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J Periodontol • March 2011

J Periodontol • March 2011

The Effect of Low-Level Laser Therapy as an Adjunct to Non-Surgical Periodontal Treatment

Gokce Aykol,* Ulku Baser,* Ilay Maden,* Zafer Kazak, Utku Onan,* Sevda Tanrikulu-Kucuk, Evin Ademoglu, Halim Issever, § and Funda Yalcin*

Background: The aim of this study is to evaluate the effect of low-level laser therapy (LLLT) as an adjunct to non-surgical periodontal therapy of smoking and non-smoking patients with moderate to advanced chronic peri- odontitis. Methods: All 36 systemically healthy patients who were included in the study initially received non-surgical periodontal therapy. The LLLT group (n = 18) received GaAlAs diode laser therapy as an adjunct to non-surgical periodontal therapy. A diode laser with a wavelength of 808 nm was used for the LLLT. Energy density of 4 J/cm 2 was applied to the gingival surface after periodontal treatment on the first, second, and seventh days. Each of the LLLT and control groups was divided into two groups as smoking and non-smoking patients to investigate the effect of smoking on treat- ment. Gingival crevicular fluid samples were collected from all patients and clinical parameters were recorded on baseline, the first, third, and sixth months after treatment. Matrix metalloproteinase-1, tissue inhibitor matrix metalloproteinase-1, transforming growth factor- b 1, and basic-fibroblast growth factor levels in the collected gingival crevicular fluid were mea- sured. Results: The primary outcome variable in this study was change in gingi- val bleeding and inflammation. At all time points, the LLLT group showed significantly more improvement in sulcus bleeding index (SBI), clinical at- tachment level, and probing depth (PD) levels compared to the control group ( P < 0.001). There were clinically significant improvements in the laser-applied smokers’ PD and SBI levels compared to smokers to whom a laser was not applied, between the baseline and all time points ( P < 0.001) (SBI score: control group 1.12, LLLT group 1.49; PD: control group 1.21 mm, LLLT group 1.46 mm, between baseline and 6 months). Transforming growth factor- b 1 levels and the ratio of matrix metalloproteinase-1 to tis- sue inhibitor matrix metalloproteinase-1 decreased significantly in both groups at 1, 3, and 6 months after periodontal therapy ( P < 0.001). Ba- sic-fibroblast growth factor levels significantly decreased in both groups in the first month after the treatment, then increased in the third and sixth months ( P < 0.005). No marker level change showed significant differences between the groups ( P < 0.05). Conclusion: LLLT as an adjunctive therapy to non-surgical periodontal treatment improves periodontal healing. J Periodontol 2011;82:481-488.

KEY WORDS Dental scaling; laser therapy, low level; matrix metalloproteinase-1; periodontitis; root planing; smoking.

* Department of Periodontology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey. † Medicadent Clinic, Kadikoy, Istanbul, Turkey. ‡ Department of Biochemistry, Istanbul Faculty of Medicine, Istanbul University.

§

Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University.

P eriodontitis is a chronic inflamma- tory disease that

affects the supporting structures of teeth, result- ing in tooth loss. Conven- tional periodontal therapy includes both surgical and non-surgical approaches that involve instrumen- tation of the inflamed dentogingival complex. 1

Non-surgical therapy 2 by mechanical instrumen- tation is the primary rec- ommended approach to control periodontal infec- tion. Because conven- tional therapies result in wounding of the already inflamed periodontal tis- sues, the consequence of such therapeutic proce- dures depends largely on the cellular and molecular events associated with wound healing. 3 Although

surgical and non-surgical approaches, such as scal- ing and root planing, are still regarded as important and useful modalities, it is essential to improve fur- ther possibilities. 4

