[Effects of Er, Cr: YSGG laser on the root surface of periodontitis and healthy teeth].
Qu Chun-na,Kang Jun,Luan Qing-xian
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
OBJECTIVE:To evaluate the effects of Er, Cr: YSGG laser on the root surface of periodontally involved teeth and healthy teeth, concerning the microstructure and the roughness. METHODS:Eight freshly extracted teeth due to severe periodontitis and eight freshly extracted teeth due to orthodontic reasons or being third molar were chosen in this study. The root surface of each tooth was divided into four areas, and received four treatment METHODS:no treatment (control group); root planing with Gracey scaler for 30 seconds; irradiation by the lower power Er, Cr: YSGG laser; irradiation by the higher power Er, Cr: YSGG laser. Four periodontally involved teeth and four healthy teeth were used for the evaluation of microstructure using scanning electron microscope (SEM). The other four periodontitis teeth and four healthy teeth were used for the evaluation of roughness (Ra value) using 3D profiler. RESULTS:Smear layer was found on the teeth scaled by Gracey scaler, while the teeth irradiated by Er, Cr: YSGG laser demonstrated a melting surface with less smear layer. In the periodontitis teeth irradiated by the higher power, opening dentinal tubules could be observed. For the periodontally involved teeth, the Ra values of groups 1 to 4 were (237.4 ± 20.0) nm, (135.7 ± 11.9) nm (P=0.01), (463.6 ± 49.3) nm (P<0.001) and (486.0 ± 59.0) nm (P<0.001) respectively. For the healthy teeth, the Ra values of groups 1 to 4 were (191.4 ± 44.5) nm, (131.6 ± 21.5) nm (P=0.482), (463.7 ± 34.6) nm (P<0.001) and (470.3 ± 121.3) nm (P<0.001) respectively. CONCLUSION:Er, Cr: YSGG laser can affect the microstructure of the cementum of the periodontitis teeth and healthy teeth. Irradiation by the Er, Cr: YSGG laser resulted in a melting surface with less smear layer and increased the roughness in the surface of root.
Er,Cr:YSGG Laser Application for the Treatment of Periodontal Furcation Involvements.
Ge Linhua,Zhang Yunxin,Shu Rong
Photomedicine and laser surgery
OBJECTIVE:The purpose of this study was to evaluate the clinical use of an erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser in the management of root furcation involvements. BACKGROUND DATA:It has been suggested that the use of laser radiation within the periodontal pocket may be effective in periodontal treatment. However, very limited data from clinical trials exist directly comparing the use of the Er,Cr:YSGG laser to conventional root planing. MATERIALS AND METHODS:Thirty patients with chronic periodontitis were recruited. A total of 128 teeth with degree II or III furcation involvement were included in a split-mouth design such that the teeth on one side of the mouth were established as Group A and treated with the Er,Cr:YSGG laser and the teeth on the other side were established as Group B and treated with manual subgingival debridement. Changes in probing depth (PD), bleeding on probing (BOP), clinical attachment loss (CAL), and visual analogue scale (VAS) pain scores were compared between Groups A and B and within individuals over time at 6 and 12 weeks after treatment, testing the null hypothesis that there would be no clinical difference between treatment modalities. RESULTS:Both treatments significantly reduced the PD, CAL, and BOP in the diseased teeth with degree II or III furcation involvement. The reduction of PD and BOP at weeks 6 and 12 was significantly higher in Group A (laser treated) than in Group B. The VAS pain score was significantly lower in Group A than in Group B (p < 0.01). CONCLUSIONS:Pocket debridement with Er,Cr:YSGG laser is a safe, comfortable, and clinically effective means of subgingival debridement in periodontal therapy.
Effect of Er,Cr:YSGG laser application in the treatment of experimental periodontitis.
Pavone Chaine,Perussi Livia Rodrigues,de Oliveira Guilherme José Pimentel Lopes,Scardueli Cássio Rocha,Cirelli Joni Augusto,Cerri Paulo Sérgio,Junior Elcio Marcantonio,Spolidorio Luis Carlos,Marcantonio Rosemary Adriana Chiérici
Lasers in medical science
The purpose of this study was to evaluate the influence of an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser in the absence or presence of manual scaling and root planning (SRP) for the treatment of induced periodontitis in rats. Ligatures were placed in the subgingival region of the maxillary first molar. After a 7-day period, the ligatures were removed, and 40 rats were randomly divided into four groups (G), as follows: (GI) no treatment, (GII) scaling and root planning (SRP) with curettes, (GIII) Er,Cr:YSGG laser irradiation and (GIV) SRP with curettes followed by Er,Cr:YSGG laser irradiation. Seven and 30 days after the treatment, the animals were sacrificed and histologic, histometric and immunohistochemistry analyses were performed. All groups showed similar histopathological characteristics during the evaluation period. The histometric analysis was confirmed using Bonferroni and paired t tests. At 7 and 30 days, groups II, III and IV exhibited greater bone formation in the furcation area when compared to group I (p < 0.0001; p < 0.05). During the 7-day period, the groups irradiated with the laser (III and IV) showed a statistically larger new bone area than the group treated with SRP (II) (p < 0.01). Immunohistochemistry analysis revealed that the control group exhibited a higher expression of tartrate-resistant acid phosphatase (TRAP) and the receptor activator of nuclear factor κΒ ligand (RANKL) when compared to groups II, III and IV (p < 0.05). All treatments were able to reduce the inflammatory processes, consequently enabling the repair of periodontal tissues. The results achieved with the application of the Er,Cr:YSGG laser suggest that this laser can stimulate greater bone formation, especially over a shorter period of time.
Calculus Removal and Root Surface Roughness When Using the Er:YAG or Er,Cr:YSGG Laser Compared with Conventional Instrumentation Method: A Literature Review.
