Diode Laser-Assisted Periodontal Therapy Enhances Clinical Outcomes for Deep Periodontal Pockets in Smokers

Diode Laser-Assisted Periodontal Therapy Enhances Clinical Outcomes for Deep Periodontal Pockets in Smokers: A Randomized Clinical Trial

This study investigated the adjunctive effects of diode laser therapy in smokers with severe periodontitis. Thirty-three patients were randomized to non-surgical periodontal therapy (SRP) with or without diode laser. Clinical parameters and salivary oxidative stress markers (MDA, 8-OHdG) were assessed at baseline, 1, and 3 months. Both groups showed improvements, but SRP+DL resulted in significantly greater reductions in deep pockets, PISA, PESA, PI, and MDA at 3 months. These findings suggest that diode laser therapy may enhance conventional treatment by improving clinical outcomes and reducing oxidative stress in smokers with severe periodontitis.

Study Overview

• Status: Completed
• Conditions: Smoking; Periodontitis; Periodontal Disease; Malondialdehyde; Diode Laser Therapy; Periodontitis Stage III
• Intervention / Treatment: Device: Diode Laser Application in Deep Periodontal Pockets; Procedure: Professional Mechanical Plaque Removal; Procedure: Scaling and Root Planing

• Study Type: Interventional
• Enrollment (Actual): 33
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Selçuklu
    • Konya, Selçuklu, Turkey (Türkiye), 42250
      • Selcuk University Faculty of Dentistry Department of Periodontology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• no periodontal treatment within the previous 6 months;
• no use of antibiotics within the previous 3 months;
• no systemic disease and alcohol drinkers, or drug users;
• no use of anti-inflammatory drugs within the past 3 months;
• no pregnancy;
• no use of hormonal contraceptives; and
• current smokers with a history of smoking ≥10 cigarettes per day for at least one year.

Exclusion Criteria:

• Patients with <20 teeth, grade III tooth mobility, partial dentures, or fixed prostheses were excluded. Additionally, those with dental implants or peri-implant diseases were also excluded.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Stage III Grade C :Non surgical periodontal therapy and an adjunct diode laser use	Device: Diode Laser Application in Deep Periodontal Pockets; A 940 nm indium-gallium-aluminum-phosphate diode laser (Ezlase, Biolase, USA) with a 400 μm fiber was used in contact mode at 1.5 W, pulse 20/20 ms, 20 s/cm², power density 1.061 W/cm², and 15 J/cm² energy in deep periodontal pockets.; Procedure: Professional Mechanical Plaque Removal; Professional mechanical removal of supragingival plaque and calculus; Procedure: Scaling and Root Planing; Subgingival scaling and root planing
Experimental: Stage III Grade C :Non surgical periodontal therapy	Procedure: Professional Mechanical Plaque Removal; Professional mechanical removal of supragingival plaque and calculus; Procedure: Scaling and Root Planing; Subgingival scaling and root planing

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Probing Pocket Dept (PPD)	The probing pocket dept was assessed on six tooth surfaces, inluding the mesiobuccal, buccal, distobuccal, mesiolingual, lingual and distolingual areas of each tooth.	Through study completion, an average of 3 months.
Periodontal Epithelial Surface Area (PESA)	PESA represents the total epithelial surface area in periodontal pockets.	Through study completion, an average of 3 months.
Periodontal Inflamed Surface Area (PISA)	PISA quantifies the inflamed portion of this surface area by integrating only sites exhibiting BOP, both measured in mm2.	Through study completion, an average of 3 months.
Salivary Malondialdehyde Levels	Evaluation of salivary malondialdehyde levels.	Through study completion, an average of 3 months.
Salivary 8-hydroxy-2'-deoxyguanosine Levels	Evaluation of salivary 8-hydroxy-2'-deoxyguanosine levels.	Through study completion, an average of 3 months.
PPD ≥4 mm, site-specific PPD (ssPPD)	For sites with PPD ≥4 mm, site-specific PPD (ssPPD) values was calculated.	Through study completion, an average of 3 months.
PPD ≥4 mm, site spesific CAL (ssCAL)	For sites with PPD ≥4 mm, site spesific CAL (ssCAL) values were also calculated.	Through study completion, an average of 3 months.
PPD ≥4 mm, site-specific PISA (ssPISA)	For sites with PPD ≥4 mm, site-specific PISA (ssPISA) values were calculated.	Through study completion, an average of 3 months.
PPD ≥4 mm, site-specific PESA (ssPESA)	For sites with PPD ≥4 mm, site-specific PESA (ssPESA) values were calculated.	Through study completion, an average of 3 months.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Plaque Index (PI)	The plaque index was assessed on six tooth surfaces, inluding the mesiobuccal, buccal, distobuccal, mesiolingual, lingual and distolingual areas of each tooth.	Through study completion, an average of 3 months.
Bleeding on Probing (BOP)	The bleeding on probing index was assessed on six tooth surfaces, inluding the mesiobuccal, buccal, distobuccal, mesiolingual, lingual and distolingual areas of each tooth.	Through study completion, an average of 3 months.
Clinical Attachment Level (CAL)	The clinical attachment level was assessed on six tooth surfaces, inluding the mesiobuccal, buccal, distobuccal, mesiolingual, lingual and distolingual areas of each tooth.	Through study completion, an average of 3 months.
Gingival Index (GI)	The gingival index was assessed on six tooth surfaces, inluding the mesiobuccal, buccal, distobuccal, mesiolingual, lingual and distolingual areas of each tooth.	Through study completion, an average of 3 months.

Collaborators and Investigators

• Sponsor: Selcuk University
• Collaborators: The Scientific and Technological Research Council of Turkey; Selcuk University Scientific Research Projects Unit

Study record dates

Study Major Dates

• Study Start (Actual): December 10, 2023
• Primary Completion (Actual): January 21, 2025
• Study Completion (Actual): June 5, 2025

Study Registration Dates

• First Submitted: September 29, 2025
• First Submitted That Met QC Criteria: October 2, 2025
• First Posted (Estimated): October 9, 2025

Study Record Updates

• Last Update Posted (Estimated): October 9, 2025
• Last Update Submitted That Met QC Criteria: October 2, 2025
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: non-surgical periodontal therapy; malondialdehyde; diode laser therapy; adjunctive periodontal treatment; smokers with periodontitis; 8-hydroxy-2'-deoxyguanosine
• Additional Relevant MeSH Terms: Mouth Diseases; Stomatognathic Diseases; Behavior; Periodontitis; Periodontal Diseases; Smoking; Digestive System and Oral Physiological Phenomena; Dentistry; Dental Physiological Phenomena; Dental Scaling; Dental Prophylaxis; Periodontics; Subgingival Curettage; Preventive Dentistry; Root Planing; Tooth Exfoliation
• Other Study ID Numbers: SU-DIAE-01

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: Yes