Clinical and biochemical effects of diode laser as an adjunct to nonsurgical treatment of chronic periodontitis: a randomized, controlled clinical trial

The efficacy of diode laser and subgingival air polishing with erythritol in treatment of periodontitis (clinical and microbiological study)

BACKGROUND

There is insufficient clinical and microbiological evidence to support the use of diode laser and air-polishing with erythritol as supplements to scaling and root planning(SRP). The aim of the current study is to evaluate the clinical and microbiologic efficacy of erythritol subgingival air polishing and diode laser in treatment of periodontitis.

METHODS

The study encompassed twenty-four individuals seeking periodontal therapy and diagnosed with stage I and stage II periodontitis. Eight patients simply underwent SRP. Eight more patients had SRP followed by erythritol subgingival air polishing, and eight patients had SRP followed by diode laser application. At baseline and six weeks, clinical periodontal parameters were measured, including Plaque Index (PI), Gingival Index (GI), periodontal Probing Depth (PPD), and Clinical Attachment Level (CAL). The bacterial count of Aggregatibacter actinomycetemcomitans(A.A), Porphyromonas gingivalis (P.G) was evaluated at different points of time.

RESULTS

The microbiological assessment revealed significant differences in the count of A.A. between the laser and erythritol groups immediately after treatment, indicating a potential impact on microbial levels. However, the microbial levels showed fluctuations over the subsequent weeks, without statistically significant differences. Plaque indices significantly decreased post-treatment in all groups, with no significant inter-group differences. Gingival indices decreased, and the laser group showed lower values than erythritol and control groups. PPD and CAL decreased significantly across all groups, with the laser group exhibiting the lowest values.

CONCLUSION

The supplementary use of diode laser and erythritol air polishing, alongside SRP, represents an expedited periodontal treatment modality. This approach leads to a reduction in bacteria and improvement in periodontal health.

TRIAL REGISTRATION

This clinical trial was registered on Clinical Trials.gov (Registration ID: NCT06209554) and released on 08/01/2024.

Change in clinical parameters after subgingival instrumentation for the treatment of periodontitis and timing of periodontal re-evaluation: A systematic review and meta-analysis

AIM

To evaluate the changes in periodontal parameters (reduction in probing pocket depth [PPD], gain in clinical attachment level [CAL] and reduction in full-mouth bleeding on probing [BoP]) after subgingival instrumentation of periodontal pockets at different time points in systemically healthy patients suffering from periodontitis.

MATERIALS AND METHODS

Four databases were searched for RCTs that carried out subgingival instrumentation in periodontal pockets and evaluated PPD at a minimum of two consecutive time points other than baseline. The analysis was conducted for both all pocket depths and stratified for initially shallow (4-5 mm) and deep (≥6 mm) pockets and data were extracted for various time points, 1-2, 3-4 and 5-6 months. Weighted mean effects (WMEs) were calculated with 95% confidence interval (CI) and predictive intervals were calculated.

RESULTS

Twenty-nine RCTs were identified, and all of them were included in the meta-analysis. The results showed that for both shallow and deep pockets there was a small though clinically meaningful change between 1- to 2-month and 3- to 4-month time points and between these and 5-6 months.

CONCLUSIONS

In systemically healthy patients, the greater part of reduction in PPD and gain in CAL occurs within the first 1-2 months after subgingival instrumentation. However, additional benefits in terms of pocket depth reduction occur beyond these early time points.

Diode laser as an adjunctive treatment for periodontitis: Arandomized controlled trial

OBJECTIVE

The aim of this randomized controlled trial was to assess clinical and patient reported outcomes of subgingival instrumentation (SI) with adjunctive use of diode laser (DL) versus SI alone in the treatment of periodontitis.

METHODS

Participants requiring non-surgical periodontal treatment were randomly allocated into two treatment groups: SI with DL or SI alone. Clinical parameters [full mouth bleeding and plaque scores (FMBS and FMPS), probing pocket depth and clinical attachment level] were recorded at baseline, three and 6 months post-treatment. Visual analogue scale was used to evaluate postoperative participants' perception of pain, swelling, bleeding, bruising and root sensitivity. The impact of periodontal treatment on quality of life was assessed using the General Oral Health Assessment Index (GOHAI) at 6 months.

RESULTS

A total of 22 participants with stage III/IV periodontitis completed the 6-month follow-up. SI with or without DL resulted in statistically significant reduction in FMBS, FMPS, PPDs, and percentage of PPDs of ≥5 mm at 3- and 6-month follow-up visits (p = 0.001 to <0.001). The participants in SI/DL group had a greater reduction in the percentage of deep PPDs (≥5 mm) compared to those receiving SI alone, but statistically significant differences between the two groups were not observed (16.40 ± 9.57 vs. 32.50 ± 38.76 at 3 months and 7.20 ± 6.86 vs. 19.50 ± 35.06 at 6 months). The difference in the mean total GOHAI scores was not statistically significant at 6 months with total GOHAI scores of 7.25 ± 2.45 and 5.40 ± 3.06 for SI and SI/DL groups, respectively.

CONCLUSION

Within the limitations of this study, the use of DL as an adjunct to SI in the treatment of stage III/IV periodontitis did not produce significant additional improvement in clinical parameters or patient reported outcomes in the 6-month observation period.

Periodontal Pocket Therapy Using a Class IV Dental Diode Laser in Dogs: A Retrospective Analysis

Class IV dental diode lasers have been introduced as a nonsurgical therapy for periodontal pockets in veterinary and human dentistry. This retrospective case series evaluates the use of Class IV dental diode laser therapy for abnormal periodontal pockets in a specialty veterinary dental practice. A hypothesis that the Class IV diode dental laser is a useful adjuvant modality in canine periodontal pocket therapy in the reduction of clinical pocket depth was made. This article discusses and demonstrates diode laser use in periodontal pocket therapy in a specialty veterinary dental practice and reviews the current literature. Inclusion in this study was limited to client-owned dogs with noted periodontal pocketing on any tooth type between 3 and 6 mm, which were treated with closed root planing (RP/C) and laser therapy who returned in 6 to 7 months for recheck of the pockets from the years 2017 to 2020. Twelve patients met the inclusion criteria. A total of 128 periodontal pockets were included in the study. Each periodontal pocket was a case receiving therapy. The mean periodontal pocket depth before the treatment is measured as 3.35 mm. The mean pocket depth of the periodontal pockets following treatment was 0.59 mm. The mean improvement in periodontal pocket depths after diode laser therapy when considering patient and tooth number using linear mixed-effects modeling was 2.63 mm (95% confidence interval [CI]: 1.81-3.46, P < .0001). No statistically significant results were observed for pocket type, as P values were greater than .05.

Assessment of clinical efficacy of 445 nm Diode laser as an adjunct to Kirkland flap surgery in the management of periodontitis - a split mouth randomized clinical trial

Aim of this study is to assess the clinical efficacy of 445 nm Diode laser as an adjunct to Kirkland flap surgery in management of periodontitis. Type of study is a Split mouth clinical trial in which a total of 13 patients were recruited based on specific inclusion and exclusion criteria. In each participant, random allocation of selected sites into test and control in contralateral quadrants was done. Clinical parameters such as probing depth and clinical attachment loss was measured in control and test sites using occlusal stents. Flap surgery was carried out 6 weeks after phase I therapy and the selected contralateral sites with a probing depth of > 5mm were subjected to surgical therapy. In a test quadrant, 445 nm diode laser with a power of 0.8 W, CW mode, 320 µm fiber, in non-contact mode was used as an adjunct to flap surgery. Primary outcome variable assessed was change in PPD between baseline, pre-operative, 1-, 3- and 6-months post-surgery. Secondary outcomes variables assessed were Clinical attachment loss at baseline, pre-operative, 1, 3 and 6 months, visual analog scale at days 3 and 7 and patient satisfaction index at day 7 post surgery. Surgery for the second site (Test/control) in the contralateral quadrants was performed 1 week after the first surgery. A higher reduction in probing depth and gain in CAL was observed in test site at 1, 3 and 6 months follow up amongst all the included participants. VAS score was lower at the test site as compared to the control sites. PSI scores were similar in both the sites. The adjunctive use of 445nm diode laser to surgical periodontal therapy contributed to improved short term clinical outcomes as assessed at the end of 6 months post- surgery. VAS score indicative of post -surgical discomfort were also lower for the laser treated sites. Hence adjunctive use of laser (445 nm wavelength) can be recommended for achieving more predictable clinical outcomes.

