvements that were achieved as a result of initial therapy.
Quirynin et al (2000)2 4 demonstrated better clinical and microbiological results when severe adult periodontitis was treated by “one stage full mouth disinfection” rather of a standard therapy strategy with consecutive root planing quadrant per quadrant. The one-stage full mouth disinfection method involves scaling and root planing of all pockets within 24 hours in along with utilization of chlorhexidine to all intraoral niches such as a periodontal pocket, tongue dorsum, tonsil. They concluded that “one -stage full mouth disinfection” in the treatment of patients suffering from severe adult periodontitis probably results from the full mouth scaling and root planing within 24 hours rather than the beneficial effect of chlorhexidine.
Schwarz F et al ( 2001)2 5 evaluated twenty patients with moderate to advanced periodontitis who were treated under local anaesthesia and the quadrants were randomly assigned in a split -mouth design to either Er:YAG laser using an energy level of 160 mJ/ pulse and 10 Hz or scaling and root planing (SRP) using hand instruments.
Clinical assessments of plaque index (PI), gingival index (GI),
16 bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment (CAL) were made before and at 3 and 6 months afte r therapy. Subgingival plaque samples were taken at each appointment and analyzed using dark field microscopy for the presence of cocci, non -motile rods, motile rods, and spirochetes.
Differences in clinical parameters and prevalence of bacteria species we re analyzed using the paired test. It was concluded tha t Er:YAG laser may represent a suitable choice for non -surgical periodontal therapy.
Heitz-Mayfield LJ et al (2002)2 6 reviewed evidence of effectiveness of surgical versus non - surgical therapy for t he treatment of chronic periodontal disease. Research was governed for randomized controlled trials of at least 12 months duration comparing surgical with non -surgical therapy of chronic periodontitis. They concluded that both scaling and root planing alone and scaling and root planing combined with flap procedure are effective methods for the treatments of chronic periodontitis in terms of attachment level gain and reduction in gingival inflammation.
Selcuk Yilmaz et al (2002)2 7 conducted a microbiological and clinical study to evaluate the effect of diode laser on human periodontal disease in 10 patients with moderate to advanced periodontitis. Both the microbiological and clinical measurements
17 were evaluated over 32 days. The s tudy resulted in a reduction of obligate anaerobes and a reduction in probing depth in sites that received both SRP and laser disinfection. Thus, they concluded that diode lasers are effective adjunct to scaling and root planing in the management of chroni c periodontitis.
Miyazaki A et al (2003)2 8 in his comparative study evaluated the effect of Nd:YAG and CO2 lasers to that of ultrasonic scaling in 18 patients with chronic periodontitis. They observed a reduction in probing depth and a decrease in inflam mation following the treatment in laser group comparing to that of the ultrasonic scaling group. Hence, they reported that lasers are a good adjunct to conventional therapy.
Schwarz F et al (2003)2 9 conducted a study in which twenty patients with moderate to advanced periodontal destruction were treated under local anaesthesia, and the quadrants were randomly allocated in a split -mouth design to either 1) Er:YAG laser (ERL) using an energy level of 1 60 mJ/pulse and 10 Hz, or 2) scaling and root planing (SRP)using hand instruments. The following clinical parameters were estimated at baseline and 1 and 2 years after therapy: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing dept h (PD), gingival recession (GR) and clinical attachment level (CAL). Subgingival plaque samples were collected at each appointment analyzed using dark field microscopy for the
18 presence of cocci, non -motile rods, motile rods, and spirochetes.
The primary ou tcome variable was CAL. No statically significant differences between the groups were found at baseline. Power analysis to establish the superiority of ERL treatment showed that the available sample size would yield 99% power to detect a 1mm difference. It was concluded that the CAL gain obtained following non-surgical periodontal therapy with Er:YAG laser (ERL) or scaling and root planing (SRP) can be sustained over 2 years.
Leyes Barrajo JL et al (2004)3 0 conducted a study to evaluate the effectiveness of diode laser as an adjunct to traditional SRP. In their study, 30 patients with moderate periodontitis was involved and randomly assigned to receive SRP alone or along with a diode laser. Clinical assessments such as PBI, BOP, CAL was recorded before and after the treatment. They found that both PBI and BOP were significantly reduced when SRP combined with diode laser while the CAL remained unchanged. Hence, they concluded that SRP, when used in combination with diode laser, produces moderate clinical imp rovement over SRP alone.
