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J Periodontal Res. 2021 Oct 05; doi: 10.1111/jre.12938. Epub 2021 Oct 05.

Adjunctive Er:YAG laser in non-surgical periodontal therapy of patients with inadequately controlled type 2 diabetes mellitus: A split-mouth randomized controlled study.

Journal of periodontal research

Chenchen Feng, Yi Ding, Liqin Tang, Yong Gui, Xiaoyun Shen, Linlin He, Xinyan Lu, Wai Keung Leung

Affiliations

  1. Department of Periodontology, Wuxi Stomatology Hospital, Wuxi, Jiangsu Province, China.
  2. State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Periodontology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
  3. Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.

PMID: 34610151 DOI: 10.1111/jre.12938

Abstract

BACKGROUND AND OBJECTIVE: Limited studies are available comparing the outcomes of non-surgical periodontal therapy (NSPT) with or without adjunctive Er:YAG laser (ERL) in patients with type 2 diabetes mellitus (T2DM). This study evaluated the effects of ERL adjunctive NSPT on single-rooted teeth of inadequately controlled T2DM patients with periodontitis.

METHODS: Twenty-two inadequately controlled T2DM participants with periodontitis were recruited. Adopting a double-blinded split-mouth design and under block randomization, we investigated the effects of ERL in calculus removal then degranulation mode, or a sham treatment, adjunct NSPT, which included two visits of full-mouth root surface debridement delivered within 4-10 days, to test or control single-rooted teeth (Wuxi Stomatology Hospital, trial 2017-016). We followed periodontal parameters (plaque %, bleeding on probing [BOP] %, probing pocket depth [PPD], probing attachment level [PAL]) and selected systemic parameters (fasting plasma glucose [FPG], glycosylated hemoglobin [HbA1c%], high sensitivity C-reactive protein) at baseline, one, three, and six months after periodontal treatment.

RESULTS: The study was completed as planned. Periodontal parameters, FPG and HbA1c% of the 22 participants appeared significantly improved at six months (p < 0.001). The 44 ERL treated, compared to 44 sham treated single-rooted teeth exhibited significant improvement in BOP, mean PPD, and mean PAL at various postoperative follow-up time points (effect size ≥0.44; p < 0.001). No adverse event was reported.

CONCLUSION: Periodontal treatment outcomes in the T2DM patients with inadequate glycemic control were better in the single-rooted teeth received ERL adjunct NSPT. Further studies are warranted to confirm the observations reported in this short-term clinical study.

© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Keywords: diabetes mellitus; lasers; periodontal debridement; periodontitis; solid-state; type 2

