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Diode Laser - A Novel Therapeutic Approach in the Treatment of Chronic Periodontitis in Type 2 Diabetes Mellitus Patients: A Prospective Randomized Controlled Clinical Trial

Sourav Chandra, Pratibha Shashikumar
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Abstract

Introduction: Maturity-onset diabetes mellitus affecting the elderly population is marked by insulin resistance and decreased insulin production. The relationship between periodontitis and diabetes is bidirectional. Type 2 diabetic patients are more prone to chronic periodontitis (CP) and severe periodontitis affects the glycemic control in such patients. Recently, dental diode laser has become an effective tool in controlling CP. To date, very few studies have been conducted to check the efficacy of diode laser in control of periodontal destruction in type 2 diabetes mellitus (DM2) patients. Hence, the need of the study was to evaluate whether diode laser helps improvement of periodontal outcome and reduction in anaerobic bacteria in elderly diabetic patients with CP.
Methods: Forty DM2 patients with CP were randomized into group A (control): scaling and root planing (SRP) only and group B (test): SRP followed by soft tissue dental diode laser (808 nm) application. Four patients (2 in each group) were lost during follow up. Clinical parameters, plaque samples and glycated hemoglobin levels were evaluated at both baseline and 90 days post-treatment.
Results: Improvement in clinical, microbiological and glycemic parameters were noted in the group that received SRP as well as SRP + LANAP (laser-assisted new attachment procedure). The reductions in clinical parameters were statistically significant after 3 months (P < 0.001). The microbial analysis of plaque samples for Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) decreased significantly after 3 months in group B than in group A. Glycated hemoglobin level (HbA1c) decreased significantly after 90 days in both the groups (P < 0.001) with more reduction in the SRP+LANAP group (6.49%) in comparison to SRP alone (16.25% vs. 9.76%). However, on the intergroup comparison, the difference in HbA1c reduction was nonsignificant.
Conclusion: Laser as an adjunct to SRP is an effective procedure for improving clinical and microbiological parameters in maturity onset diabetes mellitus patients with CP. Also, there was a better improvement in glycemic control in the test group compared to control group after 3 months. Hence, medically compromised patients like DM2 with CP with delayed wound healing can effectively be treated by laser as an adjunct to nonsurgical periodontal therapy for better results.

Keywords

Chronic periodontitis; Diode laser; Diabetes mellitus; HbA1c; LANAP; Microbiology; Nonsurgical periodontal therapy.

References

Darveau RP, Tanner A, Page RC. The microbial challenge in periodontitis. J Periodontol 2000.1997;14:12-32.

Barr EL, Zimmet PZ, Welborn TA, et al. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation. 2007;116:151-1517. doi:10.1161/CIRCULATIONAHA.106.685628

Löe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993;16:329-334.

Preshaw PM, Alba AL, Herrera D, et al. Periodontitis and diabetes: A two-way relationship. Diabetologia. 2012;55:21- 31. doi:10.1007/s00125-011-2342-y

Teeuw WJ, Gerdes VEA, Loos BG. Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis. Diabetes Care. 2010;33:421-427. doi:10.2337/dc09-1378

Wolf HF, Hassel TM. Colour Atlas of Dental Hygiene: Periodontology. Theme; 2006.

Moritz A, Schoop U, Goharkhay K, Schauer P. Treatment of periodontal pockets with a diode laser. Lasers Surg Med. 1998;22:302-311.

Mousquès T, Listgarten MA, Phillips RW. Effect of scaling and root planing on the composition of the human subgingival microbial flora. J Periodontal Res. 1980;15:144- 51.

Hinrichs JE, Wolff LF, Pihlstrom B, Schaffer EM, Liljemark WF, Bandt CL. Effects of scaling and root planing on subgingival microbial proportions standardized in terms of their naturally occurring distribution. J Periodontol. 1985;56:187-94. doi:10.1902/jop.1985.56.4.187

Yilmaz. Effect of gallium arsenide diode laser on human periodontal disease: a microbiological and clinical study. Lasers Surg Med. 2002;30(1):60-6.

