| Objective: This study aims to use the methods of evidence-based medicine,systematically evaluate Er:YAG laser-assisted traditional subgingival scaling and root planning(SRP).The clinical efficacy of non-surgical treatment of chronic periodontitis(CP)provides a scientific guidance for its application in clinical practice.Methods: Databases were searched for Er:YAG laser adjunct to traditional SRP compared with traditional SRP alone,for the treatment of CP designed as clinical randomized controlled trials,the databases including: PubMed,Cochrane Controlled Clinical Trial Register(CCCTR),Medline,EMBase,Science Direct,OVID,ISI Web of knowledge,CNKI(China National Knowledge Internet),CBM(Chinese BioMedical Literature Database),published until January 2018.Meanwhile,manually search relevant professional journals and related literature references.Two researchers selected studies based on inclusion and exclusion criteria,then extracted basic information from included studies.Jadad scale was used to assess the methodological quality and required data was extracted for the included study.The weighted mean difference and 95% confidence interval were used to calculate probing depth(PD),clinical attachment level(CAL)and visual analogue scale(VAS).The Q-test based on the chi-squared value was used to test heterogeneity intra-study,and the I2 test was used to test heterogeneity inter-studies.Random or fixed effect models were selected based on the size of the heterogeneity.Publication bias was tested by Begg's test.Sensitivity analysis of each parameter was tested by conversing effect model.The above statistical analysis was performed using stata11.0.Results:1.A total of 10 clinical randomized controlled studies,totally 12 articles met the inclusion criteria.2.There were 9 high-quality studies and 1 low-quality studies according to Jadad Scale.3.Meta-analysis of PDChanges of PD at 3-month follow-ups(WMD=0.32,95% CI range 0.14 to 0.51,P<0.001;?2=19.83,P=0.003,I2=69.7%)were statistically significant compares to SRP;there were no statistically significance in changes of PD at 6-months followed-ups(WMD=0.12,95%CI range-0.07 to 0.31,P=0.211;?2=1,P=0.801,I2=0%);and at 12-months follow-ups(WMD=0.14,95% CI range-0.10 to 0.37,P=0.254;?2=0.41,P=0.521,I2=0%)4.Meta-analysis of CALChanges of CAL at 3-month follow-ups(WMD=0.31,95%CI range 0.22 to 0.40,Z=6.62,P<0.001;?2=8.42,P=0.209,I2=28.8%)were statistically significant compared to SRP;there were no statistically significance in changes of CAL at 6-months followed-ups(WMD=-0.01,95% CI range-0.21 to 0.19,P = 0.918;?2 = 2.81,P= 0.422,I2=0%)and at 12-months follow-ups(WMD=0.09,95% CI range-0.17 to 0.36;?2=0.41,P=0.521,I2=0%).5.Meta-analysis of VASPatients were evaluated for pain perception immediately after surgery.There were significant difference in favor of Er:YAG laser adjunct to SRP compared to SRP alone(WMD=-1.38,95% CI range-2.45 to-0.31,P<0.001;?2=1.78,P=0.182,I2=44%).6.Publication bias and sensitive-analysisBegg's test indicated that no published bias was existed in the results of the parameters within the included studies.The sensitivity analysis showed that the outcomes were stable and credible.Conclusion:1.At 3-month follow-ups in terms of PD and CAL Er:YAG laser adjunct to SRP for non-surgical treatment of CP provided better clinical outcomes compared to SRP alone,patients experienced less pain while using Er:YAG laser adjunct to SRP compared to SRP alone.2.At 6-month and 12-month follow-ups Er:YAG laser adjunct to SRP used for non-surgical treatment of CP,there were no statistical difference between PD and CAL compared with conventional SRP.3.Dentists need to balance the advantages and disadvantages of various aspects with the use of Er:YAG laser assisted treatment of CP.Moreover,long-term,large sample-sized,and high quality clinical randomized trials were still needed to evaluate the clinical effectiveness of ERL adjunct to SRP. |
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