Efficacy of Laser Therapy versus Conventional Periodontal Treatment in Diabetic Patients with Periodontitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

Background: Chronic periodontitis affects 10-15% of adults, worsened by diabetes. Effective therapy reduces inflammation and bacteria, with laser therapy emerging as a promising non-surgical adjunct or standalone option. This study systematically reviews clinical papers on various lasers (low-level laser therapy [LLLT], diode, Er:YAG/Er, Cr:YSGG, Nd:YAG) as adjuncts in periodontal flap microsurgery for patients with diabetes mellitus (type 1 or type 2), assessing their effects on periodontal health, glycaemic control, and safety.

Methodology: The study protocol was prospectively registered on PROSPERO. A search strategy was conducted across multiple databases; 13 studies were included in this systematic review. Risk of bias was assessed using the Cochrane Risk of bias tool 2.0 (RoB 2), and RevMan 5.4 and STATA 18 software were used for quantitative assessment of the selected studies. Results : Out of the 13 studies selected, only one study showed a high risk of bias, while the other 12 showed moderate risk. In the quantitative assessment, I 2 = 77% for Plaque Index (PI) values, I 2 = 83% for Gingival Index (GI), I 2 = 84% for bleeding on probing (BOP), I 2 = 86% for clinical attachment level (CAL), and I 2 = 92% for pocket probing depth (PPD).

Conclusion: Laser adjuncts, particularly Er:YAG and LLLT/diode, enhance periodontal treatment for type 2 diabetes mellitus (T2DM) patients, improving clinical outcomes and inflammation. Nd:YAG lasers aid healing and inflammation regulation, but benefits are often limited, and long-term effects are unclear. Comprehensive, large-scale trials are needed to shape clinical guidelines. Clinicians should consider laser adjuncts for complex cases, balancing benefits with costs and patient needs.