**7. Latest advances**

*Public Health in Developing Countries - Challenges and Opportunities*

its use appears promising [66].

goggle use, etc.) [68].

**6. Healing following laser therapy**

studies, as well as the great heterogeneity of the results had been pointed out by a recent systematic review. Nevertheless, even though data is incomplete regarding the clinical use of CO2 (10.6 nm) lasers in the surgical treatment of peri-implantitis,

The following summary of advantages and disadvantages of using lasers for

Less pain. Less need for anesthetics (an advantage for medically compromised patients). No risk of bacteremia. Excellent wound healing. No scar tissue formation. Bleeding control (dependent on the wavelength and power settings). Usually no need for sutures. Use of fewer instruments and materials and no need for autoclaving (economic advantages). Ability to remove both hard and soft tissues. Lasers can be used in

Relatively high cost of the devices. A need for additional education (especially in basic physics). Lasers do not eliminate the need for anesthesia. Every wavelength has different properties. The need for implementation of safety measures (i.e.,

Despite apparent benefits of lasers regarding patient compliance and clinical observation, there are no enough data to support that laser is associated with reduced scarring, which itself appears to be different according to the wavelength and extremely related to the energy density, and there are no enough data to support quicker healing associated with laser therapy [13]. Limited experimental animal studies [68, 69] involving CO2,Nd:YAG, diode lasers, or Er:YAG have evaluated the histological and immunohistochemical patterns of periodontal tissue healing following surgical and nonsurgical periodontal therapy. Sculean et al. [70] and Yukna et al. [71] reported healing response of intrabony defects after open flap surgery or treatment using a laser-assisted new attachment procedure in humans using Er:YAG and Nd:YAG lasers, respectively. Lippert et al. [72] claimed that CO2 laser-induced wounds in oral and oropharyngeal mucosa healed significantly faster (in 32.8 ± 9.2 days) than those created by Nd:YAG laser (in 40.4 ± 9.2). However, in contrast to conventional scalpel surgery, the histological findings showed that the beginning of wound healing was delayed after laser surgery, and it depends on the size of the initial defect. Due to the more pronounced zone of necrosis at the base of the wound ground, this effect is more evident using the Nd:YAG laser [72]. Although, as compared to conventional treatment, overall [72] as well as initial periodontal wound healing laser application [73] has been shown to be delayed, few studies have reported that laser-induced wounds show a reduced propensity of contraction of the scar in comparison to the usual surgeries of scalpel [13]. Low-level laser treatment by GaAIAs radiation in milliwatt range has been shown to be effective in recent studies, as it absolutely affects proliferation of fibroblasts in gingiva or periodontal ligament, so it consequently maintains peri-implant and

combination with scalpels (however, the laser is a tool and not a panacea) [67].

periodontal therapy is based on the literature and the author's experience.

**4. Advantages of using lasers in the periodontal therapy**

**5. Disadvantages of using lasers in periodontal therapy**

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periodontal wound healing [73].

Waterlase® system is a revolutionary dental device that uses laser-energized water to cut or ablate soft and hard tissues and provide periodontists with the opportunity to perform more procedures in fewer appointments with less need for anesthesia, scalpels, and drill [74]. Periowave™, a photodynamic disinfection system, utilizes nontoxic dye (photosensitizer) in combination with a low-intensity laser, enabling singlet oxygen molecules to destroy bacteria [75]. After applying a light-sensitive drug (photosensitizer), low-intensity laser is directed on the area treated with the drug resulting in phototoxic reactions. Although the use of photosensitizers for complete suppression of the anaerobic perio-pathogens has been suggested, the same is not true for facultative anaerobes [76].
