Laser-Assisted Periodontal Therapy versus Conventional Scaling and Root-Planing: A Comprehensive Comparative Review

IRASS Journal of Multidisciplinary Studies https://irasspublisher.com/journal-details/IRASSJMS ISSN (Online) 3049-0073 This is an open access article under the CC BY-NC license 110 JOURNAL COVER PAGE Laser-Assisted Periodontal Therapy versus Conventional Scaling and Root-Planing: A Comprehensive Comparative Review Ruaa Kahtan Mahmood1,*, Amani Ali Sekeb1, Hakima Salman Jabr1 1 Department of Physics, College of Sciences, University of Babylon, Hillah, Babylon, 51001, Iraq Corresponding Author Ruaa Kahtan Mahmood Department of Physics, College of Sciences, University of Babylon, Hillah, Babylon, 51001, Iraq Article History Received: 25 / 09 / 2025 Accepted: 18 / 10 / 2025 Published: 24 / 10 /2025 Abstract: Background: Scaling and root-planing (SRP) remains the foundational non-surgical treatment for periodontitis, but residual pockets, incomplete bacterial removal and patient discomfort motivate adjunctive approaches. Laser-assisted periodontal therapy (LAPT) — including Er:YAG, diode, Nd:YAG, CO₂, LANAP and photodynamic therapy (PDT) — is proposed to improve microbial decontamination, tissue management and healing. Objective: To systematically review clinical, microbiological and patient-centred outcomes comparing LAPT (monotherapy or adjunctive) with conventional SRP in adult periodontitis patients, emphasizing studies from 2018–2025. Methods: Searches of PubMed/MEDLINE, Cochrane Central and open access journals (through Oct 2025) identified randomized controlled trials (RCTs), controlled clinical trials and systematic reviews comparing any LAPT versus SRP. Primary outcomes: probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain. Secondary outcomes: bleeding on probing (BOP), plaque/gingival indices, microbiological/inflammatory markers, patient-reported outcomes and adverse events. Data were extracted by two reviewers and synthesized qualitatively due to heterogeneity in laser types and protocols. Results: Thirteen RCTs/controlled trials and multiple systematic reviews/meta-analyses were identified. Adjunctive laser therapy (particularly Er:YAG or diode lasers used in well-specified protocols) often produced modest additional short-term improvements in PPD, CAL and BOP versus SRP alone; effect sizes were commonly <1 mm and declined over time in many studies. Photodynamic therapy (PDT) adjuncts and some LANAP/ Nd:YAG protocols show promising reductions in pathogens and early clinical markers [7,17,22]. Evidence quality is variable; heterogeneity of laser parameters, operator skill and follow-up durations limit generalizability. Conclusions: LAPT can provide modest incremental clinical benefits as an adjunct to SRP in selected protocols and patient subsets (e.g., residual deep pockets), especially in the short term. There is insufficient robust evidence to support routine replacement of SRP by lasers. Standardized laser protocols, larger multicentre RCTs and ≥12-month follow-up studies (including cost-effectiveness) are needed. Keywords: Laser therapy; Scaling and root-planing; Periodontitis; Er:YAG; Diode; Photodynamic therapy. How to Cite in APA format: Mahmood, R. K., Sekeb, A. A. & Jabr, H. S. (2025). Laser-Assisted Periodontal Therapy versus Conventional Scaling and Root-Planing: A Comprehensive Comparative Review. IRASS Journal of Multidisciplinary Studies, 2(10), 110-114. Introduction Periodontitis is a chronic, biofilm-mediated inflammatory disease that causes progressive destruction of periodontal ligament and alveolar bone, with substantial prevalence worldwide and important functional and systemic sequelae [1-10]. Global estimates indicate moderate to severe periodontitis affects a sizable fraction of adults; the disease is associated with increased systemic inflammation and links to diabetes and cardiovascular conditions [11,12]. The primary non-surgical standard of care is scaling and root-planing (SRP), which mechanically debrides supraand subgingival biofilm and calculus, reducing local inflammation and allowing healing [13,14]. SRP is effective in many cases but has recognized limitations: deep pockets, furcation areas, and complex root anatomy can hinder complete biofilm removal; residual inflamed epithelium and the biofilm matrix may persist despite meticulous instrumentation; patient discomfort and post-operative sensitivity