Agoob Alfergany Muftah,Nasher Riman,Gutknecht Norbert
Photobiomodulation, photomedicine, and laser surgery
The purpose of this literature review was to evaluate the effectiveness of using Er:YAG (erbium-doped yttrium/aluminum/garnet) laser or Er,Cr:YSGG (erbium, chromium-doped yttrium/scandium/gallium/garnet) laser on calculus removal and their effect on the topography and roughness of root surface in comparison with the conventional instruments in the nonsurgical periodontal therapy. One of the most challenging problems in treatment of periodontal disease is the elimination of plaque and calculus, leaving a clean and smooth root surface to decrease plaque and calculus retention, and for good gingival reattachment. PubMed and Google Scholar were searched for available literature. The electronic search was limited to articles published in the period between January 2007 and April 2017, in the English language. A total of 47 publications fulfilled the inclusion criteria of this systematic review and screened according to the research questions. Calculus removal using the ultrasonic instrument showed remaining calculus compared with the hand instrument, whereas, on the contrary, erbium lasers revealed no remaining calculus or smaller amounts compared with the conventional instruments when used in appropriate settings. The results of this review showed that ultrasonic instrumentation produced effects on the root surface almost similar to that of hand instrumentation. Er:YAG laser and Er,Cr:YSGG laser clarify a little more surface roughness when compared with conventional instruments. The present systematic review indicates that a combination of scaling and root planing (SRP) using the erbium lasers as an adjunctive therapy at certain parameters can be appropriate to remove residual debris from the root surface and at the same time have little or no negative thermal effect on the root surface. The Er:YAG laser also seems to be the most suitable for nonsurgical periodontal therapy. Additional new good-designed studies are needed to evaluate the effectiveness of erbium lasers with SRP in nonsurgical periodontal therapy.
A microscopic analysis of the effects of root surface scaling with different power parameters of Er,Cr:YSGG laser.
de Oliveira Guilherme José Pimentel Lopes,Cominotte Mariana Aline,Beraldo Tamara Pádua Pereira,Sampaio José Eduardo Cezar,Marcantonio Rosemary Adriana Chiérici
Microscopy research and technique
The aim of this study was to evaluate the effects of different power parameters of an Erbium, Cromium: Yttrium, Scandium, Gallium, Garnet laser (Er,Cr:YSGG laser) on the morphology, attachment of blood components (ABC), roughness, and wear on irradiated root surfaces. Sixty-five incisive bovine teeth were used in this study, 35 of which were used for the analysis of root surface morphology and ABC. The remaining 30 teeth were used for roughness and root wear analysis. The samples were randomly allocated into seven groups: G1: Er,Cr:YSGG laser, 0.5 W; G2: Er,Cr:YSGG laser, 1.0 W; G3: Er,Cr:YSGG laser, 1.5 W; G4: Er,Cr:YSGG laser, 2.0 W; G5: Er,Cr:YSGG laser, 2.5 W; G6: Er,Cr:YSGG laser, 3.0 W; G7: scaling and root planning (SRP) with manual curettes. The root surfaces irradiated by Er,Cr:YSGG at 1.0 W and scaling with manual curettes presented the highest degrees of ABC. The samples irradiated by the Er,Cr:YSGG laser were rougher than the samples treated by the manual curette, and increasing the laser power parameters caused more root wear and greater roughness on the root surface. The Er,Cr:YSGG laser is safe to use for periodontal treatment, but it is not appropriate to use irradiation greater than 1.0 W for this purpose.
Effects of Er,Cr:YSGG and Diode Lasers on Clinical Parameters and Gingival Crevicular Fluid IL-1 and IL-37 Levels in Generalized Aggressive Periodontitis.
Talmac Ahmet Cemil,Calisir Metin,Eroglu Emre Gurkan,Ertugrul Abdullah Seckin
Mediators of inflammation
Aim:The objective of the current study is to analyze the correlation between cytokine levels and periodontal parameters in aggressive periodontitis patients before and after periodontal treatment that was performed by using two different laser therapies. Materials and Methods:Twenty-six generalized aggressive periodontitis patients were treated with three different methods (SRP, SRP+diode laser, and SRP+Er,Cr:YSGG laser) applied to three different half-jaws in the same patients. Pre- and posttreatment clinical periodontal parameters and GCF IL-1 and IL-37 levels were measured. Results:There was a statistically significant decrease ( < 0.05) between pretreatment and posttreatment clinical periodontal parameters and IL-1 and IL-37 levels. When the reduction rates of IL-37 and IL-1 levels after treatment were evaluated, the decrease in IL-37 and IL-1 levels after treatment was lowest in the SRP group and highest in the SRP+Er,Cr:YSGG group. In addition, the amount of decrease in IL-1 in SRP+diode and SRP+Er,Cr:YSGG groups was found to be higher than that in IL-37. Furthermore, there was a positive correlation between IL-37 and IL-1 in all groups ( < 0.01). Conclusion:Er,Cr:YSGG laser is more effective than diode laser for the treatment of aggressive periodontitis. IL-37 and IL-1 are cytokines that function together and thus must be evaluated together.
The efficacy of Er,Cr:YSGG laser supported periodontal therapy on the reduction of peridodontal disease related oral malodor: a randomized clinical study.
Dereci Ömür,Hatipoğlu Mükerrem,Sindel Alper,Tozoğlu Sinan,Üstün Kemal
Head & face medicine
BACKGROUND:This study aims to evaluate the efficacy of Er,Cr:YSGG laser assisted periodontal therapy on the reduction of oral malodor and periodontal disease. METHODS:Sixty patients with chronic periodontitis were included in the study and allocated into two groups each containing 30 patients. The study was planned in a double blind fashion. Conventional periodontal therapy was performed in group 1 and conventional periodontal therapy was performed in association with Er,Cr:YSGG application in group 2. Periodontal parameters of probing depth, clinical attachment level, plaque index and bleeding on probing were measured with a periodontal probe. Quantitative analysis of volatile sulphure compunds (VSCs) were measured with a calibrated halimeter at baseline level and at post-treatment 1st, 3rd and 6th months. P values <0.05 were accepted as statistically significant. RESULTS:There was a statistical significant reduction in VSC values in group 2 at post-treatment 3rd and 6th months (p < 0.05). Pocket depth values at post-treatment 1st month and bleeding on probing values at post-treatment 3rd and 6th months were significantly decreased in group 2 (p < 0.05). Intragroup statistical analysis revealed that there were statistically significant differences for all parameters (p < 0.01). CONCLUSIONS:Er,Cr:YSGG laser assisted conventional periodontal therapy is more effective in reducing oral malodor and improving periodontal healing compared to conventional periodontal therapy alone.
