Evaluation of two low-level laser techniques as an adjunct to basic periodontal therapy: a randomized clinical trial

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Methods: A randomized, split-mouth, double-blind clinical trial was conducted, selecting three diseased periodontal sites from different quadrants in each patient. These sites were assigned to one of three treatment groups: SRP (control), SRP + TLLLT (test 1), and SRP + ILLLT (test 2). Low-level laser therapy in the test groups was applied at 48 hours, 7 days, and 14 days after full-mouth SRP. Clinical parameters such as probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were assessed at baseline (T0), 3 months (T1), and 6 months (T2). Standardized periapical radiographs were used to assess radiographic bone density (RBD) 6 months post-treatment. Statistical analyses included repeated measures ANOVA for continuous variables and chi-square tests for categorical variables, with significance set at p < 0.05 and a 95% confidence interval. Results: Significant reductions in PD (p < 0.001) and CAL (p < 0.001) were observed across all groups at 3 and 6 months, with no significant differences between groups. There were also no significant changes in BOP and RBD between groups at the follow-up intervals. Conclusion: Adjunctive photobiomodulation did not provide additional clinical or radiographic benefits over SRP alone, regardless of the laser application technique employed. periodontitis low-level laser therapy photobiomodulation non-surgical periodontal treatment. Figures Figure 1 Figure 2 Figure 3 BACKGROUND Periodontitis is a chronic, multifactorial disease characterized by the inflammatory destruction of the periodontal ligament and alveolar bone, primarily caused by a dysbiotic dental biofilm [1]. This destructive process arises from the complex interplay between the host's immune responses and the dysbiotic microbiota, where periodontopathogens trigger inflammatory cascades, and the resulting inflammatory byproducts further support microbial growth [2]. Management of periodontitis typically involves basic periodontal therapy (BPT), which encompasses scaling and root planing (SRP) to mechanically eliminate biofilm, alongside patient education aimed at effective biofilm removal [3]. BPT significantly reduces microbial and inflammatory burdens, leading to improvements in clinical parameters such as gingival bleeding, clinical attachment level, probing depth, and the volume of gingival crevicular fluid [4,5]. Adjunctive therapies, such as photobiomodulation, are designed to enhance the effects of BPT by promoting tissue healing and reducing inflammation. Photobiomodulation employs low-intensity light (lasers or LEDs) to stimulate various biochemical and biophysical processes, including ATP production, cellular metabolism, protein synthesis, and cytokine modulation. These processes facilitate tissue regeneration and contribute to inflammation reduction [6,7,8]. Furthermore, lasers have been shown to encourage osteoblast differentiation and promote bone regeneration [9]. Numerous studies have investigated the effects of photobiomodulation on periodontal tissues, reporting improvements in probing depth (PD) and clinical attachment level (CAL) [10,11,12]. Despite these findings, there is still no consensus regarding the optimal application protocol, and few studies have addressed the radiographic effects of this therapy [13]. Intrasulcular laser application has demonstrated significant clinical improvements when compared to control groups [14,15], while transgingival applications have also shown favorable outcomes [16,17]. However, some studies report comparable results between laser therapy and standard periodontal treatment [18,19], and there has been no direct comparison between these two laser application techniques. This study aims to address this gap by evaluating and comparing the efficacy of intrasulcular and transgingival low-level laser applications as adjuncts to BPT in patients with periodontitis, hypothesizing that one technique may yield superior clinical outcomes compared to the other. MATERIALS AND METHODS Study Design This study was conducted as a double-blind, split-mouth, randomized controlled clinical trial. Approval was obtained from the Research Ethics Committee of the Federal University of Rio Grande do Norte (UFRN) under protocol No. 5,695,433, and the trial adhered to the ethical principles outlined in the Helsinki Declaration of 1975, as revised in 2013. The trial was also registered in the Brazilian Clinical Trials Registry (REBEC) under registration number RBR-7r2m8c4. Participants were fully informed about the study's objectives, procedures, potential risks, and benefits, and all provided written informed consent prior to their inclusion. Study Population The sample consisted of patients with periodontitis who either sought care at the Integrated Clinics of the UFRN Department of Dentistry or were referred from other healthcare facilities. Eligible participants were adults aged 18 years or older, diagnosed with periodontitis at any stage or grade, and presenting with at least three periodontal sites in different quadrants, each with a probing depth (PD) of 4 mm or more, interproximal attachment loss of 1 mm or more, and bleeding on probing (BOP). Exclusion criteria included pregnant or breastfeeding women; smokers and individuals who had quit smoking within the past five years; patients with systemic diseases that could influence the host’s response to periodontal therapy; patients requiring prophylactic medication for dental procedures; those who had received periodontal treatment or antibiotics in the three months prior to the study; and individuals with gingival melanin pigmentation in the target sites, as melanin could interfere with light absorption during laser therapy. Sample Size Calculation A sample size of 15 participants was calculated to be sufficient to detect a minimum difference of 1 mm in clinical attachment level (CAL) changes between the study groups. The calculation was based on an alpha error of 5%, a 95% confidence interval, a beta of 80%, and a standard deviation of 1. These parameters were derived from a pilot study involving 10 patients. Data Collection and Outcome Measures For each participant, three periodontal sites from different quadrants of both single- and multi-rooted teeth were selected based on disease severity. These sites were randomly assigned to one of three groups: 1) SRP group (basic periodontal therapy only), 2) SRP + TLLLT group (basic therapy combined with transgingival low-level laser therapy), and 3) SRP + ILLLT group (basic therapy combined with intrasulcular low-level laser therapy). The randomization was conducted using the “random.org” website, ensuring independent allocation for each participant. The study had three time points: T0: Baseline, where periapical radiographs were taken, and treatments were applied. T1: Three months post-treatment, when clinical parameters were reassessed, and maintenance care, such as oral hygiene instructions and supragingival SRP, was provided if necessary. T2: Six months post-treatment, during which clinical parameters and radiographs were re-evaluated. The intraoral clinical examination was performed by a single, calibrated examiner, assessing periodontal parameters including probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP), alongside oral hygiene parameters like the visible plaque index (VPI) and gingival bleeding index (GBI). Reevaluations at T1 and T2 were conducted by two additional blinded and calibrated evaluators. PD : Measured in millimeters using a calibrated periodontal probe from the gingival margin to the most apical portion of the junctional epithelium, typically at six points around each tooth (Glavind & Löe, 1967). CAL : Measured similarly from the cementoenamel junction to the most apical portion of the junctional epithelium, reflecting the sum of gingival recession and probing depth (Glavind & Löe, 1967). BOP : Assessed dichotomously, with a score of 1 indicating bleeding within 30 seconds of probe insertion, and 0 indicating no bleeding (Ainamo & Bay, 1976). Radiographic Densitometry To standardize periapical radiographs, occlusal devices attached