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Efficacy of non-surgical periodontal therapy in the management of chronic periodontitis among obese and non-obese patients: a systematic review and meta-analysis

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Abstract

Objective

There is a controversy over the influence of obesity on the periodontal treatment outcome in patients with chronic periodontitis (CP). The aim of the present systematic review was to evaluate the efficacy of non-surgical periodontal therapy (NSPT) in the management of CP among obese and non-obese patients.

Materials and methods

The addressed focused question was “What is the efficacy, of NSPT with respect to clinical, radiographic, biochemical, microbiological, and patient-centered outcomes in obese as compared to non-obese chronic periodontitis patients?” Databases were searched from 1977 up to and including December 2014 using relevant key indexing terms. Unpublished data, experimental studies, letters to the editor, review articles, case reports, and commentaries were excluded. Meta-analysis of three studies was performed.

Results

Five clinical studies were included. The total number of patients ranged between 30 and 260 individuals. The mean age of patients was between 42.5 and 48.8 years. In three studies, the clinical periodontal parameters (plaque index (PI), gingival bleeding index (GBI), periodontal pocket depth (PPD), and clinical attachment loss (CAL)) in obese and non-obese patients following NSPT was comparable. Meta-analysis of PPD and CAL among obese and non-obese subjects showed comparable outcomes (PPD P = 0.91, I 2 67.36 %; CAL P = 0.87, I 2 77.16 %). However, in three studies, NSPT resulted in a significantly better clinical periodontal outcome among non-obese subjects than obese subjects. The difference in the levels of serum pro-inflammatory cytokine levels (IL-1β, IL-6, TNF-α, IFN-γ, leptin, adiponectin, and CRP) among obese and non-obese patients following treatment for CP was inconsistent.

Conclusion

It remains unclear whether NSPT has a significantly higher impact on the clinical periodontal outcomes in obese patients than in non-obese patients with chronic periodontitis, given that the number of selected studies was relatively low and the reported findings were inconsistent.

Clinical relevance

Although the effect of obesity on the outcome of NSPT still remains unclear, nevertheless clinicians are prompted to manage obesity prior to and during periodontal treatment

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References

  1. Tagge DL, O’Leary TJ, El-Kafrawy AH (1975) The clinical and histological response of periodontal pockets to root planing and oral hygiene. J Periodontol 46:527–533

    Article  PubMed  Google Scholar 

  2. Biagini G, Checchi L, Miccoli MC, Vasi V, Castaldini C (1988) Root curettage and gingival repair in periodontitis. J Periodontol 59:124–129

    Article  PubMed  Google Scholar 

  3. Caton JG, Zander HA (1979) The attachment between tooth and gingival tissues after periodic root planing and soft tissue curettage. J Periodontol 50:462–466

    Article  PubMed  Google Scholar 

  4. Smart GJ, Wilson M, Davies EH, Kieser JB (1990) The assessment of ultrasonic root surface debridement by determination of residual endotoxin levels. J Clin Periodontol 17:174–178

    Article  PubMed  Google Scholar 

  5. Heitz-Mayfield LJA, Trombelli L, Heitz F, Needleman I, Moles D (2002) A systematic review of the effect of surgical debridement vs. non-surgical debridement for the treatment of chronic periodontitis. J Clin Periodontol 29:92–102

    Article  PubMed  Google Scholar 

  6. Drisko CH (2001) Nonsurgical periodontal therapy. Periodontol 2000(25):77–88

    Article  Google Scholar 

  7. Cobb CM (1996) Non-surgical pocket therapy: mechanical. Ann Periodontol 1:443–490

    Article  PubMed  Google Scholar 

  8. World Health Organization (2000) Obesity: preventing and managing the global epidemic 894: World Health Organization

  9. Kopelman P, Jebb S, Butland B (2007) Executive summary: foresight ‘tackling obesities: future choices’ project. Obes Rev 8:vi–ix