References

  1. Zheng Y , Ley SH , Hu FB . Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14(2):88-98. - PubMed
  2. Petersen PE , Ogawa H . The global burden of periodontal disease: towards integration with chronic disease prevention and control. Periodontol 2000. 2012;60(1):15-39. - PubMed
  3. Ogurtsova K , da Rocha Fernandes JD , Huang Y , et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40-50. - PubMed
  4. Löe H . Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993;16(1):329-334. - PubMed
  5. Preshaw PM , Alba AL , Herrera D , et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012;55(1):21-31. - PubMed
  6. Movva LR , Ho DKL , Corbet EF , Leung WK . Type-2 diabetes mellitus, metabolic control, serum inflammatory factors, lifestyle, and periodontal status. J Dent Sci. 2014;9(1):1-9. - PubMed
  7. Casanova L , Hughes FJ , Preshaw PM . Diabetes and periodontal disease: a two-way relationship. Br Dent J. 2014;217(8):433-437. - PubMed
  8. Wang L , Gao P , Zhang M , et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA. 2017;317(24):2515-2523. - PubMed
  9. Peters AL , Legorreta AP , Ossorio RC , Davidson MB . Quality of outpatient care provided to diabetic patients. A health maintenance organization experience. Diabetes Care. 1996;19(6):601-606. - PubMed
  10. Liebl A , Neiss A , Spannheimer A , Reitberger U , Wagner T , Görtz A . Costs of type 2 diabetes in Germany. Results of the CODE-2 study. Dtsch Med Wochenschr. 2001;126(20):585-589. - PubMed
  11. Grant RW , Buse JB , Meigs JB . Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change. Diabetes Care. 2005;28(2):337-442. - PubMed
  12. Demmer RT , Desvarieux M , Holtfreter B , et al. Periodontal status and A1C change: longitudinal results from the study of health in Pomerania (SHIP). Diabetes Care. 2010;33(5):1037-1043. - PubMed
  13. Tonetti MS , Jepsen S , Jin L , Otomo-Corgel J . Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action. J Clin Periodontol. 2017;44(5):456-462. - PubMed
  14. Seppälä B , Ainamo J . A site-by-site follow-up study on the effect of controlled versus poorly controlled insulin-dependent diabetes mellitus. J Clin Periodontol. 1994;21(3):161-165. - PubMed
  15. Taylor GW , Burt BA , Becker MP , et al. Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus. J Periodontol. 1996;67(Suppl 10S):1085-1093. - PubMed
  16. Tsai C , Hayes C , Taylor GW . Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol. 2002;30(3):182-192. - PubMed
  17. Chapple IL , Bouchard P , Cagetti MG , et al. Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017;44(Suppl 18):S39-S51. - PubMed
  18. Ng SK , Leung WK . A community study on the relationship between stress, coping, affective dispositions and periodontal attachment loss. Community Dent Oral Epidemiol. 2006;34(4):252-266. - PubMed
  19. Teeuw WJ , Gerdes VE , Loos BG . Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis. Diabetes Care. 2010;33(2):421-427. - PubMed
  20. Engebretson SP , Hyman LG , Michalowicz BS , et al. The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial. JAMA. 2013;310(23):2523-2532. - PubMed
  21. Miranda TS , Feres M , Perez-Chaparro PJ , et al. Metronidazole and amoxicillin as adjuncts to scaling and root planing for the treatment of type 2 diabetic subjects with periodontitis: 1-year outcomes of a randomized placebo-controlled clinical trial. J Clin Periodontol. 2014;41(9):890-899. - PubMed
  22. Pradeep AR , Rao NS , Bajaj P , Kumari M . Efficacy of subgingivally delivered simvastatin in the treatment of patients with type 2 diabetes and chronic periodontitis: a randomized double-masked controlled clinical trial. J Periodontol. 2013;84(1):24-31. - PubMed
  23. Al-Zahrani MS , Bamshmous SO , Alhassani AA , Al-Sherbini MM . Short-term effects of photodynamic therapy on periodontal status and glycemic control of patients with diabetes. J Periodontol. 2009;80(10):1568-1573. - PubMed
  24. Javed F , Al Amri MD , Al-Kheraif AA , et al. Efficacy of non-surgical periodontal therapy with adjunct Nd:YAG laser therapy in the treatment of periodontal inflammation among patients with and without type 2 diabetes mellitus: A short-term pilot study. J Photochem Photobiol B. 2015;149:230-234. - PubMed
  25. Koçak E , Sağlam M , Kayış SA , et al. 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):343-353. - PubMed
  26. Ishikawa I , Aoki A , Takasaki AA , Mizutani K , Sasaki KM , Izumi Y . Application of lasers in periodontics: true innovation or myth? Periodontol. 2000;2009(50):90-126. - PubMed
  27. Ishikawa I , Aoki A , Takasaki AA . Potential applications of Erbium:YAG laser in periodontics. J Periodontal Res. 2004;39(4):275-285. - PubMed
  28. Aoki A , Mizutani K , Schwarz F , et al. Periodontal and peri-implant wound healing following laser therapy. Periodontol 2000. 2015;68(1):217-269. - PubMed
  29. Schwarz F , Aoki A , Becker J , Sculean A . Laser application in non-surgical periodontal therapy: a systematic review. J Clin Periodontol. 2008;35(8 Suppl):29-44. - PubMed
