***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM To evaluate the potential of antimicrobial photodynamic therapy ( aPDT ) as an adjunct to scaling and root planing ( SRP ) in the treatment of chronic periodontitis . MATERIAL AND METHODS In a single-centred r and omized and controlled clinical trial , 90 patients ( 51 females and 39 males ) with untreated chronic periodontitis were r and omly assigned to receive SRP with aPDT ( test group ) or SRP alone ( control group ) . Clinical parameters and halitosis were recorded for 6 months after treatment by a periodontist who was blinded to the procedure . RESULTS Inter-group and intra-group statistical analyses were performed . Significant difference between the two groups with respect to each variable was assessed using non-parametric Rank Order ancova . Probing pocket depth and clinical attachment levels showed statistically significant reduction in the test group on evaluation at 3 months and 6 months as compared to the control group ( p < 0.05 ) . A statistically significant improvement in gingival index and gingival bleeding index was seen for the test group after 2 weeks and 1 month of aPDT ( p < 0.01 ) , whereas the improvement in gingival index and gingival bleeding index at 3 months and in plaque index at 2 weeks after aPDT was less ( p < 0.05 ) . Also , a significant difference was detected for the test group at 1 month in terms of halitosis ( p < 0.05 ) , which did not persist for long . CONCLUSIONS Antimicrobial photodynamic therapy acts as a beneficial adjunct to SRP in non-surgical treatment and management of chronic periodontitis in short-term . Further studies are required to assess the long-term effectiveness of aPDT Objectives This r and omized split-mouth clinical trial was design ed to evaluate the efficacy of scaling and root planing associated to the high-intensity diode laser on periodontal therapy by means of clinical parameters and microbial reduction . Material s and methods A total of 36 chronic periodontitis subjects , of both genders , were selected . One pair of contralateral single-rooted teeth with pocket depth > 5 mm was chosen from each subject . All patients received non-surgical periodontal treatment  , after which the experimental teeth were design ated to either test or control groups . Both teeth received scaling , root planing and coronal polishing ( SRP ) and teeth assigned to the test group ( SRP + DL ) were irradiated with the 808 ± 5 nm diode laser , for 20 s , in two isolated appointments , 1 week apart . The laser was used in the continuous mode , with 1.5 W and power density of 1,193.7 W/cm2 . Clinical and microbiological data were collected at baseline , 6 weeks and 6 months after therapy . Results There was a significant improvement of all the clinical parameters— clinical attachment level ( CAL ) , probing depth ( PD ) , plaque index ( PI ) and Bleeding on Probing (BOP)—for both groups ( P < 0.001 ) , with no statistical difference between them at the 6 weeks and the 6 months examinations . As for microbiological analysis , a significant reduction after 6 weeks ( P > 0.05 ) was observed as far as colony forming units ( CFU ) is concerned , for both groups . As for black-pigmented bacteria , a significant reduction was observed in both groups after 6 months . However , the difference between test and control groups was not significant . There was no association between group and presence of Porphyromonas gingivalis , Prevotella intermedia and Aggregatibacter actinomycetemcomitans at any time of the study . Conclusions After 6 months of evaluation , the high-intensity diode laser has not shown any additional benefits to the conventional periodontal treatment . Clinical relevance The high intensity diode laser did not provide additional benefits to non-surgical periodontal treatment . More studies are necessary to prove the actual need of this type of laser in the periodontal clinical practice BACKGROUND / AIM Tobacco use reduces the effect of non-surgical periodontal therapy . Host-modulation with low-dose doxycycline ( LDD ) might favour repair and promote an improved treatment response . The aim of this study was to investigate the effect of LDD in smokers on non-surgical periodontal therapy .  