to radiographic positioners were customized for each tooth position and patient using acrylic resin to ensure precise bite registration. These blocks were labeled and stored to maintain consistent X-ray beam orientation at each follow-up. Digital films were used for radiographic imaging, with all radiographs captured using the same equipment [13]. The images were analyzed using ImageJ software for densitometric measurements. A grayscale ranging from 0 (lowest density) to 255 (highest density) was employed to assess bone density, with measurements focused on an elliptical area extending from the bone crest to 4 mm below the analyzed tooth [13, 20] (Fig. 1 ). Treatment Protocol All participants initially received oral hygiene instructions and full-mouth SRP using manual metal curettes (Gracey and McCall – Millenium Golgran). For the SRP + TLLLT group, low-level laser therapy was applied at 48 hours, 7 days, and 14 days after SRP, following a protocol adapted from Moreira et al. (2015) [21] and Katsikanis et al. (2019) [18]. The diode laser (Therapy EC, DMC Equipamentos Ltda, São Carlos, São Paulo, Brazil) emitted an 808 nm wavelength at 100 mW for 20 seconds, delivering 2 J per point, as recommended by Santos et al. (2019) [22]. The laser was applied perpendicularly to the periodontal pocket's base, with both operator and patient wearing protective glasses. In the SRP + ILLLT group, laser therapy was delivered intra-sulcularly using an optical fiber probe, following the same energy and time settings as in the TLLLT group. Blinding This study employed a blinding protocol involving one examiner and a blinded evaluator for the treatment instituted. All patients remained unaware of the treatment modality throughout the study period. Patient blinding was achieved by applying both treatment modalities at the three selected sites, with laser activation occurring only at the randomly assigned treatment sites. Calibration The calibration process resulted in an intraclass correlation coefficient (ICC) of 88% for intra-examiner reliability in quantitative variables, indicating a high level of consistency in measurements taken by the same examiner over time. Additionally, inter-examiner reliability was assessed with an ICC of 80%, demonstrating good agreement among different examiners. For qualitative variables, a kappa coefficient of 84% was achieved, reflecting strong agreement in categorical assessments. Statistical Analysis Data were compiled in a spreadsheet using Jamovi version 2.3 for Windows. Descriptive statistics were calculated, and inferential statistical tests were conducted with a significance level set at 5%. Repeated measures ANOVA was used to compare clinical and radiographic parameters across time points, followed by post-hoc tests to compare groups. The Chi-square test was employed for categorical variables. RESULTS General characteristics A total of 17 participants (2 males and 15 females) with a mean age of 46.9 ± 6.41 years were included in the study, which recruited participants from November 2021 to April 2023. A total of 51 periodontal sites were evaluated, with 17 sites assigned to each treatment group. Of the participants, 64.7% were classified as having stage I or II periodontitis, and 35.3% were diagnosed with stage III. Additionally, 47.1% were categorized as grade A and 52.9% as grade B. The baseline characteristics of the participants are summarized in Table 1. Table 1: Characteristics of study participants. Clinical parameters Significant reductions in clinical parameters were observed in all treatment groups at both 3 and 6 months compared to baseline: Plaque index (PI), gingival index (GI), and sulcus bleeding index (SBI) showed statistically significant decreases (p < 0.001) at both follow-up points. The number of periodontal pockets ≥ 4mm decreased significantly at 3 and 6 months (p < 0.001) compared to baseline (table 2). Table 2: Comparison of mean oral hygiene indices and the number of periodontal pockets ≥ 4mm in all participants at 3 and 6 months of follow-up. Oral hygiene indices Baseline 3 months 6 months PI (%), mean ± SD 59,3 ± 18,4 19,1 ± 17,3 * 15,4 ± 13,2 * GI (%), mean ± SD 28,6 ± 11,9 17,8 ± 7,91 * 14,4 ± 7,21 * SBI (%), mean ± SD 60,1 ± 19,4 42,9 ± 16,8 * 38,8 ± 14,2 * Periodontal pockets ≥ 4mm, mean ± SD 40,9 ± 17,2 25,5 ± 16,4 * 24,0 ± 15,3 * * Statistically significant difference from baseline (p < 0.001). Repeated measures ANOVA. PI: plaque index. GI: gingival index. SBI: sulcus bleeding index. All treatment groups exhibited significant reductions in PD (p < 0.001) and CAL (p < 0.001) at both follow-up points. However, no significant differences in PD (p = 0.252) or CAL (p = 0.279) were found among the three treatment groups or between the test groups (TLLLT or ILLLT) and the control group (table 3). Table 3: Comparison of the mean periodontal clinical parameters among the SRP, SRP + TLLLT, and SRP + ILLLT groups at 3 and 6 months post-treatment. Periodontal parameter Follow-up period Treatment groups p-value Repeated measures ANOVA SRP SRP + TLLLT SRP + ILLLT PD (mm) Baseline (t 0 ) 5,00 ± 0,70 5,29 ± 0,84 5,29 ± 0,77 0.583 3 months (t 1 ) 3,71 ± 1,16 4,29 ± 1,26 3,88 ± 1,11 6 months (t 2 ) 3,76 ± 0,83 4,35 ± 1,41 3,76 ± 1,20 ∆ Baseline - 6 months 1,24 0,94 1,53 p t 0 x t 1 < 0,001 < 0,001 < 0,001 p t 0 x t 2 < 0,001 < 0,001 < 0,001 p t 1 x t 2 1.000 1.000 1.000 CAL (mm) Baseline (t 0 ) 5,29 ± 0,92 5,88 ± 1,69 5,65 ± 1,11 0.618 3 months (t 1 ) 4,12 ± 1,11 5,00 ± 1,80 4,29 ± 1,21 6 months (t 2 ) 4,35 ± 1,11 4,88 ± 2,12 4,29 ± 1,05 ∆ Baseline - 6 months 0,94 1,00 1,36 p t 0 x t 1 < 0,001 < 0,05 < 0,001 p t 0 x t 2 < 0,001 < 0,001 < 0,001 p t 1 x t 2 0.981 1.000 1.000 PD: probing depth; CAL: clinical attachment level; SRP: scaling and root planing; TLLLT: transgingival low-level laser therapy; ILLLT: intrasulcular low-level laser therapy Bleeding on probing At baseline, all sites showed bleeding on probing. By the 3-month follow-up, the control group had 9 sites without bleeding and 8 with bleeding. At 6 months, 4 sites in the control group did not bleed, while 13 did (p = 0.893). In the TLLLT group, 7 sites did not bleed and 10 bled at 3 months; at 6 months, 6 sites did not bleed while 11 did (p = 0.505). In the ILLLT group, 5 sites did not bleed and 12 bled at 3 months, with 9 sites bleeding and 8 not bleeding at 6 months (p = 0.707). No significant differences in bleeding on probing were observed between the groups at any evaluation point (p = 0.917) (table 4). Table 4: Comparison of bleeding on probing among the SRP, SRP + TLLLT, and SRP + ILLLT groups at 3 and 6 months post-treatment. Group BOP- 3 months BOP- 6 months Total 0 1 Control 0 2 7 9 1 2 6 8 Total 4 13 17 p = 0,893 TLLLT 0 3 4 7 1 3 7 10 Total 6 11 17 p = 0,505 ILLLT 0 3 2 5 1 6 6 12 Total 9 8 17 p = 0,707 Chi-square test. 0 = No bleeding; 1 = Bleeding. BOP: Bleeding on probing; SRP: scaling and root planing; TLLLT: transgingival low-level laser therapy; ILLLT: intrasulcular low-level laser therapy Radiographic parameters Radiographic bone density was evaluated in 15 participants (2 excluded due to poor radiographic quality). After 6 months, no significant increases in bone density were noted in any treatment group compared to baseline (p = 0.202) (Figure 2). DISCUSSION Photobiomodulation uses low-intensity laser or LED light to stimulate cellular processes, accelerating tissue repair, reducing inflammation, and enhancing immune responses. Suggested as an adjunct to standard periodontal therapy [23], it addresses cases where basic therapy may be insufficient due to microbial factors, host response, or incomplete biofilm removal [24]. This study compares two techniques for low-level laser application in adjunctive photobiomodulation therapy: transgingival and intrasulcular. The null hypothesis of this study proposed that there would be no differences in clinical and radiographic parameters among periodontitis patients, regardless of whether root surface debridement was performed with or without adjunctive photobiomodulation. The results supported this hypothesis, demonstrating improvements in clinical parameters, such as PD and CAL, across all groups evaluated at 3 and 6 months post-periodontal treatment. However, statistical analysis revealed