Purpose: The aim of this pilot study was to compare the clinical outcome of initial periodontal scaling and root planing alone (SRP) or SRP combined with Neodynium Yttrium-Aluminum-Garnet (Nd:YAG) laser therapy (NLT) to the same protocol with the use of systemic antimicrobial drugs. Materials and Methods: This double-blind split-mouth design study involved 15 otherwise healthy patients suffering from generalized chronic periodontitis. The subjects were randomly assigned to the two treatment groups. 1. Ultrasonic and hand supra- and sub-gingival scaling with root planing (SRP) on the right side (quardrants 1 and 4). NLT on the left side (quadrants 2 and 3) without the use of antimicrobial drugs as an adjunctive therapy. 2. SRP on the right side (quadrants 1 and 4). NLT on the left side (quadrants 2 and 3) with adjunctive antimicrobial therapy. The clinical parameters recorded during this study were the bleeding on probing index (BPI), periodontal probing depth (PPD), and the presence of the microbes Actinobacillus actinomycetemcomitans (AA), Porphyromonas gingivalis (PG), Bacteroides forsythus (BF), and Treponema denticola (TD). Clinical measurements and microbiological assessments were taken at baseline and after completion of treatment. The clinical protocol of the periodontal treatment includes microbiological assessment, SRP, polishing, and additional NLT for quadrants 2 and 3. All subjects received hygienic instructions and a 0.05% chlorhexidine rinse twice a day. The subjects received amoxicillin, metronidazol, or a combination depending on the outcome of the bacterial testing. The control group received a placebo. Results: The present study demonstrated a significant reduction in mean total counts of the microorganisms AA and BF in the subgingival microbiota following the different test therapies. There tended to be a beneficial effect of the additional use of the Nd:YAG laser, where medication did not have this effect at 90 days. Conclusion: This tendency could encourage clinicians to use the Nd:YAG laser as an adjunctive therapy and abandon the use of antimicrobial agents that increase the risk for antibiotic resistance.
Keywords: periodontitis, Nd:YAG, amoxicillin, metronidazol