Treatment of periodontal disease with an Er,Cr:YSGG laser in rats exposed to cigarette smoke inhalation.
Pavone Chaine,Nogueira Andressa Vilas Boas,de Oliveira Guilherme José Pimentel Lopes,Scardueli Cássio Rocha,Cerri Paulo Sérgio,Marcantonio Elcio,Marcantonio Rosemary Adriana Chiérici
Lasers in medical science
The purpose of this study was to evaluate the erbium, chromium:yttrium-scandiumgallium-garnet (Er,Cr:YSGG) laser irradiation in the treatment of periodontitis in rats exposed to cigarette smoke inhalation (CSI). Ligatures were placed in the maxillary second molars. After a 15-day period, the ligatures were removed and 180 animals were randomly divided into six groups: (1) CSRP group--CSI and manual scaling and root planing (SRP) treatment; (2) CL group--CSI and Er,Cr:YSGG laser irradiation; (3) CSRP + L group-CSI, SRP, and Er,Cr:YSGG irradiation; (4) SRP group-manual SRP; (5) L group--Er,Cr:YSGG irradiation; (6) SRP + L group--SRP and Er,Cr:YSGG irradiation. At 7, 15, and 30 days after treatments, animals were euthanized and histologic, histometric, immunohistochemistry, and real-time PCR analyses were performed. Histometrically, no differences were observed in the SRP, L, and SRP + L groups exposed to CSI. The CSRP group showed more bone formation at 30 days than at 15 days (p < 0.01) but less bone at 30 days than the CL group at 30 days (p < 0.05). Immunohistochemical staining was positive for osteoblasts, fibroblasts, and osteoclasts. Real-time PCR showed more (vascular endothelial growth factor) VEGF expression in the L (p < 0.05) and SRP + L (p < 0.01) groups at 30 days than at 15 days and less VEGF expression in the CSRP group at 30 days than at 15 days (p < 0.05). There was no difference in fibroblast growth factor (FGF) expression. The Er,Cr:YSGG laser irradiation promotes favorable conditions for tissue repair even in animals exposed to CSI, with similar results as those achieved from manual scaling and root planing.
Adjunctive use of InGaAsP and Er,Cr:YSGG lasers in nonsurgical periodontal therapy: a randomized controlled clinical study.
Ciurescu Codruta Elena,Cosgarea Raluca,Ciurescu Daniel,Gheorghiu Anca,Popa Daniela,Franzen Rene,Arweiler Nicole B,Sculean Anton,Gutknecht Norbert
Quintessence international (Berlin, Germany : 1985)
OBJECTIVE:To evaluate clinically and microbiologically the outcomes following the combined application of InGaAsP diode laser and Er,Cr:YSGG laser for nonsurgical treatment of chronic periodontitis (ChP). METHOD AND MATERIALS:Forty-two patients (age 45.31 ± 9.78 years, 22 female, 23 smokers) with ChP were randomly treated with subgingival debridement (SD) by means of ultrasonic and hand instruments (control group, n = 21) or with InGaAsP followed 1 week later by InGaAsP + SD + Er,Cr:YSGG (test group, n = 21). In the test group, a second laser treatment was performed for all residual sites (bleeding sites with probing depth [PD] ≥ 4 mm) 2 months after the first laser therapy. At baseline and 6 months after therapy, periodontal clinical and microbiologic parameters were evaluated. RESULTS:Six months after therapy, statistically significant clinical and microbiologic improvements (PD reduction, clinical attachment level [CAL] gain, quantitative reduction of periopathogens) were observed in both groups compared to baseline. However, the use of InGaAsP followed by SD and the adjunctive use of an Er,Cr:YSGG laser, yielded statistically significantly higher clinical (PD, CAL, bleeding on probing, number of sites with PD ≥ 5 mm, PD ≥ 6 mm, PD ≥ 7 mm) and microbiologic (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia, Peptostreptococcus micros, Fusobacterium nucleatum) improvements (P < .05) compared to SD alone. CONCLUSIONS:In patients with ChP, the adjunctive use of InGaAsP and Er,Cr:YSGG to SD may additionally improve the clinical and microbiologic parameters obtained with SD alone, thus representing a valuable approach in nonsurgical periodontal therapy.
The Effect of an Er,Cr:YSGG Laser in the Management of Intrabony Defects Associated with Chronic Periodontitis Using Minimally Invasive Closed Flap Surgery. A Case Series.
Al-Falaki Rana,Hughes Francis,Wadia Reena,Eastman Christie,Kontogiorgos Elias,Low Samuel
This is an extended case series of patients treated with an Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser as an adjunct to scaling for the management of intrabony defects. 46 patients with 79 angular intrabony defects associated with pocket depths of >5mm, and a mean age of 53 ± 9 years presenting with chronic periodontitis were included in the analysis. All patients underwent a localized minimally invasive closed flap surgery utilizing Er,Cr:YSGG laser therapy. Final radiographs and pocket depths were compared to pretreatment measurements with a time period of 8 ± 3 months. Treatment resulted in significant overall pocket depth reduction. The mean pre-op probing depth was 8.1 ± 1.9mm, reducing to 2.4 ± 0.9mm post-treatment. Bony infill of the defects was visible radiographically and there was an increase in overall radiographic coronal osseous height compared to a pre-treatment baseline. Radiographs of 15 of the defects were available for further measurements after >12 months, and showed in these sites there was a significant reduction in intrabony defect depth, but no change in suprabony bone height. 9 of the 15 sites showed 50% or more, bony infill of the intrabony defect. The results demonstrate that the utilization of an Er,Cr:YSGG laser in a closed flap approach with chronic periodontitis may be of significant clinical benefit. Further studies using this laser surgical protocol are required to test these observations in well-designed randomized controlled trials.
Outcome of Er,Cr:YSGG laser-assisted treatment of teeth with apical periodontitis: a blind randomized clinical trial.