no significant differences between the control, intrasulcular, and transgingival groups. Additionally, no significant changes were observed in BOP among any of the groups during the 3- and 6-month follow-ups, nor were there significant differences in radiographic parameters after 6 months of treatment. Effective photobiomodulation relies on light absorption by tissues. Absorption is influenced by chromophore concentration and the match between the light's wavelength and the chromophore's absorption properties [25]. In periodontal tissues, cytochrome C oxidase is the main photoreceptor [21], while hemoglobin can absorb specific wavelengths, potentially reducing treatment efficacy if blood is present [18]. The study used multiple laser applications at 48 hours, 7 days, and 14 days post-therapy. These sessions improved bleeding on probing and reduced probing depth compared to root planing alone [12,26]. Infrared light (808 nm) was chosen to enhance tissue penetration, including alveolar bone. Infrared studies reported significant improvements in probing depth and clinical attachment [27]. This study found no significant differences between laser application techniques, suggesting their equivalence rather than a lack of efficacy. Ren et al. (2017) [23] reviewed trials on adjunctive low-level laser therapy, noting significant short-term benefits, including reduced probing depth (p < 0.001) and lower interleukin-1β levels (p = 0.01), regardless of the technique used. Comparisons of different laser techniques show positive results in reducing probing depth and clinical attachment loss for both intrasulcular [10,28] and transgingival applications [17,26]. Some studies, however, report similar outcomes with laser therapy compared to isolated periodontal treatment [16,29]. A systematic review also found no significant differences between techniques in clinical and radiographic outcomes [30]. Regarding radiographic bone density, this study aligns with Al-Rabiah et al. (2020) [5], who found no significant differences between groups at three and six months. Conversely, Makhlouf et al. (2012) [13] reported significant bone density improvements with photobiomodulation (10 sessions of infrared laser) as an adjunct to scaling and root planing. Despite the positive findings, this study has limitations that may affect the interpretation of results. The small sample size may limit the generalizability of the findings, and variations in adherence to oral hygiene practices among participants could have influenced treatment outcomes. At 6 months, a high clinical attachment loss (38.8%) indicated incomplete disease resolution [31]. The equivalence of the two laser application techniques suggests that clinicians can choose either method without compromising treatment efficacy, thereby providing flexibility in clinical practice. Future studies should involve larger, more diverse populations and investigate the effects of varying laser dosages over extended follow-up periods to assess long-term benefits of adjunctive therapies. CONCLUSIONS This study demonstrated clinical improvements across all treatment groups, with no significant differences between the control, intrasulcular, and transgingival laser application groups. These findings suggest that periodontal therapy effectively enhances clinical outcomes, irrespective of the laser application technique employed. Additionally, there were no significant differences in radiographic bone density among the groups at the 6-month follow-up. Given these results, further research is warranted to explore the long-term effects of various laser therapies on periodontal health and to assess the potential benefits of combining different treatment modalities. Declarations Ethical Approval This study is registered in the Brazilian Clinical Trials Registry (REBEC) under the number RBR-7r2m8c4. Funding No sources of funding. Author Contribution All authors have made substantial contributions to the conception and design of the study. RCMS, LGCS, NTSC, and ARLB were involved in data collection, data analysis, and data interpretation. RCMS, LGCS, PRLM, and ARLAM contributed to drafting the manuscript and revising it critically. RCMS, PRLM, and ARLAM gave final approval of the version to be published. Acknowledgement The authors express their gratitude to the Federal University of Rio Grande do Norte (UFRN) for facilitating this study, and to the Coordination for the Improvement of Higher Education Personnel (CAPES) for their support of this manuscript. References Papapanou PN, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;45(Suppl 20). DOI: 10.1002/JPER.17-0721 Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015;15(1):30-44. doi:10.1038/nri3785. Kwon T, Lamster IB, Levin L. Current concepts in the management of periodontitis. Int Dent J. 2021;71(6):462-476. doi:10.1111/idj.12630. Dalvi S, Khetal N, Ansari S, Benedicenti S, Hanna R. 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Cite Share Download PDF Status: Published Journal Publication published 03 Jan, 2025 Read the published version in Lasers in Medical Science → Version 1 posted Editorial decision: Revision requested 03 Dec, 2024 Reviews received at journal 02 Dec, 2024 Reviewers agreed at journal 27 Nov, 2024 Reviews received at journal 23 Nov, 2024 Reviewers agreed at journal 23 Nov, 2024 Reviewers agreed at journal 22 Nov, 2024 Reviewers invited by journal 06 Nov, 2024 Editor assigned by journal 06 Nov, 2024 Submission checks completed at journal 29 Oct, 2024 First submitted to journal 24 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5329027","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":375449408,"identity":"4aeaf4fc-a5e6-463f-bbbc-9f2ccf644a0e","order_by":0,"name":"Régia Carla Medeiros da Silva","email":"","orcid":"","institution":"Federal University of Rio Grande do Norte","correspondingAuthor":false,"prefix":"","firstName":"Régia","middleName":"Carla Medeiros da","lastName":"Silva","suffix":""},{"id":375449409,"identity":"50863026-694a-41ac-a84a-bde4de5e07ae","order_by":1,"name":"Lucas Gabriel Cunha da Silva","email":"","orcid":"","institution":"Federal University of Rio Grande do Norte","correspondingAuthor":false,"prefix":"","firstName":"Lucas","middleName":"Gabriel Cunha da","lastName":"Silva","suffix":""},{"id":375449410,"identity":"89a54a65-a8c4-4b1d-ac55-f274b323325f","order_by":2,"name":"Natália Teixeira Silva Cruz","email":"","orcid":"","institution":"Federal University of Rio Grande do Norte","correspondingAuthor":false,"prefix":"","firstName":"Natália","middleName":"Teixeira Silva","lastName":"Cruz","suffix":""},{"id":375449411,"identity":"3fd3a459-115a-4951-81b3-a722b054d866","order_by":3,"name":"Adylla Rominne Lima Barbosa","email":"","orcid":"","institution":"Federal University of Rio Grande do Norte","correspondingAuthor":false,"prefix":"","firstName":"Adylla","middleName":"Rominne Lima","lastName":"Barbosa","suffix":""},{"id":375449412,"identity":"cc3f4204-25d8-4787-9aae-b09394dc7b14","order_by":4,"name":"Paulo Raphael Leite Maia","email":"","orcid":"","institution":"Federal University of Rio Grande do Norte","correspondingAuthor":false,"prefix":"","firstName":"Paulo","middleName":"Raphael Leite","lastName":"Maia","suffix":""},{"id":375449413,"identity":"3e455e55-a925-4b36-8f23-6aaa43faa7e9","order_by":5,"name":"Ana Rafaela Luz de Aquino Martins","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIie3RMUvDQBTA8RcCzyX21lcS2q+QksUh1A/i8iSQLM3kaLEBIVPVVdFv4RdICaRL1PWgDuni1CHgkiGDaQXtEKI4Odx/uTfcj8dxACrVv80F6AFoyW76irqID4DN0RB/794vSfozEfeXb2XF4wEeJJAa9cuFMJ/WJUzdEzCvijZCr5lzN2fPQYMbYqyofx04BJkfRtbSbl0j2YHDSj+NYUtoRXaOQFqUhhH5rWIog3et5tksFkVD7Gc6zlGvuogtJ45ucMpI2y2ckG0gdm4ZycmZbvFyFNM6WjwkXv82Rzzi5i2xlbWSgQwetQ2fD4XwFsWmHgsxR12WUze8MeNWspcWfc8Mnz+lUqlUqr/1Abf0V+6S3uFUAAAAAElFTkSuQmCC","orcid":"","institution":"Federal University of Rio Grande do Norte","correspondingAuthor":true,"prefix":"","firstName":"Ana","middleName":"Rafaela Luz de Aquino","lastName":"Martins","suffix":""}],"badges":[],"createdAt":"2024-10-25 02:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5329027/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5329027/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10103-024-04275-w","type":"published","date":"2025-01-03T15:57:21+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69437235,"identity":"e8c9b370-5537-4a26-a626-d5151cfcd6b1","added_by":"auto","created_at":"2024-11-20 10:45:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":133459,"visible":true,"origin":"","legend":"\u003cp\u003eDensitometric radiographic analysis: an elliptical area located 4 mm from the bone crest was analyzed. A histogram displaying the grayscale values is provided. In the image, the parameter of interest is labeled as \"Mean,\" with a value of 117.703 for the radiograph in question.