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Does the literature support any uses for lasers in periodontics at this time?Dr. Cobb: Unfortunately, the topic of lasers has been condensed to a "to-use" or "not-to-use" debate, and the issue is really more complicated than that. Each laser has a different wavelength. These various wavelengths can accomplish different things; however, damage to periodontal tissues can result depending on the wavelength and power, and the periodontal procedure that the laser was used to perform.
If one is treating mucousmembrane lesions such as fibromas, inflammatory hyperplasia, gingival overgrowth, etc., lasers are an excellent instrument choice due to reduction in bleeding, swelling, and pain.
However, at this time, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities for treatment of common periodontal disease, such as periodontitis. There is limited evidence to suggest that lasers may provide an additional benefit when used as an adjunct to scaling and root planing.
Can lasers in periodontal therapy harm patients?Dr. Cobb: Yes. However, there appear to be no adverse outcomes when using an appropriate wavelength combined with a minimal energy density to accomplish the desired end-point. Therein lies the problem and debate. Subgingival periodontal therapy with a laser is currently focused on four different wavelengths and multiple protocols, with each protocol testing a variety of laser parameters. Thus, which combination is best?at this point we don't really know.
Are there potential benefits to using the laser in periodontal therapy?Dr. Cobb: When lasers are properly used, there may be less morbidity (i.e., discomfort, bleeding, etc.) to the patient. In addition, patient acceptance can be good and patients perceive the laser as modern, up-to-date, cutting edge, less invasive, more conservative and less painful. The patient's perception is generally the reason he/she accepts treatment and should not be discounted.
What would you say to practitioners who are using the laser for periodontal therapy?Dr. Cobb: I would tell them to do their homework and develop an evidence-based approach to the use of lasers for periodontal therapy, including a review of research that has appeared in peer-reviewed literature. In the healing arts there is an inherent demand that the practitioner be fully educated in regard to treatment modalities, indications, contraindications, potential for adverse outcomes, etc. All of this must be based on evidence?not advertisement.
What would you say to practitioners who are nay-sayers of laser technology?Dr. Cobb: I would tell them to do their homework and develop an evidence-based approach to the use of lasers in periodontal therapy, including a review of research that's appeared in the peer-reviewed literature. As with the possible adoption of any emerging technology, the potential benefits must outweigh the risks and be supported with evidence.
What would you say to patients who need periodontal therapy and only want it performed with a laser?Dr. Cobb: I would tell them to reconsider. At this point, an evidence-based approach to the use of lasers in periodontal therapy suggests a very limited use. At best, limited evidence suggests that lasers may provide an additional benefit when used as an adjunct to scaling and root planing.
I would also tell patients to beware of advertising that sounds too good to be true.
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