Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

Summary

This article describes two protocols: 1) adjunctive diode laser therapy for treating periodontitis and 2) probiotic Lactobacillus therapy for treating peri-implant disease, with emphasis on the laser usage mode (inside or outside pocket), laser application regimen (single or multiple sessions), and a probiotic protocol of professional and home administration.

Abstract

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people's quality of life. The diode laser has long been recommended as adjunctive therapy in treating periodontitis. However, the optimal combination of usage mode (inside or outside periodontal pocket) and application regimen (single or multiple sessions of appointment) has not been described in detail. Meanwhile, probiotic Lactobacillus is regarded as a potential adjuvant in the management of the peri-implant disease. Nonetheless, a detailed protocol for an effective probiotic application is lacking. This article aims to summarize two clinical protocols. For periodontitis, the optimal collaboration of laser usage mode and application regimen was identified. Regarding peri-implant mucositis, a combined therapy containing professional topical use and home administration of probiotic Lactobacillus was established. This updated laser protocol clarifies the relationship between the treatment mode (inside or outside the periodontal pocket) and the number of laser appointments, further refining the existing diode laser therapy. For inside pocket irradiation, a single session of laser treatment is suggested whereas, for outside pocket irradiation, multiple sessions of laser treatment provide better effects. The improved probiotic Lactobacillus therapy resulted in the disappearance of swelling of the peri-implant mucosa, a reduced bleeding on probing (BOP), and an obvious reduction and good control of plaque and pigmentation; however, probing pocket depth (PPD) had limited improvement. The current protocol should be regarded as preliminary and could be further enhanced.

Introduction

Periodontal disease is a chronic multifactorial infection resulting in progressive destruction of periodontium¹. Its severe form, periodontitis, affects up to 50% population worldwide² and is regarded as a major cause of tooth loss in adults³. Replacement of missing teeth with dental implants has been extensively favored over traditional options⁴. The implants show prominent functional and aesthetic performances with a long-term survival rate of 96.1% after 10 years^5,6. The implants, however, can suffer from peri-implant disease leading to mucosal inflammation (peri-implant mucositis) or surrounding bone loss (peri-implantitis)⁷, which may cause the implant failure⁸. Therefore, it is of utmost necessity to manage the periodontal and peri-implant diseases effectively, in order to preserve natural teeth or improve the survival rate of dental implants.

Periodontal and peri-implant diseases share similar etiology⁹, i.e., both are initiated by exposure to dental plaque, consisting mainly of anaerobic and microaerophilic bacteria¹⁰. Mechanical debridement is considered a reliable modality to achieve efficient disruption of pathogenic deposits on root or implant surfaces¹¹. Nevertheless, it has restricted accessibility using instruments when there is complex tooth anatomy (i.e., root furcation and groove), leading to insufficient decontamination¹². Under this context, the application of lasers and probiotics has emerged to supplement mechanical debridement^13,14.

A variety of lasers have been proposed for periodontal treatment, such as Nd:YAG; CO₂; Er:YAG; Er,Cr:YSGG; and diode laser¹⁵. Among these, the diode laser is the most popular choice for clinical treatment due to its portability and low cost¹⁶. The diode laser has been recommended as an ideal adjunct in destroying biofilms, eliminating inflammation, and facilitating wound healing due to its photobiomodulation and photothermal effects^12,13. The diversity of laser usages, nonetheless, leads to significant clinical heterogeneity among current studies. Thus, in our recent publication, we evaluated 30 clinical trials and summarized the optimal combination of laser usage mode and application regimen¹². However, few studies report the detailed procedure of the combination protocol. On the other hand, probiotic Lactobacillus has been drawing increasing attention as a potential adjuvant in treating peri-implant disease, due to its antimicrobial and anti-inflammatory performances^17,18. The clinical benefits, however, have not reached an agreeable consensus. One critical account referred to the variety of probiotic administration protocols¹⁷.

Based on the current evidence, this article describes two modified clinical protocols: the existing protocol for the use of adjunctive diode laser in treating periodontitis is improved based on two laser usage modes (inside or outside pocket) and two application regimens (single or multiple sessions of appointment)¹². For the adjunctive probiotic Lactobacillus therapy in treating peri-implant disease, a combination of professional local use and home administration of probiotic is described¹⁷.

Protocol

This study was approved by the Institutional Review Board of the College of Stomatology, Xi'an Jiaotong University (xjkqll[2022]NO.034). Informed consent was available from the patients involved in this study. 1. Adjunctive diode laser therapy in the non-surgical treatment of periodontitis Eligibility criteria Use the following inclusion criteria: age ≥ 18 years; probing pocket depth (PPD) ≥ 5 mm; detectable clinical attachment loss (CAL…

Representative Results

Periodontal pockets with PPD ≥ 5 mm require laser irradiation after SRP, as it is difficult to obtain complete debridement by SRP alone (Figure 1A,B). After SRP, if the periodontal pockets bleed profusely and clot on the tooth surface, the operator needs to stop the bleeding and remove the clot by rinsing and gargling several times. This is because a large amount of blood will prevent the laser from working (Figure 1C,D).<…

Discussion

Although diode laser has been widely utilized in periodontal therapy, the clinical effectiveness remains controversial among current clinical trials^15,20. As demonstrated, the laser usage mode and application regimen have significant impacts on the efficacy of periodontal laser therapy¹². Most researchers, however, ignore the potential role, eliciting results that are hard to explain. Under different usage modes, excessive or insufficient …

Materials

1% iodophor	ADF, China	21031051	100 mL
3% hydrogen peroxide	Hebei Jianning, China	210910	500 mL
75% alcohol	Shandong Anjie, China	2021100227	500 mL
Diode laser (FOX 980)	A.R.C, Germany	PS01013	300-μm fiber tip
Gracey curettes	Hu-Friedy, USA	5/6, 7/8, 11/12, 13/14
Low-speed handpiece	NSK, Japan	0BB81855
Periodontal probe	Shanghai Kangqiao Dental Instruments Factory, China	44759.00
Periodontal ultrasonic device (PT3)	Guilin zhuomuniao Medical Instrument, China	P2090028PT3
Polishing paste	Datsing, China	21010701
Primacaine adrenaline	Produits Dentaires Pierre Rolland, France	S-52	1.7 mL
Probiotic	Biogaia, Sweden	Prodentis	30 probiotic tablets (24 g)
Titanium ultrasound tip (P59)	Guilin Zhuomuniao Medical Instrument, China	200805