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wileyonlinelibrary.com/journal/idh © 2019 John Wiley & Sons A/S. Int J Dent Hygiene. 2019;17:292–299. Published by John Wiley & Sons LtdReceived: 15 August 2018
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Revised: 14 January 2019|
Accepted: 24 January 2019 DOI: 10.1111/idh.12384O R I G I N A L A R T I C L E
Evaluation of long‐term effects of diode laser application in
periodontal treatment of poorly controlled type 2 diabetic
patients with chronic periodontitis
Seydanur Dengizek Eltas
1| Mihtikar Gursel
2| Abubekir Eltas
3|
Nilgun Ozlem Alptekin
4| Tamer Ataoglu
21Department of Mouth and Dental
Health, Uskudar University, İstanbul, Turkey
2Department of Periodontology, Faculty of
Dentistry, Selcuk University, Konya, Turkey
3Department of Periodontology, Faculty
of Dentistry, University of Health Science, Istanbul, Turkey
4Department of Periodontology, Faculty
of Dentistry, Baskent University, Ankara, Turkey
Correspondence
Seydanur Dengizek Eltas, Department of Mouth and Dental Health, Uskudar University, İstanbul, Turkey. Email: seydanur.eltas@uskudar.edu.tr Funding information
This work was supported by the Scientific Research Project Fund of Inonu University (2013/202).
Abstract
Purpose: This study aimed to investigate the effects of diode laser (DL) in addition to non‐surgical periodontal treatment on periodontal parameters, systemic inflamma‐ tory response and serum haemoglobin A1c (HbA1c) level in patients with poorly con‐ trolled type 2 diabetes mellitus (T2DM) and chronic periodontitis.
Methods: Thirty‐seven patients with poorly controlled T2DM and chronic periodon‐ titis completed this study. The patients were divided into two groups. The individuals in the control group received placebo laser treatment in addition to scaling and root planing (SRP). The individuals in the study group received DL (1 watt) in addition to SRP. Clinical index measurements were performed before treatment (T0), 3 months after treatment (T1) and 6 months after treatment (T2). Plaque index, gingival index, bleeding on probing, clinical attachment level and probing depth were measured to determine periodontal status. HbA1c and C‐reactive protein (CRP) levels were also analysed using blood samples.
Results: In both groups, clinical and laboratory parameters were significantly im‐ proved at T1 and T2 compared to baseline (P < 0.05). Gingival index, bleeding on probing and probing depth were more significantly reduced after treatment in the SRP+DL group than in the SRP group (P < 0.05). The serum CRP and HbA1c levels were similar between the groups (P > 0.05).
Conclusion: The use of DL in addition to SRP in periodontal treatment of T2DM indi‐ viduals makes positive contribution to the reduction of local inflammation and to periodontal healing. On the other hand, it has no beneficial effects on systemic in‐ flammatory response and glycaemic control.
