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Infrared lasers for the treatment of moderate to severe periodontitis: An American Academy of Periodontology best evidence review
Author(s) -
Chambrone Leandro,
Ramos Umberto D.,
Reynolds Mark A.
Publication year - 2018
Publication title -
journal of periodontology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.036
H-Index - 156
eISSN - 1943-3670
pISSN - 0022-3492
DOI - 10.1902/jop.2017.160504
Subject(s) - medicine , periodontology , debridement (dental) , scaling and root planing , randomized controlled trial , meta analysis , medline , periodontitis , dentistry , laser therapy , confidence interval , chronic periodontitis , clinical trial , surgery , laser , physics , optics , political science , law
Background This systematic review assesses the efficacy of infrared laser therapy used alone or as an adjunct to nonsurgical or surgical periodontal therapy, on clinical and patient‐centered outcomes in patients with periodontitis. Methods Randomized clinical trials (RCTs) with a follow‐up duration ≥3 months that evaluated root surface debridement (i.e., scaling and root debridement with or without surgical access) to laser therapy alone or laser therapy plus root surface debridement for the treatment of adult patients (≥18 years old) with moderate to severe aggressive or chronic periodontitis were considered eligible for inclusion. The MEDLINE, EMBASE and CENTRAL databases were searched for articles published up to and including March 2016. Random effects meta‐analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences (MDs) with their associated 95% confidence intervals (CIs). Additionally, summaries are presented of the included RCTs, critical remarks of the literature and evidence quality rating/strength of recommendation of laser procedures. Results Of the 475 potentially eligible articles, 28 were included in the review. Individual study outcomes and seven sets of meta‐analysis (1 for the nonsurgical treatment of AgP and 9 for nonsurgical and surgical treatment of CP) showed a benefit of laser therapy in improving clinical attachment level (CAL) and probing depth (PD). However, the comparative differences in clinical outcomes were modest (< 1 mm) and the level of certainty for different therapies was considered low‐to‐moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the Strength of Clinical Recommendations of laser therapies were considered weak or based on expert opinion. Conclusions In patients with moderate to severe periodontitis, the nonsurgical treatment of AgP and CP by SRP plus infrared diode laser, and the surgical treatment of CP by Er:YAG laser therapy alone may promote statistically significant improvements in PD and CAL. However, these gains are relatively small (< 1 mm) and provide modest clinical relevance compared with SRP alone.