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5329027/v1/b6b3c70a65f3e0d64a11a5ad.png"},{"id":69437233,"identity":"27659ffa-6812-48eb-b5d8-07f794e603b5","added_by":"auto","created_at":"2024-11-20 10:45:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32407,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of mean radiographic bone density among the SRP, SRP + TLLLT, and SRP + ILLLT groups at 6 months of follow-up.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5329027/v1/3dd1e9b5ccae6c560259c032.png"},{"id":69437234,"identity":"e76444a4-8ee9-4dd7-9e5c-d9d72dcfbb46","added_by":"auto","created_at":"2024-11-20 10:45:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":214765,"visible":true,"origin":"","legend":"\u003cp\u003eFabrication of occlusal devices for standardized periapical radiographs. a: Creation of an alginate mold of the bite block. b: Filling the mold with acrylic resin to make a new bite block. c: Acrylic resin bite block positioned in the radiographic positioner. d: Application of acrylic resin on the bite block for customization. e: Bite registration. f: Customized and standardized bite block.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5329027/v1/caca7be15739fab5a43d3ab9.png"},{"id":73093232,"identity":"11730d0a-e89b-4bd7-aa2f-2b96c5989051","added_by":"auto","created_at":"2025-01-06 16:11:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":969978,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5329027/v1/5dd19cf6-5ca2-4ded-a9df-230129a8134d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eEvaluation of two low-level laser techniques as an adjunct to basic periodontal therapy: a randomized clinical trial\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003ePeriodontitis is a chronic, multifactorial disease characterized by the inflammatory destruction of the periodontal ligament and alveolar bone, primarily caused by a dysbiotic dental biofilm [1]. This destructive process arises from the complex interplay between the host's immune responses and the dysbiotic microbiota, where periodontopathogens trigger inflammatory cascades, and the resulting inflammatory byproducts further support microbial growth [2].\u003c/p\u003e \u003cp\u003eManagement of periodontitis typically involves basic periodontal therapy (BPT), which encompasses scaling and root planing (SRP) to mechanically eliminate biofilm, alongside patient education aimed at effective biofilm removal [3]. BPT significantly reduces microbial and inflammatory burdens, leading to improvements in clinical parameters such as gingival bleeding, clinical attachment level, probing depth, and the volume of gingival crevicular fluid [4,5].\u003c/p\u003e \u003cp\u003eAdjunctive therapies, such as photobiomodulation, are designed to enhance the effects of BPT by promoting tissue healing and reducing inflammation. Photobiomodulation employs low-intensity light (lasers or LEDs) to stimulate various biochemical and biophysical processes, including ATP production, cellular metabolism, protein synthesis, and cytokine modulation. These processes facilitate tissue regeneration and contribute to inflammation reduction [6,7,8]. Furthermore, lasers have been shown to encourage osteoblast differentiation and promote bone regeneration [9].\u003c/p\u003e \u003cp\u003eNumerous studies have investigated the effects of photobiomodulation on periodontal tissues, reporting improvements in probing depth (PD) and clinical attachment level (CAL) [10,11,12]. Despite these findings, there is still no consensus regarding the optimal application protocol, and few studies have addressed the radiographic effects of this therapy [13].\u003c/p\u003e \u003cp\u003eIntrasulcular laser application has demonstrated significant clinical improvements when compared to control groups [14,15], while transgingival applications have also shown favorable outcomes [16,17]. However, some studies report comparable results between laser therapy and standard periodontal treatment [18,19], and there has been no direct comparison between these two laser application techniques. This study aims to address this gap by evaluating and comparing the efficacy of intrasulcular and transgingival low-level laser applications as adjuncts to BPT in patients with periodontitis, hypothesizing that one technique may yield superior clinical outcomes compared to the other.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study was conducted as a double-blind, split-mouth, randomized controlled clinical trial. Approval was obtained from the Research Ethics Committee of the Federal University of Rio Grande do Norte (UFRN) under protocol No. 5,695,433, and the trial adhered to the ethical principles outlined in the Helsinki Declaration of 1975, as revised in 2013. The trial was also registered in the Brazilian Clinical Trials Registry (REBEC) under registration number RBR-7r2m8c4. Participants were fully informed about the study's objectives, procedures, potential risks, and benefits, and all provided written informed consent prior to their inclusion.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe sample consisted of patients with periodontitis who either sought care at the Integrated Clinics of the UFRN Department of Dentistry or were referred from other healthcare facilities. Eligible participants were adults aged 18 years or older, diagnosed with periodontitis at any stage or grade, and presenting with at least three periodontal sites in different quadrants, each with a probing depth (PD) of 4 mm or more, interproximal attachment loss of 1 mm or more, and bleeding on probing (BOP).\u003c/p\u003e \u003cp\u003eExclusion criteria included pregnant or breastfeeding women; smokers and individuals who had quit smoking within the past five years; patients with systemic diseases that could influence the host\u0026rsquo;s response to periodontal therapy; patients requiring prophylactic medication for dental procedures; those who had received periodontal treatment or antibiotics in the three months prior to the study; and individuals with gingival melanin pigmentation in the target sites, as melanin could interfere with light absorption during laser therapy.\u003c/p\u003e\n\u003ch3\u003eSample Size Calculation\u003c/h3\u003e\n\u003cp\u003eA sample size of 15 participants was calculated to be sufficient to detect a minimum difference of 1 mm in clinical attachment level (CAL) changes between the study groups. The calculation was based on an alpha error of 5%, a 95% confidence interval, a beta of 80%, and a standard deviation of 1. These parameters were derived from a pilot study involving 10 patients.\u003c/p\u003e\n\u003ch3\u003eData Collection and Outcome Measures\u003c/h3\u003e\n\u003cp\u003eFor each participant, three periodontal sites from different quadrants of both single- and multi-rooted teeth were selected based on disease severity. These sites were randomly assigned to one of three groups: 1) SRP group (basic periodontal therapy only), 2) SRP\u0026thinsp;+\u0026thinsp;TLLLT group (basic therapy combined with transgingival low-level laser therapy), and 3) SRP\u0026thinsp;+\u0026thinsp;ILLLT group (basic therapy combined with intrasulcular low-level laser therapy). The randomization was conducted using the \u0026ldquo;random.org\u0026rdquo; website, ensuring independent allocation for each participant. The study had three time points:\u003c/p\u003e \u003cp\u003eT0: Baseline, where periapical radiographs were taken, and treatments were applied.\u003c/p\u003e \u003cp\u003eT1: Three months post-treatment, when clinical parameters were reassessed, and maintenance care, such as oral hygiene instructions and supragingival SRP, was provided if necessary.