    Article  PubMed  Google Scholar 

  10. Field AE, Coakley EH, Must A, Spadano JL, Laird N, Dietz WH, Rimm E, Colditz GA (2001) Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Int Med 161:1581–1586

    Article  Google Scholar 

  11. Rasouli N, Kern PA (2008) Adipocytokines and the metabolic complications of obesity. J Clin Endocrinol Metab 93:s64–s73

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kim S, Popkin BM (2006) Commentary: understanding the epidemiology of overweight and obesity—a real global public health concern. Int J Epidemiol 35:60–67

    Article  PubMed  Google Scholar 

  13. Coppack SW (2001) Pro-inflammatory cytokines and adipose tissue. Proc Nutr Soc 60:349–356

    Article  PubMed  Google Scholar 

  14. Ziccardi P, Nappo F, Giugliano G, Esposito K, Marfella R, Cioffi M, D’Andrea F, Molinari AM, Giugliano D (2002) Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation 105:804–809

    Article  PubMed  Google Scholar 

  15. Falagas ME, Kompoti M (2006) Obesity and infection. Lancet Infect Dis 6:438–446

    Article  PubMed  Google Scholar 

  16. Ouchi N, Parker JL, Lugus JJ, Walsh K (2011) Adipokines in inflammation and metabolic disease. Nat Rev Immunol 11:85–97

    Article  PubMed  PubMed Central  Google Scholar 

  17. Saxlin T, Ylöstalo P, Suominen-Taipale L, Männistö S, Knuuttila M (2011) Association between periodontal infection and obesity: results of the Health 2000 Survey. J Clin Periodontol 38:236–242

    Article  PubMed  Google Scholar 

  18. Maury E, Brichard SM (2010) Adipokine dysregulation, adipose tissue inflammation and metabolic syndrome. Mol Cell Endocrinol 314:1–16

    Article  PubMed  Google Scholar 

  19. Wilson JA, Clark JJ (2003) Obesity: impediment to wound healing. Crit Care Nurs Q 26:119–132

    Article  PubMed  Google Scholar 

  20. Muñoz-Torres FJ, Jimenez MC, Rivas-Tumanyan S, Joshipura KJ (2014) Associations between measures of central adiposity and periodontitis among older adults. Comm Dent Oral Epidemiol 42:170–177

    Article  Google Scholar 

  21. Dalla Vecchia CF, Susin C, Rösing CK, Oppermann RV, Albandar JM (2005) Overweight and obesity as risk indicators for periodontitis in adults. J Periodontol 76:1721–1728

    Article  PubMed  Google Scholar 

  22. Perlstein MI, Bissada NF (1977) Influence of obesity and hypertension on the severity of periodontitis in rats. Oral Surg Oral Med Oral Pathol 43:707–719

    Article  PubMed  Google Scholar 

  23. Moura-Grec PGD, Marsicano JA, Carvalho CAPD, Sales-Peres SHDC (2014) Obesity and periodontitis: systematic review and meta-analysis. Cien Saude Colet 19:1763–1772

    Article  PubMed  Google Scholar 

  24. Kose O, Canakci V, Canakci CF, Yildirim A, Kermen E, Arabaci T, Gungor A (2015) The effects of obesity on local and circulating levels of tumor necrosis factor-α and interleukin-6 in patients with chronic periodontitis. J Periodontol Imp Dent 7:7–14

    Article  Google Scholar 

  25. Zuza EP, Barroso EM, Carrareto ALV, Pires JR, Carlos IZ, Theodoro LH, Toledo BEC (2011) The role of obesity as a modifying factor in patients undergoing non-surgical periodontal therapy. J Periodontol 82:676–682

    Article  PubMed  Google Scholar 

  26. Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y (2005) A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol 76:2075–2084

    Article  PubMed  Google Scholar 

  27. Dias Goncalves TE, Feres M, Zimmermann GS, Faveri M, Figueiredo LC, Braga PG, Duarte PM (2014) Effects of scaling and root planing on clinical response and serum levels of adipocytokines in obese patients with chronic periodontitis. J Periodontol 86:53–61

