***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: BACKGROUND The aim of this clinical study was to evaluate the association of locally delivered doxycycline ( 10 % ) with scaling and root planing in the periodontal treatment of smokers . METHODS Forty-three patients with chronic periodontitis and a minimum of four pockets ( > or = 5 mm ) on anterior teeth that bled on probing were selected . Patients were r and omly assigned to scaling and root planing ( SRP ) or scaling and root planing followed by local application of doxycycline ( SRP-D ) .  Plaque , bleeding on probing , gingival recession , relative attachment level ( RAL ) , and probing depth ( PD ) were recorded at baseline , 45 days , and 3 and 6 months . Differences between baseline and each period were considered for analysis . RESULTS At 6 months , no difference was found between groups regarding plaque , bleeding reduction , gingival recession or PD ( P > 0.05 ) . However , RAL gain was greater for SRP-D ( 1.63 + /- 0.93 mm ) than for SRP ( 1.04 + /- 0.71 mm ) ( P = 0.025 ) . In addition , deep pockets ( > or = 7 mm ) showed a significant reduction ( 3.78 + /- 1.41 versus 2.60 + /- 1.28 mm , P = 0.039 ) and RAL gain ( 2.54 + /- 1.27 mm versus 1.29 + /- 0.95 mm , P = 0.01 ) when doxycycline was applied . The proportion of sites showing RAL gain of 1 to 2 mm was 36.8 % versus 21.7 % for SRP-D and SRP , respectively ( P = 0.01 ) . CONCLUSION The use of locally delivered doxycycline may constitute an important adjunct for the treatment of severe periodontal disease in smokers 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 BACKGROUND Diabetes and periodontitis are complex chronic diseases with an established bidirectional relationship . There is long-established evidence that hyperglycaemia in diabetes is associated with adverse periodontal outcomes . However , given the ubiquity of periodontal diseases and the emerging global diabetes epidemic , the complications of which contribute to significant morbidity and premature mortality , it is timely to review the role of periodontitis in diabetes . AIMS To report the epidemiological evidence from cross-sectional , prospect i ve and intervention studies for the impact of periodontal disease on diabetes incidence , control and complications and to identify potential underpinning mechanisms . EPIDEMIOLOGY Over the last 20 years , consistent and robust evidence has emerged that severe periodontitis adversely affects glycaemic control in diabetes and glycaemia in non-diabetes subjects . In diabetes patients , there is a direct and dose-dependent relationship between periodontitis severity and diabetes complications . Emerging evidence supports an increased risk for diabetes onset in patients with severe periodontitis . BIOLOGICAL MECHANISMS Type 2 diabetes is preceded by systemic inflammation , leading to reduced pancreatic β-cell function , apoptosis and insulin resistance . Increasing evidence supports elevated systemic inflammation ( acute-phase and oxidative stress biomarkers ) result ing from the entry of periodontal organisms and their virulence factors into the circulation , providing biological plausibility for the effects of periodontitis on diabetes . AGE ( Advanced Glycation Endproducts)-RAGE ( Receptor for AGEs ) interactions and oxidative-stress-mediated pathways provide plausible mechanistic links in the diabetes to periodontitis direction . INTERVENTIONS R and omized controlled trials ( RCTs ) consistently demonstrate that mechanical periodontal therapy associates with approximately a 0.4 % reduction in HbA1C at 3 months , a clinical impact equivalent to adding a second drug to a pharmacological regime for diabetes . RCTs are needed with larger numbers of subjects and longer term follow-up , and if results are substantiated , adjunctive periodontal therapies subsequently need to be evaluated . There is no current evidence to support adjunctive use of antimicrobials for periodontal management of diabetes patients . GUIDELINES Given the current evidence , it is timely to provide guidelines for periodontal care in diabetes patients for medical and dental professionals and recommendations for patients /the public 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 irrad 
    Output:
    
The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty : systemic subantimicrobial-dose doxycycline , systemic antimicrobials , chlorhexidine chips , and photodynamic therapy with a diode laser .
There was a low level of certainty in the benefits of the other included adjunctive therapies .