Efficacy of nonsurgical periodontal treatment on patients with periodontitis and type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis

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 Rand 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.