Inthelastdecade,apply-

inglasers as an adjunctive

doi: 10.1902/jop.2010.100195

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or alternative to current mechanical treatment had a great run in the treatment of gingival inflammation. 5,6 Among laser applications, low-level laser therapy (LLLT) is recommended for its pain-reducing, wound- healing promoter and anti-inflammatory effects. 7 It is suggested that LLLT alters cellular behavior by affecting the mitochondrial respiratory chain or membrane calcium channels, and that it can facilitate collagen synthesis, angiogenesis, and growth fac- tor release, which eventually accelerate wound heal- ing. 8-12 The results of the studies investigating the effects of LLLT on periodontitis are conflicting and further studies are needed. There are few in vivo stud- ies that evaluate LLLT as an adjunct to conventional periodontal treatment. Qadri et al. 13 showed reduced periodontal gingival inflammation with two different low-level lasers used as an adjunct to periodontal treatment. On the other hand, Lai et al. 14 reported that low-power helium-neon laser as an adjunct to non- surgical periodontal treatment did not show any addi- tional clinical benefit. Periodontal tissue healing constitutes a complex biologic process regulated by interactions between cells and growth factors triggering a series of cellu- lar events leading to new tissue formation. 15 During wound healing inflammatory response and synthesis of specific extracellular matrix molecules by fibro- blasts, angiogenesis, reepithelialization, and remod- eling are regulated by growth factors including transforming growth factor- b 1(TGF- b 1) and basic- fibroblast growth factor (b-FGF). 3,16 In periodontitis the degradation of extracellular matrix is thought to be induced by an imbalance between matrix metallo- proteinases (MMPs) and their specific inhibitors (tis- sue inhibitor matrix metalloproteinase [TIMP]). 17 On the other hand, although smoking is one of the risk factors that predispose to lower rates of success after both surgical and non-surgical periodontal ther- apy, 18,19 there are a limited number of studies that evaluate the effect of LLLT on periodontal wound healing in smokers. The purpose of the study is to evaluate the effect of LLLT as an adjunct to non-surgical periodontal treat- ment on clinical parameters; the effect of LLLT as an adjunct to non-surgical periodontal treatment on MMP-1, TIMP-1, TGF-b 1, and b-FGF levels in gingival crevicular fluid (GCF); and the effect of LLLT as an ad- junct to non-surgical periodontal treatment on peri- odontal wound healing in smokers and non-smokers with moderate to advanced chronic periodontitis.

MATERIALS AND METHODS Subject Selection, Study Design, and Clinical Procedures Thirty six patients (22 men and 14 women) who were classified as moderate to advanced chronic peri-

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odontitis according to the 1999 American Academy of Periodontology workshop were included in the study. 20 Patients were referred to the Department of Periodontology, Faculty of Dentistry, Istanbul Univer- sity, for periodontal treatment between May 2007 and May 2009. The sex distribution was seven females and 11 males, and there were nine smokers in each group. The mean age was 42.22 7.53 years (age range: 31 to 53 years) for the control group, and 43.56 6.70 years (age range: 31 to 58 years) for the LLLT group. Written informed consent was ob- tained from all subjects. The study protocol was ap- proved by the Ethics Commission of Istanbul University for human subjects (2006/1471). All patients were systemically healthy and not re- ceiving any medication at the time of study. The ex- clusion criteria were as follows: patients who had any kind of periodontal treatment or used antibiotics during the last 6 months, had an acute oral infection, or had < 16 teeth and partial dentures. Teeth with a mo- bility grade of III or pockets deeper than 10 mm in the studied areas were not evaluated. Patients were grouped based on their smoking habits: patients who never smoked were accepted as non-smokers (n = 18), and patients who smoked 10 cigarettes per day were accepted as smokers (n = 18). Patients who smoked < 10 cigarettes per day were not ac- cepted to the study. The study included one test (n = 18) and one con- trol (n = 18) group. Patients were randomly assigned to these groups by a flip of a coin by one of the inves- tigators (FY). The control group consisted of patients who received only scaling and root planing treatment. The LLLT group consisted of patients who received LLLT after scaling and root planing. To evaluate the effect of smoking on treatment, patients were further divided into two subgroups according to their smok- ing habits, as smokers and non-smokers. All sites of periodontal pockets were divided into two subgroups according to their initial probing depth (PD) as initial PD 4 to 6 mm and initial PD 6 to 10 mm to investigate the effect of LLLT on pockets with different depths. All patients received oral hygiene instructions and supragingival scaling in two appointments 1 week apart before treatment. Full-mouth subgingival scal- ing and root planing under local anesthesia i was per- formed in a single appointment for each patient in all groups using hand instruments and ultrasonic de- vices # by a clinician who was not aware of the study groups (GA). Laser therapy was performed three times to the LLLT group by a clinician (IM), on the first, second, and seventh days after treatment.

i Ultracain D-S, Aventis Pharmaceuticals, Istanbul, Turkey. ¶ Gracey curets, Hu-Friedy, Chicago, IL. # Cavitron, DENTSPLY, York, PA.

