Efficacy of nonsurgical periodontal treatment on patients with periodontitis and type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis
DOI:
https://doi.org/10.2340/aos.v84.43344Keywords:
periodontitis, type 2 diabetes mellitus, network meta-analysis, probing depth, clinical attachment loss, bleeding on probing, glycated hemoglobin, fasting blood sugarAbstract
Objective: This study aimed to evaluate the effects of periodontal basic therapy combined with various adjunctive treatments on periodontal inflammation and glycemic control in patients with periodontitis and type 2 diabetes mellitus (T2DM) using network meta-analysis.
Methods: Randomized controlled trials (RCTs) involving patients with periodontitis and T2DM were retrieved from PubMed, Embase, Cochrane Library, and Web of Science up to February 29, 2024. The Cochrane quality scoring system was applied to assess study quality, and data were analyzed using R and Stata. The study was registered in PROSPERO (Registration No.: CRD42024501722).
Results: Thirty-seven RCTs involving 1,989 patients were included. Among the adjunctive therapies, scaling and root planing (SRP) with local satranidazole gel (SZ) achieved the best improvement in probing depth (PD) and clinical attachment level (CAL); SRP with systemic amoxicillin (AMX) significantly improved bleeding on probing (BOP); SRP with systemic doxycycline (Doxy) or antimicrobial photodynamic therapy (aPDT) was most effective for reducing glycated hemoglobin (HbA1c%); and SRP with diode laser (DL) improved fasting blood sugar (FBS) most effectively.
Conclusion: SRP combined with local SZ may improve PD and CAL in patients with periodontitis and T2DM. Systemic AMX may enhance BOP outcomes, while DOXY or aPDT may help reduce HbA1c. DL may contribute to better FBS improvement.
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Wu CZ, Yuan YH, Liu HH, Li SS, Zhang BW, Chen W, et al. Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. BMC Oral Health. 2020;20:204. https://doi.org/10.1186/s12903-020-01180-w DOI: https://doi.org/10.1186/s12903-020-01180-w
Meyle J, Chapple I. Molecular aspects of the pathogenesis of periodontitis. Periodontol 2000. 2015;69:7–17. https://doi.org/10.1111/prd.12104 DOI: https://doi.org/10.1111/prd.12104
Bartold PM, Van Dyke TE. Periodontitis: a host-mediated disruption of microbial homeostasis. Unlearning learned concepts. Periodontol 2000. 2013;62:203–17. https://doi.org/10.1111/j.1600-0757.2012.00450.x DOI: https://doi.org/10.1111/j.1600-0757.2012.00450.x
Buset SL, Walter C, Friedmann A, Weiger R, Borgnakke WS, Zitzmann NU. Are periodontal diseases really silent? A systematic review of their effect on quality of life. J Clin Periodontol. 2016;43:333–44. https://doi.org/10.1111/jcpe.12517 DOI: https://doi.org/10.1111/jcpe.12517
D’Aiuto F, Gable D, Syed Z, Allen Y, Wanyonyi KL, White S, et al. Evidence summary: the relationship between oral diseases and diabetes. Br Dent J. 2017;222:944–8. https://doi.org/10.1038/sj.bdj.2017.544 DOI: https://doi.org/10.1038/sj.bdj.2017.544
Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol. 1998;3:51–61. https://doi.org/10.1902/annals.1998.3.1.51 DOI: https://doi.org/10.1902/annals.1998.3.1.51
Stewart JE, Wager KA, Friedlander AH, Zadeh HH. The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol. 2001;28:306–10. https://doi.org/10.1034/j.1600-051x.2001.028004306.x DOI: https://doi.org/10.1034/j.1600-051x.2001.028004306.x
Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective. Ann Periodontol. 2001;6:99–112. https://doi.org/10.1902/annals.2001.6.1.99 DOI: https://doi.org/10.1902/annals.2001.6.1.99
Liaw A, Miller C, Nimmo A. Comparing the periodontal tissue response to non-surgical scaling and root planing alone, adjunctive azithromycin, or adjunctive amoxicillin plus metronidazole in generalized chronic moderate-to-severe periodontitis: a preliminary randomized controlled trial. Aust Dent J. 2019;64:145–52. https://doi.org/10.1111/adj.12674 DOI: https://doi.org/10.1111/adj.12674
Caruso U, Nastri L, Piccolomini R, d’Ercole S, Mazza C, Guida L. Use of diode laser 980 nm as adjunctive therapy in the treatment of chronic periodontitis. A randomized controlled clinical trial. New Microbiol. 2008;31:513–18.
