Use of adjuncts in periodontal treatment for patients with diabetes

Background + Aims

• Poorly controlled diabetes can complicate periodontal inflammation and healing.
• Antimicrobial photodynamic therapy (aPDT) uses a light-sensitive dye activated by a laser to target microorganisms locally, offering a potential alternative to systemic antibiotics.
• This study aimed to:
  • Compare repeated aPDT with systemic doxycycline as an adjunct to scaling and root planing in patients with type 2 diabetes and periodontitis.

Materials + Methods

• Randomised, placebo-controlled trial involving 30 patients with type 2 diabetes and HbA1c >7%, allocated equally between 2 groups.
• All participants received scaling and root planing (SRP) – mechanical cleaning of tooth and root surfaces below the gumline.
  • 1 group received doxycycline for 14 days systemic doxycycline (100 mg/day for 14 day)
  • Other group received aPDT applications on 0, 3, 7, and 14 days post-therapy with a placebo capsule
  • Placebo capsules and a simulated photodynamic procedure without light exposure supported masking.
• The primary outcome was change in HbA1c, reflecting average blood glucose over approximately two to three months.
• Secondary outcomes included probing depth, clinical attachment level, bleeding and inflammatory markers in fluid collected from periodontal pockets.
• Follow-up lasted 3-months, with monthly professional cleaning.

Results

• Mean HbA1c decreased by 0.76% with doxycycline and 0.99% with aPDT.
  • Both within-group reductions were significant, but the difference between treatments was not.
• Both groups showed improved probing depths and clinical attachment levels, without significant differences in their overall changes.
• Among initially 5–6 mm pockets around single-rooted teeth, 78.4% reached a final depth of ≤3 mm with aPDT, compared with 47.5% with doxycycline (p<0.01).
  • Benefits were not consistently demonstrated in deeper pockets or around multi-rooted teeth.
• At 3-months, IL-1β (a protein that promotes inflammation) was lower with aPDT than with doxycycline. However, aPDT levels were not significantly below baseline, so this represents a between-treatment difference rather than sustained suppression.
• No significant between-group differences were found for TNF-α or TGF-β, other proteins involved in inflammatory regulation.
• No adverse effects or discomfort were reported.

Limitations