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J Periodontol • March 2011 Aykol, Baser, Maden, et al.

Laser treatment was performed by using a gallium- aluminum-arsenide (GaAlAs) diode laser.** The physical parameters of this unit used during the treat- ment were as follows: wavelength, 808 nm; average output, 0.25 W; spot size, 0.28 cm 2 ; and continuous wave output. Non-contact technique was applied for 10 seconds to the gingiva of incisors and premolars and 20 seconds to the gingiva of molars. The applica- tion distance was 0.5 to 1 cm because this distance difference did not affect the spot size with the hand- piece that was used. The energy density was 4 J/cm. 2 Plaque index (PI), 21 sulcus bleeding index (SBI), 22 PD, and clinical attachment level (CAL) were recorded onsixsitespertooth(mesio-,mid-,anddisto-vestibular; mesio-, mid-, and disto-palatal) at baseline, 1, 3, and 6 months after the treatment. All parameters were measured with a periodontal Williams probe cali- brated in millimeters. The cemento-enamel junction was used as the reference point. All measurements were done by a masked, calibrated examiner (GA). Three patients were included for intraexaminer re- producibility. The examiner measured the PD and SBI scores twice, 2 days apart in each patient. The mean difference was <0.5 mm for PD. SBI scores were the same for 80% of the measurements with maxi- mum difference of one between two measurements.

GCF Sampling GCF was collected using filter paper strips from the deepest preselected inflamed non-adjacent pocket sites of 5 mm depth of the incisors and premolars. GCF sampling sites were selected according to the baseline measurement and baseline GCF collection was done before oral hygiene instructions and supra- gingival scaling. Samples were taken to evaluate GCF level of MMP-1, TIMP-1, TGF-b 1, and b-FGF at all time points. The area was isolated to prevent sam- ples from being contaminated by saliva. The sample site was gently air-dried and all supragingival plaque was removed. The paper strips were inserted into the crevice until mild resistance was felt and left in place for 30 seconds. Strips contaminated by bleeding were discarded. Strips were placed into coded Eppendorf tubes and stored at - 20 C until further enzyme pro- cessing. For each biomarker one sample was col- lected from each patient and analyzed separately.

Biochemical Analyses GCF was retrieved from the filter strips by eluting in 100- ml–phosphate buffered saline solution-Tween buffer for 30 minutes and incubation over a shaking platform overnight (minimum 18 hours). GCF sam- ples were analyzed for MMP-1, TIMP-1, TGF- b 1, and b-FGF using commercially available sandwich enzyme linked immunosorbent assays §§ ii according to the manufacturer’s instructions. The concentra- tions were measured at a wavelength of 450 nm.

Results were reported as total amounts of MMP-1, TIMP-1, TGF-b 1, and b-FGF in GCF.

Statistical Analyses The data collected were analyzed using a statistical software package. Mean values for PI, SBI, PD, and CAL were calculated to compare the difference

in the healing response using the site of the tooth as

a unit of analysis. Sites were divided into two sub-

groups according to initial PD 4 to 6 mm and initial PD 6 to 10 mm. Statistical analysis was also per- formed according to patients’ smoking status. Differences between groups and between different time points within each group were tested by the Mann-Whitney U test and Wilcoxon signed-rank test, respectively. Statistical significance was set at the 99% confidence level ( P <0.01) for Mann-Whitney U test and at the 95% confidence level ( P < 0.05) for Wilcoxon signed-rank test.

RESULTS All patients included in the evaluation completed the 6-month study period and none missed any appoint- ments. Healing was uneventful in all cases. No ad- verse effects, such as burning sensation or pain, related to the laser irradiation have been reported.

