Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo, Tokyo, Japan.
Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo, Tokyo, Japan.
PLoS One. 2020 Sep 17;15(9):e0238659. doi: 10.1371/journal.pone.0238659. eCollection 2020.
Adjunctive use of laser devices as high reactive-level laser/light therapy (HLLT) or photobiomodulation therapy (PBMT) for periodontal therapy is known to be more effective on suppressing pain than conventional therapy, however, there are no systematic reviews addressed its effectiveness. This systematic review and meta-analysis aim to investigate the following clinical question (CQ): does adjunctive use of lasers with conventional therapy suppress the pain associated with periodontal treatment? A systematic and extensive literature search was performed to summarize the currently available knowledge to answer the CQ using the PubMed, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) conducted before June 2020. Bias risk was assessed using the Cochrane tool for the risk of bias evaluation. A meta-analysis was performed on quantitative evaluation of pain control based on patient-reported outcomes. After an independent screening of 165 initial records, ten RCTs were included. Six of them focused on surgical procedures and the others on non-surgical periodontal pocket therapy. The protocols of HLLT, PBMT, and combination with HLLT and PBMT were employed in five, four and one RCTs, respectively. Following the assessment of bias risk, it is revealed that all RCTs had methodological weaknesses regarding the blinding of key personnel, although other bias risk factors were not evident. Meta-analysis showed that HLLT using erbium lasers significantly reduced the patient-reported pain immediately after treatment (two RCTs, p < 0.0001), while PBMT using diode lasers significantly reduced pain 2-7 days after treatment (two RCTs, p < 0.0001 to p = 0.03). The presented systematic review and meta-analysis suggest that the alternative use of HLLT using erbium lasers to conventional instrumentation can significantly suppress postoperative pain and that intraoperative or postoperative PBMT using diode lasers combined with periodontal surgery can significantly reduce postoperative pain. However, the evidence is still insufficient and more well-designed RCTs are required.
激光设备辅助牙周治疗（如高反应性激光/光疗[HLLT]或光生物调节疗法[PBMT]）在抑制疼痛方面比传统治疗更有效，然而，目前还没有系统评价来评估其疗效。本系统评价和荟萃分析旨在调查以下临床问题（CQ）：激光辅助治疗与传统治疗联合使用是否能抑制牙周治疗相关的疼痛？通过对 PubMed、Cochrane 图书馆和 Web of Science 数据库进行系统而广泛的文献检索，总结了截至 2020 年 6 月之前进行的随机对照试验（RCT）的现有知识，以回答 CQ。采用 Cochrane 偏倚风险评估工具评估偏倚风险。根据患者报告的结局对疼痛控制的定量评估进行荟萃分析。经过对 165 份初始记录的独立筛选，纳入了 10 项 RCT。其中 6 项研究侧重于手术治疗，其余 4 项研究侧重于非手术牙周袋治疗。HLLT、PBMT 和 HLLT 与 PBMT 联合治疗的方案分别在 5、4 和 1 项 RCT 中采用。在评估偏倚风险后，结果显示所有 RCT 在关键人员的盲法方面均存在方法学上的弱点，尽管其他偏倚风险因素不明显。荟萃分析显示，使用铒激光的 HLLT 可显著降低治疗后即刻的患者报告疼痛（2 项 RCT，p<0.0001），而使用二极管激光的 PBMT 可显著降低治疗后 2-7 天的疼痛（2 项 RCT，p<0.0001 至 p=0.03）。本系统评价和荟萃分析表明，与传统器械相比，使用铒激光的 HLLT 可显著抑制术后疼痛，而在牙周手术中使用二极管激光进行术中或术后 PBMT 可显著减轻术后疼痛。然而，证据仍然不足，需要更多设计良好的 RCT。
