Table 1.
Main characteristics of the included studies
| Authors | Study type | Number of subjects; sex (m/f) | Age (mean ± SD (range)) | Systemic conditions/health status | Ethnicity | Periodontal disease | Diabetes | Outcomes | Follow up | Type of probe and n sites/tooth evaluated | Group 1 | Group 2 | Group 3 | Group 4 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Al-Zahrani et al. 2009 Saudi Arabia |
RCT, single-blind |
43; 17/26 G1: 7/8 G2: 4/10 G3: 6/8 |
52.21 ± 8.35 G1: 53.14 ± 10.91 G2: 51.42 ± 6.24 G3: 51.92 ± 7.28 |
Excluded: atb in the previous 6 mo, pregnancy | NS | CAL loss ≥ 3 mm at ≥ 30% of sites | T2DM, no major diabetic complications | PD, CAL, REC, plaque and bleeding scores, HbA1c | 12 wks | 6 sites per tooth | SRP | SRP + doxycycline 2× 100 mg for day 1 and then 100 mg once a day for 13 days *not considered in the present review | SRP + PDT (670-nm non-thermal diode laser) | - |
|
Koçak et al. 2016 Turkey |
Parallel RCT, single-blind |
60; 30/30 G1 15/15 G2 15/15 |
35–60 G1 53.1 ± 5.1 G2 51.7 ± 5.2 |
Excluded: other systemic diseases, smoking, alcoholism, atb in the previous 6 mo, immunosuppressive medications, pregnancy/lactation | NS | CP, 8 ≤ sites with PD ≥ 5 mm, ≥ 17 remaining teeth | T2DM, no changes in diabetes therapy in the previous 12 mo HbA1c 5.7–8.5% | PD, CAL, GI, PI, HbA1c, GCF levels of IL-1β, IL-6, IL-8, ICAM, VCAM | 1 and 3 mo | PCP-UNC 15 PD/CAL: 6 sites per tooth for, GI/PI: 4 sites per tooth | SRP | SRP + diode laser (940-nm, indium–gallium–aluminum–phosphate diode laser) | - | - |
|
Barbosa et al. 2018 Brazil |
RCT, Pilot study | 12; 4/8 | 52.2 | Excluded: other systemic disease influencing periodontal status, smoking, atb in the previous 3 mo, pregnancy | NS | Moderate to severe periodontitis | T2DM using oral hypoglycemic agents and/or insulin and who had glycated hemoglobin (HbA1c) values below 7% measured no more than 90 days prior to selection were included in the study | PD, CAL, PI, GBP, GSP, HbA1c | 30, 90, 180 d | Williams color-coded probe | SRP+ aPDT (660-nm diode laser) | SRP | - | - |
|
Chandra et al. 2019 India |
RCT, single-blind |
36; 18/18 9/9; 9/9 |
48/50.6 | Excluded: smoking, alcoholism, pregnancy/lactation | NS | Generalized CP, PPD 4–7 mm with CAL ≥ 2 mm, or greater and each quadrant having at least 3 teeth (≥ 3 in each quadrant) | T2DM, non insulin dependent | PD, CAL, PI, GI, microbiological Aa, Pg, HbA1c | 3 mo | UNC-15 | SRP + diode laser (808 nm and a power setting of 1.5–1.8W were used in continuous, contact mode with a thin flexible fiber optic cable (320 nm)) + irrigation with saline | SRP + irrigation with saline | - | - |
|
Dengizek Eltas et al. 2019 Turkey |
RCT, single-blind | 37; 17/20 | 49.7/51.85 | Excluded: other systemic diseases affecting periodontal status, smoking, atb or anti-inflammatory drugs in the previous 6 mo, pregnancy/lactation | NS | Generalized CP, PD 4-7 mm in ≥4 teeth in the upper jaw, ≥ 20 remaining teeth |
T2DM for ≥ 2 yrs, no major diabetes complications HbA1c ≥ 7% |
PD, CAL, PI, GI, HbA1c, CRP | 3 and 6 mo | PCP-12 | SRP + diode laser (810 nm wavelength, 1 W power, contact mode using a 400-μm fiber optic tip) | SRP | - | - |
|
Mirza et al. 2019 Pakistan |
RCT |
30; 20/10 11/4; 9/6 |
51.45/52.93 | Excluded: current/former smokers, atb in the previous 3 mo, pregnancy/lactation | NS | Mild to moderate periodontits, no periodontal treatment in previous 6 mo |
T2DM for ≥ 2 yrs, no major diabetic complications HbA1c ≥ 6.5% |
PD, BOP, PI, AL, HbA1c, Advanced glycation end-products in GCF | 3 and 6 mo |
UNC-15 6 sites per tooth |
FMD+ PDT (670 nm 150 nW fluency of 22 J/cm2 and density of 1.1 W/cm2) | FMD | - | - |
|
Macedo et al. 2013 Brazil |
RCT |
30; 16/29 G2 6/9 G1 5/10 |
48.73 ± 7.11 G2 49.4 ± 6.8 G1 48.1 ± 9 |
excluded: smoking in the previous 5 years, atb in the previous 6 months, pregnancy/lactation | NS | ≥ 1 site with PPD ≥ 5 mm on each quadrant, and ≥ 2 teeth with CAL loss ≥ 6 mm |