K E Y W O R D S
chronic periodontitis, C‐reactive protein, diabetes mellitus, glycated haemoglobin A, laser therapy
1 | INTRODUCTION
There is a two‐way relationship between diabetes mellitus (DM) and periodontal diseases.1 The first of these is that DM is a risk factor for
periodontal diseases, which is based on very old scientific evidence.2
Other aspect of the relationship between DM and periodontal diseases is the effects of periodontal diseases on metabolic control of DM, which is based on new evidence and about which there is less information.3
Therefore, it has been reported in some studies in the literature that non‐improvement of chronic inflammation caused by periodon‐ tal diseases affects beta‐cell functions, insulin resistance and the development of type 2 diabetes mellitus (T2DM) as well as the con‐ trol and complications of DM.4,5 Recent evidence has supported that
there is an independent relationship between periodontal inflamma‐ tion, glycaemic status and complications of DM (macro albuminuria, end‐stage renal disease, etc).6
Lasers are one of the most preferred new techniques for peri‐ odontal treatment due to excellent tissue ablation, strong bacte‐ ricidal effects and detoxification properties.7,8 Another important
advantage of laser use in periodontal treatment is that it allows ac‐ cessibility to areas that cannot be reached by traditional mechanical methods.9‐11 When diode laser (DL) has been used to decontaminate
the periodontal pockets and to reduce bacterial burden, it has been shown to improve clinical periodontal parameters and to reduce the number of periodontopathogenic bacteria.11 In the literature, there
is only one study evaluating the effects of DL, which has been ap‐ plied in contact mode in addition to scaling and root planing (SRP). This study reported SRP+DL reduced haemoglobin A1c (HbA1c) lev‐ els more significantly compared to SRP in T2DM patients.12
C‐reactive protein (CRP) is an acute phase protein that is highly sensitive and non‐specific for inflammation.13 Serum CRP levels are
associated with cardiovascular diseases, smoking, obesity, DM and periodontal diseases.14,15 High levels of inflammatory markers such
as CRP are an important risk indicator for the development and pro‐ gression of T2DM.16 Recent evidence suggests that serum CRP levels
increase in patients with severe periodontitis compared to healthy controls.17 inflammatory markers such as IL‐1, IL‐6 and TNF‐α are re‐
leased in the presence of periodontitis and stimulate hepatocytes to produce CRP.18 Periodontitis can trigger a systemic inflammatory re‐
sponse.19 These studies have biologically proven the relationship be‐
tween periodontal disease and CRP. Some studies have also reported that CRP levels decrease significantly after periodontal treatment.20,21
The purpose of this study was to evaluate the effects use of DL in addition to SRP in periodontal treatment of individuals with T2DM and chronic periodontitis (CP) on periodontal healing, systemic in‐ flammatory response (CRP) and metabolic control of DM (HbA1c).
2 | MATERIALS AND METHODS
This study was approved by Ethics Committee of Inonu University (Protocol No: 2013/104), and it was registered at ClinicalTrials.gov (NCT03444363). Before performing any procedure to all individuals
included in the study, they were informed about the purpose and method of the study. A signed informed consent was obtained from them.
2.1 | Patient Selection
A total of 40 patients (22 women, 18 men) with poorly controlled T2DM and generalized CP who were selected from among those admitting to Dentistry Faculty of Inonu University and Turgut Ozal Medical Center were included in this study. Inclusion criteria for this study were as follows: (a) having a diagnosis of type 2 DM accord‐ ing to the American Diabetes Association (ADA) criteria for at least two years before the study, HbA1c ≥ 7%; (b) presence of generalized CP; (c) presence of an area with a pocket depth of 4‐7 mm in at least four teeth in the upper jaw; and (d) presence of at least 20 teeth in the mouth. Criteria for exclusion from the study were as follows: (a) suffering from systemic diseases that could affect periodontal treat‐ ment outcomes; (b) having major diabetes complications; (c) having change in antidiabetic drugs in the last 3 months; (d) smoking; (e) receiving periodontal treatment in the last 12 months; (f) receiving antibiotics or anti‐inflammatory drugs in the last 6 months; and (g) currently pregnant or breastfeeding.
2.2 | Study design
The study design is presented in Figure 1. This study was designed as a single‐blinded, randomized, controlled, full‐mouth, 6‐month clini‐ cal trial. The individuals included in the study were initially matched for CAL, HbA1c level, age, gender and body mass index. Participants were randomly assigned with the use of a computer‐generated list to receive SRP+DL group or the SRP group. Allocation was imple‐ mented by a person not involved in the study.
Then, they were divided into two similar groups. These pairings were made by someone that was not interested in the study. • The individuals in the control group underwent placebo laser
treatment in addition to SRP (only the fibre optic tip was routed in the pockets without beaming).
• The individuals in the study group underwent DL (Gigaa Cheese GaAlAs Diode Laser, China) with 810 nm wavelength, 1 watt power, contact mode using a 400 μm fibre optic tip in addition to SRP.
2.3 | Determination of the number of patients
At the beginning of the study, it was assumed that there was an es‐ timated difference of 0.5 mm in clinical attachment level (CAL) be‐ tween the two groups, and that the estimated standard error value was 0.4 in both groups. In this situation, a minimum of 17 individuals was required for each group to perform a statistical analysis with 80% power and 5% margin of error. 20 patients were included in each group due to patient losses that could occur during the study.
