Diode Laser With Periodontal Flap Surgery in Periodontitis
Condition: Periodontitis, Aggressive; Diode Laser Therapy; Periodontal Diseases
MeSH terms: Periodontitis; Periodontal Diseases; Aggressive Periodontitis; Aggression
Study type: Interventional

Summary: 
      The authors theorize that periodontal flap surgery therapy with adjunctive DL therapy might
      bring favourable therapy results (clinical and bacterial parameters) in patients with stage
      3-grade C periodontitis. Therefore, the goal of this split-mouth randomized clinical trial
      was to evaluate and compare the effectiveness of the treatment results for DL assisted
      modified Widman Flap (MWF) surgery (test site) with MWF surgery alone (control site) in
      periodontitis patients with stage 3-grade C by determining the changes in clinical parameters
      and bacterial load of pathogens (P.g., T.d., Camplyobacter rectus (C.r.), Prevotella
      intermedia (P.i.), T.f., A.a.) at preoperative and following MWF surgery at 6th week, 3rd and
      6th months
    

Detailed description: 
      A randomised control split-mouth study were performed at the Department of Periodontology,
      Faculty of Dentistry, Bülent Ecevit University, Zonguldak, Turkey, between January 2013 and
      February 2016.After clinical evaluation, a total of 30 subjects, who showed signs of stage
      3-grade C periodontitis, were enrolled to this study at baseline. These patients were
      underwent a full mouth scaling and root planning (SRP). Six weeks after non surgical
      periodontal therapy, periodontal assessment was performed to confirm the suitability of the
      sites for periodontal surgery. This split-mouth study was conducted in 18 patients with stage
      3 Grade C periodontitis aged between 22 and 35 years.

      Before the surgery, the selected quadrants were randomly allocted (by the toss of a coin)
      into test and control sites where the control site were treated with MWF+sham application of
      DL and test sites were treated with MWF+ active DL. Clinical parameters including CAL, PD,
      plaque index(PI), gingival index(GI), bleeding on probing (BOP) were recorded and
      microbiological sampling were obtained at preoperative and at 6 weeks, 3 months, 6 months
      postoperatively. Pain scale assessment (visual analog scale, VAS), pain medication
      consumption (PM), tissue edema (TE), and tissue color (TC) were evaluated one week following
      surgery. Microbiological analysis was done by real-time polymerase chain reaction (PCR) for
      detection of Porphyromonas gingivalis (P.g.), Treponema denticola (T.d.), Tannerella
      forsythia (T.f.), Camplyobacter rectus (C.r.), Prevotella intermedia (P.i.), Aggregatibacter
      actinomycetemcomitans (A.a.).

      Control sites were treated MWF with sham application of DL, while test sites were treated MWF
      with the applying of active DL (810nm±5, Picasso-AMD, USA) to the inside of the MWF. The
      interval between the two surgeries was 3 weeks. The modified Widman flap technique was
      applied.DL with a wavelength of 810±5 nm and a power of 1 watt in continuous mode was applied
      to the MWF at the test sites. A 400 micron diameter tip was used to remove all visible
      epithelium on the inside of the flap from the free gingival edge to the lower apical aspect
      of the flap (both labial and lingual / palatal). The tip was started using a blue
      articulating paper. DL irradiation performed at a 45o angle to the soft tissue flap to avoid
      any laser (810nm±5) contact to the root surface or the alveolar bone . DL therapy was carried
      out to soft tissue from the coronal to the apical aspect in parallel paths for 10seconds.
      When irradiation exceeded 10 seconds in time, laser (810nm) emission was be interrupted for
      30 seconds. The resultant char layer was be totally removed with moist gauze prior to
      replacing the flaps. A second laser application with the same laser (810nm±5) was performed
      on all the surfaces of the flap in continuous mode at 0.1 watts. All surfaces of the flap,
      inner and outer, exposed bone and exposed root structures involved in the surgery were
      irradiated, leading to a total dosage of 4 J/cm2 per surface.

      The subjects were prescribed 200 mg Ibuprofen (up to 3 tablets) every 8 hours to reduce pain.
      The subjects were instructed not to eat solid food using the treated area and to not brush
      the teeth in the treated area. They were told to rinse their mouth with chlorhexidine
      digluconate (0.2%, CHX) twice a day for 1 min during one week after surgery The sutures were
      removed at first week . After 1 weeks, the subject started brushing their teeth and oral
      hygiene training was repeated. Oral hygiene instructions were provided at each postoperative
      visit.
    

Intervention name(s): Diode Laser; Modified Widman Flap
Intervention type(s): Device; Procedure
Intervention description(s): DL with a wavelength of 810±5 nm, a 400micron diameter, and a power of 1 watt in continuous mode was applied to the MWF at the test sites.; Periodontal Surgery Technique
Other intervention name(s): Modified Widman Flap (MFW)
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: diode laser; aggressive periodontitis; Modified Widman Flap; microbiology