Clinical Assessments

A total of 2,688 sites from the control group and 2,508

sites from the LLLT group were examined. The clinical results of the study are summarized in Table 1. There were no statistically significant differences in PI, SBI, PD, and CAL between the groups at baseline ( P > 0.01). The results of clinical measurements (mean SD)

and differences between baseline and time points are displayed in Table 1. In both groups, all clinical pa- rameters showed statistically significant reduction between baseline and all time points. The SBI scores, PD, and CAL reduction were significantly higher

in the LLLT group between baseline and time points

(P < 0.001). CAL and PD changes were analyzed for ini-

tially moderate (4 to 6 mm) and deep (6 to 10 mm) pockets, and significantly more reduction was found in PD for moderate and deep pockets in the LLLT group between baseline and all time points. Further- more, no statistically significant difference of reduc- tion was observed in CAL changes among baseline and 6 months between the subgroups. The data of the smokers who did or did not re- ceive LLLT was analyzed. There were statistically sig- nificant clinical improvements in the laser-applied

** Fotona XD-2, Fotona, Ljubljana, Slovenia. †† Hu-Friedy. ‡‡ PerioPaper, Oraflow, Smithtown, NY. §§ RayBiotech, Norcross, GA.

ii Invitrogen, Carlsbad, CA.

¶¶ SPSS v. 15.0, IBM, Chicago, IL.

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Table 1.

Differences in Clinical Parameters

Parameter

   

Difference (0 to 1 month)

P

 

Difference (0 to 3 months)

   

Difference (0 to 6 months)

P

(SD)

Baseline

1 Month

Value

3 Months

P Value

6 Months

Value

PI

Control 1.79 0.66 0.70 0.67

1.09 0.81 1.20 0.64

<0.001 0.59 0.61 <0.001 0.61 0.54

1.20 0.75 1.25 0.64

<0.001 0.68 0.62 <0.001 0.67 0.60

1.11 0.74 1.19 0.66

< 0.001

LLLT

1.86 0.52 0.66 0.59

< 0.001

P

value *

< 0.001

<0.001

<0.001

SBI

Control 1.89 1.03 0.50 0.59

1.39 1.00 1.51 1.08

<0.001 0.50 0.77 <0.001 0.20 0.46

1.39 1.14 1.61 1.08

<0.001 0.37 0.67 <0.001 0.18 0.48

1.52 1.08 1.63 1.11

< 0.001

LLLT

1.81 1.04 0.30 0.57

< 0.001

P

value *

< 0.001

<0.001

0.001

PD (mm) Control 4.04 1.89 3.02 1.49

1.02 1.16 1.32 1.19

<0.001 2.98 1.42 <0.001 2.51 1.17

1.07 1.26 1.38 1.18

<0.001 2.82 1.45 <0.001 2.48 1.20

1.23 1.24 1.42 1.16

< 0.001

LLLT

3.89 1.71 2.58 1.19

< 0.001

P

value *

< 0.001

<0.001

<0.001

CAL (mm) Control 4.64 2.08 3.70 1.97

0.93 1.15 1.05 1.10

<0.001 3.74 1.92 <0.001 3.39 1.66

0.90 1.26 1.10 1.09

<0.001 3.54 1.98 <0.001 3.33 1.71

1.10 1.25 1.17 1.13

< 0.001

LLLT

4.49 1.90 3.44 1.65

< 0.001

P

value *

< 0.001

<0.001

0.023

* Mann-Whitney U test P < 0.01. † Wilcoxon test P < 0.05.

smokers’ PD and SBI levels compared to smokers to whom laser was not applied, between the baseline and all time points ( P < 0.001) (Figs. 1 and 2). The effect of LLLT was analyzed among the patients who did and did not smoke. No statistically significant difference was observed in PD and CAL changes of the LLLT group between the smokers and non-smokers at any time points.

Biochemical Assessments Differences in the levels between time points for each analyzed biochemical marker between the groups are presented in Table 2. MMP-1/TIMP-1 and TGF-b 1 showed a statistically significant reduction between baseline and all time points for both groups. A signif- icant reduction between baseline and first month and a significant increase between baseline, third, and sixth months were observed in b-FGF levels. How- ever, there was no statistically significant difference in any analyzed biochemical marker level changes between the groups at any time points.

