BACKGROUND This systematic review assesses the efficacy of infrared laser therapy used alone or as an adjunct to nonsurgical or surgical periodontal therapy, on clinical and patient-centered outcomes in patients with periodontitis. METHODS Randomized clinical trials (RCTs) with a follow-up duration ≥3 months that evaluated root surface debridement (i.e., scaling and root debridement with or without surgical access) to laser therapy alone or laser therapy plus root surface debridement for the treatment of adult patients (≥18 years old) with moderate to severe aggressive or chronic periodontitis were considered eligible for inclusion. The MEDLINE, EMBASE and CENTRAL databases were searched for articles published up to and including March 2016. Random effects meta-analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences (MDs) with their associated 95% confidence intervals (CIs). Additionally, summaries are presented of the included RCTs, critical remarks of the literature and evidence quality rating/strength of recommendation of laser procedures. RESULTS Of the 475 potentially eligible articles, 28 were included in the review. Individual study outcomes and seven sets of meta-analysis (1 for the nonsurgical treatment of AgP and 9 for nonsurgical and surgical treatment of CP) showed a benefit of laser therapy in improving clinical attachment level (CAL) and probing depth (PD). However, the comparative differences in clinical outcomes were modest (< 1 mm) and the level of certainty for different therapies was considered low-to-moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the Strength of Clinical Recommendations of laser therapies were considered weak or based on expert opinion. CONCLUSIONS In patients with moderate to severe periodontitis, the nonsurgical treatment of AgP and CP by SRP plus infrared diode laser, and the surgical treatment of CP by Er:YAG laser therapy alone may promote statistically significant improvements in PD and CAL. However, these gains are relatively small (< 1 mm) and provide modest clinical relevance compared with SRP alone.

https://aap.onlinelibrary.wiley.com/doi/pdf/10.1902/jop.2017.160504

Infrared lasers for the treatment of moderate to severe periodontitis: An American Academy of Periodontology best evidence review.

Periodontal disease is an oral infectious and inflammatory disease caused by microorganisms that determine the host-mediated destruction of soft and hard periodontal tissues, which ultimately leads to tooth loss. Periodontitis affects a large part of the population, with various degrees of severity. Treatment consists of etiologic therapy: the removal of biofilm through mechanical debridement plus microbial elimination by supplementary measures. Antibiotic administration, either systemically or through local delivery, has been shown to improve clinical outcomes after mechanical periodontal treatment. Clindamycin is a lincosamide with a broad spectrum, being active against aerobic, anaerobic, and β-lactamase-producing bacteria. This antibiotic offers several advantages and some disadvantages and has been used in periodontal treatment both systemically and locally with various degrees of success. Among the properties that recommend it for periodontal treatment is the bacteriostatic effect, the inhibition of bacterial proteins synthesis, the enhancement of neutrophil chemotaxis, phagocytosis and the oxidative burst–oxidative stress storm. Furthermore, it is easily absorbed at the level of oral tissues in a considerable amount. This substantial tissue penetration, especially inside the bone, is synergistic with a stimulating effect on the host immune system. The aim of this review is to explore the applicability of this antibiotic agent and to evaluate its antimicrobial potential and limitations at the level of the oral biofilm associated with periodontal disease.

Clindamycin as an Alternative Option in Optimizing Periodontal Therapy.

There are several studies that evaluate the use of lasers in periodontal treatment in non-surgical or surgical therapy. However, while several studies showed clinically beneficial effects of some lasers in periodontal treatment, there are few clinical reports of additional advantages of lasers as adjunctive treatments in periodontology. The aim of this paper is to demonstrate and critically analyze the level of scientific evidence of effects of low-level lasers and high-power lasers in periodontology. A narrative review of the studies was carried out in each topic and type of laser or periodontal treatment. In nonsurgical periodontal therapy the results showed that there is an additional clinical benefit when using a diode laser (DL) associated with scaling and root planing (SRP) in patients with moderate to severe periodontitis. The Er:YAG laser seems to be the most suitable for nonsurgical periodontal therapy and promotes the same clinical effects as conventional therapy. In periodontal surgery vaporization of the gingival or mucosal tissue can be carried out with DL, CO2, Nd:YAG, Er:YAG and Er,Cr:YSGG lasers. Photobiomodulation (PBM), mediated by low-level lasers associated with non-surgical periodontal therapy, promotes additional benefits in the short term and accelerates the bone and gingival tissue repair process and also reduces postoperative symptoms of periodontal surgery. The effect of antimicrobial Photodynamic Therapy is relevant in the initial reevaluation periods. Studies have shown controversial results of the use of lasers in periodontics, and this fact may be due to the lack of standard parameters of irradiation in each clinical application.

/pdf/laser-in-periodontal-treatment-is-it-an-effective-treatment-58n6k49j5u.pdf

LASER in periodontal treatment: is it an effective treatment or science fiction?

