الفهرس 
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Abstract
The goal of the present study was directed to evaluate and compare the clinical and immunological effect of diode laser with and without photosensitizing agent as adjunct to scaling and root planing in management of CP in patients with type 2 DM. Thirty sites in ten systemically healthy patients with moderate CP of both genders suffering from type 2 DM aged 35-55 years old were selected from the Periodontology Clinic, Faculty of Dentistry, Tanta University to be enrolled in the current study. All participants received basic periodontal treatment including, full mouth SRP and oral hygiene instructions. Complete SRP was done on two sessions within a week. Re-evaluation was carried out at 3 and 6 months from the initial therapy. The three sites in each patient received three modalities of treatment as follow: • group І: (Control group): Sites received SRP alone • group II: (Test group І): Sites received combined therapy of SRP plus LLLT which was done 3 minutes after SRP according to the laser machine manufacturer’s instructions. The pockets were irradiated by a 300μm fiber using diode laser 808 nm wavelength, the laser light 1.0 CW/cm2 for about 30 seconds one time application. • group ІІІ: (Test group ІІ): Sites received combined therapy of SRP plus PDT where the photosensitizer injected into the periodontal pocket. All pockets irradiated by a 300μm fiber using diode laser 808 nm wavelength, 0.3 W/cm2 power density and 0.05 kHz in a circular pattern for about 40 seconds according to laser machine manufacturer’s instructions. Comparison between the groups was assessed by the following results: The clinical results were evaluated by PI, BOP, PPD and CAL. The immunological results were evaluated by concentration of MMP-9 before and after treatment. Clinical results: The results showed significant improvement in the mean PI, BOP, PPD, and CAL gain for all groups up to 6 months as compared to baseline value (P<0.05). Furthermore, when comparing the three groups (intergroup comparison), the results showed non-significant difference for all groups at all study period in all parameters (P>0.05). However, at 6 months, results showed better improvement in the mean PPD and CAL at group II and group III than group I. Moreover, group III showed the best reduction in the mean PI as compared to group I and II at 3 and 6 months and at 3 months for BOP. Immunological results: ELISA test demonstrated significant improvement in MMP-9 levels till 6 months regarding all groups. However, when comparing this improvement in the three groups, statistically non-significant difference was reported at all study period (P>0.05). However at 6 months, group III showed better improvement in the level of MMP-9 compared to group I and II.