Cervical enamel projections from a periodontal perspective: A scoping review.

Cervical enamel projections (CEPs) represent a unique developmental and anatomical anomaly wherein the enamel structure extends apically beyond the cemento-enamel junction of the tooth. In this scoping review, the existing literature on CEPs was evaluated to delineate their characteristics, prevalence, predilection for specific teeth and surfaces, clinical significance, and management approaches. Searches were conducted on MEDLINE (PubMed), Cochrane Library, and Embase databases using the keywords "enamel projection(s)" or "ectopic enamel." In total, 24 studies meeting inclusion criteria were included in the review. The prevalence of CEPs varied widely (8.3%-85.1%), predominantly manifesting as grade I or grade III. Mandibular first and second molars exhibited a higher incidence of CEPs, with a notable predilection for buccal surfaces. The consensus in most studies was that CEPs are associated with localized periodontal diseases. Recommendations inclined toward the removal of ectopic enamel during periodontal surgery to enhance periodontal attachment formation. However, decision-making should involve careful consideration of the benefits and drawbacks based on individual circumstances.

The loss of molars in supportive periodontal care: A 10-year follow-up for tooth- and patient-related factors.

AIM: To determine the impact of the degree of furcation involvement (FI) on the longevity of molar teeth and assess the risk variables (tooth- and patient-related factors) associated with the loss of molars (LM) in individuals treated for periodontitis and monitored in a private programme of supportive periodontal care (SPC). MATERIALS AND METHODS: The present retrospective cohort study included 222 individuals with 1329 molars under a 10-year monitoring period in SPC. Periodontal clinical parameters, FI, the type of molar, pulp vitality, and other variables of interest were collected at approximately 50 days after active periodontal therapy and after 10 years. The association of tooth- and patient-related factors with LM was assessed using a multilevel Cox regression analysis. RESULTS: Two-hundred and thirty-five molars were extracted during the SPC period of 12.4 ± 1.9 years. Age >50 years, male gender, diabetes, smoking, and non-compliance were identified as relevant patient-related factors for LM during SPC (p < .05). Significant tooth-related factors for LM were bleeding on probing (BoP) and probing depth (PD) ≥5 mm, tooth non-vitality, and class II and III FI (p < .05). CONCLUSIONS: Class III FI, tooth non-vitality, higher mean PD and BoP, age, male gender, diabetes, and smoking all strongly influenced the prognosis of molars during SPC.

Vertical subclassification predicts survival of molars with class II furcation involvement during supportive periodontal care.

BACKGROUND: Furcation involvement is a major predictor of tooth survival. Focus has so far been on the predictive value of the horizontal component of furcation involvement. Residual periodontal support on each of the roots is likely to play a major role on retention of the furcated molar. Aim of this clinical audit study was to preliminarily assess the impact of vertical subclassification on tooth retention. METHODS: Tooth retention of class II furcated molars in 200 consecutive patients compliant with periodontal supportive care for a minimum of 10 years was retrospectively evaluated in a single practice. Randomly selected furcated molars were retrospectively diagnosed in terms of vertical subclassification (residual periodontal support on the most compromised root), and time to tooth extraction/loss was determined in clinical records. Kaplan-Meier survival curves were constructed. RESULTS: Ten-year survival of molar with class II furcation involvement was 52.5%. Survival was 91% for subclass A, 67% for subclass B and 23% for subclass C. Mean years of survival were 9.5-10.1, 8.5-9.3 and 6-7.3 for subclasses A, B and C, respectively. Tests of equality of the survival distributions showed highly significant differences in all portions of the curve (p < .001). Stratified analyses by smoking showed significant differences for the two groups (p < .001). Hazard rates for tooth extraction/loss were 4.2 and 14.7 for subclasses B and C, respectively. CONCLUSIONS: Residual periodontal support assessed as vertical subclassification of furcation involvement seems to be a good predictor of survival of molar with class II horizontal furcation. This has implication for prognosis, treatment planning and development of effective molar retention strategies.

The effect of furcation involvement on tooth loss in a population without regular periodontal therapy.

