Adjunctive use of the diode laser in non-surgical periodontal therapy: exploring the controversy.
Despite the controversy regarding clinical efficacy, dental hygienists use the diode laser as an adjunct to non-surgical periodontal therapy. The technique to maximize successful laser therapy outcome is controversial as well. The purpose of this review is to explore the scientific foundation of the controversy surrounding the use of the diode laser as an adjunct to non-surgical periodontal therapy. Further, this paper addresses the weaknesses in study design, the heterogeneity of methodology in the published clinical studies, especially the laser parameters, and how these issues impact the collective clinical and microbial data, and thus conclusions regarding clinical efficacy. Evaluation of the literature identifies possible mechanisms that could contribute to the varied, often conflicting results among laser studies that are the foundation of the controversy surrounding clinical efficacy. These mechanisms include current paradigms of periodontal biofilm behavior, tissue response to laser therapy being dependent on tissue type and health, and that the successful therapeutic treatment window is specific to the target tissue, biofilm composition, laser wavelength, and laser energy delivered. Lastly, this paper discusses laser parameters used in the various clinical studies, and how their diversity contributes to the controversy. Although this review does not establish clinical efficacy, it does reveal the scientific foundation of the controversy and the need for standardized, well designed randomized controlled clinical trials to develop specific guidelines for using the laser as an adjunct to non-surgical periodontal therapy. Using evidence-based laser guidelines would allow dental hygienists to provide more effective non-surgical periodontal care.
Mary Sornborger
MS
Porteous
Dorothy J
DJ
Rowe
D055113:Chronic Periodontitis / Q000382:microbiology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D003756:Dental Hygienists / Q000331:legislation & jurisprudence; D005347:Fibroblasts / Q000528:radiation effects; D006801:Humans; D054023:Lasers, Semiconductor / Q000009:adverse effects / Q000592:standards / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000295:instrumentation* / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
bacteria; dental hygienists; diode laser; non-surgical periodontal therapy; periodontal diseases; periodontitis; scaling and root planing; soft tissue laser