Effects of Nd:YAG Laser and Air Abrasive Combined Application in Patients With Periodontitis
Condition: Periodontitis
MeSH terms: Periodontitis
Study type: Interventional

Summary: 
      The aim of this clinical study is to investigate the effectiveness of the combined
      application of Nd:YAG (neodymium-doped yttrium aluminum garnet) laser and air abrasive
      applied in addition to nonsurgical periodontal treatment on clinical parameters in patients
      with periodontitis.

      A split-mouth, randomized study included 24 systemically healthy, non-smoker, periodontitis
      patients. In addition to non-surgical periodontal treatment, air abrasive
      (erythritol-chlorhexidine powder) and Nd:YAG laser (2 W, 200mJ, 10 Hz) combined application
      was applied to the test group, while only non-surgical periodontal treatment was applied to
      the control group. Clinical periodontal records of the patients, including plaque index (PI),
      gingival index (GI), bleeding on probing (BOP), probing pocket depth (PD), clinical
      attachment level (CAL), were taken before the treatment and at the 1st and 3rd months after
      the treatment.

      All clinical parameters improved significantly from baseline for both groups after treatment
      (p˂0.05). In the evaluation between the test and control groups, no statistically significant
      difference was found in the PI, GI and BOP parameters of the patients at any time (p˃0.05).
      While the amount of change in PD and CAL values after treatment in medium deep pockets in the
      study groups was compared, no significant difference was observed between the groups
      (p˃0.05), statistically significant improvements in PD and CAL parameters were observed in
      the test group compared to the control group only for deep pockets (≥7 mm) among the groups
      (p˂0.05).In conclusion, it has been observed that the combined application of Nd:YAG laser
      and air abrasive in systemically healthy, stage III and grade C periodontitis patients is in
      the short term on PD and CAL, especially in inaccessible areas such as deep pockets.
    

Detailed description: 
      Recently, erythritol has been introduced as a new air abrasive powder. Erythritol is a sugar
      alcohol. It is a water-soluble, chemically neutral artificial sweetener. Compared to glycine,
      another powder used in air abrasive devices, erythritol has a smaller particle size.
      Subgingival air abrasive application with erythritol has been shown to effectively remove
      subgingival biofilm from the root surface. In addition, erythritol has been reported to
      suppress bi-species biofilm formation of Porphyromonas gingivalis (p. gingivalis) and
      Streptococcus gordonii (s. gordonii) through ribonucleic acid (RNA) and deoxyribonucleic acid
      (DNA) depletion and metabolic changes.

      In recent years, lasers have gained increasing interest in the treatment of periodontitis as
      an adjunct or alternative treatment procedure to conventional treatment. It has been stated
      that the Nd:YAG laser provides excellent tissue ablation with strong bactericidal and
      detoxification effects, and it has been shown that it can reach deep pockets that
      conventional instruments cannot reach (7,19). It has been reported that Nd:YAG laser creates
      a very thick coagulation layer on soft tissue surfaces. It has also been proven that when
      applied to the pockets, it can remove the infected pocket epithelium. When applied in
      addition to non-surgical periodontal therapy, it has been shown to dramatically improve the
      clinical manifestations of periodontal inflammation compared to conventional therapy.

      In this clinical study, it was aimed to clinically evaluate the effectiveness of subgingival
      Nd:YAG laser and air abrasive combined application in addition to non-surgical periodontal
      treatment in systemically healthy periodontitis patients. The efficacy of the combined Nd:YAG
      laser and air abrasive application was evaluated by examining the clinical periodontal
      parameters of the patients [plaque index (PI), probing pocket depth (PD), gingival index
      (GI), probing bleeding index (BI) and clinical attachment level (CAL)].

      It is thought that, in addition to non-surgical periodontal treatment, YAG laser and air
      abrasive combined applications will have an antimicrobial effect on the biofilm in difficult
      areas and deep pockets that hand tools cannot reach, provide better penetration than
      irrigation fluids and contribute to periodontal regeneration. Thus, it is hoped to increase
      clinical success, prevent disease recurrences, reduce the need for periodontal surgery and
      increase the quality of life of patients.
    

Intervention name(s): Air Abrasive; Nd:YAG Laser; Non surgical periodontal therapy
Intervention type(s): Device; Device; Procedure
Intervention description(s): Applied with Nd:YAG Laser on periodontal pockets; Applied with Air Abrasive on periodontal pockets; The first phase, in which optimum plaque control is achieved and local etiological factors are removed, is the first step of all periodontal diseases and surgical procedures.
Other intervention name(s): EMS Dental Air-Flow® Handy Perio, Switzerland; Fotona Fidelis AT, Ljubljana, SLOVENIA
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Periodontitis; Non surgical periodontal treatment; Nd:YAG laser; Perioflow; Erythritol Powder