Noguchi T et al (2005)3 1 conducted a study to assess the effects of Nd:YAG laser irradiation into periodontal pockets with or without the combination of local antibiotic application on clinical parameters and microbiological preva lence. Sixteen patients, each of whom had 4 or more sites with probing depth 5 -7mm were
19 included in this study. They were monitored clinically and microbiologically at baseline, 1 and 3 months after the treatment.
They concluded that Nd:YAG laser irradiati on combined with local minocycline provides a better gain clinically and the number of periodontopathogens decreased than laser irradiation alone in periodontitis patients.
T Qadri et al (2005)3 2 conducted a split -mouth, double -blind controlled clinical t rial to determine the effects of irradiation with low-level lasers as an adjunctive treatment of inflamed gingival tissue. The samples of GCF and subgingival plaque were analyzed.
Low-level laser therapy with a wavelength of 635 and 830 nm was used in the test group. They observed a significant reduction in periodontal gingival inflammation after 6 weeks of laser therapy.
Hence, they suggested that low -level lasers, when used along with conventional therapy, reduces periodontal gingival inflammation.
Quiry nin et al (2006)3 3 conducted a parallel single -blind randomized control trial study with seventy -one with moderate periodontitis to compare several full mouth treatment strategies with each other. They concluded that the benefits of the full mouth treatment protocol were partially due to the antiseptics and partially, the shorter time for completion of the therapy I short time.
20 Roger Anderson et al (2007)3 4 conducted a study to compare the effectiveness of laser disinfection to that of scaling and root planing in management of chronic periodontitis were evaluated by using laser disinfection alone (group I), SRP alone (group II) SRP and PD combined (group III). The laser disinfection was done using a diode laser. Clinical assessments BOP, PPD, and CAL wer e recorded at baseline, three weeks, six weeks and 12 weeks following therapy.
They found a significant reduction of PPD and CAL in group 3 and concluded that SRP, when used in combination with laser disinfection, is effective than SRP alone in the managem ent of chronic periodontitis.
Ebenhard et al (2008)3 5 in a systematic review conducted for randomized controlled clinical trials including full mouth scaling with or without the use of antiseptics and quadrant scaling in patients with chronic periodontit is. They concluded that in an adult with chronic periodontitis only minor differences in treatment effects were observed between the treatment strategies.
Lopes BM et al (2008)3 6 conducted a study with twenty -one subjects with pockets from 5 -9mm in non -adjacent sites were studied. In a split -mouth design, each site was randomly determined to a therapy group: SRP and laser (SRPL), laser only (L), SRP only (SRP), or no treatment (C). The plaque index (PI), gingival index (GI), bleeding on probing (BOP), and interleukin (IL) -1beta levels
21 in a crevicular fluid were determined at baseline and 12 and 30 days postoperatively, whereas probing depth (PD), gingival recession (GR); and clinical attachment (CAL) was estimated at baseline and 30 days after therapy. Stat istical analysis was conducted. It was concluded that Er:YAG laser irradiation may be used as an adjunctive aid for the treatment of periodontal pockets, although a significant CAL gain was observed with SRP alone and not with laser treatment.
Schwarz F e t al (2008)3 7 evaluated a systematic review in which the results from a narrative synthesis indicate that Er:YAG laser monotherapy resulted in similar clinical outcomes, both in the short and long term (up to 24 months), compared with mechanical debridemen t. There is insufficient evidence to support the clinical applications of either CO ( 2 ), Nd:YAG, Nd :YAP, or different diode laser wavelengths. The Er:YAG laser possesses properties that are relevant for the nonsurgical therapy of chronic periodontitis.
Research organized so far has indicated that its safety and effects might be regarded to be within the range reported for conventional debridement. However, evidence from the estimated studies is still lacking.
