Preliminary Results of Non‐Surgical Periodontal Treatment in Patients With Breast Cancer Undergoing Chemotherapy

Background: Although priority is often given to treat the cancer itself, focus should also be directed to prevention and improvement of oral complications that may occur as a result of cancer and/or its treatment. This study compares periodontal treatment results in healthy patients and patients with breast cancer undergoing chemotherapy by monitoring clinical conditions and C‐reactive‐protein (CRP) levels. Methods: Thirty‐five participants were allocated to one of two groups: patients with periodontitis (P) (n = 18) and patients with breast cancer and periodontitis (CAN/P) (n = 17). The following clinical parameters were assessed at baseline and 45, 90, and 180 days after non‐surgical periodontal treatment (NSPT): 1) probing depth (PD); 2) clinical attachment level (CAL); 3) plaque index (PI); 4) gingival index (GI); 5) CRP; and 6) complete blood count. Clinical parameters and CRP levels were statistically analyzed. Results: P and CAN/P groups presented a statistically significant decrease in PD after NSPT at 45, 90, and 180 days compared with baseline (P <0.05). There was a CAL gain in the P group and a significant reduction in PI and GI at 45, 90, and 180 days for both groups (P <0.05). At 180 days after NSPT treatment, the CAN/P group showed a higher number of residual pockets (P <0.05) compared with the P group (46.48 ± 26.80 and 7.58 ± 7.40, respectively). The P group demonstrated a significant reduction in CRP levels at 45 and 180 days after NSPT compared with baseline (P <0.05), whereas this reduction was not observed in the CAN/P group. Conclusion: Patients with breast cancer who were undergoing chemotherapy responded to periodontal non‐surgical therapy, although with less favorable results than patients with periodontitis without cancer, and may require additional or adjunctive periodontal treatments.     

Non‐Surgical Periodontal Therapy Reduces Saliva Adipokine and Matrix Metalloproteinase Levels in Periodontitis

Background: Adipokines enhance the synthesis of proinflammatory cytokines and matrix metalloproteinases (MMPs), which play a role in extracellular matrix degeneration. The aim of this study is to determine the levels of some adipokines, proinflammatory cytokines, and MMPs in the saliva of patients with periodontitis and healthy individuals and to evaluate the changes after non‐surgical periodontal therapy (NSPT). Methods: Of 32 individuals included in the study, 17 had periodontitis and 15 had healthy gingiva. Saliva samples were obtained from all individuals. In patients with periodontitis, samples were recollected 3 and 6 months after NSPT. Visfatin, chemerin, progranulin, interleukin (IL)‐1β, IL‐8, MMP‐8, and MMP‐13 levels were measured using enzyme‐linked immunosorbent assay. Results: In patients with periodontitis, all of the parameters measured in the saliva were higher than those of healthy individuals. At 3 months, visfatin, progranulin, IL‐8, and MMP‐8 levels were significantly decreased compared with baseline values. The levels of other biochemical parameters, chemerin and IL‐1β, were significantly decreased compared with baseline values at 6 months, and the levels became similar to those in healthy individuals. In the periodontitis group, positive correlations were found among visfatin and IL‐8 (r = 0.909, P <0.01), MMP‐8 (r = 0.702, P = 0.02), and MMP‐13 (r = 0.781, P = 0.01); chemerin and IL‐8 (r = 0.913, P <0.01), MMP‐8 (r = 0.770, P <0.01), and MMP‐13 (r = 0.788, P <0.01); and progranulin and IL‐8 (r = 0.762, P <0.01), MMP‐8 (r = 0.845, P <0.01), and MMP‐13 (r = 0.813, P <0.01). Conclusion: Adipokines may contribute to the breakdown of periodontal tissue in periodontitis by stimulating the expression of proinflammatory cytokines and MMPs.     

