Impact of Adjunctive Diode Laser Application to Non-Surgical Periodontal Therapy on Clinical, Microbiological and Immunological Outcomes in Management of Chronic Periodontitis: A Systematic Review of Human Randomized Controlled Clinical Trials

Figures & data

Figure 1 PRISMA flow-chart of the study selection criteria for the included article reports.

Notes: Adapted from Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. © 2009 Moher et al. Creative Commons Attribution License.³⁹

Table 1 Shows a Tabular Representation of All the Eligible Randomized Controlled Trials Studies in Terms of Demography, Study Design, Journal Published in Peer Reviewed Journal, Industry Funds, Ethical Approval, Intervention Groups, Number of Laser Session After SRP Influencing Factors (Systemic Diseases and Smoking), Treatment Duration and Percentage of Documentation

Author and Citation	Origin of the Paper	Systematic Disease	Smoker	Laser Treatment Session (Day) After SRP	Type of Study	Published in a Peer Reviewed Journal	Ethical Approval	No. of Participants	M/F	Age (Range/Mean) ± SD)	Age of SPR/SPR + Laser Groups	No. of Pocket	Saline Irrigation After Lasing	Duration of Treatment (Days)	PD ≥4 mm/≥5mm
Chandra et al 2019^Citation42	INDIA	NIDDM	No	0	Parallel	No	Yes	3	18/18	30–60	50.6/48.05	–	No	90	Yes/yes
Euzebio Alves et al 2013^Citation43	BRAZIL	No	No	0,7th	Split mouth	Yes	Yes	46	13/23	37–64/46±8.11	–	–	No	180	-/Yes
De Micheli et al 2011^Citation44	BRAZIL	No	No	0,7th	Split mouth	Yes	Yes	27	8/19	-/48.5	-	-	No	42	-/Yes
Meseli et al 2019^Citation45	Turkey	No	No	0	Split mouth	No	Yes	11	-	35–65/44.09± 4.48	-	56	No	133	-/Yes Residual pocket
Dengizek et al 2018^Citation46	TURKEY	NIDDM	No	0	Parallel	Yes	Yes	37	17/20	43–57	49.7±6.63/5.85±6.23	-	No	180	Yes/yes
Dakhil et al 2019^Citation47	IRAQ	NIDDM	-	0,7th,14th	Split mouth	No	-	20	-	35–65	-	-	No	90	Yes/-
Nguyen et al 2015^Citation48	USA	No	Yes	0	Split mouth	Yes	Yes	22	13/9	47–81/61.8	-	56+58	No	90	-/yes
Saglam et al 2014^Citation49	TURKEY	No	No	0	Parallel	Yes	Yes	30	18/12	32–57	40.83±7.64/42.13±9.05	-	Yes	180	-/yes
Kocak et al 2016^Citation50	TURKEY	NIDDM	No	0	Parallel	Yes	Yes	60	30/30	35–60	53.1/51.7	-	No	90	-/yes
Hatipoglu et al 2017^Citation51	TURKEY	No	No	0	Parallel	No	Yes	40	20/20	-	-	-	No	180	-/yes
Crispino et al 2015^Citation52	ITALY	No	Yes	0	Split mouth	No	-	68	-	-/56.3	-	1224	No	120	Yes/yes
Balasubramaniam et al 2014^Citation53	INDIA	No	No	0	Parallel	Yes	Yes	30	18/12	18–65/38–27±14.1	-	1650	No	60	Yes/-
Dukic et al 2013^Citation54	CROATIA	No	No	0,3rd,7th	Split mouth	Yes	Yes	35	21/14	26–48/37±10.8	-	474+451	No	126	Yes/-
Zare et al 2014^Citation55	IRAN	Systemic diseases excluding bleeding disorders	No	0	Split mouth	No	-	21	11/10	-/42.2	-	207	No	600	Yes/-
Yadwad et al 2017^Citation56	INDIA	No	No	7th,14th	Parallel	Yes	-	40	-	30–50	-	-	No	84–98	-/yes
Percentage of documentation	100%	100%	93,33%	100%	100%	100%	73.33%	100%	73,33%	93,33%	73,33%	40%	100%	100%	100%

Abbreviations: NIDDM, non-insulin depended diabetes mellitus; SPR, scaling and root planning; SPR + laser, scaling and root planning and laser; F, female; M, male; No., number; SD, standard deviation.