    Article  Google Scholar 

  28. Suvan J, D’Aiuto F, Moles DR, Petrie A, Donos N (2011) Association between overweight/obesity and periodontitis in adults. A systematic review. Obes Rev 12:e381–e404

    Article  PubMed  Google Scholar 

  29. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Int Med 151:264–269

    Article  PubMed  Google Scholar 

  30. Boudin F, Nie JY, Bartlett JC, Grad R, Pluye P, Dawes M (2010) Combining classifiers for robust PICO element detection. BMC Med Inform Decis Mak 10:29

    Article  PubMed  PubMed Central  Google Scholar 

  31. Roberts C (2008) Modelling patterns of agreement for nominal scales. Stat Med 27:810–830

    Article  PubMed  Google Scholar 

  32. Chang CH (2014) Cohens’s kappa for capturing discrimination. Int Health 6:125–129

  33. Suvan J, Petrie A, Moles DR, Nibali L, Patel K, Darbar U, Donos N, Tonetti M, D’Aiuto F (2013) Body mass index as a predictive factor of periodontal therapy outcomes. J Dent Res:0022034513511084

  34. Al-Zahrani MS, AlGhamdi HS (2012) Effect of periodontal treatment on serum C-reactive protein level in obese and normal-weight women affected with chronic periodontitis. Saudi Med J 33:309–314

    PubMed  Google Scholar 

  35. Altay U, Gürgan CA, Ağbaht K (2013) Changes in inflammatory and metabolic parameters after periodontal treatment in patients with and without obesity. J Periodontol 84:13–23

    Article  PubMed  Google Scholar 

  36. Bondemark L, Holm AK, Hansen K, Axelsson S, Mohlin B, Brattstrom V, Paulin G, Pietila T (2007) Long-term stability of orthodontic treatment and patient satisfaction: a systematic review. Angle Orthod 77:181–191

    Article  PubMed  Google Scholar 

  37. Mohlin B, Axelsson S, Paulin G, Pietilä T, Bondemark L, Brattström V, Hansen K, Holm AK (2007) TMD in relation to malocclusion and orthodontic treatment: a systematic review. Angle Orthod 77:542–548

    Article  PubMed  Google Scholar 

  38. D’Aiuto F, Nibali L, Parkar M, Suvan J, Tonetti MS (2005) Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol. J Dent Res 84:269–273

    Article  PubMed  Google Scholar 

  39. D’Aiuto F, Parkar M, Andreou G, Suvan J, Brett PM, Ready D, Tonetti MS (2004) Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res 83:156–160

    Article  PubMed  Google Scholar 

  40. D’Aiuto F, Parkar M, Nibali L, Suvan J, Lessem J, Tonetti MS (2006) Periodontal infections cause changes in traditional and novel cardiovascular risk factors: results from a randomized controlled clinical trial. Am Heart J 151:977–984

    Article  PubMed  Google Scholar 

  41. Tonetti MS, D’Aiuto F, Nibali L, Donald A, Storry C, Parkar M, Suvan J, Hingorani AD, Vallance P, Deanfield J (2007) Treatment of periodontitis and endothelial function. N Engl J Med 356:911–920

    Article  PubMed  Google Scholar 

  42. Quirynen M, Bollen CML, Vandekerckhove BNA, Dekeyser C, Papaioannou W, Eyssen H (1995) Full-vs. partial-mouth disinfection in the treatment of periodontal infections: short-term clinical and microbiological observations. J Dent Res 74:1459–1467

    Article  PubMed  Google Scholar 

  43. Panel NCEPNE (2002) Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106:3143

    Google Scholar 

  44. Saito T, Shimazaki Y, Koga T, Tsuzuki M, Ohshima A (2001) Relationship between upper body obesity and periodontitis. J Dent Res 80:1631–1636

    Article  PubMed  Google Scholar 

  45. Akman PT, Fentoglu O, Yilmaz G, Arpak N (2012) Serum plasminogen activator inhibitor-1 and tumor necrosis factor-α levels in obesity and periodontal disease. J Periodontol 83:1057–1062