Effectiveness of Laser Application for Periodontal Surgical Therapy: Systematic Review and Meta‐Analysis

Background: Evidence has shown some improved clinical outcomes and morbidity reduction with the use of lasers for non‐surgical periodontal therapy due to ablation, vaporization, hemostasis, and field sterilization. The purpose of this systematic review is to evaluate and compare studies involving lasers as monotherapy or adjunctive to surgical periodontal treatment. Methods: Electronic and manual searches were conducted by two independent reviewers in several databases for articles written in English up to December 2014. Articles were included in this review if they reported outcomes of surgical periodontal therapy with and without the use of lasers. The primary outcome was probing depth (PD), and secondary outcomes were measured changes in clinical factors such as clinical attachment level (CAL) and gingival recession (GR). For the comparative studies included, the pooled weighted mean difference (WMD) and 95% confidence interval (CI) of each variable were calculated using random‐effects meta‐analysis. Results: Eight and nine articles were included in the quantitative and qualitative analyses, respectively. Although low‐to‐moderate risk of bias was detected, high heterogeneity among studies was found. In flap surgery with or without laser treatment, there was no statistically significant difference in primary outcome. Similarly, in guided tissue regeneration (GTR)/enamel matrix derivative (EMD) with and without laser treatment, the WMD of PD was negligible; however, the GTR/EMD group showed better outcomes (P = 0.005) than the laser group. Regarding the secondary outcomes, in the flap surgery group, the WMD of CAL gain was 1.34 mm, and the WMD of GR was ?0.24 mm; no significant difference was detected between groups. In GTR/EMD with and without laser treatment, the WMD of CAL gain was 0.10 mm and the WMD of recession was ?0.18 mm; again, no significant difference was detected between groups. Conclusions: The available evidence is insufficient to support the effectiveness of dental lasers as an adjunct to resective or regenerative surgical periodontal therapy. However, precautions must be exercised when interpreting the results of this study because of the small sample size and high heterogeneity among studies.     

Clinical Effectiveness of Diode Laser Therapy as an Adjunct to Non‐Surgical Periodontal Treatment: A Randomized Clinical Study

Background: The aim of this randomized clinical study is to evaluate the effect of a 980‐nm diode laser as an adjunct to scaling and root planing (SRP) treatment. Methods: Thirty‐five patients with chronic periodontitis were selected for the split‐mouth clinical study. SRP was performed using a sonic device and hand instruments. Quadrants were equally divided between the right and left sides. Teeth were treated with SRP in two control quadrants (control groups [CG]), and the diode laser was used adjunctively with SRP in contralateral quadrants (laser groups [LG]). Diode laser therapy was applied to periodontal pockets on days 1, 3, and 7 after SRP. Baseline data, including approximal plaque index (API), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL), were recorded before the treatment and 6 and 18 weeks after treatment. Changes in PD and CAL were analyzed separately for initially moderate (4 to 6 mm) and deep (7 to 10 mm) pockets. Results: The results were similar for both groups in terms of API, BOP, PD in deep pockets, and CAL. The laser group showed only significant PD gain in moderate pockets during the baseline to 18‐week (P <0.05) and 6‐ to 18‐ week (P <0.05) periods, whereas no difference was found between LG and CG in the remaining clinical parameters (P >0.05). Conclusion: The present study indicates that, compared to SRP alone, multiple adjunctive applications of a 980‐nm diode laser with SRP showed PD improvements only in moderate periodontal pockets (4 to 6 mm).     

Effect of Non‐Surgical Periodontal Treatment on Clinical and Biochemical Risk Markers of Cardiovascular Disease: A Randomized Trial