Figure 2 Illustrates the percentage of the gender distribution according to the number of the recruited subjects.

Table 2 Shows a Tabular Representation of Diode Laser-Assisted Treatment Parameters Reported in the Included Eligible Randomized Controlled Trials Studies

Author and Citation	Wavelength (nm)	Power Output (Watt)	Peak Power (Watt)	Average Power (Watt)	Fluence (J/cm^2), J/mm^2	Emission Mode	Tip Movement	Pulse Frequency (Hz)	Duty Cycle (Time on/Time off) (msec)	Irradiance W/cm^2	Time Treatment for Pocket (sec)	Spot Size (mm) μ	Power Meter	Hot Tip (Initiation)
Chandra et al, 2019^Citation42	808	1.5–1.8	–	–	–	CW	–	–	–	–	–	320	–	–
Euzebio Alves et al, 2013^Citation43	808	1.5	–	–	–	CW	–	–	–	1193	40	400	Yes	–
De Micheli et al, 2011^Citation44	808	1.5	–	–	–	CW	–	–	–	1193	40	400	Yes	–
Meseli et al, 2019^Citation45	810	1	–	–	–	CW	–	–	–	–	20	200	–	–
Dengizek et al, 2018^Citation46	810	1	–	–	–	Gated	–	–	–	–	45/60	400	–	–
Dakhil et al, 2019^Citation47	940	0.8	–	–	–	CW	–	–	–	–	20	300	–	–
Nguyen et al, 2015^Citation48	940	0.8	–	–	0.8	CW	–	–	–	–	–	–	–	Yes
Saglam et al, 2014^Citation49	940	1.5	–	–	15	Gated	–	–	20/20	–	20	300	–	–
Kocak et al, 2016^Citation50	940	–	–	1.5	15/20 respectively	Gated	–	–	20/20	–	20	300	–	–
Hatipoğlu et al, 2017^Citation51	940	1.5	–	–	15	Gated	–	–	20/20	–	20	300	–	–
Crispino et al, 2015^Citation52	940	3	3	1	1.2 J/mm^Citation2	Pulsed	–	15	10/20	–	–	300–400	–	Yes
Balasubbramani et al, 2014^Citation53	970±15	1	–	–	93.4	CW	–	–	–	2820	30x2*	320	Yes	Yes (on photo)
Dukić et al, 2013^Citation54	980	–	2	0.66	–	Gated	–	–	25/50	–	20	300	–	–
Zare et al, 2014^Citation55	980	1	–	–	–	CW	2 mm/sec	–	–	–	–	400	–	–
Yadwad et al, 2017^Citation56	980	2	–	–	–	CW	–	–	–	2487	30x2*	320	–	–

Note: Treatment time, 30x2*means 60 seconds interval between lasing (thermal relaxation time).

Abbreviations: (-), unreported; J, joule; W, watt; cm², square centimetre; Sec, second; mm, millimetre.

Figure 3 Illustrates the percentage of various wavelengths utilised in the selected studies and the number between brackets shows the number of the studies in which wavelength used.

Figure 4 Shows the percentage of the recruited pocket depth measurements in relation to the utilized wavelengths.

Figure 5 Shows the percentage of the missing data related to the laser parameters.

Table 3 Illustrates the Methods of Assessment for All the Eligible Randomised Controlled Studies, Which Were the Clinical Parameters (PD/PPD, PI, BOP, GI, CAL, GL, API, MGI), Microbiological Analysis (CFU, PCR), Biochemical Markers (CRP, GCF, ROM, HbA1C), as Well the Number of Assessed Variables in Each Study

