| Objective: The combination of erbium-doped yttrium aluminum garnet(Er:YAG)laser and neodymium-doped yttrium aluminum garnet(Nd:YAG)laser therapy or either of them assisted with scaling and root planning(SRP)have been widely used in the treatment of periodontitis.However,whether the combined application of Nd:YAG laser and Er:YAG laser can synergistically enhance the therapeutic effect with both microbial gain and hard tissue processing still lacks systematic evaluation.In this study we compared the efficacy of Nd:YAG laser,Er:YAG laser,and the combination of them in the treatment of periodontitis.The purpose is to screen multiple treatments and provide scientific evidences for clinical application.Methods: Studies were searched in PubMed,Embase,The Cochrane Library,China National Knowledge Infrastructure(CNKI),VIP and WanFang databases from database building to 30 th,December 2019.Two investigators independently searched and screened the literatures and extracted data including the first author,time of publication,intervention,sample size,follow-up time,and clinical observation indicators.Standard mean difference(SMD)and 95% confidence interval(CI)were calculated as the effect size for continuous outcomes.Network meta-analysis(NMA)was then performed in STATA 14.0.Results: A total of 25 literatures and 858 patients with periodontitis were included in this network meta-analysis.There were 5 periodontal treatment strategies including Nd:YAG laser adjunctive to SRP,Er:YAG laser adjunctive to SRP,Nd:YAG laser combine Er:YAG laser with SRP,Nd:YAG laser combine with Er:YAG laser and SRP alone.The reduction of probing depth(PD)and clinical attachment loss(CAL)at 3 and 6 months after treatment were analyzed.The results of the network Meta-analysis showed that the reduction in PD at 3 months in Nd:YAG+Er:YAG+SRP,Nd:YAG+Er:YAG,Nd:YAG+SRP,Er:YAG+SRP treatment groups were significantly higher than SRP alone,and the SMD and 95%CI were 0.63(0.34,0.91),0.39(0.02,0.75),0.44(0.21,0.67)and 0.28(0.14,0.43)separately,and the differences were statistically significant(P<0.05).The ranking results from best to worst were Nd:YAG+Er:YAG+SRP,Nd:YAG+SRP,Nd:YAG+Er:YAG,Er:YAG+SRP,SRP.The PD reductions in 6 months showed that Nd:YAG+Er:YAG+SRP,Er:YAG+SRP,Nd:YAG+SRP and Nd:YAG+Er:YAG were significantly higher than the SRP alone,the SMD and 95%CI were 0.55(0.39,0.71),0.17(0.04,0.29),0.25(0.12,0.37)and 0.40(0.30,0.50)separately,and the differences are statistically significant(P<0.05).The ranking results from best to worst were Nd:YAG+Er:YAG+SRP,Nd:YAG+Er:YAG,Nd:YAG+SRP,Er:YAG+SRP,Nd:YAG+SRP,SRP.In the subgroup whose CAL change was less than 5mm at 3 months after treatment,Nd:YAG+Er:YAG+SRP was more effective than Nd:YAG+Er:YAG and SRP alone,the SMD and 95%CI were 0.64(0.39,0.89)and 0.44(0.22,0.66),the difference was statistically significant(P<0.05);the ranking from best to worst were Nd:YAG+Er:YAG+SRP,Nd:YAG+SRP,Er:YAG+SRP,SRP,Nd:YAG+Er:YAG.After 6 months of treatment,the CAL reduction in Nd:YAG+Er:YAG+SRP was statistically significant compared with Er:YAG+SRP,Nd:YAG+SRP,Nd:YAG+Er:YAG,and SRP alone,the SMD and 95%CI were 0.45(0.08,0.83),0.75(0.40,1.10),0.79(0.24,1.34),and 0.89(0.32,1.46)separately,and the differences were statistically significant(P<0.05).The ranking results from best to worst were Nd:YAG+Er:YAG+SRP,Er:YAG+SRP,SRP,Nd:YAG+Er:YAG and Nd:YAG+SRP.Conclusion: Er:YAG laser combined with Nd:YAG laser assisted with SRP in the treatment of chronic periodontitis showed a lighter postoperative response,which can significantly increase the clinical attachment level and reduce the periodontal exploration depth.It was indicated that the combined therapy is not only an effective treatment but also a new trend in clinical treatment of periodontitis.However,the current strategy lacks long-term follow-up observations.More high-quality randomized controlled studies are needed to further verify the current conclusion. |
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