MATERIAL AND METHODS This was a parallel arm , r and omized , identical placebo-controlled trial with masking of examiner , care-giver , participant and statistician and 6 months of follow-up . Patients received non-surgical therapy and 3 months of test or control drug . Statistical analysis used both conventional methods and multilevel modelling . RESULTS Eighteen control and 16 test patients completed the study . The velocity of change was statistically greater for the test group for clinical attachment level -0.19 mm/month ( 95 % CI=-0.34 , 0.04 ; p=0.012 ) and probing depth 0.30 mm/month ( 95 % CI=-0.42 , -0.17 ; p<0.001 ) . However , no differences were observed for absolute change in clinical or biochemical markers at 6 months . CONCLUSIONS This study does not provide evidence of a benefit of using LDD as an adjunct to non-surgical periodontal therapy in smokers The aim of this r and omized , parallel , controlled clinical trial was to examine the clinical and biochemical efficacy of diode laser as an adjunct to scaling and root planing ( SRP ) . Thirty chronic periodontitis patients were r and omly assigned into two groups to receive SRP alone ( control ) or SRP followed by diode laser ( test ) . Plaque index , gingival index , bleeding on probing , probing depth , and clinical attachment level were measured at baseline and at 1 , 3 , and 6 months after treatment . The gingival crevicular fluid levels of interleukin-1β ( IL-1β ) , interleukin-6 ( IL-6 ) , interleukin-8 ( IL-8 ) , matrix metalloproteinase-1 ( MMP-1 ) , matrix metalloproteinase-8 ( MMP-8 ) and tissue inhibitor matrix metalloproteinase-1 ( TIMP-1 ) were analyzed by enzyme-linked immunosorbent assay . Test group showed significantly a better outcome compared to the control group in full-mouth clinical parameters . MMP-1 , MMP-8 , and TIMP-1 showed significant differences between groups after treatment compared to baseline ( p < 0.05 ) . The total amount of IL-1β , IL-6 , MMP-1 , MMP-8 , and TIMP-1 decreased ( p < 0.05 ) and IL-8 increased after treatment in both test and control groups ( p < 0.05 ) . Diode laser provided significant improvements in clinical parameters and MMP-8 was significantly impacted by the adjunctive laser treatment at first month providing an insight to how lasers can enhance the outcomes of the nonsurgical periodontal therapy The primary goal of periodontal therapy is the removal of supra and subgingival bacterial deposits by mechanical debridement consisting in scaling and root-planing ( SRP ) using manual or power-driven instruments . The complete removal of bacteria and their toxins from periodontal pockets is not always achieved with conventional mechanical treatment . The use of lasers as an adjunctive therapy for periodontal disease may improve tissue healing by bactericidal and detoxification effects . The aim of this study was to compare the effectiveness of Diode laser used as adjunctive therapy of SRP to that of SRP alone for non surgical periodontal treatment in patients with chronic periodontitis . Nineteen pairs of teeth with untreated chronic periodontitis were selected in 13 patients and r and omly treated by SRP alone ( control group ) or by SRP + laser irradiation ( test group ) . Clinical measurements ( PPD , CAL , BOP , GI , PI ) were performed before treatment at baseline ( T0 ) and at T1 ( after 4 weeks ) , T2 ( 8 weeks ) , T3 ( 12 weeks ) , T4 ( 6 months ) . Subgingival plaque sample s were taken at baseline and after treatment and examined for 8 periopathogens bacteria using PCR technique . The present study showed that the additional treatment with diode laser may lead to a slightly improvement of clinical parameters , whereas no significant differences between test and control group in reduction of periodontopathogens were found OBJECTIVE The aim of this clinical trial was to determine the clinical and biochemical efficacy of an 810 nm diode laser as an adjunct to scaling and root planing ( SRP ) . BACKGROUND DATA Lasers can achieve excellent tissue ablation with strong bactericidal and detoxification effects . The use of lasers is one of the most promising new technical modalities for nonsurgical periodontal treatment . However , the most effective wavelength and parameters for their use are still under investigation . METHODS This study was design ed as a single-blinded , r and omized-controlled , split-mouth clinical trial . Twenty-one patients ( 12 females and 9 males between 26 and 55 years of age ) , diagnosed with generalized chronic periodontitis , were included in the study . After initial periodontal therapy , which consisted of oral hygiene instructions and scaling , patients underwent two different treatment modalities . Test and control sites were chosen with coin toss r and omization . At the test site , patients received SRP and laser treatment ; at the contralateral control site , they received SRP treatment alone . RESULTS Both treatment modalities result ed in significant improvements in all clinical and biochemical parameters . Sites irradiated with an 810 nm diode laser using the " hot tip " ( ∼ 760 ° C ) technique showed enhanced healing in all the registered periodontal variables and interleukin (IL)-1β levels , compared with SRP alone . CONCLUSIONS Within the limitations of this study , the use of diode lasers as an adjunct to SRP produced significant improvements in clinical parameters as well as gingival crevicular