Effect of Scaling and Root Planing with and without Diode Laser Application on Glycated Haemoglobin Levels in Type II Diabetic Patients with Chronic Periodontitis


Chronic periodontitis
diabetes mellitus
diode laser
glycated haemoglobin
nonsurgical periodontal therapy


Introduction: Periodontitis and diabetes have a combined systemic and local effect on tooth supporting structure and has been reported for decades. The gold standard treatment protocol would be scaling and root planing (SRP), which when combined with laser therapy has an additional benefit in the reduction of clinical parameters and glycated haemoglobin (HbA1c) levels.

Objective: To evaluate the effectiveness of scaling and root planing with and without Diode laser application on glycated haemoglobin levels in type II diabetic patients with Chronic Periodontitis.

Methods: Twenty eight type II diabetic patients with Chronic Periodontitis recruited by convenient sampling were divided into two groups in this pretest post-test study design. Group A received scaling and root planing (SRP) and Group B received SRP with diode laser (980 nm) application. The HbA1c levels were evaluated at three and six months; and clinical parameters were evaluated at one, three, and six months post-treatment. Data were analysed in SPSS v.20.

Results: Mean values of HbA1c, probing depth (PD), clinical attachment level (CAL), plaque index (PI), and gingival index (GI) reduced significantly after treatment in both treatment groups with more reduction in laser group. However, on intergroup comparison HbA1c and CAL reduction were not significant.

Conclusions: The findings of the current study showed significant improvements in HbA1c and clinical parameters as compared with baseline in patients treated with SRP and SRP + Diode Laser. Thus, use of diode laser showed no significant improvement statistically when used as an adjunct to scaling and root planing.



Darveau RP, Tanner A, Page RC. The microbial challenge in periodontitis. J Periodontol 2000.1997;14:12-32.

Barr ELM, Zimmet PZ, Welborn TA, Jolley D, Magliano DJ, Dunstan DW, et al. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: The australian diabetes, obesity, and lifestyle study (AusDiab). Circulation. 2007;116(2):151-7.

Loe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993;16:329-34.

Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: An epidemiologic perspective. Ann Periodontol. 2001;6(1):99-112.

Kjellman O. The presence of glucose in gingival exudate and resting saliva of subjects with insulin-treated diabetes mellitus. Sven Tandlak Tidskr. 1970;63(1):11-9.

Grossi SG, Zambon JJ, Ho AW, Koch G, Dunford RG, Machtei EE, et al. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Periodontol. 1994;65(3):260-7.

Yilmaz S, Kuru B, Kuru L, Noyan U, Argun D, Kadir T. Effect of gallium arsenide diode laser on human periodontal disease: A microbiological and clinical study. Lasers Surg Med. 2002;30(1):60-6.

Buchanan SA, Robertson PB. Calculus removal by scaling/root planing with and without surgical access. J Periodontol 1987;58(3):159-63.

Loe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol. 1965;36:177-87.

Al-Sharif FM, Al-Jiffri SO. Impact of laser therapy added to non-surgical therapy in non-insulin dependent diabetic Saudi patients with chronic periodontitis. J Dent Health Oral Disord Ther. 2019;10(6):338-42.

Frantzis TG, Reeve CM, Brown AL, Jr. The ultrastructure of capillary basement membranes in the attached gingiva of diabetic and nondiabetic patients with periodontal disease. J Periodontol. 1971;42(7):406-11.

Yki-Järvinen H, Sammalkorpi K, Koivisto VA, Nikkilä EA. Severity, duration, and mechanisms of insulin resistance during acute infections. J Clin Endocrinol Metab. 1989;69(2):317-23.

Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: A two-way relationship. Ann Periodontol. 1998;3(1):51-61.

Stanton G, Levy M, Stahl SS. Collagen restoration in healing human gingiva. J Dent Res. 1969;48(1):27-31.

Polimeni G, Xiropaidis AV, Wikesjö UM. Biology and principles of periodontal wound healing/regeneration. Periodontol 2000. 2006;41(1):30-47.

Koçak E, Sağlam M, Kayış SA, Dündar N, Kebapçılar L, Loos BG, et al. Nonsurgical periodontal therapy with/without diode laser modulates metabolic control of type 2 diabetics with periodontitis: A randomised clinical trial. Lasers Med Sci. 2016;31(2):343-53.

Kreisler M, Al Haj H, d'Hoedt B. Clinical efficacy of semiconductor laser application as an adjunct to conventional scaling and root planing. Lasers Surg Med. 2005;37(5):350-5.

Faria-Almeida R, Navarro A, Bascones A. Clinical and metabolic changes after conventional treatment of type 2 diabetic patients with chronic periodontitis. J Periodontol. 2006;77(4):591-8.

Chandra S, Shashikumar P. Diode Laser - A novel therapeutic approach in the treatment of chronic periodontitis in type 2 diabetes mellitus patients: A prospective randomised controlled clinical trial. J Lasers Med Sci. 2019;10(1):56-63.

Dengizek Eltas S, Gursel M, Eltas A, Alptekin NO, Ataoglu T. Evaluation of long-term effects of diode laser application in periodontal treatment of poorly controlled type 2 diabetic patients with chronic periodontitis. Int J Dent Hyg. 2019;17(4):292-9.

Paul P, Bilichodmath S, Sameera U. Clinical and glycaemic level evaluation of the efficacy of diode laser and antibiotics with scaling and root planing in treating chronic periodontitis patients with diabetes. J Dent Lasers. 2018;12(1):24-30.

Caruso U, Nastri L, Piccolomini R, d'Ercole S, Mazza C, Guida L. Use of diode laser 980 nm as adjunctive therapy in the treatment of chronic periodontitis. A randomised controlled clinical trial. New Microbiol. 2008;31(4):513-8.

De Micheli G dA, Alves VT, Seto M, Pannuti CM. Efficacy of high intensity diode laser as an adjunct to nonsurgical periodontal treatment: A randomised controlled trial. Lasers Med Sci. 2011;26(1):43-8.

Castro GP, Gallas M, Nunez IG, Barrajo JLL, Varela LG. Histological evaluation of the use of diode laser as an adjunct to traditional periodontal treatment. Photomed Las Surg. 2006;24(1):64-8.