Martins Miguel R,Carvalho Manuel F,Pina-Vaz Irene,Capelas Jose A,Martins Miguel A,Gutknecht Norbert
Photomedicine and laser surgery
OBJECTIVE:As clinical studies conducted to explore the safety and efficacy of new procedures are considered an important focus in endodontic research, the aim of this controlled clinical study was to compare a laser-assisted endodontic treatment using an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser and radial firing tips (RFT) versus the conventional use of 3% sodium hypochlorite and interim calcium hydroxide paste, in teeth with chronic apical periodontitis. METHODS:Forty-three single-rooted and premolar teeth were randomly assigned. In group 1, teeth were prepared and irrigated with 3% sodium hypochlorite and calcium hydroxide inter-appointment dressing was applied; in group 2 teeth were prepared with saline solution and irradiated with Er,Cr:YSGG laser using RFT2 (140 μs, 37.5 mJ, 20 Hz) and RFT3 (140 μs, 62.5 mJ, 20 Hz) at the first and second appointments, respectively, four times each, moving at 2 mm/sec(-1) from apical to coronal. The primary outcome measure was change in apical bone density at 12 months, using the periapical index (PAI) for blind radiographic assessment. RESULTS:Thirty teeth were examined and subjected to statistical analysis, 12 in the control group and 18 in the test group. There were two treatment failures in the control group that were not included for analysis; both groups exhibited statistically significant decreases in PAI scores. CONCLUSIONS:The present findings suggest that for single-rooted and premolar teeth, this laser-assisted protocol can achieve predictable endodontic outcomes, comparable to conventional strategies in 1 year of follow-up.
Efficacy of Adjunctive Er, Cr:YSGG Laser Application Following Scaling and Root Planing in Periodontally Diseased Patients.
Magaz Vanessa Ruiz,Alemany Antonio Santos,Alfaro Federico Hernández,Molina José Nart
The International journal of periodontics & restorative dentistry
The application of laser as a monotherapy has been shown to reduce probing pocket depths and increase clinical attachment levels after treatment of patients suffering from chronic periodontitis. Its controversial use as an adjunct to scaling and root planing (SRP) is discussed. The present study aimed to evaluate the efficacy of adjunctive Er, Cr:YSGG laser application following conventional SRP. A total of 30 patients with chronic periodontitis were enrolled in the study. The quadrants of each patient were allocated to either SRP or SRP + laser. A total of 3,654 sites with pocket depths ≥ 4 mm were treated and evaluated at 6 weeks and 6 months postoperatively with respect to attachment gain. Both therapies resulted in improved probing pocket depths and clinical attachment levels. The adjunctive application of Er, Cr:YSGG laser following SRP did not improve probing pocket depth or attachment level compared with SRP alone.
One-year clinical results of Er,Cr:YSGG laser application in addition to scaling and root planing in patients with early to moderate periodontitis.
Kelbauskiene Solveiga,Baseviciene Nomeda,Goharkhay Kawe,Moritz Andreas,Machiulskiene Vita
Lasers in medical science
In 30 patients with periodontitis, a total of 278 teeth exhibiting bleeding on probing, subgingival calculus, and a probing depth between 3-6 mm were examined. For each participant, two treatment types were alternatively applied on the contralateral quadrants: scaling and root planing (SRP) as control, and SRP followed by Er,Cr:YSGG laser application (SRP+laser), as a test method. Five clinical parameters: plaque level, bleeding on probing, probing depth, gingival recession and clinical attachment level were examined at baseline and at 2, 3, 6, 12 months after treatment. Of the total of 1,668 sites examined in all patients, 1,088 sites were found with a probing depth of 3-6 mm. In these sites, differences in clinical parameters between SRP and SRP+laser-treated quadrants were analyzed, assuming the level of p < 0.05 as significant. After 2 months from baseline, the mean probing depth reduction and the clinical attachment level gain were significantly greater in SRP+laser than in SRP quadrants, and remained so throughout the study (p < 0.001). A marked reduction of the bleeding scores occurred in all examined sites, irrespective of the treatment method. However, after 12 months, significantly less teeth exhibited bleeding on probing in SRP+laser quadrants than in SRP quadrants (p < 0.001). The mean plaque and gingival recession levels did not differ between the SRP and SRP+laser quadrants neither before nor after the treatment. The periodontal procedures either using Er,Cr:YSGG laser after SRP or SRP alone, lead to significant improvements in all clinical parameters investigated. However, laser application, as an adjunct to SRP, appeared to be more advantageous.
Effects of Er,Cr:YSGG Laser Treatment on Human Gingival Fibroblast Attachment, Viability and Morphology of Root Surface: An In Vitro Study.
Amid Reza,Azizi Elahe,Torshabi Maryam,Ardakani Mohammad Reza Talebi,Ashnagar Sajjad,Moiahedi Seyed Masoud
Journal of the California Dental Association
Rehabilitation of periodontal support is the main goal of therapies for periodontitis. Hand instrumentation with curettes, piezoelectric ultrasonic scalers and lasers, such as Er,Cr:YSGG, are used for this purpose. This study was designed to evaluate human gingival fibroblast viability attachment to root surfac after modification with the mentioned therapeutic alternatives. Lasers showed significantly lower cell viability after 72 hours compared to hand instrumentation and ultrasound, probably due to more irregular root surfaces after treatment.
Clinical effectiveness of Er,Cr:YSGG lasers in non-surgical treatment of chronic periodontitis: a meta-analysis of randomized controlled trials.