Gupta ND, Sharma S, Sharma VK. Probiotic – an emerging therapy in recolonizing periodontal pocket. J Oral Biol Craniofac Res. 2017;7:72–3. https://doi.org/10.1016/j.jobcr.2016.09.002 DOI: https://doi.org/10.1016/j.jobcr.2016.09.002
Castro Dos Santos NC, Andere N, Araujo CF, de Marco AC, Kantarci A, Van Dyke TE, et al. Omega-3 PUFA and aspirin as adjuncts to periodontal debridement in patients with periodontitis and type 2 diabetes mellitus: randomized clinical trial. J Periodontol. 2020;91:1318–27. https://doi.org/10.1002/JPER.19-0613 DOI: https://doi.org/10.1002/JPER.19-0613
Kruger DF, Boucher JL, Banerji MA. Utilizing current diagnostic criteria and treatment algorithms for managing type 2 diabetes mellitus. Postgrad Med. 2011;123:54–62. https://doi.org/10.3810/pgm.2011.07.2304 DOI: https://doi.org/10.3810/pgm.2011.07.2304
Macedo Gde O, Novaes AB, Jr., Souza SL, Taba M, Jr., Palioto DB, Grisi MF. Additional effects of aPDT on nonsurgical periodontal treatment with doxycycline in type II diabetes: a randomized, controlled clinical trial. Lasers Med Sci. 2014;29:881–6. https://doi.org/10.1007/s10103-013-1285-6 DOI: https://doi.org/10.1007/s10103-013-1285-6
Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, et al. Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev. 2015;2015:Cd004714. https://doi.org/10.1002/14651858.CD004714.pub3 DOI: https://doi.org/10.1002/14651858.CD004714.pub3
Abduljabbar T, Vohra F, Javed F, Akram Z. Antimicrobial photodynamic therapy adjuvant to non-surgical periodontal therapy in patients with diabetes mellitus: a meta-analysis. Photodiagnosis Photodyn Ther. 2017;17:138–46. https://doi.org/10.1016/j.pdpdt.2016.11.008 DOI: https://doi.org/10.1016/j.pdpdt.2016.11.008
Lira Junior R, Santos CMM, Oliveira BH, Fischer RG, Santos APP. Effects on HbA1c in diabetic patients of adjunctive use of systemic antibiotics in nonsurgical periodontal treatment: a systematic review. J Dent. 2017;66:1–7. https://doi.org/10.1016/j.jdent.2017.08.001 DOI: https://doi.org/10.1016/j.jdent.2017.08.001
Wang TF, Jen IA, Chou C, Lei YP. Effects of periodontal therapy on metabolic control in patients with type 2 diabetes mellitus and periodontal disease: a meta-analysis. Medicine (Baltimore). 2014;93:e292. https://doi.org/10.1097/MD.0000000000000292 DOI: https://doi.org/10.1097/MD.0000000000000292
Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol. 1967;38(Suppl):610–16. https://doi.org/10.1902/jop.1967.38.6.610 DOI: https://doi.org/10.1902/jop.1967.38.6.610
Jansen JP, Crawford B, Bergman G, Stam W. Bayesian meta-analysis of multiple treatment comparisons: an introduction to mixed treatment comparisons. Value Health. 2008;11:956–64. https://doi.org/10.1111/j.1524-4733.2008.00347.x DOI: https://doi.org/10.1111/j.1524-4733.2008.00347.x
Acharya S, Gujjari SK, Murthy K, Battula R. Evaluation of grape seed formulation as an adjunct to scaling and root planing on oxidative stress, inflammatory status and glycaemic control in type 2 diabetic patients with chronic periodontitis: a randomised controlled trial. J Clin Diagn Res. 2021;15(4):ZC20–5. https://doi.org/10.7860/JCDR/2021/45235.14792 DOI: https://doi.org/10.7860/JCDR/2021/45235.14792