Ugo et al and colleagues (2008)3 8 conducted a study to compare the effectiveness of diode laser used as adjunctive therapy of SRP to that of SRP alone for non - surgical periodontal treatment in thirte en
22 patients with chronic periodontitis. Clinical measurements PPD, CAL, BOP, GI, PI, were performed before treatment at baseline and after 4 weeks, 8 weeks, 12 weeks and 6month. Subgingival plaque samples were taken at baseline and after treatment and exam ined for eight perio - pathogens bacteria using PCR technique. The added therapy with diode laser may lead to a slightly progress in the clinical parameters, whereas no significant difference between test and control group in the reduction of periodontopath ogens were observed.
Kamma JJ et al (2009) 3 9 compared the effect of scaling and root planing (SRP) alone, diode laser treatment (LAS) alone, and SRP combined diode laser (SRP + LAS) on clinical and microbial parameters in thirty patients with aggressive periodontitis. Diode laser-assisted treatment with SRP showed that superior effect over SRP or LAS alone for certain microbial and clinical parameters in a patient with aggressive periodontitis over the 6 months monitoring period.
Rotundo R et al (2010)4 0 conducted a study with a total of 27 patients who underwent four modalities of nonsurgical th erapy:
supragingival debridement alone, scaling and root planing (SRP) with Er:YAG laser; Er:YAG laser alone ; and SRP alone. Each strategy was randomly assigned and performed in one of the four quadrants. Clinical outcomes were evaluated at 3 and 6 months . The
23 subjective benefits of patients have been evaluated using questionnaires. The adjunctive use of Er:YAG laser to conventional SRP did not reveal a more effective result than SRP alone.
Moreover, the sites treated with Er:YAG laser exhibit similar outcome of the sites treated with supragingival scaling.
Lui J et al (2011)4 1 evaluated a study with twenty -four non- smoking adults with untreated chronic periodontitis who were randomly assigned in a split -mouth design to receive scaling and root planing with or without one course of adjunctive low -level laser therapy within 5 days. Plaque index, bleeding on probing, probing depth and gingival recession were recorded at baseline, 1 and 3 months after the treatment. The test achieved greater reductions in the percentage of sites with bleeding on probing and in mean probing depth at 1 month compared with the control teeth.
The present study proposed that a mutual course of laser therapy could be an advantageous aid to nonsurgical therapy of chronic periodont itis on a short -term basis. Further studies are required to assess the long -term effectiveness of the low -level laser therapy as an adjunct in nonsurgical treatment in periodontitis.
Fabrizio S golastra et al (2012) 4 2 did a systematic review on the adjunctive use of diode lasers to conventional therapy (SRP) in patients with chronic periodontitis. Based on their findings with
24 meta -analysis, they recommended the use of diode laser as an effective adjunct to scaling and root planing.
Harijit Kaur Virdi et al (2012)4 3 evaluated in a randomized, single-blind, split - mouth study in twenty patients with chronic periodontitis the effect of aloevera gel as an adjunct to scaling and root planing (SRP). On one side, SRP alone was done and on the contralateral s ide along with SRP pure aloevera gel (SRP - ALOEVERA) was applied in the periodontal pockets at baseline and after 1 and 2 weeks. Probing pocket depth, gingival index, and plaque index. There was a significant improvement in the pocket depth and GI readings after 6 weeks in both groups. On comparing, the SRP-ALOEVERA group showed significantly advance results than SRP alone group. In PI though the significant advance was there in both the groups, the differences between the groups were not significant. Result s enforce the use of aloevera in the therapy of periodontitis.
Mohammad Berakdar et al (2012)4 4 conducted a clinical study to evaluate the efficacy of photodynamic therapy (PDT) to scaling and root planing (SRP) in twenty -two patients with chronic periodo ntal disease. The following clinical parameters were measured at baseline, and one, three and six months after therapy: bleeding on probing, plaque index, probing depth and clinical attachment loss.
In each patient, two teeth were treated with SRP alone an d two teeth
25 with SRP and PDT. The study indicates that SRP also with PDT seems to be efficient and is therefore appropriate as an adjuvant treatment to the mechanical conditioning of the periodontal pockets in patients with chronic periodontal diseases.
