International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2015): 78.96 | Impact Factor (2015): 6.391 Volume 6 Issue 4, April 2017 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Management of Chronic Generalized Periodontitis by Adjunctive Use of Diode Laser Mariya Miteva, Stefan Peev, Ivailo Hristov Department of Periodontology and Dental Implantology, FDM, Medical University of Varna Abstract: The aim of this study was to evaluate the effect of a diode laser with nonsurgical periodontal therapy on chronic periodontitis. Fifteen patients with chronic periodontitis were treated by conventional periodontal treatment using ultrasonic devices and hand instruments and fifteen patients with additional use of diode laser Elexxion claros, fiber 300 μm, pulse output 1,0 W; pulse freq. CW; pulse duration CW; avg. power 1 W.All groups showed statistically significant improvements in terms of clinical attachment level (CAL) gain and periodontal pocket depth (PPD) reduction compared to baseline. The obtained data suggested that SRP and adjunctive laser therapy have significant short-term benefits in the treatment of chronic periodontitis. Keywords: Periodontitis, chronic, Diode laser 1. Introduction Periodontitis is caused by anaerobic bacteria, which form a biofilm on tooth surfaces or in the periodontal pocket. These actions provoke an excessive and aggressive immune reaction in the host, and cause collateral damage to periodontal tissues. Removal of the biofilm and elimination of periodontal pathogens from the periodontal pocket is the main purpose of treatment for this disease. Scaling and root-planing (SRP) is a non-surgical method of mechanical debridement to eliminate calculus, plaque, and contaminated root cementum from the periodontal pocket and usually results in significant clinical improvement. As an adjunct to SRP in inaccessible areas, various other treatment strategies have been evaluated, including the use of lasers. Diode lasers have been shown to be effective modalities in non-surgical periodontal therapy, with clinical effects including detoxification of the root surface, and bacterial lysis. 2. Literature Survey In vitro studies have tested the efficiency of diode lasers in periodontal debridement using several models: 665-nm AlGeAs (aluminium-germanium-arsenide) laser [1], 810-nm GaAlAs (gallium-aluminium-arsenide) laser [1, 2], 655-nm GaAlAs laser [3] and 980-nm diode laser [4]. In all these studies, there was a minimal increase in temperature of 5 ° C above the acceptable limits. The bactericidal effect of these lasers depend on the type of bacteria, the wavelength and the dose [3]. In vitro removal of calculus with a diode laser appears to be consistent and comparable with hand SRP [1, 2, 3, 4]. Other in vitro studies reported no beneficial effect on the attachment of periodontal cells on the root surface after irradiation with GaAlAs diode laser at the point of 1 W for 20 seconds [3] or harmful ultrastructural changes that could affect the synthesis of collagen [5]. In in vivo studies with diode lasers are established large amounts of calculus after treatment and significant structural damage to the root surface [3]. Yilmaz et al. [6] using GaAlAs laser in a randomized controlled study and they found no beneficial effects in comparison only with SRP. 3. Material The study included 30 male and female patients aged between 37-63 years, systemically healthy, none-smokers with presence of chronic generalized periodontitis - superficialis or profunda. Patients were divided into two groups - Group 1 (SRP) and Group 2 (SRP +Diode laser). Supra- and subgingival plaque and calculus are removed (scaling) with ultrasound equipment and tips for supra- and subgingivally instrumentation. After cleaning supragingival tooth surfaces are polished with rubber, brush and an abrasive paste. A rinse solution that contains 0.1% chlorhexidine and inhibits plaque formation was prescribed to the patients bid for 2 weeks. A toothpaste that inhibits plaque formation was prescribed to the patients as well. On the next visit the pocket depth, gingival margin, furcation involvement and mobility were examinated. Debridement of the root surfaces is performed within 24 hours (as per the principle of complete oral cavity disinfection - full mouth disinfection) with manual Gracey curettes with vertical, horizontal and oblique moves to a tactile sense of clean and smooth root surface. During the instrumentation washes with physiological saline solution (0,9% NaCl) are carried out - Group 1. After manual instrumentation in Group 2 the periodontal pockets are treated with Diode laser Elexxion claros, 50 Watt with fiber tip 300 μm, the settings of the laser apparatus in the program "Germ reduction in pockets" - pulse output 1,0 W; pulse freq. CW; pulse duration CW; avg. power 1 W for 15 seconds. The fiber is inserted into the periodontal pocket in depth measured from -1 mm and moves with spiral movements in coronary direction. Patient and staff put protective eyeglasses. The baseline data were recorded before treatment and at 1,5 and 3 months following treatment. Clinical measurements were taken at six points around each tooth: mesio-lingual, mesio-facial, facial, disto-facial, disto-lingual and lingual. The following clinical parameters were measured: Plaque Paper ID: ART20172149 DOI: 10.21275/ART20172149 65