The International Journal of Periodontics & Restorative Dentistry

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 507

A Novel Surgical Procedure for Er:YAG Laser–Assisted

Periodontal Regenerative Therapy:
Case Series

Yoichi Taniguchi, DDS, PhD1 Periodontal regenerative therapy us-

Akira Aoki, DDS, PhD2 ing enamel matrix derivative (EMD)
Kazuto Sakai, DDS3/Koji Mizutani, DDS, PhD4 recently has been widely performed
Walter Meinzer, DDS5/Yuichi Izumi, DDS, PhD6 for periodontal angular bone de-
fects because of its efficacy and
simplicity.1,2 However, it is often dif-
The objective of this study was to evaluate an Er:YAG laser (ErL) application ficult to achieve favorable outcomes
for periodontal regenerative surgery in angular bone defects at nine sites in using EMD alone in one- and two-
six patients. Debridement was thoroughly performed using a combination of wall angular bone defects since the
curettage with a Gracey-type curette and ErL irradiation at a panel setting of
shape of such bone defects makes it
70 mJ/pulse and 20 Hz with sterile saline spray. After applying an enamel matrix
derivative and autogenous bone grafting, ErL was used to form a blood clot difficult to retain a space to induce
coagulation on the grafted bone surface at 50 mJ/pulse and 20 Hz without bone tissue. A consensus report
water spray for approximately 30 seconds. Twelve months after surgery the from the American Academy of Peri-
mean probing depth had improved from 6.2 mm to 2.0 mm, the mean clinical odontology regeneration workshop
attachment level had reduced from 7.5 mm to 3.4 mm, and bleeding on indicates that intrabony defect mor-
probing had improved from (+) to (−). Mean intrabony defect depth decreased
phology may affect overall regen-
from 6.0 mm before surgery to 1.0 mm 12 months after surgery. A novel
procedure for periodontal regenerative surgery applying ErL irradiation for erative outcomes and/or optimal
thorough decontamination during debridement as well as blood coagulation treatment strategies.3 In such cases,
following autogenous bone grafting seems to have achieved favorable and the combination of EMD and autog-
stable healing of periodontal pockets with significant clinical improvement and enous bone (AB) and/or bone sub-
desirable regeneration of angular bone defects, including one-wall defects. stitutes have recently been reported
Int J Periodontics Restorative Dent 2016;36:507–515. doi: 10.11607/prd.2515
to achieve more favorable outcomes
than EMD alone.2–6
However, retention and stabiliza-
Lecturer (part-time), Department of Periodontology, Graduate School of Medical and
1
tion of the grafted bone tissue are
Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Private Practive,
Sapporo, Hokkaido, Japan.
difficult in one- and two-wall defects,
2Junior Associate Professor, Department of Periodontology, Graduate School of Medical and sufficient alveolar bone regen-
and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. eration does not reach the alveolar
3
Private Practice, Tokyo, Japan.
4Assistant Professor, Department of Periodontology, Graduate School of Medical and
crest in most cases.2 In these cases,
Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. a membrane for guided tissue regen-
Adjunct Lecturer, Department of Periodontology, Graduate School of Medical and Dental
5 eration (GTR) is applied to acquire
Sciences, Tokyo Medical and Dental University, Tokyo, Japan. and retain a favorable space; howev-
6Professor, Department of Periodontology, Graduate School of Medical and Dental
er, the risk of impaired healing in the
Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
interdental region increases due to
Correspondence to: Dr Akira Aoki, National University Corporation, Tokyo Medical Dental problems associated with postopera-
University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan. Fax: +81-3-5803-0193. tive membrane exposure. To date,
Email: aoki.peri@tmd.ac.jp
a highly effective and low-morbid-
 ©2016 by Quintessence Publishing Co Inc. ity surgical procedure has not been