Effectiveness of Diode (810 nm) Laser in Periodontal Parameters and Reduction of Subgingival Bacterial Load in Periodontitis Patients

AIM

This split-mouth randomized trial (RCT) aimed to assess the effect of diode laser on the clinical parameters in patients with periodontitis, compare the results with scaling and root planing (SRP) alone, and assess the implications of diode laser (DL) on plaque bacteria.

MATERIALS AND METHODS

Seventeen periodontitis patients were randomly assigned into two equal groups based on the therapy delivered. Group I (control site) received just SRP at baseline, while group II (test site) received both SRP and DL irradiation. For both groups, the clinical periodontal parameters probing pocket depth (PPD), and clinical attachment level (CAL) were measured at baseline, 30 days, and 90 days. Microbiological amount was also measured at baseline, 30, and 90 days after periodontal treatment. The amounts of Aggregatibacter actinomycetemcomitans (A.a), Prevotella intermedia (Pr. intermedia), and Porphyromonas gingivalis (P. gingivalis) were determined using real-time PCR probing with specific bacterial primers.

RESULTS

In both groups, PPD and CAL showed statistically significant reductions at different time intervals (p < 0.05). No significant difference were observed in CAL values after 1 and 3 months in both test and control groups (p > 0.05). The mean values of the concentration of A.a, Pr. intermedia and P. gingivalis were lower in the case group as compared to the control group and the difference was statistically significant after 1 month (*p = 0.001).

CLINICAL SIGNIFICANCE

According to this study, non-invasive laser treatment has the potential to improve clinical outcomes by lowering the quantity of A.a, Pr. intermedia and P. gingivalis.

CONCLUSION

In both groups, a considerable decrease in the periodontal pathogens A.a, Pr. intermedia and P. gingivalis were discovered; however, the intergroup comparison was insignificant in relation to PD and CAL. The adjunctive treatment with diode laser showed better efficacy in ensuring a better periodontal treatment than SRP alone. How to cite this article: Abdullah LA, Hashim N, Rehman MM, et al. Effectiveness of Diode (810 nm) Laser in Periodontal Parameters and Reduction of Subgingival Bacterial Load in Periodontitis Patients. J Contemp Dent Pract 2023;24(12):1008-1015.

Mechanism and application of Lactobacillus in type 2 diabetes-associated periodontitis

Type 2 diabetes mellitus (T2DM) accelerates the progression of periodontitis through diverse pathways. Abnormal immune responses, excessive activation of inflammation, increased levels of advanced glycation end products, and oxidative stress have defined roles in the pathophysiological process of T2DM-associated periodontitis. Furthermore, in the periodontium of diabetic individuals, there are high levels of advanced glycation end-products and glucose. Meanwhile, progress in microbiomics has revealed that dysbacteriosis caused by T2DM also contributes to the progression of periodontitis. Lactobacillus, owing to its fine-tuning function in the local microbiota, has sparked tremendous interest in this field. Accumulating research on Lactobacillus has detailed its beneficial role in both diabetes and oral diseases. In this study, we summarize the newly discovered mechanisms underlying Lactobacillus-mediated improvement of T2DM-associated periodontitis and propose the application of Lactobacillus in the clinic.

Systemic inflammatory markers following adjunctive Nd:YAG (1064 nm) laser irradiation to step 2 of periodontal therapy: a 12-month, randomized, controlled trial

OBJECTIVES

The aim of this study was to investigate whether the use of adjunctive Nd:YAG (1064 nm) laser irradiation to full-mouth scaling and root planing (FM-SRP) may offer additional benefit in the systemic inflammatory status of the patient, as depicted in a variety of systemic biomarkers over FM-SRP alone, up to 12 months after treatment.

MATERIALS AND METHODS

A total of 60 otherwise healthy stage III/IV periodontal patients were equally distributed in 3 groups. The control group received FM-SRP. In laser A group, 1 week after FM-SRP, Nd:YAG laser irradiation was delivered in periodontal pockets with PD ≥ 4 mm using specific settings (3 W, 150 mJ, 20 Hz, 100 μs). In laser B group Nd:YAG laser irradiation was delivered twice, 1 week after FM-SRP and 1 week later with different settings compared to laser A (2 W, 200 mJ, 10 Hz, 100 μs).

RESULTS

A significant reduction (p = 0.038) of IL-1β serum levels at the 6-month time point was observed for laser A group. IL-6 was found statistically significantly increased (p = 0.011) in the control group at the 6-week time point, whereas no difference was reported for the laser-treated groups (laser A, laser B).

CONCLUSIONS

The adjunctive use of Nd:YAG laser irradiation, prevented from IL-6 increase after FM-SRP, 6 weeks after treatment. Similarly, Nd:YAG laser irradiation (3 W, 150 mJ, 20 Hz,100 μs) was associated with significantly lower IL-1β levels, 6 months post-operatively.

CLINICAL RELEVANCE

Additional Nd:YAG laser application to FM-SRP may provide a potential beneficial effect on systemic inflammation.

TRIAL REGISTRATION NUMBER

ISRCTN26692900.

REGISTRATION DATE

09/06/2022.

Impact of low-level laser therapy as an adjunct to non-surgical periodontal treatment on the levels of tissue plasminogen activator and plasminogen activator inhibitor 1 in Stage 3-4, Grade C periodontitis patients: a split-mouth, randomized control study

AIM

To investigate the effects of low-level laser therapy (LLLT) as an adjunct to non-surgical periodontal treatment (NSPT) on the plasminogen-activating system.

MATERIALS AND METHODS

Stage 3-4 Grade C periodontitis and age-gender-matched healthy individuals participated in the split-mouth study (ClinicalTrials.gov identifier, NCT05233501). The study groups were Periodontitis/NSPT (Sham); Periodontitis/NSPT + LLLT (LLLT); Healthy (Control). Following NSPT, LLLT was applied on Days 0, 2 and 7. Clinical parameters were recorded at baseline and on Day 30. Gingival crevicular fluid (GCF) was collected at baseline, on days 7, 14, and 30; tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) levels were measured with ELISA.

RESULTS

Clinical parameters, total GCF tPA (tPAt) and PAI-1 (PAI-1t) levels significantly reduced in LLLT and Sham groups (< 0.001). GCF tPAt levels in LLLT were significantly lower (< 0.05) than Sham on Day 7. GCF tPAt levels in periodontitis groups were significantly higher than the Control at baseline, on Days 7 and 14 (< 0.01). By Day 30, both groups decreased to control levels (> 0.05). GCF PAI-1t levels were significantly lower in LLLT than the Sham on day 30 (< 0.01), comparable to healthy controls (> 0.05).

CONCLUSION

Adjunctive LLLT modulates the plasminogen activating system in severe periodontitis by altering GCF tPA and PAI-1 levels.

CLINICAL RELEVANCE

LLLT as an adjunct to non-surgical periodontal treatment in patients with Stage 3-4 Grade C leads to reduced plasminogen activation.

Evaluation of the effectiveness of diode laser therapy in conjunction with nonsurgical treatment of peri-implantitis

PURPOSE

Peri-implantitis (PI) is an inflammatory condition associated with the destruction of bone tissue around a dental implant, and diode lasers can be used to treat this disease. In this study, we aimed to evaluate the effectiveness of a 940-nm diode laser for the nonsurgical treatment of PI.