Background: Various studies have shown periodontal disease is one of the risk factors for coronary heart disease (CHD), and periodontal treatment of patients with CHD has also been correlated with reduction in systemic markers of CHD. The aim of this study is to evaluate the effect of non‐surgical periodontal treatment (NSPT) on the cardiovascular clinical and biochemical status of patients with CHD. Methods: Seventy known patients with CHD were allocated randomly to either a control group (C; no periodontal therapy) (n = 35) or an experimental group (E; NSPT in the form of scaling and root planing [SRP]) (n = 35). Cardiovascular status was assessed using clinical parameters such as pulse, respiratory rate, blood pressure (BP), and biochemical parameters, such as high‐sensitivity C‐reactive protein (hsCRP), lipid profile, and white blood cell (WBC) count, at baseline and 1, 3, and 6 months. Intergroup and intragroup comparisons were performed using Student t test, and P <0.05 was considered statistically significant. Results: The complete data at the end of the study were provided by only 55 patients (group C, n = 25; group E, n = 30). Highly statistically significant reduction was observed in systolic BP (7.1 mm Hg) and very‐low‐density lipoproteins (VLDLs; 5.16 mg/dL) in group E. Changes were also observed in other cardiovascular biochemical and clinical parameters but were not statistically significant. Conclusions: NSPT (in the form of SRP) positively affects limited cardiovascular (clinical and biochemical) status of patients with CHD. Reduction in triglyceride, VLDL, total WBC, lymphocyte, and neutrophil counts and increase in hsCRP, total cholesterol, high‐density lipoprotein, and low‐density lipoprotein levels were observed. Highly significant reduction in VLDL cholesterol levels and systolic BP was observed among the various parameters measured.     

Long‐Term Effect of Four Surgical Periodontal Therapies and One Non‐Surgical Therapy: A Systematic Review and Meta‐Analysis

Background: The aim of this systematic review is to evaluate the long term (≥2 years) effect of four surgical and non‐surgical therapies in treating periodontal disease. Methods: An electronic search of four databases and a hand search of peer‐reviewed journals for relevant articles were conducted. Prospective human controlled clinical trials were included that compared surgical therapy to non‐surgical therapy in ≥10 patients diagnosed with chronic periodontitis with a follow‐up period of ≥2 years and that reported change in probing depth (PD) and clinical attachment level (CAL) after the therapy. Random effect meta‐analysis was performed to compare the outcome of surgical and non‐surgical therapy in shallow, moderate, and deep PD. Results: Eight human prospective clinical trials were included. In 1‐ to 3‐mm PD, scaling and root planing (SRP), modified Widman flap (MWF), and osseous surgery (OS) resulted in 23.2%, 39.4%, and 61.39% CAL loss, respectively; SRP, MWF, and OS resulted in increased mean PD of 2.5%, 3.3%, and 6.3%, respectively. In 4‐ to 6‐mm PD, SRP, MWF, and OS resulted in 8.4%, 6.5%, and 5.22% CAL gain, respectively; SRP, MWF, and OS resulted in 18.7%, 25.4%, and 30.8% PD reduction, respectively. In PD ≥7 mm, SRP, MWF, and OS resulted in 9.8%, 14.2%, and 9.38% CAL gain, respectively; SRP, MWF, and OS resulted in mean PD reduction of 21.6%, 33.1%, and 42.8%, respectively. Conclusions: Surgical therapy had significantly more CAL loss than non‐surgical therapy in shallow PD. In moderate PD, MWF had significantly more PD reduction than SRP, and there was significantly less CAL gain with surgical therapy. In deep PD, OS had significantly higher PD reduction than SRP.     

Non‐Surgical Periodontal Therapy Improves Serum Levels of C‐Reactive Protein and Edematous States in Female Patients With Idiopathic Edema

Background: The relationship between periodontal disease and systemic disease is revealing new and exciting associations. Idiopathic edema presents a clinical syndrome with obscure pathophysiology. The present study investigates whether non‐surgical periodontal therapy is beneficial in patients who are not responding to conventional treatment of idiopathic edema. Methods: Thirty patients with idiopathic edema were allocated to intervention and control groups. All the subjects were assessed for systemic (body weight, body mass index, visual scale of edema, serum C‐reactive protein, and serum albumin) and periodontal (plaque index, calculus index, and gingival index) parameters. Non‐surgical periodontal therapy, including oral hygiene instructions, scaling and root planing, and systemic antibiotic therapy, was provided in the intervention group. Both groups were reevaluated after 4 weeks. Results: Both groups were comparable at baseline. All parameters, except serum albumin, showed significant improvement after periodontal therapy. The control group showed further worsening of these parameters. Conclusions: This study shows that sources for systemic inflammation, such as periodontal disease, could affect the pathogenesis of idiopathic edema. Successful elimination of such covert sources of inflammation leads to a clinical benefit in patients who are distressed by this condition.     

