|Year : 2018 | Volume
| Issue : 1 | Page : 14-17
The effect of low-level laser therapy on nonsurgical periodontal therapy: A clinico-biochemical study
Ashank Mishra1, Naveed Shergill2
1 Department of Periodontics, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
2 General Dentist, Dental Expert Clinic, Hyderabad, Telangana, India
|Date of Web Publication||27-Jun-2018|
Dr. Ashank Mishra
Department of Periodontics, Sri Sai College of Dental Surgery, Vikarabad, Telangana
Source of Support: None, Conflict of Interest: None
Aim of the study: To evaluate the effect of low-level laser therapy, as an adjunct to non-surgical periodontal treatment, on periodontal clinical and biochemical parameter i.e CRP. Materials and Methods: The study was designed as a randomized, controlled, single-blind, split-mouth clinical trial. Systemically healthy persons diagnosed with chronic periodontitis and presence of at least two bilateral maxillary premolars with ≥5-mm periodontal pocket depth were included in the study. The PPD, CAL,MGİ and SBI were measured at the baseline and at 1 and 3 months after periodontal treatment. Gingival crevicular fluid samples were taken at the baseline , 1 month and 3 months after treatment. The LLLT application was made in four sessions: after periodontal treatment, on the third day, and on the seventh day post-treatment. LLLT was applied in non-contact mode and tip tissue distance was approximately 1cm on every tooth on the test side for 15 s in the continuous mode, at 0.5 W and with an application tip 1 cm in diameter. Results: Intra group comparison for both the groups showed significant difference from baseline to one month for MGI and SBI and PD showed significant difference only in the test group , whereas from baseline to three months all the parameters showed statistically significant difference. Intergroup comparison between the groups showed statistically significant differences between MGI, SBI and CRP levels. Conclusion: Within the limitations of this study, LLLT in addition to non surgical periodontal treatment, has positive impact.
Keywords: C-reactive protein, low-level laser therapy, periodontitis
|How to cite this article:|
Mishra A, Shergill N. The effect of low-level laser therapy on nonsurgical periodontal therapy: A clinico-biochemical study. J Dent Lasers 2018;12:14-7
|How to cite this URL:|
Mishra A, Shergill N. The effect of low-level laser therapy on nonsurgical periodontal therapy: A clinico-biochemical study. J Dent Lasers [serial online] 2018 [cited 2018 Sep 22];12:14-7. Available from: http://www.jdentlasers.org/text.asp?2018/12/1/14/235377
| Introduction|| |
Periodontal diseases are chronic immunoinflammatory diseases caused by interactions between pathogenic bacteria and host response. Periodontal diseases can result in the loss of teeth-supporting tissue and teeth. The main goal in the treatment of these diseases is the elimination of supragingival and subgingival microbial biofilm and/or calculus which can be achieved by scaling and root planing. In this regard, nonsurgical periodontal treatment is the primary therapy, and its effectiveness has been documented by numerous literature.
However, in few cases, more comprehensive therapies are needed. Research is ongoing to improve the effectiveness of nonsurgical periodontal therapy and reduce patient compliance requirements after treatment with additional modalities such as employing chemotherapeutic agents or lasers.
In recent years, various studies have been done to increase the effectiveness of nonsurgical periodontal treatment; one such promising modality is the use of lasers. Recently, low-level laser therapy (LLLT) has become popular with clinicians, primarily because of its anti-inflammatory and biostimulatory effects. There is a dearth of studies about the adjunctive use of LLLT with nonsurgical periodontal treatment.
There is a concept of periodontitis, which shows an effect, created by the dissemination of systemic mediators such as C-reactive protein (CRP), interleukin-6 (IL), and tumor necrosis factor-α (TNF-α). This type of response is activated either by the local infection of bacteria, resulting in inflammatory damage of periodontal tissue or by the systemic spread of bacteria and/or their toxins and products during the course of periodontal disease. These bacterial pathogens, bacterial antigens, endotoxins, and inflammatory cytokines such as CRP, IL-1, and TNF-α contribute and modify the process of atherogenesis and thromboembolic events.,,
Thus, the present study evaluates the effect of LLLT, as an adjunct to nonsurgical periodontal treatment, on periodontal clinical and biochemical parameter, i.e. CRP.
| Materials and Methods|| |
Twenty adults diagnosed with chronic generalized periodontitis, according to the American Academy of Periodontology 1999 criteria, were recruited from FMS Dental Hospital, Hyderabad, India, for inclusion in this study between October 2016 and February 2017. The Ethics Committee of Sri Sai College of Dental Surgery approved the protocol for this study. All participants were given information about the study, and oral and written informed consent was obtained from all participants.
