Effect of Er:YAG Laser on Scaling and Root Planning and Usage of i-Platelet Rich Fibrin as a Biomodifier

Necib Fazıl Gün; Meltem Hendek; Ebru Olgun

Research Article

Er:YAG Lazerin Diş Yüzeyi Temizliği ve Kök Yüzeyi Düzleştirme Üzerindeki Etkisi ve Biyomodifiye Edici Olarak e-Trombositten Zengin Fibrinin Kullanımı

Year 2025, Volume: 28 Issue: 2, 246 - 252, 30.06.2025

Necib Fazıl Gün , Meltem Hendek , Ebru Olgun

Abstract

Amaç: Bu çalışmanın amacı, Er:YAG lazer ve Gracey küretleri ile diş yüzeyi temizliği ve kök yüzeyi düzleştirme (KYD) prosedürünü karşılaştırmak ve biyomodifiye edici olarak enjekte edilebilir-trombositten zengin fibrin (e-TZF) kullanımının etkinliğini araştırmaktır.
Gereç ve Yöntemler: Çekilen insan dişleri 4 gruba ayrıldı: Gracey Grubu (n=9): Gracey küretleri ile KYD; Gracey + e-TZF Grubu (n=9): Gracey küretleri ile KYD ve ardından kök yüzeyine e-TZF uygulanması; Er:YAG Grubu (n=9): Er:YAG lazeri ile KYD; Er:YAG + e-TZF Grubu (n=9): Er:YAG lazeri ile KYD ve ardından kök yüzeyine e-TZF uygulanması. Dentin tübüllerinin genişliği ve smear tabakasının varlığı/yokluğu taramalı elektron mikroskobu kullanılarak incelendi.
Bulgular: Er:YAG grubunda Gracey grubuna kıyasla önemli ölçüde daha az smear tabakası vardı (p=0,001). Dentin tübüllerinin genişliğinin Er:YAG ve Er:YAG+e-TZF gruplarında Gracey grubuna kıyasla önemli ölçüde daha yüksek olduğu bulundu (sırasıyla;p=0,015; p<0,001). Er:YAG+e-TZF grubundaki dentin tübüllerinin genişliği Gracey+e-TZF grubuna kıyasla belirgin şekilde daha yüksekti (p=0,026).
Sonuçlar: Er:YAG lazerin, diş yüzeyi temizliğinde altın standart olan Gracey küretlerinden daha etkili olduğu bulundu. Özellikle Er:YAG lazerle birleştirildiğinde, e-TZF daha geniş dentin tübülleriyle sonuçlandı.

Keywords

Er:YAG lazer, e-TZF, in vitro, kök biyomodifikasyonu

Project Number

2021/108.

