Clinical Efficacy Study Of Er:YAG Laser-assisted Treatment Of Chronic Periodontitis And Peri-implantitis

Objective:We applied the bait-doped yttrium aluminum garnet（Er:YAG）laser to assist in the treatment of chronic periodontitis and peri-implantitis,and conducted short-term observation of the postoperative efficacy of this method in the treatment of both diseases to evaluate the clinical effects of the Er:YAG laser in the treatment of both,and to provide new treatment ideas for the clinical treatment of patients with chronic periodontitis and peri-implantitis.Materials and methods:Research Content I:Thirty patients（14 males and 16 females）with chronic periodontitis with comparable conditions on the left and right sides,80 affected teeth（40 anterior teeth and 40 posterior teeth）,aged 18 to 65 years old,who attended the periodontal department of Affiliated Stomatological Hospital of Dalian Medical University School of Stomatology Hospital between September 2020 and December2022 were selected.The left and right quadrants of each patient’s mouth were randomly divided into groups A₁ and B₁.Group A₁（40 teeth）was the control group for chronic periodontitis,and group B₁（40 teeth）was the experimental group for chronic periodontitis,i.e.,the laser treatment group.The basic medical history of the patients was taken and both groups were treated without flap.For groups A₁ and B₁,full supragingival scaling was performed,followed by subgingival scraping and root surface leveling after 1 week,and group B1 was treated with adjuvant Er:YAG laser,which was irradiated once after mechanical debridement.Clinical parameters,including probing depth（PD）,clinical attachment level（CAL）,bleeding index（BI）,as well as the patient’s subjective perception of pain at 1,2,and 3 months after treatment,were observed and recorded at baseline and 1 and 3 months after treatment using the Florida Periodontal Electronic Probe.The patients’subjective perception of pain at 1,2 and 3 days after treatment was scored by Visual Analgue Scale Score（VAS）and the corresponding values were recorded.The clinical efficacy of each group at 1 month after treatment was compared,and finally,all the recorded data were statistically analyzed by SPSS 26.0software,with statistical significance at P<0.05.Research Component II:Twenty patients（9 males and 11 females）with peri-implantitis,with a total of 26 implants（4 anterior and 22 posterior）,aged 18 to 65years old,attending Affiliated Stomatological Hospital of Dalian Medical University School of Stomatology Hospital from September 2020 to December 2022 were selected.They were randomly grouped A₂ and B₂,with group A₂（13 implants）as the peri-implantitis control group and group B₂（13 implants）as the peri-implantitis experimental group,i.e.,the laser treatment group.All implants were mechanically cleared using a plastic scraper with a titanium brush,while the laser group was treated with the Er:YAG laser as an adjunct to the control group,once at weeks 0,2 and 4,for a total of 3 irradiations.The peri-implant clinical parameters,including peri-implant probing depth（PD）,clinical attachment level（CAL）,bleeding index（BI）,and the patient’s subjective perception of pain at 1,2,and 3 days after treatment were observed and recorded at baseline and 1 and 3 months after treatment,and scored by the VAS scale and the corresponding values were recorded.The clinical efficacy of each group at1 month after treatment was compared,and finally all recorded data were statistically analyzed by applying SPSS 26.0 software,with statistical significance at P<0.05.Results:Study component I（chronic periodontitis group）:1.At baseline,PD,CAL,and BI in the control group（A₁）and experimental group（B₁） were not statistically different（P>0.05）and were comparable.2.At 1 and 3 months after treatment,intra-group comparisons were made between A₁ and B₁ groups,and PD,CAL,and BI in both groups were significantly lower than baseline levels and showed a continuous decline,with statistically significant differences（P<0.05）.3.When the groups A₁ and B₁ were compared between groups at 1 and 3 months after treatment,patients in group B₁ had better PD,CAL,and BI than group A₁,and the difference was statistically significant（P<0.05）.4.VAS pain evaluation:the difference between the two groups A₁ and B₁ was not statistically significant at 1 day after treatment（P>0.05）,but the difference was statistically significant at 2 and 3 days after treatment（P<0.05）.5.Clinical efficacy evaluation:the efficacy of group B₁（100%）was better than that of group A₁（90%）1 month after treatment,and the difference was statistically significant（P<0.05）.Study component II（peri-implantitis group）:1.At baseline,PD,CAL,and BI in the control group（A₂）and experimental group（B₂） were not statistically different（P>0.05）and were comparable.2.At 1 and 3 months after treatment,the PD,CAL,and BI of both groups wer significantly lower than the baseline levels when compared within the A₂ and B₂ groups,and the difference was statistically significant（P<0.05）.Compared with 1 month after treatment,PD,CAL and BI in both groups slightly increased at 3 months after treatment,and the degree of increase was greater in group A₂ than in group B₂.3.When intergroup comparisons were made between the A₂ and B₂ groups at 1 and 3 months after treatment,patients in the B₂ group had better PD,CAL,and BI than those in the A₂ group,with statistically significant differences（P<0.05）.4.VAS pain evaluation:the difference between the two groups A₂ and B₂ was not statistically significant at 1 day after treatment（P>0.05）,but the difference was statistically significant at 2 and 3 days after treatment（P<0.05）.5.Clinical efficacy evaluation:the treatment effect of group B₂（92%）was better than that of group A₂（53.8%）,and the difference was statistically significant（P<0.05）Conclusion:1.Compared with mechanical debridement alone,Er:YAG laser-assisted mechanical debridement for chronic periodontitis and peri-implantitis can achieve better clinical results,significantly reduce soft tissue inflammation,decrease probing depth and bleeding index,and reduce post-treatment pain in patients.2.Er:YAG laser combined with mechanical debridement for the treatment of chronic periodontitis and peri-implantitis is effective in the short term.3.Er:YAG laser-assisted mechanical debridement for chronic periodontitis will yield better results and longer maintenance time compared to the treatment results for peri-implantitis.