Dukie W et al (2013) 4 5 conducted a split -mouth, randomized clinical study to evaluate the effect of a 980nm diode laser as an adjunct to scaling and root planing (SRP) treatment. The selected teeth were treated with SRP in two control quadrants and the di ode laser therapy was applied to periodontal p ocket on days 1,3 and 7 after SRP. The laser group showed significant PD gain in moderate pockets. Hence, they evaluated that compared to SRP alone, multiple adjunctive applications of a 980nm diode laser with SRP showed reduction in PD only in moderate periodo ntal pockets.
Mehmet Saglam et and colleagues (2014)4 6 conducted a study in thirty chronic periodontitis patients who were randomly assigned into two groups to receive SRP alone (control) or SRP followed by diode laser (test). Plaque index, gingival index , bleeding on probing, probing depth, and clinical attachment level were evaluated at baseline and 1, 3 and 6 months after therapy. The gingival crevicular fluid levels of interleukin -1β(IL-1β), interleukin -6(IL- 6), interleukin -8(IL-8), matrix metallopr oteinase -8 (MMP-8) and tissue inhibitor matrix metalloproteinase 1(TIMP -1) were examined by enzyme -linked immunosorbent assay. The test group showed
26 sufficiently a better result compared to the control group in full - mouth clinical parameters. MMP -1, MMP-8, and TIMP -1 showed significant differences between groups after treatment compared to baseline. The total amount of IL -1β, IL-6, MMP -1, MMP-8, and TIMP-1 reduced and IL -8 increased after therapy in both test and control groups. Diode laser affords sufficie nt gain in clinical parameters and MMP -8 was significantly impacted by the addition of laser treatment at the first month providing an insight into how lasers can enhance the results of the nonsurgical periodontal treatment.
Zhao Y et al (2014)4 7 performe d a literature search using six electronics databases and completed by manual searchers up to July 2013. They conducted a meta -analysis as well as heterogenicity, sensitivity, subgroup and power analyses to clarify and validate the pooled results. The 3, 6 - and 12 -month clinical outcomes were evaluated. This systematic review indicated that the clinical efficacy of Er:YAG laser was similar to SRP 3 months postoperatively. The clinical benefits of Er:YAG laser as an addition to SRP was still lacking. Since E r:YAG laser has certain benefits, it could be expected to be a novel short term alternative option for chronic periodontitis.
Antonio Crisopino et al (2015)4 8 evaluated the effect of a 940 -nm diode laser as an adjunct to SRP in sixty -eight patients affected by
27 moderate to severe periodontitis. Periodontal examination in order to detect gingival index, plaque index and probing depth. The patients were randomly d ivided into two groups: the test group received SRP treatment alone, the control group received SRP and 940 -nm diode laser therapy. For all clinical parameters, both groups showed a statistically significant differences compared to basal values. Both proc edures were effective in improving GI, PI, PD but the use of diode laser was associated with more evident results. Consider the better clinical outcomes, diode laser can be routinely associated with SRP in the treatment of periodontal pockets of patients w ith moderate - to- severe periodontitis.
Georgios Romanos et al (2015)4 9 summarizes major advantages of using lasers. The variant periodontal utilization including calculus removal using Er:YAG, Er, Cr, YSGG Lasers; soft tissue excision, incision, and abla tion; decontamination of root and implant surfaces; bio -stimulation; bacteria reduction and osseous surgery;
removal of the pocket epithelium, root conditioning.
Milne et al (2015) 5 0 conducted a study to evaluate periodontopathogen levels following the u se of an Er:YAG laser in the treatment of chronic periodontitis using multiplex qPCR. They found that Treponema denticola and Tannerella forsythia were significantly reduced post -treatment for both Er:YAG laser and scaling and root planing.
28 Nguyen NT et al and colleagues (2015)5 1 conducted a study in twenty -two patients with chronic periodontitis to evaluate the effectiveness of scaling and root planing (SRP) with the adjuvant use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediators interleukin - 1β (IL - 1β) in patients receiving regular periodontal maintenance treatment. Sites treated with SRP with adjuvant laser and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies.
Similarly, differences GCF IL - 1β levels between SRP with adjuvant laser and SRP alone were not statistically significant in periodont al maintenance patients, SRP with adjuvant laser did not improve clinical results compared to SRP alone in the therapy of inflamed sites with ≥5mm PD.
