A comparative evaluation of open flap debridement in combination with Nd:Yag laser for management of periodontal disease: a clinical and microbiological study

Periodontal disease [PD] is a plaque biofilm-related chronic inflammatory condition characterized by loss of tooth supporting structures and alveolar bone. In the setting of a long-standing PD, tooth loss is anticipated as a result of periodontal ligament, bone, and/or cementum alterations. Management of PD can range between conservative, non-surgical approach to more invasive surgical phase with aim to eradicate bacterial colonies and granulation tissues and allow for bone fill and regeneration of periodontal tissues. The purpose of this study is to evaluate the efficacy and bactericidal effect of Nd:YAG laser as an adjunct to mechanical debridement in periodontal flap surgery.

This was a randomized, split-mouth clinical trial on patients with persistent PD following Phase 1 periodontal therapy. Data of plaque index, gingival index, probing depth and relative clinical attachment level (CAL) were collected at baseline and 3-months post-operatively. Study subjects were randomly allocated to receive either open flap debridement alone or combined with laser application. Microbiological analysis was performed for all study subjects including measurement of colony-forming unit (CFU) as well as pain/discomfort level at baseline and post-operatively. The collected data was analyzed and presented as mean with Standard deviation.

A total of 20 patients were included in this study, in which 15 were females with mean age of 44.6 years (range of 30 to 50). The mean probing depth decreased from 5.93 ± 0.59 mm at baseline to 2.76 ± 0.43 mm at three months in the test group (p = 0.001) compared to 5.69 ± 0.65 mm at baseline and 3.04 ± 0.45 mm at three months in the control group (p = 0.001). In terms of gingival attachment status, the mean CAL was 10.83 ± 0.75 mm and 10.50 ± 0.79 mm in the test and control group respectively at baseline. At three months, the mean CAL was 8.73 ± 0.55 mm and 8.80 ± 0.44 mm in the test and control group respectively (p = 0.001). The recorded mean VAS was 1.95 ± 0.62 at baseline and 1.80 ± 0.51 at 1 week in the test group (p = 0.180). At the same time, the mean VAS were 1.97 ± 0.58 and 1.82 ± 0.49 in the control group (respectively for baseline and at 1 week; p = 0.180). The mean CFU at 3 months in the test group was significantly smaller compared to the control group (p = 0.001).

The application of ND:YAG laser as an adjunctive tool to open flap debridement have demonstrated a better outcome in management of persistent deep periodontal pockets in terms of probing depth reduction and greater reduction in CFU of obligate anaerobes. Further longitudinal studies with larger sample size are warranted to confirm these findings.