Comparison of Glycated Hemoglobin Levels in Individuals Without Diabetes and With and Without Periodontitis Before and After Non‐Surgical Periodontal Therapy

Background: Only a few studies have examined the association between periodontitis and glycated hemoglobin (HbA1c) levels in individuals without diabetes. The aim of this study is to compare HbA1c levels in individuals without diabetes and with and without periodontitis before and after non‐surgical periodontal therapy. Methods: This comparative study was done on individuals without diabetes who were 35 to 65 years old. Group A consisted of 30 individuals without periodontitis, and group B consisted of 30 individuals with periodontitis. Body mass indices and clinical parameters, including oral hygiene index‐simplified (OHI‐S) score, gingival index (GI), probing depth (PD), clinical attachment level (CAL), and HbA1c level, of all participants were recorded. All participants received non‐surgical periodontal therapy (scaling and root planing). After 3 months, all participants were reexamined, and clinical parameters and HbA1c levels were evaluated and compared to baseline values. Results: There were significant differences between group A and group B in regard to baseline OHI‐S, GI, PD, and HbA1c (P <0.05). There was no clinical attachment loss in group A, either at baseline or after 3 months. At the end of 3 months, group B showed improvement in all clinical parameters (P <0.05) and their HbA1c levels also significantly decreased (P <0.05), although the values never reached those of group A. Conclusion: The HbA1c levels of individuals without diabetes and with periodontitis (group B) were significantly reduced 3 months after non‐surgical periodontal therapy, although they never reached the same levels as those of the individuals without diabetes or periodontitis (group A).     

Non‐Clinical Factors Associated With Referrals to Periodontal Specialists: A Systematic Review

Background: Comprehensive understanding of the referral process and factors associated with it will assist general dentist (GD)–periodontist relationships and benefit patient care and services. Non‐clinical factors (NCFs) influence clinical decision making but are rarely considered. The objective of this review is to identify NCFs found to be associated with referrals to periodontal specialists. Methods: A systematic review of English‐language literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. An electronic search was carried out using the Cumulative Index to Nursing and Allied Health Literature, Dentistry and Oral Sciences Sources, and PubMed. Search terms used included: 1) refer; 2) referral; 3) periodontal; and 4) periodontist. Potentially relevant publications were analyzed in detail using predetermined inclusion and exclusion criteria. Selected papers were assessed using the Mixed Methods Appraisal Tool, and data extracted were thematically synthesized. Results: Ten studies that examined NCFs fulfilled inclusion criteria. Four NCF themes identified were practice‐, GD‐, patient‐, and periodontist‐related factors. Conclusions: Limited literature is available on NCFs associated with referrals to periodontal specialists. Within the limits of this systematic review, NCFs affecting the referral process are practice‐, GD‐, patient‐, and periodontist‐related factors. These vary among different GD populations studied. Factors that could be targeted to improve referral processes include geographic location, undergraduate training, and continuing professional development.     

Intrapregnancy Non‐Surgical Periodontal Treatment and Pregnancy Outcome: A Randomized Controlled Trial

Background: The purpose of the present study is to investigate the potential link between maternal periodontitis and pregnancy outcomes, including preterm birth (<37 weeks) and low birth weight (<2,500 g). Methods: Ninety nine pregnant females with mild/moderate periodontitis were randomly allocated to a control (n = 50) or test (n = 49) group. Test group participants received intrapregnancy non‐surgical periodontal treatment, whereas this was deferred until after delivery for controls. Demographic and baseline clinical data were obtained for all participants at initial assessment pretreatment. Clinical data were rerecorded for test participants at review 8 weeks after treatment. Birth outcomes were completed at delivery by midwives who also collected cord blood samples when possible; the latter were analyzed to determine the presence/levels of cytokines interleukin (IL)‐1β, IL‐6, and IL‐8. All data were analyzed on an intention‐to‐treat basis using appropriate statistical tests. Results: Random allocation of participants resulted in well‐balanced control and test groups. All test group participants and all but one control participant gave birth to a live infant. No significant differences were detected between control and test groups with regard to birth outcome measures of birth weight and gestational age or in relation to cytokine prevalence/levels. Conclusion: Intrapregnancy non‐surgical periodontal treatment, completed at 20 to 24 weeks, did not reduce the risk of preterm, low‐birth‐weight delivery in this population.     

