关键词: 牙周炎, 钇铝石榴石晶体(Nd:YAG)激光, 2型糖尿病, 16S rRNA全长基因测序, 牙周微生态

Abstract:

Objective To investigate the effects of neodymium-doped yttrium aluminium garnet (Nd:YAG) laser combined with scaling and root planing (SRP) on the clinical outcomes and the dynamics of subgingival flora in periodontitis patients with type 2 diabetes mellitus (T2DM). Methods Sixteen periodontitis patients with T2DM admitted to the Department of Periodontology of the Affiliated Stomatology Hospital of Nanjing Medical University from August 2021 to January 2022 were randomly divided into Nd:YAG group and SRP group. Patients in the Nd:YAG group received SRP and Nd:YAG laser treatment; the SRP group received SRP treatment only. Probing depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP) positive rates, fasting plasma glucose (FPG), glycated hemoglobin (HbA1c) and body mass index (BMI) were used to assess the periodontal status and glycemic control of patients before and after treatment. Subgingival plaque samples (PD≥5 mm) were collected at baseline and 3 months after treatment and analyzed by 16S rRNA full-length sequencing. Results Compared with baseline, PD was significantly lower in both the Nd:YAG and SRP groups at 3 months after treatment(P<0.05), and the Nd:YAG group was significantly lower than the SRP group (P<0.05); there was no statistically significant difference before and after treatment in CAL(P>0.05); BOP was significantly improved in both groups (P<0.05), but the difference between groups was not significant (P>0.05). VAS score in the Nd:YAG group was significantly lower than that in the SRP group (P<0.05). FPG, HbA1c levels and BMI were not significantly different after 3 months of treatment compared with baseline (P>0.05). Bacterial flora analysis showed that the abundance of g Leptotrichia and f Leptotrichiaceae was significantly higher in the Nd:YAG group after 3 months of treatment compared with that at baseline (P< 0.05), and that the p Bacteroidetes and c Bacteroidiawere significantly higher in the SRP group after 3 months of treatment. Conclusion Nd:YAG laser combined with SRP improves clinical periodontal parameters and reduces pain in periodontitis patients with T2DM, but there is no significant advantage in terms of glucose metabolism levels. Changes in the composition of the main subgingival microflora are observed in the short term after treatment and an increase in health-associated taxa following laser treatment.

Key words: periodontitis, neodymium-doped yttrium aluminium garnet, type 2 diabetes mellitus, 16S rRNA full-length sequencing, periodontal microecological