Art-2-Hajeb

www.stomaeduj.com PERIODONTOLOGY
LOW-LEVEL LASER PERIODONTAL THERAPY
Original Articles
IN DIABETIC PATIENTS: A RANDOMIZED CONTROLLED
CLINICAL TRIAL - PILOT STUDY
Fares Al Hajeb1a , Hala Zakaria2b , Jovita D’Souza3c , Wael Hamsho4d , Omar Al Jadaan5e , Jumma Al Khabuli6f*

1Department of Dentistry, Healthpoint Hospital, Mubadala Health, Abu Dhabi, UAE
2Department of Oral Radiology and Diagnosis, Faculty of Dentistry, British University of Egypt, Cairo, Egypt
3Department of Periodontics and Oral Implantology, College of Dentistry, Gulf Medical University, Ajman, UAE
4RAK College of Dental Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
5Computer Science Engineering, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
6Department of Oral Pathology, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
a
BDS, Intern; e-mail: faresalhajeb@hotmail.com; ORCIDiD: https://orcid.org/0000-0002-9003-5877
b
BDS, MSc, PhD, Professor; e-mail: hala.zakaria@bue.edu.eg; ORCIDiD: https://orcid.org/0000-0003-1926-7453
c
BDS, MDS, Specialist Periodontist, Lecturer; e-mail: dr.jovita@gmu.ac.ae; ORCIDiD: https://orcid.org/0000-0003-4520-4982
d
BDS, Intern; e-mail: wael.hamsho@hotmail.com; ORCIDiD: https://orcid.org/0000-0001-8809-0984
e
PhD, Associate Professor; e-mail: ojadaan@rakmhsu.ac.ae; ORCIDiD: https://orcid.org/0000-0003-1504-6442
f
BDS, MDentSci, FDS RCPDS (Glasg), FICD, PhD, Professor; e-mail: jkhabuli@qu.edu.qa; ORCIDiD: https://orcid.org/0000-0001-8099-5076
https://doi.org/10.25241/stomaeduj.2022.9(3-4).art.2

Objectives We aimed to evaluate the effects of low-level laser therapy as an adjunct to non-surgical
periodontal therapy in patients with periodontitis and compare the effect on periodontal healing in diabetes
mellitus and non-diabetes mellitus patients.
Methodology Ten patients with periodontitis stage II grade B were divided into two groups; Group 1 included
5 non-diabetes mellitus patients with periodontitis, and Group 2 included 5 type2 diabetes mellitus patients
with periodontitis. A 13 mW low-level laser was used in a continuous wave and non-contact mode as an
adjunct to scaling and root planning (SRP) in a split-mouth study design “OPTODAN” (Scientific Development
and Production Center, Saratov, Russia). The clinical parameters; plaque and gingival index, probing depth,
and relative clinical attachment level of the test and control sides of both groups were analyzed at baseline
and 1-month post-therapy. Visual analogue scale was used to determine patient discomfort intraoperatively
and after 1 week.
Results Statistically, significant improvement was evident in the gingival index, probing depth, and relative
clinical attachment level when comparing test and control sides in all patients 1-month post-therapy. There
was improvement in gingival index amongst type 2 diabetes mellitus patients in the test group. However,
non-diabetes mellitus patients demonstrated superior results especially in probing depth and relative
clinical attachment level.
Conclusion The use of low-level laser therapy as an adjunct in periodontal therapy showed overall
improvement in gingival inflammation, probing depth, and clinical attachment level. In comparison to
non-diabetes mellitus patients, type 2 diabetes mellitus patients demonstrated significant improvement in
gingival inflammation with low-level laser therapy.
KEYWORDS
Periodontitis; Diabetes Mellitus; Lasers; Periodontal Pockets; Photobiomodulation
1. INTRODUCTION mitochondria by chromophores including the
protein cytochrome-c oxidase which then increases
The applications of Photobiomodulation (PBM) the internal activity and three events occur as a
or Low-Level Laser Therapy (LLLT) are gaining result: An increase in adenosine triphosphate (ATP),
popularity in the field of dentistry. These lasers the main energy source for the majority of cellular
have wavelengths that range between 600 and functions which accelerates the healing process;
1,100 nm and interact with tissues via non-thermal modulation of reactive oxygen species (ROS) which
photochemical and biological mechanisms. activates transcription factors positively impacting
The low-level laser (LLL) light is absorbed in the cellular repair and healing; and temporary release
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Al Hajeb F, Zakaria H, D’Souza J, Hamsho W, Al Jadaan O, Al Khabuli J. Low-Level Laser Periodontal Therapy in Diabetic Patients: A Randomized
Controlled Clinical Trial - Pilot Study. Stoma Edu J. 2022;9(3-4):88-94.
Received: July 03, 2022; Revised: July 23, 2022; Accepted: August 23, 2022; Published: September 04, 2022.
*Corresponding author: Prof. Dr. Jumma Al Khabuli, Department of Oral Pathology, College of Dental Medicine, QU Health, Qatar University, Doha,
Qatar. e-mail: jkhabuli@qu.edu.qa.
Copyright: © 2022 the Editorial Council for the Stomatology Edu Journal.