Effect of Non‐Surgical Periodontal Treatment on Gingival Crevicular Fluid and Serum Endocan,Vascular Endothelial Growth Factor‐A,and Tumor Necrosis Factor‐Alpha Levels

Background: Periodontitis is a chronic inflammatory disease that occurs due to the interaction between pathogenic microorganisms and host defenses. Endocan is a proteoglycan secreted by endothelial cells under the control of inflammatory cytokines. Aims of the study are to determine serum and gingival crevicular fluid (GCF) endocan levels in the pathogenesis of periodontal diseases, supported with vascular endothelial growth factor (VEGF‐A) and tumor necrosis factor (TNF)‐alpha levels. This study additionally aims to evaluate correlation between GCF endocan levels, VEGF‐A, and TNF‐α levels with periodontal probing depth (PD). Methods: The study consists of two groups: group 1 (n = 20), healthy individuals; group 2 (n = 20), individuals with generalized chronic periodontitis (CP). Clinical measurements were recorded; GCF and serum samples were obtained from each participant before and 6 weeks after therapy. Levels of biomarkers were measured by enzyme‐linked immunosorbent assay. Intergroup comparisons of biochemical and clinical parameters were analyzed by Kruskal–Wallis/Bonferroni‐adjusted Mann–Whitney U test using statistical software. Results: Serum and GCF endocan, VEGF‐A, and TNF‐α levels were significantly higher in patients with CP than in healthy individuals (P <0.001) and decreased after treatment (P <0.03). A significant correlation was observed between GCF TNF‐α and PD (4 mm ≤ PD ≤5 mm and PD ≥6 mm). A significant relationship was found among GCF endocan and TNF‐α, VEGF‐A, CAL, and GI for all groups (P <0.05). Conclusions: Endocan and TNF‐α levels, both in GCF and serum, increased from health to periodontitis and decreased with non‐surgical periodontal treatment. Within the limits of the study, endocan may be considered as a potential inflammatory marker for periodontal disease.     

Impact of Cigarette Smoking on Clinical Outcomes of Periodontal Flap Surgical Procedures: A Systematic Review and Meta‐Analysis

Background: Periodontal flap surgery is frequently used to remove subgingival deposits, yielding consequential reductions in gingival inflammation and probing depth (PD) with a gain in clinical attachment level (CAL) to treat advanced periodontal disease. However, clinical studies have reported diminished periodontal healing in smokers compared with non‐smokers. The aim of the present systematic review and meta‐analysis was to assess the impact of cigarette smoking on clinical outcomes following periodontal flap surgical procedures. Methods: A systematic electronic review of articles relevant to periodontal flap surgical procedures in smokers was conducted from 1977 to March 2014 inclusive, using predefined, optimized search strategies. Meta‐analyses were done separately for changes in the two primary outcomes of PD and CAL. Results: The initial search yielded 390 titles and abstracts. After screening, eight controlled clinical studies were finally selected. Three studies were assessed as having a low risk of bias, two as having moderate risk of bias, and three as having a high risk of bias. Qualitative assessment of the articles consistently showed an improved treatment effect among non‐smokers versus smokers. The reduction in PD in smokers and non‐smokers ranged from 0.76 to 2.05 mm and 1.27 to 2.40 mm, respectively. For CAL, the gain in non‐smokers versus smokers ranged from 0.29 to 1.6 mm and 0.09 to 1.2 mm, respectively. Meta‐analysis on eight studies reporting on 363 study participants demonstrated an increased reduction in mean (95% confidence interval) PD of 0.39 (0.33 to 0.45) mm. Similar results were found for mean gain in CAL (0.35 [0.30 to 0.40] mm, n = 4 studies). Conclusions: Considering the relatively homogenous information available, the authors conclude that active smokers could be candidates for periodontal flap surgical procedures. However, the magnitude of the therapeutic effect is compromised in smokers compared with non‐smokers. Therefore, cigarette smokers should be: 1) encouraged to abstain from smoking; and 2) thoroughly informed preoperatively of substantial reduction in clinical outcomes compared with non‐smokers.     