Li Meng-Meng,Jia Jin-Hai,Wu Ming-Xuan,Zhao Cai-Yun,Jia Li-Ying,Shi Hong,Zhang Xiao-Lin
Lasers in medical science
The meta-analysis aimed to systematically evaluate all the available pieces of evidence concerning the clinical effectiveness of Er,Cr:YSGG lasers (erbium, chromium, yttrium scandium gallium garnet laser) in the non-surgical treatment of patients with chronic periodontitis, and provide guidance for clinicians about the application of Er,Cr:YSGG lasers during the process of non-surgical periodontal treatments. The meta-analysis was conducted with data extracted from 16 randomized controlled clinical trials (RCTs) that compare Er,Cr:YSGG lasers adjunct/substitute to scaling and root planing (SRP) with SRP alone for the treatment of chronic periodontitis published in English or Chinese from January 2000 to January 2020. The weighted mean differences (WMDs) and 95% confidence intervals (CIs) were counted for probing depth (PD) reduction, clinical attachment level (CAL) gain, and visual analogue scale (VAS) score. Heterogeneity of each study was evaluated with the Q test. The publication bias was measured using Begg's adjusted rank correlation test. Sixteen RCTs with 606 patients were included in the meta-analysis. There were statistically significant differences between Er,Cr:YSGG lasers adjunct/substitute to SRP and SRP alone in the PD reduction at 1-month follow-up (WMD = ‑ 0.35, 95% CI [- 0.63, ‑ 0.07], P = 0.013), 3-month follow-up (WMD = - 0.342, 95% CI [- 0.552, - 0.132], P = 0.001), CAL gain at 3-month follow-up (WMD = - 0.17, 95% CI [- 0.31, 0.03], P = 0.017), and VAS score (WMD = - 2.395, 95% CI [- 3.327, - 1.464], P = 0.000) immediately after treatment. There were no significant differences of PD reduction and CAL change at 6-month follow-up. The present meta-analysis indicated that Er,Cr:YSGG lasers provided additional effectiveness in PD reduction and CAL gain at short-term follow-ups and there was less pain compared with SRP alone.
Comparison of Er,Cr:YSGG laser to minimally invasive surgical technique in the treatment of intrabony defects: Six-month results of a multicenter, randomized, controlled study.
Clem Donald,Heard Rick,McGuire Michael,Scheyer E Todd,Richardson Chris,Toback Gregory,Gwaltney Chad,Gunsolley John C
Journal of periodontology
BACKGROUND:The purpose of this publication is to report on the six-month clinical results and patient-reported outcomes (PROs) comparing the surgical use of the erbium, chromium-doped: yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser (ERL) and minimally invasive surgical technique (MIST) for the treatment of intrabony defects in subjects with generalized periodontitis stage III, grade B. METHODS:Fifty-three adults (29 females and 24 males; aged 19 to 73 years) with 79 intrabony defects were randomized following scaling and root planing (SRP) to receive ERL monotherapy (n = 27) or MIST (n = 26). Recession, probing depth (PD), clinical attachment level (CAL), treatment time, and PROs were assessed and compared for each treatment group. Clinical measurements were recorded at baseline, 4 to 6 weeks following SRP, and 6 months following surgical therapy. RESULTS:The following primary and secondary outcome variables were non-inferior with the following margins: CAL with a non-inferiority margin of 0.6 mm (p = 0.05), PD with a non-inferiority margin of 0.5 mm (p = 0.05). Recession with a non-inferiority margin of 0.4 mm (p = 0.05). Faster procedure times were found for ERL (16.39 ± 6.21 minutes) versus MIST (20.17 ± 5.62 minutes), p = 0.0002. In the first 2 to 3 days of post-therapeutic diary outcomes, subjects reported less bruising, facial swelling, and use of ice pack for the ERL group. CONCLUSIONS:This is the first multicenter, randomized, masked, and controlled study demonstrating the ERL is not inferior to MIST in terms of clinical outcomes but is superior in PROs for the surgical treatment of intrabony defects.
Er,Cr:YSGG laser-assisted surgical treatment of peri-implantitis with 1-year reentry and 18-month follow-up.
Azzeh Manal M
Journal of periodontology
BACKGROUND:Peri-implantitis may occur because of biologic or mechanical factors. It can be treated by a variety of methods. In the present case report, treatment was attempted by regenerative osseous surgery associated with an erbium, chromium-doped:yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser. METHODS:A 28-year-old, non-smoking male complained of gum recession around an implant in the area of upper left central incisor. After clinical examination and radiographs, it was found that there was 2 mm recession, a probing depth of 7 mm, mobility grade one, and bone mesially and distally. Regenerative osseous surgery was performed using an Er,Cr:YSGG laser (2,780 nm) at different settings to open the flap, remove the granulation tissues, perforate the bone, and clean the implant surface. A bone graft and a bioabsorbable membrane were used for bone regeneration. The patient was reevaluated at 3, 6, 12 (with reentry), and 18 months postoperatively. RESULTS:At 3, 6, and 12 months postoperatively, there were no reported complications, with probing depths of 3 to 5 mm, <1 mm recession, no bleeding or implant mobility, and good bone formation. Slight pus discharge was present at 12 months. At 18 months postoperatively, probing depth was 2 mm, recession was <1 mm, there was no bleeding, implant mobility, or discharge, and there was better bone formation. The results were satisfactory to the patient and the clinician. CONCLUSION:The Er,Cr:YSGG laser enabled regenerative osseous surgery around an implant with no complications and with high patient and clinician satisfaction and confidence.
[Clinical observation of using Er,Cr:YSGG water laser to control endondontic interappointment pain].
Zhou Lei,Wang Jia,Zang Yan-Jun
Shanghai kou qiang yi xue = Shanghai journal of stomatology
PURPOSE:This study was to explore the role of Er, Cr：YSGG water laser in relieving endodontic interappointment pain (EIAP) during root canal therapy. METHODS:A total of 272 cases with chronic pulpitis and chronic periapical periodontitis were selected from the Department of Endodontics of our hospital from June 2015 to June 2017, they were randomly divided into 2 groups, 136 cases in each group. After routine root canal preparation, the teeth in group A were sealed with calcium hydroxide paste after Er, Cr : YSGG water laser treatment, while teeth in group B were sealed with calcium hydroxide paste. Caviton (GC company, Japan) was used for temporary fillings in both groups, occurrence and outcomes of postoperative EIAP were recorded and compared. SPSS 17.0 software package was used for statistical analysis. RESULTS:Among the two groups, there was no significant differences in EIAP (P>0.05) immediately and 1 week after surgery, but there was significant difference in the occurrence of EIAP between the first day, the second day and the third day after surgery (P<0.05). Group A had the lowest incidence of EIAP. CONCLUSIONS:Er, Cr: YSGG water laser can effectively reduce pain after root canal therapy, and can effectively shorten pain duration for patients; therefore, it is worthy of wide clinical application.