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508
Fig 1  Illustration of ErL-assisted periodon-
tal regenerative therapy. After conventional
mechanical debridement, thorough de-
bridement of the root surface and the bone
defect was performed by applying ErL with
saline spray in the contact mode. After
bone grafting into the defect, the grafted
bone surface was irradiated without saline
spray in a defocused mode to form a blood
clot on the grafted bone surface.
generally established for bone re-
generation in severe bone defects,7
although Cortellini et al reported a
successful case series of treatment of
extremely severe bone defects.8
Recently, laser therapy has be-
come a useful therapeutic approach.
Er:YAG and Er,Cr:YSGG lasers, which
oscillate a laser light with a highly
water-absorbable wavelength, have
superior ablation ability not only for
biologic soft tissue, which has a high
water content, but also for hard tis-
sue, composed of hydroxyapatite
with a hydration shell in its molecu-
lar structure.9–11 Er:YAG laser (ErL) is
mainly absorbed by the superficial
surface of biologic tissue contain-
ing water,12 and its thermal influence
at sites deeper in the tissue is very
weak. Compared with the relatively
thin layer of damage by a CO2 laser
of 0.1 to 0.3 mm, that of the ErL is
much smaller, approximately 10 to
50 μm.13 In addition, water spray
can be used with ErL treatment. The
addition of a saline spray further re-
duces thermal effects on the tissue
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while also cleaning the surgical area.
With this advantage, the ErL can be
used for delicate treatment of thin
soft tissue such as marginal gingiva.
In nonsurgical periodontal
pocket treatment using an ErL, it
was shown that cementum can
be preserved after the removal of
dental calculus by employing an
appropriate output and irradiation
method.14,15 A recent systematic re-
view reported that in clinical studies
comparing nonsurgical periodontal
pocket treatments of conventional
mechanical instrumentation using
a curette/ultrasonic scaler versus
ErL irradiation, pocket depth reduc-
tion and attachment gain in the ErL
group were comparable with those
achieved 3 months postoperatively
using conventional treatment.16
Other clinical studies have report-
ed favorable, long-term, stabilized
healing after ErL treatment.17,18
With regard to surgical treat-
ment, it has been reported that
there were no significant differences
in the improvement of clinical pa-
rameters between groups using
a curette and groups using ErL for
debridement in periodontal regen-
erative therapy.19 However, Mizu-
tani et al20 reported in an animal
study on open-flap debridement
for periodontitis that ErL treatment
produced significantly higher new
bone formation compared with that
induced by debridement using a cu-
rette, and Gaspirc and Skaleric21 re-
ported long-term improved clinical
outcome of ErL-assisted periodontal
flap surgery when compared with
conventional flap surgery. Addition-
ally, the promotion of osteoblast
proliferation in vitro following low-
level ErL irradiation has been dem-
onstrated.22 Recently in the surgical
treatment of peri-implantitis, favor-
able wound healing with excellent
bone regeneration was acheived
using an ErL.23–25 Based on these
findings, the integration of ErL ap-
plication into regenerative therapy
employing an EMD/AB combination
is expected to be useful in obtain-
ing thorough decontamination and
detoxification26–28 as well as cell/tis-
sue stimulation,20,22 which may be
advantageous for improving the
therapeutic outcome of tissue re-
generation.13,29 In addition, coagu-
lation of the blood clot surface by
laser irradiation recently has been
gradually applied in a clinical situ-
ation to tooth extraction sockets
to facilitate socket preservation by
increasing new bone formation,
as an in vivo study has shown that
blood clot coagulation by CO2 laser
irradiation promotes the healing of
extraction sockets.30 Thus, the appli-
cation of low-level ErL to the surface
of the grafted bone was performed
to physically strengthen the shape
of the grafted bone cluster by su-
perficial blood clot coagulation and
simultaneously promote wound
healing of the grafted bone in the
bone defect due to the biostimula-
tion effect of the laser.22
The combination of debride-
ment using ErL, AB grafting with
EMD, and laser-induced blood clot
formation to retain the grafted bone
morphology may have the potential
to promote favorable and stable tis-
sue regeneration without the use
of a membrane (Fig 1). The objec-
tive of this study was to evaluate
the efficacy of a novel ErL-assisted