Commentary: Incorporating Patient‐Reported Outcomes in Periodontal Clinical Trials

The authors review patient‐reported outcome (PRO) metrics for dentistry, and in particular, periodontics. The PRO commentary for periodontics includes a review of split‐mouth, randomized, controlled clinical trial results that specifically tracked pain at different sites over time after intervention and provided guidelines for peak pain time points and evidence for referred pain assessment when studying soft tissue augmentation procedures. Both the questions that are asked of patients and the timing of those questions are important study design considerations. The authors suggest PRO methodology for periodontal clinical trials that can be used to identify information important to patients and clinicians.     

Microbiologic Response to Periodontal Therapy and Multivariable Prediction of Clinical Outcome

Background: This study assesses the microbiologic effects of a two‐phase antimicrobial periodontal therapy and tested microbiologic, clinical, and biologic markers as prognostic indicators for clinical success. Methods: Eighty patients with chronic or aggressive periodontitis received periodontal treatment supplemented with 375 mg amoxicillin plus 500 mg metronidazole, three times daily for 7 days. In group A, antibiotics were given during the first non‐surgical phase (T1); in group B, antibiotics were given during the second surgical phase (T2). Six microorganisms, group assignment, demographic and clinical variables, peak values of 15 cytokines, and nine acute‐phase proteins in serum were evaluated as potential predictors of at least one site with probing depth (PD) >4 mm and bleeding on probing (BOP) at 12 months post‐therapy. Results: T1 decreased the counts of Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia (Pi), and Treponema denticola significantly more in group A than group B. Aggregatibacter actinomycetemcomitans and Parvimonas micra (Pm) showed a significant decrease only if the treatment was supplemented with antibiotics, i.e., T1 in group A, or T2 in group B. After T2, differences between groups were no longer significant. A multivariable model including four parameters revealed a predictive value of Pm (odds ratio [OR] = 4.38, P = 0.02) and Pi (OR = 3.44, P = 0.049) and yielded moderate accuracy for predicting the treatment outcome (area under the curve = 0.72). Host‐derived factors and treatment sequence were not significantly associated with the outcome. Conclusions: Long‐term microbiologic outcomes of periodontal therapy with adjunctive antibiotics either in T1 or T2 were similar. Detection of Pm before therapy was a predictor for persistence of sites with PD >4 mm and BOP at 12 months post‐treatment.     

Surgical Management of Peri‐Implantitis: A Systematic Review and Meta‐Analysis of Treatment Outcomes

Background: This systematic review was requested by the Task Force of the American Academy of Periodontology as a follow‐up study of the 2013 report, with an aim to investigate the efficacy of different surgical approaches to treat peri‐implantitis. Methods: A search of four electronic databases from January 1990 to May 2013 was performed. Studies included were human clinical trials published in English that applied surgeries for treating peri‐implantitis. Parameters evaluated included probing depth (PD) reduction, clinical attachment level gain, bleeding on probing (BOP) reduction, radiographic bone fill (RBF), and mucosal recession. The weighted mean (WM) and the 95% confidence interval of the studied parameters were estimated with the random‐effect model. Results: A total of 1,306 studies were initially identified, after reviewing titles, abstracts, and full texts, and 21 articles, 12 of which were case series, were finally included. Four treatment groups were identified: 1) access flap and debridement; 2) surgical resection; 3) application of bone grafting materials; and 4) guided bone regeneration. The mean initial PD ranged from 4.8 to 8.8 mm, with initial BOP ranging from 19.7% to 100%. Short‐term follow‐ups (3 to 63 months) revealed that the available surgical procedures yielded a WM PD reduction of 2.04 (group 2) to 3.16 mm (group 4), or 33.4% to 48.2% of the initial PD. The WM RBF was 2.1 mm for groups 3 and 4. Conclusions: Within the limitation of this systematic review, the application of grafting materials and barrier membranes resulted in greater PD reduction and RBF, but there is a lack of high‐quality comparative studies to support this statement. The results might be used to project treatment outcomes after surgical management of peri‐implantitis.     