DISCUSSION Recently, the use of lasers in the medical field is more pronounced. Today, low-level lasers are also used in medicine to improve wound healing. 23 Low-level la- sers have been applied on dermal wounds to accel- erate wound healing in dermatology for > 40 years. Unlike high-power lasers that are used to break down tissue by their thermal effects, low-level lasers are

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thought to work by the interaction of light with the cell and tissue. This interaction might be affected by some parameters, such as wavelength, power, energy density, treatment duration, treatment intervention time, method of application, structure, and condition of tissue. The dose applied during laser application is one of the important treatment parameters to bene- fit from LLLT. However, a precisely determined dose has not been proved for each indication. Biostimula- tion has been reported in the literature with doses between 0.001 and 10 J/cm 2 as a therapeutic win- dow. 24 Even though applied dose is in the therapeu- tic window range, it might be too low or too high for the desired effect. Mester et al. 25 suggested in 1971 that doses of 1 to 2 J/cm 2 are necessary to see an effect on wound healing. In our study we used a GaAlAs laser with a wavelength of 808 nm, output power of 0.25 W, and 4 J/cm 2 energy density on the first, second, and seventh days after the treat- ment. This dose has also been proved to enhance epithelialization and wound healing by previous stud- ies after gingivectomy and gingivoplasty. 26,27 The results of our study show that there is a statis- tically significant improvement in clinical parame- ters after non-surgical periodontal treatment in each group. The beneficial effects of scaling and root planing combined with personal plaque control in the treatment of periodontitis have been well doc- umented. 2,4,28 These include reduction of clinical inflammation, microbial shifts to a less pathogenic

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J Periodontol • March 2011 Aykol, Baser, Maden, et al.

Table 2.

Differences in Biochemical Parameters

     

Difference

   

Difference

   

Difference

 

Parameter

(0 to

(0 to

(0 to

(SD)

Baseline

1 Month

1 month)

P Value

3 Months

3 months)

P Value

6 Months

6 months)

P Value

MMP-1 (ng/sample)

 

Control

1.02 0.58 0.86 0.49

0.58 0.30 0.45 0.20

0.49 0.57 0.40 0.50

< 0.001

0.54 0.36 0.48 0.29

0.48 0.43 0.38 0.50

<0.001

0.44 0.14 0.45 0.15

0.58 0.56 0.41 0.42

< 0.001

LLLT

< 0.001

0.002

< 0.001

P

value*

0.296

0.195

0.602

0.752

TIMP-1 (ng/sample)

 

Control

1.81 0.92 1.55 0.61

2.10 1.16 1.79 0.83

- 0.49 1,09 - 0.24 0.62

0.013

1.93 0.99 1.55 0.46

-0.12 0.50 0.00 0.75

0.064

2.03 1.30 1.72 0.79

- 0.21 0.81 - 0.16 0.84

0.112

LLLT

0.078

0.528

0.170

P

value*

0.457

0.269

0.429

0.296

MMP-1/TIMP-1

 

Control

0.67 0.45 0.58 0.29

0.32 0.19 0.29 0.17

0.42 0.44 0.29 0.26

< 0.001

0.34 0.26 0.32 0.20

0.34 0.29 0.25 0.34

<0.001

0.26 0.12 0.28 0.08

0.41 0.38 0.30 0.27

< 0.001

LLLT

< 0.001

0.007

< 0.001

P

value*

0.743

0.670

0.681

0.372

TGF-b 1 (pg/sample)

 

Control 197.97 116.79 66.46 45.52 122.01 100.98 < 0.001 37.98 44.42 159.99 109.90 <0.001 15.59 16.99 182.37 112.49 < 0.001

LLLT

139.16 62.23 42.01 23.48 97.15 62.90

< 0.001 21.85 15.05 117.31 60.13

<0.001 12.75 12.26 126.42 62.64

< 0.001

P

value*

0.150

0.167

0.248

0.506

b-FGF (pg/sample)

 

Control

34.84 16.44

9.27 5.56

26.65 13.26 17.07 10.29

< 0.001 22.03 12.63 12.81 10.47

<0.001 43.95 15.40 - 9.12 7.32 0.005 38.58 15.16 - 8.58 6.18

0.001

LLLT

30.00 14.88 12.92 8.74

< 0.001 23.85 12.13

6.14 7.76

0.001

P

value*

0.339

0.335

0.628

0.192

* Mann-Whitney U test P < 0.01. † Wilcoxon test P < 0.05.