In the study period, two patients in the SRP+DL group and one pa‐ tient in the SRP group were excluded from the study, since they did not come to the control sessions after the treatment. A total of 37 individuals including 20 (54%) women and 17 (46%) men completed this study.
2.4 | Evaluation of periodontal status
In order to determine periodontal status, plaque index (PI),22 gingi‐
val index (GI),23 bleeding on probing (BoP), probing depth (PD) and
CAL measurements were performed in all teeth using the PCP‐12 Periodontal Probe (Hu‐Friedy, Chicago, IL, USA) before treatment (T0), 3 months after treatment (T1) and 6 months after treatment (T2). Measurements at all visits for a given subject were made by one calibrated examiner (AE) who was not involved in providing treat‐ ment during the study. Before the start of the study, the examiner was trained to adequate levels of accuracy and reproducibility in re‐ cording the clinical parameters and indices.
2.5 | Treatment protocol
All patients received initial periodontal therapy consisting of thor‐ ough oral hygiene instructions and SRP procedures. Oral care train‐ ing including tooth brushing method with modified Bass technique and use of dental floss and interface brush was shown to all pa‐ tients via the model one week before the treatment. It was checked whether the patients correctly implemented plaque removal tech‐ niques during the study period. The necessary warnings were made about this issue. SRP procedures were performed using ultrasonic devices (Electro Medical Systems SA, Nyon, Switzerland) and gracey curettes (Hu‐Friedy).
Following SRP in the same session with these procedures, periodontal treatment was performed by applying DL into the
periodontal pockets of the patients in the study group. DL applica‐ tion was done in contact mode with the fibre optic tip inserted into the pocket. The laser was applied to all teeth in the mouth as three sets of 15 seconds for each tooth if PD was between 3 and 3.5 mm and as three sets of 20 seconds for each tooth if PD was larger than 4 mm (in the direction of the manufacturer's recommendations). The patients in the SRP group underwent placebo laser treatment (only the fibre optic tip was routed in the pockets without beaming). No complication related to SRP or laser procedures was observed in any patient during the study period. All periodontal treatments were performed in the same session by one periodontist (SDE).
2.6 | Metabolic evaluation
While baseline blood samples were taken 1 or 2 weeks before the time at which periodontal treatment was made for diagnostic pur‐ poses, blood samples at T1 and T2 were taken 1 day after the time at which oral examination was performed.
Serum CRP levels were measured using the nephelometric method (Dade Behring BN II, Siemens Inc, Marburg, Germany). Serum HbA1c levels were measured using the high‐performance liq‐ uid chromatography method (Primer Hb 9210, Trinity Biotech Inc, Wicklow, Ireland). Analyses were performed in Turgut Ozal Medical Center Laboratory.
2.7 | Statistical analysis
The SPSS Statistics version 22.0 software (IBM, Chicago, IL, USA) was used for the statistical analysis of the data obtained from the study. The Unpaired t test and the Mann‐Whitney U test were used to compare for inter‐group comparisons. The repeated‐measures ANOVA and the Bonferroni test were used for intra‐group com‐ parisons. Yates's correction for continuity was used for comparison
F I G U R E 1 The flow chart of study design. DL, diode laser; SRP, scaling and root planning; T0, baseline; T1, three months after treatment;
of qualitative data. A value of P < 0.05 was considered statistically significant.
3 | RESULTS
There was no statistically significant difference between the two groups in terms of age, gender, duration of education, duration of DM, duration of medication use, body mass index and mean number of teeth (P > 0.05; Table 1).
3.1 | Clinical findings
All clinical parameters examined in this study showed a statistically significant improvement at both T1 and T2 compared to baseline (P < 0.05). It was seen that the intra‐group changes from T1 to T2 in clinical parameters were generally similar except for the two param‐ eters (P > 0.05). Firstly, GI showed a statistically significant increase at T2 in the SRP group (P < 0.05). Secondly, the reduction in pocket depths in areas with PD >7 was greater in the SRP+DL group than in the SRP group (P < 0.05; Table 2).