The study was designed as a randomized, controlled, single-blind, split-mouth clinical trial. The inclusion criteria for the study were (i) systemically healthy persons aged 18 years and above diagnosed with chronic periodontitis and (ii) the presence of at least two bilateral maxillary premolars with ≥5 mm probing pocket depth (PPD).
The exclusion criteria were (i) pregnant or lactating women; (ii) the use of antibiotics, anti-inflammatory drugs, hormones, or immunosuppressive agents during 6 months before the study; or (iii) any dental treatment during the last 1 year before the study.
The probing pocket depth (PPD), clinical attachment level (CAL), modified gingival index (MGI), and sulcus bleeding index (SBI) were measured using UNC-15 (Hu-Friedy, Chicago, IL, USA) from six areas (mesiobuccal, midbuccal, distobuccal, mesiopalatal, midpalatal, and distopalatal) of each tooth to determine each individual's periodontal status. The results were recorded at the baseline (visit 1) and at 1 and 3 months after periodontal treatment. PPD is the distance between the bottom of the periodontal pocket and the free gingival margin, whereas CAL is defined as the distance between the bottom of the periodontal pocket and the cementoenamel junctions. One examiner (NS), who was blinded to the treatment procedures, performed the clinical examination and collected the gingival crevicular fluid (GCF) samples.
Gingival crevicular fluid sampling
GCF samples were taken at the baseline (visit 1), 1 month, and 3 months after treatment. For the samples, contralateral maxillary premolar teeth with 5–7 mm of pocket depth were preferred [Figure 1], [Figure 2], [Figure 3]. The teeth were isolated with cotton rolls, and the area was gently dried with air spray vertically to the long axis of the tooth. GCF was collected using a microcapillary pipette that was calibrated at 0–5 μL range (Sigma Chemical Company, St. Lowis, MO, USA) using the extracrevicular method. Patients selected were seated comfortably in the dental chair with proper illumination. Supragingival plaque obstructing access to the entrance of the crevice was carefully removed using a sterile sickle scaler. Calibrated glass micropipettes were placed at the opening of the gingival crevice and fluid was collected for a period of 15–20 min. It was then transferred to a glass vial containing 100 μL of phosphate buffer (pH 7, 0.05 M) solution containing 0.1% w/v bovine serum albumin and stored at −80°C until assay. The glass vial was immediately taken to the laboratory for analysis using ELISA.
In the first visit, clinical measurements of the patients were made by NS. The patients included in the study were separated into two sites for the split-mouth treatment protocol. The site that would receive the LLLT application was determined by a coin flip randomization technique. Both the periodontal treatment and LLLT were performed by a single practitioner (AM), 1 day after the first visit. In the same visit, before treatment, control and GCF samples were taken from the predetermined premolar teeth including one tooth from the control and one from the test region. On this appointment (visit 2), full-mouth supragingival and subgingival scaling and root planing were performed within 24 h (one side in a morning session and the other side in an afternoon session) under local anesthesia if necessary.
These procedures were carried out with ultrasonic devices (Piezon, OEM Built-in Kit, EMS, Switzerland) and curettes (Gracey Curette, SG 1/2, 3/4, 5/6, 7/8, 11/12, 13/14; Hu-Friedy, USA). LLLT application was provided from the buccal surface with a GaAlAs diode laser at 810 nm wavelength (Alan Miller Designed Picasso, Dentsply). LLLT applied noncontact and tip tissue distance was approximately 1 cm. LLLT was applied on every tooth on the test side for 15 s in the continuous mode, at 0.5 W, and with an application tip 1 cm in diameter. The area covered by the ray beam coming out of the application tip was approximately 0.785 cm 2, and the density of energy applied (if π =3.14) was 7.64 J/cm 2. The LLLT application was made in four sessions: after periodontal treatment (visit 2), on the 3rd day (visit 3), and on the 7th day (visit 4) posttreatment.
