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Royal Dental College of Aarhus II

 

Documentation — Royal Dental College of Aarhus II

EVALUATION OF SURGICAL TREATMENT OF PERIODONTAL POCKETS WITH Nd:YAG LASER
N. Lioubavina, J. Jensen, T. Karring.
Royal Dental College, University of Aarhus, Denmark.

The aim of the study was to compare the effect of surgical treatment with Nd: YAG lasers versus that of conventional reverse bevelled flap (RBF) lasers in adult patients with severe Periodontitis.

Patients were subjected to a hygienic phase, including oral hygiene instructions, professional supra- and subgingival sealing.

At baseline after four weeks, 14 patients who presented at least two sites per quadrant with a pocket depth (PPD) = 6mm in two quadrants of the mouth were included in the study. At these sites the PPD, clinica1 attachment level (CAL), proportions of sites per quadrant with plaque (PL-Score), or bleeding on probing (BL-Score) were recorded by an investigator. Then, in one randomly chosen quadrant, RBF was performed at sites with PPD = 6 mm under local anaesthesia by another investigator. In the other quadrant, gingival tissue was excised at sites with PPD = 6 mm with the Nd: Y AG Genius laser (Mølsgaard Dental, Copenhagen) without local anaesthesia, except for four patients.

The laser parameters were: power — 7 W; pulse width — 250 microseconds; frequency — 50 Hz, water spray — 4 and air spray — 5. No suturing was needed after laser surgery. Following surgeries, patients performed mouth rinsing with 0.2% chlorhexidine for a week. After three and six months, PPD, CAL, PL-Scores and BL-Scores were recorded “blindly” at the treated sites.

Results revealed that both treatments showed similar (p>0.05, paired t-test) improvement of all clinical parameters at three and six months. RBF resulted in significant (p<0.001, paired t-test) reduction of the initial PPD (mean ± SD, mm) at three and six months (3.1±0.8 and 2.8±0.7, respectively). This was similar (p>0.05) to 2.6±0.7 and 2.4±0.6, observed after laser surgery at the same healing periods. At three and six months, CAL-gain (mean ± SD, mm) was 1.8±1.2 and 1.5±1.0 following RBF, while 1.6±1.0 and 1.6±0.7 following laser surgery.

At three and six months, BL-Score was significantly decreased from 0.67 to 0.27 and 0.43 after RBF, and from 0.68 to 0.31 and 0.25 after laser surgery. PL-Score was significantly (p<0.001, paired t-test) decreased only after laser surgery at six months. Postsurgical pain was found in one patient (<1%) after laser treatment, whereas it was found in seven patients (50%) after RBF. Postsurgical swelling occurred in eight patients (57%) only after RBF.

At the end of the study, all patients chose laser surgery as a preferable treatment. In conclusion, Nd: YAG laser surgery resulted in improvements of all clinical parameters in deep periodontal pockets. similar to conventional periodontal surgery. However, there were fewer postsurgical complications following laser surgery.