Do lasers and photodynamic therapy have a role in periodontal treatment?

I was asked by the organizing committee of Europerio 7 to present the current scientific evidence on lasers and photodynamic therapy. Since the audience was primarily dental hygienists, the most interesting and relevant issue is: "What is the effect of these technologies in non surgical therapy performed by the dental hygienists?" Dental hygienists are indeed specialists in this field. During non surgical therapy procedures, we would like to achieve a reduction in bacterial plaque on the root surface to levels comparable with gingival health. We assess this by recognizing a reduction in probing pocket depth, reduction of levels of supra and sub gingival microbial load, gain of attachment level, and arresting the progression of disease. Scaling and root planning (SRP) are essential parts of this success and therefore remains the gold standard in non surgical therapy.(1,2)

LASER means Light Amplification by Stimulated Emission of Radiation. It is a light which can have several wavelengths. Currently, different laser systems are on the market for intraoral use. Depending on the wavelength, they are called diode, Nd:YAG, Er:YAG or CO₂. Frequently, laser therapy is used as a desirable and dependable alternative to the traditional scalpel surgery. It is easily able to reshape oral soft tissues and increase homeostasis by heat-induced coagulation and occlusion of arterioles, venules and capillaries. The advantages of the use of LASER technology is that it gives a clear and visible surgical field, it has a bactericidal effect, and causes less pain, swelling and healing time.

As we know from the pathogenesis of periodontal infection, periodontitis is a plaque-induced disease with an initial microbial challenge. The host inflammatory response is important and risk factors contribute to susceptibility and progression of the disease. The question, therefore, is: “Do lasers/photodynamic therapy have a role in non surgical therapy performed by the dental hygienists?” Based on the highest level of evidence presented in systematic reviews, the Er:AYg laser seems the most promising. In vitro studies show that they are effective in radicular debris removal and root smoothing, although the clinical effectiveness remains controversial since no statistical difference could be obtained.(3,4,5) The U.S. Food and Drug Administration (FDA) approved the Nd:YAG laser for soft tissue treatment in the oral cavity. However, there is no evidence to support the superiority of the Nd:YAG over traditional modalities of periodontal therapy.(3,4,6) The diode laser can used alone either in combination with a photo sensitizer. The combination is better known as photodynamic therapy, has been studied, and the conclusion is that there is no evidence that this therapy, either as an independent treatment or as an adjunctive therapy, is an alternative to traditional scaling and root planning.(7,8,5) This evidence supports the American Academy of Periodontology (AAP) in its statement that says that currently there is minimal evidence to support the use of a laser for the purpose of subgingival debridement either as mono therapy or as an adjunct to SRP.(9) However, Schwartz also concluded that the research conducted to date has indicated that the use of laser is safe.(3)

Dagmar Else Slot, RDH, MSc, is a researcher at the Periodontology Department, ACTA University Amsterdam the Netherlands. To read more articles written by Dagmar Else Slot, go to articles.