| Aim: Subgingival Scaling and Root planning(SRP)is the most important non-surgical periodontal treatment,but there are also many disadvantages,such as the formation of smear layer after treatment and it is difficult for the instruments to reach the narrow areas.In recent years,it has been proved tant SRP with laser might have advantages over SRP alone,but single laser assisted therapy also has some shortcomings due to that for lasers,the property is different.This study explored the clinical,microbiological and biochemical effects of the following treatments in periodontitis: SRP + ERL + NDL,SRP + ERL,SRP + NDL.Methods: Twenty-seven volunteers were enrolled in the trial.Four quadrants in each patient were randomly assigned to the following four groups: subgingival scaling and root planing(SRP),SRP with Er: YAG laser treatment(SRP + ERL),SRP with Nd: YAG laser treatment(SRP +NDL),SRP with Er: YAG laser and Nd: YAG laser(SRP + ERL + NDL).Probing depth(PD),clinical attachment loss(CAL),and bleeding on probing(BOP)were recorded at baseline,three and six months after treatment.Subgingival plaque samples and gingival crevicular fluid(GCF)samples were collected at every visit.Quantitative analysis of red complex bacteria(porphyromonas gingivalis(Pg),Tannerella forsythia(Tf),Treponema denticola(Td))was performed using quantitative real-time polymerase chain reaction(q PCR).GCF levels of interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)were determined by enzyme-linked immunosorbent assay(ELISA).Results: Out of the 27 patients,13 are males.The average age was42.4±13.5.A total of 25 patients completed the six-month follow-up,and 2patients were lost due to the work and COVID-19,respectively.1.Changes of Periodontal clinical parameters: There was no statistical difference in PD,CAL and the percentage of BOP positive sites(BOP%)at baseline among the four groups.At three and six months after treatment,PD,CAL and BOP% were significantly lower than that in the baseline(P < 0.05).(1)PD: At three months after treatment,the comparison among groups showed that SRP + ERL(3.47 ± 1.32 mm)<SRP + ERL + NDL(3.48 ± 1.37 mm)< SRP(3.69 ± 1.31 mm)< SRP +NDL(3.71 ± 1.32 mm),and the difference was statistically significant(P <0.05);paired comparison showed that the PD values in SRP + ERL and SRP + ERL + NDL group were significantly lower than that in SRP and SRP + NDL group(P < 0.05).At six months after treatment,the comparison among groups showed that SRP + ERL(3.25 ± 1.23 mm)<SRP + ERL + NDL(3.33 ± 1.31 mm)< SRP + NDL(3.47 ± 1.29 mm)<SRP(3.54 ± 1.27 mm),and the difference was statistically significant(P <0.05);paired comparison showed that the PD values in SRP + ERL group were significantly lower than that in SRP and SRP + NDL group(P < 0.05)and the PD values in SRP + ERL + NDL group were significantly lower than that in SRP group(P < 0.05).(2)CAL: At the three months after treatment,SRP + ERL(3.46 ± 1.46 mm)< SRP + ERL + NDL(3.53 ± 1.58mm)< SRP + NDL(3.84 ± 1.58 mm)< SRP(3.91 ± 1.62 mm),the difference was statistically significant(P < 0.05);paired comparison showed that the CAL values in SRP + ERL and SRP + ERL + NDL group was significantly lower than that in SRP group and SRP + NDL group(P <0.05).At the six months after treatment,SRP + ERL(3.26 ± 1.51 mm)<SRP + ERL + NDL(3.40 ± 1.56 mm)< SRP + NDL(3.59 ± 1.58 mm)<SRP(3.75 ± 1.66 mm),the difference was statistically significant(P <0.05);paired comparison showed that the CAL values in SRP + ERL group was significantly lower than that in SRP and SRP + NDL group(P < 0.05)and the CAL values in SRP + ERL + NDL group was significantly lower than that in SRP group(P < 0.05).(3)The percentage of BOP positive sites(BOP%): There was no statistical difference among groups at three and six months after treatment.2.Changes of the proportions of Pg,Td and Tf in subgingival plaques:At baseline,there was no statistical difference for the percentage of Pg,Td and Tf among groups.At three months after treatment,the percentage of Pg,Td and Tf in each group decreased significantly from the baseline,but rebounded in six months.However,there was no statistical difference among groups at three and six months after treatment.(1)The percentage of Pg: There was statistical difference compared within groups(P < 0.05);paired comparison showed that the percentage of Pg in SRP + ERL and SRP + ERL + NDL group was significantly decreased from baseline to the three and six months after treatment(P < 0.05),and that in SRP group was significantly decreased from baseline to the three months after treatment(P< 0.05).(2)The percentage of Td: Intra-group comparison showed that the difference in SRP + NDL group was statistically significant(P < 0.05),and then pared comparison showed that the percentage of Td at the three months after treatment was significantly lower than that in baseline(P <0.05).(3)The percentage of Tf: Intra-group comparison showed statistically significant difference occurred in SRP + ERL and SRP + ERL+ NDL groups(P < 0.05),and paired comparison showed there was significant decrease from baseline to the three months months after treatment(P < 0.05).3.Changes of the levels of IL1-β and TNF-α in GCF: At baseline,there were no significant statistical differences in the overall distribution of IL-1β and TNF-α in GCF among groups;At three and six months after treatment,IL-1β and TNF-α levels in GCF decreased significantly,but there was no significant difference among groups.(1)IL-1β levels:Intra-group comparison showed there were statistically significant differences among the periods(P < 0.05),and paired comparison showed that IL-1β levels in SRP + ERL + NDL,SRP + ERL and SRP + NDL dropped to the lowest at three months after treatment,and there was statistically significant decrease from the baseline to the three and six months after treatment(P < 0.05).IL-1β levels in SRP group dropped to the lowest at six months after treatment,and the difference was significant compared with baseline(P < 0.05).(2)TNF-α levels: Intra-group comparation showed that SRP,SRP + ERL and SRP + ERL +NDL group produced statistically difference(P < 0.05),pared comparison showed SRP produced the biggest reduction at the six months after treatment,the difference was statistically significant(P < 0.05).The TNF-α levels in SRP+ ERL group dropped to the lowest at three months after treatment,the difference was statistically significant(P < 0.05).The TNF-α levels in SRP+ ERL + NDL group dropped to the lowest at three months after treatment,there were statistically differences from baseline to three and six months after treatment(P < 0.05).Conclusion: Compared with SRP,SRP with laser has a slight advantage,thus laser can be used in the adjuvant treatment of periodontitis.SRP + ERL can produced bigger reduction of PD and CAL,thus can be applied in the treatment of periodontitis.SRP + ERL + NDL had no obvious advantages compared with SRP + ERL and SRP + NDL,but it can reduce the contents of IL-1β and TNF-α in gingival crevicular fluid effectively and continuously,thus can be applied as an adjunctive anti-inflammatory treatment to maintain the long-term periodontal health of patients with periodontitis. |
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