METHODS

Twenty patients (8 women and 12 men) were enrolled in a split-mouth randomized controlled study. In the control group (CG), mechanical debridement with titanium curettes accompanied by airflow was performed around the implants. The test group (TG) was treated similarly, but with the use of a diode laser. Clinical measurements (plaque index, gingival index [GI], probing pocket depth [PPD], bleeding on probing [BOP], clinical attachment level, and interleukin-1β [IL-1β] in the peri-implant crevicular fluid) were evaluated and recorded at baseline and 3 months. IL-1β levels were determined using the enzyme-linked immunosorbent assay method.

RESULTS

The symptoms were alleviated in both groups at 3 months as assessed through clinical measurements. GI, BOP, and PPD were significantly lower in the TG than in the CG (P<0.05). The IL-1β level increased post-treatment in both groups, but this increase was only statistically significant (P<0.05) in the CG.

CONCLUSIONS

The diode laser enabled improvements in clinical parameters in the peri-implant tissue. However, it did not reduce IL-1β levels after treatment. Further studies about the use of diode lasers in the treatment of PI will be necessary to evaluate the effects of diode lasers in PI treatment.

Clinical outcomes of diode laser as an adjunct to nonsurgical periodontal therapy for residual periodontal pockets in mandibular second molars-a randomized controlled clinical trial

OBJECTIVES

The aim of this study was to evaluate the clinical outcomes of diode laser as an adjunct to nonsurgical periodontal therapy (NSPT) for residual periodontal pockets in mandibular second molars.

MATERIALS AND METHODS

Sixty-seven mandibular second molars (154 residual periodontal pockets) were recruited into the study and randomly assigned to the Laser + NSPT group and the NSPT group. The Laser + NSPT group underwent NSPT adjunct with diode laser radiation (wavelength: 810 nm, power: 1.5 W, 40 s maximum), while the NSPT group underwent nonsurgical periodontal therapy alone. Clinical parameters were measured at baseline (T0) and 4(T1), 12(T2), and 24(T3), weeks after treatment.

RESULTS

Periodontal pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP) in both groups showed significant improvements at the end of study compared to baseline. The reductions of PPD, CAL, and BOP in the Laser + NSPT group were significantly greater than NSPT group. At T3, the Laser + NSPT group had a mean PPD of 3.06 ± 0.86 mm, CAL of 2.58 ± 0.94 mm and BOP of 15.49%, while the NSPT group had a mean PPD of 4.46 ± 1.57 mm, CAL of 3.03 ± 1.25 mm and BOP of 64.29%.

CONCLUSIONS

The diode laser as an adjunct to nonsurgical periodontal therapy may contribute to clinical outcomes for residual periodontal pockets. However, the approach may cause reduction of keratinized tissue width.

TRIAL REGISTRATION NUMBER

This study was registered in the Chinese Clinical Trial Registry ChiCTR2200061194.

CLINICAL RELEVANCE

Diode laser as an adjunct to nonsurgical periodontal therapy may contribute to the clinical outcomes for residual periodontal pockets in mandibular second molars.

Effect of Low-Level Laser Therapy on Early Wound Healing and Levels of Inflammatory Mediators in Gingival Crevicular Fluid Following Open Flap Debridement

Introduction Low-level laser therapy (LLLT) has a beneficial effect on pain relief and wound healing. This study aims at a clinical evaluation of early wound healing and a biochemical evaluation of inflammatory mediators in gingival crevicular fluid (GCF) following LLLT with an open flap debridement (OFD) in periodontal therapy. Material and methods This randomized controlled trial included 40 chronic periodontitis patients with bilateral attachment loss, pocket depths of 5 mm affecting at least two quadrants, and radiographic evidence of horizontal bone loss. 120 control sites were randomly selected to receive OFD, and contralateral 120 test sites received bio-stimulation with a diode laser (890 nm) after OFD. The wound healing index was recorded at the 1st and 2nd weeks, and clinical parameters such as the plaque index, gingival index, pocket probing depth, clinical attachment level, and GCF inflammatory mediators were evaluated at baseline, 3, and 6 months. Results From the start of the study to 6 months later, there was a statistically significant drop in plaque index, gingival index, probing pocket depth, and gain clinical attachment levels in both groups. However, when the two groups were compared, there were no significant differences at any time intervals. GCF inflammatory mediators tumor necrosis factor (TNF) alpha and matrix metalloproteinases (MMP-8) decrease, and osteoprotegerin (OPG) levels increase in both the test group and control group from baseline to 3 months and 6 months. In intergroup comparisons, there was a statistically significant reduction in the test group as compared to the control group at 6 months. There was a decline in gingival crevicular fluid - interleukin-6 (GCF IL-6) levels from baseline to 3 months and 6 months in both the groups but when analysed statistically, the results were not significant on intergroup and intragroup comparison at any time interval. The Landry Wound Healing Index values in the 1st and 2nd weeks were showing statistically significant improved healing in the test group as compared to the control group. There was significantly better wound healing at sites where a diode laser was used. Conclusion LLLT increases early wound healing after periodontal surgical procedures.

Evaluation of structural and compositional changes on the root surface exposed to diode laser (810 nm): An In-vitro study

Background

The laser therapy has been used as an adjuvant for conventional periodontal disease as they exhibit a bactericidal effect on scaling and root planning by its thermal and photo disruptive effects on the pathogens. This study focuses on the structural and compositional changes induced on the root surfaces of teeth following diode laser (DL) application with increasing quantum of exposure time.

Objective

The objective of this study was to evaluate the structural and compositional changes on the root surface of extracted human permanent teeth after application of DLs (810 nm) with varying time interval.

Materials and Methods

Twenty samples of single-rooted periodontally compromised extracted teeth were utilized for this study. Root planning was done and the roughness caused by the instrumentation was measured using profilometric analysis. Then, the samples were divided into four groups, with DL application time: Group 1 - laser application for 15 s, Group 2 - laser application for 30 s, Group 3 - laser application for 45 s, and Group 4 - laser application for 60 s. A scanning electron microscope was used to examine the cemental surface and energy-dispersive X-ray analysis software assesses the compositional changes of the teeth in each group.

Results

This study reveals that on exposure of DL (810 nm) on the root surface when time of exposure increases, there were relative increases in surface irregularities and charring. There were significant changes in the chemical composition of the tooth surface.

Effects of diode and erbium lasers as an adjunct to scaling and root planing on clinical and immunological parameters in non-surgical periodontal treatment: a split-mouth randomized controlled clinical trial-"effects of lasers on immunological parameters"

This study evaluated the effects of diode and erbium lasers, as an adjunct to scaling and root planing (SRP), on clinical and immunological parameters in non-surgical periodontal therapy. In this split-mouth randomized controlled clinical trial, 17 participants with at least one periodontally involved tooth in each quadrant received oral hygiene instruction and full-mouth SRP. At baseline, probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and full-mouth plaque index (FMPI) were measured, and gingival crevicular fluid (GCF) sampling was performed. Next, one random quadrant in each participant received 940 nm diode laser (1 W, continuous-wave), and another quadrant received 2780 nm Er,Cr:YSGG laser (1.5 W, 30 Hz) irradiation. The GCF levels of interleukin (IL)-10 and matrix metalloproteinase (MMP)-13 were measured at baseline, and after 2 and 6 months using ELISA. The clinical parameters were also measured. Data were analyzed by repeated measures ANOVA. Significant clinical improvement was noted in all groups (P < 0.05). CAL in the control group was higher at 6 months than 2 months. The increase in IL-10 in erbium group was significantly greater than that in other groups (P < 0.001). The MMP-13 level was significantly lower in laser groups with greater reduction in erbium group (P < 0.001). Application of 940 nm diode and 2780 nm Er,Cr:YSGG lasers as an adjunct to SRP significantly decreased the GCF level of MMP-13, with no significant clinical advantage over SRP monotherapy. Application of 2780 nm Er,Cr:YSGG laser in addition to SRP increased the GCF level of IL-10.Trial registration numbers: IRCT20140318017053N11 and IRCT20140318017053N9.

