Araştırma Makalesi
Cerrahi Olmayan Periodontal Tedavinin Tip-2 Diabetes Mellituslu Hastalarda Klinik Parametreler, HbA1c ve IL-1β Seviyesi Üzerine Etkisi
Öz
Amaç: Bu çalışmanın
amacı cerrahi olmayan periodontal tedavinin (COPT) klinik parametreler, glisemik
kontrol ve tükürük IL-1β seviyesi üzerine
etkisini değerlendirmektir.
Gereç ve yöntemler: Çalışmamıza 10 sistemik olarak sağlıklı kronik periodontitisli (KP) ve 10
tip-2 diabetes mellitusu olan kronik periodontitisli (DMKP) birey dahil edildi.
Tüm bireylere 4 seansta kök yüzey temizliği ve kök yüzey düzleştirmesini içeren
cerrahi olmayan periodontal tedavi (COPT) uygulandı. Plak indeks (Pİ), gingival
indeks, sondalama derinliği, sondalamada kanama ve klinik ataşman seviyesi
değerleri başlangıçta ve tedavi sonrası 3. ayda ölçüldü. Tükürük örnekleri
toplanarak IL-1β seviyeleri analiz edildi. HbA1c testleri başlangıçta ve tedavi
sonrası 3. ayda ölçüldü.
Bulgular: Tedavi sonrası
3. ayda tüm klinik parametreler, HbA1c ve tükürükte IL-1β seviyesi her iki
grupta da anlamlı olarak azaldı (p<0.05).
Başlangıçta iki grup arasında tüm klinik parametreler benzerdi
(p>0.05). Tedavi sonrası 3. ayda DMKP
grubunda Pİ ve HbA1c seviyesi sistemik olarak sağlıklı KP bireylere göre daha
yüksek bulundu (p<0.05).
Sonuç:
COPT’nin, KP ve DMKP bireylerin klinik ve
biyokimyasal parametrelerinde iyileşme sağladığı ortaya kondu.
Anahtar Kelimeler
Hemoglobin A1c proteini interlökin 1 beta kronik periodontitis tip 2 diabetes mellitus
Destekleyen Kurum
Marmara Üniversitesi Bilimsel Araştırma Projeleri Komisyonu Başkanlığı
Proje Numarası
SAG-C-DRP 100216-0041
Teşekkür
Bu çalışma, Marmara Üniversitesi Bilimsel Araştırma Projeleri Komisyonu Başkanlığı SAG-C-DRP 100216-0041 numaralı proje ile desteklenmiştir.
Kaynakça
- 1. Page RC: The role of inflammatory mediators in the pathogenesis of periodontal disease. J Periodontal Res 1991, 26;3 Pt 2:230-242.2. American Diabetes Association: 2. Classification and Diagnosis of Diabetes. Diabetes Care 2017, 40;Suppl 1:S11-S24.3. American Diabetes Association: 2. Classification and Diagnosis of Diabetes. Diabetes Care 2016, 39 Suppl 1:S13-22.4. Loe H: Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 1993, 16;1:329-334.5. Gursoy UK, Yildiz Ciftlikli S, Kononen E, Gursoy M, Dogan B: Salivary interleukin-17 and tumor necrosis factor-alpha in relation to periodontitis and glycemic status in type 2 diabetes mellitus. J Diabetes 2015, 7;5:681-688.6. Grossi SG, Genco RJ: Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol 1998, 3;1:51-61.7. Mealey BL, Oates TW, American Academy of P: Diabetes mellitus and periodontal diseases. J Periodontol 2006, 77;8:1289-1303.8. Preshaw PM, Bissett SM: Periodontitis: oral complication of diabetes. Endocrinol Metab Clin North Am 2013, 42;4:849-867.9. Taylor JJ, Preshaw PM, Lalla E: A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes. J Clin Periodontol 2013, 40 Suppl 14:S113-134.10. Salvi GE, Collins JG, Yalda B, Arnold RR, Lang NP, Offenbacher S: Monocytic TNF alpha secretion patterns in IDDM patients with periodontal diseases. J Clin Periodontol 1997, 24;1:8-16.11. Graves DT, Cochran D: The contribution of interleukin-1 and tumor necrosis factor to periodontal tissue destruction. J Periodontol 2003, 74;3:391-401.12. Cutler CW, Machen RL, Jotwani R, Iacopino AM: Heightened gingival