\u003c/p\u003e \u003cp\u003eT2: Six months post-treatment, during which clinical parameters and radiographs were re-evaluated.\u003c/p\u003e \u003cp\u003eThe intraoral clinical examination was performed by a single, calibrated examiner, assessing periodontal parameters including probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP), alongside oral hygiene parameters like the visible plaque index (VPI) and gingival bleeding index (GBI). Reevaluations at T1 and T2 were conducted by two additional blinded and calibrated evaluators.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePD\u003c/b\u003e: Measured in millimeters using a calibrated periodontal probe from the gingival margin to the most apical portion of the junctional epithelium, typically at six points around each tooth (Glavind \u0026amp; L\u0026ouml;e, 1967).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCAL\u003c/b\u003e: Measured similarly from the cementoenamel junction to the most apical portion of the junctional epithelium, reflecting the sum of gingival recession and probing depth (Glavind \u0026amp; L\u0026ouml;e, 1967).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eBOP\u003c/b\u003e: Assessed dichotomously, with a score of 1 indicating bleeding within 30 seconds of probe insertion, and 0 indicating no bleeding (Ainamo \u0026amp; Bay, 1976).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eRadiographic Densitometry\u003c/h3\u003e\n\u003cp\u003eTo standardize periapical radiographs, occlusal devices attached to radiographic positioners were customized for each tooth position and patient using acrylic resin to ensure precise bite registration. These blocks were labeled and stored to maintain consistent X-ray beam orientation at each follow-up. Digital films were used for radiographic imaging, with all radiographs captured using the same equipment [13]. The images were analyzed using ImageJ software for densitometric measurements. A grayscale ranging from 0 (lowest density) to 255 (highest density) was employed to assess bone density, with measurements focused on an elliptical area extending from the bone crest to 4 mm below the analyzed tooth [13, 20] (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTreatment Protocol\u003c/h2\u003e \u003cp\u003eAll participants initially received oral hygiene instructions and full-mouth SRP using manual metal curettes (Gracey and McCall \u0026ndash; Millenium Golgran). For the SRP\u0026thinsp;+\u0026thinsp;TLLLT group, low-level laser therapy was applied at 48 hours, 7 days, and 14 days after SRP, following a protocol adapted from Moreira et al. (2015) [21] and Katsikanis et al. (2019) [18]. The diode laser (Therapy EC, DMC Equipamentos Ltda, S\u0026atilde;o Carlos, S\u0026atilde;o Paulo, Brazil) emitted an 808 nm wavelength at 100 mW for 20 seconds, delivering 2 J per point, as recommended by Santos et al. (2019) [22]. The laser was applied perpendicularly to the periodontal pocket's base, with both operator and patient wearing protective glasses. In the SRP\u0026thinsp;+\u0026thinsp;ILLLT group, laser therapy was delivered intra-sulcularly using an optical fiber probe, following the same energy and time settings as in the TLLLT group.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eBlinding\u003c/h3\u003e\n\u003cp\u003eThis study employed a blinding protocol involving one examiner and a blinded evaluator for the treatment instituted. All patients remained unaware of the treatment modality throughout the study period. Patient blinding was achieved by applying both treatment modalities at the three selected sites, with laser activation occurring only at the randomly assigned treatment sites.\u003c/p\u003e\n\u003ch3\u003eCalibration\u003c/h3\u003e\n\u003cp\u003eThe calibration process resulted in an intraclass correlation coefficient (ICC) of 88% for intra-examiner reliability in quantitative variables, indicating a high level of consistency in measurements taken by the same examiner over time. Additionally, inter-examiner reliability was assessed with an ICC of 80%, demonstrating good agreement among different examiners. For qualitative variables, a kappa coefficient of 84% was achieved, reflecting strong agreement in categorical assessments.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were compiled in a spreadsheet using Jamovi version 2.3 for Windows. Descriptive statistics were calculated, and inferential statistical tests were conducted with a significance level set at 5%. Repeated measures ANOVA was used to compare clinical and radiographic parameters across time points, followed by post-hoc tests to compare groups. The Chi-square test was employed for categorical variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eGeneral characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 17 participants (2 males and 15 females) with a mean age of 46.9 \u0026plusmn; 6.41 years were included in the study, which recruited participants from November 2021 to April 2023. A total of 51 periodontal sites were evaluated, with 17 sites assigned to each treatment group. Of the participants, 64.7% were classified as having stage I or II periodontitis, and 35.3% were diagnosed with stage III. Additionally, 47.1% were categorized as grade A and 52.9% as grade B. The baseline characteristics of the participants are summarized in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eCharacteristics of study participants.\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" width=\"506\" height=\"232\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSignificant reductions in clinical parameters were observed in all treatment groups at both 3 and 6 months compared to baseline:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ePlaque index (PI), gingival index (GI), and sulcus bleeding index (SBI) showed statistically significant decreases (p \u0026lt; 0.001) at both follow-up points.\u003c/li\u003e\n \u003cli\u003eThe number of periodontal pockets \u0026ge; 4mm decreased significantly at 3 and 6 months (p \u0026lt; 0.001) compared to baseline (table 2).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Comparison of mean oral hygiene indices and the number of periodontal pockets \u0026ge; 4mm in all participants at 3 and 6 months of follow-up.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.8362%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral hygiene indices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.7387%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.9965%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.8362%;\"\u003e\n \u003cp\u003ePI (%), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e59,3 \u0026plusmn; 18,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7387%;\"\u003e\n \u003cp\u003e19,1 \u0026plusmn; 17,3 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.9965%;\"\u003e\n \u003cp\u003e15,4 \u0026plusmn; 13,2 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.8362%;\"\u003e\n \u003cp\u003eGI (%), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e28,6 \u0026plusmn; 11,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7387%;\"\u003e\n \u003cp\u003e17,8 \u0026plusmn; 7,91 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.9965%;\"\u003e\n \u003cp\u003e14,4 \u0026plusmn; 7,21 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.8362%;\"\u003e\n \u003cp\u003eSBI (%), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e60,1 \u0026plusmn; 19,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7387%;\"\u003e\n \u003cp\u003e42,9 \u0026plusmn; 16,8 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.9965%;\"\u003e\n \u003cp\u003e38,8 \u0026plusmn; 14,2 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.8362%;\"\u003e\n \u003cp\u003ePeriodontal pockets \u0026ge; 4mm, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e40,9 \u0026plusmn; 17,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7387%;\"\u003e\n \u003cp\u003e25,5 \u0026plusmn; 16,4 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.9965%;\"\u003e\n \u003cp\u003e24,0 \u0026plusmn; 15,3 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Statistically significant difference from baseline (p \u0026lt; 0.001). Repeated measures ANOVA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePI: plaque index. GI: gingival index. SBI: sulcus bleeding index.