Comparison of laser therapy and ozonated water on gingival inflammation in orthodontic patients with fixed appliances
Background: There is an increased prevalence of oral ailments such as dental caries, gingivitis and periodontitis when orthodontic therapy is administered. Poor oral hygiene in conjunction with the placement of fixed orthodontic appliances is considered a significant factor in raising accumulation of bacterial plaque and its associated inflammatory response.
Aim: The present study aimed to evaluate and compare laser therapy with subgingival irrigation using ozonated water on gingivitis in patients undergoing fixed orthodontic treatment and to ascertain the presence of the inflammatory marker monocyte chemoattractant protein (MCP-1) in gingival crevicular fluid (GCF).
Methods: This study was a double-blind clinical study in which a split-mouth design was applied in 30 subjects for 28 days that received fixed orthodontic therapy. In each subject the upper right quadrant (control side) was irrigated with 0.01 mg/L ozonated water and the upper left quadrant (experimental side) was irradiated with a diode laser on day 0 (baseline) and day 7. The patients were recalled on days 7, 14 and 28 and clinical parameters were recorded at each visit. Biochemical evaluation of gingival inflammation with MCP-1 levels in GCF was obtained at the baseline (day 0) and on day 28.
Results: A statistically significant (p<0.05) reduction of all clinical parameters and MCP-1 activity in GCF was observed on both sides. Low-level laser irradiation showed a significant reduction of clinical parameters and MCP-1 activity compared to subgingival ozone irrigation.
Conclusions: Laser therapy can be considered a more effective method than subgingival ozone irrigation in patients undergoing fixed orthodontic treatment as it showed a consistent improvement in gingival inflammation.
Relevance for patients: Fixed orthodontic appliances makes oral hygiene maintenance difficult and results in gingivitis. Adjunctive oral hygiene procedures like subgingival irrigation with ozonated water or laser irradiation is beneficial. The data from this study suggests that irrigation with ozonated water or laser irradiation reduces gingival inflammation, with laser therapy being more effective.
[1] The Justification for Orthodontic Treatment, British Orthodontic Society; 2008.
[2] Amigoni NA, Johnson GK, Kalkwarf KL. The Use of Sodium Bicarbonate and Hydrogen Peroxide in Periodontal Therapy: A Review. J Am Dent Assoc 1987;114:217-21.
[3] Gold SI. Early Origins of Hydrogen Peroxide Use in Oral Hygiene. J Periodontol 1983;54:247.
[4] Moran J, Addy N, Newcombe R. A Clinical Trial to Assess the Efficacy of Sanguinarine-Zinc Mouthrinse. J Clin Periodontol 1998;15:612-6.
[5] Babay N, Al Jasser N. Subgingival Irrigation Effects of Chlorhexidine or Sanguinarine on Gingivitis in Orthodontic Patients. J Clin Pediatr Dent 1996;20:225-8.
[6] Nagayoshi M, Fukuizumi T, Kitamura C, Yano J, Terashita M, Nishihara T. Efficacy of Ozone on Survival and Permeability of Oral Microorganisms. Oral Microbiol Immunol 2004;19:240-6.
[7] Ramzy MI, Gomaa HE, Mostafa MI, Zaki BM. Management of Aggressive Periodontitis Using Ozonized Water. Egypt Med JNRC 2005;6:229-45.
[8] Kshitish D, Laxman VK. The Use of Ozonated Water and 0.2% Chlorhexidine in the Treatment of Periodontitis Patients. Indian J Dent Res 2010;21:341-8.
[9] Dhingara K, Vandana KL. Management of Gingival Inflammation in Orthodontic Patients with Ozonated Water Irrigation-a Pilot Study. Int J Dent Hyg 2011;9:296-302.
[10] Sandra VK, Nagireddy RR, Nooney A, Nadhamuni M. Comparison of Efficiency of Ozone and Chlorhexidine Subgingival Irrigation in Orthodontic Patients for Controlling Gingival Inflammation. S Afr Dent J 2019;74:82-6.
[11] Nooney A, Sandra VK, Jayade CV, Nadhamuni M, Sai P, Reddy L. Comparison of Efficiency of Ozone and Chlorhexidine Subgingival Irrigation in Orthodontic Patients for Controlling Gingival Inflammation. IJDSIR 2019;2:17-29.
[12] Moritz A. Oral Laser Application. Chicago: Quintessence; 2006.
[13] Sarver DM, Yanosky M. Principles of Cosmetic Dentistry in Orthodontics: Part 2. Soft Tissue Laser Technology and Cosmetic Gingival Contouring. Am J Orthod Dentofacial Orthop 2005;127:85-90.
[14] de Paula EC, de Freitas PM, Esteves OM, Aranha AC, Ramalho KM, Simoes A, et al. Laser Phototherapy in the Treatment of Periodontal Disease. A review. Lasers Med Sci 2010;125:781-92.
[15] Cardoso BS, Fioranelli VG, Eduardo CD, de Freitas PM, Aranha AC. Laser Phototherapy (660 nm) Can be Beneficial for Reducing Gingival Inflammation in Prosthodontics. Case Rep Dent 2015;2015:132656.
[16] Pejcic A, Zivkovic V. Histological Examination of Gingiva Treated with Low Level Laser in Periodontal Therapy. J Oral Laser Appl 2007;71:37-43.
[17] Pejcic A, Kojovic D, Kesic L, Obradovic R. The Effects of Low-Level Laser Irradiation on gingival inflammation. Photomed Laser Surg 2010;28:69-74.
[18] Nisha KJ, Suresh A, Anilkumar A, Padmanabhan S. MIP1α and MCP-1 as Salivary Biomarkers in Periodontal Disease. Saudi Dent J 2018;30:292-8.
[19] Jose P, Ramabhadran BK, Emmatty R, Paul TP. Assessment of the Effect of Ozonated Water Irrigation on Gingival Inflammation in Patients Undergoing Fixed Orthodontic Treatment. J Indian Soc Periodontol 2017;21:484-8.
[20] Seydanur DE, Serkan D, Abubekir E, Aysun BK, Onder O, Arife C. Evaluating Clinical and Laboratory Effects of Ozone in Non-Surgical Periodontal Treatment: A Randomized Controlled Trial. J Appl Oral Sci 2019;27:e20180108.
[21] Ren C, McGrath C, Gu M, Jin L, Chang C, Sum FH, et al. Low-Level Laser-Aided Orthodontic Treatment of Periodontally Compromised Patients: A Randomised Controlled Trial. Lasers Med Sci 2020;35:729-39.
[22] Duki WC, Bago I, Aurer A, Rogulji M. Clinical Effectiveness of Diode Laser Therapy as an Adjunct to Non-Surgical Periodontal Treatment: A Randomized Clinical Study. J Periodontol 2013;84:1111-7.
[23] Zare D, Haerian A, Molla R, Vaziri F. Evaluation of the Effects of Diode (980 Nm) Laser on Gingival Inflammation after Nonsurgical Periodontal Therapy. J Lasers Med Sci 2014;5:27-31.
[24] Qadri T, Miranda L, Tuner J, Gustafsson A. The Short‐Term Effects of Low‐Level Lasers as Adjunct Therapy in the Treatment of Periodontal Inflammation. J Clin Periodontol 2005;32:714-9.