AIM: We aimed to assess the association between furcation involvement (FI) and tooth loss for subjects not undergoing regular periodontal treatment. MATERIALS AND METHODS: Data from 2333 subjects participating in the baseline and 11-year follow-up of the Study of Health in Pomerania (SHIP) were used. All subjects had half-mouth periodontal examinations, including FI in one upper and one lower molar, at baseline. A total of 1897 subjects and 3267 molars were included in the final analysis. RESULTS: In total, 375 subjects (19.8%) lost molars during the follow-up period. Respectively, 5.6%, 12.7%, 34.0% and 55.6% of molars without FI, degree I FI, degree II FI and degree III FI were lost. Initial probing pocket depth (PPD) and clinical attachment level (CAL) were associated with molar loss (p < .001). Baseline degree I FI was associated with a 1.73 IRR (incidence rate ratio) (95% CI=1.34-2.23, p < .001) of tooth loss while degree II-III was associated with a 3.88 IRR (95% CI=2.94-5.11, p < .001) of tooth loss compared to molars without FI at baseline. CONCLUSION: This study provides evidence for an increased risk of molar loss affected by periodontal furcation involvement in a general population not undergoing regular periodontal care.

Tooth loss in generalized aggressive periodontitis: Prognostic factors after 17 years of supportive periodontal treatment.

AIM: This retrospective longitudinal study assessed the risk of and prognostic factors for tooth loss in patients with generalized aggressive periodontitis (GAgP) after periodontal treatment in a university setting. METHODS: Fifty-seven patients (1,505 teeth) were examined before (T0) and after active periodontal therapy (APT, T1) as well as after 17.4 ± 4.8 [range: 9-28] years of supportive periodontal therapy (SPT, T2). Descriptive statistics and a Cox-proportional-hazards shared-frailty model were applied. RESULTS: Overall, 98 and 134 teeth were lost during APT and SPT, respectively, with 0.14 ± 0.18 teeth being lost per patient and year. During SPT, three patients (5%) lost ≥10 teeth, 14 (25%) lost 4-9 teeth, 40 lost 0-3 (70%) teeth, respectively. One-third (n = 19) of all patients lost no teeth. Mean PPD of the teeth surviving SPT was stable from T1 (3.5 ± 1.1 mm) to T2 (3.4 ± 1.1 mm). Nearly, 84% of all survived teeth showed stable or improved bone level at T2. Risk of tooth loss was significantly increased in active smokers (HR[95% CI]: 4.94[1.91/12.75]), the upper dental arch (1.94[1,16/3.25]), with each mm of residual PPD (1.41[1.29/1.53]), teeth with furcation involvement (FI) (HR 4.00-4.44 for different degrees) and mobility (5.39 [2.06/14.1] for degree III). CONCLUSION: Within the provided conservative treatment regimen, GAgP patients lost only few teeth.

Significance of maxillary sinus mucosal thickening in patients with periodontal disease.

AIM: To characterise and measure the Schneiderian membranes of individuals with periodontal diseases in China and to analyse the factors impacting maxillary sinus mucosal thickness using cone-beam computed tomography (CBCT). MATERIAL AND METHOD: A cohort of 221 patients with periodontal disease was subjected to cross-sectional CBCT examination. Various parameters, including age, sex, alveolar bone loss, furcation lesions and vertical infrabony pockets, were analysed as correlates of mucosal thickening (MT). Sinus mucosal thickness ≥ 2 mm qualified as MT. RESULTS: MT was detected in 103 (48.9%) patients, increasing in frequency as the degree of alveolar bone loss advanced (mild, 14.5%; moderate, 29.5%; severe, 87.9%). The association between MT and vertical infrabony pockets was statistically significant (P < 0.001). The likelihood of MT increased with moderate [odds ratio (OR) = 1.02] and severe (OR = 4.62) periodontal bone loss (P < 0.001), as well as with furcation lesions (OR = 2.76) and vertical infrabony pockets (OR = 13.58). CONCLUSIONS: Relative to the case in patients with periodontitis and normal mucosa, the probability of MT increased dramatically as alveolar bone loss worsened. Periodontal pathologies (i.e. furcation lesions and vertical infrabony pockets) were also more likely to coincide with MT.

Is furcation involvement in maxillary molars a predictor for subsequent bone augmentation prior to implant placement? A pilot study.