Wound fluid sampling methods for proteomic studies: A scoping review

Understanding why some wounds are hard to heal is important for improving care and developing more effective treatments. The method of sample collection used is an integral step in the research process and thus may affect the results obtained. The primary objective of this study was to summarise and map the methods currently used to sample wound fluid for protein profiling and analysis. Eligible studies were those that used a sampling method to collect wound fluid from any human wound for analysis of proteins. A search for eligible studies was performed using MEDLINE, Embase and CINAHL Plus in May 2020. All references were screened for eligibility by one reviewer, followed by discussion and consensus with a second reviewer. Quantitative data were mapped and visualised using appropriate software and summarised via a narrative summary. After screening, 280 studies were included in this review. The most commonly used group of wound fluid collection methods were vacuum, drainage or use of other external devices, with surgical wounds being the most common sample source. Other frequently used collection methods were extraction from absorbent materials, collection beneath an occlusive dressing and direct collection of wound fluid. This scoping review highlights the variety of methods used for wound fluid collection. Many studies had small sample sizes and short sample collection periods; these weaknesses have hampered the discovery and validation of novel biomarkers. Future research should aim to assess the reproducibility and feasibility of sampling and analytical methods for use in larger longitudinal studies.

The rationale and potential for using Lactobacillus in the management of periodontitis

Periodontitis refers to a wide range of the inflammatory conditions of supporting dental structures. For some patients with periodontitis, antibacterial agents are needed as an adjuvant to mechanical debridement treatments and oral hygiene maintenance. However, the widespread use of broad-spectrum antibiotics for the prophylaxis and treatment of periodontal infections results in the emergence of resistant pathogens. Therefore, probiotics have become markedly interesting to researchers as a potentially safe alternative to periodontal treatment and maintenance. Probiotics have been used in medicine for decades and extensively applied to the treatment of inflammatory diseases through the modulation of microbial synergy and other mechanisms. A growing amount of evidence has shown that using Lactobacillus strains for oral cavity maintenance could improve periodontal health. In this study, we reviewed studies showing proof of the inhibitory effects of Lactobacillus species on periodontal inflammation. We also explored the rationale and potential for using Lactobacillus species in the management of periodontitis.

Clinical efficacy of melatonin as adjunctive therapy to non-surgical treatment of periodontitis: a systematic review and meta-analysis

OBJECTIVE

This study aimed to evaluate the effect of adjunctive melatonin supplementation on clinical outcomes after non-surgical periodontal treatment.

METHODS

PubMed, Embase, and Web of Science databases were systematically searched for randomised controlled trials (RCTs) of melatonin adjuvant therapy for periodontitis from inception until May 2021. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered on The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021250630). The risk of bias of included studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. The pooled effect estimates were calculated by a random-effects model, and results were expressed as weighted mean differences (WMD).

RESULTS

Seven RCTs comprising 412 participants were included in the meta-analysis. The pooled results showed that adjuvant use of melatonin for non-surgical periodontal treatment significantly improved the probing depth (PD) [WMD = - 1.18, 95% CI (- 1.75, - 0.62) I² = 85.7%], clinical attachment loss (CAL) [WMD = - 1.16, 95% CI (- 1.60, - 0.72) I² = 76.7%] and gingival index (WMD = - 0.29, 95%CI [- 0.48, - 0.11], I² = 63.6%) compared with non-surgical treatment alone. In addition, subgroup analysis showed that higher doses of melatonin (3-10 mg) significantly improved PD [WMD = - 1.32, 95%CI (- 2.31, - 0.15) I² = 93%] and CAL [WMD = - 1.30, 95%CI (- 1.80, - 0.81) I² = 73.7%] compared with lower doses of melatonin (< 3 mg).

CONCLUSIONS

We found that adjunctive melatonin supplementation can significantly improve the periodontal status after non-surgical treatment, suggesting that melatonin may be a new adjuvant therapy for periodontitis when non-surgical periodontal treatment alone cannot achieve the desired improvement.

Probing depth reduction of laser application in periodontal therapy: a network meta-analysis

The aim was to systematically evaluate the probing depth (PD) reduction of lasers in scaling and root planing (SRP) of chronic periodontitis by network meta-analysis (NMA). Randomized controlled clinical trials (RCTs) were searched through electronic-search and hand-search up to January 2020. Standard mean different (SMD) and 95% confidence interval (CI) were counted for PD reduction. The random-effects NMA were performed using mvmeta routine in STATA software (version 13). This NMA analysed seven periodontal treatments through 37 RCTs. No inconsistency was detected. Compared with mechanical SRP, significant differences were in favour of diode laser (DL) as adjunct at 3 months (SMD = 0.61; 95% CI range: 0.27-0.96) and Nd:YAG as adjunct (SMD = 0.29; 95% CI range: 0.03-0.55), Er,Cr:YSGG as monotherapy (SMD = 0.37; 95% CI range: 0.04-0.71) and Er,Cr:YSGG as adjunct (SMD = 0.53; 95% CI range: 0.23-0.84) at 6 months after treatment. Compared with Er:YAG as monotherapy, significant differences were in favour of DL as adjunct at 6 months (SMD = 0.51; 95% CI range: 0.07-0.95) after treatment. In terms of PD reduction at 3-month follow-up, the ranking result from best to worst was Nd:YAG as adjunct, DL as adjunct, Er:YAG as adjunct, Er,Cr:YSGG as monotherapy, Er:YAG as monotherapy and mechanical SRP. In terms of PD reduction at 6-month follow-up, the ranking result was DL as adjunct, Nd:YAG as adjunct, Er:YAG as adjunct, Er,Cr:YSGG as adjunct, Er:YAG as monotherapy, Er,Cr:YSGG as monotherapy and mechanical SRP. Laser-assisted periodontal treatment has better PD reduction.

The Effect of Periodontal Therapy on the Level of MMP-8 in Patients with Chronic Periodontitis

OBJECTIVE

 The complete removal of bacterial plaque and their endotoxins in deeper areas of periodontal pockets is often difficult to achieve with conventional methods such as periodontal pocket curettage. An alternative to these methods that recently gained popularity in periodontology is the diode laser, with its antibacterial effect, angiogenesis promotion as advantages.

MATERIALS AND METHODS

 This study included 100 patients diagnosed with chronic periodontitis, with periodontal pockets up to 6 mm, and who were divided into two groups: patients treated with basic therapy and diode laser application, and patients treated with basic therapy and with flap surgery. The clinical periodontal evaluation was done before the treatment and 6 months after the treatment. Evaluation of matrix metalloproteinase (MMP)-8 as an inflammatory indicator in gingival exudate was done with dipstick immunoassay test before the treatment and 6 months later.

RESULTS

 This study showed a more pronounced improvement of periodontal clinical parameters, as well as a decrease in MMP-8 values in gingival exudate in the laser-treated group compared with the surgically treated group.

CONCLUSION

 The results of this study are encouraging for the use of the diode laser as a noninvasive method in the treatment of periodontal pathologies.

Comparison of salivary calprotectin levels in periodontitis associated with diabetes mellitus after low-level laser therapy as an adjunct to scaling and root planing: A randomized clinical trial

Context and Aims:

Calprotectin is a myeloid protein, exerting pro-inflammatory effects on various cells and are shown to be elevated in inflammatory diseases. Periodontal therapy has been shown to decrease the levels of calprotectin in body fluids. Hence, the present study was aimed at assessing salivary calprotectin levels in periodontitis associated with diabetes mellitus after low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP).

Materials and Methods:

Sixty-four participants were divided into Groups A (periodontitis) and B (periodontitis associated with type 2 diabetes mellitus [T2DM]) based on probing depth of ≥5 mm, clinical attachment level (CAL) of >2 mm, and history of T2DM. Based on assigned treatments, the groups were subdivided into A1, A2, B1, and B2 where A1 and B1 were subjected to SRP alone and A2 and B2 received LLLT as an adjunct to SRP, respectively. The parameters assessed included probing pocket depth, CAL, bleeding on probing (BOP), plaque index (PI), and salivary calprotectin. All the values were subjected for comparison at baseline and 8 weeks.