\u003c/p\u003e\n\u003cp\u003eAll treatment groups exhibited significant reductions in PD (p \u0026lt; 0.001) and CAL (p \u0026lt; 0.001) at both follow-up points. However, no significant differences in PD (p = 0.252) or CAL (p = 0.279) were found among the three treatment groups or between the test groups (TLLLT or ILLLT) and the control group (table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eComparison of the mean periodontal clinical parameters among the SRP, SRP + TLLLT, and SRP + ILLLT groups at 3 and 6 months post-treatment.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"657\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeriodontal parameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up period\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 341px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u003cbr\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eRepeated measures ANOVA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSRP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSRP + TLLLT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSRP + ILLLT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003ePD (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eBaseline (t\u003csub\u003e0\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e5,00 \u0026plusmn; 0,70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5,29 \u0026plusmn; 0,84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e5,29 \u0026plusmn; 0,77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e3 months (t\u003csub\u003e1\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e3,71 \u0026plusmn; 1,16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4,29 \u0026plusmn; 1,26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e3,88 \u0026plusmn; 1,11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e6 months (t\u003csub\u003e2\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e3,76 \u0026plusmn; 0,83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4,35 \u0026plusmn; 1,41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e3,76 \u0026plusmn; 1,20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e∆ Baseline - 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e1,24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0,94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e1,53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e t\u003csub\u003e0\u0026nbsp;\u003c/sub\u003ex t\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e t\u003csub\u003e0\u0026nbsp;\u003c/sub\u003ex t\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e t\u003csub\u003e1\u0026nbsp;\u003c/sub\u003ex t\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eCAL (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eBaseline (t\u003csub\u003e0\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e5,29 \u0026plusmn; 0,92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5,88 \u0026plusmn; 1,69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e5,65 \u0026plusmn; 1,11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e3 months (t\u003csub\u003e1\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e4,12 \u0026plusmn; 1,11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5,00 \u0026plusmn; 1,80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e4,29 \u0026plusmn; 1,21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e6 months (t\u003csub\u003e2\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e4,35 \u0026plusmn; 1,11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4,88 \u0026plusmn; 2,12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e4,29 \u0026plusmn; 1,05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e∆ Baseline - 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0,94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e1,36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e t\u003csub\u003e0\u0026nbsp;\u003c/sub\u003ex t\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026lt; 0,05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e t\u003csub\u003e0\u0026nbsp;\u003c/sub\u003ex t\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e t\u003csub\u003e1\u0026nbsp;\u003c/sub\u003ex t\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePD: probing depth; CAL: clinical attachment level; SRP: scaling and root planing; TLLLT: transgingival low-level laser therapy; ILLLT: intrasulcular low-level laser therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBleeding on probing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt baseline, all sites showed bleeding on probing. By the 3-month follow-up, the control group had 9 sites without bleeding and 8 with bleeding. At 6 months, 4 sites in the control group did not bleed, while 13 did (p = 0.893). In the TLLLT group, 7 sites did not bleed and 10 bled at 3 months; at 6 months, 6 sites did not bleed while 11 did (p = 0.505). In the ILLLT group, 5 sites did not bleed and 12 bled at 3 months, with 9 sites bleeding and 8 not bleeding at 6 months (p = 0.707). No significant differences in bleeding on probing were observed between the groups at any evaluation point (p = 0.917) (table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Comparison of bleeding on probing among the SRP, SRP + TLLLT, and SRP + ILLLT groups at 3 and 6 months post-treatment.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBOP- 3 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBOP- 6 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 70px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 391px;\"\u003e\n \u003cp\u003ep = 0,893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003eTLLLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 391px;\"\u003e\n \u003cp\u003ep = 0,505\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003eILLLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 391px;\"\u003e\n \u003cp\u003ep = 0,707\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eChi-square test.\u003cbr\u003e0 = No bleeding; 1 = Bleeding.\u003cbr\u003eBOP: Bleeding on probing; SRP: scaling and root planing; TLLLT: transgingival low-level laser therapy; ILLLT: intrasulcular low-level laser therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRadiographic parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRadiographic bone density was evaluated in 15 participants (2 excluded due to poor radiographic quality). After 6 months, no significant increases in bone density were noted in any treatment group compared to baseline (p = 0.202) (Figure 2).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003ePhotobiomodulation uses low-intensity laser or LED light to stimulate cellular processes, accelerating tissue repair, reducing inflammation, and enhancing immune responses. Suggested as an adjunct to standard periodontal therapy [23], it addresses cases where basic therapy may be insufficient due to microbial factors, host response, or incomplete biofilm removal [24]. This study compares two techniques for low-level laser application in adjunctive photobiomodulation therapy: transgingival and intrasulcular.\u003c/p\u003e \u003cp\u003eThe null hypothesis of this study proposed that there would be no differences in clinical and radiographic parameters among periodontitis patients, regardless of whether root surface debridement was performed with or without adjunctive photobiomodulation. The results supported this hypothesis, demonstrating improvements in clinical parameters, such as PD and CAL, across all groups evaluated at 3 and 6 months post-periodontal treatment. However, statistical analysis revealed no significant differences between the control, intrasulcular, and transgingival groups. Additionally, no significant changes were observed in BOP among any of the groups during the 3- and 6-month follow-ups, nor were there significant differences in radiographic parameters after 6 months of treatment.\u003c/p\u003e \u003cp\u003eEffective photobiomodulation relies on light absorption by tissues. Absorption is influenced by chromophore concentration and the match between the light's wavelength and the chromophore's absorption properties [25]. In periodontal tissues, cytochrome C oxidase is the main photoreceptor [21], while hemoglobin can absorb specific wavelengths, potentially reducing treatment efficacy if blood is present [18].