Advances in Clinical and Experimental Medicine
2018, vol. 27, nr 9, September, p. 1263–1270
Publication type: original article
Comparison of the clinical and microbiological effects of antibiotic therapy in periodontal pockets following laser treatment: An in vivo study
1 Department of Dental Surgery, Wroclaw Medical University, Poland
2 Private Dental Practice, Wschowa, Poland
Background. Laser technology in periodontal therapy could help in reducing total bacterial count.
Objectives. The aim of this study was to evaluate the effects of pocket debridement using an erbium-doped yttrium aluminium garnet laser (Er:YAG laser – ERL), scaling and root planing (SRP) with photodynamic therapy (PDT), or SRP alone. Teeth vitality and soft tissue carbonization were also assessed.
Material and Methods. This study included 1,169 single-rooted teeth from 84 patients divided into 3 groups (n = 28). The G1 group had ERL with 40 mJ of energy, a frequency of 40 Hz and a fluence of 63.66 J/cm2. The G2 group had SRP + PDT (635 nm diode laser, 12 J of energy and irradiation time of 30 s) and a Toluidine Blue photosensitizer (PS) (application time of 60 s). The G3 group was administered SRP alone. In the 42 subjects (G1: n = 11, G2: n = 14 and G3: n = 17) with high amounts of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td) and Tannerella forsythia (Tf), additional 1-week antibiotic treatments with clindamycin or amoxicillin + clavulanic acid – in doses of 600 mg/day or 1000 mg/day, respectively – were prescribed 3 months after the therapy. Microbiological and clinical analyses of the probing depth (PD), recession (RC), plaque index (PI), bleeding on probing (BOP), and attachment loss (AT) were performed at baseline and at the follow-up of 3 months, 3 months and 1 week, and 6 months.
Results. Plaque index decreased in G1 after 3 months, 3 months and 1 week, and 6 months (p < 0.05) and was lower in G1 vs G2 after 3 months (p < 0.05). The reduction in BOP in G1 after 3 months and 1 week was higher in comparison with G2 or G3 (p < 0.02). Probing depth decreased in all groups (p < 0.05). We found a reduction in the percentage of sites with some bacteria after 3 months – Prevotella intermedia (Pi) (G1 and G2), Capnocytophaga gingivalis (Cg) and Eubacterium nucleatum (En) (G3), and after 3 months and 1 week with En, Td, Tf (G1, G2 and G3), Pi (G1 and G2), Aa, Peptostreptococcus micros (Pm), and Cg (G3), and with Pi (G1 and G2), Tf (G2), Pg, En (G2 and G3), and Pm (G3) after 6 months (p < 0.05). We observed no signs of carbonization or teeth injury.
Conclusion. Scaling and root planing + PDT and ERL may be an alternative therapy for chronic periodontitis.
chronic periodontitis, photodynamic therapy, antibacterial therapy, scaling and root planning, Er:YAG laser
- Wright GD. Something new: Revisiting natural products in antibiotic drug discovery. Can J Microbiol. 2014;60(3):147–154.
- Ventola CL. The antibiotic resistance crisis: Part 1: Causes and threats. P&T. 2015;40(4):277–283.
- Piddock LJ. The crisis of no new antibiotics – what is the way forward? Lancet Infect Dis. 2012;12(3):249–253.
- Michael CA, Dominey-Howes D, Labbate M. The antibiotic resistance crisis: Causes, consequences, and management. Front Public Health. 2014;2:145.
- Górska R, Pietruska M, Dembowska E, Wysokińska-Miszczuk J, Włosowicz M, Konopka T. Prevalence of periodontal diseases in 35–44 year-olds in the large urban agglomerations. Dent Med Probl. 2012;49:19–27.
- Górski B, Nargiełło E, Grabowska E, Opolski G, Górska R. The association between dental status and risk of acute myocardial infarction among poles: Case-control study. Adv Clin Exp Med. 2016;25(5):861–870.
- Slowik J, Wnuk MA, Grzech K, et al. Periodontitis affects neurological deficit in acute stroke. J Neurol Sci. 2010;15:297(1):82–84.
- Yoshida A, Ansai T. Microbiological diagnosis for periodontal diseases. In: Manakil J, ed. Periodontal Diseases – A Clinician’s Guide. Rijeka, Croatia: InTech; 2012:55.
- Valones MA, Guimarães RL, Brandão LA, Souza PR, Carvalho AD, Crovela S. Principles and applications of polymerase chain reaction in medical diagnostic fields: A review. Braz J Microbiol. 2009;40(1):1–11.
