Clinical Outcomes and Bacterial Recolonization Following Scaling and Root Planing With and Without Er:YAG Laser in Chronic Periodontitis Patient

Introduction: Er:YAG laser is one of the most frequently used lasers in non-surgical and surgical periodontal therapy. Er:YAG laser removes calculus and decontaminates root surfaces. The literature is inconclusive regarding the clinical effects of Er:YAG lasers in scaling and root planing and the microbiological outcomes when used as an adjunctive therapy to conventional scaling and root planing. Objective: The purpose of this investigation was to evaluate the efficacy of Er:YAG laser as an adjunct to scaling and root planing in non-surgical periodontal therapy on probing depth, clinical attachment levels, gingival bleeding and microbial colonization patterns. Materials and methods: The investigation was randomized, controlled, split mouth single blinded clinical trial. Eleven participants over 24 years of age that did not receive scaling and root planing in the past 6 months and without uncontrolled systemic diseases, smoking, antibiotic use 6 months prior the enrollment were selected. Participants were diagnosed with moderate to severe periodontitis. Following a randomization scheme, two quadrants were selected per participant. One quadrant received scaling and root planing only, while in the other quadrant in addition to scaling and root planing Er:YAG laser was used in periodontal pockets ≥ 5mm. Clinical data were collected at the initial visit and at 6 weeks and 3 months following scaling and root planing +/- Er:YAG laser. Microbial cultures were collected from sites that exhibited probing depth ≥ 5mm and bleeding on probing using paper points at the initial visit and the same sites were used for microbial analysis at the 3 months re-evaluation visit. Results: Eleven quadrants were evaluated in each treatment assignment. The scaling and root planing group had an initial mean probing depth of 4.0 +/- 1.6mm which decreased to 3.5+/-1.5mm at 6 weeks and remained 3.5+/-1.5mm at 3 months. The scaling and root planing + Er:YAG group had an initial mean probing depth of 3.9+/-1.6mm that decreased to 3.4+/-1.6 and to 3.3+/-1.5mm at 6 weeks and 3 months, respectively. The scaling and root planing group had an initial mean bleeding on probing of 55.44+/-17.5% which decreased to mean of 42.8+/-38.8% and 20.2+/-7.5% at the 6 weeks and 3 months follow up visits respectively. The scaling and root planing + Er:YAG group had an initial mean bleeding on probing of 51.4+/- 30.9%. In the 6 weeks follow up visit, bleeding on probing decreased to 28.7+/-24.4% and at the 3 months follow up visit to 29.4+/-26.08%. There was an overall trend towards a decrease in the percentage of the subgingival cultivable microflora at 3 months compared to baseline but this decrease was not statistically significant. Conclusion: Within the limitations of this study, the use of Er:YAG laser as an adjunctive therapy to SRP in patients diagnosed with moderate to severe chronic periodontitis conferred no additional clinical and microbial benefit compared to SRP alone.