1. Erbium:YAG laser compared to scaling and root planing in periodontal treatment A controlled, prospective clinical study Frank Schwarz*¹, Anton Sculean², Thomas Georg² and Elmar Reich²

2. ¹ Department of Oral and Maxillofacial Surgery Ludwig Maximilians University Munich, Germany ² Department of Periodontology and Conservative Dentistry, University of Saarland Homburg, Germany

3. Background: The Er:YAG laser is expected to be useful in medical and dental applications because its emission wavelenght (2.94 µm) is highly absorbed by water

4. Background: Er:YAG lasers have shown their capacity in removing plaque and calculus present on periodontally diseased root surfaces in vitro and in vivo (Aoki et al. 1994, Folwaczny et al. 2000, Schwarz et al. 2001)

5. Background: StudyTimeGroup PPD (0) PPD (1) CAL (0) CAL (1) Watanabe et al. J Clin Laser Med Surg 1996 4 Weeks Laser 5.6 ± 2.0 2.6 ± 0.9 -- Jepsen at al. J Dent Res (Abstr) 2000 3 Months LaserSRP 3.9 ± 0.8 2.9  0.6 Gain:Gain: 0.3  0.2 0.4  0.3 Schwarz et al. Parodontologie 2000 6 Months Laser 4.7 ± 0.7 3.1 ± 0.6 6.1 ± 1.1 4.6 ± 1.0 Schwarz et al. J Periodontol 2001 6 Months LaserSRP 4.9 ± 0.7 5.0 ± 0.6 2.9 ± 0.6 3.4 ± 0.7 6.3 ± 1.1 6.5 ± 1.0 4.4 ± 1.0 5.5 ± 1.0 Schwarz et al. J Clin Periodontol (in press) 12 Months Laser + SRP Laser 5.2 ± 0.8 5.0 ± 0.7 3.2 ± 0.8 3.3 ± 0.7 6.9 ± 1.0 6.6 ± 1.1 5.3 ± 1.0 5.0 ± 0.7

6. Objectives: The aim of the present study was to assess the clinical effectiveness of an Er:YAG laser when compared to well established procedures such as scaling and root planing

7. Material and Methods: 20 patients (age: 28 to 79 years) advanced periodontal disease a total of 34 maxillary and 21 mandibular pairs of contralateral single- and multi- rooted teeth good oral hygiene no systemic diseases treatment according to a split-mouth design

8. Material and Methods: For 4 weeks before treatment all patients were enrolled in a hygiene program and received oral hygiene instructions at 2 to 4 appointments as well as professional tooth cleaning according to individual needs A supragingival professional tooth cleaning was performed at baseline as well as 3, 6 and 12 months after treatment

9. Treatment of test group: KEY II® (KaVo, Biberach, Germany) handpiece 2056 fiber tips of 0.5 x 1.65 and 0.5 x 1.1 energy level 160 mJ/pulse at 10 pps water irrigation treatment from coronal to apical in parallel paths inclination of the fiber tip of 15-20° to root surface (Folwaczny et al. 2001) treatment under local anesthesia

10. CLINICAL PICTURE HANDPIECE 2056

11. Background:

12. Treatment of control group: scaling and root planing (SRP) Gracey curettes (Hu-Friedy, Chicago, USA) no. 1/2, 3/4, 7/8, 11/12, 13/14 no. 1/2, 3/4, 7/8, 11/12, 13/14 treatment under local anesthesia

13. Treatment time: Single rooted teeth Multi rooted teeth Laser 5 minutes 10 minutes SRP 9 minutes 15 minutes

14. Clinical measurements: plaque index (PI) (Silness & Löe 1964) gingival index (GI) (Löe & Silness 1963) bleeding on probing (BOP) probing pocket depth (PPD) gingival recessions (GR) clinical attachment level (CAL)

15. Microbiological evaluation: subgingival plaque samples analysed using darkfield microscopy for the presence of: –cocci –non motile rods –motile rods –Spirochetes (Listgarten & Helldén 1978)

16. Assessments: recordings of clinical indices were assessed before treatment, 3, 6 and 12 months after treatment one calibrated and blinded examiner statistical analysis by paired t-test (n.s. = non significant; * p  0.05; ** p  0.01; *** p  0.001)

17. IndexBaseline (± SD) 3 Months (± SD) P 6 Months (± SD) P 12 Months (± SD) P PI Laser Laser SRP SRP P Value P Value 1.0  0.6 n.s. 0.7  0.4 0.5  0.5 n.s.** 0.7  0.4 0.7  0.5 n.s.** 0.6  0.4 0.7  0.5 n.s.** GI Laser Laser SRP SRP P Value P Value 1.9  0.6 n.s. 0.5  0.6 0.7  0.8 n.s.****** 0.3  0.6 0.4  0.8 n.s.****** 0.4  0.3 0.5  0.7 n.s.****** BOP Laser Laser SRP SRP P Value P Value 56 % 52 % n.s. 17 % 22 % ******* 13 % 23 % ******* 14 % 26 % ******** Results (PI/ GI/ BOP):

18. Results (PPD/ GR/ CAL): IndexBaseline (± SD) 3 Months (± SD) P 6 Months (± SD) P 12 Months (± SD) P PPD Laser Laser SRP SRP P Value P Value 4.9 ± 0.7 5.0 ± 0.6 n.s. 3.5 ± 0.6 3.8 ± 0.7 ******* 2.9 ± 0.6 3.4 ± 0.7 ********* 3.0 ± 0.8 3.5 ± 1.3 ********* GR Laser Laser SRP SRP P Value P Value 1.4 ± 0.8 1.5 ± 0.8 n.s. 1.5 ± 0.7 1.9 ± 0.8 **n.s.*** 1.5 ± 0.7 2.0 ± 0.8 ***n.s.*** 1.5 ± 0.7 2.1 ± 0.7 ***n.s.*** CAL Laser Laser SRP SRP P Value P Value 6.3 ± 1.1 6.5 ± 1.0 n.s. 5.1 ± 1.0 5.6 ± 1.1 ******** 4.4 ± 1.0 5.5 ± 1.0 ********* 4.5 ± 1.3 5.6 ± 1.4 *********

19. Distribution of bacteria (Laser):

20. Distribution of bacteria (SRP):

21. Conclusion: The results of the present study indicate that non-surgical periodontal treatment with an Er:YAG laser is an alternative to scaling and root planing with hand instruments