T2DM > 5 yrs, no major diabetic complications HbA1c > 7% |
PPD, CAL, PI, BOP, HbA1c, suppuration | 3 mo |
Computerized periodontal probe 6 sites per tooth |
SRP | SRP + aPDT (660-nm diode laser, phenothiazine chloride photosensitizer-induced aPDT) | - | - |
|
Al-Zawawi et al. 2020 Saudi Arabia |
RCT | 128; diabetic subjects 27/6 | diabetic subjects 55.5 | Excluded: other systemic diseases, smoking, tobacco chewing, alcoholism, pregnancy/lactation | NS | Stage II grade C periodontitis according to Consensus report 2017 World Workshop | T2DM | PD, CAL, GI, PI, MBL, cortisol in GCF, HbA1c | 3 and 6 mo |
Click-probe 6 sites per tooth |
(Diabetic patients) SRP + aPDT (diode laser at 660 nm and 150 mW, irradiation was performed for 60 s with a fiber optic tip of 300 μm diameter) | (Diabetic patients) SRP | (Non-diabetic patients) SRP + aPDT (diode laser at 660 nm and 150 mW, irradiation was performed for 60 s with a fiber-optic tip of 300 μm diameter) [not included] | (Non-diabetic patients) SRP [not included] |
|
Elsadek et al. 2020 Saudi Arabia |
RCT |
60; 34/26 11/9; 10/10; 13/7 |
52.16/51.87/52.88 | Excluded: other systemic disease influencing periodontal disease course, current/former smokers, patients on anti-inflammatory/antimicrobials/statin therapy, pregnancy/lactation | NS | Stage III and grade C generalized periodontitis, CAL ≥ 5 mm and radiographic bone loss extending to middle or apical third of root, no previous periodontal therapy | T2DM (ADA 2018) | PD, CAL, REC, BOP, PS, HbA1c | 3 mo |
UNC probe 6 sites per tooth |
SRP + PDT (diode laser670 nm wavelength, 150 mW maximum power, 60 s per site, 20 J/cm2 per site) | SRP + probiotic L. reuteri (2 × 108 CFU/tablet, 2 lozenges/day for 3 wks) | Debridement | - |
|
Soi et al. 2021 India |
RCT | 37; 21/16 | 51.58/51.67 | Excluded: other systemic diseases, smoking, alcoholism, medication other than hypoglycemics, pregnancy/lactation | NS | Stage II or III/grade B or C periodontitis, ≥ 8 sites with CAL loss ≥ 3 mm and PPD ≥ 3 mm, ≥ 20 teeth |
T2DM (FPG ≥ 126 mg/dl, RBS ≥ 200 mg/dl, PP ≥ 200 mg/dl) HbA1c > 6% |
PD, CAL, PI, GI, RBS, FBS, HbA1c | 1, 3, 6 mo |
UNC-15 CAL, PD: 6 sites per tooth, PI, GI: 4 sites per tooth |
SRP + diode laser (0.8 W, pulse interval 1.0 ms, pulse length 1.0 ms, 24 J) | SRP | - | - |
| Claudio et al. 2021 | RCT, double-blind (surgeon and examiner) | 34, 31 examined (22/9) |
G1: 53.13 ± 7.58 G2: 54 ± 8.56 |
Age 30–70; excluded: medical disorders that required antibiotic prophylaxis, antibiotics, anti-inflammatories, anticonvulsants, immunosuppressants or calcium channel blockers in the last 6 mo, smokers in the last 12 mo, pregnancy | NS | Periodontitis stages III and IV, grade C with at least 6 sites with PD and CAL ≥ 5 mm and BOP in at least 15 teeth, excluding third molars; no SRP in the last 6 mo | decompensated DM2: HbA1c ≥ 7.0% | PD, CAL, REC, PI, BOP, number of PD ≥ 5 mm, P. gingivalis and P. intermedia quantification | 3 mo, 6 mo | PCPUNC-15, Hu-Friedy, six sites of each tooth | SRP | SRP + aPDT (immediately after SRP, 48 and 96 h after in pockets with PD ≥ 5 mm) | - | - |
Abbreviations:ADA American Diabetes Association, atb antibiotics, BOP bleeding on probing, CAL clinical attachment level, CFU colony-forming units, CP chronic periodontitis, CRP C-reactive protein, d days, FPG fasting plasma glucose, FBS fasting blood sugar, GCF gingival crevicular fluid, GSP glycated serum proteins, GBP glycated blood proteins, Hb1Ac glycated hemoglobin 1Ac, mo months, NS not specified, PP 2-h post-prandial glucose, PPD probing pocket depth, RBS random blood sugar, REC recession, wks weeks, yrs years, SRP scaling and root 22planing, OHI oral hygiene instructions, PDT p22hotodynamic therapy, FMD full-mouth disinfection, UNC University of North Carolina, T2DM type 2 diabetes mellitus, Aa Aggregatibacter actynomycetemcomitans, Pg Porphyromonas gingivalis