    Article  PubMed  Google Scholar 

  46. Shourie V, Dwarakanath CD, Prashanth GV, Alampalli RV, Padmanabhan S, Bali S (2011) The effect of menstrual cycle on periodontal health-a clinical and microbiological study. Oral Health Prev Dent 10:185–192

    Google Scholar 

  47. Becerik S, Ozçaka O, Nalbantsoy A, Atilla G, Celec P, Behuliak M, Emingil G (2010) Effects of menstrual cycle on periodontal health and gingival crevicular fluid markers. J Periodontol 81:673–681

    Article  PubMed  Google Scholar 

  48. Fantuzzi G (2005) Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol 115:911–919

    Article  PubMed  Google Scholar 

  49. Kullo IJ, Hensrud DD, Allison TG (2002) Comparison of numbers of circulating blood monocytes in men grouped by body mass index (<25, 25 to <30,≥ 30). Am J Cardiol 89:1441–1443

    Article  PubMed  Google Scholar 

  50. Lundin M, Yucel-Lindberg T, Dahllöf G, Marcus C, Modéer T (2004) Correlation between TNFalpha in gingival crevicular fluid and body mass index in obese subjects. Acta Odontol Scand 62:273–277

    Article  PubMed  Google Scholar 

  51. Rosa EF, Corraini P, Inoue G, Gomes EF, Guglielmetti MR, Sanda SR, Lotufo JPB, Romito GA, Pannuti CM (2014) Effect of smoking cessation on non-surgical periodontal therapy: results after 24 months. J Clin Periodontol 41:1145–1153

    Article  PubMed  Google Scholar 

  52. Bergstrom J (2014) Smoking rate and periodontal disease prevalence: 40-year trends in Sweden 1970–2010. J Clin Periodontol 41:952–957

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was approved by Medical Ethics Committee, University of Malaya Medical Centre (UMMC), and supported by University of Malaya [Grant No. PG140-2013A] and RG303/11HTM.

Author information

Authors and Affiliations

  1. Department of Restorative Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Zohaib Akram, Syarida Hasnur Safii, Rathna Devi Vaithilingam & Nor Adinar Baharuddin

  2. Department of Periodontology, Faculty of Dentistry, Ziauddin University, Karachi, 75600, Pakistan

    Zohaib Akram

  3. Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, 14620, USA

    Fawad Javed

  4. Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, PO-Box-60169, Riyadh, 11545, Saudi Arabia

    Fahim Vohra

Authors
  1. Zohaib Akram
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  2. Syarida Hasnur Safii
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  3. Rathna Devi Vaithilingam
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  4. Nor Adinar Baharuddin
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  6. Fahim Vohra
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Corresponding author

Correspondence to Fahim Vohra.

Ethics declarations

This study was approved by Medical Ethics Committee, University of Malaya Medical Centre (UMMC).

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The work was supported by University of Malaya [Grant No. PG140-2013A] and RG303/11HTM, Department of Periodontology, Kuala Lumpur, Malaysia.

Informed consent

For a systematic review and meta-analysis, formal consent is not required.

Appendix 1

Appendix 1

List of excluded studies after full-text examination. Reason for exclusion is shown in parenthesis.

  1. a)

    Rocha, Miriam L., et al. “Effect of alendronate on periodontal disease in postmenopausal women: a randomized placebo-controlled trial.” Journal of periodontology 75.12 (2004): 1579–1585. (Use of adjunct with NSPT)

  2. b)

    Offenbacher, Steven, et al. “Results from the Periodontitis and Vascular Events (PAVE) Study: a pilot multicentered, randomized, controlled trial to study effects of periodontal therapy in a secondary prevention model of cardiovascular disease.” Journal of periodontology 80.2 (2009): 190–201. (Obesity associated with cardiovascular disease)

  3. c)

    Lakkis, Dima, et al. “Response to periodontal therapy in patients who had weight loss after bariatric surgery and obese counterparts: a pilot study.”Journal of periodontology 83.6 (2012): 684–689. (No inclusion of non-obese control)