fluid ( GCF ) IL-1β levels in the 6 month study period Experimental studies in animals and in vitro have shown the usefulness of photodynamic therapy ( PDT ) as an adjunct to periodontal treatment . The aim of this study was to evaluate the long-term clinical and microbiological effects of PDT associated with nonsurgical periodontal treatment . Three sites in each of 33 patients with chronic periodontitis were r and omly allocated in a split-mouth design to a treatment group : ( 1 ) scaling and root planing ( SRP group ) ; ( 2 ) SRP and irrigation with toluidine blue O ( TBO group ) ; and ( 3 ) SRP , irrigation with TBO and low-level laser irradiation ( PDT group ) . Clinical parameters including visible plaque index , bleeding gingival index , bleeding on probing , probing depth , gingival recession and clinical attachment level were measured at baseline , and after 60 , 90 and 180 days . Additionally , subgingival plaque sample s were collected for microbiological analysis by PCR . Intergroup and intragroup statistical analyses were performed . All treatment groups showed an improvement in all clinical parameters , and a significant reduction in the proportion of sites positive for periodontopathogens at 60 , 90 and 180 days compared to baseline ( p < 0.05 ) . None of the periodontal parameters showed a significant difference among the groups ( p > 0.05 ) . At 180 days , PDT treatment led to a significant reduction in the percentage of sites positive for all bacteria compared to SRP alone ( p < 0.05 ) . Within the limits of this study it may be concluded that PDT as an adjunct to periodontal treatment produced statistically significant reductions in some of the key periodontal pathogens but produced no statistically significant benefit in terms of clinical outcome The present investigation was performed to study the effect of long-term , low dosage tetracycline therapy on advanced periodontal disease in humans . 14 volunteers participated in the trial . Each of the participants had at least 4 pairs of diseased sites around contralateral premolars and incisors with deep pockets and advanced bone loss . The trial extended over a 50-week period and was design ed as a double-blind split-mouth study . A Baseline examination included assessment s of oral hygiene , gingival conditions , probing depth , attachment level and analysis of the composition of the subgingival microbiota in sample s obtained from 8 selected diseased sites . All participants received oral hygiene instruction . In each patient 2 quadrants of the mouth , chosen at r and om , were treated by scaling and root planing . The 2 remaining quadrants were left unscaled . Following the Baseline examination the patients were r and omly distributed into 2 groups of 7 members each . In one of the groups the patients received tetracycline on a daily basis during a 50-week period . The participants of the control group received placebo . Reexaminations were performed 2 , 10 , 20 , 30 and 50 weeks after the Baseline examination . The findings demonstrated that in patients with advanced periodontal disease long-term tetracycline therapy in the absence of scaling result ed in the establishment of a subgingival microbiota almost devoid of motile bacteria and in markedly reduced signs of gingivitis , probing depth and attachment loss . In fact , the alterations observed as a result of tetracycline administration to patients with excellent self-performed plaque control were similar to those obtained by conventional scaling and root planing in the control group Recent results of a limited clinical trial suggest that mechanical root scaling and root planing therapy alone may not be the most effective mode of treatment for patients affected by moderate to severe adult periodontitis . However , scaling and planing combined with laser therapy utilizing a low-powered pulsed Nd : YAG laser have been shown to be successful in the elimination of the bacteria commonly associated with the development of this oral condition . The double-blind , split mouth design study involved 10 human subjects r and omly assigned to one of three treatments : 1 ) scaling and root planing alone , 2 ) dental laser plus scaling and root planing 
    Output:
    
PRACTICAL IMPLICATION S AND CONCLUSIONS For patients with chronic periodontitis , SRP showed a moderate benefit , and the benefits were judged to outweigh potential adverse effects .
Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP , they were recommended at different strengths ( in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials ) because of the higher potential for adverse effects with higher doses of antimicrobials .
The strengths of 2 other recommendations are weak : chlorhexidine chips and photodynamic therapy with a diode laser .
Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low