Laser Assisted New Attachment Procedure: An Adjunct to Scaling and Root Planing in Moderate to Deep Periodontal Pockets Treatment

ABSTRACT

Introduction:

In order to assess the effectiveness of a laser-assisted new attachment method (LANAP) employing a diode in treating moderate to deep periodontal pockets, a split-mouth randomized controlled trial was carried out.

Methods:

Ten participants, aged 18–65, with moderate to deep periodontal pockets were included in the research. The subjects were split into two groups, control and test, each with ten sites. Scaling and root planing (SRP) was applied to the control sites using a universal curette, whereas SRP and a diode laser were used on the test sites. At six and twenty-four weeks, the subjects were summoned back for a post-operative assessment. The clinical parameters, including the clinical attachment level (CAL), periodontal pocket depth (PPD), gingival index (GI), and plaque index (PI) for both groups were noted, and the information gathered was statistically examined.

Results:

PPD and CAL in the test groups showed a clinically significant decline, and the values of the test and control groups at six and twenty-four weeks differed statistically significantly.

Conclusion:

Based on the study’s findings, moderate-to-deep periodontal pockets may benefit from LANAP treatment before scaling.

INTRODUCTION

The goal of periodontal treatment is to stop the infection from spreading as quickly and effectively as possible. Periodontal disease may be roughly categorized into surgical and non-surgical treatments, with many treatment techniques available.[1] Due to its ability to promote new attachment and bone regeneration in severe instances, laser therapy has been a pioneer in the treatment of periodontal disorders since the 1990s. Gregg and McCarthy[2] persisted in improving the process in order to foresee a new therapeutic objective for periodontal diseases worldwide.[1,3]

“Cementum-mediated new attachment to the root surfaces in the absence of a long junctional epithelium” is the definition of Laser Assisted New Attachment Procedure, or LANAP. This minimally invasive approach involves the surgical removal of the sulcular epithelium, bone modification (osteoplasty), a piezoelectric cutting tip to break the periodontal ligament, and thermogenic secure fibrin clot closure to close the wound.[3,4] In order to promote healing from the apical to the coronal direction, the fibrin clot at the pocket orifice functions as a barrier that stops the apical development of epithelium, so triggering the release of periodontal ligament and alveolar bone pluripotent cells.[3,5]

When used to treat periodontal pockets, LANAP has a low risk of post-operative pain and problems, promotes quicker healing after surgery, and has an antibacterial effect.[5] The current study was conducted to assess the effectiveness of LANAP employing diode Laser in the treatment of moderate to deep periodontal pockets since there is currently little research in this area.

MATERIAL AND METHODS

Those with systemically healthy subjects, those without a history of periodontal treatment during the preceding 12 months, those with chronic periodontitis, and those with probing depths (PD) of at least 4 mm on either side of the arch with comparable measurements were all included. The research excluded respondents who were wearing removable or permanent partial dentures, smokers, patients with grade III mobile teeth, pregnant and lactating women, and subjects who were unwilling to sign the permission form.

Prior to the procedure, written informed permission was acquired and the committee granted institutional ethical clearance (IEC/19-20/PERIO5).

Ten patients, aged between 18 and 65, who had chronic periodontitis and a pocket depth of more than 4 mm were chosen. The two locations’ subjects were split into test and control groups. Test and control groups were randomly assigned to the locations.

Scaling and root planning (SRP) were applied to the sites of the control group.

Phase I treatment was administered to each participant, along with advice on proper dental hygiene. Following that, they were brought back for further care, and clinical characteristics like the pocket probing depth (PPD), clinical attachment level (CAL), gingival index (GI), and plaque index (PI) were noted. For the purpose of aligning the probe to measure the PPD and CAL, an acrylic stent was made over the chosen locations on a model cast. Every parameter was noted at baseline, six, and twenty-four weeks.

Following the completion of intraoral and extraoral disinfection, local anesthetic (LA) was applied to the affected region. Using a universal curette, SRP was carried out on the control group’s roots until they were smooth and no signs of calculus or changed cementum were seen.

The diode Laser’s fiber optic tip was placed into the periodontal pocket in the test group, being sure to maintain it parallel to the tooth’s long axis. The tip was pushed apically and laterally until it reached a depth of 1 mm less than the site’s clinical pocket depth. It was delivered at 3.0 W power and 980 nm wavelength in continuous mode. After that, SRP was carried out just how it was in the control group. In order to close the pocket and create a stable fibrin clot, the region was once again exposed to a laser beam operating at 7.0 W of power and 980 nm of wavelength. The investigations were carried out by a skilled investigator.

