## 4 Discussion  
The goal of our research was to evaluate the effectiveness of two different protocols (LANAP and OHLLT) that rely on the use of lasers to treat patients suffering from periodontitis through the microbiological analysis of real-time PCR. Studies conducted in the literature showed the effectiveness of this highly specific and sensitive method, which allows the quantitative and specific detection of significant markers of periodontitis and peri-implantitis and the determination of the total bacterial load [32]. This appears to be extremely interesting considering the relevant literature data, in particular in relation to the efficacy of periodontal surgical and nonsurgical protocols, when periodontal pathogenic bacteria were present in the periodontal pockets or in the maxillary and mandibular alveoli. The persistence of specific subgingival species, including _A. actinomycetemcomitans_, _P. gingivalis_ and _T. denticola_ (their ability to invade the subjacent periodontal tissues), has been associated with poor response to treatment by scaling and root planing. In effect, if _Actinobacillus actynomicetemcomitans_, _Porphyromonas gingivalis_, _Prevotella internedia_ and _Campylobacter rectus_ are inside the pockets, the nonsurgical periodontal approach is not effective [1]. The same results with a regenerative surgical approach, as indicated by [PERSON] and the Ergoperio Group [2], where the presence of a high bacterial load and specific pathogen complexes in deep periodontal and peri-implant pockets had a significant negative impact on the 1-year outcome of surgical or regenerative treatment. If the presence of a red and orange Sokransky's complex has a negative impact on the nonsurgical and surgical periodontal approach, we suggest a real-time PCR for every time it is needed to treat an affected tooth. In a recent meta-analysis, [PERSON] et al. [27] evaluated the in vivo articles published in accordance with PRISMA guidelines [33] and the _Cochrane handbook for Systematic reviews of Intervention_[34] concerning the in vivo treatment of peri-implantitis with lasers protocols[PERSON] The authors analyzed 49 articles, but just 7 were included due to the strict eligibility criteria of the quality assessment[PERSON] The seven studies included were the following: [PERSON] et al. [35], [PERSON] et al. [26], [PERSON] et al[PERSON] [36], [PERSON] et al. [37], [PERSON] et al. [38], [PERSON] et al. [39] and [PERSON] et al. [40]. They concluded that \"a high-power diode laser may have some effect on peri-implant pathogens causing peri-implantitis, whereas Er:YAG laser application shows no significant effect on oral bacteria in the long term[PERSON] aPDT has the ability to reduce the total count of the different bacterial strains associated with peri-implantitis, e.g., _A. actinomycetemcomitans_, _P. gingivalis_, _P. intermedia_, \begin{table}
\begin{tabular}{l l l l} \hline \hline  & **Group A + B (\(\mathbf{u}\) = 20)** & **Group C (\(\mathbf{n}\) = 10)** & \(\mathbf{p}\) **Value** \\ \hline
**BoP** & 1.92 \(\pm\) 0.58 & 1.86 \(\pm\) 0.66 & \textless{}0.0018 * \\
**P.I.** & 1 \(\pm\) 0.23 & 1.84 \(\pm\) 0.43 & 0.006 \\
**P.D.** & 4.28 \(\pm\) 0.25 & 4.25 \(\pm\) 0.21 & 0.281 \\ \hline \hline \end{tabular}  
* BoP: bleeding on probing; P.I.: plaque index; and P.D.: periodontal depth.
* \(p\) value \(<\) 0.001 is statistically significant.  
\end{table} 
Table 1: Periodontal and microbial parameters among the A + B groups and C group before treatment. \begin{table}
\begin{tabular}{l l l l} \hline \hline  & **Group A + B (\(\mathbf{u}\) = 20)** & **Group C (\(\mathbf{n}\) = 10)** & \(\mathbf{p}\) **Value** \\ \hline
**BoP** & 0.12 \(\pm\) 0.05 & 1.35 \(\pm\) 0.25 & \textless{}0.0015 * \\
**P.I.** & 0.12 \(\pm\) 0.15 & 1.43 \(\pm\) 0.52 & 0.004 \\
**P.D.** & 2.15 \(\pm\) 0.21 & 3.21 \(\pm\) 0.34 & 0.112 \\ \hline \hline \end{tabular}  
* BoP: bleeding on probing; P.I.: plaque index and P.D.: periodontal depth.
* \(p\) value \(<\) 0.001 is statistically significant.  
\end{table}