Prospective comparison of Er,Cr:YSGG laser and diode laser assisted periodontal flap microsurgery in diabetic individuals

Objectives: This study aimed to compare the efficacy of Er,Cr:YSGG laser and diode laser-assisted periodontal flap microsurgery in diabetic individuals, based on clinical parameters and microbiological changes using RT-PCR. Methods: A split-mouth prospective study was conducted on 75 sites from 25 patients with moderately severe chronic periodontitis (probing depth 5–8 mm) and moderately controlled type II diabetes mellitus (HbA1c 7–8%) diagnosed with Stage II Grade B periodontitis. Sites were randomly allocated into three groups: Group A (Er,Cr:YSGG laser-assisted flap surgery, n=25), Group B (diode laser-assisted flap surgery, n=25), and Group C (conventional flap surgery, control, n=25). Microsurgical flap procedures were performed with adjunctive laser therapy on inner and outer flap surfaces. Clinical parameters assessed included relative attachment level (RAL), gingival index (GI), plaque index (PI), probing pocket depth (PPD), bleeding on probing (BOP), visual analogue scale (VAS) for pain, and wound healing index at specified intervals up to 6 months. Microbiological evaluation included total microbial count and PCR-based quantification of Porphyromonas gingivalis at baseline and 3 months. Statistical analysis was performed using SPSS v21 with significance set at p<0.05. Results: Group B showed a significant reduction in plaque index (1.4600 ± 0.22546 to 0.4528 ± 0.17377; p=0.000). Group A demonstrated a marked reduction in gingival index (1.4880 ± 0.24718 to 0.3640 ± 0.14967; p=0.000). Significant improvements in probing pocket depth were observed across all groups. RAL improved significantly (7.4000 ± 0.81650 to 5.4400 ± 0.65064; p=0.000). BOP scores showed statistically significant intergroup differences (p=0.031). Pain reduction (VAS) was significantly better in laser groups compared to control (p<0.001). PCR analysis revealed significantly higher Ct values at 3 months in Group A, indicating greater reduction in P. gingivalis. Conclusions: Periodontitis modified by type 2 diabetes mellitus can be effectively managed using minimally invasive microsurgical flap techniques with adjunctive laser therapy. Both Er,Cr:YSGG and diode lasers demonstrated superior clinical and microbiological outcomes, including reduced inflammation, enhanced wound healing, decreased microbial load, and improved patient comfort.