Author and Citation	PI	GI	CAL	CFU	HbA1C	PD/PPD	BOP	GCF	CRP	ROM	API	GL	MGI	PCR
Chadra et al, 2019^Citation42	Yes	Yes	Yes	Yes	Yes	Yes	–	–	–	–	–	–	–	–
Alves et al, 2013^Citation43	Yes	–	Yes	Yes	–	Yes	Yes	–	–	–	–	–	–	–
De Micheli et al, 2011^Citation44	Yes	–	Yes	Yes	–	Yes	Yes	–	–	–	–	–	–	–
Meseli et al, 2019^Citation45	Yes	Yes	–	–	–	Yes	Yes	Yes	–	–	–	–	–	–
Dengizek et al, 2018^Citation46	Yes	Yes	Yes	–	Yes	Yes	Yes	–	Yes	–	–	–	–	–
Dakhil et al, 2019^Citation47	–	–	Yes	–	–	Yes	Yes	–	–	–	–	–	–	–
Nguyen et al, 2015^Citation48	–	–	Yes	–	–	Yes	Yes	Yes	–	–	–	–	–	–
Saglam et al, 2014^Citation49	Yes	Yes	Yes	–	–	Yes	Yes	Yes	–	–	–	–	–	–
Koçak et al, 2016^Citation50	Yes	Yes	Yes	–	Yes	Yes	–	Yes	–	–	–		–	–
Hatipoğlu et al, 2017^Citation51	Yes	Yes	Yes	–	–	Yes	Yes	–	–	–	–	–	–	–
Crispino et al, 2015^Citation52	Yes	Yes	–	–	–	Yes	Yes	–	–	–	–	–	–	–
Balasubbramani et al, 2014^Citation53	Yes	–	Yes	–	–	Yes	Yes	–	–	Yes	–	–	–	–
Dukić et al, 2013^Citation54	–	–	Yes	–	–	Yes	Yes	–	–	–	Yes	–	–	–
Zare et al, 2014^Citation55	–	–	–	–	–	Yes	Yes	–	–	–	–	Yes	Yes	–
Yadwad et al, 2017^Citation56	Yes	Yes	Yes	–	–	Yes	Yes	–	–	–	–	–	–	Yes
Number of tests for the selected studies	11	8	12	3	3	15	13	4	1	1	1	1	1	1

Abbreviations: PD/PPD, pocket depth/periodontal pocket depth; PI, xx; BOP, bleeding on probing; GI, gingival index; CAL, clinical attachment level; GL, gingival level; API, approximal plaque index; MGI, marginal gingival index; CFU, colony forming units; PCR, polymerase chain reaction; CRP, C-reactive protein; GCF, gingival crevicular fluid; plasma ROM, reactive oxygen metabolite; HbA1C, glycated haemoglobin.

Table 4 Illustrates the Outcomes and the Follow-Up Period of the Eligible Studies

