Effect of repeated adjunctive antimicrobial photodynamic therapy on subgingival periodontal pathogens in the treatment of chronic periodontitis

Effect of treatment frequency on the efficacy of superhydrophobic antimicrobial photodynamic therapy of periodontitis in a wistar rat model

Superhydrophobic antimicrobial photodynamic therapy (SH-aPDT) is advantageous wherein airborne singlet oxygen (1O2) is delivered from a device tip to kill a biofilm with no photosensitizer exposure and no bacterial selectivity (Gram + or Gram -). For effective treatment of periodontitis, the frequency of treatment as well as the optical light fluence required is not known. Thus, we sought to determine whether single or repeated SH-aPDT treatments would work best in vivo using two fluence values: 60 and 125 J/cm2. We assessed the efficacy of three protocols: single treatment; interval treatments (days 0, 2, and 7); and consecutive treatments (days 0, 1, and 2). After 30 days of evaluation, we found that, SH-aPDT in 3 consecutive treatments significantly decreased Porphyromonas gingivalis levels compared to single and interval SH-aPDT treatments, as well as SRP-chlorhexidine (CHX) controls (p < 0.05). Notably, clinical parameters also improved (p < 0.05), and histological and stereometric analyses revealed that consecutive SH-aPDT treatments were the most effective for promoting healing and reducing inflammation. Our study shows what works best for SH-aPDT, while also demonstrating SH-aPDT advantages to treatment of periodontitis including no bacterial selectivity (Gram + or Gram -) and preventing the development of bacterial resistance.

Adjuvant antimicrobial photodynamic therapy improves periodontal health and reduces inflammatory cytokines in patients with type 1 diabetes mellitus

BACKGROUND

Antimicrobial photodynamic therapy (aPDT) is an adjuvant treatment to scaling and root planing (SRP) which improves periodontal health. It may be beneficial to patients with systemic diseases, such as type 1 diabetes mellitus.

OBJECTIVE

This randomized clinical trial evaluated the adjunctive effect of aPDT on the periodontal treatment of patients with type 1 diabetes (T1D).

METHODOLOGY

38 patients were included in the study and divided into four groups: DSRP - T1D patients treated with SRP; CSRP - normoglycemic patients treated with SRP; DPDT - T1D patients treated with SRP + aPDT (methylene blue and red laser); CPDT - normoglycemic patients treated with SRP + aPDT. , Periodontal clinical parameters and inflammatory cytokines in crevicular fluid were recorded at baseline and then after 1, 3 and 6 months. The clinical endpoint for treatment was evaluated after 6 months.

RESULTS

Adjuvant aPDT treatment resulted in reduction of probing depth after 3 months (0.38 mm - p<0.05) on T1D patients and in control group after 6 months (0.66 mm - p<0.05). Reduction of clinical attachment levels was similar for both treatments in control patients (p>0.05). There was a significant reduction of TNF-α in crevicular fluid in both groups treated with aPDT (p<0.05). The T1D (65%) and normoglycemic (72%) groups achieved the clinical endpoint after both treatments (p>0.05).

CONCLUSIONS

Adjuvant aPDT provided additional benefits in improving periodontal clinical parameters and reducing inflammatory cytokines in both T1D and normoglycemic patients. However, normoglycemic patients showed greater clinical improvements compared to T1D patients following adjuvant aPDT treatment.

Effectiveness of photodynamic therapy as an adjunctive treatment for periodontitis: A systematic review and meta-analysis

OBJECTIVE

Periodontitis is a prevalent inflammatory disease affecting the supporting structures of teeth. While scaling and root planing (SRP) remains the gold standard for treatment, adjunctive therapies are being explored to enhance outcomes. This systematic review and meta-analysis aimed to evaluate the effectiveness of photodynamic therapy (PDT) as an adjunct to SRP in the treatment of periodontitis.

METHODS

A comprehensive literature search was conducted in PubMed, Embase, Web of Science, CNKI, Wanfang, and Weipu databases. Randomized controlled trials (RCTs) comparing SRP alone to SRP with adjunctive PDT were included. The primary outcomes were changes in clinical attachment level (CAL) and probing depth (PD). Secondary outcomes included plaque index (PI). Random-effects models were used for meta-analysis, and heterogeneity was assessed using I² statistics.

RESULTS

Eighteen RCTs met the inclusion criteria. Meta-analysis revealed that adjunctive PDT significantly improved CAL (SMD: -0.16; 95% CI: -0.40, -0.07; P < 0.001; I² = 60.7%) and PD (SMD: -0.55; 95% CI: -0.97, -0.13; P < 0.001; I² = 76.2%) compared to SRP alone. PI also showed improvement with adjunctive PDT (SMD: -0.40; 95% CI: -0.67, -0.14; P = 0.072; I² = 43.0%). Egger's test indicated a borderline significant publication bias for CAL, while no significant publication bias for PD.

CONCLUSION

This meta-analysis provides evidence that PDT as an adjunct to SRP can significantly improve clinical outcomes in periodontitis treatment. However, the high heterogeneity observed suggests that optimal PDT protocols need further investigation. Future research should focus on standardizing PDT parameters and exploring its long-term effects.

Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri-implant diseases

BACKGROUND

Periodontitis and peri-implant diseases are chronic inflammatory conditions occurring in the mouth. Left untreated, periodontitis progressively destroys the tooth-supporting apparatus. Peri-implant diseases occur in tissues around dental implants and are characterised by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Treatment aims to clean the pockets around teeth or dental implants and prevent damage to surrounding soft tissue and bone, including improvement of oral hygiene, risk factor control (e.g. encouraging cessation of smoking) and surgical interventions. The key aspect of standard non-surgical treatment is the removal of the subgingival biofilm using subgingival instrumentation (SI) (also called scaling and root planing). Antimicrobial photodynamic therapy (aPDT) can be used an adjunctive treatment to SI. It uses light energy to kill micro-organisms that have been treated with a light-absorbing photosensitising agent immediately prior to aPDT.