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of nitrous oxide (NO), a potent vasodilator, which The exact mechanism linking both conditions is

Original Articles
improves circulation as well as lymphatic drainage. still not yet fully understood, but it is believed that
Therefore, clinically these lasers are known to reduce chronic hyperglycemia produces advanced glycation
pain, inflammation and promote wound healing. end products (AGEs) which bind to specific receptors
Due to these properties, researchers are constantly on different cells such fibroblasts, macrophages
striving to find different therapeutic applications of and endothelial cells. As a result, macrophages are
this non-invasive treatment modality [1]. transformed into hyperactive cells that increase
Periodontitis is a multifactorial chronic inflammatory the production of inflammatory cytokines, tumour
disease that causes progressive destruction of tooth- necrosis factor-alpha (TNF-α), and interleukins
supporting tissues (gingiva, periodontal ligament, 1β and 6 (IL-1β, IL-6) which leads to periodontitis.
and surrounding bone), eventually resulting in Moreover, the production of AGEs increases the
loss of tooth support. The main etiological factor permeability and molecule adhesion in endothelial
is microbial plaque accumulation at the gingival cells, while fibroblasts will show decreased collagen
margin. When allowed to become chronic, drastic production which also contributes to periodontal
consequences in the periodontium occur causing disease. There is growing evidence supporting
inflammatory changes in the gingiva, which initially the fact that periodontal disease adversely affects
appear as redness and bleeding on probing (BOP). glycemic control; it is now acknowledged that due
With persistence of inflammation and progression to untreated periodontal disease, the systemic
of tissue damage; clinical attachment loss (CAL), inflammatory burden may be increased in patients
bone loss and periodontal pocket formation are with DM. Due to this, they have an altered or delayed
evident. Several anaerobic gram-negative species healing as compared to non-DM patients. There are
are considered the culprits of periodontal disease, relatively few studies that evaluate the adjunctive
mainly; Porphyromonas gingivalis, Aggregatibacter effect of LLLT in T2DM patients with periodontitis [9].
actinomycetemcomitans and Fusobacterium Therefore, this study sought to evaluate the
nucleatum [2,3]. The basic principle of periodontal effectiveness of LLL as an adjunct to non-surgical
therapy is to restore function and avoid further periodontal therapy (NSPT) in patients with T2DM,
progression of the periodontal disease by removing by observing changes in clinical parameters such as
or altering the causative factors [4]. Conventional plaque index (PI), gingival index (GI), PD, and CAL.
treatment for periodontitis consists of non-surgical
methods that involve debridement of the inflamed 2. MATERIALS AND METHODS
tissues to control the periodontal infection and
allow healing of the periodontium [5,6]. Disruption 2.1 Study design
of biofilm by the mechanical removal of subgingival A randomized controlled cross-sectional study using
plaque reduces the bacterial load and facilitates a split-mouth design was planned. The study was
resolution of inflammation as well as decrease the approved by the local research and ethics committee;
probing depth (PD). Considering that LLL is effective MOHP/RAK/SUBC/NO: 31-2017-UG-D. The study
sample consisted of 10 patients aged 35-50 years
in reducing gingival inflammation, swelling, as well
diagnosed with periodontitis that were recruited
as inducing wound healing and providing pain relief, from the Ras Al Khaimah College of Dental Sciences
a lot of research is directed towards understanding (RAKCODS) clinic, Ras Al Khaimah, United Arab
if the adjunctive use of these lasers could promote Emirates. The sample was divided into two groups;
accelerated healing and periodontal tissue Group 1: 5 Non-DM patients with periodontitis, and
regeneration. In a study, Obradović et al. achieved Group 2: 5 DM patients with periodontitis.
better therapeutic results when LLLT was combined The inclusion criteria for Group 1 were (i) Non-DM
with scaling and root planing (SRP) compared to SRP patients diagnosed with Stage II Grade B periodontitis
alone [7]. (ii) Presence of 4-5mm periodontal pockets on the
Various systemic conditions influence the mandibular 1st molars. For Group 2, the inclusion
periodontium. Diabetes mellitus (DM) is a prevalent criteria were (i) T2DM patients diagnosed with
metabolic disorder affecting nearly 90% of the Stage II Grade B periodontitis (ii) Presence of 4-5mm
world’s population. It could be due to a defect periodontal pockets on the mandibular 1st molars.
in the secretion of insulin from beta-cells of the According to the 2017 World Workshop Classification
pancreatic islets of Langerhans, a defect in insulin of Periodontal and Peri-Implant Diseases, Stage II
Grade B periodontitis patients were selected for this
action or a combination of both. Type 2 diabetes
study, as these cases are of moderately progressing
mellitus (T2DM) results from the body’s ineffective
periodontitis with pocket depths of < 5mm and a
use of insulin. Insulin resistance is a cardinal feature clinical attachment loss of 2-3 mm and there were
of T2DM. Diabetes is a risk factor for periodontal no teeth lost due to periodontal disease.
disease and there is strong evidence suggesting Although Glycated hemoglobin (HbA1c) blood levels
a two-way relationship between T2DM and were not obtained from the patients, they were asked
periodontal disease; with diabetes increasing the if their blood glucose levels were controlled over the
risk of periodontal disease, and periodontal disease past 3 months, and all patients admitted that they
adversely affecting glycemic control [8]. had controlled levels (<7%). This was also confirmed