procedure applying the aforemen-
tioned effects of ErL (thorough de-
contamination of root surface and
bone defect during debridement,
and blood coagulation following AB
grafting) in periodontal regenerative
surgery in angular bone defects in-
cluding one- and two-wall defects
and buccal dehiscence.
Materials and methods
Subjects
The subjects were six patients (one
man and five women), each with
at least one residual periodontal
pocket depth ≥ 4 mm associated
with an angular bone defect evident
on dental radiographs (Fig 2) after
initial periodontal treatment (Table
1). Two cases were included in the
present case series that demonstrat-
ed residual shallow probing depths
of 4 mm following scaling and root
planing. Since severe bone defects
were still evident radiographically
and BoP was still positive in these
two cases, a surgical approach for
tissue regeneration was indicated.
Prior to treatment, informed con-
sent was verbally obtained from
patients regarding treatment goals
and protocols. The patients all un-
derwent ErL-combined periodon-
tal regenerative surgery between
April 2010 and June 2012. A total
of nine defects (cases) were treated
(in six patients), and clinical data at
12 months following surgery was
obtained from their records and
analyzed (Tokyo Medical and Dental
University School of Dentistry Ethics
Committee Approval, no. 840).
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Surgical procedure
After local anesthesia, flap eleva-
tion was performed and granulation
tissue in the bone defect was ini-
tially removed using a conventional
curette. Then, ErL (Erwin AdvErL,
J. Morita) was applied in contact
mode at a panel setting of 70 mJ/
pulse and 20 Hz (energy output: ap-
proximately 35 mJ/pulse) with sterile
saline spray to thoroughly remove
the remaining inflammatory granula-
tion tissue, especially at the bottom
of the bone defect, and to debride
the root surface. Curved contact
tips with tip diameters of 400, 600,
or 800 μm (C400F, C600F, or C800F
corresponding energy density; 27.8,
12.3, or 6.9 J/cm2/pulse, respec-
tively) were used depending on the
bone defect dimensions (Figs 3a to
3d). After debridement, if the bone
defects did not demonstrate bleed-
ing, decortication was performed
using rotary instruments on the in-
ner wall of the bone defect. The ex-
posed root surface within the bone
defect was treated with pH neutral
24% ethylenediaminetetraacetic
acid (EDTA) for 2 minutes and thor-
oughly rinsed with sterile saline.
EMD was then applied (Emdogain
gel, Straumann). AB was collected
from a site near the surgical region,
mixed with blood (Fig 3e), and filled
into the bone defect to the level
of the alveolar crest. In treatment
areas with buccal or lingual bone
loss (intraosseous or dehiscence),
AB grafting was placed at a level
matching the known coronal level
of the respective buccal or lingual
marginal bone of adjacent teeth. Af-
ter AB grafting, ErL was applied in a
509
Crest
of the residual
alveolar bone
IDD
Deepest part of
bone defect
Fig 2  Illustration of radiograph measure-
ment technique. A line perpendicular to
the tooth axis was drawn from the alveolar
crest, and the distance between the point
crossing the root surface on this line and
the deepest point of the bone defect was
regarded as the intrabony defect depth
(IDD).
sweeping motion in defocus mode
(5-mm distance) at a panel setting
of 50 mJ/pulse and 20 Hz with-
out water spray for approximately
30 seconds to enhance blood clot
formation by inducing thermal co-
agulation of the blood covering the
graft particles, thereby improving
grafted bone stability (Figs 3f and
3g). The wound was closed with
simple sutures. In cases exhibiting
presurgical tooth mobility in estheti-
cally undemanding regions, fixation
with methyl methacrylate resin ce-
ment was performed after suturing.
Fixation with a temporary crown
was applied in regions in which
prosthetic treatment was planned
to follow regenerative therapy. An-
timicrobial and anti-inflammatory
drugs were administered after sur-
gery, and the sutures were removed
after adequate wound healing was
confirmed, approximately 2 weeks
postsurgery. At 12 months, reentry
surgery was performed in those pa-
tients requiring improvement of the
mucogingival and alveolar contour,
Volume 36, Number 4, 2016
510

