title: Efficacy of Combined Photoablative-Photodynamic Diode Laser Therapy Adjunctive to Scaling and Root Planing in Periodontitis: Randomized Split-Mouth Trial with 4-Year Follow-Up.
abstract: OBJECTIVE
  We previously showed that photoablative laser therapy followed by multiple photodynamic cycles (PAPD) after scaling/root planing (SRP) improved healing of periodontitis patients as compared with conventional SRP after 1-year follow-up. This study reports the favorable results of PAPD plus SRP in patients with chronic periodontitis at a 4-year follow-up.
  
  
  METHODS
  Twenty-four patients were studied. Maxillary left or right quadrants were randomly assigned to PAPD laser treatment or sham-treatment and SRP. PAPD consisted of: (1) photoablative intra/extrapocket de-epithelization with diode laser (λ 810 nm, 1 W), and (2) photodynamic treatments (4-10 weekly) with diode laser (λ 635 nm, 100 mW) and 0.3% methylene blue as photoactive antiseptic, performed after SRP. Sham treatment was performed with switched- off laser. Probing depth (PD), clinical attachment level (CAL), and bleeding-on-probing (BOP) were evaluated. Additional disease markers, namely polymorphonuclear leukocytes (PMN), erythrocytes (RBC), damaged epithelial cells (DEC), and bacteria were assayed by cytofluorescence on gingival exfoliative samples.
  
  
  RESULTS
  At 4-year follow-up, PAPD plus SRP significantly improved PD, CAL, and BOP, as well as bacterial contamination and PMN-RBC shedding in the exfoliative samples, compared with sham treatment plus SRP. This effect was greater than that observed at 1-year follow-up.
  
  
  CONCLUSIONS
  PAPD plus SRP provided significant, durable improvement of chronic periodontitis over sham treatment plus SRP alone.
authors.affiliation: 1 Odontostomatologic Laser Therapy Center , Florence, Italy .
authors.forename: Marco
authors.initials: M
authors.lastname: Giannelli
authors.affiliation: 2 Department of Experimental and Clinical Medicine, Section Anatomy and Histology, University of Florence , Florence, Italy .
authors.forename: Lucia
authors.initials: L
authors.lastname: Formigli
authors.affiliation: 1 Odontostomatologic Laser Therapy Center , Florence, Italy .
authors.forename: Luca
authors.initials: L
authors.lastname: Lorenzini
authors.affiliation: 2 Department of Experimental and Clinical Medicine, Section Anatomy and Histology, University of Florence , Florence, Italy .
authors.forename: Daniele
authors.initials: D
authors.lastname: Bani
mesh_terms: D000328:Adult; D000368:Aged; D055113:Chronic Periodontitis / Q000628:therapy*; D003131:Combined Modality Therapy; D012534:Dental Scaling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D016745:Root Planing