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 periodontitis.
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/cm2 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 treatment. 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-b1, and basic-fibroblast
growth factor levels in the collected gingival crevicular fluid were measured.
Results: The primary outcome variable in this study was change in gingival bleeding and inflammation. At all time points, the LLLT group showed
significantly more improvement in sulcus bleeding index (SBI), clinical attachment 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-b1 levels and the ratio of matrix metalloproteinase-1 to tissue inhibitor matrix metalloproteinase-1 decreased significantly in both
groups at 1, 3, and 6 months after periodontal therapy (P <0.001). Basic-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.

eriodontitis is a
chronic inflammatory disease that
affects the supporting
structures of teeth, resulting in tooth loss. Conventional periodontal therapy
includes both surgical and
non-surgical approaches
that involve instrumentation of the inflamed
dentogingival complex.1
Non-surgical therapy 2
by mechanical instrumentation is the primary recommended approach to
control periodontal infection. Because conventional therapies result in
wounding of the already
inflamed periodontal tissues, the consequence of
such therapeutic procedures depends largely on
the cellular and molecular
events associated with
wound healing.3 Although
surgical and non-surgical
approaches, such as scaling and root planing, are
still regarded as important
and useful modalities, it is
essential to improve further possibilities.4
In the last decade, applying lasers as an adjunctive
doi: 10.1902/jop.2010.100195

481

Low-Level Laser Therapy Reduced Periodontal Inflammation

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, woundhealing 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 factor release, which eventually accelerate wound healing.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 studies 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 nonsurgical periodontal treatment did not show any additional clinical benefit.
Periodontal tissue healing constitutes a complex
biologic process regulated by interactions between
cells and growth factors triggering a series of cellular events leading to new tissue formation.15 During
wound healing inflammatory response and synthesis
of specific extracellular matrix molecules by fibroblasts, angiogenesis, reepithelialization, and remodeling are regulated by growth factors including
transforming growth factor-b1(TGF-b1) and basicfibroblast growth factor (b-FGF).3,16 In periodontitis
the degradation of extracellular matrix is thought to
be induced by an imbalance between matrix metalloproteinases (MMPs) and their specific inhibitors (tissue 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 therapy,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 treatment on clinical parameters; the effect of LLLT as an
adjunct to non-surgical periodontal treatment on
MMP-1, TIMP-1, TGF-b1, and b-FGF levels in gingival
crevicular fluid (GCF); and the effect of LLLT as an adjunct to non-surgical periodontal treatment on periodontal 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 peri482

Volume 82 Number 3

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 University, 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 obtained from all subjects. The study protocol was approved by the Ethics Commission of Istanbul
University for human subjects (2006/1471).
All patients were systemically healthy and not receiving any medication at the time of study. The exclusion 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 mobility 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 accepted to the study.
The study included one test (n = 18) and one control (n = 18) group. Patients were randomly assigned
to these groups by a flip of a coin by one of the investigators (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 smoking 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 scaling and root planing under local anesthesiai was performed in a single appointment for each patient in all
groups using hand instruments and ultrasonic devices# 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.

Aykol, Baser, Maden, et al.

J Periodontol March 2011

Laser treatment was performed by using a galliumaluminum-arsenide (GaAlAs) diode laser.** The
physical parameters of this unit used during the treatment were as follows: wavelength, 808 nm; average
output, 0.25 W; spot size, 0.28 cm2; 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 application distance was 0.5 to 1 cm because this distance
difference did not affect the spot size with the handpiece 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
on six sites per tooth (mesio-, mid-, and disto-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 calibrated 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 reproducibility. 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 maximum 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 supragingival scaling. Samples were taken to evaluate
GCF level of MMP-1, TIMP-1, TGF-b1, and b-FGF at
all time points. The area was isolated to prevent samples 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 -20C until further enzyme processing. For each biomarker one sample was collected from each patient and analyzed separately.
Biochemical Analyses
GCF was retrieved from the filter strips by eluting in
100-mlphosphate buffered saline solution-Tween
buffer for 30 minutes and incubation over a shaking
platform overnight (minimum 18 hours). GCF samples were analyzed for MMP-1, TIMP-1, TGF-b1,
and b-FGF using commercially available sandwich
enzyme linked immunosorbent assaysii according
to the manufacturers instructions. The concentrations were measured at a wavelength of 450 nm.