Statistical Analysis Used:

Multiple group comparisons were done using analysis of variance; intragroup comparisons were made using t-test. The level of significance was assessed at P < 0.05 for all tests.

Results:

All parameters showed a significant difference within the groups from baseline to 8 weeks. Intergroup comparison of PI, BOP, and salivary calprotectin showed a significant difference (P < 0.05).

Conclusions:

Reduction in calprotectin levels was noticed with LLLT when used as an adjunct to SRP. Calprotectin may be used as a prognostic marker for periodontitis.

Mucosal Vaccination Against Periodontal Disease: Current Status and Opportunities

Approximately 9 out of 10 adults have some form of periodontal disease, an infection-induced inflammatory disease of the tooth-supporting tissues. The initial form, gingivitis, often remains asymptomatic, but this can evolve into periodontitis, which is typically associated with halitosis, oral pain or discomfort, and tooth loss. Furthermore, periodontitis may contribute to systemic disorders like cardiovascular disease and type 2 diabetes mellitus. Control options remain nonspecific, time-consuming, and costly; largely relying on the removal of dental plaque and calculus by mechanical debridement. However, while dental plaque bacteria trigger periodontal disease, it is the host-specific inflammatory response that acts as main driver of tissue destruction and disease progression. Therefore, periodontal disease control should aim to alter the host's inflammatory response as well as to reduce the bacterial triggers. Vaccines may provide a potent adjunct to mechanical debridement for periodontal disease prevention and treatment. However, the immunopathogenic complexity and polymicrobial aspect of PD appear to complicate the development of periodontal vaccines. Moreover, a successful periodontal vaccine should induce protective immunity in the oral cavity, which proves difficult with traditional vaccination methods. Recent advances in mucosal vaccination may bridge the gap in periodontal vaccine development. In this review, we offer a comprehensive overview of mucosal vaccination strategies to induce protective immunity in the oral cavity for periodontal disease control. Furthermore, we highlight the need for additional research with appropriate and clinically relevant animal models. Finally, we discuss several opportunities in periodontal vaccine development such as multivalency, vaccine formulations, and delivery systems.

Clinical Efficacy of the 940-nm Diode Laser in the Treatment of Recurrent Pockets in the Periodontal Maintenance Phase

Introduction: The basis of periodontal treatments is the mechanical removal of bacterial biofilm, which is often not sufficient. Therefore, laser therapy can be effective as an adjunct treatment. The aim of the present study was to evaluate the clinical efficacy of the 940-nm diode laser in the treatment of recurrent pockets of patients in the periodontal maintenance phase. Methods: The present clinical trial study was performed on 20 patients. Clinical indices, including bleeding index (BI), probing pocket depth (PPD), and clinical attachment level (CAL) of the studied teeth were recorded before the test. The different quadrants were randomly divided into two experimental (scaling and root planing (SRP)+Laser) and control groups (SRP alone). Both groups were matched in terms of plaque index (PI). Clinical indices were re-recorded using therapeutic methods 30 and 90 days after the treatment, and data analysis was carried out using the t test and LSD. Results: There were no significant differences in PI, PPD, CAL, and BI in both groups before the treatment (P>0.05). However, there were significant differences in PPD, CAL, and BI in the two groups one month after the treatment (P<0.05); it means that improvements were more significant in the experimental group than in the control group. Comparing experimental and control groups, we found that there were no significant differences in PPD and CAL indices three months after the treatment (P>0.05); however, there were significant improvements in the BI index in both groups (P<0.05), so that the improvement was better in the experimental group than the control group. Conclusion: Both SRP+Laser and SRP alone improved clinical indices in patients. In short-term follow-up, the effect of SRP+Laser treatment on BI, CAL, PPD was significantly superior to SRP treatment alone, but in long-term follow-up, SRP+laser was more effective than SRP alone in improving the BI index.

Effectiveness of an 810-nm Diode Laser in Addition to Non-surgical Periodontal Therapy in Patients With Chronic Periodontitis: A Randomized Single-Blind Clinical Trial

Introduction: This study evaluated the effectiveness of an 810-nm diode laser as an adjunct to scaling and root planning (SRP) in improving periodontal parameters in patients with chronic periodontitis. Methods: This randomized clinical trial consisted of 36 patients (16 females and 20 males) with chronic periodontitis and pocket depths of 4-6 mm. The quadrants were randomly divided into two sides; one side of each patient was selected as the laser group (SRP + laser) and the other side served as the control group (SRP alone). An 810-nm diode laser was applied in the laser side to remove the outer gingival epithelium (1.5 W, CW) as well as the inner epithelium of the periodontal pockets (1 W, CW). The clinical parameters including bleeding on probing (BOP), probing depth (PD), plaque index (PI), and clinical attachment level (CAL) were measured at baseline and 6 and 18 weeks after therapy. Results: In both groups, there was a significant improvement in BOP, PD, PI and CAL over the course of the experiment (P < 0.001). Significantly lower BOP was found in the SRP + laser group than the SRP alone group after 6 and 18 weeks of intervention (P < 0.05). The difference in other parameters was not significant between the two groups, neither at 6 nor at 18 weeks after the treatment (P > 0.05). Conclusion: Within the limitations of this study, the association of the diode laser with standard non-surgical periodontal therapy (SRP) provided minimal additional benefits for patients with moderate chronic periodontitis.

Comparison of the Effect of Er,Cr:YSGG Laser and Halita Mouthwash on Oral Malodor in Patients With Chronic Periodontitis: A Randomized Clinical Trial

Introduction: Periodontal disease and tongue coatings are among the major factors associated with oral malodor. The present study, comparatively evaluated the effects of the Er,Cr:YSGG laser and Halita mouthwash as adjunctive treatments to nonsurgical periodontal debridement on oral malodor reduction in chronic periodontitis patients. Methods: Sixty patients with stage II and III chronic periodontitis and bad breath. The patients were randomly divided into two groups (n=30). After conventional scaling and root planing, patients in group 1 underwent Er,Cr:YSGG laser (Waterlase; Biolase, San Clemente, CA, USA) irradiation of the internal surface of the pockets (1.5 W, 30 Hz, 20% A, 40% W) and the dorsum of the tongue (1 W, 30 Hz, 20% A, 40% W) immediately after SRP and on the third and seventh days. Group 2 patients were asked to use Halita mouthwash twice daily for one week. Baseline, 1 and 3-month post-treatment measurements of plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), bleeding on probing (BOP) and organoleptic assessment of Halitosis severity were performed. Results: Significant improvement in all parameters was noted in both groups after 1 and 3 months, compared with baseline (P < 0.05). The two groups had significant reductions which occurred in PPD, CAL and BOP levels and the organoleptic score in 1 and 3 months after the intervention (P < 0.05). Conclusion: Er,Cr:YSGG laser irradiation and Halita mouthwash as adjuncts to non-surgical periodontal therapy are both effective in the treatment of oral malodor and improvement of periodontal parameters.

Clinical effectiveness of adjunctive diode laser on scaling and root planing in the treatment of periodontitis: is there an optimal combination of usage mode and application regimen? A systematic review and meta-analysis

This review aims to evaluate the adjunctive clinical effectiveness of diode laser (DL) to scaling and root planing (SRP) in the treatment of periodontitis, and identify the optimal combination of usage mode and application regimen of DL. Eight electronic databases were searched up to January 2021. Probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI), and gingival index (GI) were assessed at short-term (4-6 weeks), 3-month, and 6-month follow-ups. Based on DL usage mode, studies were divided into three groups: inside, outside pocket, and combined modes. As for application regimen, studies in each group were further subdivided into single- and multiple-session subgroups. Thirty randomized controlled trials with 825 participants were included. For inside mode, single-session DL showed significant improvements for PPD (short-term, and 3-month, p < 0.05), CAL (short-term, and 3-month, p < 0.05), PI (3- and 6-month, p < 0.05), and GI (short-term, 3-month, and 6-month, p < 0.05). For outside mode, multiple-session DL showed notable improvements for most clinical outcomes (p < 0.05). The effect of combined mode was still uncertain. Adjunctive DL had additional clinical benefits in the treatment of periodontitis. One session laser treatment is suggested when DL is applied inside pocket in future clinical practice. Meanwhile, more than one session laser treatment presents better outcomes when DL is used outside pocket. PROSPERO: CRD42020156162.

