ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Antimicrobial Laser Therapy Is an Effective Adjunct to Non-Surgical Periodontal Therapy (NSPT) When Treating Aggressive Periodontitis As Compared to NSPT Alone
Clinical Question In patients with aggressive periodontal disease, does the adjunctive use of dental lasers with non-surgical periodontal therapy (NSPT) produce a significant effect in tissue healing and pocket depth reduction as compared to traditional NSPT alone?
Clinical Bottom Line The adjunctive use of dental lasers in non-surgical periodontal therapy is more effective when treating aggressive periodontitis than NSPT alone. This is supported by a systematic review performed in 2015, which included many randomized control trials and concluded that the benefits in pocket reduction, bleeding upon probing, and gingival recession were greater with the addition of dental laser therapy. This systematic review and a clinical trial by Annaji in 2016 also showed that the use of dental lasers reduced the bacterial count in the pockets significantly with a p value ranging from 0.000-0.032.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26184762Vohra/2016144 subjects in 7 randomized control trialsSystematic review of randomized trials
Key resultsFive of the 7 studies included in this review reported measurements of periodontal parameters (BOP, Pocket Depth, CAL, and Recession) at post-treatment intervals of 12-24 weeks. Three studies showed significant improvement of the test groups (SCRP with adjunct of laser therapy) as compared to SCRP alone, the other two studies showed no significant difference between the two groups. One study measured bacterial count and showed that laser therapy resulted in a significantly lower count of bacteria in the test group. The conclusion of this review indicates there are clinical advantages to the addition of lasers in connection with SCRP. However, with two studies showing no significant difference, further research is needed for a more definitive answer.
#2) 27042576Annaji/201615 untreated aggressive periodontitis patients Randomized Controlled Trial
Key resultsThis study compared the bacteria count before treatment and at 1 month and 3 months post-therapy using p < 0.05 to show statistical significance. The quadrants that were treated with laser therapy showed a significant reduction in bacteria count, especially at 3 months post-therapy with the reduction of Aggregatibacter actinomycetemcomitans (p=0.000) and black pigmented bacteroids (p=0.032.) This study showed significant benefit for the use of lasers with NSPT.
Evidence Search ("laser therapy"[MeSH Terms] OR ("laser"[All Fields] AND "therapy"[All Fields]) OR "laser therapy"[All Fields]) AND ("aggressive periodontitis"[MeSH Terms] OR ("aggressive"[All Fields] AND "periodontitis"[All Fields]) OR "aggressive periodontitis"[All Fields])
Comments on
The Evidence
Validity: The articles reviewed in this CAT were valid evidence based on the systematic review examining multiple randomized control trials and the Annaji study being a single-blind randomized control trial. There was no evidence of bias or competing interests in either of the articles published. Perspective: I found that laser therapy is an easy skill to learn and something that a hygienist can master through the proper CE courses. Many patients accept the addition of laser therapy when presented with the evidence. Given the evidence provided in the CAT, I believe laser therapy is a valuable adjunct to any treatment of aggressive periodontitis.
Applicability The addition of laser therapy in conjunction with NSPT will require minimal additional chair time. Some disadvantages of laser therapy include the initial cost of the dental lasers (which can exceed $3000), plus the needed training and required state laser certifications. The cost to the patient is also a concern; many patients are surprised to learn they need NSPT. Adding the cost of laser therapy will require explaining the benefits of the therapy to the patient. Considering the evidence presented, the standard treatment for patients with aggressive periodontitis should include NSPT and laser therapy in general practices as well as periodontal specialty practices. Finally, the addition of performing the laser therapy in connection with NSPT for patients with aggressive periodontitis can be implemented in both general practices as well as periodontal specialists’ practices with ease.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords laser therapy, non-surgical periodontal therapy, aggressive periodontitis, periodontal maintenance, localized aggressive periodontitis
ID# 3168
Date of submission: 03/22/2017spacer
E-mail hurstd@livemail.uthscsa.edu
Author David Hurst, RDH
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Mary Jacks RDH, MS
Faculty mentor/Co-author e-mail jacks@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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