Journal of Education and Health Promotion

Comparative evaluation of postoperative pain and tissue response in patients undergoing conventional flap surgeries with or without 940 nm diode laser exposure ‑ A randomized clinical study

Authors

Sonali Roy .
. Dhirendra K. Singh
. Balaji Manohar
Abstract
BACKGROUND: Over the past few years, a growing body of evidence has allowed us to ascertain
that the initiation of periodontitis stems from the existence of oral microbial biofilm and that this
requires definitive treatment. Owing to its exceptional usability, affordability, and antibacterial
activity, the “diode laser” (DL) has increasingly become a popular and important tool in a dentist’s
armamentarium. However, there is a scarcity of scientific evidence on the utility and advantages of
using “diode laser” in periodontal flap surgery. The study aimed to determine the efficacy of 940 nm
diode laser exposure in combination with conventional periodontal flap surgery for the treatment of
chronic periodontitis to evaluate postoperative discomfort and clinical parameters.
MATERIALS AND METHODS: A total of 10 subjects (7 males and 3 females) with generalized
chronic periodontitis were recruited and completed the study without any dropouts. For this split‑mouth
study, 40 sample sites with pocket probing depth (PPD) 5–7 mm post periodontal Phase I therapy
were selected. The quadrants were randomly allocated to Groups A, B, C, and D using the fish
bowl lottery method. Kirkland flap surgery with laser and modified Widman flap (MWF) with laser
were performed in Group A and C, respectively, while Kirkland flap surgery and MWF surgery were
performed in Group B and Group D. Clinical parameters including visual analog scale (VAS) score
and gingival inflammation were determined at 3rd and 7th day postoperatively while PPD, clinical
attachment level (CAL), and sulcus bleeding index (SBI) were recorded at baseline and 6 months
following treatment. Wilcoxon signed‑rank test and Kruskal–Wallis test were used for intra‑group
and inter‑group comparison of parameters, respectively.
RESULTS: Statistically significant difference was attained with postoperative discomfort in
laser‑assisted groups on 1st and 3rd day postoperatively (P < 0.001). There was no significant difference
in the proportion of subjects with gingival inflammation. A statistically significant reduction in mean
PPD at 6 months postoperatively was seen among all study groups (P < 0.05) but the inter‑group
difference was not statistically significant. SBI score reduced significantly from baseline to 6 months
follow‑up among all four groups (P < 0.05). However, we did not find the inter‑group difference to
be statistically non‑significant.
CONCLUSION: Diode laser as an adjunct to the surgical procedure can demonstrate appreciable
benefits by increasing the CAL and minimizing the postoperative pain and the probing pocket, but
such additional effects were not observed with gingival inflammation.