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by the screening glucometer tests for average blood
Original Articles glucose levels performed just before the initiation of
the treatment which had a range of (126-146mg/dl).
A patient with average blood glucose levels<150mg/
dl corresponds to<7% HbA1c levels [10,11]. The
exclusion criteria for both groups were (i) Use of
antibiotics or corticosteroid therapy 3 months
before the study (ii) Patients with acute systemic
illness (iii) Pregnant women (iv) Patients suffering
from any hemorrhagic disorder or autoimmune (a) (b)
disease (v) Smokers or tobacco chewers (vi) Patients Figure 2. Low-level diode laser“OPTODAN” device (a), Positioning of the
who underwent periodontal treatment 3 months laser tip during application (b)
before the study.
LLLT was applied to the test side on the 1st, 4th
All participants were given information about the
and 7th day respectively. On the first day, the laser
study and informed consent was obtained from all application was for 2 minutes with an energy density
participants. of 8.2 J/cm2. The second application, on day 4 was
for 4 minutes delivering a total energy density of
2.2 Clinical examination 16.4J/cm2. The third application, on day 7 was for
Clinical examination included measurements of 5 minutes, with an energy density of 20.5J/cm2.
Plaque Index (PI) (Silness and Loe), Gingival Index Re-evaluation of all clinical parameters was performed
(GI) (Loe and Silness), Probing Depth (PD), and after 1 month of the laser therapy. The pain intensity
Relative Clinical Attachment Level (RCAL). felt by the patients during the treatment and 1 week
Acrylic stents were fabricated to be used to postoperatively was determined with the help of a
standardize the probe angulation and as a fixed visual analogue scale (VAS), where the patients were
reference point (Fig.1a). told to rate the pain experienced on a scale of 0 to
PD and RCAL were measured using acrylic stents 10, with 0=no pain, 1-3=mild pain, 4-6=moderate
on the mesial, mid buccal and distal surfaces of pain, and 7-10=severe pain. Patients were on a
the mandibular 1st molars using the University of maintenance protocol and given routine oral
North Carolina (UNC-15) periodontal probe. Acrylic hygiene instructions. No antibiotics were prescribed
stents were used to ensure accurate measurements, post treatment, as they were not indicated in these
reproducibility, as well as minimize errors while cases since only non-surgical periodontal therapy
probing (Fig.1b). was performed. Moreover, antibiotics can modify
the oral flora and host response thereby altering the
effect of LLLT by causing an ecological disturbance
and inducing the selection of resistant strains as well
as increasing their number, causing more amoxicillin
resistant strains to be present [12].

