Department of Periodontology, Faculty of Dentistry, Yeditepe Univesity, Istanbul, Turkey.
Department of Periodontology, Faculty of Dentistry, Istanbul Aydin University, Istanbul, Turkey.
J Periodontal Res. 2017 Oct;52(5):872-882. doi: 10.1111/jre.12457. Epub 2017 Apr 10.
This study aimed to investigate the effects of low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP) on smoking and non-smoking patients with chronic periodontitis.
The study was conducted using a split-mouth design with 30 patients with chronic periodontitis (15 smokers, 15 non-smokers) and 30 healthy individuals matched for age, sex and smoking status as controls. Groups were constituted as follows: Cp+SRP+Sham: non-smokers with chronic periodontitis treated with SRP; Cp+SRP+LLLT: non-smokers with chronic periodontitis treated with SRP+LLLT; SCp+SRP+Sham: smokers with chronic periodontitis treated with SRP; SCp+SRP+LLLT: smokers with chronic periodontitis treated with SRP+LLLT; C: control group comprised of periodontally healthy non-smokers; SC: control group comprised of periodontally healthy smokers. LLLT was first applied on the same day as SRP and again on days 2 and 7 after SRP treatment. Clinical parameters were recorded before non-surgical periodontal treatment (baseline) and on day 30. Gingival crevicular fluid samples were collected before periodontal treatment (baseline) and during follow-up visits on days 7, 14 and 30. Gingival crevicular fluid transforming growth factor (TGF)-β1, tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) levels were measured using enzyme-linked immunosorbent assay.
All clinical parameters showed significant reductions between baseline and day 30 following SRP treatment in both the LLLT and sham groups (P<.001). No significant differences were observed between the LLLT and sham groups of either the smokers or non-smokers (P>.05). Gingival crevicular fluid PAI-1 levels decreased significantly in the SCp+SRP+sham and SCp+SRP+LLLT groups (P<.05), and gingival crevicular fluid tPA levels decreased significantly in the Cp+SRP+sham, Cp+SRP+LLLT and SCp+SRP+LLLT groups (P<.05). Gingival crevicular fluid TGF-β1 levels decreased significantly in all treatment groups (P<.05). Although no significant differences were found between the gingival crevicular fluid PAI-1, tPA and TGF-β1 levels of the LLLT versus sham groups (P>.05) at any of the time points measured, both LLLT groups showed significant reductions in tPA/PAI-1 ratios over time.
Within the limits of this study, LLLT may be understood to play a role in the modulation of periodontal tissue tPA and PAI-1 gingival crevicular fluid levels, particularly in smoking patients with chronic periodontitis, and may thus be recommended as an adjunct to non-surgical periodontal treatment.
本研究旨在探讨低水平激光疗法（LLLT）作为牙周基础治疗（SRP）辅助手段对吸烟和非吸烟慢性牙周炎患者的疗效。
采用分口设计，纳入 30 例慢性牙周炎患者（吸烟者 15 例，非吸烟者 15 例）和 30 例年龄、性别和吸烟状况相匹配的健康个体作为对照组。分组如下：Cp+SRP+Sham：非吸烟者，慢性牙周炎，接受 SRP 治疗；Cp+SRP+LLLT：非吸烟者，慢性牙周炎，接受 SRP+LLLT 治疗；SCp+SRP+Sham：吸烟者，慢性牙周炎，接受 SRP 治疗；SCp+SRP+LLLT：吸烟者，慢性牙周炎，接受 SRP+LLLT 治疗；C：对照组，非吸烟者，牙周健康；SC：对照组，吸烟者，牙周健康。LLLT 在 SRP 治疗的同一天首次应用，并在 SRP 治疗后第 2 天和第 7 天再次应用。在非手术牙周治疗前（基线）和第 30 天记录临床参数。在牙周治疗前（基线）和第 7、14 和 30 天的随访中收集龈沟液样本。使用酶联免疫吸附试验测量龈沟液转化生长因子（TGF）-β1、组织纤溶酶原激活物（tPA）和纤溶酶原激活物抑制剂 1（PAI-1）水平。
在 LLLT 和假手术组中，所有临床参数均在 SRP 治疗后的基线和第 30 天之间显著降低（P<.001）。在吸烟者和非吸烟者中，LLLT 和假手术组之间未观察到显著差异（P>.05）。SCp+SRP+Sham 和 SCp+SRP+LLLT 组龈沟液 PAI-1 水平显著降低（P<.05），Cp+SRP+Sham、Cp+SRP+LLLT 和 SCp+SRP+LLLT 组龈沟液 tPA 水平显著降低（P<.05）。所有治疗组龈沟液 TGF-β1 水平均显著降低（P<.05）。尽管在任何测量时间点，LLLT 组与假手术组的龈沟液 PAI-1、tPA 和 TGF-β1 水平之间均无显著差异（P>.05），但两组的 tPA/PAI-1 比值均随时间显著降低。
在本研究范围内，可以认为 LLLT 可调节牙周组织 tPA 和 PAI-1 龈沟液水平，特别是在吸烟的慢性牙周炎患者中，因此可推荐作为牙周非手术治疗的辅助手段。