References

1. Polson AM, Caton J. Factors influencing periodontal repair and regeneration. J Periodontol 1982;53(10):617–625.
2. Belal MH, Watanabe H. Comparative study on morphologic changes and cell attachment of periodontitis-affected root surfaces following conditioning with CO2 and Er: YAG laser irradiations. Photomed Laser Surg 2014;32(10):553-560.
3. Drisko CL. Periodontal debridement: still the treatment of choice. J Evid Based Dent Pract 2014 Jun;14 Suppl:33-41.e1.
4. Lavu V, Sundaram S, Sabarish R, Rao SR. Root Surface Bio-modification with Erbium Lasers-A Myth or a Reality? Open Dent J 2015;9:79.
5. Suchetha A, Darshan BM, Prasad R, Ashit GB. Root biomodification-a boon or bane? Indian J Stomatol 2011;2(4):251-255.
6. Zan R, Topçuoğlu H, Hubbezoğlu İ, Altunbaş D, Demir AŞ. The Roughening Effects of Er:YAG, Nd:YAG and KTP Laser Systems on Root Dentin Surface. Cumhuriyet Dent J 2023;26(1):63- 68.
7. Schwarz F, Sculean A, Berakdar M, Szathmari L, Georg T, Becker J. In vivo and in vitro effects of an Er: YAG laser, a GaAlAs diode laser, and scaling and root planing on periodontally diseased root surfaces: a comparative histologic study. Lasers Surg Med 2003;32(5):359-366.
8. Akiyama F, Aoki A, Miura-Uchiyama M, et al. In vitro studies of the ablation mechanism of periodontopathic bacteria and decontamination effect on periodontally diseased root surfaces by erbium: Yttrium–aluminum–garnet laser. Lasers Med Sci 2011;26(2):193-204.
9. Theodoro LH, Garcia VG, Haypek P, Zezell DM, Eduardo CDP. Morphologic analysis, by means of scanning electron microscopy, of the effect of Er: YAG laser on root surfaces submitted to scaling and root planing. Pesqui Odontol Bras 2002;16:308-312.
10. Ishikawa I, Aoki A, Takasaki AA, Mizutani K, Sasaki KM, Izumi Y. Application of lasers in periodontics: true innovation or myth? Periodontol 2000. 2009;50:90-126.
11. Crespi R, Capparè P, Toscanelli I, Gherlone E, Romanos GE. Effects of Er:YAG laser compared to ultrasonic scaler in periodontal treatment: a 2-year follow-up split-mouth clinical study. J Periodontol 2007 Jul;78(7):1195-1200.
12. Galli C, Passeri G, Cacchioli A, Gualini G, Ravanetti F, Elezi E, Macaluso GM. Effect of laser-induced dentin modifications on periodontal fibroblasts and osteoblasts: a new in vitro model. J Periodontol 2009 Oct;80(10):1648-1654.
13. Cobb CM. Clinical significance of non‐surgical periodontal therapy: an evidence‐based perspective of scaling and root planing. J Clin Periodontol 2002;29:22-32.
14. Dohan DM, Choukroun J, Diss A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part III: leucocyte activation: a new feature for platelet concentrates?. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101(3):51-55.
15. Choukroun J, Ghanaati S. Reduction of relative centrifugation force within injectable platelet-rich-fibrin (PRF) concentrates advances patients’ own inflammatory cells, platelets and growth factors: the first introduction to the low speed centrifugation concept. Eur J Trauma Emerg Surg 2018;44(1):87-95.
16. Miron RJ, Fujioka-Kobayashi M, Hernandez M, et al. Injectable platelet rich fibrin (i-PRF): opportunities in regenerative dentistry? Clin Oral Investig 2017;21(8):2619-2627.
17. Cavassim R, Leite FRM, Zandim DL, Dantas AAR, Rached RSGA, Sampaio JEC. Influence of concentration, time and method of application of citric acid and sodium citrate in root conditioning. J Appl Oral Sci 2012;20(3):376-383.
18. Chahal GS, Chhina K, Chhabra V, Bhatnagar R, Chahal A. Effect of citric acid, tetracycline, and doxycycline on instrumented periodontally involved root surfaces: A SEM study. J Indian Soc Periodontol 2014;18(1):32-37.
19. Fekrazad R, Lotfi G, Harandi M, Ayremlou S, Kalhori KA. Evaluation of fibroblast attachment in root conditioning with Er, Cr: YSGG laser versus EDTA: a SEM study. Microsc Res Tech 2015;78(4):317-322.
20. Ferreira R, de Toledo Barros RT, Karam PSBH, et al. Comparison of the effect of root surface modification with citric acid, EDTA, and aPDT on adhesion and proliferation of human gingival fibroblasts and osteoblasts: an in vitro study. Lasers Med Sci 2018;33(3):533-538.
21. Feist IS, De Micheli G, Carneiro SR, Eduardo CP, Miyagi SP, Marques MM. Adhesion and growth of cultured human gingival fibroblasts on periodontally involved root surfaces treated by Er: YAG laser. J Periodontol 2003;74(9):1368-1375.
22. Pourzarandian A, Watanabe H, Ruwanpura SM, Aoki A, Ishikawa I. Effect of low‐level Er: YAG laser irradiation on cultured human gingival fibroblasts. J Periodontol 2005;76(2):187-193.
23. Crespi R, Romanos GE, Cassinelli C, Gherlone E. Effects of Er: YAG laser and ultrasonic treatment on fibroblast attachment to root surfaces: an in vitro study. J Periodontol 2006;77(7):1217-1222.
24. Rossa Jr C, Silvério KG, Zanin IC, Brugnera Jr A, Sampaio JEC. Root instrumentation with an erbium: yttrium-aluminum-garnet laser: Effect on the morphology of fibroblasts. Quintessence Int 2002;33(7):496–502.
25. Karthikeyan R, Yadalam PK, Anand AJ, Padmanabhan K, Sivaram G. Morphological and chemical alterations of root surface after Er: Yag laser, Nd: Yag laser irradiation: A scanning electron microscopic and infrared spectroscopy study. J Int Soc Prev Community Dent 2020;10(2):205-212.
26. Iozon S, Caracostea GV, Páll E, et al. Injectable platelet-rich fibrin influences the behavior of gingival mesenchymal stem cells. Rom J Morphol Embryol 2020;61(1):189.
27. Zheng S, Zhang X, Zhao Q, Chai J, Zhang Y. Liquid platelet‐rich fibrin promotes the regenerative potential of human periodontal ligament cells. Oral Dis 2020;26(8):1755-1763.
28. Thanasrisuebwong P, Kiattavorncharoen S, Surarit R, Phruksaniyom C, Ruangsawasdi N. Red and yellow injectable platelet-rich fibrin demonstrated differential effects on periodontal ligament stem cell proliferation, migration, and osteogenic differentiation. Int J Mol Sci 2020;21(14):5153.
29. Wang X, Zhang Y, Choukroun J, Ghanaati S, Miron RJ. Behavior of gingival fibroblasts on titanium implant surfaces in combination with either injectable-PRF or PRP. Int J Mol Sci 2017;18(2):331.
30. Okuda K, Kawase T, Momose M, Murata M, Saito Y, Suzuki H, Wolff LF, Yoshie H. Platelet-rich plasma contains high levels of platelet-derived growth factor and transforming growth factor-beta and modulates the proliferation of periodontally related cells in vitro. J Periodontol 2023;74(6):849–857.
31. Aydinyurt HS, Sancak T, Taskin C, Basbugan Y, Akinci L. Effects of ınjectable platelet-rich fibrin in experimental periodontitis in rats. Odontol 2021;109(2):422-432.
32. İzol BS, Üner DD. A new approach for root surface biomodification using injectable platelet-rich fibrin (I-PRF). Med Sci Monit 2019;25:4744–4750.
33. Ucak Turer O, Ozcan M, Alkaya B, Surmeli S, Seydaoglu G, Haytac MC. Clinical evaluation of injectable platelet-rich fibrin with connective tissue graft for the treatment of deep gingival recession defects: A controlled randomized clinical trial. J Clin Periodontol 2020; 47(1):72-80.
34. Albonni H, El Abdelah AAAD, Al Hamwi MOMS, Al Hamoui WB, Sawaf H. Clinical effectiveness of a topical subgingival application of injectable platelet-rich fibrin as adjunctive therapy to scaling and root planing: a double-blind, split-mouth, randomized, prospective, comparative controlled trial. Quintessence Int 2021;52:676-685.