  30. Abduljabbar T , Javed F , Shah A , Samer MS , Vohra F , Akram Z . Role of lasers as an adjunct to scaling and root planing in patients with type 2 diabetes mellitus: a systematic review. Lasers Med Sci. 2017;32(2):449-459. - PubMed
  31. Moher D , Hopewell S , Schulz KF , et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869. - PubMed
  32. Feng C , Shen X , Lu X , Gui Y . The effects of Nd:YAG laser in the treatment of periodontitis for the patients with type 2 diabetes mellitus: a self-controlled study. Chin J Conserv Dent. 2018;28(11):659-662. - PubMed
  33. Faul F , Erdfelder E , Lang AG , Buchner A . G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-191. - PubMed
  34. Eke PI , Page RC , Wei L , Thornton-Evans G , Genco RJ . Update of the case definitions for population-based surveillance of periodontitis. J Periodontol. 2012;83(12):1449-1454. - PubMed
  35. Miller SC . Textbook of Periodontia (Oral Medicine), 3rd ed. Philadelphia: Blakiston; 1950:125. - PubMed
  36. Efird J . Blocked randomization with randomly selected block sizes. Int J Environ Res Public Health. 2011;8(1):15-20. - PubMed
  37. Schwarz F , Sculean A , Georg T , Reich E . Periodontal treatment with an Er: YAG laser compared to scaling and root planing. A controlled clinical study. J Periodontol. 2001;72(3):361-367. - PubMed
  38. Folwaczny M , Thiele L , Mehl A , Hickel R . The effect of working tip angulation on root substance removal using Er:YAG laser radiation: an in vitro study. J Clin Periodontol. 2001;28(3):220-226. - PubMed
  39. Lesaffre E , Garcia Zattera MJ , Redmond C , Huber H , Needleman I . Reported methodological quality of split-mouth studies. J Clin Periodontol. 2007;34(9):756-761. - PubMed
  40. Lesaffre E , Philstrom B , Needleman I , Worthington H . The design and analysis of split-mouth studies: what statisticians and clinicians should know. Stat Med. 2009;28(28):3470-3482. - PubMed
  41. Tonetti MS , Greenwell H , Kornman KS . Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018;89(Suppl 1):S159-S172. - PubMed
  42. Khader YS , Dauod AS , El-Qaderi SS , Alkafajei A , Batayha WQ . Periodontal status of diabetics compared with nondiabetics: a meta-analysis. J Diabetes Complications. 2006;20(1):59-68. - PubMed
  43. Leung WK , Siu SC , Chu FC , et al. Oral health status of low-income, middle-aged to elderly Hong Kong Chinese with type 2 diabetes mellitus. Oral Health Prev Dent. 2008;6(2):105-118. - PubMed
  44. Yang Y-Z , Sun Z , Hu C-Z , et al. Therapeutic effect of non-surgical treatment of chronic periodontitis in diabetic Chinese. J Shanghai Second Med Univ. 2004;16(1):22-26. - PubMed
  45. Kocher T , König J , Borgnakke WS , Pink C , Meisel P . Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge. Periodontol 2000. 2018;78(1):59-97. - PubMed
  46. Mealey BL , Rose LF . Diabetes mellitus and inflammatory periodontal diseases. Curr Opin Endocrinol Diabetes Obes. 2008;15(2):135-141. - PubMed
  47. Simpson TC , Needleman I , Wild SH , Moles DR , Mills EJ . Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database Syst Rev. 2010(5):Cd004714. - PubMed
  48. Lim LP , Tay FB , Sum CF , Thai AC . Relationship between markers of metabolic control and inflammation on severity of periodontal disease in patients with diabetes mellitus. J Clin Periodontol. 2007;34(2):118-123. - PubMed
  49. Westfelt E , Rylander H , Blohmé G , Jonasson P , Lindhe J . The effect of periodontal therapy in diabetics. Results after 5 years. J Clin Periodontol. 1996;23(2):92-100. - PubMed
  50. Grossi SG , Skrepcinski FB , DeCaro T , et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J Periodontol. 1997;68(8):713-719. - PubMed
  51. Janket SJ , Wightman A , Baird AE , Van Dyke TE , Jones JA . Does periodontal treatment improve glycemic control in diabetic patients? A meta-analysis of intervention studies. J Dent Res. 2005;84(12):1154-1159. - PubMed
  52. Darré L , Vergnes JN , Gourdy P , Sixou M . Efficacy of periodontal treatment on glycaemic control in diabetic patients: A meta-analysis of interventional studies. Diabetes Metab. 2008;34(5):497-506. - PubMed
  53. Watts T . Periodontal treatment and glycemic control in diabetic patients: the problem of a possible Hawthorne effect. J Dent Res. 2006;85(4):294-295. - PubMed
  54. Friedlander AH . Effect of periodontal treatment on glycemic control of diabetic patients: comment to Teeuw, Gerdes, and Loos. Diabetes Care. 2010;33(7):e101. - PubMed
  55. Ishikawa I , Aoki A , Takasaki AA . Clinical application of erbium:YAG laser in periodontology. J Int Acad Periodontol. 2008;10(1):22-30. - PubMed
  56. Sumra N , Kulshrestha R , Umale V , Chandurkar K . Lasers in non-surgical periodontal treatment - a review. J Cosmet Laser Ther. 2019;21(5):255-261. - PubMed
  57. Zhao Y , Yin Y , Tao L , Nie P , Tang Y , Zhu M . Er:YAG laser versus scaling and root planing as alternative or adjuvant for chronic periodontitis treatment: a systematic review. J Clin Periodontol. 2014;41(11):1069-1079. - PubMed