\u003c/p\u003e \u003cp\u003eThe study used multiple laser applications at 48 hours, 7 days, and 14 days post-therapy. These sessions improved bleeding on probing and reduced probing depth compared to root planing alone [12,26]. Infrared light (808 nm) was chosen to enhance tissue penetration, including alveolar bone. Infrared studies reported significant improvements in probing depth and clinical attachment [27].\u003c/p\u003e \u003cp\u003eThis study found no significant differences between laser application techniques, suggesting their equivalence rather than a lack of efficacy. Ren et al. (2017) [23] reviewed trials on adjunctive low-level laser therapy, noting significant short-term benefits, including reduced probing depth (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and lower interleukin-1β levels (p\u0026thinsp;=\u0026thinsp;0.01), regardless of the technique used.\u003c/p\u003e \u003cp\u003eComparisons of different laser techniques show positive results in reducing probing depth and clinical attachment loss for both intrasulcular [10,28] and transgingival applications [17,26]. Some studies, however, report similar outcomes with laser therapy compared to isolated periodontal treatment [16,29]. A systematic review also found no significant differences between techniques in clinical and radiographic outcomes [30].\u003c/p\u003e \u003cp\u003eRegarding radiographic bone density, this study aligns with Al-Rabiah et al. (2020) [5], who found no significant differences between groups at three and six months. Conversely, Makhlouf et al. (2012) [13] reported significant bone density improvements with photobiomodulation (10 sessions of infrared laser) as an adjunct to scaling and root planing.\u003c/p\u003e \u003cp\u003eDespite the positive findings, this study has limitations that may affect the interpretation of results. The small sample size may limit the generalizability of the findings, and variations in adherence to oral hygiene practices among participants could have influenced treatment outcomes. At 6 months, a high clinical attachment loss (38.8%) indicated incomplete disease resolution [31].\u003c/p\u003e \u003cp\u003eThe equivalence of the two laser application techniques suggests that clinicians can choose either method without compromising treatment efficacy, thereby providing flexibility in clinical practice. Future studies should involve larger, more diverse populations and investigate the effects of varying laser dosages over extended follow-up periods to assess long-term benefits of adjunctive therapies.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study demonstrated clinical improvements across all treatment groups, with no significant differences between the control, intrasulcular, and transgingival laser application groups. These findings suggest that periodontal therapy effectively enhances clinical outcomes, irrespective of the laser application technique employed. Additionally, there were no significant differences in radiographic bone density among the groups at the 6-month follow-up. Given these results, further research is warranted to explore the long-term effects of various laser therapies on periodontal health and to assess the potential benefits of combining different treatment modalities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is registered in the Brazilian Clinical Trials Registry (REBEC) under the number RBR-7r2m8c4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo sources of funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors have made substantial contributions to the conception and design of the study. RCMS, LGCS, NTSC, and ARLB were involved in data collection, data analysis, and data interpretation. RCMS, LGCS, PRLM, and ARLAM contributed to drafting the manuscript and revising it critically. RCMS, PRLM, and ARLAM gave final approval of the version to be published.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors express their gratitude to the Federal University of Rio Grande do Norte (UFRN) for facilitating this study, and to the Coordination for the Improvement of Higher Education Personnel (CAPES) for their support of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePapapanou PN, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;45(Suppl 20). DOI: 10.1002/JPER.17-0721\u003c/li\u003e\n\u003cli\u003eHajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015;15(1):30-44. doi:10.1038/nri3785.\u003c/li\u003e\n\u003cli\u003eKwon T, Lamster IB, Levin L. Current concepts in the management of periodontitis. Int Dent J. 2021;71(6):462-476. doi:10.1111/idj.12630.\u003c/li\u003e\n\u003cli\u003eDalvi S, Khetal N, Ansari S, Benedicenti S, Hanna R. Utilization of 810 nm diode laser treatment in periodontitis as an alternative to surgical debridement approach. Photochem Photobiol. 2021;97(3):566-573. doi:10.1111/php.13417.\u003c/li\u003e\n\u003cli\u003eAl-Rabiah M, Al-Hamoudi N, Abdulrahman K, et al. Efficacy of scaling and root planing with photobiomodulation for treating periodontitis in gutka chewers: A randomized controlled trial. Photobiomodul Photomed Laser Surg. 2020;38(9):645-652. DOI: 10.1089/photob.2020.4819\u003c/li\u003e\n\u003cli\u003eHopkins JT, McLoda TA, Seegmiller JG, Baxter GD. Low-level laser therapy facilitates superficial wound healing in humans: a triple-blind, sham-controlled study. J Athl Train. 2003;39(3):223-229.\u003c/li\u003e\n\u003cli\u003ePosten W, Wrone DA, Dover JS, et al. Low-level laser therapy for wound healing: Mechanism and efficacy. 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PMID: 29577710.\u003c/li\u003e\n\u003cli\u003eDemirturk-Gocgun O, Baser U, Aykol-Sahin G, Dinccag N, Issever H, Yalcin F. Role of low-level laser therapy as an adjunct to initial periodontal treatment in type 2 diabetic patients: a split-mouth, randomized, controlled clinical trial. Photomed Laser Surg. 2017;35(2):111-115. doi: 10.1089/pho.2016.4117. Epub 2016 Nov 17. PMID: 27855270.\u003c/li\u003e\n\u003cli\u003eMakhlouf M, Dahaba MM, Tuner J, Eissa SA, Harhash TA. Effect of adjunctive low level laser therapy (LLLT) on nonsurgical treatment of chronic periodontitis. Photomed Laser Surg. 2012;30(3):160-166. doi: 10.1089/pho.2011.3069. Epub 2012 Jan 10. PMID: 22233558.\u003c/li\u003e\n\u003cli\u003eMatarese G, Ramaglia L, Cicci\u0026ugrave; M, Cordasco G, Isola G. The effects of diode laser therapy as an adjunct to scaling and root planing in the treatment of aggressive periodontitis: a 1-year randomized controlled clinical trial. Photomed Laser Surg. 2017;35(12):702-709. doi: 10.1089/pho.2017.4288. Epub 2017 Sep 14. PMID: 28945145.\u003c/li\u003e\n\u003cli\u003eDUKIĆ 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 Aug;84(8):1111-7. doi: 10.1902/jop.2012.110708. Epub 2012 Oct 17. PMID: 23075433.\u003c/li\u003e\n\u003cli\u003eISMAILI, B.; BOKONJIC, D. Short-Term Low-Level Laser Therapy Attenuates Inflammation and Production of Interleukin-1, But Elevates the Level of Matrix Metalloproteinase 9 in Chronic Periodontitis. Journal of International Dental and Medical Research. 2014. \u003c/li\u003e\n\u003cli\u003ePETROVIĆ, M.S.; et al. Clinical, microbiological and cytomorphometric evaluation of low-level laser therapy as an adjunct to periodontal therapy in patients with chronic periodontitis. International Journal of Dental Hygiene. 2018 May;16(2):e120-e127. doi: 10.1111/idh.12328. Epub 2018 Jan 12. PMID: 29327449. \u003c/li\u003e\n\u003cli\u003eKATSIKANIS, F., STRAKAS, D., \u0026amp; VOUROS, I. The application of antimicrobial photodynamic therapy (aPDT, 670 nm) and diode laser (940 nm) as adjunctive approach in the conventional cause-related treatment of chronic periodontal disease: a randomized controlled split-mouth clinical trial. Clinical Oral Investigations, 2019, 24(5), 1821\u0026ndash;1827. DOI: 10.1007/s00784-019-03045-1\u003c/li\u003e\n\u003cli\u003eANGIERO, F.; et al. Evaluation of bradykinin, VEGF, and EGF biomarkers in gingival crevicular fluid and comparison of PhotoBioModulation with conventional techniques in periodontitis: a split-mouth randomized clinical trial. Lasers in Medical Science. 