- Sanz I, Alonso B, Carasol M, Herrera D, Sanz M. Nonsurgical treatment of periodontitis. J Evid Base Dent Pract. 2012;12(3):76–86.
- Graetz C, Plaumann A, Wittich R, et al. Removal of simulated biofilm: An evaluation of the effect on root surfaces roughness after scaling. Clin Oral Invest. 2016;27:1–8.
- Graetz C, Plaumann A, Bielfeldt J, Tillner A, Sälzer S, Dörfer CE. Efficacy versus health risks: An in vitro evaluation of power-driven scalers. J Indian Soc Periodontol. 2015;19(1):18.
- Gutknecht N, Van Betteray C, Ozturan S, Vanweersch L, Franzen R. Laser supported reduction of specific microorganisms in the periodontal pocket with the aid of an Er,Cr:YSGG laser: A pilot study. Sci World J. 2015;2015:450258. doi:10.1155/2015/450258
- Lopes BM, Theodoro LH, Melo RF, Thompson GM, Marcantonio RA. Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with erbium: YAG laser and scaling and root planing. J Periodontol. 2010;81(5):682–691.
- Sgolastra F, Petrucci A, Gatto R, Monaco A. Efficacy of Er:YAG laser in the treatment of chronic periodontitis: Systematic review and meta-analysis. Laser Med Sci. 2012;27(3):661–673.
- Talebi M, Taliee R, Mojahedi M, Meymandi M, Torshabi M. Microbiological efficacy of photodynamic therapy as an adjunct to non-surgical periodontal treatment: A clinical trial. J Lasers Med Sci. 2016;(2): 126–130.
- Nielsen HK, Garcia J, Væth M, Schlafer S. Comparison of riboflavin and toluidine blue O as photosensitizers for photoactivated disinfection on endodontic and periodontal pathogens in vitro. PloS ONE. 2015;10(10):e0140720.
- Prates RA, Yamada AM, Suzuki LC, et al. Histomorphometric and microbiological assessment of photodynamic therapy as an adjuvant treatment for periodontitis: A short-term evaluation of inflammatory periodontal conditions and bacterial reduction in a rat model. Photomed Laser Surg. 2011;29:835–844.
- de Oliveira GJ, Cominotte MA, Beraldo TP, Sampaio JE, Marcantonio RA. A microscopic analysis of the effects of root surface scaling with different power parameters of Er, Cr: YSGG laser. Microsc Res Techniq. 2015;78(6):529–535.
- Zach L, Cohen G. Pulp response to externally applied heat. Oral Surg Oral Med Oral Pathol. 1965;19:515–530.
- Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999:4:1–6.
- Ciurescu C, Teslaru S, Zetu L, Ciurescu D. Laser assisted periodontal treatment: From bactericidal effect to local modification of the host response. Paper presented at: Sixth International Conference on Lasers in Medicine; May 7–9, 2015; Bucharest, Romania. doi:10. 1117/12.2189324
- Polansky R, Haas M, Heschl A, Wimmer G. Clinical effectiveness of photodynamic therapy in the treatment of periodontitis. J Clin Periodontol. 2009;36:575–580.
- Dai T, Huang YY, Hamblin MR. Photodynamic therapy for localized infections – state of the art. Photodiagnosis Photodyn Ther. 2009; 6(3):170–188.
- Tomasi C, Schander K, Dahlén G, Wennström JL. Short-term clinical and microbiologic effects of pocket debridement with an Er:YAG laser during periodontal maintenance. J Periodontol. 2006;77(1):111–118.
- Rotundo R, Nieri M, Cairo F, et al. Lack of adjunctive benefit of Er:YAG laser in non-surgical periodontal treatment: A randomized split-mouth clinical trial. J Clin Periodontol. 2010;37:526–533.
- Moreira AL, Novaes Jr AB, Grisi MF, et al. Antimicrobial photodynamic therapy as an adjunct to non-surgical treatment of aggressive periodontitis: A split-mouth randomized controlled trial. J Periodont. 2015;86(3):376–386.
- Deas DE, Mealey BL. Response of chronic and aggressive periodontitis to treatment. Periodontol 2000. 2010;53(1):154–166.
- Bizzarro S, Laine ML, Buijs MJ, et al. Microbial profiles at baseline and not the use of antibiotics determine the clinical outcome of the treatment of chronic periodontitis. Sci Rep. 2016;6:20205. doi:10.1038/srep20205
- Walters J, Lai PC. Should antibiotics be prescribed to treat chronic periodontitis? Dent Clin North Am. 2015;59(4):919–933.