All clinical parameter values were found to be similar for both groups at T0 (P > 0.05). After the treatment, the PI, CAL and PD scores were similar for the two groups (P > 0.05). In the SRP+DL group, GI, BoP, PD >4 mm and PD >7 mm recovery were higher than in the SRP group at both T1 and T2 (P < 0.05; Table 2).
3.2 | Systemic findings
In intra‐group evaluations, it was seen that CRP and HbA1c levels de‐ creased significantly at both T1 and T2 compared to T0 (P < 0.05). In
both groups, there were no statistically significant changes between T1 and T2 (P > 0.05). The CRP and HbA1c levels of the SRP+DL and DL groups were similar at T0, T1 and T2 (P > 0.05; Table 3).
TA B L E 1 Evaluation of demographic data of patients
Laser group Control group
P Mean ± SD Mean ± SD Agea 49.7 ± 6.63 51.85 ± 6.23 0.297 Duration of education (y)a 8.1 ± 3.19 8.45 ± 2.72 0.711 Duration of DM (y)b 4.45 ± 1.35 4.5 ± 1.4 0.789 Duration of medication use (y)b 3.7 ± 1.26 3.85 ± 1.18 0.633
Body mass index (kg/
m2)b 26.2 ± 2.1 26.8 ± 1.9 0.276 Mean number of teethb 21.85 ± 1.73 22.25 ± 1.65 0.363 Gender, n (%)c Female 10 (%55.5) 10 (%52.6) 1.000 Male 8 (%44.5) 9 (%47.4) aUnpaired t test. bMann‐Whitney U test. cYates's correction for continuity.
TA B L E 2 Intra‐group and inter‐group clinical outcomes of all
teeth
Laser group Control group
Pa Mean ± SD Mean ± SD Plaque index TO 1.85 ± 0.37 1.75 ± 0.33 0.409 T1 0.70 ± 0.15‡ 0.66 ± 0.16‡ 0.485 T2 0.86 ± 0.25‡ 0.80 ± 0.24‡ 0.442 Pb 0.001** 0.001** Gingival index TO 1.77 ± 0.29 1.69 ± 0.36 0.313 T1 0.50 ± 0.11‡ 0.71 ± 0.18‡ 0.001** T2 0.58 ± 0.16‡ 0.91 ± 0.23‡,§ 0.001** P 0.001** 0.001** Bleeding on probing (%) TO 73.12 ± 12.38 69.7 ± 12.38 0.388 T1 23.6 ± 6.0‡ 30.15 ± 8.63‡ 0.008** T2 24.65 ± 7.06‡ 31.7 ± 9.03‡ 0.009** P 0.001** 0.001**
Clinical attachment level (mm)
TO 4.60 ± 0.59 4.38 ± 0.77 0.310 T1 3.81 ± 0.48‡ 3.8 ± 0.66‡ 0.398 T2 3.78 ± 0.52‡ 3.85 ± 0.66‡ 0.343 P 0.001** 0.001** Probing depth (mm) TO 3.45 ± 0.45 3.39 ± 0.43 0.914 T1 2.89 ± 0.24‡ 2.92 ± 0.34‡ 0.442 T2 2.77 ± 0.12‡ 2.99 ± 0.33‡ 0.055 P 0.001** 0.001** 4 < probing depth<7 (mm) TO 5.62 ± 0.46 5.52 ± 0.36 0.450 T1 4.06 ± 0.38‡ 4.50 ± 0.34‡ 0.01* T2 3.65 ± 0.28‡,§ 4.31 ± 0.27‡ 0.01* P 0.001** 0.001** 7 (mm) ≤ probing depth TO 7.18 ± 0.16 7.22 ± 0.28 0.664 T1 5.43 ± 0.28‡ 6.04 ± 0.45‡ 0.01** T2 5.06 ± 0.25‡,§ 6.04 ± 0.54‡ 0.01** Pb 0.001** 0.001** aUnpaired t test. bRepeated‐measures ANOVA.
