4. Periodontics
PBM in periodontal therapy
Periodontal disease is a biofilm-driven inflammatory condition. PBM does not remove biofilm and does not substitute mechanical instrumentation or cause-related therapy.
As a possible adjunct for postoperative pain, inflammatory modulation and soft-tissue healing after cause-related or surgical periodontal therapy.
Modulation of inflammatory mediators and support of soft-tissue repair in a thin, highly vascular, biofilm-exposed tissue.
Tissue and anatomical targets
- • Gingival margin and papillae
- • Surgical flap margins
- • Palatal donor site
- • Interproximal soft tissue
Clinical objectives
- • Postoperative pain modulation
- • Inflammatory modulation
- • Soft-tissue healing support
- • Patient comfort during maintenance
Dosimetric reasoning
- • Thin tissue and short optical path — favour lower fluence per point across multiple points.
- • Define the treated area per sextant/site rather than 'per tooth'.
- • Record points, area and interval so maintenance visits are reproducible.
Technique
- • Intraoral, point-by-point along the gingival margin.
- • Contact technique where hygiene and tissue integrity allow.
- • Standardise point positions between sessions for comparison.
Limitations
- • No antimicrobial effect without a photosensitiser.
- • Cannot compensate for residual calculus or uncontrolled plaque.
- • Effect on long-term attachment levels remains uncertain.
Common errors
- • Applying PBM before debridement.
- • Recording 'per tooth' doses without area.
- • Promising attachment gain from PBM alone.
Clinical pearls
- • Cause-related therapy first; PBM supports comfort and healing, not disease control.
Indications and evidence level
Biphasic dose-response, irradiance and light–tissue interaction were established there. Now apply them to this specialty's tissue thickness, vascularity and inflammatory state.
State the diagnosis and clinical objective before selecting a single parameter, and record the evidence level supporting what you tell the patient.
Eye protection for patient, operator and assistant. PBM does not remove the need for diagnosis, clinical judgment or medical coordination.
Knowledge checkpoint
Patient with generalised periodontitis, heavy plaque, requests 'laser therapy instead of cleaning'. Correct response?
Chapter summary
- • The biological principles are unchanged; the target, objective and strategy change.
- • Etiological treatment first; PBM as adjunct where justified.
- • Only claim what the evidence level supports.
- • Systematic reviews and meta-analyses on PBM in dentistry — to be curated by the academic team.
- • International PBM/laser safety guidance applicable in the institution's jurisdiction.
- • Institutional clinical protocol documentation (where authorised).
Linked educational cases
Educational content only. These algorithms are educational decision-support tools and never autonomous medical decision-makers. Clinical decisions remain the responsibility of the treating professional. Certification within OHDR Study™ is not a university award unless an authorised institution has been formally configured.