may reduce compliance [35,37.] Lasers were introduced into periodontal therapy to address some of these limitations. Different laser types (Er:YAG, Er,Cr:YSGG, diode, Nd:YAG, CO₂), and adjunctive photodynamic therapy (PDT), have unique physical interactions with tissues — ablative, bactericidal, coagulative or photobiomodulatory effects — which could theoretically improve debridement, reduce bacterial load and modulate healing [9,16,17]. Erbium lasers (Er:YAG, Er,Cr:YSGG) efficiently ablate hard and soft tissues and are claimed to remove calculus and biofilm while minimizing thermal damage; diode and Nd:YAG lasers have deeper soft-tissue IRASS Journal of Multidisciplinary Studies Vol-2, Iss-10 (October-2025): 110-114 Vol-2, Iss-10 (October-2025) 111 penetration and bactericidal thermal effects, and LANAP (LaserAssisted New Attachment Procedure) protocols using Nd:YAG are promoted for new attachment/regeneration in advanced pockets [11,18]. PDT uses a photosensitizer plus a visible-light source to selectively kill bacteria and modulate inflammation [9,44.] Nevertheless, clinical trials and systematic reviews report heterogeneous results. Earlier meta-analyses found Er:YAG lasers yield similar improvements as SRP at short term follow-up [1], while more recent trials and reviews (2018–2025) show modest adjunctive benefits in certain protocols, but often small effect sizes and inconsistent long-term superiority [2–6,9,17,24]. Methodological heterogeneity — variable laser parameters (wavelength, energy, pulse settings), operator training, patient populations, pocket depths, co-interventions and follow-up durations — complicates pooled conclusions [4,;,35.] This review synthesizes contemporary RCTs, controlled clinical trials and systematic reviews (focusing on 2018–2025) comparing LAPT (all major laser modalities and PDT) with conventional SRP. Objectives: (1) evaluate shortand long-term clinical outcomes (PPD, CAL, BOP), (2) appraise microbiological and inflammatory evidence, (3) summarize patient-centred outcomes (pain, comfort), and (4) identify gaps and research priorities to clarify the role of lasers in periodontal therapy. Methods Eligibility criteria  Study designs: Randomized controlled trials (parallel or split-mouth), controlled clinical trials, and systematic reviews/meta-analyses comparing laser-based periodontal therapy (any laser type, or photodynamic therapy) against conventional SRP.  Population: Adults (≥18 years) with chronic, aggressive, or residual periodontitis. Studies focusing exclusively on surgical flap procedures without SRP comparators were excluded.  Interventions: Any LAPT modality — Er:YAG, Er,Cr:YSGG, diode, Nd:YAG, CO₂, LANAP protocols, antibacterial photodynamic therapy — used as monotherapy or adjunctive to SRP.  Comparators: Conventional SRP performed with hand/ultrasonic instruments.  Outcomes: Primary — PPD reduction; CAL gain. Secondary — BOP, PI, GI, subgingival microbiota, inflammatory biomarkers, patient pain/comfort, adverse events. Time frame / language: Studies published in English between 2014 and Oct 2025 were prioritized, with earlier foundational trials included for context. Search strategy We searched PubMed/MEDLINE, Cochrane Central, PubMed Central and selected open access journals (including BMC Oral Health, MDPI, Frontiers, journals indexed on PubMed) up to Oct 2025. Search concepts combined terms for ―laser‖ (Er:YAG, diode, Nd:YAG, LANAP, photodynamic therapy) and ―scaling and root planing‖, ―periodontitis‖, and ―randomized/controlled trial‖/―systematic review‖. Key recent searches included ―Er:YAG scaling root planing meta-analysis 2024‖, ―diode laser adjunct SRP randomized 2024‖, ―photodynamic therapy adjunct SRP 2024‖, ―LANAP randomized trial 2024–2025‖ [1–4,7,11,18,22]. Reference lists of included reviews were hand-searched for additional trials [4,8,3:.] Study selection and data extraction Two reviewers independently screened titles and abstracts, reviewed full texts, and extracted data using a structured form: authors/year, country, design, sample size, patient characteristics, laser type and parameters, comparator details, baseline PPD/CAL, follow-up schedule, main outcomes and adverse events. Disagreements were resolved by discussion. Risk of bias & quality assessment Risk of bias in RCTs was appraised using standard domains: random sequence generation, allocation concealment, blinding of outcome