AIM: The aim of this pilot study was to analyze the interfurcal bone height in relation to the possible need for subsequent sinus floor elevation in patients with advanced periodontitis and furcation involvement of first and/or second maxillary molars. MATERIAL AND METHODS: Seventeen dentate patients, who received cone beam computed tomography (CBCT) for detailed preoperative diagnosis and planning of surgical interventions at periodontally involved maxillary molars (17 first and 15 second molars), were consecutively recruited for the study. The minimal bone height in the interfurcal region was measured from CBCT and related to furcation involvement, residual bone above the root tips, and the clinical probing pocket depth (PPD). RESULTS: The minimal interfurcal bone height measured 4.1 ± 2.6 mm on average with 75% of maxillary molars having ≤ 6 mm and almost 60% having only ≤ 4 mm bone height left below the sinus floor. A higher risk for reduced interfurcal bone height of ≤ 4 mm was given when residual PPD of ≥ 6 mm was remaining at two or more tooth sites (OR 0.10; 0.11). CONCLUSIONS: The majority of periodontally involved maxillary molars had a substantially reduced interfurcal bone height, particularly with at least two sites with residual PPD ≥ 6 mm. This was a predictor for a subsequent need for sinus floor elevation when tooth replacement with a dental implant is desired.

Is the Schneiderian membrane thickness affected by periodontal disease? A cone beam computed tomography-based extended case series.

OBJECTIVE: The aim was to assess the thickness of Schneiderian membranes (SM) in patients with advanced periodontal disease. METHODS: 17 dentate patients (DG) scheduled for periodontal surgery on maxillary molars were consecutively recruited and cone beam computed tomographies performed for preoperative diagnosis. Twenty-one patients (EG) requiring cone beam computed tomography-based planning of implant placement in the edentulous posterior maxilla served as controls. RESULTS: Schneiderian membrane thickness measured from cone beam computed tomography was significantly greater in the dentate group compared to the edentulous group, both in the first (p = 0.028) and second (p < 0.001) molar position. In the dentate group, clinical signs of periodontal destruction (increased probing pocket depth or furcation involvement) were not associated with Schneiderian membrane thickness. Additional findings, such as periapical lesions (p = 0.008), and the distance between root tips and maxillary sinus revealed a significant association (p = 0.036) with Schneiderian membrane thickness. CONCLUSION: In molar regions with periodontal destruction, Schneiderian membrane thickening occurred, particularly in combination with small bone layers above the root tips or periapical lesions.

Clinical outcome in periradicular surgery: effect of patient- and tooth-related factors--a multicenter study.

OBJECTIVE: To evaluate the effect of patient- and tooth-related factors on the outcome of apical surgery in a multicenter study. METHOD AND MATERIALS: A total of 281 teeth in 255 patients undergoing periradicular surgery were investigated clinically and radiographically 6 to 12 months postoperatively. RESULTS: The overall success rate was 88.0%. Sex was a significant (P = .024) predictor, with a success rate of 89.8% in females and 84.0% in males. The success rate was significantly higher in patients 31 to 40 years of age. The treatment of premolars resulted in a significantly higher success rate (91.9%) than the treatment of anterior teeth (86.1%, P = .042) and molars (86.4 %, P = .026). The loss of the buccal bone plate and the extension of apical osteolysis to the furcation area in molars resulted in a considerably lower success rate. Lesion size, preoperative pain, tenderness to percussion, fistula, and resurgery were significant factors. CONCLUSION: There are several factors influencing the success rate of apical surgery that must be taken into account when considering apical surgery as a treatment alternative.

Survival of molar teeth after resective periodontal therapy--a retrospective study.

AIM: To study outcomes of molar teeth after resective therapy performed with the intention to prolong the lifespan of teeth having one or more unsaveable roots, and without which tooth extraction would be inevitable. MATERIAL AND METHODS: Clinical records of 149 subjects who had undergone resective therapy were retrieved. Demography and dental history were recorded, and a recall examination was undertaken. Cox regression models were performed. RESULTS: Of the 149 resective therapies, 132 (88.6%) were performed for periodontal reasons. Eighty-nine (59.7%) teeth subjected to resective therapies had been extracted by the time of recall (mean 10 years post-resection). The median survival period was 74 months. Factors significantly associated with shorter survival duration of teeth subjected to resective therapy were: age at resective therapy; pre-operative radiographic bone height of the remaining root(s) <50%; pre-treatment mobility II or above and not being splinted to neighbouring teeth nor incorporated as a bridge abutment. CONCLUSION: There was increased risk of tooth loss with increasing age at resection, grade II mobility or above, and reduced pre-operative radiographic bone heights around roots to remain. Splinting of a resected tooth to neighbouring teeth appeared to confer a protective effect towards its survival.