Results were reported as total amounts of MMP-1,

TIMP-1, TGF-b1, 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 subgroups according to initial PD 4 to 6 mm and initial
PD 6 to 10 mm. Statistical analysis was also performed 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 appointments. Healing was uneventful in all cases. No adverse 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 parameters 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 initially 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. Furthermore, no statistically significant difference of reduction was observed in CAL changes among baseline
and 6 months between the subgroups.
The data of the smokers who did or did not receive LLLT was analyzed. There were statistically significant clinical improvements in the laser-applied
**

ii

Fotona XD-2, Fotona, Ljubljana, Slovenia.

Hu-Friedy.
PerioPaper, Oraflow, Smithtown, NY.
RayBiotech, Norcross, GA.
Invitrogen, Carlsbad, CA.
SPSS v. 15.0, IBM, Chicago, IL.

483

Low-Level Laser Therapy Reduced Periodontal Inflammation

Volume 82 Number 3

Table 1.

Differences in Clinical Parameters

Parameter
(SD)

Baseline

1 Month

Difference
P
Difference
Difference
P
(0 to 1 month) Value 3 Months (0 to 3 months) P Value 6 Months (0 to 6 months) Value

PI
Control 1.79 0.66 0.70 0.67
LLLT
1.86 0.52 0.66 0.59
P value*

1.09 0.81
1.20 0.64
<0.001

<0.001 0.59 0.61

<0.001 0.61 0.54

1.20 0.75
1.25 0.64
<0.001

<0.001 0.68 0.62

<0.001 0.67 0.60

1.11 0.74
1.19 0.66
<0.001

<0.001
<0.001

SBI
Control 1.89 1.03 0.50 0.59
LLLT
1.81 1.04 0.30 0.57
P value*

1.39 1.00
1.51 1.08
<0.001

<0.001 0.50 0.77

<0.001 0.20 0.46

1.39 1.14
1.61 1.08
<0.001

<0.001 0.37 0.67

<0.001 0.18 0.48

1.52 1.08
1.63 1.11
0.001

<0.001
<0.001

PD (mm)
Control 4.04 1.89 3.02 1.49
LLLT
3.89 1.71 2.58 1.19
P value*

1.02 1.16
1.32 1.19
<0.001

<0.001 2.98 1.42

<0.001 2.51 1.17

1.07 1.26
1.38 1.18
<0.001

<0.001 2.82 1.45

<0.001 2.48 1.20

1.23 1.24
1.42 1.16
<0.001

<0.001
<0.001

CAL (mm)
Control 4.64 2.08 3.70 1.97
LLLT
4.49 1.90 3.44 1.65
P value*

0.93 1.15
1.05 1.10
<0.001

<0.001 3.74 1.92

<0.001 3.39 1.66

0.90 1.26
1.10 1.09
<0.001

<0.001 3.54 1.98

<0.001 3.33 1.71

1.10 1.25
1.17 1.13
0.023

<0.001
<0.001

* 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-b1
showed a statistically significant reduction between
baseline and all time points for both groups. A significant reduction between baseline and first month and
a significant increase between baseline, third, and
sixth months were observed in b-FGF levels. However, 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 lasers have been applied on dermal wounds to accelerate 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
484

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 benefit from LLLT. However, a precisely determined dose
has not been proved for each indication. Biostimulation has been reported in the literature with doses
between 0.001 and 10 J/cm2 as a therapeutic window.24 Even though applied dose is in the therapeutic 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/cm2 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/cm2 energy density on
the first, second, and seventh days after the treatment. This dose has also been proved to enhance
epithelialization and wound healing by previous studies after gingivectomy and gingivoplasty.26,27
The results of our study show that there is a statistically significant improvement in clinical parameters 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 documented.2,4,28 These include reduction of clinical
inflammation, microbial shifts to a less pathogenic

Aykol, Baser, Maden, et al.

J Periodontol March 2011

Table 2.

Differences in Biochemical Parameters

Parameter
(SD)

Baseline

1 Month

Difference
(0 to
1 month)

P Value 3 Months

Difference
(0 to
3 months)

P Value 6 Months

Difference
(0 to
6 months)