  4. d)

    Shimada Y, Komatsu Y, Ikezawa-Suzuki I, Tai H, Sugita N, Yoshie H (2010) The effect of periodontal treatment on serum leptin, interleukin-6, and C-reactive protein. J Periodontol 81:1118–1123. (Focused question not answered)

  5. e)

    Shimoe M, Yamamoto T, Iwamoto Y, Shiomi N, Maeda H, Nishimura F, Takashiba S (2011) Chronic periodontitis with multiple risk factor syndrome: a case report. J Int Acad Periodontol 13:40–47. (Case report)

  6. f)

    Sora ND, Marlow NM, Bandyopadhyay D, Leite RS, Slate EH, Fernandes JK (2013) Metabolic syndrome and periodontitis in Gullah African Americans with type 2 diabetes mellitus. J Clin Periodontol 40:599–606. (Focused question not answered)

  7. g)

    Gorman A, Kaye EK, Nunn M, Garcia RI (2012) Changes in body weight and adiposity predict periodontitis progression in men. J Dent Res 91:921–926. (Focused question not answered)

  8. h)

    Gursoy UK, Marakoglu I, Ersan S (2006) Periodontal status and cytoplasmic enzyme activities in gingival crevicular fluid of type 2 diabetic and/or obese patients with chronic periodontitis. J Int Acad Periodontol 8:2–5. (Focused question not answered)

  9. i)

    Keller JJ, Wu CS, Chen YH, Lin HC (2013) Association between obstructive sleep apnoea and chronic periodontitis: a population-based study. J Clin Periodontol 40:111–117. (Irrelevant citation)

  10. j)

    Kshirsagar AV, Moss KL, Elter JR, Beck JD, Offenbacher S, Falk RJ (2005) Periodontal disease is associated with renal insufficiency in the Atherosclerosis Risk In Communities (ARIC) study. Am J Kidney Dis 45:650–657. (Irrelevant citation)

  11. k)

    Mohangi GU, Singh-Rambirich S, Volchansky A (2013) Periodontal disease: Mechanisms of infection and inflammation and possible impact on miscellaneous systemic diseases and conditions. SADJ 68: 462, 464–467. (Irrelevant citation)

  12. l)

    Leung WK ML, Wong MC, Corbet EF, Siu SC, Kawamura M. (2008) Health behaviour, metabolic control and periodontal status in medically treated Chinese with type 2 diabetes mellitus. Annals of the Royal Australasian College of Dental Surgeons:102–110. (Focused question not answered)

  13. m)

    Ekuni D, Yamamoto T, Koyama R, Tsuneishi M, Naito K, Tobe K (2008) Relationship between body mass index and periodontitis in young Japanese adults. J Periodontal Res 43:417–421. (Focused question not answered)

  14. n)

    Kapellas K, Maple-Brown LJ, Jamieson LM, Do LG, O’Dea K, Brown A, Cai TY, Anstey NM, Sullivan DR, Wang H, Celermajer DS, Slade GD, Skilton MR (2014) Effect of periodontal therapy on arterial structure and function among aboriginal Australians: a randomized, controlled trial. Hypertension 64:702–708. (Irrelevant citation)

  15. o)

    Pradeep AR, Kumari M, Kalra N, Priyanka N (2013) Correlation of MCP-4 and high-sensitivity C-reactive protein as a marker of inflammation in obesity and chronic periodontitis. Cytokine 61:772–777. (Review article)

  16. p)

    Pradeep AR, Priyanka N, Prasad MV, Kalra N, Kumari M (2012) Association of progranulin and high-sensitivity CRP concentrations in gingival crevicular fluid and serum in chronic periodontitis subjects with and without obesity. Dis Markers 33:207–213. (Focused question not answered)

  17. q)

    Al-Zahrani MS, Zawawi KH, Altaf FM (2013) The effect of obesity and periodontitis on the expression of antimicrobial peptides in gingival tissues. Saudi Med J 34:525–530. (Focused question not answered)