Table 1 Results of clinical and radiographic evaluation

Patient
1 2 3 4 5 6 Mean ± SD
Case no. 1 2 3 4 5 6 7 8 9
Sex F F F M F F F F F
Age (y) 46 46 69 36 63 63 65 65 24 53.0 ± 14.8
Treatment 34MB 35MB 21MB 14MB 14MB 46D 45ML 13MB 31D
area (FDI)
Type of bone 3+ 3+ 2+ 2+ 3+ 2+ 2 + 1-wall + 3 + 1-wall + 1-wall +
defect 1-wall 1-wall 1-wall 1-wall 1-wall 1-wall dehiscence dehiscence dehiscence
PD (baseline) 6 7 6 8 4 6 6 9 4 6.2 ± 1.5
(mm)
PD (12 mo) 2 2 1 3 1 2 3 3 1 2.0 ± 0.8*
(mm)
PDR (mm) 4 5 5 5 3 4 3 6 3 4.2 ± 1.0
BoP (baseline) + + + + + + + + +
(mm)
BoP (12 mo) − − − − − − − − −
(mm)
CAL (baseline) 9 9 8 9 7 6 6 9 5 7.5 ± 1.4
(mm)
CAL (12 mo) 4 3 3 6 3 3 3 3 3 3.4 ± 0.9*
(mm)
CAL gain (mm) 5 6 5 3 4 3 3 6 2 4.1 ± 1.3
IDD (baseline) 6.4 5.6 7.7 5.6 6.4 2.4 6.9 8.6 9.7 6.4 ± 2.1
(mm)
IDD (12 mo) 0.2 1.2 3.3 0.5 0.2 0.1 2.3 1.4 1.1 1.1 ± 1.0*
(mm)
IDDR (mm) 6.2 2.8 4.4 5.1 6.2 2.3 4.6 7.2 8.6 5.2 ± 1.9
SD = standard deviation; M = mesial, B = buccal; D = distal; L = lingual; PD = probing depth; PDR = probing depth reduction; BoP = bleeding on probing;
CAL = clinical attachment level; IDD = intrabony defect depth; IDDR = intrabony defect depth reduction.
*P < .01 relative to baseline.

and osseous recontouring was un-
dertaken (Figs 3h and 3i).
Clinical evaluation
Probing depth (PD), clinical attach-
ment level (CAL), and bleeding on
probing (BoP) were measured by a
single nonblinded examiner before
surgery and 6 and 12 months after
surgery. Probing depth reduction
(PDR) and CAL gain were calculated
by comparing these measurements.
Radiographic evaluation
For assessment of the intrabony de-
fect depth (IDD), dental radiographs
were taken before surgery and 12
months after surgery. The radio-
graphic analysis was performed on
the pictures printed out at ×8 mag-
nification by a single blinded ex-
aminer. A line perpendicular to the
tooth axis was drawn from the most
coronal portion of the proximal al-
veolar crest of the bone defect. The
distance between the point crossing
the root surface on this line and the
deepest region of the bone defect
(transition to the normal periodontal
ligament space) was measured as
the IDD (Fig 2), and the IDD reduc-
tion (IDDR) was calculated.
Statistical analysis
PD, CAL, and IDD were compared
before surgery and 12 months after
surgery using Wilcoxon signed-rank
test.

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 511

Fig 3  Cases 1 and 2. (a) Before surgery, the mesial PD and CAL of the first premolar
(Case 1) were 6 and 9 mm, respectively, and those of the second premolar (Case 2) were
7 and 9 mm, respectively. (b) Deep angular bone defects were noted in the mesial regions
of the first and second premolars on preoperative radiographs. (c) After debridement with a
curette of the coronal area of the bone defects, remaining granulation tissue and calculus from
all inner defect surfaces including the apical area of the bone defect were thoroughly removed
using ErL. (d) After debridement, a three-wall angular bone defect in the apical area and a
one-wall angular bone defect in the coronal area were observed in the mesial region of the first
premolar. Granulation tissue in microconcavities on the inner surface of the bone defects had
been removed, and more bleeding was observed than is caused by conventional mechanical
debridement. (e) The root surface was treated with ethylene- a
diamenetetraacetic acid and irrigated with saline, followed by
EMD application to the root surface and AB graft placement
into the bone defect. (f) ErL defocused irradiation without
saline was applied to the grafted bone surface to enhance
blood clot formation. (g) At 12 months after surgery, the
papilla and marginal gingiva were slightly recessed, but no
interdental concavity or flap dehiscence had occurred during
the healing process. (h) A radiograph taken 12 months after
surgery showed that alveolar bone regeneration had reached
the alveolar crest, including the one-wall defect region. (i)
At reentry surgery after periodontal regenerative treatment,
dramatic bone regeneration included even the one-wall com-
ponent of the defect in the interdental alveolar bone. b c

Results

ErL irradiation with saline spray eas-

ily and thoroughly debrided the root
surface and the bone defect without
visible thermal damage, such as car-
bonization and coagulation, on the
tissue surface. After laser debride- d e
ment, microconcavities on the bone
surface in the bone defect could be
clearly observed, and there was more
bleeding from the bone surface com-
pared with conventional debride-
ment using the mechanical method.
In addition, blood coagulation was
induced on the grafted bone surface
by the subsequent defocused Erl ir- f g
radiation without irrigation, which
improved the stability of the grafted
bone morphology. Furthermore,
eight of the nine teeth were fixed
(bonding or temporary crown) imme-
diately after surgery to stabilize them.
In all cases, healing was favorable and
no dehiscence of the interdental flap
or infection of the grafted bone oc- i
curred (Figs 3 to 5). h