*Significant differences between Laser and Control groups (P < 0.05). **Significant differences between Laser and Control groups (P < 0.01). ‡P < 0.01; P‐values represent changes from TO within each treatment group.
§P < 0.01; P‐values represent changes from T1 within each treatment group.
4 | DISCUSSION
For the second time in the literature, this study investigated the ef‐ fects of DL application in addition to SRP on systemic inflammatory response (CRP) and metabolic control of DM (HbA1c level) in poorly
controlled DM patients.12 Findings of this study indicate that both
SRP and SRP+DL application provided positive contributions to peri‐ odontal and systemic conditions in patients with T2DM. It may be beneficial of the effect of DL on the clinical periodontal healing, but no significant differences existed between groups for systemic in‐ flammatory response and metabolic control of DM.
In periodontal diseases, the host produces an inflammatory re‐ sponse against microorganisms that form biofilms and against bacte‐ rial metabolites that colonize in the subgingival area.24 In the light of
this information, periodontal treatment is currently based on remov‐ ing microbial dental plaque, which is the main cause of the disease, and on preventing its recurrence. On the other hand, SRP proce‐ dures made with traditional methods have some clinical limitations. Incomplete subgingival plaque removal has similar effects with a lack of plaque control. For these reasons, taking into consideration the situations where traditional methods have limited effects, research‐ ers are seeking to develop new treatment methods to increase peri‐ odontal healing. One of the most remarkable developments in this regard is the use of laser beams in periodontal therapy.
Our results showed that there was no statistically significant dif‐ ference in PI and CAL, and laboratory findings at 3 and 6 months between the SRP+DL group and the SRP group, but there was a greater reduction in GI and BoP in regions where deep periodontal pockets are located at both T1 and T2 in the SRP+DL group. These findings are consistent with the results of previous studies that re‐ ported that DL application could reduce local inflammation and bone resorption markers, increase bone formation markers and stimulate
collagen formation.25,26 The fact that there were statistically signif‐
icant differences especially in deep periodontal pockets supports that DL application may increase the healing potential of the peri‐ odontal tissues in areas where conventional methods are inadequate for treatment. Kocak et al expressed SRP + DL in contact mode has more improvement in PD and CAL levels compared to SRP in DM2 with periodontitis.12
In this study, DL in addition to SRP was applied into all periodon‐ tal pockets of patients in the SRP+DL group in order to reduce the inflammation tendency and to increase the healing potential in in‐ dividuals with DM. The fact that there was a greater reduction in GI, BoP and deep periodontal pockets in the SRP+DL group demon‐ strates that DL application may have beneficial effects in increasing the healing potential and in reducing the periodontal inflammation in DM individuals in this study.
Current scientific evidence suggests that periodontal diseases are not limited to the oral cavity but also have systemic effects.27,28
In other words, periodontal diseases may be associated with sys‐ temic inflammatory response.29 Recent studies have shown that pre‐
vention or treatment of periodontal diseases has important clinical effects in clinical conditions such as DM, pregnancy complications and cardiovascular disease.30 Many researchers have reported that
the incidence of these diseases may increase in relation to the pres‐ ence and severity of periodontal inflammation.31,32
Acute and chronic infections are known to affect glycaemic con‐ trol. It has also been reported that HbA1c level may be affected by systemic inflammation.33 Periodontal inflammation is thought to
cause a glycaemic control to be reduced, particularly by stimulating systemic inflammation.34 Decreased inflammation after periodontal
therapy locally leads to a decrease in the level of inflammatory mark‐ ers, so that levels of these markers in the systemic circulation may also decrease.27,35 Markers such as IL‐6 and TNF‐a may stimulate the
release of acute phase reactants such as CRP and may alter intracel‐ lular insulin signalling.36 Theoretically, decrease in the levels of these
markers may contribute to metabolic control of DM. For this pur‐ pose, researchers have studied the effects of periodontal treatment on glycaemic control.