A multidisciplinary approach for the management of pathologic tooth migration in a patient with moderately advanced periodontal disease.

The physiologic tooth position is determined by interactions between the periodontal tissue and occlusal, tongue, and lip forces. Bone destruction resulting from chronic periodontal disease disturbs the equilibrium of these interactive balances, leading to pathologic tooth migration, often requiring multidisciplinary treatment approaches. The present case demonstrates a systematic periodontal-orthodontic-prosthetic treatment for achieving the optimal structural, functional, and esthetic outcomes.

Effect of a calcium hydroxide/chlorhexidine paste as intracanal dressing in human primary teeth with necrotic pulp against Porphyromonas gingivalis and Enterococcus faecalis.

BACKGROUND: Intracanal medication is important for endodontic treatment success as it eliminates microorganisms that persist after biomechanical preparation. Aim. To evaluate the effect of two intracanal medications against Porphyromonas gingivalis and Enterococcus faecalis in the root canals of human primary teeth with necrotic pulp with and without furcal/periapical lesion, using quantitative real-time polymerase chain reaction (qRT-PCR). DESIGN: Thirty-two teeth with necrotic pulp were used. Twelve teeth did not present lesion, and 20 teeth presented radiographically visible furca/periapical lesion. Microbiological samples were collected after coronal access and biomechanical preparation. The teeth were medicated with calcium hydroxide pastes prepared with either polyethylene glycol or chlorhexidine. After 30days, the medication was removed and a third collection was performed. Microbiological samples were processed using qRT-PCR. Data were analysed by Wilcoxon and Mann-Whitney tests (α=0.05). RESULTS: There was no significant difference in the microbiota present in the primary teeth with and without furcal/periapical lesion. Biomechanical preparation was effective in reducing the number of microorganisms (P<0.05). The intracanal medications had similar antibacterial activity. CONCLUSION: The association of chlorhexidine with calcium hydroxide did not increase the antibacterial activity of the intracanal medication in the treatment of primary teeth with necrotic pulp with and without furcal/periapical lesion.

A clinical predicament--diagnosis and differential diagnosis of cutaneous facial sinus tracts of dental origin: a series of case reports.

A cutaneous draining sinus tract of dental origin is often a diagnostic challenge, because of its uncommon occurrence and absence of dental symptoms. Proper diagnosis, treatment, and the elimination of the source of infection are a must; otherwise, it can result in ineffective and inappropriate outcome of treatment. This article presents 4 cases of facial lesions misdiagnosed as being of nonodontogenic origin. The correct diagnosis in each case was cutaneous sinus tract secondary to pulpal necrosis, suppurative apical periodontitis, and osteomyelitis. In all cases, facial sinus tracts of dental origin were excised and the source of infection eliminated. The purpose of this paper is to provide diagnostic guidelines and examination protocols for differential diagnosis of cutaneous facial sinus tracts of dental origin.

Tooth loss in aggressive periodontitis after active periodontal therapy: patient-related and tooth-related prognostic factors.

OBJECTIVES: To assess prognostic factors for tooth loss after active periodontal therapy (APT) in patients with aggressive periodontitis (AgP) at tooth level. MATERIAL AND METHODS: Eighty-four patients with AgP were re-evaluated after a mean period of 10.5 years of supportive periodontal therapy (SPT). Two thousand and fifty-four teeth were entered into the model. The tooth-related factors including baseline bone loss, tooth location and type, furcation involvement (FI), regenerative therapy, and abutment status, as well as time of follow-up and other patient-related factors were tested for their prognostic value at tooth level. Multilevel regression analysis was performed for statistical analysis to identify factors contributing to tooth loss. RESULTS: During SPT, 113 teeth (1.34 teeth per patient) were lost. Baseline bone loss, use as abutment tooth, tooth type, and maxillary location contributed significantly to tooth loss during SPT. Molars showed the highest risk for tooth loss after APT. Moreover, time of follow-up and the patient-related factor "educational status" significantly accounted for tooth loss at tooth level. CONCLUSION: Baseline bone loss, abutment status, tooth location, and type as well as time of follow-up and educational status were detected as prognostic factors for tooth loss during SPT in patients with AgP at tooth level.

Maintenance of class III trifurcated molars versus implant placement in regenerated extraction sockets: long-term results of 2 cases.