Citation	Follow-Up	Outcomes of Treatment
Chandra et al, 2019^Citation42	3 months	Laser group
		At 3 months: a significant reduction in the CFU (Aa and Pg), but 6.49% more reduction in HbA1c level without statistically significant.
		Both groups
		At 3 months: statistically significant improvement in PI (p value 0.003), but no statistically significant in the GI, PD, and CAL (p =0.000)
Euzebio Alves et al, 2013^Citation43	6 weeks 6 months	Laser group
		At 6 weeks and 6 months: no statistically significant improvement in CAL, PD, PI and BOP, compared to the control (SRP)
		At 6 weeks: statistically significant reduction in CFU (P>0.05) in Laser +SPR, compared to SRP
		Both groups
		At 6 weeks and 6 months: a statistically significant improvement in the CAL, PD, PI and BOP (P<0.001), an increase in the CEJ-MG distance without statistically difference between groups.
		At 6 months: Reduction in the CFU (Pg, Pi, Aa) was statistically significant in both groups
De Micheli et al 2011^Citation44	6 weeks	Laser group vs SRP
		No statistically significant difference in the CAL gain as well in the PPD, BOP and microbes’ reduction in laser group
		An increase in the average value of the gingival retraction of 0.6 mm (P=0.019), average 0.5mm (p=0,009);
		Statistically significant reduction in the numbers of CFU BT (P<0.001) in the laser group and (P<0.001) in the control group, but no significant differences between the groups 6 months after the treatment (P=0.55).
		Control group
		Statistically significant in the CAL gain (P<0.001) in the average value of 1.9 mm higher than that in the laser group (P=0.039).
		Both groups
		A reduction in the A.a colonies was higher in the control group, but statistically insignificant (P=0.10). No association observed in the presence of P.g and P.I at any time in control group.
		The studied cclinical parameters: the clinical probing depth (CPD) CAL resulted in significant enhancement in the control group, compared to laser group (P = 0.014 and P = 0.039, respectively). The results of the PI and BOP were similar in both groups.
		The microbiological parameters showed no significant differences between both groups.
Meseli et al, 2019^Citation45	8 weeks	Both groups
		PI, PD, CAL, GI, BOP showed significant improvement;
		GCF volume decreased parallel to the declines in GI and BOP
Dengizek et al, 2018^Citation46	3,6 months	Laser group,
		At 3, 6 months: statistically significant (P < 0.05) reduction GI, BOP, PD > 4 mm and PD >7 mm, compared to control group.
		Control group
		At 6 months: GI was a statistically significant (P < 0.05).
		Both groups
		At 3, 6 months: CRP serum and HbA1c levels were similar between the groups (P > 0.05). The clinical parameters, GI, BOP, PD showed statistically significant (P < 0.05) improvement, compared to the baseline, as well as PI, CAL and PD (P > 0.05)
Dakhil et al, 2019^Citation47	3 months	Both groups
		At 3 months: statistically significant gain in the CAL and a reduction in the BOP but no significant differences between the groups
Nguyen et al, 2015^Citation48	3 months	Both groups
		At 3 months: statistically significant reduction in the PD and BOP and gain in the CAL but not significantly different between groups.
		The GCF IL-1b levels between both groups were not statistically significant. IL-1b levels were not statistically different between both groups (baseline, P <0.36; 3 months, P <0.97).
Saglam et al, 2014^Citation49	1,3,6 months	Laser group vs control group
		Statistically significant (p < 0.05) improvement in the below clinical parameters and biochemical markers, compared to control:
		At 1 month: PPD, GI BOP, MMP-8
		At 3 months: BOP, TIMP-1
		At 6 months: PI, GI, TIMP-1. The reduction in PD was 1.0 mm and in the gain of CAL was 0.2 mm and both of them
Koçak et al, 2016^Citation50	1,3 months	Laser group
		At 1, 3 months: statistically significant reduction in the PD of 5 and 6mm and gain in the CAL (P<0.05), compared to the control.
		Control group
		At 1, 3 months: the levels of GCF IL-8 showed statistically significant (P<0.05) differences, compared to baseline.
		Both groups
		At 1, 3 months: - PD, CAL, PI, and GI were statistically significant (P<0.05) reduced, compared with baseline in both groups but no statistically significant difference in any analyzed whole-mouth clinical parameter changes between the groups at any time points (P>0.05) - The PD ≥ 7mm and CAL showed statistically significantly improvement in both groups at all time points, compared to the baseline (P < 0.05). - Statistically significant reduced in the levels of GCF IL-8 (P<0.05) - Statistically significant reduced in the levels of GCF IL-6 (P<0.05)
		At 3 months: - HbA1c values statistically significantly reduced (P<0.05) - GCF IL-1β levels statistically significant reduced in both groups (P<0.05). - Statistically significant increase in the GCF IL-8 level (P<0.05), compared to the first month follow-up.
Hatipoğlum et al, 2017^Citation51	1,3,6 month	Both groups
		At 1month: significant improvement (p<0.05) in GI level, no significant improvement in PD but significant reduction in the CAL (p<0.05).
		At 3months: Statistically significant reduction in The PI and GI (p<0.05), statistically significant gain in the CAL (p<0.05); but no significant improvement in PD.
		At 6 months: Statistically significant improvement in the PI, GI, and BOP (p<0.05), statistically significant gain in the CAL (p<0.05); but no significant improvement in PD
Crispino et al, 2015^Citation52	4 months	Laser group vs control group
		The average GI level reduced double compared to the control group (80% vs 44%)
		The PI and PD were reduced by a mean percentage of 67% and 76%, whereas in the control group the mean percentage of reduction was 57% and 58%.
Balasubramaniam et al, 2014^Citation53	1,2 months	Laser group
		At 1, 2 months: there was no statistically significant in the ROM serum level. Statistically significant improvement in the BOP and CAL gain in single and multirooted teeth
		At 2 months: there was no statistically significant in the clinical parameters.
		Both groups
		At 1, 2 months: statistically significant improvement in the BOP and CAL gain in single and multirooted teeth
Dukić et al 2013^Citation54	6,18 weeks	Laser group
		At 18 weeks: ONLY statistically significant reduction in the PD of 4–6mm, compared to the baseline (P < 0.05).
		At period time between 6 to 18-week, statistically significant reduction in PD of 4–6mm (P < 0.05).
		Both groups
		At 6, 18 weeks: the results were similar in terms of API, BOP, PD in deep pockets and CAL.
Zare et al, 2014^Citation55	2 months	Laser group
		Statistically significant improvement in the BOP (p = 0.033)
		Both groups:
		Statistically significant reduction in the GL (recession) and MGI (p < 0.001) and but no statistically significant differences between both group in the above clinical parameters of p = 0.903 and p = 0.379 respectively
Yadwad et al, 2017^Citation56	4–6weeks 12–14 weeks	Laser group
		At 4–6 weeks: there was a statistically significant reduction in the Pg level better of 21.2%, compared to the baseline (41,1%).
		At 12–14 weeks: there was no statistically significant increase in Pg level.
		Both groups
		At 4–6 weeks: Statistically significant improvement in the BOP, PI, GI and Pg (PCR)
		At 12–14 weeks: Statistically significant improvement in the BOP, PI, GI, PD and PCR

