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Title Adjunctive Erbium:yttrium-Aluminum-Garnet Laser Treatment (ER:YAG) With Scaling And Root Planing (SRP) Shows Negligible Evidence In Decreasing Probing Depth More Effectively Than SRP Alone
Clinical Question In individuals with chronic periodontitis will adjunctive erbium:yttrium-aluminum-garnet laser treatment with scaling and root planing decrease probing depth more effectively than scaling and root planing alone?
Clinical Bottom Line Statistically, studies have shown improvement with the adjunctive ER:YAG and SRP but the improvement is negligible and probably not an effective option clinically considering the cost and time put forth by the additional treatment.
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) 25543679Sanz-Sánchez/2014Chronic PeriodontitisRandomized Controlled Trial
Key resultsThe 12 month follow up showed that ER:YAG combined with SRP had a significantly lower percentage of periodontal depths > 4.5 mm when compared to SRP alone (17.44% versus 22.83%; P=0.004). This article was statistically significant but of questionable clinical significance. In addition, a potential design flaw was noted.
#2) 26113099Smiley/2015Chronic PeriodontitisMeta-Analysis
Key resultsFor the three studies that the systemic review evaluated it showed that SRP and ER:YAG had a 0.18 mm gain in clinical attachment level (CAL) over SRP alone (95% CI, -0.63 to 0.98). The author concluded the level of certainty was low and the results are not significant at a p value less than 0.05.
#3) 18597597Lopes/2008Chronic PeriodontitisRandomized Controlled Trial
Key resultsIn this short term clinical trial (30 days) the SRP plus ER:YAG had no significant differences in CAL over SRP alone.
Evidence Search (Adjunctive[All Fields] AND ("erbium"[MeSH Terms] OR "erbium"[All Fields])) AND (("lasers, solid-state"[MeSH Terms] OR ("lasers"[All Fields] AND "solid-state"[All Fields]) OR "solid-state lasers"[All Fields] OR ("yttrium"[All Fields] AND "aluminum"[All Fields] AND "garnet"[All Fields] AND "laser"[All Fields]) OR "yttrium aluminum garnet laser"[All Fields]) AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND ("lasers"[MeSH Terms] OR "lasers"[All Fields] OR "laser"[All Fields]))
Comments on
The Evidence
Validity: A meta-analysis was performed in the systematic review, but since there were very few studies analyzed the bias was not assessed. The individual studies were tested for their validity and were all randomized clinical trial with a total of 225 analyzed patients in 5 trials. There is also a potential design flaw in the Sanz-Sánchez study in that the groups were treated by different operators. Although not specific to adjunctive ER:YAG therapy other low level laser therapies have shown similar results as seen in “The Efficacy Of Low-Level Laser Therapy In Treating Periodontitis” by Popatia (CAT ID: #613). Perspective: In the 12 month trials there was a statistical improvement in pocket depths when ER:YAG was combined with SRP while the short term clinical trials showed no significant difference when compared to SRP alone. In a longer treatment term the ER:YAG plus SRP may be a viable option, however, the actual clinical significance seems negligible. Also it must be noted that the studies reported their results in both CAL and pocket depth and were analyzed as a viable substitute for one another.
Applicability The ER:YAG laser treatment adjunctive with SRP has shown to be effective at decreasing pockets depths after 12 months of treatment while the Lopes study showed no significant improvement in CAL over a short 30 day clinical term. Clinically, adjunctive ER:YAG may not be a viable option considering the results were minimal and a potential bias due to a design flaw. More studies need to be conducted to support evidence that adjunctive ER:YAG with SRP is an effective treatment.
Specialty/Discipline (Periodontics)
Keywords Chronic Periodontics, ER:YAG laser, scaling and root planing
ID# 3071
Date of submission: 05/05/2016spacer
E-mail tatschc@livemail.uthscsa.edu
Author Casey Tatsch
Co-author(s) e-mail
Faculty mentor/Co-author Archie Jones, DDS, MBA
Faculty mentor/Co-author e-mail JonesA@uthscsa.edu
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