Effect of Guided Biofilm Therapy in Patients With Stage 3 Periodontitis

The Effect of Guided Biofilm Therapy and Adjunctive Diode Laser on Periodontal Inflammation and Alveolar Bone Destruction in Patients With Stage 3 Periodontitis

This randomized interventional study aims to compare the clinical and biochemical effects of conventional non-surgical periodontal therapy (NSPT), adjunctive diode laser therapy, and guided biofilm therapy (GBT) in patients with Stage 3 periodontitis.

Participants are allocated to one of three treatment groups: conventional NSPT alone, NSPT combined with diode laser therapy, or NSPT combined with guided biofilm therapy. Clinical periodontal parameters, including plaque index, gingival index, probing pocket depth, clinical attachment level, and bleeding on probing, are evaluated before treatment and during follow-up. In addition, serum and gingival crevicular fluid samples are collected to determine the levels of inflammatory biomarkers, including IL-1β, IL-1 receptor antagonist (IL-1RA), sclerostin, and transforming growth factor-beta 1 (TGF-β1).

The study evaluates whether adjunctive treatment modalities provide additional clinical and biological benefits compared with conventional non-surgical periodontal therapy alone.

Periodontitis is a chronic inflammatory disease characterized by the destruction of periodontal supporting tissues. Conventional non-surgical periodontal therapy (NSPT) is considered the standard treatment; however, adjunctive treatment approaches have been introduced to improve clinical outcomes and reduce inflammation.

Guided biofilm therapy (GBT) is a minimally invasive treatment protocol that combines biofilm visualization, air-polishing, and selective calculus removal. Diode laser therapy has also been proposed as an adjunctive treatment because of its antimicrobial, anti-inflammatory, and biostimulatory effects.

The purpose of this randomized clinical study is to compare the effects of conventional NSPT alone, NSPT combined with diode laser therapy, and NSPT combined with GBT in patients diagnosed with Stage 3 periodontitis.

Participants are randomly assigned to one of three parallel treatment groups. Clinical periodontal parameters are recorded at baseline and during follow-up. Gingival crevicular fluid and serum samples are collected for biochemical analysis. The concentrations of IL-1β, IL-1 receptor antagonist (IL-1RA), sclerostin, and transforming growth factor-beta 1 (TGF-β1) are measured using enzyme-linked immunosorbent assay (ELISA).

The primary objective is to compare the effects of the three treatment protocols on periodontal inflammation and clinical periodontal outcomes. Secondary objectives include evaluating changes in inflammatory biomarker levels in serum and gingival crevicular fluid and investigating the potential biological mechanisms associated with each treatment modality.

The findings of this study are expected to contribute to the evidence regarding adjunctive treatment approaches for Stage 3 periodontitis and improve understanding of the biological effects of guided biofilm therapy and diode laser therapy in periodontal treatment.

Inclusion Criteria:

• Adults aged 18 to 65 years.
• Diagnosis of Stage III periodontitis with clinical attachment loss (CAL) ≥5 mm, probing pocket depth (PPD) ≥6 mm, and radiographic bone loss extending to the middle or apical third of the root.
• Systemically healthy individuals.
• Non-smokers and non-alcohol users.
• No periodontal treatment within the previous 6 months.
• No history of destructive periodontal disease.
• Not pregnant or breastfeeding.
• Written informed consent provided.

Exclusion Criteria:

• Age <18 years or >65 years.
• Periodontitis other than Stage III.
• Presence of systemic diseases affecting periodontal health.
• Current smokers or alcohol users.
• Periodontal treatment within the previous 6 months.
• History of destructive periodontal disease.
• Pregnancy or breastfeeding.
• Inability or unwillingness to provide written informed consent.