Terapia Fotodinâmica em pacientes diabéticos tipo 2 com doença periodontal - ensaio clínico randomizado boca dividida.

Abstract

Introduction: Diabetic individuals with untreated periodontal disease are known to be more predisposed to glycemic imbalance and the consequent development of diabetes-related complications. Due to the impaired quality of life caused by type 2 diabetes mellitus and periodontal disease, studies are needed to investigate the relationship between the two diseases and the mechanisms involved in this association, seeking ways to minimize the consequences of these changes to individual health. Antimicrobial photodynamic therapy (aPDT) is an adjunctive treatment to scaling and root planing (SRP) that can contribute to improving periodontal outcomes, especially in patients with compromised healing, such as decompensated type 2 diabetics. Objective: To compare, through clinical analysis, the use of three aPDT applications as adjunctive therapy to non-surgical periodontal treatment of stage III and IV periodontitis in type 2 diabetic patients (T2DM). Methods: Twenty patients were evaluated in a randomized, split-mouth clinical trial. The inclusion criteria were: patients of both sexes, aged 25 to 65 years, with type 2 DM (glycated hemoglobin ≥ 7%) and Stage III or IV periodontitis. All selected patients underwent non-surgical periodontal treatment and were evaluated using clinical parameters: plaque index, probing depth, clinical attachment level, and bleeding on probing. Laboratory tests (fasting blood glucose, glycated hemoglobin, and lipid profile) were requested. In addition, gingival crevicular fluid was quantified. The side for each treatment was defined by randomization. aPDT was performed immediately after SRP and reapplied at 7 and 14 days, in combination with a low-level laser (660 nm) and methylene blue (10 mg/ml). Patients were evaluated for a total period of 12 months, comprising the periods of baseline, 3, 6, and 12 months. Results: The results demonstrate an improvement in periodontal outcomes at 3, 6, and 12 months, with no significant difference between the SRP and SRP+PDT groups. There was a statistically significant reduction in glycated hemoglobin levels during the reassessment periods compared to baseline. Conclusion: We can conclude that adjunctive PDT to SRP did not provide additional clinical benefits in periodontal parameters in this patient profile, but that basic periodontal treatment was effective in reducing glycated hemoglobin levels and, consequently, improved metabolic control.