Table 5 Shows the Summary of the Statistical Significance Improvement in the Clinical, Microbiological and Immune-Biochemical Parameters and Markers for SPR Alone Group, SPR + Laser Group, as Well the Difference Between SPR Alone Group and SPR + Laser Group at Various Follow-Up Time-Points

Follow-Up Time Point	4–6 Weeks			2–3 Months			6 Months
Author and Citation	Scaling and Root Planning Group	Scaling and Root Planning and Laser Group	Difference Between Scaling and Root Planning and Scaling and Root Planing and Laser Groups	Scaling and Root Planning Group	Scaling and Root Planning and Laser Group	Difference Between Scaling and Root Planning and Scaling and Root Planing and Laser Groups	Scaling and Root Planning Group	Scaling and Root Planning and Laser Group	Difference Between Scaling and Root Planning and Scaling and Root Planing and Laser Groups
	(SRP)	(SRP + laser)	(SRP alone/SRP+ laser)	(SRP)	(SRP + laser)	(SRP alone/SRP + laser)	(SRP)	(SRP + laser)	(SRP alone/SRP + laser)
Chandra et al, 2019^Citation42				CFU, HbA1c, PI, GI, CAL, PD	CFU, HbA1c, PI, GI, CAL, PD	CFU
Euzebio Alves et al, 2013^Citation43	CFU, CAL, PD, PI, BOP	CFU, CAL, PD, PI, BOP	0				PD, CAL, BOP	PD, CAL, BOP	0
De Micheli et al, 2013^Citation44	CAL, GM, PD, CEJ	CAL, GM, PD, CEJ	0				CFU, PI, BOP	CFU, PI, BOP	0
Meseli et al, 2019^Citation45				CGF, GI, BOP, PD, CAL	CGF, GI, BOP, PD, CAL	0
Dengizek et al, 2018^Citation46				PI, GI, BOP, PD, HbA1c	PI, GI, BOP, PD, HbA1c	CAL, GI	PI, GI, BOP, PD, HbA1c	PI, GI, BOP, PD, HbA1c	CA, GI
Dakhil et al, 2019^Citation47				CAL, BOP	CAL, BOP	0
Nguyen et al, 2015^Citation48				PD, BOP, CAL, GCF	PD, BOP, CAL, GCF	0
Saglam et al, 2014^Citation49	GCF, PD, CAL, BOP	GCF, PD, CAL, BOP	BOP	PD, CAL, GCF, PI, GI, BOP	PD, CAL, GCF, PI, GI, BOP	BOP	PD, CAL, GCF, PI, GI, BOP	PD, CAL, GCF, PI, GI, BOP	PI, GI
Kocak et al, 2016^Citation50	GCF, PD, CAL, BOP/GI, PI	GCF, PD, CAL, BOP/GI, PI	0	PD, CAL, GCF, PI, GI, BOP, HbA1c	PD, CAL, GCF, PI, GI, BOP, HbA1c	0
Hatipoğlu et al, 2017^Citation51	PD, CAL, BOP/GI, PI	PD, CAL, BOP/GI, PI	CAL, BOP, PI	PD, CAL, PI, GI, BOP	PD, CAL, PI, GI, BOP	PI	PD, CAL, PI, GI, BOP	PD, CAL, PI, GI, BOP	BOP, PI
Crispino et al, 2015^Citation52				GI, PI, PD	GI, PI, PD	GI
Balasubbramani et al, 2014^Citation53	PD, CAL, BOP/BI, ROM, PI,	PD, CAL, BOP/BI, ROM	0	PD, CAL, BOP, ROM	PD, CAL, BOP, ROM	0
Dukić et al, 2013^Citation54	PD, CAL, BOP	PD, CAL, BOP	0
Zare et al, 2014^Citation55	MGI/GI, GL/CAL, BOP	MGI/GI, GL/CAL, BOP	BOP
Yadwad et al, 2017^Citation56	GCF, PI, GI, BOP	GCF, PI, GI, BOP	0	BOP, CAL, PPD, GI, PI	BOP, CAL, PPD, GI, PI	0