2.4 Statistical analysis
The statistical significance of various periodontal
indices that were elaborated between both
(a) (b) groups was examined using the paired t-test.
Using the following formula (postoperative index
- preoperative index) the absolute change in every
Figure 1. Acrylic stent (a), UNC-15 periodontal probe and acrylic stent in
place with surface markings (b) periodontal index at 1month post-therapy about the
baseline was calculated. The site with the deepest
PD and RCAL in both groups was used to measure
2.3 Treatment protocol all parameters.
Patients in both groups received thorough clinical A p-value <0.05 was deemed statistically significant,
examination, oral hygiene instructions (OHI), full and the valid data was analyzed using Statistical
mouth scaling, polishing and root planning. Package for the Social Sciences Statistics “SPSS
In each patient, the right and left mandibular first Statistics” (International Business Machines
molars were then randomly allocated to either Corporation “IBM”, Chicago, IL, USA) for Microsoft
Control (SRP alone) or Test (SRP+LLLT) side. Windows operating system (Microsoft Inc.,
A low-level diode laser “OPTODAN” (Scientific Redmond, WA, USA).
Development and Production Center “VEND",
Saratov, Russia) with a 980 nm wavelength and a 3. RESULTS
power setting of 13 mW was used in a continuous
wave, non-contact mode with the help of a metallic The comparison of the mean values and change
knob delivery system having an optical diameter tip from day 0 to day 30 as well as standard deviation
of 5 mm (Fig. 2a). The knob was used in a “brushstroke” between parenthesis of PI, GI, PD, and RCAL in all
motion on the gingival margin and attached gingiva patients within the test and control sides is described
of the buccal surface on the tooth (Fig. 2b). in Tab. 1.

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the baseline in the test and control sides (p-value

Original Articles
Table 1. Test and Control Sides Comparison of Periodontal Parameters
Studied (n=10) 0.517 and 0.196), while the difference in the absolute
Test side Control side change in the values of RCAL was statistically
Parameters P-value Significance
(n=10) (n=10) significant (p-value 0.001).
Plaque Index Tab. 2 demonstrates the comparison of VAS values
on both sides. The differences between the test and
Day 0 1.20 (0.23) 1.22 (0.21) 0.806 NS
control sides as well as the difference in the absolute
Day 30 0.17 (0.16) 0.48 (0.47) 0.078 NS change were all not statistically significant, either
Change intraoperatively or postoperatively (p-value 1.000).
1.03 (0.25) 0.74 (0.50) 0.065 NS
(Day 0-Day 30) Table 2. Test and Control Sides Comparison of Visual Analogue Scale
Gingival Index (VAS) (n=10)

