Laser Use in Periodontal Treatment

By Brian J. Gray, DDS, MAGD, FICOI

Since their introduction in the 1960's, laser use in medicine and dentistry has increased steadily. The CO2 and the Nd:YAG lasers have both received Food and Drug Administration (FDA) approval for soft tissue surgery and are the most commonly used lasers in dentistry. Lasers work by delivering concentrated beams of light strong enough to cut through tissue.

Pros & Cons

The popularity of lasers results from claims that laser treatment is painless. Although the FDA has not permitted the manufacturer of any laser to make that claim, the general experience described by patients is that there is less pain and swelling after laser treatment compared to conventional surgery. Local anesthesia for pain control is still required during laser surgery.

Another advantage of the laser is that it causes less bleeding in the area of surgery than traditional surgical techniques. This is especially helpful in the oral cavity, which has an abundant blood supply. The laser decreases bleeding by sealing the blood vessels at the surgical wound. On the flip side, this can delay healing and create a less stable wound.

Application of Lasers in Periodontal Treatment

The application of lasers in periodontal treatment is restricted to the removal of gum tissue to reduce pocket depth, or for some minor periodontal plastic surgery procedures. These surgeries can be easily performed with traditional instruments without the additional high cost of laser treatment.

More recently, lasers have been evaluated for use in scaling and root planing. But in a research study recently published in the Journal of Periodontology, laser therapy appeared to be less effective than traditional scaling and root planing treatment. In fact, research has not conclusively shown that laser therapy is effective in removing the tartar that has accumulated under the gum line and can actually damage the surfaces of teeth and the bone. This damage could delay healing and the ability of the gum tissue to reattach to the root surface.

For all these reasons, the American Academy of Periodontology is concerned about misleading claims regarding the use of lasers in periodontics. It is important to remember that laser treatment in periodontics is limited to soft tissue (gum) surgery and that the laser beam should not touch the tooth or bone. Anesthesia is required during laser treatment, and laser treatment may be more expensive than traditional surgical procedures.