Chandra Sourav, Shashikumar Pratibha
Department of Periodontology & Implantology, Hazaribag College of Dental Sciences & Hospital, Hazaribag, Jharkhand825301, India.
Department of Periodontology, JSS Dental College & Hospital (Constituent College), Jagadguru Sri Shivarathreeshwara University, Mysuru- 570015, Karnataka, India.
J Lasers Med Sci. 2019 Winter;10(1):56-63. doi: 10.15171/jlms.2019.09. Epub 2018 Dec 15.
Maturity-onset diabetes mellitus affecting the elderly population is marked by insulin resistance and decreased insulin production. The relationship between periodontitis and diabetes is bidirectional. Type 2 diabetic patients are more prone to chronic periodontitis (CP) and severe periodontitis affects the glycemic control in such patients. Recently, dental diode laser has become an effective tool in controlling CP. To date, very few studies have been conducted to check the efficacy of diode laser in control of periodontal destruction in type 2 diabetes mellitus (DM2) patients. Hence, the need of the study was to evaluate whether diode laser helps improvement of periodontal outcome and reduction in anaerobic bacteria in elderly diabetic patients with CP. Forty DM2 patients with CP were randomized into group A (control): scaling and root planing (SRP) only and group B (test): SRP followed by soft tissue dental diode laser (808 nm) application. Four patients (2 in each group) were lost during follow up. Clinical parameters, plaque samples and glycated hemoglobin levels were evaluated at both baseline and 90 days post-treatment. Improvement in clinical, microbiological and glycemic parameters were noted in the group that received SRP as well as SRP + LANAP (laser-assisted new attachment procedure). The reductions in clinical parameters were statistically significant after 3 months (<0.001). The microbial analysis of plaque samples for () and () decreased significantly after 3 months in group B than in group A. Glycated hemoglobin level (HbA1c) decreased significantly after 90 days in both the groups (<0.001) with more reduction in the SRP+LANAP group (6.49%) in comparison to SRP alone (16.25% vs. 9.76%). However, on the intergroup comparison, the difference in HbA1c reduction was nonsignificant. Laser as an adjunct to SRP is an effective procedure for improving clinical and microbiological parameters in maturity onset diabetes mellitus patients with CP. Also, there was a better improvement in glycemic control in the test group compared to control group after 3 months. Hence, medically compromised patients like DM2 with CP with delayed wound healing can effectively be treated by laser as an adjunct to nonsurgical periodontal therapy for better results.
影响老年人群的成年型糖尿病的特征是胰岛素抵抗和胰岛素分泌减少。牙周炎与糖尿病之间的关系是双向的。2型糖尿病患者更容易患慢性牙周炎（CP），而重度牙周炎会影响此类患者的血糖控制。最近，牙科二极管激光已成为控制CP的有效工具。迄今为止，很少有研究检验二极管激光对2型糖尿病（DM2）患者牙周破坏的控制效果。因此，本研究旨在评估二极管激光是否有助于改善老年CP糖尿病患者的牙周状况并减少厌氧菌数量。40例患有CP的DM2患者被随机分为A组（对照组）：仅进行龈上洁治和根面平整（SRP）；B组（试验组）：SRP后应用软组织牙科二极管激光（808 nm）。随访期间有4例患者（每组2例）失访。在基线和治疗后90天评估临床参数、菌斑样本和糖化血红蛋白水平。接受SRP以及SRP+激光辅助新附着程序（LANAP）的组在临床、微生物学和血糖参数方面均有改善。3个月后临床参数的降低具有统计学意义（<0.001）。3个月后，B组菌斑样本中（）和（）的微生物分析结果比A组显著降低。两组糖化血红蛋白水平（HbA1c）在90天后均显著降低（<0.001），与单独SRP组（16.25%对9.76%）相比，SRP+LANAP组降低幅度更大（6.49%）。然而，组间比较时，HbA1c降低幅度的差异无统计学意义。激光作为SRP的辅助手段对于改善成年型糖尿病CP患者的临床和微生物学参数是一种有效的方法。此外，3个月后试验组的血糖控制改善情况优于对照组。因此，像DM2这种患有CP且伤口愈合延迟的医学上存在缺陷的患者，激光作为非手术牙周治疗的辅助手段可以有效治疗，以获得更好的效果。