Comparing the efficiency of Er,Cr:YSGG laser and diode laser for the treatment of generalized aggressive periodontitis

BACKGROUND

This study aims to determine the effects of Er,Cr:YSGG and diode laser treatments on IL-1β, IL-8, and TNF-α levels in patients with generalized aggressive periodontitis.

METHODS

Twenty-six generalized aggressive periodontitis patients were enrolled in the study. We performed three treatment models: "scaling and root planning (SRP-only)," "SRP + Er,Cr:YSGG laser," and "SRP + diode laser." Each experimental quadrant was randomly allocated to the control group or the test group. The IL-1β, IL-8, and TNF-α levels were analyzed with an enzyme-linked immune-sorbent assay.

RESULTS

When the baseline and post-treatment IL-1β, IL-8, and TNF-α levels were compared, the most significant difference was observed in the SRP + Er,Cr:YSGG group and the least difference was observed in the SRP-only group.

CONCLUSIONS

The use of Er,Cr:YSGG laser as an addition to the conventional mechanical periodontal treatment was found to be more successful than the diode laser + SRP use in aggressive periodontitis treatment.

Impact of Adjunctive Diode Laser Application to Non-Surgical Periodontal Therapy on Clinical, Microbiological and Immunological Outcomes in Management of Chronic Periodontitis: A Systematic Review of Human Randomized Controlled Clinical Trials

Background

Due to the limitations of scaling and root planing (SRP) in chronic periodontitis (CP) management, research has been focused on utilising additional therapies to enhance conventional treatment methods. The present systematic review is aimed to appraise the accessible scientific evidence of in vivo human studies to establish the effectiveness of adjunctive diode (λ 808- λ 980nm) laser treatment to SRP in CP.

Methodology

This systematic review was conducted following the PRISMA statement guidelines. The review protocol is registered in PROSPERO (CRD 42021227695). The search strategies were based on structured electronic and manual (with appropriate keywords) and were conducted to collect the applicable published data on RCTs studies (in vivo human), spanning over ten years between August 2010 and August 2020. The articles were selected to address the following research focus question: “Does diode laser (λ 808- λ 980nm) therapy have superior effects as an adjunct to SPR, compared to SRP alone, in terms of clinical or microbiological or immunological profiles in the management of CP?”

Results

Fifteen articles met the eligibility criteria and are included in this review. A wide range of discrepancies and inconsistencies were shown in the outcomes of the laser and SPR treatment modality, compared to SRP alone. The data on standardised study protocol, optimal laser parameters and outcome measurements were inconclusive, and a high risk of bias in the majority of the studies observed, which are crucial in establishing a homogenous and reproducible protocol.

Conclusion

In light of the confined evidence-based data and critical evaluation of this systematic review, the efficacy of adjunctive diode laser treatment ranging between 808 and 980nm to SRP remains debatable. The observational quality of the present systematic review was emphasised after scrutinising the available data, and an attempt to propose a laser protocol for future RCTs consideration was a great challenge due to an absence of clear and standardised recommendations in delivering a reliable laser protocol which can be replicable by future investigators. RCTs with robust methodology are warranted.

Clinical and biochemical effect of laser as an adjunct to non-surgical treatment of chronic periodontitis

Objectives

To evaluate the clinical and biochemical efficacy of laser therapy as an adjunct to non‐surgical treatment in chronic periodontitis.

Methods

A systematic search was performed through the PubMed, EMBASE, and Cochrane Library for eligible articles published as of May 2, 2020, supplemented by information search in the System for Information on Programme Literature in Europe and a manual literature search. Only randomized controlled trials (RCTs) used to compare the adjunctive use of laser and non‐surgical treatment alone with an observation period of at least 6 months were included.

Results

Sixteen RCTs with a total of 525 subjects were included. Meta‐analysis suggested that the additional use of laser to scaling and root planing (SRP) showed significant superiority over SRP alone among most of clinical parameters involved. Regarding the GCF, although volume in the laser group was lower at week 4 and 12, no significant difference was found regarding the cytokines level. Subgroup analysis revealed that the combined therapy produced no significant difference in PD, CAL and PI at most time points for studies in respect to smokers. No treatment‐related adverse events had been reported in the included studies.

Conclusions

Pooled analysis suggested that laser‐assisted non‐surgical treatment improved clinical outcome to SRP alone in the management of non‐smoking chronic periodontitis patients.

Adjunctive laser or antimicrobial photodynamic therapy to non-surgical mechanical instrumentation in patients with untreated periodontitis: A systematic review and meta-analysis

AIM

To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non-surgical mechanical instrumentation alone in untreated periodontitis patients.

MATERIALS AND METHODS

Two focused questions were addressed using the Population, Intervention, Comparison and Outcome criteria as follows: in patients with untreated periodontitis, (a) does laser application provide adjunctive effects on probing pocket depth (PPD) changes compared with non-surgical instrumentation alone? and (b) does application of aPDT provide adjunctive effects on PPD changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Results of the meta-analysis are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines.

RESULTS

Out of 1,202 records, 10 articles for adjunctive laser and 8 for adjunctive aPDT were included. With respect to PPD changes, 1 meta-analysis including 2 articles (total n = 42; split-mouth design) failed to identify a statistically significant difference (WMD = 0.35 mm; 95%CI: -0.04/0.73; p = .08) in favour of adjunctive aPDT (wavelength range 650-700 nm). In terms of adjunctive laser application, a high variability of clinical outcomes at 6 months was noted. Two articles included patient-reported outcomes and 10 reported on the presence/absence of harms/adverse effects.

CONCLUSIONS

Available evidence on adjunctive therapy with lasers and aPDT is limited by (a) the low number of controlled studies and (b) the heterogeneity of study designs. Patient-reported benefits remain to be demonstrated.

Effects of Low Level Laser Therapy (LLLT) on Serum Values of Interleukin 6 (IL-6) in Patients with Periodontitis and Type 2 Diabetes Mellitus (T2DM)

BACKGROUND

In patients with T2DM, the therapeutic effects of conservative treatment are quite limited, and there is a need for additional therapeutic procedures to achieve the desired satisfactory and solid effect. Low-level laser therapy (LLLT) has an anti-inflammatory effect, and is used to heal lesions. This mechanism is realized through inhibition of lipopolysaccharides (LPS), so it can be used in the treatment of periodontal disease in patients with diabetes.

OBJECTIVE

The aim of this study is to assess the effect of level laser therapy (LLLT) on serum IL-6 values in patients with periodontitis and T2DM.

METHODS

Patients at age between 35-60 years old, with chronic periodontitis (CH) where the clinical loss of attachment (CAL) was ≥4 mm therefore covering at least 50 % of affected teeth. In this study we included 80 patients, divided into two groups: 40 patients with type 2 diabetes mellitus (2TDM) treated with conservative periodontal treatment supplemented with laser therapy (LLLT), group A, and 40 patients with 2TDM, conservatively treated without LLLT. therapy i.e. group B. The laser light was applied to the gingiva in separate quadrants in 5 sessions for the next five days in a row. Blood samples were taken from all subjects at the first treatment, then in 6 weeks and 3 months after treatment, and interleukin 6 (IL-6) levels were measured. The blood samples in the test tubes remained for about 30 minutes and were then distributed in a biochemical laboratory, where they were centrifuged at 6,000 rpm for 10 minutes. The serum was separated from the test tube and transferred to the eppendorph. All serum samples were stored at -80 ° C until complete analysis and determination of IL-6, according to the standardized methodology.

