Citation Information :
Gupta R, Arora SA, Gupta G, Kalsi R, Saurav K, Mishra SK, Saluja S, Wadhwa S. Effect of Open Flap Debridement with and without LLLT in Patients with Periodontitis on Wound Healing, GCF ALP Levels, and Clinical Parameters. J Contemp Dent Pract 2024; 25 (12):1148-1155.
Aim: The tenet of the study is to evaluate the efficacy of low-level laser therapy (LLLT) as an adjunct to surgical periodontal therapy [open flap debridement (OFD)] on clinical parameters, gingival crevicular fluid (GCF) alkaline phosphatase (ALP) levels in GCF and wound healing.
Materials and methods: Thirty subjects afflicted with chronic periodontitis showing evidence of horizontal bone loss on the radiograph, pocket probing depth (PPD) between 4 and 7 mm, and ≥20 natural teeth present in the oral cavity were included in the study. In every patient, OFD+LLLT was done in one quadrant and OFD in another was performed. The clinical parameters were assessed at baseline, 3 and 6 months visits while the GCF sample was collected at baseline visit and 6 months recall. Wound healing indices were recorded 1-week post-op surgery for each group.
Results: The results showed an evident improvement in all the clinical parameters [pocket probing depth, gingival index (GI), plaque index (PI), and CAL] from baseline–6 months values; however, no statistically significant difference was seen on the intergroup comparison. Wound healing was statistically significantly superior in the OFD + LLLT group in comparison to the OFD group, indicating a positive effect of lasers on healing. Gingival crevicular fluid ALP levels in the two groups decreased after 6 months and a statistically significant reduction in the laser group indicated an anti-inflammatory effect.
Conclusion: The results clearly indicated the efficacy of lasers in terms of acceleration of wound healing and control of inflammation.
Clinical significance: Lasers as an adjunct to surgical periodontal therapy evidently have an anti-inflammatory effect (decrease in GCF ALP levels) as well as accelerate the wound healing process.
Karu T. Primary and secondary mechanisms of action of visible to near-IR radiation on cells. J Photochem Photobiol B 1999,49:1–17. DOI: 10.1016/S1011-1344(98)00219-X.
Morais MO, Elias MR, Leles CR, et al. The effect of preventive oral care on treatment outcomes of a cohort of oral cancer patients. Support Care Cancer 2016 Apr;24(4):1663–1670. DOI: 10.1007/s00520-015-2956-6.
Mester E. Effect of laser rays on wound healing. Am J Surg 1971:122:532–535. DOI: 10.1016/0002-9610(71)90482-x.
Ishikawa I, Aoki A, Takasaki AA, et al. Application of lasers in periodontics: True innovation or myth? Periodontol 2000 2009;50:90–126. DOI: 10.1111/j.1600-0757.2008.00283.x.
Ishikawa I, Cimasoni G. Alkaline phosphatase in humal gingival fluid and its relation to periodontitis. Arch Oral Biol 1970;15:1401–1404. DOI: 10.1016/0003-9969(70)90032-4.
Malhotra R, Grover V, Kapoor A, et al. Alkaline phosphatase as a periodontal disease marker. Indian J Dent Res 2010;21:531–536. DOI: 10.4103/0970-9290.74209.
Marini L, Rojas MA, Sahrmann P, et al. Early wound healing score: A system to evaluate the early healing of periodontal soft tissue wounds. J Periodontal Implant Sci 2018;48(5):274–283. DOI: 10.5051/jpis.2018.48.5.274.
Lingamaneni S, Mandadi LR, Pathakota KR. Assessment of healing following low-level laser irradiation after gingivectomy operations using a novel soft tissue healing index: A randomized, double-blind, split-mouth clinical pilot study. J Indian Soc Periodontol 2019;23(1):53–57. DOI: 10.4103/jisp.jisp_226_18.
Abdulkareem AA, Al-Taweel FB, Al-Sharqi AJB, et al. Current concepts in the pathogenesis of periodontitis: From symbiosis to dysbiosis. J Oral Microbiol 2023;15(1):2197779. DOI: 10.1080/20002297.2023.2197779.
Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand 1964;22:121–135. DOI: 10.3109/00016356408993968.
Loe H, silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963;21:533–551. DOI: 10.3109/00016356309011240.
Al Shbool BD, Habashneh RA, Ta'ani DS, et al. Clinical effectiveness of diode laser as an adjunct in the treatment of periodontitis. Int J Oral Dent Health 2021;7:137. DOI: 10.1902/jop.2012.110708.
Misra P, Kalsi R, Anand Arora S, et al. Effect of low-level laser therapy on early wound healing and levels of inflammatory mediators in gingival crevicular fluid following open flap debridement. Cureus 2023;15(2):e34755. DOI: 10.7759/cureus.34755.
Karthikeyan J, Vijayalakshmi R, Mahendra J, et al. Diode laser as an adjunct to kirkland flap surgery-a randomized split-mouth clinical and microbiological study. Photobiomodul Photomed Laser Surg 2019;37(2):99–109. DOI: 10.1089/photob.2018.4519.
Sobouti F, Khatami M, Heydari M, et al. The role of low-level laser in periodontal surgeries. J Lasers Med Sci 2015;6(2):45–50. PMCID: PMC4431963.
Rathod A, Jaiswal P, Bajaj P, et al. Implementation of low-level laser therapy in dentistry: A review. Cureus 2022;14(9):e28799. DOI: 10.7759/cureus.28799.
Sanikop S, Patil S, Agrawal P. Gingival crevicular fluid alkaline phosphatase as a potential diagnostic marker of periodontal disease. J Indian Soc Periodontol 2012;16(4):513–518. DOI: 10.4103/0972-124X.106889.
Carranza FA, Cabrini RL. Histochemical reactions of periodontal tissues: A review of the literature. J Am Dent Assoc 1960;60: 464–470. DOI: 10.14219/jada.archive.1960.0102.
Teymouri F, Farhad SZ, Golestaneh H. The effect of photodynamic therapy and diode laser as adjunctive periodontal therapy on the inflammatory mediators levels in gingival crevicular fluid and clinical periodontal status. J Dent 2016;17(3):226–232. PMID: 27602399.
Riya K, Siddhartha AV, Girish S, et al. Effect of Low-level laser therapy as an adjunct to nonsurgical periodontal therapy on salivary interleukin -1 beta levels in smokers with periodontitis: A case control study. J Dent Oral Biol 2023;8(2):1213. ISSN: 2475-5680.
Cho YD, Kim KH, Lee YM, et al. Periodontal wound healing and tissue regeneration: A narrative review. Pharmaceuticals 2021;14(5):456. DOI: 10.3390/ph14050456.
Kolamala N, Nagarakanti S, Chava VK. Effect of diode laser as an adjunct to open flap debridement in treatment of periodontitis – A randomized clinical trial. J Indian Soc Periodontol 2022;26(5):451–457. DOI: 10.4103/jisp.jisp_213_21.
Kohale BR, Agrawal AA, Raut CP. Effect of low-level laser therapy on wound healing and patients’ response after scalpel gingivectomy: A randomized clinical split-mouth study. J Indian Soc Periodontol 2018;22(5):419–426. DOI: 10.4103/jisp.jisp_239_18.
Silviya S, C M A, Prakash PSG, Bahammam SA, et al. The efficacy of low-level laser therapy combined with single flap periodontal surgery in the management of intrabony periodontal defects: A randomized controlled trial. Healthcare (Basel) 2022;10(7):1301. DOI: 10.3390/healthcare10071301.
Jonnalagadda BD, Gottumukkala SNVS, Dwarakanath CD, et al. Effect of diode laser-assisted flap surgery on postoperative healing and clinical parameters: A randomized controlled clinical trial. Contemp Clin Dent 2018;9(2):205–212. DOI: 10.4103/ccd.ccd_810_17.
Walsh LJ. The current status of low level laser therapy in dentistry. Part 1. Soft tissue applications. Aust Dent J 1997;42(4):247–254. DOI: 10.1111/j.1834-7819.1997.tb00129.x.