Purpose The aim of this cross-sectional study was to investigate the effect of scaling and root planing (SRP) on the expression of anti-inflammatory cytokines (interleukin [IL]-4, IL-9, IL-10, and IL-13) in the gingival crevicular fluid (GCF) of electronic cigarette users and non-smokers with moderate chronic periodontitis (CP). Methods Electronic cigarette users and non-smokers with CP were included in the study. Full-mouth plaque and gingival indices, probing depth (PD), clinical attachment loss (CAL), and marginal bone loss (MBL) were assessed. The GCF was collected, and its volume and levels of IL-4, IL-9, IL-10, and IL-13 were assessed. These parameters were evaluated at baseline and 3 months after SRP. The sample size was estimated, and comparisons between groups were performed. P<0.05 was considered to indicate statistical significance. Results Thirty-six electronic cigarette users (47.7±5.8 years old) and 35 non-smokers (46.5±3.4 years old) with CP were included. At baseline, there were no differences in plaque index (PI), PD, CAL, MBL, and GCF IL-4, IL-9, IL-10, and IL-13 between electronic cigarette users and non-smokers. At the 3-month follow-up, there were no significant differences in PI, gingival index (GI), PD, CAL, and MBL in electronic cigarette users compared to baseline, while there were significant reductions in PI, GI, and PD among non-smokers. At the 3-month follow-up, GCF IL-4, IL-9, IL-10, and IL-13 levels were significantly elevated in both groups (P<0.05) compared to baseline. The increases in GCF IL-4, IL-9, IL-10, and IL-13 levels were significantly higher in non-smokers (P<0.05) than in electronic cigarette users at the 3-month follow-up. Conclusions Levels of GCF IL-4, IL-9, IL-10, and IL-13 increased after SRP in electronic cigarette users and non-smokers with CP; however, the anti-inflammatory effect of SRP was more profound in non-smokers than in electronic cigarette users.

/pdf/effect-of-scaling-and-root-planing-on-the-expression-of-anti-22dzler69x.pdf

Effect of scaling and root planing on the expression of anti-inflammatory cytokines (IL-4, IL-9, IL-10, and IL-13) in the gingival crevicular fluid of electronic cigarette users and non-smokers with moderate chronic periodontitis

Ecosystem services balance and its influencing factors detection in China: A case study in Chengdu-Chongqing urban agglomerations

The objective of this study was to evaluate the clinical attachment level (CAL) gain of Er:YAG, Er,Cr; YSGG, Nd:YAG; and diode laser (DL) as monotherapy or adjunctive to scaling and root planing (SRP) of chronic periodontitis by network meta-analysis (NMA). Randomized controlled clinical trials (RCTs) about lasers applied in SRP of chronic periodontitis were searched from PubMed, Cochrane Library, Web of Science, Ovid, Science Direct, Wan Fang, and China National Knowledge Infrastructure (CNKI) databases up to September 2018 and from references of selected full-texts and related reviews. Standard mean differences and 95% confidence intervals were counted for CAL gain. The random effects NMA were performed in STATA software. There were 25 RCTs about CAL gain at 3 and/or 6 months after lasers were applied in SRP. No inconsistency was detected. Er:YAG as monotherapy gained significantly more CAL at 3 months than did SRP; no significant differences were detected among other comparisons. In terms of CAL gain at 3 months, the ranking result from best to worst was as follows: Er:YAG as monotherapy, DL adjunctive to SRP, Er:YAG adjunctive to SRP, Er,Cr;YSGG as monotherapy, Nd:YAG adjunctive to SRP, and SRP. In terms of CAL gain at 6 months, the ranking result from best to worst was as follows: DL adjunctive to SRP, Nd:YAG adjunctive to SRP, SRP, Er:YAG adjunctive to SRP, and Er:YAG as monotherapy. Laser-assisted periodontal treatment could be superior to SRP alone and could serve as a good adjunctive treatment tool.

Clinical attachment level gain of lasers in scaling and root planing of chronic periodontitis: a network meta-analysis of randomized controlled clinical trials

The aim of this meta-analysis was to systematically evaluate the applications of Er:YAG lasers for the removal of caries and cavity preparation in children The meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was conducted with data extracted from seven relevant randomized controlled trials (RCTs) published from 1997 to July 2017 The data heterogeneity of each study was assessed by a Q test We used the heterogeneity results to calculate the standard mean difference (SMD) or relative risk (RR) and 95% confidence interval (95%CI) using STATA version 100 The publication bias was evaluated using Begger’s test There were seven randomized controlled trials included in this study The analysis results indicate that compared to the conventional mechanical method, more time was needed for Er:YAG laser treatment (SMD 1945, 95%CI 0942 to 2948) However, the pain reported by patients was reduced with Er:YAG laser treatment (SMD − 1013, 95%CI − 1892 to − 0196) There were no significant differences between the groups in the complete retention rate (RR 1021, 95%CI 0963 to 1114), the marginal discoloration (RR 1638, 95% CI 0240 to 11986) and the marginal adaptation (RR 1480, 95%CI 0257 to 8515) In conclusion, our data indicate that the time required for Er:YAG laser treatment was longer than that for the conventional mechanical method, but there was less pain associated with the Er:YAG laser treatment There were no significant differences in the complete retention rate, marginal discoloration, and marginal adaptation between the two groups

