The Effect Of Adjunctive Laser Therapy On The Periodontal Microbiome

Objectives: Adjunctive Laser Therapy (ALT) is a supplemental treatment option that can be used in conjunction with the thorough mechanical removal of biofilm and calculus from a periodontally diseased root surface via Scaling and Root Planing (SRP), the gold standard for periodontal therapies. Despite the increasing popularity of SRP+ALT, studies addressing this procedural combination are still relatively limited. Here, we present a comprehensive comparison of SRP+ALT with SRP including clinical parameters as well as periodontal microbiome changes upon treatment.
Methods: 15 systemically healthy non-smokers presenting with chronic periodontitis stages II-IV participated in the study. In a split-mouth design, quadrants with pockets ≥ 5mm were randomly assigned to receive either SRP or SRP+ALT using a Waterlase iPLUS Er:Cr:YSGG laser. Two qualifying sites per treatment type and periodontally healthy sites were selected in independent quadrants for collection of clinical parameters and subgingival biofilm samples over a period ranging from pre-treatment baseline to 3, 6, 9 and 12 months post-treatment. Clinical parameters (bleeding upon probing, pocket depth, clinical attachment levels) were recorded. Subgingival biofilm samples were processed for next generation sequencing.
Results: Microbial community changes presented similar after SRP+ALT and SRP with pocket depth, disease resolution and patient specific factors being the main determinants of periodontal microbiome composition. However, at the individual species level marked differences were observed. Both types of treatments resulted in a similar reduction in pocket depth and bleeding on probing (BOP), as well as an increase in clinical attachment. However, pockets with depth of ≥ 7mm displayed significantly improved outcome with SRP+ALT.
Conclusions: Clinical outcome and microbiome composition are similar for both treatment of 5-6mm pockets. Deeper pockets may benefit from SRP+ALT treatment.