Bian Zirui, Zhang Haizheng, Chen Yifan, Yang Yuxuan, Lin Qian, Chen Xiaoyu, Chen Lili, Sun Weilian, Tan Jingyi
Department of Periodontology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Cancer Institute, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Periodontology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of Stomatology, Taizhou First People's Hospital, Taizhou, China; Cancer Institute, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
J Dent. 2025 Aug 26;162:106056. doi: 10.1016/j.jdent.2025.106056.
The aim of this study was to investigate the clinical effect of Nd:YAG laser-assisted non-surgical periodontal treatment on patients with stage II/III periodontitis.
A total of 599 teeth from 22 patients with stage II/III periodontitis were included in this study. A split-mouth design randomly assigned one side to the laser group (subgingival instrumentation + Nd:YAG laser) and the other to the control group (subgingival instrumentation alone). Clinical parameters, including probing depth (PD), gingival recession (GR), clinical attachment loss (CAL), and bleeding on probing (BOP) were measured at baseline, 6 weeks, and 3 months post-treatment. Biochemical parameters (interleukin-6 [IL-6], tumor necrosis factor-alpha [TNF-α], and malondialdehyde [MDA]) were analyzed from gingival crevicular fluid (GCF) samples collected at the same time points. Treatment method, site location, site type, age, and gender were evaluated using a multilevel logistic regression model.
At 6 weeks, the laser group demonstrated limited but statistically significant improvements in PD and more notable reductions in biochemical parameters compared to the control group. At 3 months, reductions in IL-6 and TNF-α remained significant compared to the control. Multilevel logistic regression analysis indicated that adjunctive laser therapy reduced the odds ratio of disease persistence (OR = 0.58, 95 % CI: 0.38-0.89). In sites with PD ≥ 7 mm, the laser group showed greater improvements in PD, CAL, and healing rate of BOP (+) sites at 3 months, while no differences were found in sites with PD 4-6 mm.
While Nd:YAG laser adjunct to subgingival instrumentation lacked broad efficacy in stage II/III periodontitis, it selectively enhanced outcomes in deep pockets (≥7 mm) in stage III periodontitis, emphasizing its role as an adjunct for severe periodontal defects. (This study was registered at ClinicalTrials.gov under the registration number NCT06587334.) CLINICAL SIGNIFICANCE: Nd:YAG laser adjunct to subgingival instrumentation enhances clinical outcomes in deep periodontal pockets (≥7 mm) in stage III periodontitis and reduces inflammatory mediators, but shows minimal impact on shallow pockets (4-6 mm) across stages. It highlights selective efficacy, reinforcing its adjunctive use in managing severe periodontal defects.
本研究旨在探讨钕钇铝石榴石（Nd:YAG）激光辅助非手术牙周治疗对II/III期牙周炎患者的临床效果。
本研究纳入了22例II/III期牙周炎患者的599颗牙齿。采用自身对照设计，随机将一侧牙齿分配至激光组（龈下器械治疗+Nd:YAG激光），另一侧分配至对照组（仅龈下器械治疗）。在基线、治疗后6周和3个月时测量临床参数，包括探诊深度（PD）、牙龈退缩（GR）、临床附着丧失（CAL）和探诊出血（BOP）。同时从龈沟液（GCF）样本中分析生化参数（白细胞介素-6 [IL-6]、肿瘤坏死因子-α [TNF-α]和丙二醛 [MDA]）。使用多水平逻辑回归模型评估治疗方法、部位位置、部位类型、年龄和性别。
在6周时，与对照组相比，激光组在PD方面有有限但具有统计学意义的改善，生化参数的降低更显著。在3个月时，与对照组相比，IL-6和TNF-α的降低仍然显著。多水平逻辑回归分析表明，辅助激光治疗降低了疾病持续存在的比值比（OR = 0.58，95% CI：0.38 - 0.89）。在PD≥7 mm的部位，激光组在3个月时PD、CAL和BOP（+）部位的愈合率有更大改善，而在PD为4 - 6 mm的部位未发现差异。
虽然Nd:YAG激光辅助龈下器械治疗在II/III期牙周炎中缺乏广泛疗效，但它在III期牙周炎的深牙周袋（≥7 mm）中选择性地改善了治疗效果，强调了其作为严重牙周缺损辅助治疗的作用。（本研究已在ClinicalTrials.gov注册，注册号为NCT06587334。）临床意义：Nd:YAG激光辅助龈下器械治疗可改善III期牙周炎深牙周袋（≥7 mm）的临床效果并减少炎症介质，但对各阶段浅牙周袋（4 - 6 mm）影响极小。它突出了选择性疗效，加强了其在管理严重牙周缺损中的辅助应用。
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