Diode Lasers

In order to become a standard of care, the technique needs to demonstrate clinical effectiveness with a high level of scientific evidence. Although the use of lasers in periodontal therapy has been increasing, neither the American Dental Association nor the American Academy of Periodontology has made a statement supporting the use of a diode laser as the standard of care in nonsurgical management of periodontitis.1 Presently, scaling and root planing is the standard of care in the initial treatment of periodontitis. It reduces the bacterial load, decontaminates all or part of the diseased root surface, reduces probing depths, decreases bleeding on probing, and increases clinical attachment gain. A high level of scientific evidence has demonstrated that scaling and root planing improves outcomes relative to the aforementioned parameters. Diode lasers are used in periodontal treatment for sulcular debridement (eg, soft tissue curettage) and for bactericidal effects in periodontal pockets. The use of the diode laser in this regard has been approved as a treatment that can be provided by dental hygienists in at least 16 states. Currently, many states are reviewing their regulations on laser usage by dental hygienists. Diode lasers, however, are contraindicated for root debridement, as they can damage the root surface. Diode laser therapy is typically used in conjunction with scaling and root planing, as an adjunctive treatment. It is often provided at a later date subsequent to completion of scaling and root planing. The goal is to further reduce bacterial pathogens post-scaling and root planing, and curettage the diseased epithelium of the pocket. Evidence indicates that although various laser therapies may offer a promising role in the future, the current use of a diode laser as an adjunct to scaling and root planing does not provide an improved clinically significant benefit to scaling and root planing alone when evaluating pocket probing depth (PD), clinical attachment loss (CAL), or plaque indices (PI). Measured outcomes for bleeding on probing and gingival inflammation, however, showed a small, but statistically significant advantage in favor of the adjunctive use of diode lasers.2 Because periodontitis is an infective process, a therapy that could reduce bacterial load without the side effects of antibiotics would be beneficial. As your question is specifically related to colony-forming units (CFUs) of bacteria, it makes sense to inquire about the clinical advantages of diode laser therapy in the reduction of subgingival bacteria—the etiology of periodontitis. Evidence suggests that lasers can be bactericidal to subgingival pathogens. Moritz et al3 compared treatment with scaling and root planing to scaling and root planing with diode laser therapy. The investigators demonstrated a marked reduction in CFUs of periodontal pathogens post-treatment over 6 months with diode laser therapy. However, this investigation included five treatments with laser therapy over 6 months. In addition, the sampled pockets were never noted to be completely disinfected of periodontal pathogens.3 Other clinical investigations also compared scaling and root planing with or without laser therapy, evaluating the reduction in bacterial load. These studies also noted a decrease in bacterial load; however, the reduction caused by the laser therapy was inconsistent and unpredictable in its capability to reduce subgingival bacterial loads further than that achieved by scaling and root planing alone. In summary, diode laser therapy as an adjunctive therapy to scaling and root planing may offer some reduction in bacterial load. However, when comparing scaling and root planing and adjunctive diode laser therapy to scaling and root planing alone, commonly used criteria for successful clinical outcomes in non-surgical management (eg, PD, CAL, and bleeding on probing) are similar for both treatments. REFERENCES

1. Mills MP, Rosen PS, Chambrone L, et al. American Academy of Periodontology best evidence consensus statement on the efficacy of laser therapy used alone or as an adjunct to non-surgical and surgical treatment of periodontitis and peri-implant diseases. J Periodontol. 2018;89:737–742.
2. Slot DE, Jorritsma KH, Cobb CM, Van der Weijden FA. The effect of the thermal diode laser (wavelength 808–980 nm) in non-surgical periodontal therapy: a systematic review and and meta-analysis. J Clin Periodontol .2014;41:681–692.
3. Moritz A, Schoop U, Goharkhay K, et al. Treatment of periodontal pockets with a diode laser. Lasers Surg Med. 1998;22:302–311.