Er:YAG laser application in caries removal and cavity preparation in children: a meta-analysis

BACKGROUND The aim of this research was to systematically analyze the effectiveness of calcium hydroxide compared to formocresol (FC) and camphor phenol (CP) in root canal disinfection of primary teeth. MATERIAL AND METHODS The meta-analysis was based on the participants, interventions, control, outcome (PICO) study design principle and 16 randomized-controlled clinical trials published from January 2000 to August 2018. The data heterogeneity of each study was assessed by the Q-test. The odds ratio and 95% confidence interval (CI) were calculated based on the heterogeneity results by Revman software. RESULTS Sixteen randomized-controlled clinical trials of 3047 primary teeth were included in this meta-analysis. There were significant differences of clinical effectiveness between calcium hydroxide and FC in root canal disinfection of primary teeth (OR=3.37; 95% CI range: 2.54-4.48, P<0.01) and endodontic inter-appointment emergencies (EIAE) after disinfection for 7 days (OR=0.26; 95% CI range: 0.16-0.42, P<0.01). However, there was no statistical difference of EIAE, after disinfection of primary teeth for 48 hours, between calcium hydroxide and FC (OR=0.62; 95% CI range: 0.34-1.11, P=0.11). There were significant differences of clinical effectiveness between the calcium hydroxide and CP in root canal disinfection of primary teeth (OR=5.50; 95% CI range: 3.36-8.98, P<0.01). CONCLUSIONS This meta-analysis indicated that the effectiveness of calcium hydroxide as root canal disinfectant in primary teeth was more effective than that of FC and CP.

/pdf/the-clinical-effectiveness-of-calcium-hydroxide-in-root-14f2ffvm60.pdf

The Clinical Effectiveness of Calcium Hydroxide in Root Canal Disinfection of Primary Teeth: A Meta-Analysis

Revealing the spatial and temporal changing characteristics and key factors driving the relationship between the supply of and demand for ecosystem services (SDES) is paramount for the effective management of regional ecosystems and the rational allocation of natural resources. This study calculated the supply of ecosystem services (ESS) in Jiangsu Province, China, in 2000, 2010, and 2020, and quantitatively evaluated the ecosystem service demand (ESD) in those years by considering land development intensity, population density, and economic conditions. The ‘coupling coordination degree and relative development degree’ (CDRD) model is introduced to explore the degree of coordination and change in the relationship of supply versus demand of ecosystem services, and then to reveal the impact of various factors on the spatial differentiation characteristics of the SDES. The results show that: 1) the ESS is high in the Taihu Lake Plain, the southwest of Huaihai area and the eastern coastal zone of Jiangsu Province, yet low in the northwest and middle of Huaihai area, and along the Yangtze River Plain. The overall distribution pattern of ESD and the coordinating degree of the SDES is high in the south and north of Jiangsu Province but low in the province’s middle. 2) The degree of coordination for the SDES increased from 0.371 to 0.415, and the relationship between supply and demand changed from one of moderate imbalance to one of basic coordination. The imbalance of supply and demand is mainly concentrated in the Lixiahe area, coastal plain area, and middle of the Huaihe River Basin, for which the predominant type is a moderate imbalance–demand lag. Meanwhile, the analysis of influencing factors shows that there is an obvious synergistic effect between different factors. The results of this research could contribute to sustainable ecosystem management and decision-making for the construction of ecological civilization in Jiangsu Province.

/pdf/ecosystem-services-in-jiangsu-province-changes-in-the-supply-11jb2ye1.pdf

Ecosystem services in Jiangsu province: Changes in the supply and demand patterns and its influencing factors

This publication has been retracted by the Editor due to non-original content and deficiencies in the conduct of the study. Reference: Liying Jia, Xiaolin Zhang, Hong Shi, Ting Li, Bingjian Lv, Meng Xie. The Clinical Effectiveness of Calcium Hydroxide in Root Canal Disinfection of Primary Teeth: A Meta-Analysis. Med Sci Monit, 2019; 25: 2908-216. DOI: 10.12659/MSM.913256.

Retracted: The Clinical Effectiveness of Calcium Hydroxide in Root Canal Disinfection of Primary Teeth: A Meta-Analysis.

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