Combined Piezoelectric and Laser Therapy for Severely Compromised Teeth: Two Case Reports.

Background: Deep periodontal defects (probing depths: 10-15 mm) are traditionally considered hopeless and are frequently recommended for extraction. This report describes two patients demonstrating substantial periodontal tissue healing using a minimally invasive, nonsurgical approach combining piezoelectric instrumentation with Nd:YAG laser therapy, without bone grafts or biologic adjuncts. Methods: Two systemically healthy, nonsmoking adults with periodontally hopeless teeth underwent subgingival scaling with chlorhexidine irrigation, followed by Nd:YAG laser therapy. Case 1 received delayed laser therapy at 6 months; Case 2 received immediate combined therapy for an acute periodontal abscess. Teeth were stabilized by splinting. Clinical parameters, including probing depth, clinical attachment level (CAL), gingival recession, bleeding on probing, and gingival and plaque indices, were recorded at baseline and follow-up. Periapical radiographs were qualitatively evaluated for bone density changes. Results: Case 1 showed a 90.0% reduction in probing depth (10 mm to 1 mm) at 12 months, with a 9-mm CAL gain (15 mm to 6 mm; 60.0% improvement) and stable recession. Case 2 demonstrated a 93.3% reduction at most sites (15 mm to 1 mm) by 4 months, with a 14-mm CAL gain (20 mm to 6 mm; 70.0% improvement) and stable recession; however, one site retained a 4-mm probing depth with a persistent vertical defect. Radiographs revealed increased bone density and re-established trabecular patterns. No immediate postoperative pain or swelling was reported. Conclusion: Combined piezoelectric and Nd:YAG laser therapy was associated with substantial clinical and radiographic improvement in periodontally hopeless teeth, suggesting a minimally invasive alternative to extraction in selected cases with severe attachment loss, when bacterial control and patient compliance are favorable.