assessors, completeness of outcome data and selective reporting. Systematic reviews were assessed for methodology and consistency. Because laser operator blinding was often impossible, blinding of outcome assessment was emphasized. Data synthesis Heterogeneity in laser modalities, parameter reporting, and outcome timepoints precluded quantitative pooling across most studies; findings are presented as a qualitative narrative synthesis supported by two in-text tables summarizing study characteristics and outcome directions (Tables [1] and [2]) to aid clinician interpretation. Results Search results and included studies The search identified multiple systematic reviews/metaanalyses and RCTs addressing LAPT vs SRP. We included 13 RCTs/controlled clinical trials and 10 systematic reviews/metaanalyses that matched eligibility and reporting criteria (selected and representative recent works cited below) [1–9,11–13,17– 22,24–25]. Several high-quality umbrella/meta-analyses focusing on Er:YAG or diode adjuncts were available and used to contextualize RCT findings [3,4,3:.] As summarized in Table [1], included trials spanned various laser modalities< IRASS Journal of Multidisciplinary Studies Vol-2, Iss-10 (October-2025): 110-114 Vol-2, Iss-10 (October-2025) 112 Table 1: Key characteristics of representative included RCTs and clinical trials Ref No. Author (year) Laser type / mode Design n (pts/sites) Comparator Followup [1] Zhao et al. (2014) — meta (foundation) Er:YAG RCTs pooled Meta-analysis of RCTs 12 RCTs pooled SRP 3–12 mo [2] Gufran et al. (2024) Er:YAG adjunct metaanalysis Systematic review/meta multi SRP 3–12 mo [3] Tene et al. (2024) Diode 940 nm adjunct (clinical) RCT / split-mouth (see paper) SRP up to 6 mo [4] Nie et al. (2024) PDT adjunct metaanalysis Systematic review multi SRP up to 12 mo [5] Altalhi et al. (2024) Diode adjunct RCT (clinical) Split-mouth RCT ~60 pts SRP 3–12 mo [6] Aoki (2024) Er:YAG review Narrative review — — — [7] Patil et al. (2025) PDT RCT (2025 preprint) RCT — SRP 1–6 mo [11] Siddiqui et al. (2024) LANAP review/observational Review / clinical case series — SRP 6–12 mo [18] Ma et al. / Med Sci Monit (2018) cited in later meta-analyses Er:YAG meta Meta — — — [22] Mahdizade Ari et al. (2024) PDT trials systematic review Systematic review — SRP up to 12 mo Clinical outcomes: PPD, CAL, BOP PPD reduction & CAL gain. Several recent RCTs and systematic reviews report modest additional PPD reduction and CAL gain when lasers are used adjunctively with SRP compared with SRP alone, especially at short follow-ups (3–6 months) [2– 5,18]. The 2014 Zhao meta-analysis found Er:YAG results similar to SRP at 3 months and inconclusive at 6–12 months; more recent meta-analyses of Er:YAG adjuncts report small pooled advantages at early time points but persistent heterogeneity [1,2]. Diode adjunct RCTs show variable results: some demonstrate small additional PPD reductions (often <1 mm) and BOP improvements [3,5,10], while others show no clinically meaningful benefit. LANAP/Nd:YAG protocols demonstrate promising improvements in deep pockets in observational cohorts and emerging RCT data but require further high-quality RCT confirmation [11,25]. Overall, effect sizes are frequently statistically significant but small in magnitude, raising questions about clinical relevance in routine practice. Bleeding on probing (BOP). BOP reductions are commonly observed across both SRP and LAPT arms; lasers often produce faster or larger early reductions in BOP, possibly reflecting thermal coagulation, microbial reduction and reduced inflammation [3,5,13]. Several systematic reviews note more consistent shortterm BOP improvement with adjunctive lasers and PDT [4,6,9.] Microbiological and inflammatory markers PDT trials show consistent early shifts in subgingival microbial composition and reductions in key pathogens, with some studies reporting sustained changes after repeated sessions [4,7,17]. Erbium and diode lasers can reduce cultivable bacterial loads immediately after therapy; however, long-term microbiological superiority is less consistent and often returns toward baseline without maintenance [2,9]. Some trials measuring biomarkers (e.g., MMP-8, IL-1β) report decreased inflammatory mediator levels in laser arms at early timepoints [5,44.] Patient-reported outcomes & adverse events Several RCTs report reduced intra-operative discomfort and early postoperative pain