Contents lists available at ScienceDirect Photodiagnosis and Photodynamic Therapy journal homepage: www.elsevier.com/locate/pdpdt Effectiveness of mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of periodontal inflammation among patients with prediabetes Mansour Al-Askar a , Abdulaziz A. Al-Kheraif b, ⁎ , Hameeda Bashir Ahmed c , Sergio Varela Kellesarian d , Hans Malmstrom d , Fawad Javed d a Department of Periodontology, College of Dentistry, King Saud University, Riyadh, Saudi Arabia b Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia c Private Dental Practice, Doha, Qatar d Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, NY, USA ARTICLE INFO Keywords: Alveolar bone loss Antimicrobial photodynamic therapy Bleeding on probing Probing pocket depth Questionnaire ABSTRACT Aim: The aim of the present study was to assess the effectiveness of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of periodontal inflammation among patients with prediabetes. Methods: Demographic information was collected using a questionnaire. Hemoglobin A1c (HbA1c) levels were measured at baseline and at 3 and 6 months’ follow-up. Treatment: Individuals were randomly divided into 2 groups as follows: (a) Group-1, participants underwent full- mouth MD; and Group-2: participants underwent full-mouth MD with adjunct aPDT. In groups 1 and 2, full- mouth plaque index (PI), bleeding on probing (BOP) and probing pocket depth (PPD) were measured at baseline and at 3 and 6 months’ follow-up. In both groups, full-mouth digital intraoral radiographs were also taken. Sample-size was estimated and statistical analysis was performed with level of significance set as P < 0.05. Results: In total, 70 prediabetic male individuals (35 patients in group-1 and 35 in group-2) were included. At baseline, PI, BOP, number of sites with PPD ≥4 mm were comparable among individuals in groups 1 and 2. In groups 1 and 2, PI (P < 0.05), BOP (P < 0.05), number of sites with PPD ≥4 mm (P < 0.05) were sig- nificantly higher at baseline compared with 3 months’ follow-up. There was no statistically significant difference in PI, BOP, number of sites with PPD ≥4 mm at 3 and 6 months’ follow-up. At 6 months’ follow-up, PI, BOP, number of sites with PPD ≥4 mm were comparable to their respective baseline values. There was no statistically significant difference in CBL in both groups at 3 and 6 months’ follow-up. There was no statistically significant difference in HbA1c levels among individuals in groups 1 and 2 at all-time intervals. Conclusion: In the short-term, MD is effective in reducing periodontal inflammation among patients with pre- diabetes. The contribution of adjunct aPDT in this regard is insignificant. 1. Introduction Prediabetes is a state of chronic hyperglycemia (CH) in which, he- moglobin A1c (HbA1c) and fasting blood glucose levels range between 5.7%–6.4% and 100–125 mg/dL (5.6–6.9 mmol/L), respectively [1]. Clinical [2–4] and experimental [5,6] studies have shown that period- ontal inflammation is worse among subjects with prediabetes compared with systemically healthy controls. There are a number of events that play a role in aggravating periodontal inflammation among patients with CH (such as those with prediabetes). Firstly, it is hypothesized that CH increases the formation and deposition of advanced glycation end products (AGEs) in periodontal tissues [7]; thereby increasing the in- teractions between AGEs and their receptors (RAGE) [7]. These AGEs- RAGE interactions have been reported to augment oxidative stress within cells and increase the production of destructive inflammatory cytokines, such as interleukin (IL)-6, IL-1β, matrix metalloproteinases (MMP), which further aggravate the previously existing chronic in- flammatory state [8,9]. Moreover, the state of cellular oxidative stress in patients with CH increases the production of reactive oxygen species (ROS) such as superoxide anion, hydroxyl radical, and peroxyl radical http://dx.doi.org/10.1016/j.pdpdt.2017.09.005 Received 27 August 2017; Received in revised form 2 September 2017; Accepted 8 September 2017 ⁎ Corresponding author at: Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia. E-mail address: aalkhuraif@ksu.edu.sa (A.A. Al-Kheraif). Photodiagnosis and Photodynamic Therapy 20 (2017) 91–94 Available online 09 September 2017 1572-1000/ © 2017 Published by Elsevier B.V. MARK