Reza Birang et al (2015) 5 2 conducted a split -mouth study in twenty patients with at least three quadran ts involved and each of them presenting pockets with 4 -8mm deep, each quadrant was randomly treated with SRP alone( GROUP I), SRP with laser therapy (GROUP II), and SRP with photodynamic therapy (group III). The clinical indices were measured at baseline, 6 weeks and 3 months after treatment. Microbiological samples were taken and evaluated at baseline and 3 months follow up. The adjunctive laser therapy and photodynamic therapy have significant short -term benefits in the
29 treatment of chronic periodontitis. Laser therapy showed minimal additional advantages compared to photodynamic therapy.
Smiley et al (2015) 5 3 presented an evidence -based clinical practice guideline for nonsurgical therapy of patients with chronic periodontitis by means of SRP with or without adjuncts. They concluded that for patients with chronic periodontitis, SRP had shown a moderate advantag e, and benefits were judged to outweigh potential adverse effects.
Sugumari et al and colleagues (2015)5 4 conducted a split -mouth study in ten patients in two groups group I (SRP alone) and group II (SRP with laser curettage). The following clinical param eters were recorded: gingival index, plaque index, sulcular bleeding index, probing depth, clinical attachment level. SRP was done in one quadrant using Gracey curettes and in another quadrant, SRP plus laser curettage was done. In both groups, gingival in flammation was reduced. When laser curettage was availed as an adjuvant to SRP better reduction in PD and CAL was seen.
Kachapilly Arun Jose et al (2016) 5 5 in their study compared the effect of diode laser and chlorhexidine chip alone and in combination with scaling and root planing in the management of chronic periodontitis. They clinically assessed using PPD, rCal, PI and GI at baseline (before the treatme nt),1 and 3 months (after the
30 treatment). They found that chlorhexidine alone and in combination with diode laser decontamination showed effective improvement in oral hygiene, reduction in gingival inflammation, reduction in probing pocket depth and improv ement in clinical attachment levels when used as adjuncts to be scaling and root planing. Hence, they suggested that chlorhexidine alone is effective than diode laser decontamination when used as an adjunct to be scaling and root planing.
Santosh et al (2 016)5 6 evaluated the effect of a diode laser with non-surgical periodontal therapy on chronic periodontitis. The periodontal examination included a gingival index and complete periodontal probing depth with William’s graduated probe and the patient was tre ated with 940 nm diode laser and scaling and root planing. The following estimation was done after six months following laser treatment; the probing depths reduced; gain in clinical attachment levels; no inflammation; the tissue tone was good, showing incr eased stippling.
Shilpi Gupta et al (2016)5 7 in a split -mouth study evaluated the effectiveness of diode laser on plaque index, gingival index, probing pocket depth, and clinical attachment level in twenty generalized chronic periodontitis patients who were divided into two treatment groups: SRP alone (group I control group ) and diode laser as an adjunct to SRP (group II Test group) and to compare the
31 outcome with SRP alone and to evaluate the efficacy of diode laser on plaque microorganisms namely Agg regatibacter actinomyecemcomitans and Prevotella intermedia. Adjuvant therapy with a diode laser at a higher but clinically safe frequency (940 nm) at repeated intervals showed an improvement in ensuring better periodontal health as compared to SRP alone.
Suryakanth Maligikar et al (2016)5 8 conducted a single centered randomized controlled trial in 24 patients (15 males and 9 females) with untreated chronic periodontitis were randomly assigned in a split-mouth design into three treatment groups which included group I: Scaling and root planing only; Group II: Scaling an d root planing with photodynamic therapy and Group III: Scaling and root planing along with photodynamic therapy and low level laser therapy.
Clinical parameters such as plaque index (PI), gingival index (GI), modified sulcular bleeding index (mSBI), probi ng depth (PD), and clinical attachment level (CAL), were measured at baseline, 1, 3 and 6 months after therapy. In patients with chronic periodontitis, a combination of a single application of photodynamic therapy and low level laser therapy provide additi onal benefit to SRP in terms of clinical parameters 6 months following the intervention.