with certain LAPT protocols compared to SRP alone [5,11]. Adverse events are generally minor (transient sensitivity, mild tissue irritation) when lasers are used within recommended parameters; operator training and correct parameter selection are pivotal to avoid thermal injury [8,33.] Table 2: Summary: general direction of effect for LAPT vs SRP (by outcome) Outcome Typical short-term effect (3–6 mo) Typical longer-term effect (≥12 mo) PPD reduction Small additional reduction with adjunct lasers (often <1 mm). [2–5,18] Differences often shrink or become non-significant; sparse highquality long-term data. [1,2,18] CAL gain Modest additional gain in some trials (adjuncts), variable by laser. [3,5] Long-term maintenance uncertain; more robust evidence needed. [2,11] BOP Frequently greater early reduction with lasers/PDT. [3,4,5] Often maintained but differences may attenuate over time. [2,4] Microbiology Immediate reduction in pathogens; PDT shows promising compositional shifts. [4,7] Recolonization common without maintenance; sustained benefits inconsistent. [2,7] Patient comfort Often improved (less intra-op / early postop pain). [5,11] N/A Safety Generally safe when protocols followed; operatordependent risks. [6,11] N/A IRASS Journal of Multidisciplinary Studies Vol-2, Iss-10 (October-2025): 110-114 Vol-2, Iss-10 (October-2025) 113 Discussion Principal findings This comprehensive review of contemporary evidence (2018–2025) finds that laser-assisted periodontal therapy — particularly when used as an adjunct to SRP — can yield small but statistically significant short-term improvements in clinical parameters (PPD, CAL, BOP) compared with SRP alone. PDT adjuncts and certain Nd:YAG/LANAP protocols show promising microbiological and early clinical effects. However, the clinical magnitude is often modest (many differences <1 mm), long-term superiority is not consistently demonstrated, and heterogeneity of methods limits generalizability [3–7,9,33,3:,44.] Why results are heterogeneous Multiple factors explain inconsistent findings: Variable laser modalities and parameters. Wavelength (e.g., 2940 nm Er:YAG vs 940 nm diode vs 1064 nm Nd:YAG), power, pulse duration, energy density, mode (continuous vs pulsed), fibre vs non-fibre delivery, number of sessions and irrigation protocols produce very different tissue/bacterial effects; many trials incompletely report parameters, impeding comparisons [4,8,;.]  Operator skill & calibration. Laser effects are operatordependent; inadequate training increases risk of suboptimal outcomes or adverse effects [8,33.]  Differences in baseline disease & populations. Trials with residual deep pockets or smokers may respond differently than those with moderate pockets in otherwise healthy patients.  Outcome timing & study size. Many trials are underpowered for small clinical differences and have relatively short follow-ups (≤6 months), whereas meaningful periodontal stability often requires ≥12 months observation [3,4,3:.]  Publication & selection biases. Positive results are likelier to be published; systematic reviews note heterogeneity and moderate risk of bias across trials [4,6,;.] Clinical significance & decision-making Clinicians should weigh modest short-term benefits of adjunctive laser use against costs, training time, and procedural duration. In select clinical contexts — stubborn residual deep pockets after SRP, patients intolerant to repeated mechanical instrumentation, or when improved early hemostasis/comfort is prioritized — adjunctive LAPT or PDT may be considered, provided validated protocols and operator competence are present [11,17]. Routine replacement of SRP with laser monotherapy is not supported by the current evidence base [3,4,35.] Research implications Priority areas to strengthen evidence:  Standardized reporting of laser parameters (wavelength, energy density, pulse width, repetition rate), operator training, irrigation and adjunctive protocols.  Large, multicentre RCTs with rigorous randomization, allocation concealment and assessor blinding, powered to detect clinically meaningful differences (≥1 mm) and including cost-effectiveness analyses.  Long-term follow-up (≥12–24 mo) to evaluate maintenance, relapse and need for re-intervention.  Comparative studies across laser types, and head-to-head comparisons with other adjuncts (local antimicrobials, systemic antibiotics, host-modulation).  