  18. r)

    Alabdulkarim M, Bissada N, Al-Zahrani M, Ficara A, Siegel B (2005) Alveolar bone loss in obese subjects. J Int Acad Periodontol 7: 34–38. (Irrelevant citation)

  19. s)

    Rao Deepika PC, Saxena RM (2013) Comparison of glycosylated hemoglobin levels in severe periodontitis patients and healthy controls: a study in an Indian population. Quintessence Int 44: 319–325. (Irrelevant citation)

  20. t)

    Susanto H, Nesse W, Dijkstra PU, Hoedemaker E, van Reenen YH, Agustina D, Vissink A, Abbas F (2012) Periodontal inflamed surface area and C-reactive protein as predictors of HbA1c: a study in Indonesia. Clin Oral Investig 16: 1237–1242. (Irrelevant citation)

  21. u)

    Ueda H, Yagi T, Amitani H, Asakawa A, Ikeda S, Miyawaki S, Inui A (2013) The roles of salivary secretion, brain-gut peptides, and oral hygiene in obesity. Obes Res Clin Pract 7:e321–329. (Irrelevant citation)

  22. v)

    Zimmermann GS, Bastos MF, Dias Goncalves TE, Chambrone L, Duarte PM (2013) Local and circulating levels of adipocytokines in obese and normal weight individuals with chronic periodontitis. J Periodontol 84:624–633. (Focused question not answered)

  23. w)

    Gursoy UK, Marakoglu I, Oztop AY (2008) Relationship between neutrophil functions and severity of periodontitis in obese and/or type 2 diabetic chronic periodontitis patients. Quintessence Int 39:485–489.(Irrelevant citation)

  24. x)

    Haffajee AD, Socransky SS (2009) Relation of body mass index, periodontitis and Tannerella forsythia. J Clin Periodontol 36:89–99. (Focused question not answered)

  25. y)

    Palle AR, Reddy CM, Shankar BS, Gelli V, Sudhakar J, Reddy KK (2013) Association between obesity and chronic periodontitis: a cross-sectional study. J Contemp Dent Pract 14:168–173. (Focused question not answered)

  26. z)

    Chaffee BW, Weston SJ (2010) Association between chronic periodontal disease and obesity: a systematic review and meta-analysis. J Periodontol 81 (12):1708–1724. (Review article)

  27. aa)

    Chitsazi MT, Pourabbas R, Shirmohammadi A, Ahmadi Zenouz G, Vatankhah AH (2008) Association of Periodontal Diseases with Elevation of Serum C-reactive Protein and Body Mass Index. J Dent Res Dent Clin Dent Prospects 2: 9–14. (Focused question not answered)

  28. bb)

    Fan WH, Liu DL, Xiao LM, Xie CJ, Sun SY, Zhang JC (2011) Coronary heart disease and chronic periodontitis: is polymorphism of interleukin-6 gene the common risk factor in a Chinese population? Oral Dis 17: 270–276. (Irrelevant citation)

  29. cc)

    Kumar A, Masamatti SS, Virdi MS (2012) Periodontal diseases in children and adolescents: a clinician’s perspective part 2. Dent Update 39:639–642, 645–636, 649–652. (Irrelevant citation)

  30. dd)

    Moravec LJ, Boyd LD (2011) Bariatric surgery and implications for oral health: a case report. J Dent Hyg 85:166–176. (Case report)

  31. ee)

    Bawadi HA, Khader YS, Haroun TF, Al-Omari M, Tayyem RF (2011) The association between periodontal disease, physical activity and healthy diet among adults in Jordan. J Periodontal Res 46: 74–81. (Irrelevant citation)

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Akram, Z., Safii, S.H., Vaithilingam, R.D. et al. Efficacy of non-surgical periodontal therapy in the management of chronic periodontitis among obese and non-obese patients: a systematic review and meta-analysis. Clin Oral Invest 20, 903–914 (2016). https://doi.org/10.1007/s00784-016-1793-4

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