Clinical Effectiveness Of Er,Cr:YSGG Lasers In Non-surgical Treatment Of Chronic Periodontitis

Objective: The study aimed to comprehensively and systematically evaluate the clinical effectiveness of probing depth(PD)reduction,clinical attachment level(CAL)gain,and visual analogue scale(VAS)score of Er,Cr:YSGG lasers(erbium,chromium,yttrium scandium gallium garnet laser)in the non-surgical treatment of patients with chronic periodontitis by meta-analysis to provide guidance for the application of Er,Cr:YSGG lasers in the treatment of chronic periodontitis.Methods: Researches relevant to Er,Cr:YSGG lasers adjunct/substitute to scaling and root planing(SRP)for the treatment of chronic periodontitis were retrieved through electronic-search and manual-search up to January2020.The electronic database included: Pub Med,Cochrane Library,Medline,Science Direct,Ovid,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang,and the Chinese Bio Medical Literature Database(CBM).Research selection,data extraction and quality evaluation were performed by two reviewers independently according to the inclusion and exclusion criteria.The meta-analysis was conducted with data extracted from 16 randomized controlled clinical trials(RCTs)published in English or Chinese from January 2000 to January 2020.The weighted mean differences(WMDs)and 95% confidence intervals(CIs)were counted for PD reduction,CAL gain,and VAS score.Heterogeneity of each study was evaluated with the Q test.The publication bias was measured using Begg’s adjusted rank correlation test.Sensitivity analysis was conducted through examining the impact of individual study on the effect size.The source of heterogeneity among various studies was explored through meta-regression analysis.The meta-analysis was conducted by STATA version 12.0 software.Results:1.Sixteen RCTs in total of 606 patients application with Er,Cr: YSGG laser in non-surgical treatment of chronic periodontitis were selected in the meta-analysis including 8 Split-mouth studies and 8 parallel trials,in which there were 11 trials comparing Er,Cr:YSGG laser adjunct to SRP with SRP alone and 5 trials comparing Er,Cr:YSGG laser substitute to SRP with SRP alone.2.In the Meta-analysis,there were 4 included RCTs concerning PD reduction at 1-month follow-up.Compared to the troditional SRP,the clinical effectiveness of Er,Cr:YSGG lasers adjunct/substitute to SRP was significantly better(WMD =-0.35,95% CI [-0.63,-0.07],P=0.013).3.In the Meta-analysis,there were 14 included RCTs concerning PD reduction at 3-month follow-up.Compared to the troditional SRP,the clinical effectiveness of Er,Cr:YSGG lasers adjunct/substitute to SRP was significantly better(WMD =-0.342,95%CI[-0.552,-0.132],P=0.001).4.In the Meta-analysis,there were 12 included RCTs concerning CAL improvement at 3-month follow-up.Compared to troditional SRP,the clinical effectiveness of Er,Cr:YSGG lasers adjunct/substitute to SRP was significantly better(WMD =-0.17,95%CI[-0.31,0.03],P=0.017).5.There were 7 RCTs included in this Meta-analysis to evaluate the VAS value immediately after treatment,Compared to troditional SRP,the pain level of Er,Cr: YSGG lasers adjunct/substitute to SRP was significantly lower(WMD=-2.395,95%CI[-3.327,-1.464],P=0.000).6.There were no significant difference in PD reduction and CAL increase at 6-month follow-up between the Er,Cr:YSGG lasers adjunct/substitute to SRP and SRP alone(P>0.05).7.The results of the Begg tests showed that there were no publication bias in the Meta-analysis of all the observation indicaters at different follow-up periods,and the results were reliable.Conclusions: This meta-analysis indicated that Er,Cr:YSGG lasers provided additional effectiveness in PD reduction and CAL gain at short-term follow-ups and there was less pain compared with SRP alone.