RESULTS

In group A, on the first examination serum IL-6 levels varies in the interval 11.54 ± 1.11 pg / mL, after 6 weeks of therapy the values range between 11.26 ± 0.77 pg / mL, and after 3 months of therapy levels oscillate at intervals of 11.02 ± 0.67 pg / mL. In group B the findings are similar. At the first examination, the serum IL-6 values were 11.56 ± 0.81 pg / mL, after 6 weeks of therapy ranged from 11.59 ± 0.71 pg / mL, and after 3 months of therapy levels were recorded at intervals. 11.41 ± 0.78 pg /mL. The serum IL-6 value after 6 weeks of therapy in patients in group B for Z = -2.04 and p <0.05 (p = 0.04) was significantly higher than in patients in group A, while after 3 months of therapy in patients in group B for Z = -2.42 and p <0.05 (p = 0.02) is significantly higher than the value in patients in group A.

CONCLUSION

LLLT resulted in significantly reduced serum IL-6 values in patients with periodontitis and T2DM after 6 weeks and 3 months of therapy in which conservative treatment was supplemented with LLLT.

Comparative evaluation of improvement in periodontal and glycemic health status of type 2 diabetes mellitus patients after scaling and root planing with or without adjunctive use of diode laser

BACKGROUND

Periodontal treatment in diabetic patients reduces systemic inflammatory burden and hence should be closely coordinated with the patient's overall clinical diabetic management.

OBJECTIVE

To evaluate the effectiveness of diode laser (DL) (Biolase Epic^TM, 940 nm, Irvine, CA, USA) as an adjunct to scaling root and planing (SRP) on periodontal health and glycated hemoglobin (HbA1c) level of type 2 diabetes mellitus (T2DM) patients suffering from generalized chronic periodontitis (CP), currently, stage II or above/grade B or C periodontitis.

MATERIALS AND METHODOLOGY

After initial screening of 55 T2DM patients, a total of 44 T2DM-CP patients (between the age group of 30 and 65 years) were selected and randomly assigned into two groups. The groups were divided into control group (n=22), treated with scaling and root planing alone (SRP alone), and experimental group (n=22), treated with scaling and root planing along with laser therapy (SRP + DL). Laser irradiation was accomplished at perio pocket setting of 0.8 W (average) in a pulse interval of 1.0 ms and pulse length of 1.0 ms delivering 24 J of energy using a 300-μm fiber optic delivery system.

RESULTS

Thirty-seven out of 44 enrolled T2DM-CP patients completed the study. Both treatment modalities, i.e., SRP alone and SRP+DL resulted in mean significant (p < 0.001) improvement in periodontal health parameters (plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL)) and glycemic level (RBS, FBS, and HbA1c) in T2DM-CP patients after 6 months, and was higher in SRP+DL group in comparison to SRP alone. Among the periodontal health parameters, the mean PPD reduction and CAL gain were 51.78% and 48.26% in control as compared to 61.56% and 62.54% in experimental group respectively, whereas the mean significant reduction in HbA1c was 13.8% in SRP alone and 22.52% in SRP+DL group after 6 months (p < 0.05).

CONCLUSION

Periodontal treatment involving SRP+DL contributes to improved periodontal health parameters and HbA1c level in T2DM-CP patients.

Effect of adjunctive diode laser in the non-surgical periodontal treatment in patients with diabetes mellitus: a systematic review and meta-analysis

This study aimed to systematically review and analyze the present randomized clinical trials (RCTs) regarding the clinical efficacy of a diode laser (DL) adjuvant to scaling and root planning (SRP) in patients with chronic periodontitis (CP) who have diabetes mellitus (DM). Five databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trails, Web of Science, and Chinese BioMedical Literature Databases) were searched. A meta-analysis was implemented to evaluate periodontal parameters including probing depth (PD) and clinical attachment level (CAL) as primary outcomes. Hemoglobin A1c (HbA1c), plaque index (PI), and the gingival index (GI) were also observed as secondary outcomes. Independent scanning of 239 papers resulted in 9 RCTs. Moderate evidence demonstrated that the test groups showed significant benefits for PD reduction, CAL gain, and HbA1c reduction after 3 and 6 months. Significant differences in PI and GI reduction were not found except for GI reduction within 1 month. The collective evidence suggested that the DL with SRP had significant improvements in clinical results compared to SRP alone. Based on our results, the DL could be a recommended therapy for patients with CP who have DM.

Effectiveness of Photobiomodulation as an Adjunct to Nonsurgical Periodontal Therapy in the Management of Periodontitis- A Systematic Review of in vivo Human Studies

Photobiomodulation therapy (PBMT) has anti-inflammatory, analgesic and regenerative properties. This systematic review aimed to critically appraise the published data of in vivo human randomized clinical trials (RCTs), and present a comprehensive overview of the efficacy of PBMT, as an adjunct to the nonsurgical periodontal therapy (NSPT) in the management of periodontitis. The systematic review protocol is registered in the Prospective Register Of Systematic Reviews (PROSPERO) (www.crd.york.ac.uk/PROSPERO/; ref CRD 42020169108). With the help of the appropriate key words, structured electronic and manual search strategies were applied to gather the relevant published data on in vivo human RCTs based on this topic. Seventeen papers that met the eligibility criteria were included in this review and subjected to a qualitative assessment. Current evidence lacks adequate information regarding the photobiomodulation (PBM) dosimetry, which is fundamental in establishing a standardized and replicable protocol for future researches. Furthermore, substantial discrepancies in the study methodology and a high risk of bias, arising from the majority of the included papers, abet to the inferior quality of these studies. Ultimately, there is an urgent necessity to conduct further well-designed RCTs in order to determine the effectiveness of PBMT, if any, by taking into consideration the abovementioned confounding factors.

Nonsurgical periodontal therapy with/without 980 nm diode laser in patients after myocardial infarction: a randomized clinical trial

The purpose of this study was to evaluate the possible benefits (in terms of periodontal status improvement and periodontal bacteria count reduction) of using 980 nm diode laser in the treatment of periodontitis in patients after myocardial infarction. Thirty-six patients under 65 years of age (mean: 56.3 ± 7.9) with periodontitis, 6 weeks to 6 months after myocardial infarction, were recruited for the study. The control group (n = 18) received SRP (scaling, root planing and polishing) while the test group (n = 18) received SRP followed by laser therapy of the periodontal pockets with 980 nm diode laser, 1 W, continuous wave mode, 20 s per tooth side. Procedures were repeated twice at 5-7 day intervals. Microbiological and periodontal examination, including periodontal pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP) and plaque control record (PCR), were performed before treatment, 2 weeks and 3 months after treatment. The study was registered on ClinicalTrials.gov with Identifier: NCT04145557, 29.10.2019 "retrospectively registered". Additional use of laser resulted in a significant reduction in pockets with PPD ≥ 7 mm (p = 0.0151). The diode laser reduced total bacteria count (p = 0.0154) and delayed recolonisation during a 3-month observation period. A significant increase in the number of Capnocytophaga gingivalis was observed in the control group (p = 0.048). Additional use of the diode laser after SRP had no significant effect on BOP, CAL and PCR. Within the limitations of our study, we can conclude that 980 nm diode laser can be a useful tool in the treatment of periodontitis in patients after myocardial infarction.

