The effects of diode laser adjunctive to non surgical periodontal therapy on clinical and biochemical parameters in smoking with moderate periodontitis

Periodontal diseases are chronic inflammatory conditions that arise from the interaction between the host immune response and microorganisms, in which pro- and anti-inflammatory cytokines as well as oxidative stress mediators play a role in the pathogenesis. The aim of this study is to evaluate the effects of adjunctive diode laser application to non-surgical periodontal therapy on periodontal and biochemical parameters in moderately periodontitis patients who smoke. A total of 60 systemically healthy individuals diagnosed with Stage 3 Grade B periodontitis who presented to the Department of Periodontology, Faculty of Dentistry, Selçuk University, were included in the study. The participants were divided into four groups: 15 smokers who received diode laser treatment (L+S+), 15 smokers who did not receive diode laser treatment (L−S+), 15 non-smokers who received diode laser treatment (L+S−), and 15 non-smokers who did not receive diode laser treatment (L−S−). Clinical periodontal parameters, including probing pocket depth (PPD; PPD≥4 mm, PPD≥5 mm, PPD≥6 mm), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP) percentage were recorded. In addition, unstimulated saliva samples were collected and the levels of Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Malondialdehyde (MDA), and 8-Hydroxy-2'-deoxyguanosine (8-OHdG) were analyzed using the ELISA method. All statistical data were analyzed using Student's t test for pairs with homogeneous variance and Welch's t test for pairs with heterogeneous variance. The homogeneity of variances was tested with Bartlett's test.Dependent Sample t test was used to check the difference between repeated measurements of two-level variables.The homogeneity of variance was tested with Bartlett's test before the difference between means of variables with more than two levels. Fisher's ANOVA test was used for variables with homogeneous variance and Welch's ANOVA test was used for variables with heterogeneous variance. In pairwise comparisons of significant differences, Tukey's test was used for pairs with homogeneous variance and Games-Howell test was used for pairs with heterogeneous variance. In the control of the difference between repeated measures of variables with more than two levels, sphericity was first tested with Mauchly's W test. Then, the difference between the measurements was tested with repeated measures ANOVA test. In pairwise comparisons of significant differences, Bonferroni test was used in pairs where sphericity was ensured and Holm test was used in pairs where sphericity was violated.Correlation analysis between parameters was tested with Pearson correlation coefficient. According to the data obtained in our study, a significant difference was observed in the mean age between the control group of smokers and the test group of non-smokers. In terms of gender distribution, the majority of smokers in both the test and control groups were male. Following non-surgical periodontal treatment, all clinical parameters including CAL, PPD, PPD≥4 mm, PPD≥5 mm, PPD≥6 mm, PESA, PISA, BOP, PI, and GI showed a statistically significant reduction at the 1st and 3rd months in all groups (p<0.05). In the laser-treated non-smoker test group, a significant reduction was observed in PPD≥6 from baseline to the 1st month, in PPD≥5 and GI from baseline to the 3rd month, and in PPD≥4, PPD≥5, GI, and CAL from the 1st to the 3rd month compared to other groups (p<0.05). At baseline, the biochemical parameters TAS, MDA, and 8-OHdG did not show any statistically significant differences among the groups (p>0.05). TAS levels showed a statistically significant increase at the third month compared to baseline in the L-S+, L+S+, and L-S- groups (p<0.05), whereas in the test groups (L+S+ and L+S-), a significant increase was observed as early as the first month (p<0.05). When examining the changes from baseline to the first month, it was noted that the increase in TAS levels was more pronounced in the non-smoking groups compared to the others (p<0.05).TOS levels demonstrated a significant reduction from baseline to the third month in the L-S+, L+S+, and L+S- groups (p<0.05). When evaluating the group differences in TOS changes from baseline to the first month, greater reductions were observed in the L+S- and L-S+ groups (p<0.05).Regarding MDA levels, a significant decrease from baseline to the third month was observed in all groups except L-S+ (p<0.05), while significant reductions were detected in the L-S- and L-S+ groups already at the first month (p<0.05). Similarly, the TOS parameter showed more pronounced decreases from baseline to the first month in the L+S- and L-S+ groups (p<0.05). For 8-OHdG levels, a statistically significant decrease from baseline to the third month was observed in all four groups (p<0.05), with the L-S- and L+S+ groups also showing significant reductions from the first to the third month (p<0.05). Strong positive correlations were found between the clinical parameters PESA, PISA, GI, PI, CAL, PPD, and BOP (p<0.05). In the correlation analysis of the changes from baseline to the third month, a significant positive relationship was detected between the change in MDA and the change in PESA. Furthermore, TOS changes were positively correlated with changes in PPD, CAL, and PESA. Between the first and third months, MDA changes were also positively correlated with changes in SCD≥4, SCD≥5, PISA, and PI. TOS changes were found to be positively correlated with changes in SCD≥4, SCD≥5, and TAS (p<0.05). The results of this study suggest that adjunctive diode laser application to non-surgical periodontal therapy has a beneficial effect, particularly in non-smoking individuals. It is thought that studies with longer observation periods should be conducted on larger samples in order to better see this effect and to better understand the role of the examined mediators in treatment follow-up.