inflammation and attachment loss in type 2 diabetics with hyperlipidemia. J Periodontol 1999, 70;11:1313-1321.13. Bulut U, Develioglu H, Taner IL, Berker E: Interleukin-1 beta levels in gingival crevicular fluid in type 2 diabetes mellitus and adult periodontitis. J Oral Sci 2001, 43;3:171-177.14. Yoon AJ, Cheng B, Philipone E, Turner R, Lamster IB: Inflammatory biomarkers in saliva: assessing the strength of association of diabetes mellitus and periodontal status with the oral inflammatory burden. J Clin Periodontol 2012, 39;5:434-440.15. Salvi GE, Yalda B, Collins JG, Jones BH, Smith FW, Arnold RR, Offenbacher S: Inflammatory mediator response as a potential risk marker for periodontal diseases in insulin-dependent diabetes mellitus patients. J Periodontol 1997, 68;2:127-135.16. Salvi GE, Beck JD, Offenbacher S: PGE2, IL-1 beta, and TNF-alpha responses in diabetics as modifiers of periodontal disease expression. Ann Periodontol 1998, 3;1:40-50.17. Kardesler L, Buduneli N, Biyikoglu B, Cetinkalp S, Kutukculer N: Gingival crevicular fluid PGE2, IL-1beta, t-PA, PAI-2 levels in type 2 diabetes and relationship with periodontal disease. Clin Biochem 2008, 41;10-11:863-868.18. Navarro-Sanchez AB, Faria-Almeida R, Bascones-Martinez A: Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis. J Clin Periodontol 2007, 34;10:835-843.19. Engebretson SP, Grbic JT, Singer R, Lamster IB: GCF IL-1beta profiles in periodontal disease. J Clin Periodontol 2002, 29;1:48-53.20. O'Connell PA, Taba M, Nomizo A, Foss Freitas MC, Suaid FA, Uyemura SA, Trevisan GL, Novaes AB, Souza SL, Palioto DB et al: Effects of periodontal therapy on glycemic control and inflammatory markers. J Periodontol 2008, 79;5:774-783.21. Auyeung L, Wang PW, Lin RT, Hsieh CJ, Lee PY, Zhuang RY, Chang HW: Evaluation of periodontal status and effectiveness of non-surgical treatment in patients with type 2 diabetes mellitus in Taiwan for a 1-year period. J Periodontol 2012, 83;5:621-628.22. Chapple IL, Genco R, working group 2 of the joint EFPAAPw: Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol 2013, 84;4 Suppl:S106-112.23. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR: Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000, 321;7258:405-412.24. Engebretson S, Kocher T: Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis. J Periodontol 2013, 84;4 Suppl:S153-169.25. Gokhale NH, Acharya AB, Patil VS, Trivedi DJ, Setty S, Thakur SL: Resistin levels in gingival crevicular fluid of patients with chronic periodontitis and type 2 diabetes mellitus. J Periodontol 2014, 85;4:610-617.26. Silness J, Loe H: Periodontal Disease in Pregnancy. Ii. Correlation between Oral Hygiene and Periodontal Condtion. Acta Odontol Scand 1964, 22:121-135.27. Loe H, Silness J: Periodontal Disease in Pregnancy. I. Prevalence and Severity. Acta Odontol Scand 1963, 21:533-551.28. Corbet EF, Leung WK: Epidemiology of periodontitis in the Asia and Oceania regions. Periodontol 2000 2011, 56;1:25-64.29. Rodrigues DC, Taba MJ, Novaes AB, Souza SL, Grisi MF: Effect of non-surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus. J Periodontol 2003, 74;9:1361-1367.30. Dag A, Firat ET, Arikan S, Kadiroglu AK, Kaplan A: The effect of periodontal therapy on serum TNF-alpha and HbA1c levels in type 2 diabetic patients. Aust Dent J 2009, 54;1:17-22.31. Kudva