Comparison of periodontal open flap debridement versus closed debridement with Er,Cr:YSGG laser.
Gupta M,Lamba A K,Verma M,Faraz F,Tandon S,Chawla K,Koli D K
Australian dental journal
BACKGROUND:Traditional periodontal open flap debridement (OFD) results in reduced pocket depth (PD), clinical attachment loss (CAL), gingival recession (GR) and postoperative pain and discomfort. The quest to overcome these shortcomings has led to research into Er,Cr:YSGG laser assisted pocket therapy (ELAPT). This study was designed to compare the clinical outcomes of ELAPT versus OFD. METHODS:Fifteen patients with a PD of ≥5 mm and ≤8 mm at two sites were selected. Test sites (Group 1) were treated by ELAPT and the control (Group 2) by OFD. Clinical parameters were recorded at baseline, 3 and 6 months and included Plaque Index (PI), Gingival Index (GI), modified Sulcular Bleeding Index (mSBI), PD, CAL and GR. RESULTS:Both treatments produced a reduction in PI, GI, mSBI and PD, an increase in GR, and a gain in CAL at 3 and 6 months. The mean gain of CAL in Group 1 at 3 and 6 months (1.60 ± 0.78 and 1.80 ± 0.63) was similar (p > 0.05) to the value of Group 2 (1.93 ± 0.88 and 2.00 ± 0.54). GR increased significantly (p < 0.05) only in Group 2 at 3 and 6 months (1.80 ± 0.56 and 1.87 ± 0.64) compared to Group 1 (0.50 ± 0.68 and 0.60 ± 0.74). CONCLUSIONS:ELAPT compared with OFD results in similar CAL gains with less GR and significant reductions in PD, GI and mSBI, and may be considered as an alternative to surgical therapy.
Periodontal Bone Regeneration and the Er,Cr:YSGG Laser: A Case Report.
Perio Douglas N Dederich Cert
The open dentistry journal
BACKGROUND:Traditional methods of regenerating bone in periodontal bone defects have been partially successful and have involved numerous protocols and materials. More recently, it has been proposed that Er,Cr:YSGG laser energy may also be beneficial in the treatment of periodontal pockets, particularly in the regeneration of bone lost due to periodontal disease. CASE DESCRIPTION:The purpose of this paper is to present a case report of the Er,Cr:YSGG laser being used to conservatively treat a recalcitrant periodontal pocket in the presence of a periodontal bone defect and that resulted in successful resolution of the pocket and significant radiographic bone fill at the 1 year recall visit. CLINICAL IMPLICATIONS:This protocol using the Er,Cr:YSGG laser for the treatment of periodontal loss of attachment and periodontal bone loss may represent a less invasive alternative than traditional open-flap periodontal surgery or the intrasulcular use of other more penetrating laser wavelengths.
Minimally Invasive Periodontal Treatment Using the Er,Cr: YSGG Laser. A 2-year Retrospective Preliminary Clinical Study.
Dyer Bret,Sung Eric C
The open dentistry journal
MINIMALLY INVASIVE SURGERY (MIS) USING THE ERBIUM, CHROMIUM: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser (Waterlase MD, Biolase, Irvine, CA) to treat moderate to advanced periodontal disease is presented as an alternative to conventional therapies. To date, there are few short- or long-term studies to demonstrate the effects of this laser in treating and maintaining periodontal health. Electronic clinical records from 16 patients - total of 126 teeth, with pocket depths ranging from 4 mm to 9 mm - were treated with the same protocol using the Er,Cr:YSGG laser. The mean baseline probing depths (PD) were 5 mm and clinical attachment levels (CAL) were 5 mm in the 4 - 6 mm pretreated laser group. The mean baseline probing depths were 7.5 and 7.6 mm for PD and CAL respectfully in the 7 - 9 mm pretreatment laser group. At the 2 year mark, the average PD was 3.2 ± 1.1 mm for the 4-6 mm pocket group and the 7-9 mm pocket group had a mean PD of 3.7 ± 1.2 mm. mean CAL was 3.1 ± 1.1 mm for the 4-6 mm group and 3.6 ± 1.2 for the 7-9 mm group with an overall reduction of 1.9 mm and 4.0 mm respectively. At one and two years, both groups remained stable with PD comparable to the three-month gains. The CAL measurements at one and two years were also comparable to the three-month gains.
A pilot study of Er,Cr:YSGG laser therapy used as an adjunct to scaling and root planing in patients with early and moderate periodontitis.
Kelbauskiene Solveiga,Maciulskiene Vita
OBJECTIVES:The study aim was to compare the results of an Er,Cr:YSGG laser therapy used in adjunct to scaling and root planing (SRP), and of SRP alone, in a small group of patients with early to moderate periodontitis. MATERIALS AND METHODS:Ten adult patients with periodontitis were treated according to split-mouth design, using Protocol A (SRP alone) or, Protocol B (Er;Cr:YSGG laser therapy combined with SRP). At baseline, and 3 months after the treatment the following periodontal parameters were evaluated: bleeding on probing (BOP), probing depth (PD), plaque index (PI). RESULTS:no statistically significant difference in plaque levels was noted before and after the treatment between the treated quadrants, however a tendency of a more pronounced decrease in plaque levels was noted in the group of laser-SRP treated teeth. After three months, 60-68% decrease of BOP-positive teeth compared to baseline status was noted in all treated quadrants, without significant difference between the treatment modes. The decrease of mean PD values was measured after three months compared to baseline: on the lingual surfaces in 'SRP" group the mean PD improvement value was 0,94+/-12, and in the laser-SRP group it was 1,96+/-11, (p<0,001); on the vestibular surfaces the mean improvement values were 0,99+/-0,14 and 2,03+/-0,11, respectively (p<0,001). CONCLUSIONS:Non-surgical periodontal therapy using both an Er;Cr:YSGG laser + SRP and SRP alone, lead to significant improvements in all the investigated clinical parameters. The combined treatment using laser as an adjunct to root scaling and planing seemed to be advantageous when compared to SRP alone, due to more efficient attachment level restoration.