Garrett JS. Effects of non-surgical therapy on periodontitis in humans: a review. J Clin Periodontol. 1983;10:515-23.

Kaldahl WB, Kalkwarf KL, Patil KD. A review of longitudinal studies that compared periodontal therapies. J Periodontol. 1993;64:243-253. doi:10.1902/jop.1993.64.4.243

Buchanan SA, Robertson PB.. Calculus removal by scaling/ root planing with and without surgical access. J Periodontol 1987;58(3):159-163. doi:10.1902/jop.1987.58.3.159

Matia JI, Bissada NF, Maybury JE, Richette P. Efficiency of scaling of molar furcation area with and without surgical access. Int J Periodontics Restorative Dent. 1986;6:25-35.

Adriaens PA, Edwards CA, De Boever JA, Loesche WJ. Ultrastructural observation on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth. J Periodontol. 1988;59:493-503. doi:10.1902/ jop.1988.59.8.493

Loesche WJ. The antimicrobial treatment of periodontal disease: Changing the treatment paradigm. Crit Rev Oral Biol Med. 1999;10(3):245-275.

Herrera D, Sanz M, Jepsen S, Needleman I, Roldan S. A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol. 2002;29(Suppl 3):136-59.

Haffajee AD, Cugini MA, Dibart S, Smith C, Kent RL, Socransky SS. Clinical and microbiological features of subjects with adult periodontitis who responded poorly to scaling and root planing. J Clin Periodontol. 1997;24(10):767-76.

Lopez NJ, Gamonal JA, Martinez B. Repeated metronidazole and amoxicillin treatment of periodontitis. A follow-up study. J Periodontol. 2000;71(1):79-89. doi:10.1902/ jop.2000.71.1.79

Löe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol. 1965;36:177-187. doi:10.1902/ jop.1965.36.3.177

Dortbudak O, Haas R, Bernhart T, Mailath-Pokorny G. Lethal photosensitization for decontamination of implant surfaces in the treatment of peri-implantitis. Clin Oral Implants Res. 2001;12(2):104-108.

Coleton S. Lasers in surgical procedures and oral medicine. Dent Clin North Am. 2004;48:937-62. doi:10.1016/j. cden.2004.05.008

Lang NP, Brägger U. Periodontal diagnosis in the 1990s. J Clin Periodontol. 1991;18:370-379.

Wolf HF, Rateitschak K. Periodontology. Vol 1. Thieme: 2005

Iwamoto Y, Nishimura F, Nakagawa M, et al. The effect of antimicrobial periodontal treatment on circulating tumor necrosis factor-alpha and glycated hemoglobin level in patients with type 2 diabetes. J Periodontol. 2001;72:774- 778. doi:10.1902/jop.2001.72.6.774

Kiran M, Arpak N, Unsal E, Erdogan MF. The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. J Clin Periodontol. 2005;32:266-272. doi:10.1111/j.1600-051X.2005.00658.x

Koromantzos PA, Makrilakis K, Dereka X, et al. A randomized, controlled trial on the effect of non-surgical periodontal therapy in patients with type 2 diabetes. Part I effect on periodontal status and glycaemic control. J Clin Periodontol. 2011;38:142-147. doi:10.1111/j.1600- 051X.2010.01652.x

Navarro-Sanchez AB, Faria-Almeida R, Bascones- Martinez. Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis. J Clin Periodontol. 2007;34:835-843. doi:10.1111/j.1600- 051X.2007.01127.x

Borgnakke WS, Chapple IL, Genco RJ, et al. The multi-center randomized controlled trial (RCT) published by the journal of the American Medical Association (JAMA) on the effect of periodontal therapy on glycated hemoglobin (HbA1c) has fundamental problems. J Evid Based Dent Pract. 2014;14:127–132. doi:10.1016/j.jebdp.2014.04.017

Christodoulides N, Nikolidakis D, Chondros P, et al. Photodynamic therapy as an adjunct to non-surgical periodontal treatment: A randomized, controlled clinical trial. J Periodontol. 2008;79:1638-1644. doi:10.1902/ jop.2008.070652