P, Tabasum ST, Garg N: Evaluation of clinical and metabolic changes after non surgical periodontal treatment of type 2 diabetes mellitus patients: A clinico biochemical study. J Indian Soc Periodontol 2010, 14;4:257-262.32. Stewart JE, Wager KA, Friedlander AH, Zadeh HH: The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol 2001, 28;4:306-310.33. Koromantzos PA, Makrilakis K, Dereka X, Offenbacher S, Katsilambros N, Vrotsos IA, Madianos PN: Effect of non-surgical periodontal therapy on C-reactive protein, oxidative stress, and matrix metalloproteinase (MMP)-9 and MMP-2 levels in patients with type 2 diabetes: a randomized controlled study. J Periodontol 2012, 83;1:3-10.34. Kardesler L, Buduneli N, Cetinkalp S, Lappin D, Kinane DF: Gingival crevicular fluid IL-6, tPA, PAI-2, albumin levels following initial periodontal treatment in chronic periodontitis patients with or without type 2 diabetes. Inflammation research : official journal of the European Histamine Research Society [et al] 2011, 60;2:143-151.35. Moeintaghavi A, Arab HR, Bozorgnia Y, Kianoush K, Alizadeh M: Non-surgical periodontal therapy affects metabolic control in diabetics: a randomized controlled clinical trial. Aust Dent J 2012, 57;1:31-37.36. Goel K, Pradhan S, Bhattarai MD: Effects of nonsurgical periodontal therapy in patients with moderately controlled type 2 diabetes mellitus and chronic periodontitis in Nepalese population. Clin Cosmet Investig Dent 2017, 9:73-80.37. Mammen J, Vadakkekuttical RJ, George JM, Kaziyarakath JA, Radhakrishnan C: Effect of non-surgical periodontal therapy on insulin resistance in patients with type II diabetes mellitus and chronic periodontitis, as assessed by C-peptide and the Homeostasis Assessment Index. J Investig Clin Dent 2017, 8;3.38. Perayil J, Suresh N, Fenol A, Vyloppillil R, Bhaskar A, Menon S: Comparison of glycated hemoglobin levels in individuals without diabetes and with and without periodontitis before and after non-surgical periodontal therapy. J Periodontol 2014, 85;12:1658-1666.39. Raman RP, Taiyeb-Ali TB, Chan SP, Chinna K, Vaithilingam RD: Effect of nonsurgical periodontal therapy verses oral hygiene instructions on type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial. BMC Oral Health 2014, 14:79.40. Calabrese N, D'Aiuto F, Calabrese A, Patel K, Calabrese G, Massi-Benedetti M: Effects of periodontal therapy on glucose management in people with diabetes mellitus. Diabetes Metab 2011, 37;5:456-459.41. Botero JE, Rodriguez C, Agudelo-Suarez AA: Periodontal treatment and glycaemic control in patients with diabetes and periodontitis: an umbrella review. Aust Dent J 2016, 61;2:134-148.42. Haytaç MC, Özçelik O: Tükürük, Kan ve Ürünleri, Dişeti Oluğu Sıvısı ve Peri-İmplant Oluğu Sıvısı: Teşhis ve Tedavideki Önemi. Turkiye Klinikleri J Dental Sci (Special Topics) 2014, 5;1:9-12.43. Gursoy UK, Kononen E: Editorial: Use of Saliva in Diagnosis of Periodontitis: Cumulative Use of Bacterial and Host-Derived Biomarkers. Front Cell Infect Microbiol 2016, 6:196.44. Groschl M: The physiological role of hormones in saliva. Bioessays 2009, 31;8:843-852.45. Akram Z, Abduljabbar T, Abu Hassan MI, Javed F, Vohra F: Cytokine Profile in Chronic Periodontitis Patients with and without Obesity: A Systematic Review and Meta-Analysis. Dis Markers 2016, 2016:4801418.
