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

Periodontitis and the peri-implant disease are plaque-induced lesions that seriously impact the people's quality of life. Our protocol can provide more reliable outcomes for these patients because it is improved than the existing measures. This protocol provides an optimal combination of laser usage mode and application regimen for periodontitis.

Meanwhile, it introduces a combination of professional and home use of probiotics for peri-implant mucositis. As a modified protocol for existing methods, our protocol helps to reduce clinical heterogeneity and can contribute to the implementation of future clinical studies and systematic reviews in this field. Most of the existing studies do not show specific procedures to the detriment of reproducibility of the results.

A video demonstration will help to provide the clinical techniques. Begin with the clinical examination of the mouth by measuring clinical parameters, such as full-mouth probing pocket depth, bleeding on probing at six sites per tooth, and mobility of each tooth, excluding third molars. Then, measure clinical attachment loss for teeth having a probing pocket depth of more than 5 millimeters.

After recording the baseline parameters on a periodontal chart, ask the participant to first gargle with 3%hydrogen peroxide for 1 minute, then with pure water. Disinfect the operating area with 1%iodophor and administer an injection of primacaine adrenaline to induce anesthesia. For mechanical debridement of the tissue, perform scaling in root planing, or SRP, for teeth with PPD more than 3 millimeters with an ultrasonic device, followed by using handheld instruments.

Use an ultrasonic device to perform SRP for the same tooth a second time. Apply the polishing paste to polish the full-mouth teeth surfaces using a low-speed handpiece with a rubber cap. Before proceeding with adjunctive diode laser therapy, ensure that the operator and patient wear protective goggles to protect the eyes.

Prepare the diode laser device by setting the parameters as described in the manuscript and calibrate the length of the fiber tip exposed to a depth of 1 millimeter less than the measured probing pocket. For the laser irradiation inside the pocket, insert the fiber tip into the periodontal pocket 1 millimeter less than the measured pocket depth, and slowly sweep the tip in mesial-distal and apical-coronal directions for 30 seconds per tooth. To irradiate the outside area of the pocket, set the parameters on the diode laser device and direct the laser fiber tip 5 millimeters away from the gingival surface at an angle of 90 degrees.

Irradiate the gingival surface of a pocket for approximately 15 seconds. Repeat the outside pocket treatment after 1, 3, 5, and 7 days. At 4 to 6 weeks, 3 months, and 6 months after periodontal treatment, measure the probing pocket depth, bleeding on probing, and clinical attachment loss for each tooth.

In the clinical examination, measure and record the clinical parameters, such as probing pocket depth, bleeding on probing, as explained before, and determined plaque index at four sites per implant. After disinfection of the operating site, use a titanium ultrasound tip with the mode adjusted to medium power to perform supragingival scaling for the mucositis implants. Next, grind the probiotic tablet into powder using a sterilized mortar.

Then, make a solution of probiotic powder and sterile saline in a 1:3 ratio. Deliver the probiotic solution into the peri-implant sulcus using a 5 milliliter syringe with a blunt and soft tip. For the self-administration of probiotics, instruct the patients to dissolve one tablet in the oral cavity for 10 minutes every 12 hours, twice a day for 1 month.

Measure the clinical parameters for each implant at 4 to 6 weeks, 3 months, and 6 months after treatment, and record the postoperative parameters on a new periodontal chart, as demonstrated before. The diode laser-assisted SRP therapy effectively removed pathogenic plaque biofilm and eliminated inflammation in patients with periodontitis. The probiotic therapy resulted in the disappearance of swelling of the peri-implant mucosa, reduced bleeding on probing, and a reduction in good control of plaque and pigmentation when compared to pre-operation condition.

However, there was no significant change in probing pocket depth. It is crucial to keep the fiber tip moving inside the pocket because prolonged action on a particular site can cause photothermal damage to the periodontal tissues. Our protocols paved the way for studying other types of periodontal lasers.

Also, it helps to investigate new probiotic active ingredients.