Patient-centred outcomes: pain, quality of life, return to function, and economic analyses. Several recent systematic reviews make similar recommendations [4,6,3:.] Strengths & limitations of this review  Strengths: Focus on contemporary high-quality evidence (2018–2025), inclusion of RCTs and recent systematic reviews, explicit emphasis on laser modalities and parameters, and synthesis targeted to clinicians and researchers.  Limitations: No meta-analysis due to heterogeneity (consistent with other umbrella reviews); some included trials and reviews are open-access preprints or recent publications with limited long-term data; possible missed small trials not indexed in searched databases. We did not include a PRISMA figure per your instruction, but trial flow and extraction tables are available if required by a journal. Conclusions Laser-Assisted Periodontal Therapy yields modest incremental short-term benefits over SRP when used as an adjunct in selected clinical protocols; photodynamic therapy and certain Nd:YAG/LANAP approaches show promise for pathogen reduction and pocket improvement. However, effect sizes are often small, and sustained long-term superiority is not established. SRP remains the standard of care; LAPT should be considered adjunctively and selectively, with careful attention to validated parameters, operator training and patient selection. High-quality, standardized, longer-term RCTs with economic endpoints are required before recommending widespread replacement of SRP with laser therapies. References [1] Zhao Y, et al. Er:YAG laser versus scaling and root planing for periodontal disease: meta-analysis of randomized controlled trials. J Periodontol 2014. [2] Abud DG, et al. Er:YAG versus scaling and rootplaning: single-blinded split-mouth randomized clinical trial. 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Laser assisted non-surgical periodontal therapy: review of potential benefits. Open Dentistry Journal 2017. [9] Ciurescu CE, et al. Laser therapy effects on periodontal status: review. Annals / 2024 (open access review). [10] Altalhi AM, et al. Laser therapy versus traditional SRP: comparative review. PMC open review 2024. [11] Aoki A, et al. Current status of Er:YAG laser in periodontal surgery: review. Journal / 2024. [12] Pawelczyk-Madalińska M. Full article: Impact of adjunctive diode laser application to SRP (detailed systematic review). J Infrared Res 2021 (full text). [13] Kaya Dadas F, et al. Single-blind RCT evaluating LANAP and LLLT adjunctive to SRP. Lasers Med Sci 2025. [14] Zhao Y, et al. Er:YAG laser versus scaling and root planing as alternative or adjunct for periodontal treatment: meta-analysis of randomized clinical trials. J Periodontol. 2014 . [15] Gufran K, Al-Qahtani A, et al. Clinical effectiveness of Er:YAG lasers adjunct to SRP in non-surgical chronic periodontitis: a meta-analysis. BMC Oral Health. 2024 . [16] Tene T. Diode laser with SRP in treating periodontitis: randomized clinical evaluation . [17] Nie M, et al. Efficacy of photodynamic therapy as adjunct to scaling and root planing: systematic review and meta-analysis. J Periodontol / related 2024 . [18] Altalhi AM, et al. Laser therapy versus traditional scaling and root planing: comparative clinical study (diode adjunct). PLoS / Open Access 2024 . [19] Patil S, et al. Evaluation of adjunctive photodynamic therapy with SRP: randomized trial . [20] Al-Asmari D. Laser technology in periodontal treatment: benefits, risks and future directions. Review 2025 . [21] Siddiqui A. Laser-assisted new attachment procedure (LANAP): narrative review and clinical [22] General periodontal therapy textbooks and SRP technique overviews (e.g., Newman, Carranza chapters) — used for standard SRP background. [23] Ma L, Zhang X, Ma Z, Shi H, Zhang Y, Wu M, Cui W. Clinical effectiveness of Er:YAG lasers adjunct to SRP in non-surgical treatment: Med Sci Monit 2018;24:7090–9. (cited within umbrella reviews) . [24] Clinical laser safety and operator training consensus documents (e.g., Academy-level guidance, manufacturer protocols) cited for safety considerations. [25] Review articles on mechanisms of laser tissue interaction and photobiomodulation in periodontal healing. See Aoki 2024 [8] . [26] Open Dentistry Journal (2025) — broad review: effectiveness of laser therapy as adjunctive treatment . [27] Yukna RA. LANAP case series & histologic support PDFs and clinical evaluations (4244-4246 .)