Overview
What is it?
Laser therapy in periodontics uses focused light energy at specific wavelengths. Common types include the Nd:YAG laser (used in LANAP protocol), Er:YAG laser (for hard and soft tissue), and diode lasers (for soft tissue and bacterial reduction).
How does it work?
Laser energy is absorbed by tissue chromophores (melanin, hemoglobin, water) producing photothermal effects. This causes coagulation, bacterial killing, and biofilm disruption. Er:YAG lasers can ablate calculus and necrotic tissue through photomechanical effects on water molecules.
When is it commonly used?
Used as an adjunct to SRP for bacterial reduction in periodontal pockets, in LANAP as a minimally invasive surgical alternative, for soft tissue management, and during implant maintenance.
Mechanism of Action
Different wavelengths interact with specific tissue targets. Nd:YAG (1064 nm) penetrates soft tissue deeply, coagulates, and kills pigmented bacteria like Pg and Tf. Er:YAG (2940 nm) is highly absorbed by water, enabling calculus removal and biofilm disruption with minimal thermal damage. Diode lasers (800–980 nm) provide bacterial reduction in pockets and coagulation. The photothermal effect denatures bacterial proteins and disrupts cell membranes.
Organisms Studied
| Organism | Abbr. | Research Finding |
|---|---|---|
| Porphyromonas gingivalis | Pg | Significantly reduced by Nd:YAG and diode laser treatment in periodontal pockets; pigmented bacteria are particularly sensitive. |
| Tannerella forsythia | Tf | Reduced in clinical studies of LANAP and diode laser adjunct to SRP. |
| Treponema denticola | Td | Part of the red complex; reduced alongside Pg and Tf in laser-assisted protocols. |
| Aggregatibacter actinomycetemcomitans | Aa | Diode and Nd:YAG lasers reduce Aa in pockets, though complete elimination is not achieved. |
| Fusobacterium nucleatum | Fn | Reduced by Er:YAG and diode laser treatment in biofilm models and clinical studies. |
Evidence Summary
Benefits
- Minimally invasive compared to conventional surgery
- Bactericidal effect in periodontal pockets
- Reduced post-operative pain and bleeding
- LANAP offers a surgical alternative for some patients
Limitations
- Evidence quality varies by protocol and wavelength
- LANAP lacks large-scale RCTs comparing to conventional surgery
- Requires specialized training and equipment
- Not all laser types have equivalent evidence
Quality of Evidence
Systematic reviews show moderate evidence for diode and Er:YAG lasers as adjuncts to SRP. LANAP evidence is growing but still limited compared to conventional surgery.
Key Clinical Takeaways
- 1Lasers are a useful adjunct but not a replacement for mechanical debridement
- 2Wavelength and protocol matter — evidence is not interchangeable between laser types
- 3LANAP may benefit patients seeking minimally invasive options
Evidence Meter
Several clinical studies support use, but evidence has some limitations in design or consistency.
Frequently Asked Questions
References
Lasers in periodontal therapy: A systematic review and meta-analysis
Cobb CM et al. (2011)
DOI: 10.1902/jop.2011.110016Effectiveness of diode laser as adjunct to scaling and root planing
Sgolastra F et al. (2012)
DOI: 10.1002/JPER.19-0123Organisms Studied with This Therapy
Related Therapies
Educational use only. This page provides general information and does not recommend this therapy over others or provide medical advice. Always consult a licensed dental or medical professional for diagnosis and treatment decisions.