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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 1  |  Page : 42-45

Management of chronic periodontitis using diode laser and tetracycline fibers


Department of Periodontics, Asan Memorial Dental College and Hospital, Chengalpattu, Tamil Nadu, India

Date of Submission29-May-2020
Date of Decision04-Aug-2020
Date of Acceptance18-Sep-2020
Date of Web Publication15-Feb-2021

Correspondence Address:
Nilofer Farjana Habeeb Rahman
Asan Memorial Dental College and Hospital, Chengalpattu, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_22_20

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  Abstract 


Periodontal disease is host immune-mediated inflammatory disease with periods of progression and periods of remission. It results in the breakdown of supporting connective tissue and alveolar bone with the resultant permanent loss of the teeth. There are nonsurgical and surgical therapies available along with local and systemic antibiotic adjuncts. The diode laser therapy is an effective adjunct along with nonsurgical treatment in treating periodontitis. The diode laser not only removes infected sulcular epithelium but also infected connective tissue even in anatomically inaccessible niches. It fastens the treatment and healing with more patient comfort. To overcome antibiotic resistance due to systemic administration, local drug delivery agents are effective in eliminating the bacteria. The antimicrobial agents used as local drug delivery agents include tetracycline, ofloxacin, clindamycin, chlorhexidine, etc., Tetracycline, as well as its derivatives doxycycline and minocycline, are the most commonly used antimicrobial agents in the treatment of periodontal infections. These local drug delivery agents are used either alone or as an adjunct with scaling and root planning.

Keywords: Diode laser therapy, gingivectomy, periodontitis, scaling and root planning, tetracycline fibers


How to cite this article:
Habeeb Rahman NF, Suresh N, Nowfiya S. Management of chronic periodontitis using diode laser and tetracycline fibers. J Oral Res Rev 2021;13:42-5

How to cite this URL:
Habeeb Rahman NF, Suresh N, Nowfiya S. Management of chronic periodontitis using diode laser and tetracycline fibers. J Oral Res Rev [serial online] 2021 [cited 2021 Mar 7];13:42-5. Available from: https://www.jorr.org/text.asp?2021/13/1/42/309433




  Introduction Top


Chronic periodontitis is an inflammatory disease resulting in progressive loss of supporting tissue of the teeth and bone with periods of progression and periods of remission. Studies have strongly proved that dental plaque containing bacteria are the primary etiologic factor for periodontal disease.[1],[2],[3] The conventional method of scaling and root planing (SRP) is the gold standard treatment for periodontitis. The other various adjuncts to SRP have been in practice for many years. The concept of local delivery is based on the concept of placing the antimicrobial agent directly into the pocket for a prolonged period with higher concentration without any systemic side effects. The different antibiotics used are tetracycline, nitromidazoles, fluoroquinolones, and macrolides. Laser is an innovation in periodontal practice with many potential benefits. The laser energy interacts strongly with inflamed tissue components (from preferential absorption by chromophores, which are more abundant in diseased tissue) and less strongly with healthy tissues, thereby reducing the microbial population.

The case report here presents a case of generalized chronic periodontitis which is managed by using 940 nm diode laser with SRP along with tetracycline fibers.


  Case Report Top


The study was conducted in the department of periodontics, Asan memorial dental college and hospital, Chengalpet. 33-year-old male patient presented with the increase in the size of gingiva in lower front teeth along with generalized bleeding and gingival inflammation. The patient is systemically healthy. The patient consent form was duly signed and obtained. The following clinical parameter (oral hygiene index simplified (OHIS-S), gingival index, plaque index, periodontal pocket depth, and clinical attachment level) were taken at the baseline and after a period of 1 month. The periodontal examination was done using a graduated Williams periodontal probe. The clinical findings showed the presence of generalized periodontal pocket depth 5–6 mm throughout confirming the case as generalized chronic periodontitis as shown in [Figure 1]. Pocket depth is more than 10 mm in relation to 16. The presence of gingival enlargement in lower anterior. A diagnosis of chronic generalized periodontitis was made. The treatment was done using diode laser 940 nm (Ezlase 940, Biolase, Cromwell, USA). The area was anesthetized using xylocaine spray. The pocket disinfection was done using full-mouth ultrasonic SRP using with Gracey Curettes (Hu-Friedy USA). The pockets were irrigated with normal saline to remove the blood clots. The inflamed epithelial lining of the pocket was debrided using a diode laser with a setting of 3.5 W pulsed mode, pulse length 0.50 ms, and pulse interval of 0.20 ms as shown in [Figure 2]. Tetracycline fibers were placed in relation to 16 after soaking in saline and then it was covered with cyanoacrylate adhesive to prevent the entry of oral fluids. Gingivectomy was done in lower anterior to eliminate the pseudo pockets and aesthetics was restored as shown in [Figure 3]. Postoperative instructions were given. With better hemostasis and high patient satisfaction, the treatment was completed. The patient was reviewed postoperatively after a period of 1 week and 1 month. The healing was highly satisfactory and found normal as shown in [Figure 4]. The patient was highly satisfied.
Figure 1: Generalized chronic periodontitis

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Figure 2: Diode laser debridement

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Figure 3: Epithelial denudation

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Figure 4: One-month posttherapy

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  Discussion Top


Lasers in periodontal treatment can be used as an adjunct to SRP[4] to control bacteria, remove the pocket epithelium, subgingival calculus, and improves periodontal regeneration. Laser-assisted subgingival debridement is less invasive and painless over conventional methods.[5] It has other advantages such as efficiency, visibility, minimal treatment time, and increases patient comfort. It also accelerates wound healing, fibroblast proliferation, and collagen synthesis through biostimulation.[6] Diode soft-tissue laser has a bactericidal effect by reducing inflammation when combined with scaling. The conventional method generally requires >15 min that necessarily includes hemostasis and suturing, However, the laser indigenously possesses the property of cauterization that heals well by secondary intention. It also avoids the food lodgment across the sutures and omits the overall inconvenience to the patient.

