Long-term clinical outcomes of Er:YAG or Er,Cr:YSGG lasers utilized as monotherapy or as adjuncts to mechanical therapy in the treatment of chronic periodontitis: a systematic review

Purpose The aim of the present systematic review was to address the following focused question: In patients with generalized chronic periodontitis, what is the long-term effect of the Er:YAG or Er,Cr:YSGG lasers, as monotherapy or as adjuvant to mechanical therapy, on the following clinical outcomes: probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and gingival index (GI). Methods A thorough electronic search was performed in PubMed, Scopus, Cochrane, Web of Science, and Ovid databases according to PRISMA guidelines. The screening process and data extraction was conducted independently by two reviewers. A quality assessment using Cochrane Collaboration Methodology for randomized controlled trials (RCTs) was performed. Results Eight eligible RCTs fulfilled the criteria. Two RCTs utilising Er,Cr:YSGG laser, and six RCTs using Er:YAG laser in conjunction with non-surgical periodontal therapy. The primary outcome was PPD, while the secondary outcomes were CAL, BOP, and GI. When evaluating CAL benefits, two out of two of the included studies, which assessed Er:YAG as monotherapy in 24 months, indicated a significant difference in favor of Erbium lasers compared to SRP. It seems that Erbium lasers perform better in terms of PPD reduction compared to SRP in both 12-month and 24-month follow-up periods, especially with regard to moderate and deep periodontal pockets. The quality assessment revealed that four studies were presented with some concerns, while the rest of the studies were judged to be at low risk of bias. Conclusion It may be advocated that Er:YAG and Er,Cr:YSGG lasers as monotherapy or as adjunct to SRP seem to perform better in terms of CAL and PPD reduction in the long term, especially in deep pockets ≥ 7 mm; nevertheless, limited evidence for appropriate comparability is available in the existing literature.