Day 0 1.67 (0.47) 1.77 (0.60) 0.685 NS Control
Test side
Parameters side P-value Significance
Day 30 1.05 (0.15) 1.42 (0.31) 0.003 S (n=10)
(n=10)
Change
0.62 (0.43) 0.35 (0.54) 0.016 S VAS
(Day 0-Day 30)
Intraoperative 3.50 (1.26) 3.50 (1.26) 1.000 NS
Probing Depth
1 week
Day 0 4.50 (0.70) 5.00 (0.94) 0.196 NS 1.40 (0.51) 1.40 (0.51) 1.000 NS
postoperative
Day 30 3.60 (0.84) 5.00 (0.94) 0.003 S
Change (1 week-
Change 2.10 (0.88) 2.10 (0.88) 1.000 NS
0.90 (0.57) 0 (0) 0.001 S intraoperative)
(Day 0-Day 30)
p<0.05= Significant (S), p>0.05= Not Significant (NS)
RCAL*
Day 0 9.70 (1.05) 9.40 (0.96) 0.517 NS
3.1 Intergroup Comparison
Day 30 8.80 (1.03) 9.40 (0.96) 0.196 NS Tab. 3 elucidates the comparison in the mean values
Change and change from day 0 to day 30 as well as standard
0.90 (0.57) 0 (0) 0.001 S
(Day 0-Day 30) deviation of PI, GI, PD, and RCAL in the test side
p<0.05= Significant (S), p>0.05= Not Significant (NS) amongst both groups studied.
*Relative Clinical Attachment Level
Table 2. Test Side Comparison of Periodontal Parameters Studied in
The values of PI in the test side were 1.20±0.23 at Non-DM with Periodontitis and DM with Periodontitis Patients (n=5)
baseline and 0.17±0.16 at 1 month, while the values Periodontitis
Periodontitis
in the control side were 1.22±0.21 at baseline and Parameters
Test side (n=5)
+DM P-value Significance
0.48±0.47 at 1 month, so the differences were not Test side (n=5)
statistically significant (p-value 0.806 and 0.078). Plaque Index
Regarding the absolute change in the values of PI, Day 0 1.20 (0.20) 1.20 (0.27) 1.000 NS
the difference has shown no statistical significance
Day 30 0.15 (0.13) 0.20 (0.20) 0.667 NS
either (p-value 0.065).
The GI has decreased from 1.67±0.47 to 1.05±0.15 Change
1.05 (0.21) 1.00 (0.31) 0.419 NS
in the test side and from 1.77±0.60 to 1.42±0.31 in (Day 0-Day 30)
the control side group after 1 month; the difference Gingival Index
showed no statistical significance at baseline Day 0 1.40 (0.37) 1.95 (0.41) 0.347 NS
(p-value 0.685) but was statistically significant at
Day 30 1.00 (0) 1.10 (0.22) 0.049 S
1 month (p-value 0.003). The difference shows
statistical significance in the absolute change of the Change
0.40 (0.38) 0.85 (0.38) 0.048 S
GI values as well (p-value 0.016). (Day 0-Day 30)
With regard to the PD, there was a reduction from Probing Depth
4.50±0.70 mm to 3.60±0.84 mm in the test side at 1 Day 0 4.40 (0.54) 4.60 (0.89) 0.681 NS
month. The PD remained unchanged; 5.00±0.94 mm
Day 30 3.20 (0.83) 4.00 (0.70) 0.141 NS
in the control side at 1 month, the difference was not
statistically significant at baseline (p-value 0.196) Change
1.20 (0.45) 0.60 (0.55) 0.047 S
and was statistically significant at 1 month (p-value (Day 0-Day 30)
0.003). The difference in the absolute change in the RCAL*
values of PD was also statistically significant (p-value Day 0 10.0 (1.41) 9.40 (0.54) 0.402 NS
0.001).
Day 30 8.80 (1.48) 8.80 (0.44) 1.000 NS
The RCAL was 9.70±1.05 and 9.40±0.96 mm in the
test and control sides respectively at baseline; and at Change
1.20 (0.45) 0.60 (0.55) 0.047 S
1 month the RCAL was 8.80±1.03 and 9.40±0.96 mm (Day 0-Day 30)
in the test and control sides respectively. Therefore, p<0.05= Significant (S), p>0.05= Not Significant (NS)
no statistically significant gain in RCAL compared to *Relative Clinical Attachment Level