Bazyar H, Gholinezhad H, Moradi L, Salehi P, Abadi F, Ravanbakhsh M, et al. The effects of melatonin supplementation in adjunct with non-surgical periodontal therapy on periodontal status, serum melatonin and inflammatory markers in type 2 diabetes mellitus patients with chronic periodontitis: a double-blind, placebo-controlled trial. Inflammopharmacology. 2019;27:67–76. https://doi.org/10.1007/s10787-018-0539-0 DOI: https://doi.org/10.1007/s10787-018-0539-0
Bazyar H, Maghsoumi-Norouzabad L, Yarahmadi M, Gholinezhad H, Moradi L, Salehi P, et al. The impacts of synbiotic supplementation on periodontal indices and biomarkers of oxidative stress in type 2 diabetes mellitus patients with chronic periodontitis under non-surgical periodontal therapy. A double-blind, placebo-controlled trial. Diabetes Metab Syndr Obes. 2020;13:19–29. https://doi.org/10.2147/DMSO.S230060 DOI: https://doi.org/10.2147/DMSO.S230060
Castro Dos Santos NC, Andere NM, Araujo CF, de Marco AC, Dos Santos LM, Jardini MA, et al. Local adjunct effect of antimicrobial photodynamic therapy for the treatment of chronic periodontitis in type 2 diabetics: split-mouth double-blind randomized controlled clinical trial. Lasers Med Sci. 2016;31:1633–40. https://doi.org/10.1007/s10103-016-2030-8 DOI: https://doi.org/10.1007/s10103-016-2030-8
Chandra S, Shashikumar P. Diode laser – a novel therapeutic approach in the treatment of chronic periodontitis in type 2 diabetes mellitus patients: a prospective randomized controlled clinical trial. J Lasers Med Sci. 2019;10:56–63. https://doi.org/10.15171/jlms.2019.09 DOI: https://doi.org/10.15171/jlms.2019.09
Cruz DFD, Duarte PM, Figueiredo LC, da Silva HDP, Retamal-Valdes B, Feres M, et al. Metronidazole and amoxicillin for patients with periodontitis and diabetes mellitus: 5-year secondary analysis of a randomized controlled trial. J Periodontol. 2021;92:479–87. https://doi.org/10.1002/JPER.20-0196 DOI: https://doi.org/10.1002/JPER.20-0196
da Silva Júnior FL, de Araújo Silva DN, da Silva Azevedo ML, da Silva NT, Almeida HC, da Silva RCM, et al. Efficacy of ILIB on periodontal clinical parameters and glycemic control in patients with periodontitis and type II diabetes-randomized clinical trial. Lasers Med Sci. 2022;37:1945–52. https://doi.org/10.1007/s10103-021-03455-2 DOI: https://doi.org/10.1007/s10103-021-03455-2
Elsadek MF, Ahmed BM, Alkhawtani DM, Zia Siddiqui A. A comparative clinical, microbiological and glycemic analysis of photodynamic therapy and Lactobacillus reuteri in the treatment of chronic periodontitis in type-2 diabetes mellitus patients. Photodiagnosis Photodyn Ther. 2020;29:101629. https://doi.org/10.1016/j.pdpdt.2019.101629 DOI: https://doi.org/10.1016/j.pdpdt.2019.101629
Engebretson SP, Hyman LG, Michalowicz BS, Schoenfeld ER, Gelato MC, Hou W, et al. The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial. JAMA. 2013;310:2523–32. https://doi.org/10.1001/jama.2013.282431 DOI: https://doi.org/10.1001/jama.2013.282431
Feng C, Ding Y, Tang L, Gui Y, Shen X, He L, et al. Adjunctive Er:YAG laser in non-surgical periodontal therapy of patients with inadequately controlled type 2 diabetes mellitus: a split-mouth randomized controlled study. J Periodontal Res. 2022;57:63–74. https://doi.org/10.1111/jre.12938 DOI: https://doi.org/10.1111/jre.12938
