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Study, country
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Groups
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Periodontal inclusion criteria
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Diabetes inclusion criteria
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Therapy
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Confounders controlled
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Results
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Effect
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Masi et al93, UK
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51 patients with T2DM and PD;27 IPT; 24 CPT; Mean age: IPT, 56 ± 9 y, and CPT, 58 ± 11 y.
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≥ 15 teeth, ≥ 20 sites with PD ≥ 5 mm and radiographic bone loss.
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T2DM according to the WHO criteria and confirmed in specialist.
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IPT group received whole mouth SRP at the baseline and 2 mo later. Additional periodontal surgery was performed if there were deeper residual periodontal pockets. CPT patients received supra-gingival scaling and polishing at the baseline and 2 mo later.
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Age, gender, race, smoking, BP, cholesterol, cytokines, ROS.
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Patients in the IPT group had lower levels of HbA1c 6 mo after therapy compared to CPT patients (average between-group difference of 0.65%, 95% CI 0.22–1.14, P = 0.003).
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Yes
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D’Aiuto et al88, UK
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264 patients with T2DM and PD; 133 IPT and 131 CPT; Mean age: IPT, 58.2 ± 9.7 y, and CPT, 55.5 ± 10 y.
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≥ 20 periodontal pockets with PD > 4 mm, marginal alveolar bone loss of > 30%, and at least 15 teeth, with active signs of gingival inflammation rather than history of breakdown of periodontal soft and hard tissues.
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T2DM (using WHO diagnostic criteria) for 6 mo or longer.
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IPT: whole mouth SRP, surgical periodontal therapy, and supportive periodontal therapy every 3 mo until completion of the study. Control: supragingival scaling and polishing at the same time-points as in the IPT group.
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Age, gender, ethnicity, smoking, duration of diabetes, BMI.
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After 12 mo, HbA1c was 0.6% (95% CI 0.3–0.9; P < 0.0001) lower in the IPT group than in the control group.
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Yes
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Mauri-Obradors et al94, Spain
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90 patients with T2DM and PD; 48 treatment group and 42 treatment control;Mean age: treatment group, 61 ± 11 y, and control, 62 ± 11 y.
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Periodontitis (Armitage108) at least nine teeth present and > 30% of the probed gingiva with a depth and clinical attachment level ≥ 4 mm.
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T2DM diagnosed at least 1.5 years prior the study.
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Treatment group: OHI, supragingival scaling and polishing, whole mouth SRP and supportive periodontal therapy when needed until completion of the study. Control: OHI, supragingival scaling and polishing.
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Groups matched for: age, sex, medications, duration of diabetes, tooth brushing frequency, interproximal brush use, weight.
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After 6 mo, improvement of HbA1c in the treatment group (P = 0.019)
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Yes
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Engebretson et al91, USA
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514 patients with T2DM and PD;257 treatment group and 257 treatment control;Mean age: treatment group, 56.7 ± 10.5 y, and control, 57.9 ± 9.6 y.
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≥ 16 natural teeth, CAL and PD > 5 mm in 2 or more quadrants.
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T2DM for more than 3 mo; HbA1c 7.0% > 9.0%.
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Control: OHI; Treatment group: SRP and chlorhexidine gluconate (twice daily for 2 weeks).
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Age, gender, smoking, systemic disease.
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After 3 and 6 mo, no statistically significant difference in the HbA1c between the two groups. Control: −0.11 to −0.09; Treatment group: −0.14 to −0.11; P = 0.55; 3 and 6 mo respectively.
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No
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Katagiri et al95, Japan
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41 patients with T2DM and PD; no controls;Mean age: 63.3 ± 9.9 y.
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≥ 10 remaining teeth, at least two sites with a PD ≥ 4 mm.
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HbA1c 6.2% > 10.4%.
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All patients had SRP plus 10 mg minocycline 4 times every other week, followed by additional supportive periodontal treatments after 2 and 6 mo.
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Age, gender, BMI.
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After 2 and 6 mo, no statistically significant difference in the HbA1c. Baseline: 7.3 ± 0.8, 2 mo: 7.2 ± 0.7, 6 mo: 7.1 ± 0.6.
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No
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Moeintaghavi et al96, Iran
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40 patients with T2DM and PD; 22 treatment group, 18 treatment controls;Mean age: 50.29 ± 3 y.
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Mild to moderate periodontitis in accordance with the AAP criteria.
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HbA1c ≥ 7%.
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Both groups: OHI, placement of emergency restorations and extraction of unsalvageable teeth. Treatment group: SRP.
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Age, gender, smoking, other systemic diseases.
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After 3 mo, HbA1c showed an improvement in the treatment group. Control: 8.72 ± 2.22% vs. 8.97 ± 1.82%. Treatment group: 8.15 ± 1.18 vs. 7.41 ± 1.18%, P < 0.001.
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Yes
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Chen et al97, China
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134 with T2DM and PD; 45 treatment 1; 45 treatment 2; 44 treatment control;Mean age:treatment 1, 59.86 ± 9.48 y, treatment 2, 57.91 ± 11.35 y and treatment control, 63.2 ± 8.51 y.
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Mean CAL ≥ 1 mm (including slight, moderate, and severe periodontitis), with ≥ 16 teeth. In accordance with the AAP criteria.
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T2DM for more than 1 year.
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Control: no treatment measure or formal oral hygiene instructions. Group 1: SRP at the baseline and additional subgingival debridement at the 3-mo follow-up. Group 2: SRP at the baseline only.
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Age, gender, smoking status, alcohol, physical exercise, BMI.
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No differences were observed in HbA1c in month 1.5 and 3. After 6 mo, only group 2 had a significant reduction in the HbA1c. Control: 7.25 ± 1.49 to 7.38 ± 1.57%; Group 1: 7.31 ± 1.23 to 7.09 ± 1.34%; Group 2: 7.29 ± 1.55 to 6.87 ± 1.12%, P < 0.05.
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Yes
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Koromantzos et al98, Greece
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60 patients with T2DM and PD; no controls;Mean age: 59.5 ± 8.9 y.
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≥ 16 teeth with at least 8 sites with PD ≥ 6 mm and 4 sites with CAL ≥ 5 mm, distributed in at least 2 different quadrants.
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HbA1c 7% > 10%.
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Teeth with hopeless teeth were extracted at SRP visit. Control: periodontal prophylaxis at baseline; Treatment group: SRP
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Age, gender, smoking, BMI.
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After 6 mo, HbA1cshowed an improvement in the treatment group. Treatment vs. control group: −0.72 ± 0.93%, P < 0.001.
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Yes
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Sun et al
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