Effect of Er:YAG Laser on Scaling and Root Planning and Usage of i-Platelet Rich Fibrin as a Biomodifier

Year 2025, Volume: 28 Issue: 2, 246 - 252, 30.06.2025

Necib Fazıl Gün , Meltem Hendek , Ebru Olgun

Abstract

Objectives: The purpose of this study was to compare scaling and root planning (SRP) with Er:YAG laser and Gracey curettes and the effectiveness of using injectable platelet-rich fibrin (i-PRF) as a biomodifier was also investigated.
Materials and Methods: There were 4 groups of extracted human teeth: Gracey Group (n=9): SRP with Gracey curettes; Gracey + i-PRF Group (n=9): SRP with Gracey curettes followed by application of i-PRF to the root surface; Er:YAG Group (n=9): SRP with Er:YAG laser; Er:YAG + i-PRF Group (n=9): SRP with Er:YAG laser followed by application of i-PRF to the root surface. The width of dentin tubules and the presence/absence of smear layer were examined using scanning electron microscopy (SEM).
Results: There was significantly less smear layer in the Er:YAG group compared to the Gracey group (p=0.001). The width of dentin tubules was found to be significantly higher in the Er:YAG and Er:YAG+i-PRF groups compared to the Gracey group (respectively;p=0.015;p<0.001). The width of dentin tubules in the Er:YAG+i-PRF group was profoundly higher than in the Gracey+i-PRF group (p=0.026).
Conclusions: Er:YAG laser was found to be more effective than Gracey curettes, which are the gold standard in root surface cleaning. Especially when combined with Er:YAG laser, i-PRF resulted in wider dentin tubules.

Keywords

Er:YAG laser, i-PRF, in vitro, root biomodification

Supporting Institution

This study was supported by the Kirikkale University Scientific Research Projects Unit with project number 2021/108

Project Number

2021/108.