Systemic Inflammatory Biomarkers and Their Association With Periodontal and Diabetes‐Related Factors in the Diabetes and Periodontal Therapy Trial,A Randomized Controlled Trial

Background: The present study evaluates effects of non‐surgical periodontal treatment on serum biomarkers in patients with type 2 diabetes mellitus (t2DM) and chronic periodontitis who participated in the Diabetes and Periodontal Therapy Trial (DPTT); and associations among diabetes markers, serum biomarkers, and periodontal measures in these patients. Methods: DPTT participants randomized to receive immediate or delayed non‐surgical periodontal therapy were evaluated at baseline and 6 months. Serum samples from 475 participants with 6‐month data were analyzed for the following biomarkers: 1) high sensitivity C‐reactive protein; 2) E‐selectin; 3) tumor necrosis factor (TNF)‐α; 4) vascular cell adhesion molecule (VCAM); 5) interleukin (IL)‐6; 6) IL‐8; 7) intercellular adhesion molecule; and 8) IL‐10. Changes in biomarker levels from baseline and correlations among biomarker levels and clinical findings were analyzed. Results: No differences between treatment and control groups were observed for any biomarkers at baseline or 6 months (P >0.05 for all variables). VCAM levels increased by an average (standard deviation) of 17.9 (99.5); ng/mL (P = 0.006) and E‐selectin decreased by 2.33 (16.08) ng/mL (P = 0.03) in the treatment group after 6 months. E‐selectin levels were significantly correlated with DM‐related variables (hemoglobin A1c [HbA1c] and fasting glucose) at baseline and with 6‐month change in both groups; no significant correlations were found among periodontal clinical parameters and serum biomarkers or DM‐related variables. Neither HbA1c or body mass index varied during the study period in either study group. Conclusions: Non‐surgical periodontal therapy and periodontal disease severity were not associated with significant changes in serum biomarkers in DPTT participants during the 6‐month follow‐up. Correlations among changes in E‐selectin, IL‐6, and DM‐related variables suggest that t2DM may be the primary driver of systemic inflammation in these patients.     

Efficacy of Local Antimicrobials in the Non‐Surgical Treatment of Patients With Periodontitis and Diabetes: A Systematic Review

Background: Patients with diabetes present a worse response to periodontal treatment. Local antimicrobials as an adjunct to scaling and root planing (SRP) provide additional benefits in the treatment of periodontitis in healthy patients. This review aims to evaluate the effects of local antimicrobials as an adjunct to SRP, compared with SRP alone, on periodontal clinical parameters of patients with chronic periodontitis (CP) and diabetes mellitus (DM). Methods: Only randomized controlled trials with: 1) at least 6 months of follow‐up; 2) SRP, in combination with local antimicrobials; and 3) patients with periodontitis and DM were considered eligible. MEDLINE, EMBASE, and LILACS databases were searched for articles published up to January 2016. Random‐effects meta‐analyses were conducted for clinical attachment level (CAL), probing depth (PD), bleeding on probing, and gingival index change after treatment. Results: Of 153 papers potentially relevant to this review, six were included. The majority of trials showed a significant PD reduction and CAL gain associated with use of local antimicrobials in patients with type 1 and type 2 DM. Only studies that included well‐controlled patients and applied antimicrobials at the deepest sites or sites with baseline PD ≥5 mm presented significant PD reduction and CAL gain. Conclusion: In patients with DM and CP, use of local antimicrobials as an adjunct to SRP may result in additional benefits compared with SRP alone in PD reduction and CAL gain, especially in well‐controlled individuals and deep sites.