# Comparative Analysis of Er:YAG and Er,Cr:YSGG Lasers on Root Debridement and Cell Attachment Versus Conventional Instrumentation Methods: A Scoping Review

## TL;DR

This review compares erbium lasers and traditional methods for root debridement, finding that lasers offer benefits but require careful parameter control.

## Contribution

A comparative analysis of Er:YAG and Er,Cr:YSGG lasers versus conventional methods for root debridement in periodontal therapy.

## Key findings

- Erbium lasers produce smear layer-free surfaces with increased porosity, potentially aiding fibroblast attachment.
- Laser-treated surfaces show greater roughness and crater formation compared to conventional methods.
- Er:YAG lasers enhance fibroblast viability, while high-energy Er,Cr:YSGG applications show variable biocompatibility.

## Abstract

Effective subgingival debridement is essential for periodontal therapy. Subgingival debridement techniques induce morphological changes that influence healing. While hand instruments and ultrasonic scalers are the gold standard, erbium lasers offer potential advantages in biocompatibility and healing. This scoping review compares the effectiveness of erbium lasers (Er,Cr:YSGG (erbium, chromium-doped yttrium-scandium-gallium-garnet) and Er:YAG (erbium-doped yttrium-aluminum-garnet)) and conventional debridement methods in calculus removal, root surface topography, and cellular attachment following root debridement, based on in vitro studies. A systematic search was conducted in PubMed and Google Scholar for English-language articles published between 2014 and 2024. Studies evaluating erbium lasers compared to conventional debridement methods were included. A total of 1224 studies were initially identified from two databases: PubMed and Google Scholar. Following the eligibility assessment, 15 in vitro studies were analyzed. All methods effectively achieved subgingival instrumentation; additionally, erbium lasers produced smear layer-free surfaces with increased porosity, which may facilitate fibroblast attachment. However, laser-treated surfaces exhibited greater roughness and crater formation compared to conventional methods, with higher energy levels contributing to thermal damage. While some studies reported residual calculus on laser-treated surfaces, others demonstrated enhanced calculus removal and minimal root substance loss. Cell attachment studies indicated that Er:YAG lasers promoted fibroblast viability and proliferation, whereas high-energy Er,Cr:YSGG applications had variable effects on biocompatibility. Erbium lasers present a promising alternative to conventional debridement methods, improving smear layer removal and cell adhesion. However, variations in laser parameters impact treatment outcomes, emphasizing the need for standardized protocols. Further in vivo and clinical studies are required to validate their long-term effectiveness in periodontal therapy.