Abstract
Recent reviews and meta-analyses of the literature over the past quarter-century have failed to provide enough evidence to prove or disprove the actual utility of photonic therapy in periodontitis, alone or adjunctive to conventional approaches. This apparent paradox has been explained by the many physical, molecular, biological, anatomical, and technical variables of photonic treatments, which can differ in light-emitting devices (laser or LED), wavelengths, irradiation power and modes, clinical objectives, follow-up times, disease grading, and assessment methods. This multi-faceted, controversial scenario has led practitioners to underestimate the actual potential of photonic therapy in periodontal diseases. In this critical appraisal of the literature, we have briefly summarized the main photonic therapies and instruments used in Periodontology, highlighting their main characteristics and limitations. Then, we have tried to identify and discuss the key methodological issues which can have an impact on the outcome of photonic therapies. Our main goal was to identify the best parameters, settings, and methodologies to perform effective periodontal photonic treatments and to extrapolate some recommendations for clinical use. Should these recommendations find a consensus among periodontologists and be adopted in future clinical studies, they will hopefully contribute to dissipate the present confusion and uncertainty on this complex matter.
Highlights
In a recent review dedicated to the most important advancements in periodontology over the past quarter-century, Professor C.M
The meta-analyses conducted on more than one hundred human clinical studies have not collected sufficient statistical evidence to suggest that integration of a laser, either as a monotherapy or as an adjunct to surgical and nonsurgical therapy in a periodontal treatment protocol will provide clinical outcomes superior to those achieved by traditional therapy based on scaling and root planing (SRP) [2]
Periodontologists are divided between supporters and skeptics about the usefulness of photonic therapy, the discriminating factor being basically dependent on individual positive or negative experience
Summary
In a recent review dedicated to the most important advancements in periodontology over the past quarter-century, Professor C.M. The many diverse photonic treatments, exploiting different light-emitting devices (laser and LED), wavelengths, beam power, and irradiation modes, as well as the heterogeneous treatment protocols, exact biological rationale, follow-up times, disease grading, and assessment methods all contribute to make the literature on the clinical effects of photonic therapy in periodontal treatment controversial and difficult, if not impossible, to interpret [1] This leads dentists to underestimate the actual potential of this therapeutic approach in periodontal diseases. Having been involved for several years in the study of photonic therapies in periodontics, we have felt the need for standardized, specific guidelines for the correct delivery of such therapies, as an adjunct to conventional SRP, to provide non-invasive, patient-friendly, effective periodontal care [6] In this critical appraisal of the literature available in the PubMed database (published in English), both reviews and primary clinical research, we have briefly summarized the main photonic therapies and instruments used in Periodontology, highlighting their main characteristics and limitations. Should these points become a shared base, they could be adopted as recommendations for future clinical studies, hopefully contributing to the disambiguation of the actual therapeutic value of the photonic approach
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