SPSS version 22.0 (IBM Corp., Armonk, NY, USA) was used to evaluate the data, and a P value of less than 0.05 was deemed statistically significant.

RESULTS

An intergroup comparison of the two groups’ GI, PI, PPD, and CAL at various time points is shown in Table 1. At six and twenty-four weeks, the test group’s percentage decrease in PI and GI scores from the baseline was larger, but the difference was not statistically significant. At six and twenty-four weeks, the test group’s percentage decrease from baseline scores for GI, PI, CAL, and PPD was larger; nevertheless, the differences between GI and PI and CAL and PPD were statistically significant, while the differences between GI and PI were not statistically significant [Table 1].

Table 1.

Intergroup comparison of percentage change in clinical parameters mean scores between the test and control groups

Clinical parameters	Group	Mean±S.D.			P (% Change)
		Baseline	Six weeks	24 weeks	Baseline to six weeks	Baseline to 24 weeks
GI	Test	0.95±0.41	0.91±0.30	0.86±0.29	0.947 (n.s)	0.874 (n.s)
	Control	0.95±0.41	0.90±0.28	0.85±0.26
PI	Test	0.90±0.34	0.87±0.31	0.85±0.29	0.738 (n.s)	0.740 (n.s)
	Control	0.90±0.34	0.85±0.27	0.83±0.25
PPD	Test	4.60±0.69	4.10±0.69	4.10±0.69	0.031 (sig)	0.001 (sig)
	Control	4.55±0.59	3.70±0.52	3.50±0.52
CAL	Test	4.90±0.87	4.40±0.87	4.40±0.87	0.028 (sig)	0.001 (sig)
	Control	4.90±0.87	4.00±0.87	3.90±0.87

According to Table 2, the intragroup comparison between the three time periods was statistically significant for CAL and PPD and statistically non-significant for PI and GI.

Table 2.

Intragroup comparison of the clinical parameters in the test and control groups

Group	Clinical parameter	P (% Change)
		Baseline to six weeks	Baseline to 24 weeks
Test	GI	0.339 (n.s)	0.105 (n.s)
	PI	0.181 (n.s)	0.087 (n.s)
	PPD	0.001 (sig)	0.001 (sig)
	CAL	0.001 (sig)	0.001 (sig)
Control	GI	0.304 (n.s)	0.084 (n.s)
	PI	0.171 (n.s)	0.166 (n.s)
	PPD	0.001 (sig)	0.001 (sig)
	CAL	0.001 (sig)	0.001 (sig)

DISCUSSION

Because it is less invasive, unpleasant, and associated with less post-operative bleeding than traditional procedures, laser-assisted SRP has shown to be profitable.[2,3,4,5] Because they bio-stimulate collagen production and fibroblast proliferation, lasers are known to speed up wound healing.[1] In addition to vaporizing the harmful tissue, the beam reduces and delays the bacterial sub-gingival microflora’s ability to recolonize the area.[2]

The results of this research showed that both groups’ mean values had clinically decreased from the baseline to six weeks. It was also observed that, while statistically insignificant in the control group, the difference was substantial in the test group. At six weeks, there was a clinically and statistically significant difference between the two groups’ PPD and CAL levels.

These may be due to the laser’s selective photothermolysis characteristic, which selectively and assiduously absorbs only the ill tissues, resulting in bactericidal effects and spares the healthy tissues.[3,4,5] Additionally, lasers are known to more efficiently remove deposits and biofilm, producing biocompatible surfaces that facilitate tissue attachment.[1,2,3,4]

By creating a heated fibrin clot that obturates the pocket slit and acts as a physical barrier to prevent epithelial development in the apical direction, LANAP promotes healing from the apical to the coronal direction by inducing the release of pluripotent cells from the alveolar bone and periodontal ligament. Therefore, LANAP is linked to tissue regeneration mediated by the cementum, which lowers clinical parameters.[5,6]

The sample size and length of the research are the main sources of our study’s limitations. Another is that there was no correlation between the radiographic and histological results and the clinical findings.

CONCLUSION

Based on the results of this research, it can be said that LANAP is very patient-accepted and minimally invasive. When managing periodontal pockets, it aids in raising the clinical attachment level more than SRP by itself.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.