Aydin E Ecem, Baser Ulku, Yalcin Funda, Aykol Sahin Gokce
Periodontology, Istanbul University School of Dentistry, Istanbul, TUR.
Periodontology, Istanbul Okan University, Istanbul, TUR.
Cureus. 2025 Mar 29;17(3):e81415. doi: 10.7759/cureus.81415. eCollection 2025 Mar.
Effective subgingival debridement is essential for periodontal therapy. Subgingival debridement techniques induce morphological changes that influence healing. While hand instruments and ultrasonic scalers are the gold standard, erbium lasers offer potential advantages in biocompatibility and healing. This scoping review compares the effectiveness of erbium lasers (Er,Cr:YSGG (erbium, chromium-doped yttrium-scandium-gallium-garnet) and Er:YAG (erbium-doped yttrium-aluminum-garnet)) and conventional debridement methods in calculus removal, root surface topography, and cellular attachment following root debridement, based on in vitro studies. A systematic search was conducted in PubMed and Google Scholar for English-language articles published between 2014 and 2024. Studies evaluating erbium lasers compared to conventional debridement methods were included. A total of 1224 studies were initially identified from two databases: PubMed and Google Scholar. Following the eligibility assessment, 15 in vitro studies were analyzed. All methods effectively achieved subgingival instrumentation; additionally, erbium lasers produced smear layer-free surfaces with increased porosity, which may facilitate fibroblast attachment. However, laser-treated surfaces exhibited greater roughness and crater formation compared to conventional methods, with higher energy levels contributing to thermal damage. While some studies reported residual calculus on laser-treated surfaces, others demonstrated enhanced calculus removal and minimal root substance loss. Cell attachment studies indicated that Er:YAG lasers promoted fibroblast viability and proliferation, whereas high-energy Er,Cr:YSGG applications had variable effects on biocompatibility. Erbium lasers present a promising alternative to conventional debridement methods, improving smear layer removal and cell adhesion. However, variations in laser parameters impact treatment outcomes, emphasizing the need for standardized protocols. Further in vivo and clinical studies are required to validate their long-term effectiveness in periodontal therapy.
有效的龈下刮治对于牙周治疗至关重要。龈下刮治技术会引发影响愈合的形态学变化。虽然手动器械和超声洁牙器是金标准，但铒激光在生物相容性和愈合方面具有潜在优势。本综述性研究基于体外研究，比较了铒激光（铒铬掺杂钇钪镓石榴石（Er,Cr:YSGG）和掺铒钇铝石榴石（Er:YAG））与传统刮治方法在去除牙石、根面形貌以及根面清创后细胞附着方面的有效性。在PubMed和谷歌学术上对2014年至2024年发表的英文文章进行了系统检索。纳入了评估铒激光与传统刮治方法比较的研究。最初从两个数据库（PubMed和谷歌学术）中识别出1224项研究。经过资格评估后，分析了15项体外研究。所有方法均有效地实现了龈下器械操作；此外，铒激光产生了无玷污层且孔隙率增加的表面，这可能有助于成纤维细胞附着。然而，与传统方法相比，激光处理过的表面表现出更大的粗糙度和凹坑形成，更高的能量水平会导致热损伤。虽然一些研究报告了激光处理过的表面上有残留牙石，但其他研究表明牙石去除得到增强且根物质损失最小。细胞附着研究表明，Er:YAG激光促进成纤维细胞活力和增殖，而高能量的Er,Cr:YSGG应用对生物相容性有不同影响。铒激光是传统刮治方法的一种有前景的替代方法，可改善玷污层去除和细胞黏附。然而，激光参数的变化会影响治疗结果，强调了标准化方案的必要性。需要进一步的体内和临床研究来验证它们在牙周治疗中的长期有效性。