The Effect of Non-Surgical Periodontal Therapy on Clinical Parameteres, Hba1c and Il-1β Level in Type 2 Diabetes Mellitus Patients
Öz
Amaç: Bu çalışmanın
amacı cerrahi olmayan periodontal tedavinin (COPT) klinik parametreler, glisemik
kontrol ve tükürük IL-1β seviyesi üzerine
etkisini değerlendirmektir.
Gereç ve yöntemler: Çalışmamıza 10 sistemik olarak sağlıklı kronik periodontitisli (KP) ve 10
tip-2 diabetes mellitusu olan kronik periodontitisli (DMKP) birey dahil edildi.
Tüm bireylere 4 seansta kök yüzey temizliği ve kök yüzey düzleştirmesini içeren
cerrahi olmayan periodontal tedavi (COPT) uygulandı. Plak indeks (Pİ), gingival
indeks, sondalama derinliği, sondalamada kanama ve klinik ataşman seviyesi
değerleri başlangıçta ve tedavi sonrası 3. ayda ölçüldü. Tükürük örnekleri
toplanarak IL-1β seviyeleri analiz edildi. HbA1c testleri başlangıçta ve tedavi
sonrası 3. ayda ölçüldü.
Bulgular: Tedavi sonrası
3. ayda tüm klinik parametreler, HbA1c ve tükürükte IL-1β seviyesi her iki
grupta da anlamlı olarak azaldı (p<0.05).
Başlangıçta iki grup arasında tüm klinik parametreler benzerdi
(p>0.05). Tedavi sonrası 3. ayda DMKP
grubunda Pİ ve HbA1c seviyesi sistemik olarak sağlıklı KP bireylere göre daha
yüksek bulundu (p<0.05).
Sonuç: COPT’nin, KP ve
DMKP bireylerin klinik ve biyokimyasal parametrelerinde iyileşme sağladığı
ortaya kondu.
Anahtar Kelimeler
Hemoglobin A1c protein interleukin 1 beta chronic periodontitis type 2 diabetes mellitus
Proje Numarası
SAG-C-DRP 100216-0041
Kaynakça
- 1. Page RC: The role of inflammatory mediators in the pathogenesis of periodontal disease. J Periodontal Res 1991, 26;3 Pt 2:230-242.2. American Diabetes Association: 2. Classification and Diagnosis of Diabetes. Diabetes Care 2017, 40;Suppl 1:S11-S24.3. American Diabetes Association: 2. Classification and Diagnosis of Diabetes. Diabetes Care 2016, 39 Suppl 1:S13-22.4. Loe H: Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 1993, 16;1:329-334.5. Gursoy UK, Yildiz Ciftlikli S, Kononen E, Gursoy M, Dogan B: Salivary interleukin-17 and tumor necrosis factor-alpha in relation to periodontitis and glycemic status in type 2 diabetes mellitus. J Diabetes 2015, 7;5:681-688.6. Grossi SG, Genco RJ: Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol 1998, 3;1:51-61.7. Mealey BL, Oates TW, American Academy of P: Diabetes mellitus and periodontal diseases. J Periodontol 2006, 77;8:1289-1303.8. Preshaw PM, Bissett SM: Periodontitis: oral complication of diabetes. Endocrinol Metab Clin North Am 2013, 42;4:849-867.9. Taylor JJ, Preshaw PM, Lalla E: A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes. J Clin Periodontol 2013, 40 Suppl 14:S113-134.10. Salvi GE, Collins JG, Yalda B, Arnold RR, Lang NP, Offenbacher S: Monocytic TNF alpha secretion patterns in IDDM patients with periodontal diseases. J Clin Periodontol 1997, 24;1:8-16.11. Graves DT, Cochran D: The contribution of interleukin-1 and tumor necrosis factor to periodontal tissue destruction. J Periodontol 2003, 74;3:391-401.12. Cutler CW, Machen RL, Jotwani R, Iacopino AM: Heightened gingival inflammation and attachment loss in type 2 diabetics with hyperlipidemia. J Periodontol 1999, 70;11:1313-1321.13. Bulut U, Develioglu H, Taner IL, Berker E: Interleukin-1 beta levels in gingival crevicular fluid in type 2 diabetes mellitus and adult