Aims: The aim of this study was to compare two different methods of root surface debridement for the treatment of moderate to advanced chronic periodontitis; fluorescence-guided laser debridement using an Er:YAG laser (ERL) or mechanical scaling and root-planing (SRP/UL) using an ultrasonic scaler and hand instruments. The effectiveness of each treatment method was assessed by patient-centred outcomes such as clinical periodontal measurements and patients� overall experience.
Methods: This study was a phase IV randomised controlled clinical trial, with all examinations and treatments carried out between 1st February 2007 and 7th March 2008. Using a split-mouth design, each patient received both test and control treatments. The control quadrants received scaling and root planing using a Piezon� (EMS, Nyon, Switzerland) ultrasonic scaler and Gracey curettes, while the test quadrants received fluorescence-guided Er:YAG laser root debridement (Keylaser 3, Kavo, Biberach, Germany; panel settings 160mJ/pulse, 10Hz, water spray, 655nm fluorescence calculus-detection system). Full mouth clinical measurements [plaque index (PlI), probing depth (PD), gingival recession (GR), bleeding on probing (BOP), and clinical attachment level (CAL)] were recorded at baseline, and 6 and 12 weeks post-therapy. A patient questionnaire was used to evaluate patient perception in terms of pain, discomfort and satisfaction during treatment, and 24 hours and one week post-treatment. A wash-out period of 6 weeks enabled each patient to evaluate their experience of each treatment on its own merit.
Results: Twenty-eight patients received both treatments and completed the patient perception questionnaire. No significant difference was found between ERL and SRP/UL in terms of pain and discomfort during treatment, and 24 hours and one week post-treatment. In terms of patient satisfaction, none of the patients rated ERL more favourably than SRP/UL immediately following treatment, however no significant difference was found 24 hours later and one week post-therapy. Complete clinical data was collected for 22 patients, four of whom increased their tobacco consumption to [greater than or equal to] 10 cigarettes/day. Therefore, the analysis of clinical data was carried out twice with respect to patients� smoking status. In patients who smoked [less than or equal to] 9 cigarettes/day (n = 18 patients), ERL provided less PD reduction at 6 and 12 weeks (p < 0.001, 6 weeks; p < 0.05, 12 weeks) than SRP/UL. Even though SRP/UL quadrants had a greater proportion of sites with BOP (% BOP) at baseline, at 6 weeks they showed a significantly greater reduction in %BOP (p = 0.0123) than ERL quadrants, however there was with no significant difference in bleeding scores (p = 0.202) at 12 weeks post-therapy. When patients who smoked [greater than or equal to] 10 cigarettes/day were included in the analyses (n = 22 patients), ERL resulted in less BOP reduction and PD reduction at 6 and 12 weeks following treatment (BOP reduction: 6 weeks p < 0.05, 12 weeks p < 0.001; PD reduction: 6 weeks p < 0.01, 12 weeks p < 0.05). Although statistically significant, the differences between the treatment groups were very small and were not clinically significant.
Conclusion: The use of ERL for root surface debridement offers no significant advantages over mechanical therapy in the treatment of moderate to advanced chronic periodontitis, in terms of clinical outcomes and patient perception of pain, discomfort or satisfaction related to the procedure.
| Identifer | oai:union.ndltd.org:ADTP/266382 |
| Date | January 2008 |
| Creators | Soo, Lingfeng, n/a |
| Publisher | University of Otago. School of Dentistry |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | http://policy01.otago.ac.nz/policies/FMPro?-db=policies.fm&-format=viewpolicy.html&-lay=viewpolicy&-sortfield=Title&Type=Academic&-recid=33025&-find), Copyright Lingfeng Soo |
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