Studies to date have reached differing conclusions regarding the long-term prognosis of teeth with class III furcation involvement. Replacement of such teeth with implants could be an alternative. This report compares the treatment outcomes of 2 cases with similar disease progression: 1 treated by implant therapy and 1 maintained with nonsurgical periodontal treatment. Two patients with advanced chronic periodontitis and class III furcation involvement of all molars were treated. Case 1 received a conservative periodontal and antibiotic treatment, followed by 15 years of maintenance. In case 2, the molars were extracted and replaced with implants, and the implants were observed for 7 years. Clinical attachment level (CAL), probing attachment level (PAL), bleeding on probing, plaque index, and periodontal pathogens were recorded. Despite good compliance of case 1, periodontal pathogens were not eliminated and tissue destruction was not halted. The PAL outcomes of case 2 improved over time; mean PAL loss reached 0.35 mm/y in the first 3 years and then decreased to 0.01 mm/y. While CAL outcomes did not change in case 2, case 1 showed increased CAL loss after 8 years. Based on the limited findings of this case report, extraction of molars with class III furcation involvement and subsequent implant placement may render a better predictability of treatment outcomes than nonsurgical periodontal therapy in the cases of infection with periodontal pathogens.

Locally delivered doxycycline as an adjunct to mechanical debridement at retreatment of periodontal pockets: outcome at furcation sites.

BACKGROUND: The goal was to evaluate the clinical outcome of non-surgical retreatment at molar furcation sites by ultrasonic debridement with or without adjunctive application of locally delivered doxycycline, and to explore factors affecting the healing results. METHODS: This study involves 32 patients with chronic periodontitis, who received initial pocket/root debridement by ultrasonic instrumentation, followed by random assignment to retreatment of remaining pathologic sites at 3 months by ultrasonic instrumentation with or without adjunctive local application of an 8.8% doxycycline gel. Clinical examinations of plaque, probing depth (PD), relative attachment level, furcation involvement, and bleeding after furcation probing were performed initially, before retreatment at 3 months (baseline), and 3 and 9 months after retreatment. The primary efficacy variable was reduction in the degree of furcation involvement. A multilevel logistic model was used to evaluate the impact of patient and tooth site related factors on the main outcome variable. RESULTS: The retreatment including locally delivered doxycycline resulted in closure of 50% of degree I furcation sites, compared to 29% for sites treated with mechanical debridement only (P >0.05). Of the degree II furcation sites, 17% in the test and 11% in the control group were reduced in depth (P >0.05). The logistic multilevel model with "furcation improvement" as the dichotomous outcome variable revealed that local application of doxycycline had no statistically significant effect. The odds ratio for ?furcation improvement? was 0.80 (95% confidence interval [CI], 0.65 to 0.99) for 1-mm increase of initial vertical PD, 0.36 (95% CI, 0.17 to 0.80) for initial furcation involvement degree II compared to degree I, and 0.24 (95% CI, 0.08 to 0.72) for smokers compared to non-smokers. CONCLUSION: Improvement in molar furcation involvement after non-surgical periodontal therapy was not enhanced by adjunctive locally applied doxycycline and negatively affected by increased vertical PD and tobacco smoking.

Mandibular molar root resection versus implant therapy: a retrospective nonrandomized study.

Success rates for both periodontal and implant therapy are often dependent on site and tooth type. For periodontally involved mandibular molars, the decision to hemisect or to extract and place an implant is often complicated. The purpose of the present study was to evaluate the outcomes of the aforementioned treatment modalities for mandibular molars in a private practice setting. A retrospective chart review was performed. In one group of patients (n = 32), 56 mandibular first or first and second molars were treated by hemisection (Group H). A second group (n = 28) received 36 implants in the mandible to replace periodontally involved first or first and second molars (Group I). All patients had been in maintenance for at least 4 years after treatment. The occurrence and timing of posttreatment complications were evaluated. Data were analyzed by parametric and nonparametric statistics, as indicated. The majority of hemisected teeth (68% of Group H) and implants (89% of Group I) remained free of complications for the entire observation period. Group H had a greater incidence of overall complications (P = .027) and nonsalvageable complications (P = .013) than Group I. For both groups, the percent CAL loss per year was greater for the teeth/implants that experienced complications than in the those that remained complication free (p < 0.015). Within the limitations of this study, the results indicated that, in periodontitis patients, hemisected mandibular molars were more prone to complications than implants.

