The Influence of Low-Level Laser Therapy on CBCT Radiographic and Biochemical Profiles of Type II Controlled Diabetic Patients After Dental Implant Insertion: A Randomized Case-Control Study

Abstract

Background Low-level laser treatment (LLLT) was thought to increase bone quality during osseointegration when combined with dental implants. However, there is no sufficient information on its impact on dental implants in diabetics. Osteoprotegerin (OPG) has been described as a marker for bone turnover to determine implant prognosis. The current research aims to evaluate the effect of low-level laser therapy (LLLT) on bone density (BD) and osteoprotegerin levels in peri-implant crevicular fluid (PICF) in type II diabetic patients. Methods This study comprised 40 individuals with type II diabetes mellitus (T2DM). Implants were randomly placed in 20 non-lasered T2DM patients (control) and 20 lasered T2DM patients (LLLT group). At the follow-up stages, BD and OPG levels in the PICF were evaluated in both groups. Results Significant variations were shown among control and LLLT groups concerning OPG level and BD (p≤0.001). OPG was significantly decreasing with follow-up points (p≤0.001). There was a significant decrease in OPG with time in both groups with a higher decrease in the control group. Conclusion LLLT is promising in controlled T2DM patients due to its outstanding influence on BD and estimated crevicular levels of OPG. Regarding its clinical significance, LLLT significantly improved bone quality during osseointegration on dental implants in T2DM. LLLT is considered potentially important for T2DM patients during implant placement. Trial registration The study was registered on ClinicalTrial.gov under registration number NCT05279911 (registration date: March 15, 2022) (https://clinicaltrials.gov/ct2/show/NCT05279911).

Keywords: bone density; implant; low-level laser therapy; opg; osteoprotegerin; type ii diabetes.

Figure 1. Flowchart of the study population selection.

LLLT: low-level laser treatment

Figure 2. Photographs of the control group (A-F) and LLLT group (G-L).

Preoperative (A,G), fixture placement at the crestal level (B,H), after three months showing healing abutment (C,I), tissue profile after the removal of the healing abutment (D,J), final abutment construction (E,K), and after crown cementation (F,L) in the control and LLLT groups, respectively LLLT: low-level laser treatment

Figure 3. Radiographic evaluation of bone density using CBCT six months after fixture insertion in the control group (A,B) and LLLT group (C,D).

The cross-sectional view along the middle of the implant was used to measure the gray values in three regions buccally and lingually. The total length of the implant was measured and then divided into four parts in total; the first part is the most coronal 2 mm of the bone representing compact bone, and the rest of the distance was divided into three parts representing the cervical, middle, and apical thirds. CBCT: cone beam computed tomography, LLLT: low-level laser treatment

Figure 4. Bar chart comparing the mean BD level for both groups (control and LLLT).

Bars with different letters are significantly different according to DMRTs. LLLT: low-level laser treatment, BD: bone density, DMRTs: Duncan’s multiple range test

Figure 5. Bar chart comparing the mean OPG level for both groups (control and LLLT) at different time intervals.

Bars with different letters are significantly different according to DMRT. OPG: osteoprotegerin, LLLT: low-level laser treatment, DMRTs: Duncan’s multiple range test

Figure 6. Regression trendline showing the relationship between time of investigation and OPG level.

OPG: osteoprotegerin, LLLT: low-level laser treatment