Chondros P, Nikolidakis D, Christodoulides N, Rössler R, Gutknecht N, Sculean A. Photodynamic therapy as an adjunct to non-surgical periodontal treatment in patients on periodontal maintenance: A randomized controlled clinical trial. Lasers Med Sci. 2009;24:681-688. doi:10.1007/ s10103-008-0565-z

Koçak1 E, Sağlam M. Nonsurgical periodontal therapy with/without diode laser modulates metabolic control of type 2 diabetics with periodontitis: a randomized clinical trial. Lasers Med Sci. 2016;31(2):343-53. doi:10.1007/ s10103-016-1868-0

Berakdar M, Callaway A, Eddin MF, Ross A, Willershausen B. Comparison between scaling-root-planing (SRP) and SRP/photodynamic therapy: a six-month study. Head Face Med. 2012;8:12. doi:10.1186/1746-160X-8-12

Fallah A. Effects of 980 diode laser treatments combined with scaling and root planing on periodontal pockets in chronic periodontitis patients. Lasers Dent. 2010;14:1-11.

Dukic W, Bago I, Aurer A, Roguljic M. Clinical effectiveness of diode laser therapy as an adjunct to non-surgical periodontal treatment: a randomized clinical study. J Periodontol. 2013;84:1111-1117. doi:10.1902/ jop.2012.110708

Kreisler M, Al Haj H, d’Hoedt B. Clinical efficacy of semiconductor laser application as an adjunct to conventional scaling and root planing. Lasers Surg Med. 2005;37:350-355. doi:10.1002/lsm.20252

Qadri T, Miranda L, Tuner J, Gustafsson A. The short-term effects of low-level lasers as adjunct therapy in the treatment of periodontal inflammation. J Clin Periodontol. 2005;32:714-719. doi:10.1111/j.1600-051X.2005.00749.x

Sağlam M, Kantarcı A, Dündar N, Hakkı SS. Clinical and biochemical effects of diode laser as an adjunct to nonsurgical treatment of chronic periodontitis: a randomized, controlled clinical trial. Lasers Med Sci. 2014;29:37-46. doi:10.1007/s10103-012-1230-0

Obradovic R, Kesic L, Mihailovic D, et al. Low-level lasers as an adjunct in periodontal therapy in patients with diabetes mellitus. Diabetes Technol Ther. 2012;14:799-803. doi:10.1089/dia.2012.0027

Obradovic R, Kesic L, Mihailovic D, Antic S, Jovanovic G et al A histological evaluation of a low-level laser therapy as an adjunct to periodontal therapy in patients with diabetes mellitus. Lasers Med Sci. 2013;28:19–24. doi:10.1007/ s10103-012-1058-7

Yukna RA, Carr RL, Evans GH. Histologic evaluation of a Nd: YAG laser-assisted new attachment procedure in humans. Int J Periodontics Restorative Dent. 2007;27:577- 587.

Romanos GE, Henze M, Banihashemi S, et al Removal of epithelium in periodontal pockets following diode (980 nm) laser application in the animal model: an in vitro study. Photomed Laser Surg. 2004;22:177-183. doi:10.1089/1549541041438597

Schwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker J. Periodontal treatment with an Er: YAG laser or scaling and root planing. A 2-year follow-up split-mouth study. J Periodontol. 2003;74(5):590-596. doi:10.1902/ jop.2003.74.5.590

Moritz A, Gutknecht N, Doertbudak O, et al. Bacterial reduction in periodontal pockets through irradiation with a diode laser: A pilot study. J Clin Laser Med Surg. 1997;15:33–7. doi:10.1089/clm.1997.15.33

Pick RM, Colvard MD. Current status of lasers in soft tissue dental surgery. J Periodontol. 1993; Jul;64(7):589-602. doi:10.1902/jop.1993.64.7.589

Lin PP, Rosen S, Beck FM, Matsue M, Horton JE. A comparative effect of the Nd: YAG Laser with root planing on subgingival anaerobes in periodontal pockets. J Dent Res. 1992;71:299. doi:10.1902/jop.1999.70.11.1276




DOI: https://doi.org/10.22037/jlms.v10i1.18946