Evaluation of 2 endodontic techniques used to treat human primary molars with furcation radiolucency area: A 48-month radiographic study.

OBJECTIVE: To evaluate 2 techniques for the treatment of human primary molars with necrotic pulp and bifurcation bone loss by means of radiographic examination for 48 months. METHOD AND MATERIALS: Fifty-one mandibular primary molars were evaluated in children ranging from 4.5 to 6.5 years of age. The teeth with necrotic pulp and bifurcation bone loss were diagnosed by radiographic examination. The teeth were divided into 2 groups: group 1 (28 teeth) -- pulpotomy technique using formocresol as a temporary dressing between sessions and coronal chamber obturation with zinc oxide-eugenol cement; and group 2 (23 teeth) -- pulpectomy technique with calcium hydroxide paste as a temporary dressing between sessions and root canal obturation with a dense calcium hydroxide paste. Standardized radiographs were taken immediately after the fillings were completed and after 12, 24, 36, and 48 months. The radiographs were digitized and analyzed with software that outlined and measured the bifurcation radiolucency. RESULTS: Bifurcation radiolucency reduced significantly or repaired completely for both treatments in the first 12 months. Minor radiographic reduction of the lesion was observed from 12 to 24 months, and no significant reduction of the remaining radiolucent area was observed from 24 to 48 months after treatment. CONCLUSION: The 2 endodontic techniques evaluated showed similar results. The main effect of treatment on the lesion repair was obtained in the first year after treatment.

Treatment of experimental periodontal disease by photodynamic therapy in rats with diabetes.

BACKGROUND: The aim of this study was to evaluate histologically and histometrically the influence of photodynamic therapy (PDT) as an adjuvant treatment on induced periodontitis in rats with diabetes. METHODS: Two hundred forty rats were divided evenly into two groups: non-diabetic (ND; n = 120) and alloxan diabetic (D; n = 120). Periodontal disease was induced in both groups at the first mandibular molar. After 7 days, the ligature was removed, and all animals underwent scaling and root planing (SRP) and were divided according to the following treatments: irrigation with saline solution (SRP); irrigation with a phenothiazinium dye (100 microg/ml) (TBO); laser irradiation (660 nm, 24 J) (LLLT); and PDT (TBO and laser irradiation). Ten animals in each experimental group and treatment subgroup were euthanized at 7, 15, and 30 days. The histometric values were analyzed statistically (P <0.05). RESULTS: In the ND group, the animals treated by PDT showed less bone loss (0.33 +/- 0.05 mm(2), 0.35 +/- 0.06 mm(2), and 0.27 +/- 0.07 mm(2) at 7, 15, and 30 days, respectively; P <0.05) at all experimental periods than the SRP group (1.11 +/- 0.11 mm(2), 0.84 +/- 0.12 mm(2), and 0.97 +/- 0.13 mm(2) at 7, 15, and 30 days, respectively), the TBO group (0.51 +/- 0.12 mm(2), 0.70 +/- 0.13 mm(2), and 0.64 +/- 0.08 mm(2) at 7, 15, and 30 days, respectively), and the LLLT group (0.59 +/- 0.03 mm(2), 0.61 +/- 0.04 mm(2), and 0.60 +/- 0.03 mm(2) at 7, 15, and 30 days, respectively). In the D group, the animals treated by PDT showed less bone loss (0.29 +/- 0.03 mm(2), 0.24 +/- 0.02 mm(2), and 0.27 +/- 0.06 mm(2) at 7, 15, and 30 days, respectively; P <0.05) at all experimental periods than the SRP group (2.27 +/- 0.47 mm(2), 3.23 +/- 0.34 mm(2), and 2.82 +/- 0.75 mm(2) at 7, 15, and 30 days, respectively), the TBO group (0.51 +/- 0.15 mm(2), 0.44 +/- 0.07 mm(2), and 0.57 +/- 0.13 mm(2) at 7, 15, and 30 days, respectively), and the LLLT group (0.37 +/- 0.05 mm(2), 0.35 +/- 0.09 mm(2), and 0.39 +/- 0.12 mm(2) at 7, 15, and 30 days, respectively). CONCLUSION: PDT was a beneficial adjuvant treatment for periodontal diseases induced by bacterial plaque and systemically modified by diabetes mellitus.