Periodontal disease results from inflammation of the supporting structures of the teeth in response to chronic infections caused by various periodontopathic bacteria .
The main goalsofperiodontaltherapyaretoeliminatebacterialdeposits and niches by removing the supragingival and subgingival biofilms [2, 3] and to restore the biological compatibility of periodontally diseased root surfaces for subsequent attachment of periodontal tissues to the treated root surface . Generally, these objectives are achieved by mechanical scaling and root planning (SRP), which consists of hand- or electronic instrumentation of the periodontally affected sites.
Although SRP produces significant clinical improvements inpatientswithchronicperiodontitis(CP),thecompleteeliminationofbacterial depositscanbedifficulttoaccomplish. Indeed, mechanical therapy alone may fail to eliminate pathogenic bacterial niches in the soft tissue and in areas that are inaccessible to periodontal instruments, such as deep pockets, furcation areas, and rootdepressions [6, 7].Moreover, the use of SRP in the treatment of CP may result in a moderate and temporary shift in the composition of the microbial flora [8, 9], particularly in deep pockets where periodontopathic bacteria can persist after SRP. This situation can lead to the recolonization of treated sites [10, 11].
To overcome these limitations of conventional mechanical therapy, several adjunctive protocols have been developed. Among these, the use of lasers has been proposed for its bactericidal and detoxification effects and for its capacity to reach sites that conventional mechanical instrumentation cannot . In particular, studies [12, 13] have shown that the application of the diode laser (DL), with a wavelength between 655 and 980 nm, can accelerate wound healing through the facilitation of collagen synthesis, promotion of angiogenesis, and augmentation of growth factor release. Furthermore, DL displays in vitro bactericidal and detoxification effects  and can prevent ablation of the root surface , which theoretically reduces the risk of normal root tissue removal. Despite these potential beneficial effects, controversial clinical results for DL have been reported by studies conducted on humans comparing the adjunctive use of DL (SRP+DL) to SRP alone [16, 17].
Furthermore, important issues with paramount clinical implications remain to be defined, such as the effectiveness of adjunctive DL on microbiological outcomes and its clinical safety [17, 18]. Given the contrasting results of the studies and the absence of any previous meta-analyses, there is a great need to assess the literature systematically. The aim of the present meta-analysis is to evaluate scientific evidence concerning the effectiveness of SRP+DL compared with SRP alone in the treatment of patients affected by CP.
Materials and methods
The present meta-analysis was conducted according to guidelinesoftheCochraneCollaborationandPreferredReporting Items for Systematic Reviews and Meta-analysis .
The following databases were searched from their earliest records through 18 March 2012: MEDLINE, Cochrane Controlled Clinical Trial Register, Cochrane Database of Systematic Reviews, CINAHL, Science Direct, ISI Web of Knowledge, and SCOPUS.
In addition, a manual search was performed of issues from the last 15 years of the following journals: Lasers in Medical Science, Lasers in Surgery and Medicine, Photomedicineand LaserSurgery,JournalofPeriodontology,InternationalJournal of Periodontics and Restorative Dentistry, Journal of ClinicalPeriodontology,JournalofDentalResearch,Journal of Periodontal Research, Periodontology 2000, Journal of Dentistry, Journal of the American Dental Association, Journal of Clinical Dentistry, andClinical Oral Investigations. To be as inclusive as possible, no restrictions were applied with regard to the publication year or language of the studies. The references of all selected full-text articles and related reviews were scanned.
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