What are the benefits of laser therapy?

This response summary is based on “Laser-Assisted Nonsurgical Periodontal Therapy” in Principles and Practice of Laser Dentistry (2nd Edition), Elsevier, 2016

Mary Lynn Smith & Angie Mott

In any periodontal therapy, it is essential that contaminants be thoroughly removed from the tooth structure. Lasers have a direct damaging effect on bacteria, supporting the body’s healing response. Incorporating lasers into conventional therapies helps accomplish treatment objectives.

Instrumentation in conventional non-surgical periodontal therapy focuses on the tooth structure and debridement most often is accomplished by means of manual and power scaling. In the future, lasers also will be used for root debridement.

Although the U.S. Food and Drug Administration (FDA) has not yet cleared the use of lasers for removal of deposits and biofilm from tooth structure, some studies suggest there are benefits in using lasers. It should be emphasized that laser treatment is an addition to, not a replacement for, conventional periodontal therapy.

• Deposits and biofilm are more thoroughly removed and a more biocompatible surface is created for reattachment with use of an erbium laser than with con­ventional methods. (1, 2)
• The carbon dioxide (CO2) laser has been shown to increase adherence of fibroblasts to root surfaces, and the fibroblast adherence is superior to conventional techniques both in quantity of fibroblasts attached and in the quality of the attachment. (3)
• The argon (Ar), neodymium-doped yttrium-aluminum-garnet (Nd:YAG), and diode laser wavelengths show strong absorption in darkly pigmented bacteria, with a consequent direct, increased effect on the red and orange–complex bacteria associated with periodontitis. (4)
• Both CO2 and erbium lasers act on pathogens by heating intracellular fluids, causing the microbes to collapse. (5, 6) The absorption of laser energy by tissues produces a photothermal effect. With use of the appropriate settings, most non-sporulating bacteria, including anaerobes, are readily deactivated at 50° C. (7, 8)
• In laser-assisted active phase I periodontal infection therapy, the diseased biofilm-infested tissues of periodontal pockets are debrided. With laser techniques that involve working close to the recommended parameter of 60° C (9), the healthy tissue beneath the non-healing granulation layer is not affected by the low energy.
• It was reported that the bleed­ing index improved in 96.9% of the patients treated with laser-assisted periodontal therapy after conventional therapy, compared with 66.7% of patients treated convention­ally without laser: “the diode laser assisted periodontal therapy provided a bacteri­cidal effect, reduced inflammation, and supported healing of periodontal pockets through elimination of bacteria.” (10)
• Lasers have the ability to seal capillaries and lymphatics, and therefore, reducing swelling at the treated site and minimizing postoperative discomfort. (11)
• Another benefit is the healing stimulated at the cellular level. (12) Low-level laser treatment depresses the exudative phase while enhancing the proliferative processes during acute and chronic inflammation. Laser photobio-modulation can activate the local blood circulation and stimulate proliferation of endothelial cells. (13, 14)

References

1. Aoki A, Sasaki KM, Watanabe H, Ishikawa I: Lasers in nonsurgi­cal periodontal therapy, Periodontol 2000(36):59–97, 2004.
2. Schwarz F, Sculean A, Berakdar M, et al.: In vivo and in vitro effects of an Er:YAG laser, a GaAlAs diode laser and scaling and root planing on periodontally diseased root surfaces: a compara­tive histologic study, Lasers Surg Med 32:359–366, 2003.
3. Crespi R, Barone A, Covanin U, et al.: Effects of CO2 laser treat­ment on fibroblast attachment to root surfaces: an SEM analysis, J Periodontol 73:1308–1312, 2002.
4. Finkbeiner RL: The results of 1328 periodontal pockets treated with the argon laser: selective pocket thermolysis, J Clin Laser Med Surg 13:273–281, 1995.
5. Kreisler M, Kohnen W, Marinello C, et al.: Bactericidal effect of the Er:YAG laser radiation on dental implant surfaces: an in vitro study, J Periodontol 73(11):1292–1298, 2002.
6. Alling C, Catone G: Laser applications in oral and maxillofacial surgery, Philadelphia, 1997, Saunders.
7. Coluzzi DJ, Convissar RA: Atlas of laser applications in dentistry, Chicago, 2007, Quintessence.
8. Cobb CM: Non-surgical pocket therapy: mechanical, Ann Peri­odontol 1:443–490, 1996.
9. Manni JG: Dental applications of advanced lasers, Burlington Mass, 2004, JGM Associates.
10. Moritz A, Schoop U, Goharkhay K, et al.: Treatment of peri­odontal pockets with a diode laser. Department of Conservative Dentistry, Dental School of the University of Vienna, Austria, Lasers Surg Med 22(5):302–311, 1998.
11. Gans SL, Austin E: The use of lasers in pediatric surgery, J Pediatr Surg 23(8):695–704, 1988.
12. Jia YL, Guo ZY: Effect of low-power He-Ne laser irradiation on rab­bit articular chondrocytes in vitro, Lasers Surg Med 34(4):323–328, 2004.
13. Schindl A, Schindl M, Schindl L, et al.: Increased dermal angio­genesis after low-intensity laser therapy for a chronic radiation ulcer determined by a video measuring system, J Am Acad Dermatol 40(3):481–484, 1999.
14. Garavello I, Baranauskas V, da Cruz-Hofling MA: The effects of low laser irradiation on angiogenesis in injured rat tibiae, Histol Histopathol 19(1):43–48, 2004.