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512

a b c d
Fig 4  Case 7. (a) Preoperative radiograph. An angular bone defect was noted on the mesial aspect of the second premolar, and it was
continuous with the lingual circumferential bone defect. (b) During surgery, a two-wall bone defect with a large mesiodistal width continu-
ous from the mesial region to the distolingual side was noted. The lingual alveolar bone was circumferentially lost. (c) Radiograph taken 12
months after surgery. Bone regeneration had reached the alveolar crest in the angular bone defect, and regeneration was observed in the
circumferential bone defect. (d) At reentry surgery, successful alveolar bone regeneration was noted in the wide bone defect, reaching the
alveolar crest.

a b c d
Fig 5  Case 8. (a) Preoperative radiograph. An angular bone defect with a large mesiodistal width was noted. (b) During surgery, an angular
bone defect composed of a two-wall defect inferiorly and a one-wall defect superiorly was observed. (c) Bone regeneration was observed
close to the alveolar crest in the angular bone defect as seen in a 12-months-postoperative radiograph. (d) On reentry, it was observed
that bone tissue had regenerated and reached the alveolar crest in the one-wall angular bone defect region, and the buccal alveolar bone
level had improved.

The results of clinical param-
eters and radiographic evaluation
are shown in Table 1. At 12 months
after surgery, mean PD significantly
improved to 2.0 mm from 6.2 mm
before surgery (P < .01), for a mean
4.2-mm pocket reduction. Mean
CAL significantly improved to
3.4 mm from 7.5 mm (P < .01), result-
ing in a mean CAL gain of 4.1 mm.
Radiographs showed an increase in
favorable opacity of the bone defect
in all cases, and mean IDD signifi-
cantly improved from 6.4 mm be-
fore surgery to 1.1 mm at 12 months
after surgery (P < .01), achieving a
5.2-mm reduction.
To improve mucogingival and
alveolar contour, reentry surgery
was undertaken in seven sites 12
months after surgery, after obtain-
ing consent from the patients. Fa-
vorable bone regeneration and
sufficient hardness of the regener-
ated bone were confirmed during
osseous recontouring. In particular,
successful regenerative augmenta-
tion of alveolar bone was observed
even in the sites of one-wall an-
gular bone defects (Figs 3h and
3i). Sufficient bone regeneration
was also noted clinically on reen-
try, in regions where it was difficult
to observe radiographically, such
as a circumferential mesiolingual
bone defect with a large mesiodis-
tal width (Fig 4) and a combined
defect with an interdental angu-
lar bone defect and buccal dehis-
cence (Fig 5).
Discussion
Thorough debridement of the bone
defect and root surface is essential
in periodontal regenerative therapy.
Curettes and rotary instruments are
appropriate to remove relatively
large and accessible areas of in-
flammatory granulation tissue, but
complete debridement in smaller
regions is difficult with conventional
mechanical instruments. The resi-
dues of dental calculus in grooves
and bifurcation areas, as well as in-
flammatory granulation tissue in the
narrow portions of bone defects,
are of concern after mechanical
debridement. In contrast, ErL irra-
diation with an appropriate contact
tip can easily reach concavities on