Diode laser thus has a bactericidal effect and is able to reduce inflammation in combination with scaling. Similar results were reported by Moritz et al. in a study which showed that laser, when used along with scaling, are highly efficient in eliminating bacteria.[7] Gingivectomy is the excision or removal of gingival done to reduce infection and decrease the depth of the gingival sulcus thereby improves hygiene and smile in patients.

Abraham et al. in a comparative study showed that adjunctive use of locally administered chlorhexidine gel, metronidazole gel, and tetracycline fibers is therapeutically beneficial.[8] Katsikanis et al. in a split-mouth study proved that high-intensity diode laser and the antimicrobial photodynamic therapy have not shown any additional benefits to the conventional periodontal treatment after a period of 6 months evaluation.[9] Ozener et al. in a retrospective study concluded that the diode laser could be used effectively as an alternative to the conventional frenectomy technique.[10]

Periodontal diseases are a localized microbial induced infection involving the gingiva and supporting tissues of the teeth resulting in progressive loss of attachment and bone loss. Studies have proved that the systemic administration of antimicrobial agents. Tetracyclines are superior to other antibiotics as they are the only class of antibiotics which has the ability for retention to the tooth cementum and soft tissues. It can achieve higher levels of gingival fluid concentrations than serum levels. The substantivity of tetracyclines has proved to be effective against Gram-positive and Gram-negative anaerobic microflora associated with periodontitis. They exert their antimicrobial effect by inhibiting protein synthesis.[11]

Manjunath et al. in a randomized clinical trial proved that diode lasers are an effective adjunct to SRP.[12] Tawfig et al. in a study showed that laser-assisted nonsurgical therapy in the treatment of periodontal pockets of patients with moderate-to-severe chronic periodontitis is effective and significant.[13]


  Conclusion Top


The laser is effective in pocket depth reduction, reducing bleeding on probing, improving clinical attachment level, and a significant reduction in the bacterial counts which are the main reason for periodontal disease progression. Laser-assisted Phase I nonsurgical periodontal therapy can be used effectively to achieve better clinical results in anatomically inaccessible areas and in severe periodontitis patients with the compromised systemic condition. With education and experience, lasers will become a part of the standard protocol and a powerful tool of nonsurgical periodontal therapy in treating periodontal disease. Tetracycline fiber is an effective local adjunct in controlling the localized periodontal infection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Haffajee AD, Socransky SS. Microbial etiological agents of destructive periodontal diseases. Periodontol 2000 1994;5:78-111.  Back to cited text no. 1
    
2.
Listgarten MA. The role of dental plaque in gingivitis and periodontitis. J Clin Periodontol 1988;15:485-7.  Back to cited text no. 2
    
3.
Socransky SS, Haffajee AD. The bacterial etiology of destructive 3 periodontal disease: Current concepts. J Periodontol 1992;63:322-31.  Back to cited text no. 3
    
4.
Cobb CM. Lasers in periodontics: A review of the literature. J Periodontol 2006;77:545-64.  Back to cited text no. 4
    
5.
White JM, Goodis HE, Rose CL. Use of the pulsed Nd: YAG laser for intraoral soft tissue surgery. Lasers Surg Med 1991;11:455-61.  Back to cited text no. 5
    
6.
Schoop U, Moritz A, Blum R, Romanos G, Schwarz F. Laser assisted periodontal therapy. Mortiz A, Beer F, Goharkhay K, Schoop U. Oral Laser Application. Berlin: Quintessence; 2006. p. 333-76.  Back to cited text no. 6
    
7.
Moritz A, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J, et al. Treatment of periodontal pockets with a diode laser. Laser surg med 1998;22:302-11.  Back to cited text no. 7
    
8.
Abraham A, Raghavan R, Joseph A, Devi MPS, Varghese M, Sreedevi PV. Evaluation of different local drug delivery systems in the management of chronic periodontitis: A comparative study. J Contemp Dent Pract 2020;21:280-4.  Back to cited text no. 8
    
9.
Katsikanis F, Strakas D, Vouros I. The application of antimicrobial photodynamic therapy (aPDT, 670 nm) and diode laser (940 nm) as adjunctive approach in the conventional cause-related treatment of chronic periodontal disease: A randomized controlled split-mouth clinical trial. Clin Oral Investig 2020;24:1821-7.  Back to cited text no. 9
    
10.
Ozener HO, Meseli SE, Sezgin G, Kuru L. Clinical efficacy of conventional and diode laser-assisted frenectomy in patients with different abnormal frenulum insertions: A retrospective study. Photobiomodul Photomed Laser Surg:2020 38:565-70.  Back to cited text no. 10
    
11.
Goodson JM. Antimicrobial strategies for treatment of periodontal diseases. Periodontol 2000 1994;5:142-68.  Back to cited text no. 11
    
12.
Manjunath S, Singla D, Singh R. Clinical and microbilogical evaluation of the synergistic effects of diode laser with nonsurgical periodontal therapy: A randomized clinical trial. J Indian Periodontal 2020;24:145-9.  Back to cited text no. 12
    
13.
Tawfig A, Abdullah A, Madani Y, Alsuwaidan S, Alghamdi G, Albishri T et al. The effect of laser therapy on pocket depth reduction in chronic periodontitis patients. EC Dent Sci 16.1 (2017):06-16.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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