Many researchers have reported that SRP has beneficial effects on glycaemic control in their studies.37,38 Kiran et al37 found that
there was a significant decrease in HbA1c level after mechanical periodontal treatment in T2DM individuals with periodontal disease. Yang et al38 found that there was a significant decrease in TNF‐α and
HbA1c levels after initial periodontal therapy in T2DM patients with CP. This relationship has been explained by the fact that periodon‐ tal treatment may also reduce HbA1c concentration by decreasing TNF‐α concentration. In contrast to these studies, some researchers could not have found a statistically significant reduction in glycaemic control of type 1 or type 2 DM patients by mechanical periodontal treatment.39,40 The fact that the mean HbA
1c levels of the patients
in our study were lower at T1 and T2 compared to baseline supports the results of studies in the literature reporting that decreased lev‐ els of systemic inflammatory markers with the effect of periodontal therapy would contribute to glycaemic control.
TA B L E 3 Evaluation of serum CRP and HbA1c levels
Laser group Control group
pa Mean ± SD Mean ± SD CRP T0 3.00 ± 0.48 2.92 ± 0.43 0.598 T1 2.57 ± 0.48* 2.61 ± 0.34* 0.205 T2 2.51 ± 0.42* 2.66 ± 0.38* 0.089 Pb 0.001** 0.001** HbA1c T0 7.43 ± 0.32 7.31 ± 0.32 0.545 T1 7.06 ± 0.31* 7.00 ± 0.29* 0.330 T2 6.98 ± 0.34* 7.09 ± 0.29* 0.203 Pb 0.001** 0.001** aUnpaired t test. bRepeated‐measures ANOVA.
*P < 0.05; P‐values represent changes from TO within each treatment group.
**P < 0.01; P‐values represent changes from TO within each treatment group.
If there may be a prolonged decrease in HbA1c levels after peri‐ odontal therapy, it may contribute to a decrease in DM‐related morbidity and mortality. For this purpose, it has been desired to increase the efficacy of periodontal treatment and to be more ef‐ fective on glycaemic control in DM individuals. In some studies, it has been shown that antibiotic use in addition to periodontal treat‐ ment in DM patients has positive effects on glycaemic control.41,42
In some studies, it has been observed that the administration of antibiotic, mouthwash and irrigation water in addition to traditional methods has no significant effects on glycaemic control.43,44 Some
researchers have investigated the effects of various laser beams in addition to periodontal treatment in order to regulate meta‐ bolic control in DM patients.43,45 In a study of Al‐Zahrani et al45
who divided the patients with type 2 DM and CP into three groups, the first group underwent only SRP, the second group underwent doxycycline treatment in addition to SRP and the third group un‐ derwent photodynamic therapy with DL in addition to SRP. It was seen that HbA1c level decreased in all groups, but the decrease in the doxycycline group was greater than those in the other groups. In a study of Macedo et al46 conducted in DM patients undergoing
periodontal treatment with doxycycline, one group underwent only SRP whereas other group underwent photodynamic therapy using a 660 nm laser in addition to SRP. They reported that there was a greater reduction in HbA1c levels in the photodynamic therapy group compared to the control group. Although there are indica‐ tors that laser applications may have enhancing healing effects on glycaemic control in these studies, the number of studies is limited and there are many factors that need to be examined. In the study using DL in contact mode, it has been found the use of DL adjunct to SRP produces significant better improvement in the glycaemic control compared to SRP.12 As a result of this study, it was seen
that there was no statistically significant difference in the change of HbA1c levels after treatment between the SRP+DL group and the control group. However, there was a greater reduction in HbA1c levels in the SRP+DL group compared to the control group. These findings indicate that DL application for periodontal treatment of DM individuals does not make significant additional contributions to glycaemic control. On the other hand, our findings provide weak evidence that the reduction in HbA1c level in the SRP+DL group may be more stable.