Kamatham SA, Chava VK. Comparison of salivary calprotectin levels in periodontitis associated with diabetes mellitus after low-level laser therapy as an adjunct to scaling and root planing: a randomized clinical trial. J Indian Soc Periodontol. 2022;26:143–50. https://doi.org/10.4103/jisp.jisp_149_21 DOI: https://doi.org/10.4103/jisp.jisp_149_21
Katagiri S, Nitta H, Nagasawa T, Uchimura I, Izumiyama H, Inagaki K, et al. Multi-center intervention study on glycohemoglobin (HbA1c) and serum, high-sensitivity CRP (hs-CRP) after local anti-infectious periodontal treatment in type 2 diabetic patients with periodontal disease. Diabetes Res Clin Pract. 2009;83:308–15. https://doi.org/10.1016/j.diabres.2008.10.016 DOI: https://doi.org/10.1016/j.diabres.2008.10.016
Komatsu S, Oshikiri S, Nagano T, Yashima A, Matsushima Y, Shirakawa S, et al. Effects of one-stage full-mouth scaling and root planing with azithromycin on diabetes and periodontal disease: a randomized controlled trial. Antibiotics (Basel). 2022;11:1266. https://doi.org/10.3390/antibiotics11091266 DOI: https://doi.org/10.3390/antibiotics11091266
Kondzielnik P, Gilowski Ł, Wiench R, Płocica I, Strojek K, Krzemiński TF. Effect of non-surgical therapy and adjunctive subantimicrobial dose doxycycline in patients with chronic periodontitis and type 2 diabetes mellitus – randomized, double-blind study. Dent Med Prob. 2009;46:411–16.
Kumar M, Bandyopadhyay P, Mishra L, Das S, Kundu PK, Mistry S. Effect of periodontal therapy on glycemic control and circulating TNF-α in type 2 diabetic patients. Int J Diabetes Dev Ctries. 2015;35:96–102. https://doi.org/10.1007/s13410-014-0236-5 DOI: https://doi.org/10.1007/s13410-014-0236-5
Lee JY, Choi YY, Choi Y, Jin BH. Efficacy of non-surgical treatment accompanied by professional toothbrushing in the treatment of chronic periodontitis in patients with type 2 diabetes mellitus: a randomized controlled clinical trial. J Periodontal Implant Sci. 2020;50:83–96. https://doi.org/10.5051/jpis.2020.50.2.83 DOI: https://doi.org/10.5051/jpis.2020.50.2.83
Miranda TS, Feres M, Perez-Chaparro PJ, Faveri M, Figueiredo LC, Tamashiro NS, et al. Metronidazole and amoxicillin as adjuncts to scaling and root planing for the treatment of type 2 diabetic subjects with periodontitis: 1-year outcomes of a randomized placebo-controlled clinical trial. J Clin Periodontol. 2014;41:890–9. https://doi.org/10.1111/jcpe.12282 DOI: https://doi.org/10.1111/jcpe.12282
O’Connell PA, Taba M, Nomizo A, Foss Freitas MC, Suaid FA, Uyemura SA, et al. Effects of periodontal therapy on glycemic control and inflammatory markers. J Periodontol. 2008;79:774–83. https://doi.org/10.1902/jop.2008.070250 DOI: https://doi.org/10.1902/jop.2008.070250
Özberk SS, Gündoğar H, Özkaya M, Taner İL, Erciyas K. The effect of photobiomodulation therapy on nonsurgical periodontal treatment in patients with type 2 diabetes mellitus: a randomized controlled, single-blind, split-mouth clinical trial. Lasers Med Sci. 2020;35:497–504. https://doi.org/10.1007/s10103-019-02897-z DOI: https://doi.org/10.1007/s10103-019-02897-z
Priyanka N, Kalra N, Saquib S, Malgaonkar N, Tarakji B, Varsha J, et al. Efficacy of subgingivally delivered satranidazole in the treatment of type 2 diabetes subjects with chronic periodontitis: a randomized controlled clinical trial. J Int Acad Periodontol. 2015;17:42–8.