Clinical and biochemical effects of erbium, chromium: yttrium, scandium, gallium, garnet laser treatment as a complement to periodontal treatment.
Ustun K,Hatipoglu M,Daltaban O,Felek R,Firat M Z
Nigerian journal of clinical practice
Objective:The purpose of this study was to investigate the clinical effects of erbium, chromium: yttrium, scandium, gallium, garnet (Er, Cr: YSGG) laser treatment as a complementary to scaling and root planning (SRP) during the treatment of chronic periodontitis and gingival crevicular fluid (GCF) interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and interleukin-35 (IL-35) levels. Materials and Methods:Forty patients with chronic periodontitis were divided into two equal groups at random to receive SRP alone and SRP followed by Er, Cr: YSGG laser treatment, which are control and test groups, respectively. Clinical attachment level (CAL), probing depth (PD), bleeding on probing (BOP), gingival index (GI), and plaque index (PI) were measured for all patients in both groups at baseline and again at the end of the 1, 3, and 6 months following the treatment. Levels of GCF IL-1β, IL-6, and IL-35 were analyzed by enzyme-linked immunosorbent assay. Results:After periodontal treatment, CAL, PD, BOP, GI, and PI, which are clinical parameters analyzed, decreased significantly (P < 0.05) in both test and control groups. GCF volume, IL-1 β, IL-6, and IL-35, levels in both groups proved statistically significant reductions compared to the baseline (P < 0.05), but no substantial variations were detected among both groups. Conclusion:According to these results, we can suggest that IL-35 may be related to the pathogenesis of periodontitis and that Er, Cr: YSGG laser can be used as an adjunct to SRP in periodontal treatment.
Comparing the effects of root surface scaling with ultrasound instruments and Er,Cr:YSGG laser.
Noori Zohre Tabibzadeh,Fekrazad Reza,Eslami Behnam,Etemadi Ardavan,Khosravi Shabnam,Mir Maziar
Lasers in medical science
There are several studies done to show the comparability of laser scaling and root planing with routine methods. The most suitable wavelengths for such an application are reported as 2,940 and 2,780 nm. The superficial interactions of the current wavelength with root surface is investigated in this study to compare the crater and crack formation during the procedures between ultrasound and Er,Cr:yttrium-scandium-gallium garnet (YSGG; 2,780 nm) laser-treated teeth. Thirty human teeth with calculus on their root surface, which were extracted because of the severe periodontitis, were selected for this interventional in vitro study. Calculus area were divided into two equal parts: One of them was prepared for Er,Cr:YSGG (Biolase, Waterlase, USA) laser irradiation and the other one for ultrasound treatment (Dentsply cavitron, DENTSPLY International, USA). The Er,Cr:YSGG laser was specified as follows: pulse energy = 50 mJ, power = 1 W, wavelength = 2,780 nm, pulse repetition rate = 20 pulse per seconds, tip length = 6 mm, and tip diameter = 600 microm. Nineteen of the laser samples (95%) and eight of ultrasound ones (40%) out of 20 samples in each group had craters showing a statistical significant difference (p < 0.001). The number and depth of these craters are also evaluated. Thirteen samples of the laser cases (65%) and all samples of the ultrasound group showed cracks with significant differences (p = 0.008). In addition, the number and width of cracks in both groups are reported. As a general conclusion, the laser-treated samples show more craters but less cracks.
Clinical attachment level gain of lasers in scaling and root planing of chronic periodontitis: a network meta-analysis of randomized controlled clinical trials.
Jia Liying,Jia Jinhai,Xie Meng,Zhang Xiaoxiao,Li Ting,Shi Linan,Shi Hong,Zhang Xiaolin
Lasers in medical science
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.
Effects of root planing procedures with hand instrument or erbium, chromium:yttrium-scandium-gallium-garnet laser irradiation on the root surfaces: a comparative scanning electron microscopy study.
Hakki Sema S,Berk Gizem,Dundar Niyazi,Saglam Mehmet,Berk Nukhet
Lasers in medical science
The purpose of this study was to investigate the efficiency of hand instrumentation and laser irradiation on calculus removal from the root surfaces, in vitro. Thirty-two human teeth, extracted for periodontal reasons, were used in this study. Root surfaces of single-rooted teeth were treated by different methods including (1) conventional hand instruments; (2) hand instruments and tetracycline-hydrochloride (Tet-HCl); (3) erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser irradiation, setting I (short pulse); (4) Er,Cr:YSGG laser irradiation, setting II (long pulse). Three premolar teeth, extracted for orthodontic reasons, served as control. The morphology of the root surfaces was evaluated by light and scanning electron microscopy. Energy dispersive X-ray (EDX) analysis was performed to compare the mineral content of root surfaces treated with hand instrumentation and lasing procedures. The results of this study demonstrated that all treatments were efficient in calculus removal from the root surfaces. Thermal changes, including melting and carbonization, were not observed in either lasing procedure. The surface was rougher in the laser groups than in the groups treated with hand instruments. Moreover, roughness was greater in the long-pulse laser setting than in the short-pulse setting. While increased calcium (Ca) and decreased phosphate (P) (weight concentration percent) were observed in all treatments when compared with the control, laser procedures resulted in a more similar mineral content than in the groups treated with hand instruments. Based on these findings, laser procedures, when used in appropriate settings, are capable of performing scaling and root planing in the treatment of periodontitis. It may be concluded that short pulse laser may be more suitable for the micro-morphology of the root surface. However, additional in vitro and clinical studies are necessary to clarify the success of laser in periodontal therapy.
The Adjunctive Use of the Erbium, Chromium: Yttrium Scandium Gallium Garnet Laser in Closed Flap Periodontal Therapy. A Retrospective Cohort Study.
