Patients with Type II diabetes show long-term benefit from periodontal surgery
MedWire News: Study findings suggest that patients with Type 2 diabetes respond to periodontal surgical procedures as well as patients without diabetes, provided they maintain good glycemic control and optimum oral hygiene.
"This positive response of diabetics to periodontal flap procedures should be a motivating factor in providing these patients with the benefits of all forms of periodontal therapy, and disease per se should not be an impeding factor," say Sheetal Oswal (Sri Hasanamba Dental College and Hospital, Karnataka, India) and colleagues.
The researchers performed periodontal surgery in 20 patients with Type 2 diabetes and 20 patients without diabetes (mean age 42.4 and 40.0 years, respectively) with moderate-to-advanced periodontal disease. The researchers defined this as at least three adjacent teeth in the same quadrant with pocket depths of at least 5 mm after phase I therapy and horizontal bone defects.
Postoperative evaluations were performed 6 months after surgery and included changes in gingival status, probing pocket depth, clinical attachment level, mobility, and position of the gingiva.
None of the patients who underwent surgery presented any significant postoperative complications, except one patient in the diabetes group who developed a periodontal abscess at the surgical site during the fifth postoperative month. Furthermore, no teeth were extracted in both groups during the 6-month study period.
Analysis of plaque and calculus scores and gingival and bleeding indices at 6 months revealed no significant differences compared with baseline, either within or between the groups.
Significant reductions in overall probing pocket depth were achieved in both patients with diabetes (4.17 to 2.70 mm; 35.3% improvement) and controls (3.91 to 2.51 mm; 35.8% improvement), with no significant difference seen between the groups. Similar findings were observed for overall mean clinical attachment loss (CAL), with improvements of 27.3% (4.32 to 3.14 mm) and 29.2% (4.69 to 3.32 mm), respectively.
When the researchers analyzed each category of probing pocket depth severity, they found significant improvements from baseline among both patients with and without diabetes who had mild (0-4 and 1-2 mm; 19.6% and 15.8%, respectively), moderate (>4-7 and 3-4 mm; 41.1% and 39.8%, respectively), and severe (>7 and ≥5 mm; 47.6% and 51.9%, respectively) periodontitis.
In the severe category of CAL (≥5 mm), the percentage of loss reduction was similar for both patients with diabetes and controls, at 28.7% and 32.1%, respectively. However, the reduction in CAL in the moderate category (3-4 mm) was less among patients with diabetes compared with individuals without diabetes (18.3 vs 31.1%, respectively), although this difference was not significant.
Patients with diabetes with mild CAL (1-2 mm) showed a greater loss of attachment (-16.5%) at 6 months than moderate CAL patients, while CAL in the nondiabetes group remained the same.
"Stability in long-term control of glucose metabolism and optimal oral hygiene along with a sound supportive periodontal therapy can go a long way in contributing to the success of periodontal therapy in diabetics," write the authors in the International Journal of Stomatology and Occlusion Medicine.
By Ingrid Grasmo