The effects of photobiomodulation and/or azithromycin treatment on bone resorption biomarkers in gingival crevicular fluid from patients with stage III-IV grade C periodontitis.

Abstract

Objectives: This study aimed to investigate the impact of photobiomodulation and/or azithromycin therapy in combination with full-mouth subgingival instrumentation on receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin levels and RANKL/osteoprotegerin ratios in gingival crevicular fluid on patients with stage III-IV grade C periodontitis.

Method and materials: The study was conducted on 77 stage III-IV grade C periodontitis patients and 20 periodontally healthy controls. Patients with stage III-IV grade C periodontitis were categorized into four treatment groups: 1) only full-mouth subgingival instrumentation (FSI) group; 2) full-mouth subgingival instrumentation + azithromycin (AZM) group; 3) full-mouth subgingival instrumentation + photobiomodulation (PBM) group; and 4) full-mouth subgingival instrumentation + photobiomodulation + azithromycin (AZM+PBM) group. Clinical periodontal parameters and RANKL and osteoprotegerin levels and RANKL/osteoprotegerin ratios in gingival crevicular fluid were measured at baseline and at the third month of therapy.

Results: Compared with the periodontally healthy controls, all the baseline clinical parameters were higher in the stage III-IV grade C periodontitis groups (P .05); however, there were no statistically significant differences between the stage III-IV grade C periodontitis groups (P > .05). At month 3, the lowest values in all clinical parameters were generally observed in the antibiotics groups, whereas the highest values were observed in the FSI group. Furthermore, the highest RANKL and osteoprotegerin values in antibiotic groups and the highest RANKL/osteoprotegerin ratio in the PBM group were observed in month 3. RANKL/osteoprotegerin ratios did not change in the FSI and antibiotics groups after the treatment, but increased significantly in the PBM group.

Conclusion: While photobiomodulation treatment combined with full-mouth subgingival instrumentation increases the RANKL levels, azithromycin increases osteoprotegerin levels. Also, AZM + PBM treatment shows additional clinical and immunologic beneficial efficacy.