Al-Falaki Rana,Cronshaw Mark,Parker Steven
The open dentistry journal
OBJECTIVES:The current periodontal literature has been inconsistent in finding an added advantage to using lasers in periodontal therapy. The aim of this study was to compare treatment outcomes following root surface instrumentation alone (NL group), or with adjunctive use of Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser (L group). MATERIAL AND METHODS:Patients diagnosed with generalized chronic periodontitis, having a minimum of 1 year follow up were selected by a blinded party for inclusion in a retrospective analysis from patients treated prior to and after integration of laser in a single clinic setting. Probing depths (PD) of all sites ≥5 mm and full mouth bleeding scores were analyzed. Further analysis was carried out on the treatment outcomes of only the molar teeth and of pockets >6mm. RESULTS:53 patients were included (25 NL,28 L). There was no significant difference between baseline PDs (NL=6.19mm, L=6.27mm, range 5-11mm). The mean PD after one year was 2.83mm (NL) 2.45mm (L), with the mean PD reductions being 3.35mm (NL) and 3.82mm (L) (p<0.002). The mean PD reduction for the molars were 3.32mm (NL) and 3.86mm (L) (p< 0.007), and for ≥7mm group were 4.75mm (NL) compared to 5.14mm (L) (p< 0.009). There was significantly less bleeding on probing in the laser group after one year (p<0.001). CONCLUSION:Both treatment modalities were effective in treating chronic periodontitis, but the added use of laser may have advantages, particularly in molar tooth sites and deeper pockets. Further research with RCTs is needed to test this hypothesis further.
Lasers in minimally invasive periodontal and peri-implant therapy.
Mizutani Koji,Aoki Akira,Coluzzi Donald,Yukna Raymond,Wang Chen-Ying,Pavlic Verica,Izumi Yuichi
Laser therapy has the potential to be an effective, minimally invasive procedure in periodontal therapy. The aim of the present review was to survey the relevant literature on the clinical application of lasers as a minimally invasive treatment for periodontitis and peri-implant disease. Currently, there are a large number of published clinical studies and case reports that evaluate the adjunctive use of diode, carbon dioxide, neodymium-doped yttrium aluminium garnet (Nd:YAG), erbium-doped yttrium aluminium garnet (Er:YAG) and erbium, chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) lasers or antimicrobial photodynamic therapy for nonsurgical and minimally invasive surgical treatment of periodontal pockets. These procedures are expected not only to control inflammation but also to provide biostimulation effects with photonic energy. Recent meta-analyses did not show statistically significant differences in pocket reduction and clinical attachment gain compared with mechanical debridement alone, although limited positive effects of adjunctive laser therapy were reported. At present, systematic literature approaches suggest that more evidence-based studies need to be performed to support the integration of various laser therapies into the treatment of periodontal and peri-implant diseases. The disparity between previous statistical analyses and individual successful clinical outcomes of laser applications might reveal the necessity of developing optimal laser-treatment modalities of different wavelengths and better-defined indications for each protocol.
Laser supported reduction of specific microorganisms in the periodontal pocket with the aid of an Er,Cr:YSGG laser: a pilot study.
Gutknecht N,Van Betteray C,Ozturan S,Vanweersch L,Franzen R
OBJECTIVE:The aim of this study was to evaluate the effectiveness of a radial firing tip of an Er,Cr:YSGG laser as an adjunct to a nonsurgical periodontal treatment. METHODS:Twelve patients with chronic or aggressive periodontitis were treated by conventional periodontal treatment using ultrasonic devices and hand instruments and, additionally, in two quadrants with an Er,Cr:YSGG laser. A new radial firing tip (RFPT 14-5, Biolase) was used with 1.5 W, 30 Hz, 11% air, 20% water, and pulse duration 140 μs. Microbiological smears were taken before treatment, one day after lasing, and three and six months after lasing. Pocket depths of all periodontal sites were measured before and six months after treatment. RESULTS:The total bacterial load of Prevotella intermedia, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, Porphyromonas gingivalis, and Aggregatibacter actinomycetemcomitans inside the pocket was reduced significantly throughout the whole examination time. Greater pocket depth reductions were observed in all groups. There was a slight higher reduction of pocket depth in the lased group after six months. CONCLUSIONS:These results support the thesis that Er,Cr:YSGG laser supported periodontal treatment leads to a significant reduction of periopathogenes and thereby helps the maintenance of periodontal health.
Clinical and Immunological Effects of Er,Cr:YSGG Laser in Nonsurgical Periodontal Treatment: A Randomized Clinical Trial.
Erbil Deniz,Nazaroglu Kenan,Baser Ulku,İssever Halim,Mese Sevim,İsik Aysen G
Photobiomodulation, photomedicine, and laser surgery
The aim of this study was to compare the clinical and immunological results of nonsurgical periodontal treatment with or without the erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser. As lasers have begun to be used in dentistry, the Er,Cr:YSGG laser has started to attract attention in the field of periodontology. Fifty-nine nonsmoking patients with advanced chronic periodontitis were randomly allocated to a test group (full-mouth ultrasonic supra- and subgingival debridement+Er,Cr:YSGG laser application) and a control group (full-mouth ultrasonic supra- and subgingival debridement+root planing with Gracey curettes). The laser parameters were set as follows: 1.5 W output power, pulse mode H (pulse duration of 140 μs), pulse frequency of 20 Hz, and an air-water spray ratio of 10% air and 15% water. The instrumentation was performed until the operator felt that the root surfaces were adequately debrided. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index, interleukin-1 beta (IL-1β), matrix metalloproteinase-8 (MMP-8), tissue inhibitor metalloproteinase-1 (TIMP-1), and MMP-8/TIMP-1 levels in gingival crevicular fluid were evaluated at baseline, 6 weeks, and 3 months postoperatively. There were statistically significant differences in PD, which was our primary outcome, and BOP between the groups at both examinations [ < 0.001 and < 0.001 (for PD) and = 0.048 and < 0.001 (for BOP), respectively], in favor of the laser group. However, there were no significant differences among groups at any time for CAL gain ( = 563 and = 369, respectively). No significant differences in MMP-8, TIMP-1, and MMP-8/TIMP-1 levels were detected among groups. There was a statistically significant difference for IL-1β levels among groups at 3-month evaluations in favor of the laser group. Using the Er,Cr:YSGG laser instead of hand instruments in nonsurgical periodontal treatment has shown additional improvements in terms of pocket reduction and gingival bleeding compared with traditional nonsurgical therapy.