Abbreviations: PD/PPD, pocket depth/periodontal pocket depth; PI, plaque index; BOP, bleeding on probing; GI, gingival index; CAL, clinical attachment level; GL, gingival level; API, approximal plaque index; MGI, marginal gingival index; CFU, colony forming units; PCR, polymerase chain reaction; CRP, C-reactive protein; GCF, gingival crevicular fluid; plasma ROM, reactive oxygen metabolite; HbA1C, glycated hemoglobin.

Figure 6 Quality assessment of all the included eligible studies (n=15) in 4 domains and overall bias. Studies were graded as low risk (green), moderate risk (some concerns, yellow) or high risk (red) for each domain. There is no summation across fields. The assessment was performed using RoB tool for randomised trials, Version 2.0 (RoB 2).⁴⁰,⁴¹

Figure 7 Risk of bias assessment graph of all the included studies expressed as percentages for 4 main domains as well overall bias, based on the agreed answers across two independent authors (MM and RH). The assessment was performed using RoB tool for randomised trials, Version 2.0 (RoB 2).⁴⁰,⁴¹

Figure 8 Shows the summary of the risk of Bias assessment of all the domains of the included studies based on agreed answers across two independent authors (MM &RH). The assessment was performed using RoB tool for randomised trials, Version 2.0 (RoB 2).⁴⁰,⁴¹

Figure 9 Risk of bias assessment graph of all the included studies for all the domains expressed as percentages, based on agreed answers across two independent authors (MM and RH). The assessment was performed using RoB tool for randomised trials, Version 2.0 (RoB 2).⁴⁰,⁴¹

Figure 10 Illustrates the spiral movement of the laser fiber (arrow in yellow) inside the periodontal pocket by which 14 of the selected studies in this systematic review utilized.

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097

 PubMed Web of Science ®Google Scholar

Chandra S, Shashikumar P. Diode laser - a novel therapeutic approach in the treatment of chronic periodontitis in type 2 diabetes mellitus patients: a prospective randomized controlled clinical trial. J Lasers Med Sci. 2019;10(1):56–63. doi:10.15171/jlms.2019.09

 PubMed Web of Science ®Google Scholar

Euzebio Alves VT, de Andrade AK, Toaliar JM, et al. Clinical and microbiological evaluation of high intensity diode laser adjutant to non-surgical periodontal treatment: a 6-month clinical trial. Clin Oral Investig. 2013;17(1):87–95. doi:10.1007/s00784-012-0703-7

 PubMed Web of Science ®Google Scholar

De Micheli G, de Andrade AK, Alves VT, et al. Efficacy of high intensity diode laser as an adjunct to non-surgical periodontal treatment: a randomized controlled trial. Lasers Med Sci. 2011;26(1):43–48. doi:10.1007/s10103-009-0753-5

 PubMed Web of Science ®Google Scholar

Meseli SE, Kuru B, Kuru L. Effects of 810-nanometer diode laser as an adjunct to mechanical periodontal treatment on clinical periodontal parameters and gingival crevicular fluid volume of residual periodontal pockets. Niger J Clin Pract. 2017;20(4):427–432. doi:10.4103/1119-3077.181382

 PubMed Web of Science ®Google Scholar

Dengizek ES, Gursel M, Eltas A, et al. 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 Hygiene. 2019;17:292–299. doi:10.1111/idh.12384

 PubMed Web of Science ®Google Scholar

Dakhil FF, Mahmood AS. Evaluation of clinical effects of a 940nm diode laser as adjunctive therapy in the treatment of periodontal pockets. Iraqi Dent J. 2017;39(1):12–15.