Promsudthi A, Pimapansri S, Deerochanawong C, Kanchanavasita W. The effect of periodontal therapy on uncontrolled type 2 diabetes mellitus in older subjects. Oral Dis. 2005;11:293–8. https://doi.org/10.1111/j.1601-0825.2005.01119.x DOI: https://doi.org/10.1111/j.1601-0825.2005.01119.x
Pulivarthi P, Chava VK, Gunupati S. Salivary tumor necrosis factor-alpha levels in periodontitis associated with diabetes mellitus after low level laser therapy as an adjunct to scaling and root planning: a randomized clinical trial. J Indian Soc Periodontol. 2022;26:236–44. https://doi.org/10.4103/jisp.jisp_150_21 DOI: https://doi.org/10.4103/jisp.jisp_150_21
Raj SC, Mishra AK, Mohanty D, Katti N, Pattnaik S, Patra L, et al. Comparative evaluation of the clinical and radiographic efficacy of 0.05% zoledronate gel as local drug delivery system in treating intrabony defects in stage III grade B periodontitis patients with and without type-2 diabetes mellitus – a randomized split-mouth clinical trial. Clin Adv Periodontics. 2024;14:211–22. https://doi.org/10.1002/cap.10262 DOI: https://doi.org/10.1002/cap.10262
Raman RP, Taiyeb-Ali TB, Chan SP, Chinna K, Vaithilingam RD. Effect of nonsurgical periodontal therapy verses oral hygiene instructions on type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial. BMC Oral Health. 2014;14:79. https://doi.org/10.1186/1472-6831-14-79 DOI: https://doi.org/10.1186/1472-6831-14-79
Ramaprabha G, Khan NS, Kunusoth R, Kakati I, Hussain Qadri SS, Seshadri PR. Assessment of outcome of oral supplementation of vitamin D3 as an adjunct to scaling and root planing in chronic periodontitis patients with type II diabetes mellitus – a randomized controlled clinical trial. J Pharm Bioallied Sci. 2023;15:S346–9. https://doi.org/10.4103/jpbs.jpbs_543_22 DOI: https://doi.org/10.4103/jpbs.jpbs_543_22
Ramos UD, Ayub LG, Reino DM, Grisi MF, Taba M, Jr., Souza SL, et al. Antimicrobial photodynamic therapy as an alternative to systemic antibiotics: results from a double-blind, randomized, placebo-controlled, clinical study on type 2 diabetics. J Clin Periodontol. 2016;43:147–55. https://doi.org/10.1111/jcpe.12498 DOI: https://doi.org/10.1111/jcpe.12498
Shashikumar P, Nisha S, Das D, Debanth K, Kanthal LK, Pattanayak S. Effect of Morinda citrifolia L. Mouthwash on periodontal health in type 2 diabetes mellitus patients – a randomized controlled trial. Int J Nutr Pharmacol Neurol Dis. 2022;12:7–13. https://doi.org/10.4103/ijnpnd.ijnpnd_66_21 DOI: https://doi.org/10.4103/ijnpnd.ijnpnd_66_21
Singh S, Kumar V, Kumar S, Subbappa A. The effect of periodontal therapy on the improvement of glycemic control in patients with type 2 diabetes mellitus: a randomized controlled clinical trial. Int J Diabetes Dev Ctries. 2008;28:38–44. https://doi.org/10.4103/0973-3930.43097 DOI: https://doi.org/10.4103/0973-3930.43097
Soi S, Bains VK, Srivastava R, Madan R. Comparative evaluation of improvement in periodontal and glycemic health status of type 2 diabetes mellitus patients after scaling and root planing with or without adjunctive use of diode laser. Lasers Med Sci. 2021;36:
1307–15. https://doi.org/10.1007/s10103-021-03261-w DOI: https://doi.org/10.1007/s10103-021-03261-w
Sufaru IG, Martu MA, Luchian I, Stoleriu S, Diaconu-Popa D, Martu C, et al. The effects of 810 nm diode laser and indocyanine green on periodontal parameters and HbA1c in patients with periodontitis and type II diabetes mellitus: a randomized controlled study. Diagnostics (Basel). 2022;12:1614. https://doi.org/10.3390/diagnostics12071614 DOI: https://doi.org/10.3390/diagnostics12071614