P Value

MMP-1 (ng/sample)
Control
1.02 0.58
LLLT
0.86 0.49
P value*
0.296

0.58 0.30
0.45 0.20
0.195

0.49 0.57
0.40 0.50

<0.001
<0.001

0.54 0.36
0.48 0.29
0.602

0.48 0.43
0.38 0.50

<0.001
0.002

0.44 0.14
0.45 0.15
0.752

0.58 0.56
0.41 0.42

<0.001
<0.001

TIMP-1 (ng/sample)
Control
1.81 0.92
LLLT
1.55 0.61
P value*
0.457

2.10 1.16
1.79 0.83
0.269

-0.49 1,09
-0.24 0.62

0.013
0.078

1.93 0.99
1.55 0.46
0.429

-0.12 0.50
0.00 0.75

0.064
0.528

2.03 1.30
1.72 0.79
0.296

-0.21 0.81
-0.16 0.84

0.112
0.170

MMP-1/TIMP-1
Control
0.67 0.45
LLLT
0.58 0.29
P value*
0.743

0.32 0.19
0.29 0.17
0.670

0.42 0.44
0.29 0.26

<0.001
<0.001

0.34 0.26
0.32 0.20
0.681

0.34 0.29
0.25 0.34

<0.001
0.007

0.26 0.12
0.28 0.08
0.372

0.41 0.38
0.30 0.27

<0.001
<0.001

TGF-b1 (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
LLLT
30.00 14.88 12.92 8.74
P value*
0.339
0.335

26.65 13.26
17.07 10.29

<0.001 22.03 12.63 12.81 10.47

<0.001 23.85 12.13 6.14 7.76
0.628

<0.001 43.95 15.40 -9.12 7.32

0.005 38.58 15.16 -8.58 6.18
0.192

0.001
0.001

* 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 difference 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 reduced 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 application power density being low (2.83 mW/cm2) and
having limited application sites. The use of different
kinds of lasers, doses, and duration preclude a comparison of these two articles with our study.
LLLT after non-surgical periodontal treatment resulted in significantly more reduction of SBI score
compared to the control group. This improvement
could be a result of an increase of the anti-inflammatory cytokine levels and an increase of microcirculation by the low-level laser irradiation.29
It is known that the efficacy of non-surgical periodontal 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 reduction of PD in both moderate and deeper sites
was found to be statistically significant between the
groups. The LLLT groups 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 additional improvements in the smoking LLLT group
compared to smokers who did not receive laser treatment. 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 effected 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 inflammation. MMP-1 is the major type of proteolytic
485

Low-Level Laser Therapy Reduced Periodontal Inflammation

Figure 1.
Differences (mean SD) in PD in smokers between baseline and time
points.

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 because of predominant collagenase in healthy adult tissues. The expression of MMP-1 is regulated by growth
486

Volume 82 Number 3

factors and cytokines.32 Proteolytic activity is controlled through TIMP-1 in repair and remodeling processes 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 decrease of the ratio of MMP-1 to TIMP-1 after non-surgical 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 between LLLT and control groups ratio of MMP-1 to
TIMP-1.
TGF-b1 plays an important role in wound healing
by stimulating fibroblast proliferation, increasing the
synthesis of extracellular matrix molecules and inhibitors of MMPs, and inhibiting MMP synthesis.16
During periodontal disease TGF-b1 can alternate between proinflammatory or anti-inflammatory roles
related to the nature of host response. TGF-b1 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-b1 in wound
healing and periodontitis, high levels of this cytokine
might be expected because sampling sites were severely diseased and inflamed before periodontal
treatment. Skaleric et al.36 have demonstrated that
TGF-b1 concentration in GCF positively correlated
with PD. In our study, total amount of TGF-b1 in GCF
decreased in both the LLLT and control groups after
elimination of inflammation by non-surgical periodontal treatment. TGF-b1 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. Conversely, 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

J Periodontol March 2011

still unknown how b-FGF plays a role in periodontal

wound healing.
Within its limits, our study shows that adjunction of
LLLT to scaling and root planing improves clinical results, but the differences between the groups in clinical results do not reflect biochemical parameters. In
our study, the parameters that we evaluated to observe wound healing with or without laser application
show compatible results with the clinical changes after periodontal therapy.
We observed statistically significant differences on
clinical parameter changes when we applied laser as
an adjunct to non-surgical periodontal treatment.
Even though there were statistical differences between the groups, the clinical improvement observed
was rather minor. Only the laser-applied group in
smokers showed statistically significant clinical improvements. However, the differences between test
and control group in all evaluated parameters were
minimal at 6 months.
CONCLUSION
LLLT application as an adjunct to non-surgical treatment reduced gingival inflammation in patients who
smoke.
ACKNOWLEDGMENTS
The present work was supported by the research
foundation of Istanbul University (Project No: T-969/
06102006). The authors report no conflicts of interest
related to this study.
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Correspondence: Dr. Ulku Baser, Department of Periodontology, Faculty of Dentistry, Istanbul University, 34390
Capa, Istanbul, Turkey. E-mail: baserulku@hotmail.com.
Submitted April 6, 2010; accepted for publication August
29, 2010.