2020 Jun;35(4):965-970. doi: 10.1007/s10103-019-02919-w. Epub 2019 Nov 29. PMID: 31784929.\u003c/li\u003e\n\u003cli\u003eNART, J.; PONS, R.; VALLES, C.; ESMATGES, A.; SANZ-MART\u0026Iacute;N, I.; MONJE, A. Non-surgical therapeutic outcomes of peri-implantitis: 12-month results. Clinical Oral Investigations. 2020 Feb;24(2):675-682. doi: 10.1007/s00784-019-02943-8. Epub 2019 May 23. PMID: 31123873.\u003c/li\u003e\n\u003cli\u003eMOREIRA, A. L.; et al. Antimicrobial Photodynamic Therapy as an Adjunct to Non-Surgical Treatment of Aggressive Periodontitis: A Split-Mouth Randomized Controlled Trial. Journal of Periodontology, 2015, 86(3), 376\u0026ndash;386. DOI: 10.1902/jop.2014.140392\u003c/li\u003e\n\u003cli\u003eSANTOS, N.C.; ANDERE, N.M.R.B.; MIGUEL, M.M.V.; et al. Photobiomodulation for the treatment of periodontal pockets in patients with type 2 diabetes: 1-year results of a randomized clinical trial. Lasers in Medical Science. 2019 Dec;34(9):1897-1904. DOI: 10.1007/s10103-019-02799-0\u003c/li\u003e\n\u003cli\u003eRen C, McGrath C, Jin L, Zhang C, Yang Y. The effectiveness of low-level laser therapy as an adjunct to non-surgical periodontal treatment: a meta-analysis. J Periodont Res. 2017;52(1):8-20. doi:10.1111/jre.12361. Epub 2016 Mar 2. PMID: 26932392; PMCID: PMC5297978.\u003c/li\u003e\n\u003cli\u003eAdriaens PA, Adriaens LM. Effects of nonsurgical periodontal therapy on hard and soft tissues. Periodontol 2000. 2004;36:121-145. DOI: 10.1111/j.1600-0757.2004.03676.x\u003c/li\u003e\n\u003cli\u003eCavalcanti TM, et al. Conhecimento das propriedades f\u0026iacute;sicas e da intera\u0026ccedil;\u0026atilde;o do laser com os tecidos biol\u0026oacute;gicos na odontologia. An Bras Dermatol. 2011;86(5):665-673. doi:10.1590/S0365-05962011000500014.\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;ndoğar H, Şenyurt SZ, Erciyas K, Yalim M, \u0026Uuml;st\u0026uuml;n K. The effect of low-level laser therapy on non-surgical periodontal treatment: a randomized controlled, single-blind, split-mouth clinical trial. Lasers Med Sci. 2016 Dec;31(9):1767-1773. doi:10.1007/s10103-016-2047-z. Epub 2016 Aug 14. PMID: 27523046.\u003c/li\u003e\n\u003cli\u003eGupta S, Chhina S, Sharma E, Sinha S, Mathur A, Gupta R. Comparative evaluation of laser biostimulation as an adjunct to NSPT and its effects on AST levels in the management of chronic periodontitis: A randomized controlled trial. J Int Oral Health. 2021;13:227-233. \u003cem\u003eDOI: \u003c/em\u003e10.4103/jioh.jioh_204_20.\u003c/li\u003e\n\u003cli\u003eAlzoman HA, Diab HM. Effect of gallium aluminium arsenide diode laser therapy on Porphyromonas gingivalis in chronic periodontitis: a randomized controlled trial. Int J Dent Hyg. 2016 Nov;14(4):261-266. doi: 10.1111/idh.12169. Epub 2015 Aug 6. PMID: 26250477.\u003c/li\u003e\n\u003cli\u003eNguyen NT, Byralay MR, Reinhardt RA, Marx DB, Meinberg TA, Kaldahl WB. Adjunctive non-surgical therapy of inflamed periodontal pockets during maintenance therapy using diode laser: a randomized clinical trial. J Periodontol. 2015 Oct;86(10):1133-40. doi: 10.1902/jop.2015.150152. Epub 2015 Jun 5. PMID: 26418666.\u003c/li\u003e\n\u003cli\u003eda Silva R, da Silva L, Martins A, et al. Adjunctive photobiomodulation to basic periodontal therapy using different low-power laser application techniques: a systematic review and meta-analysis. Lasers Med Sci. 2024;39:207. doi: 10.1007/s10103-024-04148-2.\u003c/li\u003e\n\u003cli\u003eGraziani F, Karapetsa D, Alonso B, Herrera D. Nonsurgical and surgical treatment of periodontitis: how many options for one disease? Periodontol 2000. 2017 Oct;75(1):152-188. doi: 10.1111/prd.12201. PMID: 28758300.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"lasers-in-medical-science","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"lims","sideBox":"Learn more about [Lasers in Medical Science](https://link.springer.com/journal/10103)","snPcode":"10103","submissionUrl":"https://submission.springernature.com/new-submission/10103/3","title":"Lasers in Medical Science","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"periodontitis, low-level laser therapy, photobiomodulation, non-surgical periodontal treatment.","lastPublishedDoi":"10.21203/rs.3.rs-5329027/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5329027/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e To assess and compare two techniques of low-level laser application—transgingival (TLLLT) and intrasulcular (ILLLT)—used in photobiomodulation as an adjunct to basic periodontal therapy (BPT) in patients with periodontitis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA randomized, split-mouth, double-blind clinical trial was conducted, selecting three diseased periodontal sites from different quadrants in each patient. These sites were assigned to one of three treatment groups: SRP (control), SRP + TLLLT (test 1), and SRP + ILLLT (test 2). Low-level laser therapy in the test groups was applied at 48 hours, 7 days, and 14 days after full-mouth SRP. Clinical parameters such as probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were assessed at baseline (T0), 3 months (T1), and 6 months (T2). Standardized periapical radiographs were used to assess radiographic bone density (RBD) 6 months post-treatment. Statistical analyses included repeated measures ANOVA for continuous variables and chi-square tests for categorical variables, with significance set at p \u0026lt; 0.05 and a 95% confidence interval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Significant reductions in PD (p \u0026lt; 0.001) and CAL (p \u0026lt; 0.001) were observed across all groups at 3 and 6 months, with no significant differences between groups. There were also no significant changes in BOP and RBD between groups at the follow-up intervals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Adjunctive photobiomodulation did not provide additional clinical or radiographic benefits over SRP alone, regardless of the laser application technique employed.\u003c/p\u003e","manuscriptTitle":"Evaluation of two low-level laser techniques as an adjunct to basic periodontal therapy: a randomized clinical trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-20 10:45:25","doi":"10.21203/rs.3.rs-5329027/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-04T00:52:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-02T08:39:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229715373812852309675151945781408107287","date":"2024-11-27T10:21:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-23T21:28:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"190216992135228114667273804038976191412","date":"2024-11-23T20:14:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"305830958184590850676266171602474253697","date":"2024-11-22T10:13:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-06T20:43:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-06T20:41:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-29T12:37:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"Lasers in Medical Science","date":"2024-10-25T02:44:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"lasers-in-medical-science","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"lims","sideBox":"Learn more about [Lasers in Medical Science](https://link.springer.com/journal/10103)","snPcode":"10103","submissionUrl":"https://submission.springernature.com/new-submission/10103/3","title":"Lasers in Medical Science","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0b222253-561a-414b-bee8-36c1a7cb6e0b","owner":[],"postedDate":"November 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T16:01:00+00:00","versionOfRecord":{"articleIdentity":"rs-5329027","link":"https://doi.org/10.1007/s10103-024-04275-w","journal":{"identity":"lasers-in-medical-science","isVorOnly":false,"title":"Lasers in Medical Science"},"publishedOn":"2025-01-03 15:57:21","publishedOnDateReadable":"January 3rd, 2025"},"versionCreatedAt":"2024-11-20 10:45:25","video":"","vorDoi":"10.1007/s10103-024-04275-w","vorDoiUrl":"https://doi.org/10.1007/s10103-024-04275-w","workflowStages":[]},"version":"v1","identity":"rs-5329027","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5329027","identity":"rs-5329027","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}