Adjunctive neodymium-doped yttrium aluminum garnet laser therapy for periodontitis in type 2 diabetes: A randomized controlled trial

Objective To determine whether adjunctive neodymium-doped yttrium aluminum garnet laser therapy added to conventional nonsurgical periodontal therapy provides greater improvement in baseline-adjusted 6-month probing depth than conventional nonsurgical periodontal therapy alone in patients with periodontitis and type 2 diabetes mellitus. Methods This randomized controlled trial included 120 patients with periodontitis and type 2 diabetes mellitus. Participants were randomly assigned in a 1:1 ratio to the laser group (conventional nonsurgical periodontal therapy plus adjunctive neodymium-doped yttrium aluminum garnet laser therapy, n = 60) or the control group (conventional nonsurgical periodontal therapy alone, n = 60). Conventional nonsurgical periodontal therapy comprised scaling and root planing with standardized home oral-hygiene instruction and reinforcement. Periodontal and glycemic outcomes were assessed at baseline and 6 months. The primary outcome was the between-group difference in the 6-month mean probing depth, adjusted for baseline probing depth using analysis of covariance. Secondary outcomes included baseline-adjusted between-group differences in clinical attachment level, bleeding on probing-positive sites, gingival recession, glycosylated hemoglobin, and fasting plasma glucose level. Results Baseline characteristics were generally comparable between groups, except a modest difference in mean gingival recession. Based on the primary analysis, the baseline-adjusted 6-month mean probing depth was significantly lower in the laser group than in the control group (adjusted difference, −0.70 mm (95% confidence interval, −0.84 to −0.56) p < 0.001). Baseline-adjusted differences also favored the laser group for clinical attachment level (−0.67 mm; 95% confidence interval, −0.79 to −0.55), bleeding on probing-positive sites (−11.3 percentage points; 95% confidence interval, −13.9 to −8.7), glycosylated hemoglobin (−0.26%; 95% confidence interval, −0.34 to −0.17), and fasting plasma glucose level (−0.62 mmol/L; 95% confidence interval, −0.81 to −0.44) (all p < 0.001). Gingival recession was slightly higher in the laser group after baseline adjustment (+0.09 mm; 95% confidence interval, 0.03 to 0.14; p = 0.004). No serious treatment-related adverse events were recorded. Conclusions Adjunctive neodymium-doped yttrium aluminum garnet laser therapy was associated with greater short-term improvement in periodontal clinical outcomes than conventional nonsurgical periodontal therapy alone. Favorable changes in secondary glycemic outcomes were also observed; however, these results should be interpreted cautiously because cautiously because glycemic variables were secondary endpoints, and the follow-up duration was limited to 6 months. Research registration number researchregistry12005.