Keywords

Diode laser
pain assessment
periodontal pocket debridement
periodontitis
1. Paster BJ, Olsen I, Aas JA, Dewhirst FE. The breadth of bacterial
diversity in the human periodontal pocket and other oral sites.
Periodontol 2000 2006;42:80–7.
2. Berezow AB, Darveau RP. Microbial shift and periodontitis.
Periodontol 2000 2011;55:36–47.
3. SundarC, RamalingamS, MohanV, PradeepaR, RamakrishnanMJ.
Periodontal therapy as an adjunctive modality for HbA1creduction in type‑2 diabetic patients. J Educ Health Promot
2018;7:152.
4. Botelho J, Machado V, Proença L, Bellini D, Chambrone L,
Alcoforado G, et al. The impact of nonsurgical periodontal
treatment on oral health‑related quality of life: A systematic
review and meta‑analysis. Clin Oral Invest 2020;24:585–96.
5. Sumra N, Kulshrestha R, Umale V, Chandurkar K. Lasers in
non‑surgical periodontal treatment‑ A review. J Cosmet Laser
Ther 2018;21:255‑61.
6. Ramfjord SP, Nissle RR. The MWF. J Periodontol 1974;45:601‑7.
7. Arjmand B, Khodadost M, Jahani Sherafat S, Rezaei Tavirani M,
Ahmadi N, Hamzeloo Moghadam M, et al. Low‑level laser
therapy: Potential and complications. J Lasers Med Sci 2021;12:e42.
8. Cobb CM. Non‑surgical pocket therapy: Mechanical. Ann
Periodontol 1996;1:443‑90.
9. Sterczała B, Grzech‑Leśniak K, Michel O, Trzeciakowski W,
Dominiak M, Jurczyszyn K. Assessment of human gingival
fibroblast proliferation after laser stimulation in vitro using
different laser types and wavelengths (1064, 980, 635, 450, and
405 nm)—Preliminary report. J Pers Med 2021;11:98.
10. Tan OL, Safii SH, Razali M. Clinical efficacy of repeated
applications of local drug delivery and adjunctive agents
in nonsurgical periodontal therapy: A systematic review.
Antibiotics (Basel) 2021;10:1178.
11. Nguyen NT, Byarlay MR, Reinhardt RA, Marx DB, Meinberg TA,
Kaldahl WB, et al. Adjunctive non‑surgical therapy of inflamed
periodontal pockets during maintenance therapy using diode
laser: A Randomized clinical trial. J Periodontol 2015;86:1133‑40.
12. Mester E, Spiry T, Szende B, Tota JG. Effect of laser rays on wound
healing. Am J Surg 1971;122:532‑5.
13. Mussttaf RA, Jenkins DFL, Jha AN. Assessing the impact of low
level laser therapy (LLLT) on biological systems: A review. Int J
Radiat Biol 2019;95:120‑43.
14. Alzoman HA, Diab HM. Effect of gallium aluminium arsenide
diode laser therapy on Porphyromonas gingivalis in chronic
periodontitis: A randomized controlled trial. Int J Dent Hyg
2016;14:261–6.
15. Isidor F, Karring T, Attstrom R. Reproducibility of pocket depth
and attachment level measurements when using a flexible splint.
J Clin Periodontol 2005;11:662‑8.
16. Kirkland O. The suppurative periodontal pus pocket; its treatment
by the modified flap operation. J Am Dent Assoc 1931;18:1462–70.
17. Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki
AA Periodontal and peri-implant wound healing following laser
therapy. Periodontal 2000 2015;68:217–69.
18. Manjunath S, Singla D, Singh R. Clinical and microbiological
evaluation of the synergistic effects of diode laser with nonsurgical
periodontal therapy: A randomized clinical trial. J Indian Soc
Periodontol 2020;24:145‑9.
19. Shehab NF, Al‑Sabawi NA, Alkhalidi EF. Influence of an
810‑nm diode laser on the temperature changes of the external
root surface: An in vitro study. J Int Soc Prev Community Dent
2020;10:445‑51.
20. Chow R, Armati P, Laakso EL, Bjordal JM, Baxter GD. Inhibitory
effects of laser irradiation on peripheral mammalian nerves and
relevance to analgesic effects: A systematic review. Photomed
Laser Surg 2011;29:365‑81.
21. Ravi M, Nalini HE, Prasad AK, Devi RR. The effect of
biostimulation with 980‑ nm diode laser on postoperative pain
and tissue response after surgical periodontal therapy: A pilot
study. J Indian Acad Dent Spec Res 2016;3:47‑51.
22. Khan F, Chopra R, Sharma N, Agrawal E, Achom M, Sharma P.
Comparative evaluation of the efficacy of diode laser as an
adjunct to MWF surgery for the treatment of chronic periodontitis:
A randomized split‑mouth clinical trial. J Indian Soc Periodontal
2021;25:213‑9.
23. Sanz Moliner JD, Nart J, Cohen RE, Ciancio SG. The effect of an
810‑nm diode laser on post‑operative pain and tissue response
after MWF surgery: A pilot study in humans. J Periodontal
2013;84:152‑8.
24. Nagaraj A, Shetty M, Bhandary S. Effect of 810 nm diode laser on
post‑operative pain adjunct to periodontal flap surgery. IJPHRD
2020;11:91‑6.
25. Young C, Mak CL. Low Level Light Therapy (LLLT): Penetration
and Photobiomodulation. J Oral Health Craniofac Sci. 2017;
2: 80‑82
26. Takei HH, Carranza FA. Clinical diagnosis. In: Newman MG,
Takei HH, Klokkevold PR, Carranza FA, editors. Clinical
Periodontology. 11th ed. St. Louis, MO: Elsevier Saunders; 2012.
p. 340‑58.
27. Shetty S, Shetty K, Alghamdi S, Almehmadi N, Mukherjee T.
A comparative evaluation of laser assisted & conventional open
flap surgical debridement procedure in patients with chronic
periodontitis – A clinical and microbiological study‑ A pilot
project. Int J Pharm Sci Res 2020;11:4957‑65.
28. Aena PJ, Parul A, Siddharth P, Pravesh G, Vikas D, Vandita A.
The clinical efficacy of laser assisted MWF: A randomized split
mouth clinical trial. Indian J Dent Res 2015;26:384‑9.
29. Lobo TM, Pol DG. Evaluation of the use of a 940 nm diode laser as
an adjunct in flap surgery for treatment of chronic periodontitis.
J Indian Soc Periodontol 2015;19:43‑8.
30. Karthikeyan J, Vijayalakshmi R, Mahendra J, Kanakamedala A,
Chellathurai BN, Selvarajan, et al. Diode Laser as an adjunct to
kirkland flap surgery—A randomized split‑mouth clinical and
microbiological study. Photomed Laser Surg 2019;1:1–11.
31. Boddun M. Laser hazards and safety in dental practice: A review.
Oral Health Care 2020;5:1‑4.
Journal of Education and Health Promotion
Volume 12, Issue 11
December 2022
Pages 1-10

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us