 Google Scholar

Nguyen NT, Byarlay MR, Reinhardt RA, et al. Adjunctive non-surgical therapy of inflamed periodontal pockets during maintenance therapy using diode laser: a randomized clinical trial. J Periodontol. 2015;86(10):1133–1140. doi:10.1902/jop.2015.150152

 PubMed Web of Science ®Google Scholar

Saglam M, Kantarci A, Dundar N, Hakki SS. Clinical and biochemical effects of diode laser as an adjunct to nonsurgical treatment of chronic periodontitis: a randomized, controlled clinical trial. Lasers Med Sci. 2014;29(1):37–46. doi:10.1007/s10103-012-1230-0

 PubMed Web of Science ®Google Scholar

Koçak E, Sağlam M, Kayış SA, et al. Nonsurgical periodontal therapy with/without diode laser modulates metabolic control of type 2 diabetics with periodontitis: a randomized clinical trial. Lasers Med Sci. 2016;31(2):343–353. doi:10.1007/s10103-016-1868-0

 PubMed Web of Science ®Google Scholar

Hatipoğlu M, Aytekin Z, Daltaban Ö, et al. The effect of diode laser as an adjunct to periodontal treatment on clinical periodontal parameters and halitosis: a randomized controlled clinical trial. Cumhuriyet Dent J. 2017;20:152–160. doi:10.7126/cumudj.369035

 Google Scholar

Crispino A, Figliuzzi MM, Iovane C, et al. Effectiveness of a diode laser in addition to non-surgical periodontal therapy: study of intervention. Ann Stomatol. 2015;6(1):15–20.

 PubMedGoogle Scholar

Balasubramaniam AS, Thomas LJ, Ramakrishnanan T, Ambalavanan N. Short-term effects of nonsurgical periodontal treatment with and without use of diode laser (980 nm) on serum levels of reactive oxygen metabolites and clinical periodontal parameters in patients with chronic periodontitis: a randomized controlled trial. Quintessence Int. 2014;45(3):193–201. doi:10.3290/j.qi.a31206

 PubMed Web of Science ®Google Scholar

Dukić W, Bago I, Aurer A, Roguljić M. Clinical effectiveness of diode laser therapy as an adjunct to non-surgical periodontal treatment: a randomized clinical study. J Periodontol. 2013;84(8):1111–1117. doi:10.1902/jop.2012.110708

 PubMed Web of Science ®Google Scholar

Zare D, Haerian A, Molla R, Vaziri F. Evaluation of the effects of diode (980 nm) laser on gingival inflammation after nonsurgical periodontal therapy. J Lasers Med Sci. 2014;5(1):27–31.

 PubMedGoogle Scholar

Yadwad KJ, Veena HR, Patil SR, Shivaprasad BM. Diode laser therapy in the management of chronic periodontitis - A clinico-microbiological study. Interv Med Appl Sci. 2017;9(4):191–198. doi:10.1556/1646.9.2017.38

 PubMedGoogle Scholar

Bosshardt DD, Stadlinger B, Terheyden H. Cell-to-cell communication - periodontal regeneration. Clin Oral Implants Res. 2015;26(3):229–239. doi:10.1111/clr.12543

 PubMed Web of Science ®Google Scholar

Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898

 PubMed Web of Science ®Google Scholar

Higgins JPT, Eldridge S, Li T. Chapter 23: including variants on randomized trials. In: Higgins JPT, Thomas J, Chandler J, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions Version 6.0 (Updated July 2019). Cochrane; 2019. Available from: www.training.cochrane.org/handbook. Accessed April 29, 2021.

 Google Scholar