References

1. Polson AM, Caton J. Factors influencing periodontal repair and regeneration. J Periodontol 1982;53(10):617–625.
2. Belal MH, Watanabe H. Comparative study on morphologic changes and cell attachment of periodontitis-affected root surfaces following conditioning with CO2 and Er: YAG laser irradiations. Photomed Laser Surg 2014;32(10):553-560.
3. Drisko CL. Periodontal debridement: still the treatment of choice. J Evid Based Dent Pract 2014 Jun;14 Suppl:33-41.e1.
4. Lavu V, Sundaram S, Sabarish R, Rao SR. Root Surface Bio-modification with Erbium Lasers-A Myth or a Reality? Open Dent J 2015;9:79.
5. Suchetha A, Darshan BM, Prasad R, Ashit GB. Root biomodification-a boon or bane? Indian J Stomatol 2011;2(4):251-255.
6. Zan R, Topçuoğlu H, Hubbezoğlu İ, Altunbaş D, Demir AŞ. The Roughening Effects of Er:YAG, Nd:YAG and KTP Laser Systems on Root Dentin Surface. Cumhuriyet Dent J 2023;26(1):63- 68.
7. Schwarz F, Sculean A, Berakdar M, Szathmari L, Georg T, Becker J. In vivo and in vitro effects of an Er: YAG laser, a GaAlAs diode laser, and scaling and root planing on periodontally diseased root surfaces: a comparative histologic study. Lasers Surg Med 2003;32(5):359-366.
8. Akiyama F, Aoki A, Miura-Uchiyama M, et al. In vitro studies of the ablation mechanism of periodontopathic bacteria and decontamination effect on periodontally diseased root surfaces by erbium: Yttrium–aluminum–garnet laser. Lasers Med Sci 2011;26(2):193-204.
9. Theodoro LH, Garcia VG, Haypek P, Zezell DM, Eduardo CDP. Morphologic analysis, by means of scanning electron microscopy, of the effect of Er: YAG laser on root surfaces submitted to scaling and root planing. Pesqui Odontol Bras 2002;16:308-312.
10. Ishikawa I, Aoki A, Takasaki AA, Mizutani K, Sasaki KM, Izumi Y. Application of lasers in periodontics: true innovation or myth? Periodontol 2000. 2009;50:90-126.
11. Crespi R, Capparè P, Toscanelli I, Gherlone E, Romanos GE. Effects of Er:YAG laser compared to ultrasonic scaler in periodontal treatment: a 2-year follow-up split-mouth clinical study. J Periodontol 2007 Jul;78(7):1195-1200.
12. Galli C, Passeri G, Cacchioli A, Gualini G, Ravanetti F, Elezi E, Macaluso GM. Effect of laser-induced dentin modifications on periodontal fibroblasts and osteoblasts: a new in vitro model. J Periodontol 2009 Oct;80(10):1648-1654.
13. Cobb CM. Clinical significance of non‐surgical periodontal therapy: an evidence‐based perspective of scaling and root planing. J Clin Periodontol 2002;29:22-32.
14. Dohan DM, Choukroun J, Diss A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part III: leucocyte activation: a new feature for platelet concentrates?. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101(3):51-55.
15. Choukroun J, Ghanaati S. Reduction of relative centrifugation force within injectable platelet-rich-fibrin (PRF) concentrates advances patients’ own inflammatory cells, platelets and growth factors: the first introduction to the low speed centrifugation concept. Eur J Trauma Emerg Surg 2018;44(1):87-95.
16. Miron RJ, Fujioka-Kobayashi M, Hernandez M, et al. Injectable platelet rich fibrin (i-PRF): opportunities in regenerative dentistry? Clin Oral Investig 2017;21(8):2619-2627.
17. Cavassim R, Leite FRM, Zandim DL, Dantas AAR, Rached RSGA, Sampaio JEC. Influence of concentration, time and method of application of citric acid and sodium citrate in root conditioning. J Appl Oral Sci 2012;20(3):376-383.
18. Chahal GS, Chhina K, Chhabra V, Bhatnagar R, Chahal A. Effect of citric acid, tetracycline, and doxycycline on instrumented periodontally involved root surfaces: A SEM study. J Indian Soc Periodontol 2014;18(1):32-37.
19. Fekrazad R, Lotfi G, Harandi M, Ayremlou S, Kalhori KA. Evaluation of fibroblast attachment in root conditioning with Er, Cr: YSGG laser versus EDTA: a SEM study. Microsc Res Tech 2015;78(4):317-322.
20. Ferreira R, de Toledo Barros RT, Karam PSBH, et al. Comparison of the effect of root surface modification with citric acid, EDTA, and aPDT on adhesion and proliferation of human gingival fibroblasts and osteoblasts: an in vitro study. Lasers Med Sci 2018;33(3):533-538.
