The effect on clinical parameters of periodontal inflammation following non-surgical periodontal therapy with ultrasonics and chemotherapeutic cooling solutions: a systematic review

Aim: To establish the added effect of a chemotherapeutic cooling solution in an ultrasonic device on clinical parameters of periodontal inflammation following non-surgical periodontal therapy. Methods: The MEDLINE-PubMed, Cochrane-CENTRAL, and the EMBASE databases were searched. Probing pocket depth (PPD) and clinical attachment level (CAL) and their changes were selected as outcome variables. Subgroup analyses were performed according to the following active ingredients: essential oils (EO), povidone–iodine (PVP), and chlorhexidine (CHX). Results: Screening of 100 unique papers resulted in 14 eligible publications, including 16 comparisons. The meta-analysis (MA) showed that when the ultrasonic cooling solution had adjuvant chemotherapeutic properties, the difference of means (DiffM) for end value PPD-0.12 (95% CI: −0.42; 0.18) and for CAL the DiffM+-0.13 (95% CI: −0.39; 0.14). None of these were statistically significant, and the findings were supported by the overall descriptive analysis. Subgroup analysis only revealed a small effect for PVP on the difference (DiffM = −0.23, 95% CI: −0.43; −0.02) with respect to CAL (p = 0.03). Conclusions: The collective evidence indicates that overall, no additional effects were observed. There is a “very weak” recommendation based on the sub-analysis showing that in conjunction with PVP, a very small gain in CAL may be expected. For the use of CHX or EO, the added effect can be considered to be “zero.” Therefore, the strength and direction of the recommendation emerging from this review is against their use

Adjunctive clinical effect of a water-cooled Nd:YAG laser in a periodontal maintenance care programme: a randomized controlled trial

Background Various laser systems are currently available for intra-oral use. Neodymium:Yttrium-Aluminium Garnet lasers(Nd:YAG) have been approved by the US Food and Drug Administration for soft tissue treatment in the oral cavity. Objectives The aim of this study was to test whether the use of a water-cooled Nd:YAG laser during a maintenance care programme as an adjunct to supragingival and subgingival debridement (scaling and root planing, SRP) with hand and ultrasonic instruments results in clinical improvement compared with SRP alone. Material and Methods This study was an examiner-blind, randomized and controlled clinical trial using a split-mouth design. Thirty subjects were selected, originally diagnosed with moderate to severe generalized periodontitis, following a periodontal maintenance care programme (PMC). Immediately after SRP in two randomly assigned contra-lateral quadrants, all pockets ≥5 mm were additionally treated with a Nd:YAG laser (1064 nm, 4W, 250-μsec pulse). Clinical assessments [probing pocket depth PPD, bleeding on pocket probing (BOPP)] were performed pre-treatment and at 6 months. Based on these assessments, the periodontal inflamed surface area (PISA) was calculated. Results At 6 months, the clinical parameters had significantly improved for both regimens. No statistically significant differences between treatment modalities were observed for PPD and BOPP scores at any time. PISA scores supported these findings. Conclusions In residual pockets ≥5 mm, treated in a PMC, the adjunctive use of an Nd:YAG laser does not provide a clinically significant additional advantage

The effect of the thermal diode laser (wavelength 808-980 nm) in non-surgical periodontal therapy: a systematic review and meta-analysis

Focused question What is the adjunctive effect of a diode laser (DL) following non-surgical periodontal debridement (SRP) during the initial phase of periodontal therapy on the clinical parameters of periodontal inflammation. Material and Methods The MEDLINE-PubMed, Cochrane-Central Register of Controlled Trials and EMBASE databases were searched up to September 2013. Probing pocket depth (PPD) and clinical attachment loss (CAL) were selected as outcome variables. Also plaque scores (PS), bleeding scores (BS) and the Gingival Index (GI) were considered outcome measures. Data were extracted and a meta-analysis (MA) was performed where appropriate. Results Independent screening of 416 unique papers resulted in nine eligible publications. The MA evaluating PPD, CAL and PS showed no significant effect. The only significance favouring adjunctive use of the DL was observed for the outcome parameters GI and BS. Conclusion The collective evidence regarding adjunctive use of the DL with SRP indicates that the combined treatment provides an effect comparable to that of SRP alone. That is for PPD and CAL. The body of evidence considering the adjunctive use of the DL is judged to be "moderate" for changes in PPD and CAL. With respect to BS, the results showed a small but significant effect favouring the DL, however, the clinical relevance of this difference remains a question. This systematic review questions the adjunctive use of DL with traditional mechanical modalities of periodontal therapy in patients with periodontitis