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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) 25543679 | Sanz-Sánchez/2014 | Chronic Periodontitis | Randomized Controlled Trial | Key results | The 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) 26113099 | Smiley/2015 | Chronic Periodontitis | Meta-Analysis | Key results | For 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) 18597597 | Lopes/2008 | Chronic Periodontitis | Randomized Controlled Trial | Key results | In 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: |
05/05/2016 |
E-mail |
tatschc@livemail.uthscsa.edu |
Author |
Casey Tatsch |
Co-author(s) |
|
Co-author(s) e-mail |
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Faculty mentor/Co-author |
Archie Jones, DDS, MBA |
Faculty mentor/Co-author e-mail |
JonesA@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?) |
post a rationale |
None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
None available | |
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