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the root surface and narrow bone
defect areas. In addition, ErL used
with water spray can simultaneously
perform debridement and irrigation
of the surgical field. Therefore, more
effective and efficient debridement
can be performed using ErL in com-
bination with the mechanical meth-
od than by mechanical debridement
alone.13
The achievement of more fa-
vorable outcomes of periodontal
regenerative therapy through a
combination of EMD and AB graft-
ing compared with outcomes ob-
tained using EMD alone has recently
been reported.6,31 However, in one-
and two-wall defects and buc-
cal dehiscences where the defect
shape causes difficulty in retaining
the shape of the cluster of grafted
bone, the grafted materials are likely
to lose the desired morphology due
to pressure from the surrounding
soft tissue after suturing. To retain
a favorable space, combination with
a GTR membrane is frequently em-
ployed. However, secure suturing
by close adherence of the gingival
flap margins is more difficult after
membrane placement, thus a larger
relaxation incision in the periosteum
underlying the flaps is necessary to
allow passive flap adaptation. Such
extensive relaxing incisions increase
soft tissue invasion, which may result
in increased swelling, reduction of
the blood supply to the gingival flap,
and narrowing of the oral vestibule
after surgery. Moreover, membrane
exposure due to increased tissue
trauma and incomplete healing of
the flaps in the interdental region
carries a high risk of infection of the
membrane and grafted materials.32
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In the present case series, a
blood clot was formed on the graft-
ed bone surface by laser irradiation
to retain and stabilize the shape of
the cluster of grafted bone frag-
ments without a membrane. Based
on the clinical outcomes, the aims
were achieved to a significant ex-
tent indicating that a stable space
may have been created. In this
procedure, passive adaptation of
flap margins could be more read-
ily achieved with a smaller relax-
ation incision compared with those
needed in methods using GTR.
Favorable bone regeneration was
noted even in one-wall bone de-
fects, including areas with alveolar
bone dehiscence. This novel regen-
erative procedure may have fewer
complications and disadvantages
when compared with methods em-
ploying GTR. In addition, postoper-
ative fixation, applied after surgery
in most of the patients, may have
minimized postoperative tooth mo-
bility and improved the bone re-
generation conditions, since clinical
outcomes of periodontal regenera-
tion may be negatively affected by
tooth mobility.3 A number of factors
may have acted synergistically, re-
sulting in favorable and stable bone
regeneration in these patients.
These factors include thorough de-
contamination, detoxification, acti-
vation of surrounding bone tissue
by ErL irradiation during debride-
ment of the root surface and bone
defect, stabilization of the grafted
bone by blood clot formation in
the grafted bone region, and sta-
bilization of the grafted bone and
blood clot by fixation of mobile
teeth.
513
Thermal generation resulting
from irradiation with high-power
lasers can have various effects on
tissues, such as carbonization, ne-
crosis, and coagulation, depend-
ing on the wavelength. In the
wavelength of the ErL (2,940 nm),
thermal generation on tissues is ex-
tremely low compared with other
high-power lasers, such as Nd:YAG,
diode, and CO2 lasers,11,13 and the
thermally affected layer in gingival
tissue was reported to be only 20
µm in rats histologically.33 The wa-
ter spraying usually employed with
ErL irradiation makes the thermal
effect much smaller.
For bone defect and root sur-
face debridement with ErL, Mizu-
tani et al20 reported in a dog study
that ErL application during surgery
is safe and effective and does not
jeopardize subsequent wound
healing, including periodontal tis-
sue attachment to the laser-treated
root surface, and rather improved
wound healing of bone tissue. As
for the use of defocused irradiation
without water spray on implant-
ed bone particles, ErL may cause
slight carbonization of blood and
coagulation of the bone particles.
However, the clinical results of the
present study showed no negative
thermal side effects and the proce-
dure seems to be safe. Despite the
favorable clinical findings, the actu-
al clinical benefits of this procedure
need to be clarified by further ani-
mal and clinical studies. Induction
of protein denaturation of EMD by
thermal influence is possible during
ErL irradiation for blood coagula-
tion on the AB graft. However, neg-
ative side effects are unlikely as no
Volume 36, Number 4, 2016
514
postsurgical complications or de-
terioration of wound healing were
observed.
In previous studies, Trombelli et
al reported a mean CAL gain of 4.3
mm achieved by the combination of
EMD and AB grafting,6 and Sculean
et al reported a 3.0-mm CAL gain
using a combination of EMD and an
expanded polytetrafluoroethylene
membrane.34 In this study, in which
the periodontal pockets treated
were shallower at baseline than
those in the aforementioned stud-
ies, a mean CAL gain of 4.1 mm was
obtained. Furthermore, a high IDD
reduction of 5.2 mm was observed
after surgery in the present study.
Conclusions
A novel procedure applying ErL
for multiple purposes, including
thorough decontamination of root
surface and bone defect during
debridement as well as blood co-
agulation following AB grafting in
periodontal regenerative surgery,
seems to have achieved sufficient
bone regeneration and favorable
and stable clinical outcomes in an-
gular bone defects, including deep
one-wall defects and areas of buccal
bone dehiscence.
Acknowledgments
The authors reported no conflicts of interest
related to this study.
The International Journal of Periodontics & Restorative Dentistry
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