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The mean values of PD and RCAL showed statistical BOP and inflammation in periodontitis patients as
Original Articles improvement in non-DM patients with periodontitis compared to basic periodontal therapy alone [22].
compared to T2DM patients with periodontitis Most of the studies on LLLT as an adjunct to SRP
(p-value 0.047). The mean values of GI indicate a have recorded and evaluated short-term outcomes
statistically significant improvement was obtained demonstrating positive effects overall. However,
in T2DM patients with periodontitis post-therapy researchers have still not been able to reach a
(p-value 0.049), with an absolute change of specific treatment protocol [23].
0.85 compared to 0.40 in non-DM patients with The adjunctive application of LLLT in periodontitis
periodontitis which was statistically significant as patients with systemic conditions or diseases is
well (p-value 0.048). able to modify the course of periodontal therapy.
Upon comparison of the change (Day 0 - Day 30)
4. DISCUSSION in the test side (LLLT+SRP) of both groups, non-DM
The biostimulatory and bioinhibitory effects of patients (Group 1) showed statistically significant
laser are governed by the Arndt-Schultz law, which improvement in PD and RCAL post-therapy as
states that weak stimuli excite the biologic activity, compared to T2DM patients (Group 2), while there
while stronger stimuli will have an inhibitory effect. was a statistically significant improvement in GI in
The treatment dose is probably the most important T2DM patients (Group 2) as compared to non-DM
variable in laser treatment and should always be kept patients (Group 1). Obradovic et al. studied the
in mind when using PBM. If the anticipated response effect of LLLT on gingival inflammation using the GI
is not achieved then the clinician may need to re- by Loe & Silness; they concluded that LLLT is efficient
evaluate the dose to ensure it is within the optimal in gingival inflammation elimination and can be
range. The intended target for PBM treatments is proposed as an adjunctive tool in basic periodontal
to remain within the therapeutic window, which therapy of DM patients [24]. He performed another
includes both biostimulatory and bioinhibitory histological study in 2013, where he found that LLLT
effects [13]. expressed healing and is evident by the absence of
In the present study, the treatment protocol was inflammatory cells. Tissue edema could not be seen
and the number of blood vessels was reduced. In the
according to Prokhonchukov et al. [14].
gingival lamina propria, pronounced collagenization
The success of the periodontal treatment depends
and homogenization were present. They then
on the elimination of periodontal pathogens and
concluded that LLLT showed efficacy in the treatment
their toxic byproducts from the dental root surface
of periodontitis in DM patients. Because of the more
and periodontal soft tissue [15]. Currently, non-
pronounced alterations of the periodontium in DM,
surgical periodontal therapy remains the “gold
the use of LLLT is of particular importance [7].
standard” of care to treat periodontal diseases
Demirturk-Goegun et al. found the additional benefit
[16,17]. However, patients with systemic conditions
of the LLLT as an adjunct to SRP on gingival bleeding,
like DM demonstrate an altered or delayed healing.
but did not find any significant improvement on
LLLT has shown to be effective in the treatment
other clinical parameters [25].
of impaired microcirculation, improves wound
Al-Sharif et al. stated that the mean values of GI, PI,
healing, pain relief, fracture healing, and reduction
and PD reduced significantly after-treatment of the
of inﬂammation as well as swelling [18,19,20]. Yet,
two groups; SRP and SRP with laser groups. However,
there are a few articles about the study of LLLT in
the SRP with laser group gained a greater reduction
periodontal diseases in patients with DM. Therefore,
in the measured parameters in DM patients with
we aimed to assess the adjunctive effects of LLLT
periodontitis [26].
with a diode laser in combination with SRP in T2DM
Seda et al. in their randomized controlled trial
patients with periodontitis.
concluded that the adjunctive use of LLLT with NSPT
Although not our primary objective, we compared
in DM patients have positively affected the clinical
the effect of the LLL on both test and control sides
and biochemical parameters, which was similar to
in all patients (n=10) in group 1 and group 2, which
the results of our study [27].
exhibited a significant improvement in GI, PD and
RCAL on the test side (LLLT + SRP) when compared 5. CONCLUSION
to the control side (SRP alone) at 1 month. A VAS was
used to determine pain perception by the patients Within the limitations of this study, LLLT being
intraoperatively and 1 week post-operatively. There used as an adjunct in periodontal therapy reduced
was no statistically significant difference between gingival inflammation, decreased probing depth,
the control and test sides in both groups, which and improved clinical attachment level. Non-
indicates that the level of discomfort was similar in DM patients with periodontitis had statistically
both groups. There was no statistically significant significant improvement in both PD and RCAL, while
difference in PI and VAS when comparing the control DM patients with periodontitis had statistically
and test sides for both groups after 1 month. In a significant improvement in GI only. Moreover, other
systematic review and meta-analysis on the PBM parameters demonstrated strong correlation, yet
effect of LLL in the non-surgical treatment of no statistically significant result was reached. Most
periodontitis patients, Ren et al. found that LLLT- likely, this is due to the small sample size and short
mediated SRP resulted in a significant improvement follow-up periods.
in PD and levels of IL-1β in the gingival crevicular 6. RECOMMENDATION
fluid compared with SRP alone in the short term
[21]. There are a lot of studies where the adjunctive The efficacy of LLLT on periodontal pockets in DM
application of LLLT with SRP has shown to improve patients is promising. Future randomized controlled

