Evaluation of long‐term effects of diode laser application in periodontal treatment of poorly controlled type 2 diabetic patients with chronic periodontitis
Abstract:Purpose: This study aimed to investigate the effects of diode laser (DL) in addition to non-surgical periodontal treatment on periodontal parameters, systemic inflammatory response and serum haemoglobin A 1c (HbA 1c ) level in patients with poorly controlled type 2 diabetes mellitus (T2DM) and chronic periodontitis.
Methods:Thirty-seven patients with poorly controlled T2DM and chronic periodontitis completed this study. The patients were divided into two groups. The individuals in the control group received pl… Show more
“…An extensive diversity in the country of origin was noted amongst the included papers ( Table 1 ). The distribution of the studies was as follows: three in India, 42 , 53 , 56 two in Brazil, 43 , 44 five in Turkey 45 , 46 , 49–51 and one study noted in each of the following countries: Italy, 52 Iraq, 47 USA, 48 Croatia 54 and Iran. 55…”
Section: Resultsmentioning
confidence: 99%
“…The range of the participant number were as follows: from 11 to 20 in two studies, 45 , 47 from 21 to 50 in eleven studies 42–44 , 46 , 48 , 49 , 51 , 53–56 and from 51 to 60 participants in two studies 50 , 52 ( Table 1 ), whereas the distribution of the subjects’ number according to gender is illustrated in Figure 2 for only 11 of the 15 studies, whereas four studies failed to document the gender of their participants. 45 , 47 , 52 , 56 Figure 2 Illustrates the percentage of the gender distribution according to the number of the recruited subjects.…”
Section: Resultsmentioning
confidence: 99%
“…Eight of the 15 studies conducted a split-mouth study design 43–45 , 47 , 48 , 52 , 54 , 55 (53.33%), whereas the remaining seven studies conducted a parallel group study design (46.67%), 42 , 46 , 49–51 , 53 , 56 in which 60% published in a peer-reviewed journal and 26.66% failed to report ethical approval ( Table 1 ).…”
Section: Resultsmentioning
confidence: 99%
“…Four of the 15 studies included subjects with well-controlled NIDDM in their eligibility criteria (26.66%), 42 , 46 , 47 , 50 whereas one study included systematic diseases without specifying their nature, but excluded bleeding disorders in its eligibility criteria (6.6%). 55 Therefore, a total of 33% of the included studies in this systematic review represents subjects with systematic diseases, which might influence the outcomes.…”
Section: Resultsmentioning
confidence: 99%
“…Three studies used 808nm, 42–44 whereas two employed λ 810 nm. 45 , 46 Ten of the 15 studies utilised various wavelengths ranging from λ 940nm- λ 980nm, in which six studies used 940nm, 47–52 one study employed λ 970 ±15nm, 53 and three studies utilised 980nm 54–56 ( Table 2 ) ( Figure 3 ).…”
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.
“…An extensive diversity in the country of origin was noted amongst the included papers ( Table 1 ). The distribution of the studies was as follows: three in India, 42 , 53 , 56 two in Brazil, 43 , 44 five in Turkey 45 , 46 , 49–51 and one study noted in each of the following countries: Italy, 52 Iraq, 47 USA, 48 Croatia 54 and Iran. 55…”
Section: Resultsmentioning
confidence: 99%
“…The range of the participant number were as follows: from 11 to 20 in two studies, 45 , 47 from 21 to 50 in eleven studies 42–44 , 46 , 48 , 49 , 51 , 53–56 and from 51 to 60 participants in two studies 50 , 52 ( Table 1 ), whereas the distribution of the subjects’ number according to gender is illustrated in Figure 2 for only 11 of the 15 studies, whereas four studies failed to document the gender of their participants. 45 , 47 , 52 , 56 Figure 2 Illustrates the percentage of the gender distribution according to the number of the recruited subjects.…”
Section: Resultsmentioning
confidence: 99%
“…Eight of the 15 studies conducted a split-mouth study design 43–45 , 47 , 48 , 52 , 54 , 55 (53.33%), whereas the remaining seven studies conducted a parallel group study design (46.67%), 42 , 46 , 49–51 , 53 , 56 in which 60% published in a peer-reviewed journal and 26.66% failed to report ethical approval ( Table 1 ).…”
Section: Resultsmentioning
confidence: 99%
“…Four of the 15 studies included subjects with well-controlled NIDDM in their eligibility criteria (26.66%), 42 , 46 , 47 , 50 whereas one study included systematic diseases without specifying their nature, but excluded bleeding disorders in its eligibility criteria (6.6%). 55 Therefore, a total of 33% of the included studies in this systematic review represents subjects with systematic diseases, which might influence the outcomes.…”
Section: Resultsmentioning
confidence: 99%
“…Three studies used 808nm, 42–44 whereas two employed λ 810 nm. 45 , 46 Ten of the 15 studies utilised various wavelengths ranging from λ 940nm- λ 980nm, in which six studies used 940nm, 47–52 one study employed λ 970 ±15nm, 53 and three studies utilised 980nm 54–56 ( Table 2 ) ( Figure 3 ).…”
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.
Objectives
Periodontal disease and diabetes have an extensively investigated bidirectional correlation. Non-surgical periodontal treatment (NSPT) was proven to contribute to glycemic control. Moreover, it may benefit from the association of adjunctive therapies. The aim of the present systematic review is to assess the clinical efficacy of NSPT in association with laser (LT) or photodynamic therapy (PDT) in controlled or uncontrolled diabetic patients, and to grade the level of evidence.
Materials and methods
Randomized controlled clinical trials with at least 3-month follow-up were searched in MEDLINE via OVID, EMBASE, and Cochrane Central, screened for inclusion, and grouped based on the performed treatments, follow-up time, type of diabetes, and level of glycemic control.
Results
Eleven RCTs with 504 total subjects were included. The adjunct of PDT showed a statistically significant 6-month difference in PD changes (with low certainty of evidence), but not in CAL changes, while a significant difference in 3-month PD and CAL changes was found with the adjunct of LT (low certainty of evidence). Patients treated with PDT registered a higher decrease in HbA1c levels at 3 months, but no significant difference was noted at 6 months; LT also led to better HbA1c changes at 3 months with a moderate certainty of evidence.
Conclusion
Despite the promising short-term HbA1c decrease, the results should be interpreted with caution due to the small effect sizes and the statistical heterogeneity, and further evidence from well-designed RCTs is needed to support the routine use of PDT or LT in adjunct to NSPT.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
