UTCAT613, Found CAT view, CRITICALLY APPRAISED TOPICs

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Title

The Efficacy Of Low-Level Laser Therapy In Treating Periodontitis

Clinical Question

In patients with periodontitis, does low-level laser therapy in addition to scaling and root planing reduce periodontal inflammation more effectively than treatment with scaling and root planing alone?

Clinical Bottom Line

In treating periodontitis, the effectiveness of the addition of low-level laser therapy to scaling and root planing is currently unclear in decreasing periodontal inflammation compared to treating with scaling and root planing alone due to discrepancies between the clinical results presented in the researched randomized controlled trials. (See Comments on the CAT below)

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) 15966876	Qadri/2005	Seventeen patients with moderate periodontitis	Split Mouth Randomized Controlled Trial
Key results	In this split-mouth clinical trial, each patient received scaling and root planing treatment on all teeth. The low-level laser therapy began approximately two weeks later and was performed for six weeks on the upper jaw, whereas the lower jaw was treated with a placebo. As a result, the probing pocket depth decreased significantly more on the laser-treated side than the placebo-treated side (p < 0.001). The gingival and plaque indices were both reduced more on the laser side as well (p < 0.001). The gingival crevicular volume reduction was greater on the laser-treated side than the placebo side (p = 0.01). The amount of metalloproteinase-8 (MMP-8) measured in the gingival crevicular fluid increased on the placebo side but decreased on the laser side (p = 0.052). The elastase activity and interleukin-1β concentration measured in the gingival crevicular fluid showed no significant differences between the two sides. This data suggests that treatment with low-level laser therapy reduces periodontal gingival inflammation in patients with moderate periodontitis.
#2) 19903643	Angelov/2009	Sixty subjects with chronic advanced periodontitis	Comparative Study; Randomized Controlled Trial
Key results	In this trial, sixty patients were divided randomly into three twenty-subject groups. Group A received scaling and root planing treatment without low-level laser treatment (which included scaling and root planing one quadrant each day for four days and on the fifth day all quadrants were scaled again). Group B received the same treatment as group A plus low-level laser treatment for five days. Group C received the same treatment as group B but the low-level laser treatment was extended to ten days. The plaque index, gingival index, and sulcular bleeding index where recorded for each group, and as a result, these clinical measurements demonstrated statistically significant differences (p < 0.005) compared to the initial values. In comparison to group A, groups B and C reported greater statistically significant differences in improvement of the clinical factors. Therefore, according to the data found, low-level diode laser treatment in addition to scaling and root planing does have a favorable effect when treating inflammatory chronic advanced periodontitis.
#3) 18785848	Lai/2009	Sixteen patients diagnosed with moderate to advanced chronic periodontitis	Randomized Controlled Trial
Key results	In this study, sixteen patients were recruited. At baseline and also at 3, 6, 9, and 12 months, the supragingival plaque, bleeding on probing, probing pocket depth, and probing attachment level were recorded. The gingival crevicular fluid samples and intra-oral radiographs were taken at the same time periods, but also were done at a 1 month period as well. After non-surgical mechanical periodontal treatment was performed, test sites were chosen randomly (through a coin toss) and given laser therapy with a low-power He-Ne laser. This was done 8 times and lasted 10 minutes each time during the first 3-month period. As a result, the study found that the subgingival plaque level and bleeding on probing decreased greatly after 12 months (83%-16%, 95%-34%, respectively). Reductions of probing pocket depth, and gingival crevicular fluid volume were noted, as well as an increase in the probing attachment level and in recession in both control and test sites compared to the start levels (p < 0.05). There were no statistically significant differences in any of the information recorded between the control and the test sites. Due to the result of no significant findings, it was concluded that the laser treatment used in addition to non-surgical periodontal therapy did not give any supplementary clinical benefit to the patients.

Evidence Search

ReviewRandomized Controlled Trial, Search "Root Planing"[Mesh] Search "Laser Therapy, Low-Level"[Mesh]"Periodontal Diseases"[Mesh] Search "Periodontitis"[Mesh]

Comments on
The Evidence

In the articles found, the study design was a randomized controlled clinical trial. The groups in each trial were similar at start, the first patient group having moderate periodontitis, the second having chronic advanced periodontitis, and the third patient group was diagnosed with moderate to advanced chronic periodontitis. The completion rate was greater than 90%, and the groups were treated the same throughout both of the trials. An adequate follow-up was performed in each study in order to evaluate the evidence. The first article consisted of a clinical trial which was a double-blind study, whereas it is uncertain whether the second or third clinical trials were double-blinded. The compliance for treatment was adequate in all randomized controlled trials. Overall, the results found in both the first two clinical trials in the articles researched demonstrate strong evidence for an increase in the reduction of periodontal inflammation using low-level laser therapy in addition to scaling and root planing as opposed to treating with only scaling and root planing. However, findings from the third clinical trial contradict the first two, stating that there are no significant differences or clinical benefits in the addition of low-level laser therapy to non-surgical periodontal therapy. In conclusion, low-level laser therapy for periodontal treatment is still a new area of research that is currently growing. The differences in the results presented suggest that more studies must be done and taken into consideration to confirm that low-level laser therapy is a valid adjunct therapy that can be applied in treating periodontitis and contribute to improving periodontal health.

Applicability

The information presented for this CAT can apply to a diverse group of patients since periodontal therapy is an important aspect of overall oral hygiene. Patients who go to a general dentist or periodontist to receive scaling and root planning treatment could also consider receiving low-level laser therapy to improve the outcome of their treatment in the future. Once there have been more studies done to confirm if low-level laser therapy does demonstrate better periodontal results than that with scaling and root planing alone, this evidence will be applicable to many patients who visit their dentist for routine periodontal therapy.

Specialty/Discipline

(General Dentistry) (Periodontics) (Dental Hygiene)

Keywords

Periodontal disease, Low-level laser therapy, Scaling and root planing

ID#

613

Date of submission:

04/08/2010

E-mail

Popatia@livemail.uthscsa.edu

Author

Shaheen Popatia

Co-author(s)

Co-author(s) e-mail

Faculty mentor/Co-author

Vidya Sankar, DMD, MHS

Faculty mentor/Co-author e-mail

SankarV@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

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

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