periodontitis. J Oral Sci 2001, 43;3:171-177.14. Yoon AJ, Cheng B, Philipone E, Turner R, Lamster IB: Inflammatory biomarkers in saliva: assessing the strength of association of diabetes mellitus and periodontal status with the oral inflammatory burden. J Clin Periodontol 2012, 39;5:434-440.15. Salvi GE, Yalda B, Collins JG, Jones BH, Smith FW, Arnold RR, Offenbacher S: Inflammatory mediator response as a potential risk marker for periodontal diseases in insulin-dependent diabetes mellitus patients. J Periodontol 1997, 68;2:127-135.16. Salvi GE, Beck JD, Offenbacher S: PGE2, IL-1 beta, and TNF-alpha responses in diabetics as modifiers of periodontal disease expression. Ann Periodontol 1998, 3;1:40-50.17. Kardesler L, Buduneli N, Biyikoglu B, Cetinkalp S, Kutukculer N: Gingival crevicular fluid PGE2, IL-1beta, t-PA, PAI-2 levels in type 2 diabetes and relationship with periodontal disease. Clin Biochem 2008, 41;10-11:863-868.18. Navarro-Sanchez AB, Faria-Almeida R, Bascones-Martinez A: Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis. J Clin Periodontol 2007, 34;10:835-843.19. Engebretson SP, Grbic JT, Singer R, Lamster IB: GCF IL-1beta profiles in periodontal disease. J Clin Periodontol 2002, 29;1:48-53.20. O'Connell PA, Taba M, Nomizo A, Foss Freitas MC, Suaid FA, Uyemura SA, Trevisan GL, Novaes AB, Souza SL, Palioto DB et al: Effects of periodontal therapy on glycemic control and inflammatory markers. J Periodontol 2008, 79;5:774-783.21. Auyeung L, Wang PW, Lin RT, Hsieh CJ, Lee PY, Zhuang RY, Chang HW: Evaluation of periodontal status and effectiveness of non-surgical treatment in patients with type 2 diabetes mellitus in Taiwan for a 1-year period. J Periodontol 2012, 83;5:621-628.22. Chapple IL, Genco R, working group 2 of the joint EFPAAPw: Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol 2013, 84;4 Suppl:S106-112.23. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR: Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000, 321;7258:405-412.24. Engebretson S, Kocher T: Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis. J Periodontol 2013, 84;4 Suppl:S153-169.25. Gokhale NH, Acharya AB, Patil VS, Trivedi DJ, Setty S, Thakur SL: Resistin levels in gingival crevicular fluid of patients with chronic periodontitis and type 2 diabetes mellitus. J Periodontol 2014, 85;4:610-617.26. Silness J, Loe H: Periodontal Disease in Pregnancy. Ii. Correlation between Oral Hygiene and Periodontal Condtion. Acta Odontol Scand 1964, 22:121-135.27. Loe H, Silness J: Periodontal Disease in Pregnancy. I. Prevalence and Severity. Acta Odontol Scand 1963, 21:533-551.28. Corbet EF, Leung WK: Epidemiology of periodontitis in the Asia and Oceania regions. Periodontol 2000 2011, 56;1:25-64.29. Rodrigues DC, Taba MJ, Novaes AB, Souza SL, Grisi MF: Effect of non-surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus. J Periodontol 2003, 74;9:1361-1367.30. Dag A, Firat ET, Arikan S, Kadiroglu AK, Kaplan A: The effect of periodontal therapy on serum TNF-alpha and HbA1c levels in type 2 diabetic patients. Aust Dent J 2009, 54;1:17-22.31. Kudva P, Tabasum ST, Garg N: Evaluation of clinical and metabolic changes after non surgical periodontal treatment of type 2 diabetes mellitus patients: A clinico biochemical study. J Indian Soc Periodontol 2010, 14;4:257-262.32. Stewart JE, Wager