Effect of Er:YAG laser as adjunct to guided tissue regeneration

Objective: To evaluate the effect of the erbium:yttrium-aluminium-garnet laser (ERL; Key II®, KaVo, Germany) on the healing of human intrabony defects treated with a demineralised bovine bone mineral (DBBM) and a bioresorbable collagen barrier (BioOss® and BioGide®, Geistlich, Switzerland). Methods: Twenty-two periodontitis patients were included. Inclusion criteria were: presence of intrabony defect with minimum 3 mm of depth following initial periodontal therapy; good oral hygiene (FMPS<25%); non-contributing medical history and signed informed consent. Plaque/bleeding score (FMPS/FMBS); pocket depth (PPD); gingival recession (REC) and attachment level (CAL) were measured at baseline and after twelve months. Following flap reflection, subjects were randomised in two groups. Root surface debridement and granulation tissue removal were carried out either with ERL at 160 mJ/pulse, 10 Hz and 15-20 degree between the chisel shaped tip and the root surface (test) or by ultrasonic and hand instruments (control). Defects were then filled with DBBM and covered with the collagen membrane prior to flap closure. Postsurgical regime included amoxicillin (500mg, TID, 7 days) and chlorhexidine rinse (0.2%, BID, 2 weeks). Patients were enrolled in a supportive oral hygiene program. Results: No statistically significant differences were detected between test and control groups at baseline. Postoperative healing was uneventful in both groups. In the ERL group mean PPD was reduced from 9.2±2.8 mm to 3.7±1.1 mm (p<0.001) and mean CAL changed from 11.7±2.9 mm to 7.5±1.8 mm (p<0.001). In the test group mean PPD was reduced from 8.5±2.6 mm to 3.4±1.0 mm (p<0.001) and mean CAL changed from 10.6±3.6 mm to 6.5±2.0 mm (p<0.001). None of the investigated parameters showed statistically significant intergroup differences. Conclusion: Within their limits, the present findings indicate that: a) both therapies led to significant clinical improvements and b) ERL has failed to additionally enhance the benefit of conventional debridement, as adjunct to guided tissue regeneration.