subgingival flora, PD reduction, and gain of clinical attachment. In our study, the improvement in terms of mean dif- ference of PD, CAL, and SBI scores is significantly more in the LLLT group compared to the control group. Even though the methodology of two studies were not the same, Qadri et al. 13 found in their study that additional treatment with low-level lasers re- duced periodontal gingival inflammation and PD; the results of our study are parallel to this study, which reported only short-term effects of low-level laser. Contrary to our findings, Lai et al. 14 suggested that low-power laser did not result in any additional clinical benefit. This might be a result of their appli- cation power density being low (2.83 mW/cm 2 ) and having limited application sites. The use of different kinds of lasers, doses, and duration preclude a com- parison of these two articles with our study. LLLT after non-surgical periodontal treatment re- sulted in significantly more reduction of SBI score compared to the control group. This improvement could be a result of an increase of the anti-inflamma- tory cytokine levels and an increase of microcircula- tion by the low-level laser irradiation. 29 It is known that the efficacy of non-surgical peri- odontal treatment is related to the initial PD, and

deeper pockets have more potential of PD reduction and CAL gain. Therefore, we allocated sites by initial PD to evaluate the adjunctive effect of low-level diode laser separately for these sites. The difference of re- duction of PD in both moderate and deeper sites was found to be statistically significant between the groups. The LLLT group’s reduction was significantly more in the 6 months after treatment. Smoking is one of the factors that affect the healing of periodontal tissues. 30 We have also found addi- tional improvements in the smoking LLLT group compared to smokers who did not receive laser treat- ment. Significant reduction was found in SBI and PD after 6 months and CAL after 3 months. This change may be related to LLLT, because LLLT is reported to have positive effects on microcirculation, collagen, and cytokine production, which are negatively ef- fected by smoking. We have also compared smokers and non-smokers who both received LLLT. Although significantly more reduction of SBI was detected in non-smokers, no statistically significant reduction difference was found in PD and CAL among smokers and non-smokers in the LLLT group. MMPs are key enzymes in normal and pathologic tissue remodeling, such as wound healing and in- flammation. MMP-1 is the major type of proteolytic

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Low-Level Laser Therapy Reduced Periodontal Inflammation Volume 82 • Number 3
Reduced Periodontal Inflammation Volume 82 • Number 3 Figure 1. Differences (mean – SD) in PD

Figure 1.

Differences (mean SD) in PD in smokers between baseline and time points.

– SD) in PD in smokers between baseline and time points. Figure 2. Differences (mean –

Figure 2.

Differences (mean SD) in SBI in smokers between baseline and time points.

enzyme that can cleave interstitial collagens type I and type III. 31 The level of MMP-1 is usually low be- cause of predominant collagenase in healthy adult tis- sues. The expression of MMP-1 is regulated by growth

486

factors and cytokines. 32 Proteolytic activity is con- trolled through TIMP-1 in repair and remodeling pro- cesses or several pathologic conditions. The ratio of MMP-1 to TIMP-1 has been shown as a predictor of wound healing. 33 Tuter et al. 34 suggested the de- crease of the ratio of MMP-1 to TIMP-1 after non-sur- gical periodontal therapy, becoming close to the healthy controls. In our study we also observed the same reduction in the ratio of MMP-1 to TIMP-1 after non-surgical periodontal therapy. However, we did not observe any significant reduction difference be- tween LLLT and control groups’ ratio of MMP-1 to

TIMP-1.