  58. Chambrone L , Ramos UD , Reynolds MA . Infrared lasers for the treatment of moderate to severe periodontitis: An American Academy of Periodontology best evidence review. J Periodontol. 2018;89(7):743-765. - PubMed
  59. Ando Y , Aoki A , Watanabe H , Ishikawa I . Bactericidal effect of erbium YAG laser on periodontopathic bacteria. Lasers Surg Med. 1996;19(2):190-200. - PubMed
  60. Lopes BM , Theodoro LH , Melo RF , Thompson GM , Marcantonio RA . Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with erbium:YAG laser and scaling and root planing. J Periodontol. 2010;81(5):682-691. - PubMed
  61. Ogita M , Tsuchida S , Aoki A , et al. Increased cell proliferation and differential protein expression induced by low-level Er:YAG laser irradiation in human gingival fibroblasts: proteomic analysis. Lasers Med Sci. 2015;30(7):1855-1866. - PubMed
  62. Capon A , Mordon S . Can thermal lasers promote skin wound healing? Am J Clin Dermatol. 2003;4(1):1-12. - PubMed
  63. Pozos-Guillén A , Chavarría-Bolaños D , Garrocho-Rangel A . Split-mouth design in Paediatric Dentistry clinical trials. Eur J Paediatr Dent. 2017;18(1):61-65. - PubMed
  64. Davies MJ , D’Alessio DA , Fradkin J , et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American diabetes association (ADA) and the European association for the study of diabetes (EASD). Diabetes Care. 2018;41(12):2669-2701 - PubMed
  65. Klokkevold PR , Mealey BL , Otomo-Corgel J . Periodontal treatment of medically compromised patients. In: Newman MG , Takei HH , Klokkevold PR , Carranza FA , eds. Newman and Carranza's clinical periodontology, 13th Edn, Chapter 39. St. Louis, Missouri; 2018:442-456.e7. - PubMed
  66. Teshome A , Yitayeh A . The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients: systematic review and meta-analysis. BMC Oral Health. 2016;30;17(1):31. - PubMed
  67. Cobb CM . Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing. J Clin Periodontol. 2002;29(Suppl 2):6-16. - PubMed
  68. Ma RC , Chan JC . Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci. 2013;1281(1):64-91. - PubMed
  69. Vaag A , Lund SS . Non-obese patients with type 2 diabetes and prediabetic subjects: distinct phenotypes requiring special diabetes treatment and (or) prevention? Appl Physiol Nutr Metab. 2007;32(5):912-920. - PubMed
  70. Pradhan AD , Manson JE , Rifai N , Buring JE , Ridker PM . C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA. 2001;286(3):327-334. - PubMed
  71. Wang X , Bao W , Liu J , et al. Inflammatory markers and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2013;36(1):166-175. - PubMed
  72. Pradeep AR , Manjunath RG , Kathariya R . Progressive periodontal disease has a simultaneous incremental elevation of gingival crevicular fluid and serum CRP levels. J Investig Clin Dent. 2010;1(2):133-138. - PubMed
  73. Seo YH , Shin HY . Relationship between hs-CRP and HbA1c in diabetes mellitus patients: 2015-2017 Korean National Health and Nutrition Examination Survey. Chonnam Med J. 2021;57(1):62-67. - PubMed
  74. Correa FO , Gonçalves D , Figueredo CM , Bastos AS , Gustafsson A , Orrico SR . Effect of periodontal treatment on metabolic control, systemic inflammation and cytokines in patients with type 2 diabetes. J Clin Periodontol. 2010;37(1):53-58. - PubMed
  75. Preshaw PM , Taylor JJ , Jaedicke KM , et al. Treatment of periodontitis reduces systemic inflammation in type 2 diabetes. J Clin Periodontol. 2020;47(6):737-746. - PubMed
  76. Madianos PN , Koromantzos PA . An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes. J Clin Periodontol. 2018;45:188-195. - PubMed
  77. Zhou X , Lin M , Zhang D , Song Y , Wang Z . Efficacy of Er:YAG laser on periodontitis as an adjunctive non-surgical treatment: A split-mouth randomized controlled study. J Clin Periodontol. 2019;46(5):539-547. - PubMed
  78. Greene D , Egbert BM , Utley DS , Koch RJ . In vivo model of histologic changes after treatment with the superpulsed CO2 laser, Erbium: YAG laser, and blended lasers: a 4- to 6-months prospective histologic and clinical study. Lasers Surg Med. 2000;27(4):362-372. - PubMed
  79. Serhan CN . Treating inflammation and infection in the 21st century: new hints from decoding resolution mediators and mechanisms. FASEB J. 2017;31(4):1273-1288. - PubMed
  80. Pretzl B , Kaltschmitt J , Kim TS , Reitmeir P , Eickholz P . Tooth loss after active periodontal therapy. 2: tooth-related factors. J Clin Periodontol. 2008;35(2):175-182. - PubMed
  81. Listl S , Frühauf N , Dannewitz B , et al. Cost-effectiveness of non-surgical peri-implantitis treatments. J Clin Periodontol. 2015;42(5):470-477. - PubMed
  82. Lin Z , Strauss FJ , Lang NP , Sculean A , Salvi GE , Stähli A . Efficacy of laser monotherapy or non-surgical mechanical instrumentation in the management of untreated periodontitis patients. A systematic review and meta-analysis. Clin Oral Investig. 2021;25(2):375-391. - PubMed
  83. Goo CL , Goh V . Beyond osseointegration: dealing with late dental implant complications. J Oral Implantol. 2020;46(6):602-611. - PubMed

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