[A quadrant-design trial of four therapeutic modalities in chronic moderate periodontitis].
This randomized clinical study (blind and controlled) compared the effectiveness of an ER:YAG laser (combined with a calculus detection system using fluorescence induced by diode laser radiation for use in non-surgical periodontal therapy) as well as sonic and ultrasonic scalers and scaling and root planning with hand instruments to each other. 72 patients suffering from moderate chronic periodontitis (based on a probing depth of 4 mm or more of at least one tooth in each quadrant) were treated using either an Er:YAG-Laser (KEY 3, KaVo), a piezo-electric ultrasonic system (Piezon Master 400, EMS), a sonic scaler (Sonicflex 2003 L, KaVo), or Gracey Mini-five curettes (Hu Friedy) (control). These four kinds of treatment were randomized and grouped into quadrants. Oral health indicators, probing depths (PD) and clinical attachment levels were examined before commencement of the hygiene phase as well as three months after by a blind, calibrated examination. Within the study period, the mean PD (+/- SE) of the control group fell from 4.40 (0.03) mm to 3.08 (0.03) mm; for the laser group, the reduction was slightly greater, falling from 4.47 (0.04) mm to 3.08 (0.03). In comparison, values for the ultrasonic group were 4.39 (0.04) mm in the pre-study examination and 3.09 (0.04) after treatment; in the sonic group, the values were 4.40 (0.03) mm pre-study and 3.07 (0.03) mm post-study. Within the control group, the mean CAL (+/- SE) decreased from 4.95 (0.07) mm to 3.92 (0.07) mm. Within the laser group, the reduction was more distinct, falling from 5.05 (0.07) mm to 3.88 (0.07) mm. In the ultrasonic group, the median CAL decreased from 5.02 (0.08) mm to 3.88 (0.08) mm and from 4.95 (0.07) mm to 3.84 (0.08) mm within the sonic group. From the date of treatment until the third month thereafter, all of the clinical parameters were shown to be statistically significant (p < 0.0001; GEE). Use of the laser led to a much greater reduction in PD levels (p = 0.0021; GEE) than in the ultrasonic group and demonstrated a higher increase in CAL (p = 0.0010; GEE) relative to the manual methods.


CONCLUSIONS
All four methods of treatment lead to a clinically comparable outcome.
Nonhoff
Jörg
J
Poliklinik für Zahnerhaltungskunde und Parodontologie, Klinik und Polikliniken für Zahn-, Mund- und Kieferheilkunde, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin. joerg.nonhoff@charite.de
Derdilopoulou
Foteini
F
Neumann
Konrad
K
Kielbassa
Andrej M
AM
D000328:Adult; D000368:Aged; D003762:Dental Instruments; D003774:Dental Plaque Index; D012534:Dental Scaling / Q000295:instrumentation* / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D053685:Laser Therapy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010512:Periodontal Index; D010518:Periodontitis / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D014464:Ultrasonic Therapy