21. Feist IS, De Micheli G, Carneiro SR, Eduardo CP, Miyagi SP, Marques MM. Adhesion and growth of cultured human gingival fibroblasts on periodontally involved root surfaces treated by Er: YAG laser. J Periodontol 2003;74(9):1368-1375.
22. Pourzarandian A, Watanabe H, Ruwanpura SM, Aoki A, Ishikawa I. Effect of low‐level Er: YAG laser irradiation on cultured human gingival fibroblasts. J Periodontol 2005;76(2):187-193.
23. Crespi R, Romanos GE, Cassinelli C, Gherlone E. Effects of Er: YAG laser and ultrasonic treatment on fibroblast attachment to root surfaces: an in vitro study. J Periodontol 2006;77(7):1217-1222.
24. Rossa Jr C, Silvério KG, Zanin IC, Brugnera Jr A, Sampaio JEC. Root instrumentation with an erbium: yttrium-aluminum-garnet laser: Effect on the morphology of fibroblasts. Quintessence Int 2002;33(7):496–502.
25. Karthikeyan R, Yadalam PK, Anand AJ, Padmanabhan K, Sivaram G. Morphological and chemical alterations of root surface after Er: Yag laser, Nd: Yag laser irradiation: A scanning electron microscopic and infrared spectroscopy study. J Int Soc Prev Community Dent 2020;10(2):205-212.
26. Iozon S, Caracostea GV, Páll E, et al. Injectable platelet-rich fibrin influences the behavior of gingival mesenchymal stem cells. Rom J Morphol Embryol 2020;61(1):189.
27. Zheng S, Zhang X, Zhao Q, Chai J, Zhang Y. Liquid platelet‐rich fibrin promotes the regenerative potential of human periodontal ligament cells. Oral Dis 2020;26(8):1755-1763.
28. Thanasrisuebwong P, Kiattavorncharoen S, Surarit R, Phruksaniyom C, Ruangsawasdi N. Red and yellow injectable platelet-rich fibrin demonstrated differential effects on periodontal ligament stem cell proliferation, migration, and osteogenic differentiation. Int J Mol Sci 2020;21(14):5153.
29. Wang X, Zhang Y, Choukroun J, Ghanaati S, Miron RJ. Behavior of gingival fibroblasts on titanium implant surfaces in combination with either injectable-PRF or PRP. Int J Mol Sci 2017;18(2):331.
30. Okuda K, Kawase T, Momose M, Murata M, Saito Y, Suzuki H, Wolff LF, Yoshie H. Platelet-rich plasma contains high levels of platelet-derived growth factor and transforming growth factor-beta and modulates the proliferation of periodontally related cells in vitro. J Periodontol 2023;74(6):849–857.
31. Aydinyurt HS, Sancak T, Taskin C, Basbugan Y, Akinci L. Effects of ınjectable platelet-rich fibrin in experimental periodontitis in rats. Odontol 2021;109(2):422-432.
32. İzol BS, Üner DD. A new approach for root surface biomodification using injectable platelet-rich fibrin (I-PRF). Med Sci Monit 2019;25:4744–4750.
33. Ucak Turer O, Ozcan M, Alkaya B, Surmeli S, Seydaoglu G, Haytac MC. Clinical evaluation of injectable platelet-rich fibrin with connective tissue graft for the treatment of deep gingival recession defects: A controlled randomized clinical trial. J Clin Periodontol 2020; 47(1):72-80.
34. Albonni H, El Abdelah AAAD, Al Hamwi MOMS, Al Hamoui WB, Sawaf H. Clinical effectiveness of a topical subgingival application of injectable platelet-rich fibrin as adjunctive therapy to scaling and root planing: a double-blind, split-mouth, randomized, prospective, comparative controlled trial. Quintessence Int 2021;52:676-685.

There are 34 citations in total.

Details

Primary Language	English
Subjects	Periodontics
Journal Section	Original Research Articles
Authors	Necib Fazıl Gün 0000-0002-7955-3497 Meltem Hendek 0000-0003-1518-4159 Ebru Olgun 0000-0001-7298-8589
Project Number	2021/108.
Publication Date	June 30, 2025
Submission Date	February 10, 2025
Acceptance Date	June 1, 2025
Published in Issue	Year 2025Volume: 28 Issue: 2

Cite

EndNote	Gün NF, Hendek M, Olgun E (June 1, 2025) Effect of Er:YAG Laser on Scaling and Root Planning and Usage of i-Platelet Rich Fibrin as a Biomodifier. Cumhuriyet Dental Journal 28 2 246–252.

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