C‐reactive protein is an acute phase reactant produced by the liver in response to a variety of inflammatory stimuli and is consid‐ ered as a marker of systemic inflammation. Many studies have re‐ ported that the serum level of CRP may increase both in relation to the severity of periodontal disease and DM.16,17 Several studies
have reported that host inflammatory response caused by periodon‐ tal disease may lead to an increase in levels of systemic inflammatory markers. The increase in CRP level is also considered as a result of this relationship. In some studies, it has been reported that serum CRP level may decrease after successful periodontal treatment or DM treatment.17,47 Mohan et al48 reported that there was a greater
reduction in serum CRP levels after periodontal treatment in T2DM patients than in non‐DM patients. Lalla et al47 reported that there
was a significant decrease in serum CRP levels after periodontal treatment in patients with DM and CP. The decrease in serum CRP levels after periodontal treatment in both groups in our study is ev‐ idence supporting the results of studies reporting that periodontal inflammation may lead to an increase in serum CRP level by stimulat‐ ing systemic inflammatory response.
In a study of Giannopoulou et al49 investigating the effect of DL
on periodontal tissues, they examined serum amyloid‐A and serum amyloid‐P levels at baseline, 2 weeks, 2 months and 6 months in order to assess systemic effects. Serum amyloid‐P level decreased at 2 weeks but increased significantly at 6 months. Serum amyloid‐A level did not show a significant difference at 2 weeks and 2 months but increased at 6 months. There is no study in the literature that ex‐ amined the effect of DL application on serum CRP levels in humans. Our study is the first study in this respect. Our findings showed that DL application did not make a statistically significant contribution to serum CRP levels. It is noteworthy that while serum CRP level was similar at 3 and 6 months in the SRP+DL group, there was an upward trend in the control group. The similar changes in CRP lev‐ els in the two groups suggest that systemic reflections of DL are not statistically significant despite its beneficial clinical effects. The coexistence of reductions in HbA1c and CRP levels are consistent with studies in the literature reporting that systemic inflammatory response caused by periodontal disease may be associated with weaken glycaemic control. On the other hand, the findings of this study indicate that SRP plus DL use did not affect CRP and HbA1c levels for long term.
In this study, HbA1c level was examined and only glycaemic con‐ trol was evaluated among DM‐related factors. However, factors such as triglyceride, HDL and LDL are known to be influenced by DM. The fact that these serum parameters, which may be related to DM, have not been evaluated can be considered as a limitation for our study.
5 | CONCLUSION
In summary, the findings of this study suggest that periodontal treat‐ ment is effective in reducing systemic inflammatory response and in improving glycaemic control, but periodontal treatment additional DL use has no effects on systemic inflammation and glycaemic con‐ trol. On the other hand, considering the clinical results obtained in this study and the high cost of laser devices, the clinical efficacy of laser applications in the treatment of periodontal diseases is not at the desired level in terms of cost‐benefit.
6 | CLINICAL RELEVANCE
6.1 | Scientific rationales
This study investigated the effects on local and systemic inflamma‐ tory healing of diode laser use on periodontal therapy in diabetic patients.
6.2 | Principal findings
The use of diode laser contributed to reducing pocket depth and local inflammation. However, it did not affect systemic inflammatory response.
6.3 | Practical implications
The diode laser use in periodontal therapy is beneficial for peri‐ odontal healing but is not beneficial for metabolic control of diabetes.
CONFLIC T OF INTEREST
There is no conflict of interest for this study.
ORCID
Seydanur Dengizek Eltas https://orcid.org/0000‐0002‐7640‐551X
Mihtikar Gursel https://orcid.org/0000‐0003‐2454‐5059
Abubekir Eltas https://orcid.org/0000‐0001‐9300‐4091
Nilgun Ozlem Alptekin https://orcid.org/0000‐0002‐2277‐378X
Tamer Ataoglu https://orcid.org/0000‐0003‐1937‐0290
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How to cite this article: Dengizek Eltas S, Gursel M, Eltas A,
Alptekin NO, Ataoglu T. Evaluation of long‐term effects of diode laser application in periodontal treatment of poorly controlled type 2 diabetic patients with chronic periodontitis. Int J Dent Hygiene. 2019;17:292–299. https://doi.org/10.1111/ idh.12384