Yadwad KJ et al (2017)5 9 conducted a study with a total of 40 systemically healthy subjects diagnosed with chronic periodontitis were randomly assigned into two grou ps G1: (SRP and sham
32 application of laser) and G2 (SRP and laser irradiation) with equal numbers in each. The levels of Porphyromonas gingivalis (Pg) were estimated from plaque samples using real -time polymerase chain reaction. Clinical and microbiological parameters were assessed at baseline,4 -6, and 12 -14 weeks posttreatment in both groups.
Although a 980 nm diode laser may not have any added benefit compared with SRP, it may emerge as an effective non - surgical treatment option in advanced periodontitis with complex inaccessible subgingival niches where comprehensive periodontal care may not be feasible.
Angel Fenol et al (2018) 6 0 did a study to detect and compare the presence of periodontal pathogens using the BANA test in chronic periodontitis patient s after nonsurgical periodontal therapy with and without diode laser disinfection. Thus, the efficacy of laser was analyzed when it was used as an adjunct to nonsurgical periodontal therapy. The periodontal parameters (OHI, GI, PPD, and CAL) were assessed at baseline, 2 weeks, and 2 months. They observed that laser when used as an adjuvant to SRP were more effective in reducing the OHI, GI, PPD and CAL and the periodontal pathogens which shows that the amount of recolonization of microbes is less when laser is used as an adjuvant to conventional therapy. And BANA- enzymatic kit is a simple chair side kit which can be reliable indicator of BANA positive species in dental plaque.
33 Xuan Zhou et al (2019) 6 1 evaluated the adjunctive efficacy of Er:YAG laser use with conventional scaling and root planing (SRP) for non -surgical treatment of periodontitis in a single -blinded randomized controlled trial in twenty -seven patients with chronic periodontitis. Er:YAG laser treatment combined with conventional SRP significantly improved PD and CAL compared to SRP therapy alone; however these differences were very small and, as a result the adjunctive effect of Er:YAG laser is likely to be minimally clinical important.
34
MATERIALS AND METHODS
The current comparat ive split -m outh random ized cli nical stud y was conduct ed in Departm ent of Periodontology, M adha Dental Col lege and Hospital, Kundrat hur, Chennai .
The purpos e of this stud y was t o eval uat e the effi cac y of soft tissue di ode laser as an adj unct to scali ng and root pl aning in the managem ent of generaliz ed chroni c periodontitis . This study was approved b y t he Instituti onal Ethi cal Committ ee ( IEC) of Mad ha Medi cal C oll ege and Hos pit al kundrathur (M DCH/ IEC/2016/ 06)
SOURC E OF S AMP LE AND STUDY P ER IOD: The stud y group com pri sed of 30 s ys temi call y health y patient s who were di agnos ed with chroni c peri odontitis with age rangi ng from 30 -60 ye ars and who reporte d to the out patient Departm ent of Periodont ics, M adha Dental C oll ege and Hospital, Madha Nagar, Kundrathur Chennai for the managem ent of t hei r periodont al condition. The stud y period for each pati ent was of six months durati on and the whol e stud y was com plet ed in 10 m onths. All pati ent s who quali fi ed t he stud y cri teri a were verball y informed and writ ten informed consent was obt ained from all the patients in Engl ish / Tamil l anguage.
35 SELECTIO N CRIT ERIA:
Inclus ion crit eria are as follows:
S ys temicall y health y subj ects .
Subject s with chroni c periodontitis wi th at least 20 remaining nat ural t eeth.
A minim um of t wo sites per quadrant with probing pocket depth ≥ 4mm-5mm.
Pati ents with est abli shed willi ngnes s and abili t y to perform adequat e oral h ygiene.
Pati ents who have not taken an y anti biotics for the past 6 months.
Exclusi on crit eri a are as fol lows:
Subject s who are suffering from an y known s ys t emi c dis eas e or i mmunocompromi sed.
Subject s who had received an y s urgical or non -surgi cal therap y six mont hs prior t o the start of the st ud y.
Subject s who had received an y ant ibiot i c therap y in t he l as t six months.
Pregnanc y and l act at ion subj ects.
Subject s with habi t of bet el -nut, pan m as al a, tobacco chewi ng, sm oking, and al cohol consumpt ion.
Subject s who ar e prone to phot os ensit ivit y.