Evaluation of the Effectiveness of the Use of the Diode Laser in the Reduction of the Volume of the Edematous Gingival Tissue after Causal Therapy

Aim: The aim of this study was to evaluate and compare two different techniques for the treatment of plaque-induced gingivitis, demonstrating whether the causal therapy supported by diode laser can allow a resolution of the edema caused by gingivitis in less time compared to the single traditional causal therapy. Materials and methods: Twenty-five patients between 20 and 60 years of age with a specific diagnosis of gingivitis were evaluated at the CLID-HSR oral hygiene department. Once the clinical parameters (bleeding index, plaque index, recession, and clinical attack level) were recorded, each of them was subjected to a professional oral hygiene session and instructed in correct home hygiene procedures. Through a split-mouth protocol for each individual patient, hemi-arches were treated by simple randomization to be treated with causal therapy supported by the action of the diode laser (experimental therapy) and which with traditional causal therapy (control therapy). A first intraoral scan was performed before therapy (T0), which was repeated 20 min after rinsing with CHX. The intraoral scans were repeated at a control 7 (T1) and 14 days (T2) after the session. For each intraoral scan, a volumetric value was calculated, proportional to the edema of the gingival tissues, using special digital software. The operator who carried out the volumetric measurements on the software was not aware of the therapy implemented on each half-arch. The operator who carried out the statistical analysis was not aware of the therapy applied to each group. The collected data were statistically compared in order to detect any differences between the volumetric variations between the two therapy groups and within the therapy groups over time. After evaluating the distribution of data by means of the Kolmogorov-Smirnov statistical test, the appropriate nonparametric tests were chosen to carry out the statistical comparisons. Results: Based on the analysis of the gingival-periodontal health parameters and the volumetric value of the treated areas, no statistically significant differences were detected between the areas treated with the adjuvant action of the diode laser compared to those treated with causal therapy alone. Conclusions: With the limitations of this study, in accordance with the statistical results obtained, diode laser therapy does not allow a faster resolution of gingival edema compared to traditional therapy; the two treatment techniques for plaque-induced gingivitis, therefore, have the same efficacy.

Do Lasers Have an Adjunctive Role in Initial Non-Surgical Periodontal Therapy? A Systematic Review

(1) Background: dental lasers have numerous applications for periodontal therapy which include surgical procedures of soft tissue and osseous structures, and non-surgical treatments such as pathogen reduction, removal of surface accretions, and photobiomodulation. The aim of this review was to evaluate the scientific literature to ascertain whether lasers have a beneficial role when used adjunctively in initial non-surgical periodontal therapy. (2) Methods: A PubMed search was performed specifically for randomized clinical trials where a dental laser was used adjunctively for initial periodontal therapy on human patients published from January 2010–April 2020. The first search identified 1294 eligible studies. After additional criteria and filters were applied, 20 manuscripts were included in this review. (3) Results: The chosen manuscripts reported on investigations into initial therapy for patients diagnosed with chronic periodontitis. After periodontal charting, conventional instrumentation such as hand and ultrasonic scaling was performed on all patients in the studies, and then a test group or groups of patients were treated adjunctively with a laser. That adjunctive laser group’s periodontal findings showed various degrees of improved health compared to the group treated with only conventional methods. (4) Conclusion: This systematic review found that 70% of the included studies reported significantly better outcomes in certain clinical parameters, but no improvement in others. The remaining 30% of the manuscripts reported no significant difference in any of the measurements. With consideration to correct parametry, lasers have an adjunctive role in initial non-surgical periodontal therapy.

Clinical and Biochemical Evaluation of the Effect of Diode Laser Treatment Compared to the Non-surgical and Surgical Treatment of Periodontal Diseases

Background:

Periodontal therapy consists of eliminating the inflammation, treating periodontal pockets, motivating the patient for oral hygiene, and, if necessary, for surgical treatment. Recently, the application of a diode laser is widely being investigated for periodontal disease treatment.

Objective:

The analysis and evaluation of the clinical and biochemical impact of diode laser periodontal treatment, compared to either surgical or non-surgical, therapy, was the aim of this study.

Methods:

The study involved 80 patients older than 18 with at least 20 teeth. Evaluation of periodontal parameters was done conveniently on a single-rooted tooth (incisive, canine, premolar) on six surfaces, before the start of periodontal therapy, and after three, and six months. The laser used in the study was a diode laser with a wavelength of 980 nm. Digital X-rays were taken for bone level evaluation before and after the treatment. The presence of a bone destruction mediator (Matrix metalloproteinase-8 - MMP-8) was evaluated by the dipstick immunoassay test. Biochemical analysis and radiographic measurements were evaluated at the baseline and six months after the treatment. The statistical analysis included χ2-test and one-way ANOVA.

Results:

The results of this study showed that diode laser treatment was more effective in reducing periodontal clinical parameters, lowering MMP-8 levels and reducing the bone loss, compared to the group treated with scaling and root planning, or with a surgical approach.

Conclusion:

Diode laser may be considered as an effective alternative for periodontal treatment, with benefits in clinical and biochemical parameters.

Clinical and microbiological evaluation of the synergistic effects of diode laser with nonsurgical periodontal therapy: A randomized clinical trial

Context:

Nonsurgical and surgical therapies along with local and systemic antibiotic regimens have been advocated in the treatment of periodontitis. Due to increasing risk of developing antibiotic resistance and inability of nonsurgical periodontal therapy to completely eradicate the pathogenic microorganisms, lasers have been used as an adjunct to conventional therapy.

Aim:

The aim of the present study is to evaluate the effectiveness of the use of diode lasers as adjunct to scaling and root planing (SRP) compared to SRP alone on various clinical and microbiologic parameters in chronic periodontitis patients.

Settings and Design:

Patients were taken from the department of periodontology and implantology, who were having chronic periodontitis.

Materials and Methods:

A total of forty patients participated in the study and they were divided into Group I – the test group (SRP + diode laser) and Group II – the control group (SRP alone). The following clinical parameters were assessed: oral hygiene index simplified; clinical attachment level (CAL); probing pocket depth (PPD); bleeding on probing (BOP) at baseline, 4 weeks, and 12 weeks after the treatment; and colony-forming units (CFUs) 1 week postoperatively.

Statistical Analysis Used:

The statistical analysis was performed using paired t-test, unpaired t-test, Wilcoxon signed-rank test, and Mann–Whitney test.

Results:

There was reduction in BOP, PPD, and gain in CAL from baseline to 3 months and also a reduction in CFU 1 week postoperatively.

Conclusion:

There was a significant improvement in clinical parameters in test group (SRP + laser) as compared to the control group (SRP alone).

Interleukin-1β is a potential therapeutic target for periodontitis: a narrative review

Interleukin(IL)-1β, a pro-inflammatory cytokine, was elevated and participates in periodontitis. Not only the link between IL-1β and periodontitis was proved by clinical evidence, but also the increased IL-1β triggers a series of inflammatory reactions and promotes bone resorption. Currently, IL-1β blockage has been therapeutic strategies for autoimmune and autoinflammatory diseases such as rheumatoid arthritis, cryopyrin-associated periodic syndromes, gout and type II diabetes mellitus. It is speculated that IL-1β be a potential therapeutic target for periodontitis. The review focuses on the production, mechanism, present treatments and future potential strategies for IL-1β in periodontitis.

Photonic Therapy in Periodontal Diseases an Overview with Appraisal of the Literature and Reasoned Treatment Recommendations

Recent reviews and meta-analyses of the literature over the past quarter-century have failed to provide enough evidence to prove or disprove the actual utility of photonic therapy in periodontitis, alone or adjunctive to conventional approaches. This apparent paradox has been explained by the many physical, molecular, biological, anatomical, and technical variables of photonic treatments, which can differ in light-emitting devices (laser or LED), wavelengths, irradiation power and modes, clinical objectives, follow-up times, disease grading, and assessment methods. This multi-faceted, controversial scenario has led practitioners to underestimate the actual potential of photonic therapy in periodontal diseases. In this critical appraisal of the literature, we have briefly summarized the main photonic therapies and instruments used in Periodontology, highlighting their main characteristics and limitations. Then, we have tried to identify and discuss the key methodological issues which can have an impact on the outcome of photonic therapies. Our main goal was to identify the best parameters, settings, and methodologies to perform effective periodontal photonic treatments and to extrapolate some recommendations for clinical use. Should these recommendations find a consensus among periodontologists and be adopted in future clinical studies, they will hopefully contribute to dissipate the present confusion and uncertainty on this complex matter.