Toyama G, Felipetti FA, Bertoldo KP, Viera CS, Kottwitz LBM, Nassar CA, et al. Evaluation of different periodontal treatments modes for patients with type 2 diabetes mellitus. J Public Health. 2014;22:529–34. https://doi.org/10.1007/s10389-014-0648-1 DOI: https://doi.org/10.1007/s10389-014-0648-1
Zare Javid A, Bazyar H, Gholinezhad H, Rahimlou M, Rashidi H, Salehi P, et al. The effects of ginger supplementation on inflammatory, antioxidant, and periodontal parameters in type 2 diabetes mellitus patients with chronic periodontitis under non-surgical periodontal therapy. A double-blind, placebo-controlled trial. Diabetes Metab Syndr Obes. 2019;12:1751–61. https://doi.org/10.2147/DMSO.S214333 DOI: https://doi.org/10.2147/DMSO.S214333
Mizuno H, Ekuni D, Maruyama T, Kataoka K, Yoneda T, Fukuhara D, et al. The effects of non-surgical periodontal treatment on glycemic control, oxidative stress balance and quality of life in patients with type 2 diabetes: a randomized clinical trial. PLoS One. 2017;12:e0188171. https://doi.org/10.1371/journal.pone.0188171 DOI: https://doi.org/10.1371/journal.pone.0188171
Liew AK, Punnanithinont N, Lee YC, Yang J. Effect of non-surgical periodontal treatment on HbA1c: a meta-analysis of randomized controlled trials. Aust Dent J. 2013;58:350–7. https://doi.org/10.1111/adj.12091 DOI: https://doi.org/10.1111/adj.12091
Micu IC, Muntean A, Roman A, Stratul ȘI, Pall E, Ciurea A, et al. A local desiccant antimicrobial agent as an alternative to adjunctive antibiotics in the treatment of periodontitis: a narrative review. Antibiotics (Basel). 2023;12:456. https://doi.org/10.3390/antibiotics12030456 DOI: https://doi.org/10.3390/antibiotics12030456
Fiorillo L, Cervino G, Laino L, D’Amico C, Mauceri R, Tozum TF, et al. Porphyromonas gingivalis, periodontal and systemic implications: a systematic review. Dent J (Basel). 2019;7:114. https://doi.org/10.3390/dj7040114 DOI: https://doi.org/10.3390/dj7040114
Harris DM, Yessik M. Therapeutic ratio quantifies laser antisepsis: ablation of Porphyromonas gingivalis with dental lasers. Lasers Surg Med. 2004;35:206–13. https://doi.org/10.1002/lsm.20086 DOI: https://doi.org/10.1002/lsm.20086
Qadri T, Javed F, Johannsen G, Gustafsson A. Role of diode lasers (800–980 nm) as adjuncts to scaling and root planing in the treatment of chronic periodontitis: a systematic review. Photomed Laser Surg. 2015;33:568–75. https://doi.org/10.1089/pho.2015.3914 DOI: https://doi.org/10.1089/pho.2015.3914
Meimandi M, Talebi Ardakani MR, Esmaeil Nejad A, Yousefnejad P, Saebi K, Tayeed MH. The effect of photodynamic therapy in the treatment of chronic periodontitis: a review of literature. J Lasers Med Sci. 2017;8:S7–11. https://doi.org/10.15171/jlms.2017.s2 DOI: https://doi.org/10.15171/jlms.2017.s2
Pourabbas R, Kashefimehr A, Rahmanpour N, Babaloo Z, Kishen A, Tenenbaum HC, et al. Effects of photodynamic therapy on clinical and gingival crevicular fluid inflammatory biomarkers in chronic periodontitis: a split-mouth randomized clinical trial. J Periodontol. 2014;85:1222–9. https://doi.org/10.1902/jop.2014.130464 DOI: https://doi.org/10.1902/jop.2014.130464
Sgolastra F, Severino M, Gatto R, Monaco A. Effectiveness of diode laser as adjunctive therapy to scaling root planning in the treatment of chronic periodontitis: a meta-analysis. Lasers Med Sci. 2013;28:1393–402. https://doi.org/10.1007/s10103-012-1181-5 DOI: https://doi.org/10.1007/s10103-012-1181-5
Cao R, Li Q, Wu Q, Yao M, Chen Y, Zhou H. Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis. BMC Oral Health. 2019;19:176. https://doi.org/10.1186/s12903-019-0829-y DOI: https://doi.org/10.1186/s12903-019-0829-y
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