KA, Friedlander AH, Zadeh HH: The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol 2001, 28;4:306-310.33. Koromantzos PA, Makrilakis K, Dereka X, Offenbacher S, Katsilambros N, Vrotsos IA, Madianos PN: Effect of non-surgical periodontal therapy on C-reactive protein, oxidative stress, and matrix metalloproteinase (MMP)-9 and MMP-2 levels in patients with type 2 diabetes: a randomized controlled study. J Periodontol 2012, 83;1:3-10.34. Kardesler L, Buduneli N, Cetinkalp S, Lappin D, Kinane DF: Gingival crevicular fluid IL-6, tPA, PAI-2, albumin levels following initial periodontal treatment in chronic periodontitis patients with or without type 2 diabetes. Inflammation research : official journal of the European Histamine Research Society [et al] 2011, 60;2:143-151.35. Moeintaghavi A, Arab HR, Bozorgnia Y, Kianoush K, Alizadeh M: Non-surgical periodontal therapy affects metabolic control in diabetics: a randomized controlled clinical trial. Aust Dent J 2012, 57;1:31-37.36. Goel K, Pradhan S, Bhattarai MD: Effects of nonsurgical periodontal therapy in patients with moderately controlled type 2 diabetes mellitus and chronic periodontitis in Nepalese population. Clin Cosmet Investig Dent 2017, 9:73-80.37. Mammen J, Vadakkekuttical RJ, George JM, Kaziyarakath JA, Radhakrishnan C: Effect of non-surgical periodontal therapy on insulin resistance in patients with type II diabetes mellitus and chronic periodontitis, as assessed by C-peptide and the Homeostasis Assessment Index. J Investig Clin Dent 2017, 8;3.38. Perayil J, Suresh N, Fenol A, Vyloppillil R, Bhaskar A, Menon S: Comparison of glycated hemoglobin levels in individuals without diabetes and with and without periodontitis before and after non-surgical periodontal therapy. J Periodontol 2014, 85;12:1658-1666.39. Raman RP, Taiyeb-Ali TB, Chan SP, Chinna K, Vaithilingam RD: Effect of nonsurgical periodontal therapy verses oral hygiene instructions on type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial. BMC Oral Health 2014, 14:79.40. Calabrese N, D'Aiuto F, Calabrese A, Patel K, Calabrese G, Massi-Benedetti M: Effects of periodontal therapy on glucose management in people with diabetes mellitus. Diabetes Metab 2011, 37;5:456-459.41. Botero JE, Rodriguez C, Agudelo-Suarez AA: Periodontal treatment and glycaemic control in patients with diabetes and periodontitis: an umbrella review. Aust Dent J 2016, 61;2:134-148.42. Haytaç MC, Özçelik O: Tükürük, Kan ve Ürünleri, Dişeti Oluğu Sıvısı ve Peri-İmplant Oluğu Sıvısı: Teşhis ve Tedavideki Önemi. Turkiye Klinikleri J Dental Sci (Special Topics) 2014, 5;1:9-12.43. Gursoy UK, Kononen E: Editorial: Use of Saliva in Diagnosis of Periodontitis: Cumulative Use of Bacterial and Host-Derived Biomarkers. Front Cell Infect Microbiol 2016, 6:196.44. Groschl M: The physiological role of hormones in saliva. Bioessays 2009, 31;8:843-852.45. Akram Z, Abduljabbar T, Abu Hassan MI, Javed F, Vohra F: Cytokine Profile in Chronic Periodontitis Patients with and without Obesity: A Systematic Review and Meta-Analysis. Dis Markers 2016, 2016:4801418.
Toplam 1 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Diş Hekimliği |
| Bölüm | Özgün Araştırmalar |
| Yazarlar | |
| Proje Numarası | SAG-C-DRP 100216-0041 |
| Yayımlanma Tarihi | 28 Haziran 2019 |
| Yayımlandığı Sayı | Yıl 2019 |