TGF- b 1 plays an important role in wound healing by stimulating fibroblast proliferation, increasing the synthesis of extracellular matrix molecules and in- hibitors of MMPs, and inhibiting MMP synthesis. 16 During periodontal disease TGF- b 1 can alternate be- tween proinflammatory or anti-inflammatory roles related to the nature of host response. TGF-b 1 levels have been shown to be higher in gingival tissues and GCF at sites of inflammation compared to healthy sites. 35 Considering the role of TGF- b 1 in wound healing and periodontitis, high levels of this cytokine might be expected because sampling sites were se- verely diseased and inflamed before periodontal treatment. Skaleric et al. 36 have demonstrated that TGF- b 1 concentration in GCF positively correlated with PD. In our study, total amount of TGF- b 1 in GCF decreased in both the LLLT and control groups after elimination of inflammation by non-surgical periodon- tal treatment. TGF- b 1 level change in GCF did not show any significant difference between the LLLT and control groups. b-FGF is a potent mitogen and chemoattractant for fibroblasts and endothelial cells and induces a predominantly angiogenic response in the wound and activates neutral proteases in both epithelial cells and fibroblasts. 37 Various in vitro studies have shown that laser irradiation increases b-FGF release from gingival fibroblasts. 38-40 In our study we aim to observe whether LLLT affects periodontal wound healing via increasing the release of b-FGF. Con- versely, the GCF level of b-FGF was decreased in all patients and groups after periodontal treatment and this decrease did not show any significant change when LLLT was applied. After the reduction at the first month, an increase of b-FGF levels in GCF was seen in the following months. The increase of b-FGF levels during the following months was in parallel with the clinical improvement. To our knowledge, it has not been reported that periodontal treatment or laser application affects the levels of b-FGF in GCF. The results of this study demonstrate that b-FGF is present in the GCF of all patients with periodontitis and decreases after periodontal treatment. Yet, it is

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J Periodontol • March 2011 Aykol, Baser, Maden, et al.

still unknown how b-FGF plays a role in periodontal wound healing.

9. Silveira PC, Streck EL, Pinho RA. Evaluation of

 

Within its limits, our study shows that adjunction of

 

mitochondrial respiratory chain activity in wound healing by low-level laser therapy. J Photochem Photo-

 
 

biol B 2007;86:279-282.

 

LLLT to scaling and root planing improves clinical re-

10.

Alexandratou E, Yova D, Handris P, Kletsas D, Loukas

 

sults, but the differences between the groups in clini- cal results do not reflect biochemical parameters. In our study, the parameters that we evaluated to ob-

 

S. Human fibroblast alterations induced by low power laser irradiation at the single cell level using confocal microscopy. Photochem Photobiol Sci 2002;1:547-

 
 

552.

                             

serve wound healing with or without laser application

11.

Hawkins D, Abrahamse H. Effect of multiple expo-

 

show compatible results with the clinical changes af- ter periodontal therapy. We observed statistically significant differences on clinical parameter changes when we applied laser as

12.

sures of low-level laser therapy on the cellular re- sponses of wounded human skin fibroblasts. Photomed Laser Surg 2006;24:705-714. Pereira AN, Eduardo CdeP, Matson E, Marques MM. Effect of low-power laser irradiation on cell growth and

 

an adjunct to non-surgical periodontal treatment.

 

procollagen synthesis of cultured fibroblasts. Lasers

 

Even though there were statistical differences be-

 

Surg Med 2002;31:263-267.

 

tween the groups, the clinical improvement observed was rather minor. Only the laser-applied group in

13.

Qadri T, Miranda L, Tune´ r J, Gustafsson A. The short- term effects of low-level lasers as adjunct therapy in

 

smokers showed statistically significant clinical im-

 

the treatment of periodontal inflammation. J Clin Peri-

 

provements. However, the differences between test

 

odontol 2005;32:714-719.

 

and control group in all evaluated parameters were minimal at 6 months.

14.

Lai SM, Zee KY, Lai MK, Corbet EF. Clinical and radiographic investigation of the adjunctive effects of a low-power He-Ne laser in the treatment of moderate

 
                       

to advanced periodontal disease: A pilot study. Pho-

 

CONCLUSION

 

tomed Laser Surg 2009;27:287-293.

 

15.

Dereka XE, Markopoulou CE, Vrotsos IA. Role of

 

LLLT application as an adjunct to non-surgical treat-

 

growth factors on periodontal repair. Growth Factors

 

ment reduced gingival inflammation in patients who

 

2006;24:260-267.

                   

smoke.

16.

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foundation of Istanbul University (Project No: T-969/

 

pathogenesis of periodontal disease. J Periodontal Res

 

06102006). The authors report no conflicts of interest related to this study.

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