Data were analyzed using the statistical software, Statistical Package for the Social Sciences version 20.0 for Windows (SPSS Inc., Chicago, IL, USA). Since the data demonstrated normal distribution, parametric test, namely, Student's t-test and ANOVA used for intragroup comparisons. Independent t-test was used to assess intergroup variations, and P < 0.01 was considered statistically significant.
| Results|| |
Intragroup comparison for both the groups showed a significant difference from baseline to 1 month for MGI and SBI, and PD showed a significant difference only in the test group [Table 1], whereas from baseline to 3 months, all the parameters showed statistically significant difference [Table 2]. Intergroup comparison between the groups showed statistically significant differences between MGI, SBI, and CRP levels [Table 3].
| Discussion|| |
Nonsurgical periodontal therapy, with adjunctive treatment options such as LLLT, is a well-established modality in treating chronic periodontitis. The present split-mouth study evaluates LLLT effects as an adjunct to nonsurgical treatment of chronic periodontitis.
The results of the present study demonstrate that the adjunct use of LLLT promotes clinical improvements in terms of gingival inflammation. In addition, LLLT has the ability to promote CRP levels modulation. With respect to clinical outcomes, the present study demonstrated improvements in terms of MGI and SBI (gingival inflammatory indices) in sites treated with the LLLT + scaling and root planning (SRP) compared to sites treated with SRP alone. It is very uncertain to attribute the improvement in the inflammation to laser irradiation per se. It is noteworthy that biochemical parameter, i.e. CRP level showed statistically significant difference, and it may have related with minor clinical improvements.
Previous studies on the adjunct use of LLLT in treating chronic periodontitis are few and have discrete results. In accordance with our results, Qadri et al. reported statistically significant decrease in GI levels for the LLLT group compared with SRP alone, but a split-mouth study stated no statistical difference between the LLLT and control groups in plaque index and GI levels and that there was a statistical difference for PPD levels in the short term but not in the long term. Another parallel-designed study by Aykol et al. reported that LLLT results in a statistically significant decrease in PPD and CAL levels in the 1st, 3rd, and 6th months.
We think that these inconsistencies in the previous literature are related with lasers nature (such as penetration depth), study design, and laser duration. It is difficult to choose ideal laser and parameters due to lack of studies. The parameters used in the present study may not be optimal but have been within a therapeutic window of 1–2 J/cm 2.
Currently, lasers are being used and researched both in combination with in-pocket disinfection methods and for speeding up wound recovery and possible anti-inflammatory effects. Despite this, the ideal means for using LLLT in addition to SRP are not currently available. The data from our clinical trial indicate that LLLT adjunct to SRP improves clinical parameters.
| Conclusion|| |
We are of the opinion that more research should be focused on the kind of cellular interactions through which the clinically observed minor positive changes take place through LLLT application in addition to nonsurgical periodontal treatment. We think that LLLT use, in addition to periodontal treatment, will increase treatment efficacy and further insight into this is warranted.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999;4:1-6.
Cobb CM. Clinical significance of non-surgical periodontal therapy: An evidence-based perspective of scaling and root planing. J Clin Periodontol 2002;29 Suppl 2:6-16.
Cobb CM. Lasers in periodontics: A review of the literature. J Periodontol 2006;77:545-64.
Claesson R, Johansson A, Belibasakis G, Hänström L, Kalfas S. Release and activation of matrix metalloproteinase 8 from human neutrophils triggered by the leukotoxin of actinobacillus actinomycetemcomitans. J Periodontal Res 2002;37:353-9.
Fiorellini J, Kim D, Ishikawa S. The gingiva. In: Newman M, Takei H, Klokkevold P, Carranza F, editors. Carranza's Clinical Periodontology. 10th
ed. Philadelphia: Saunders Elsevier; 2006. p. 46-67.
Reinhardt RA, Stoner JA, Golub LM, Lee HM, Nummikoski PV, Sorsa T, et al.
Association of gingival crevicular fluid biomarkers during periodontal maintenance with subsequent progressive periodontitis. J Periodontol 2010;81:251-9.
Qadri T, Miranda L, Tunér J, Gustafsson A. The short-term effects of low-level lasers as adjunct therapy in the treatment of periodontal inflammation. J Clin Periodontol 2005;32:714-9.
Makhlouf M, Dahaba MM, Tunér J, Eissa SA, Harhash TA. Effect of adjunctive low level laser therapy (LLLT) on nonsurgical treatment of chronic periodontitis. Photomed Laser Surg 2012;30:160-6.
Aykol G, Baser U, Maden I, Kazak Z, Onan U, Tanrikulu-Kucuk S, et al
. The effect of low-level laser therapy as an adjunct to non-surgical periodontal treatment. J Periodontol 2011;82:481-8.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]