Dynamics of clinical and immunological parameters in the integrated management of endo-­periodontal lesions, including laser therapy

Aim. To determine the dynamics of clinical changes and indicators of local immunity in integrating the diode laser into the treatment of the endo-periodontal lesion. Methods. We performed a prospective study of 110 patients of both sexes aged 25–55 years with endo-periodontal lesions. The patients were randomized into two groups — the main group (n=54), whose received root canal treatment and periodontal pockets with a diode laser in addition to standard therapy, which included endodontic and periodontal treatment, and control group (n=56), whose patients received only standard treatment. The Green–Vermillion oral hygiene index and Russell’s periodontal index, as well as the levels of immunoglobulin (Ig) A, tumor necrosis factor-alpha (TNF-alpha) and cytokine interleukin-10 (IL-10) in the mixed saliva of patients, were determined during the study. Quantitative data were described using median, lower and upper quartiles. These data were visualized using boxplots. The Mann–Whitney U test was used to compare differences between an independent set of quantitative data. Differences were considered significant at a confidence level of p <0.05. Results. The median oral hygiene index decreased from 2.9 to 1.0 (p <0.001) in the main group and from 2.9 to 1.6 (p <0.001) in the control group. The median Russell's periodontal index decreased from 3.38 to 1.3 (p <0.001) in the main group and from 3.95 to 2.0 (p <0.001) in the control group. The median immunoglobulin A content decreased from 5.25 to 3.13 mg/L (p <0.001) in the main group and from 5.23 to 4.21 mg/L (p <0.001) in the control group. The tumor necrosis factor-alpha level decreased from 16.65 pg/ml in the main group and 18.28 pg/ml in the control group to 3.96 and 8.44 pg/ml (p <0.001), respectively. The median cytokine interleukin-10 levels increased from 0.83 to 2.94 pg/ml (p <0.001) in the main group and from 1.29 to 2.13 pg/ml (p <0.001) in the control group. Conclusion. The use of a diode laser in the treatment of endo-periodontal lesions has a positive effect on the dynamics of clinical and immunological parameters, as evidenced by a statistically significant decrease in clinical indices, as well as the normalization of the immunoglobulin A and cytokine levels in mixed saliva.