The Clinical Effectiveness Of Lasers In Scaling And Root Planing For Chronic Periodontitis: A Network Meta-analysis

Objective: A variety of lasers have been applied in periodontal treatment for many years.The aim of this research was to systematically evaluate the clinical effectiveness in clinical attachment loss(CAL)and probing depth(PD)of all kinds of lasers applied in scaling and root planing(SRP)for chronic periodontitis by network meta-analysis(NMA)which will provide scientific evidence and guidance for its clinical application.Method: There were a variety of lasers applied in periodontal treatment,such as Er:YAG laser,Er,Cr:YSGG laser,Nd:YAG laser,Nd:YAP laser and diode laser(DL).Relevant articles were retrieved through computer-search and manual-search up to September,2018.The electronic databases included Pub Med,Cochrane library,Web of Science,Ovid,Science Direct,Wanfang and CNKI.The process including study selection,data extraction and quality evaluation was performed by 2 reviewers independently.Standard mean difference(SMD)and 95% confidence interval(CI)were calculated as the effect size for continuous outcomes.The random effects network meta-analysis was performed using STATA software(version 13).Results:1.There were 28 articles included in this NMA,which were all randomized controlled clinical trial(RCT)related with the CAL and PD improvement at 3 and 6 months after lasers applied in SRP for chronic periodontitis.There were 4 kinds of lasers and 6 periodontal treatment models in total,which included Er,Cr:YSGG laser as monotherapy,Er:YAG laser as monotherapy,Er:YAG laser adjunctive to SRP,DL adjunctive to SRP,Nd:YAG laser adjunctive to SRP and mechanical SRP.2.In term of CAL gain at 3 months after treatment,the result of this NMA evaluated by 23 researches showed that Er:YAG laser as monotherapy was significantly more effective than mechanical SRP(SMD = 0.34;95% CI: 0.01-0.68),no significant differences were found among other treatment models.The treatment ranking result from best to worst was: Er:YAG laser as monotherapy,DL adjunctive to SRP,Er:YAG laser adjunctive to SRP,Er,Cr:YSGG laser as monotherapy,Nd:YAG laser adjunctive to SRP,mechanical SRP.3.In term of CAL gain at 6 months after treatment,the result of this NMA evaluated by 10 researches showed that there were no significant differences found among all treatment models.The treatment ranking result from best to worst was: DL adjunctive to SRP,Nd:YAG laser adjunctive to SRP,mechanical SRP,Er:YAG laser adjunctive to SRP,Er:YAG laser as monotherapy.4.In term of PD reduction at 3 months after treatment,the result of this NMA evaluated by 26 researches showed that DL adjunctive to SRP was significantly more effective than mechanical SRP(WMD = 0.57;95% CI: 0.16-0.98),no significant differences were found among other treatment models.The treatment ranking result from best to worst was: Nd:YAG laser adjunctive to SRP,DL adjunctive to SRP,Er:YAG laser as monotherapy,Er,Cr:YSGG laser as monotherapy,Er:YAG laser adjunctive to SRP,mechanical SRP.5.In term of PD reduction at 6 months after treatment,the result of this NMA evaluated by 11 researches showed DL adjunctive to SRP was significantly more effective than mechanical SRP(WMD = 0.37;95% CI :0.03-0.72),no significant differences were found among other treatment models.The treatment ranking result from best to worst was: DL adjunctive to SRP,Nd:YAG laser adjunctive to SRP,Er:YAG laser adjunctive to SRP,Er:YAG laser as monotherapy,mechanical SRP.6.In this NMA,there was no inconsistency between direct comparisons and indirect comparisons of all parameters.The publication was limited of all parameters which was acceptable.Conclusion:1.Lasers applied in SRP for chronic periodontitis were better than mechanical SRP with the consideration of CAL and PD improvement at 3 and 6 months follow-up.2.In term of CAL and PD improvement at 3 months follow-up,Er:YAG laser as monotherapy was the best treatment model of erbium laser which was better than Er:YAG laser as adjunct of SRP and Er,Cr:YSGG laser as monotherapy.3.In term of CAL and PD improvement at 6 months follow-up,Er:YAG laser as adjunct of SRP was better than Er:YAG laser as monotherapy.4.In term of CAL and PD improvement at 3 and 6months follow-up,DL as adjunct of SRP was better than Er:YAG laser as adjunct of SRP.5.More further study about lasers in SRP for chronic periodontitis was needed to explore the clinical effectiveness in the future,especially about clinical effectiveness for long term and its best application parameters.