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clinical trials with larger sample sizes and longer PATIENTS CONSENT

Original Articles
follow-up periods are highly recommended to assess All participants were informed about the clinical procedure of the
the extent and effectiveness of LLLT as an adjunct to study and willingly signed the informed consent.
NSPT in DM patients. FUNDING
This study was not funded.
7. LIMITATION OF THE STUDY
STATEMENT OF HUMAN RIGHTS
This study was performed during the COVID-19 This study was conducted in accordance with the 1964 Declaration of
pandemic. The sample size is relatively small Helsinki and its subsequent amendments.
because of the strict selection criteria applied and
the limited number of patient flow to the students’ ACKNOWLEDGMENTS
clinic because of the COVID-19 restrictions. Also, the We would like to thank the clinical staff of the RAK College of Dental
Sciences for the continuous support and help while conducting this
study had to be completed before end of May; the
research.
end of the academic year.
AUTHOR CONTRIBUTIONS
CONFLICT OF INTEREST FAH: background writing, clinical work, preparation of results
All authors declare that there is no financial/personal interest or belief and manuscript. HZ: study design, background review, results.
that could affect their objectivity.
JD: clinical work, results, discussion. WH: background writing,
ETHICAL APPROVAL clinical work, preparation of results. OAJ: statistical analysis,
The study was approved by the Research and Ethics Committee, UAE: preparation of results. JAK: study design, result writing, review of
MOHP/RAK/SUBC/NO: 31-2017-UG-D. the discussion, overall writing up, preparation of the manuscript.

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Fares Al HAJEB
BDS, Intern
Department of Dentistry
Healthpoint Hospital
Mubadala Health
CV Abu Dhabi, UAE

Dr. Fares Al Hajeb, a dedicated general dentist who is passionate about evidence-based dentistry as well as devoted to keeping
up to date with the latest research in the dental field; he graduated from the RAK College of Dental Sciences in 2020 and
completed his one year Internship program at Healthpoint Hospital in early 2022. He practices as a GP Dentist in the private
sector in Abu Dhabi, UAE.
The main contribution in this study was to find and adhere to the strict selection criteria of patients during the COVID-19
pandemic as well as the complete clinical workflow and result preparation after data interpretation of an adjunctive measure to
treat periodontitis in both DM and non-DM patients by incorporating a low level laser therapy.

Questions
1. In periodontitis, the inflammatory cytokines, such as TNF-α, IL6 and IL 1β are thought
to be released by which of the following cells?
qa. T-Lymphocytes;
qb. Mast cells;
qc. Neutrophils;
qd. Macrophages.

2. Which of the following activities is/are associated with the use of Low-level laser in the
treatment of periodontitis?
qa. Increase the phagocytosis process;
qb. Increase in cellular repair and healing;
qc. Promotes local hemostasis;
qd. Reduces glycemia.

3. When using photobiomodulation, which of the following laws govern the biostimulatory
and bioinhibitory effects of a low level laser?
qa. Arndt-Shultz Law;
qb. Newton’s Law;
qc. Snell’s Law;
qd. Beer-Lambert Law.

4. What is the typical wavelength range for a diode laser used?
qa. 1500-2000 Nm;
qb. 2900-3000 Nmt;
qc. 600-1100 Nm;
qd. 500-550 Nm.

94 Stoma Edu J. 2022;9(3-4):88-94 pISSN 2360-2406; eISSN 2502-0285