Effects of Nd:YAG Laser and Air Abrasive Combined Application in Patients With Periodontitis

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* Systemically healthy (The determination of healthy volunteers will be based on the statements of the patients in the anamnesis. No additional examinations will be made.),
* Having a total of at least twenty permanent teeth in the mouth,
* Non-smoker
* Have not used antibiotics, anti-inflammatory and systemic corticosteroid drugs in the last 6 months,
* Not in pregnancy or lactation period,
* Patients who have not received periodontal treatment in the last 6 months,
* Patients who accepted the research and signed the informed volunteer consent form
* Bleeding on probing in 30% or more areas,
* 5 mm or more probing pocket depth in each quadrant in at least 2 non-adjacent teeth
* 4mm or more attachment loss,
* Coronal 1/3 or more (horizontal and/or vertical) on radiograph individuals with bone loss were included

Exclusion Criteria:

* Having any systemic disease,
* Regularly using a systemic medication,
* Being pregnant or lactating.
* To have had periodontal treatment in the last 6 months.
* Receiving antibiotic, anti-inflammatory or systemic corticosteroid medication in the last 6 months.
* Smoking.