OBJECTIVES

To assess the effects of SI with adjunctive aPDT versus SI alone or with placebo aPDT for periodontitis and peri-implant diseases in adults.

SEARCH METHODS

We searched the Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase, two other databases and two trials registers up to 14 February 2024.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) (both parallel-group and split-mouth design) in participants with a clinical diagnosis of periodontitis, peri-implantitis or peri-implant disease. We compared the adjunctive use of antimicrobial photodynamic therapy (aPDT), in which aPDT was given after subgingival or submucosal instrumentation (SI), versus SI alone or a combination of SI and a placebo aPDT given during the active or supportive phase of therapy.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodological procedures, and we used GRADE to assess the certainty of the evidence. We prioritised six outcomes and the measure of change from baseline to six months after treatment: probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), gingival recession (REC), pocket closure and adverse effects related to aPDT. We were also interested in change in bone level (for participants with peri-implantitis), and participant satisfaction and quality of life.

MAIN RESULTS

We included 50 RCTs with 1407 participants. Most studies used a split-mouth study design; only 18 studies used a parallel-group design. Studies were small, ranging from 10 participants to 88. Adjunctive aPDT was given in a single session in 39 studies, in multiple sessions (between two and four sessions) in 11 studies, and one study included both single and multiple sessions. SI was given using hand or power-driven instrumentation (or both), and was carried out prior to adjunctive aPDT. Five studies used placebo aPDT in the control group and we combined these in meta-analyses with studies in which SI alone was used. All studies included high or unclear risks of bias, such as selection bias or performance bias of personnel (when SI was carried out by an operator aware of group allocation). We downgraded the certainty of all the evidence owing to these risks of bias, as well as for unexplained statistical inconsistency in the pooled effect estimates or for imprecision when evidence was derived from very few participants and confidence intervals (CI) indicated possible benefit to both intervention and control groups. Adjunctive aPDT versus SI alone during active treatment of periodontitis (44 studies) We are very uncertain whether adjunctive aPDT during active treatment of periodontitis leads to improvement in any clinical outcomes at six months when compared to SI alone: PPD (mean difference (MD) 0.52 mm, 95% CI 0.31 to 0.74; 15 studies, 452 participants), BOP (MD 5.72%, 95% CI 1.62 to 9.81; 5 studies, 171 studies), CAL (MD 0.44 mm, 95% CI 0.24 to 0.64; 13 studies, 414 participants) and REC (MD 0.00, 95% CI -0.16 to 0.16; 4 studies, 95 participants); very low-certainty evidence. Any apparent differences between adjunctive aPDT and SI alone were not judged to be clinically important. Twenty-four studies (639 participants) observed no adverse effects related to aPDT (moderate-certainty evidence). No studies reported pocket closure at six months, participant satisfaction or quality of life. Adjunctive aPDT versus SI alone during supportive treatment of periodontitis (six studies) We were very uncertain whether adjunctive aPDT during supportive treatment of periodontitis leads to improvement in any clinical outcomes at six months when compared to SI alone: PPD (MD -0.04 mm, 95% CI -0.19 to 0.10; 3 studies, 125 participants), BOP (MD 4.98%, 95% CI -2.51 to 12.46; 3 studies, 127 participants), CAL (MD 0.07 mm, 95% CI -0.26 to 0.40; 2 studies, 85 participants) and REC (MD -0.20 mm, 95% CI -0.48 to 0.08; 1 study, 24 participants); very low-certainty evidence. These findings were all imprecise and included no clinically important benefits for aPDT. Three studies (134 participants) reported adverse effects: a single participant developed an abscess, though it is not evident whether this was related to aPDT, and two studies observed no adverse effects related to aPDT (moderate-certainty evidence). No studies reported pocket closure at six months, participant satisfaction or quality of life.

AUTHORS' CONCLUSIONS

Because the certainty of the evidence is very low, we cannot be sure if adjunctive aPDT leads to improved clinical outcomes during the active or supportive treatment of periodontitis; moreover, results suggest that any improvements may be too small to be clinically important. The certainty of this evidence can only be increased by the inclusion of large, well-conducted RCTs that are appropriately analysed to account for change in outcome over time or within-participant split-mouth study designs (or both). We found no studies including people with peri-implantitis, and only one study including people with peri-implant mucositis, but this very small study reported no data at six months, warranting more evidence for adjunctive aPDT in this population group.

Efficacy of photodynamic therapy as an adjunct to scaling and root planing on clinical parameters and microbial composition in subgingival plaque of periodontitis patients: A split-mouth randomized clinical trial

BACKGROUND

The aim of this study was to assess the efficacy of photodynamic therapy (PDT) as an adjunct to scaling and root planing (SRP) on clinical parameters and microbial composition in subgingival plaque of periodontitis patients.

METHODS

Seventeen patients were included in this split-mouth randomized clinical trial. Sites with probing pocket depth (PPD) ≥5 mm in combination with bleeding on probing in different quadrants were randomized into the control group, the group with a single PDT application right after SRP, and the group with three repeated PDT applications 1 week after SRP. The subgingival plaque was collected for 16S rRNA gene sequencing at baseline, Week 2, and Week 8.

RESULTS

Seventeen patients with 60 sites completed this 8-week follow-up, and 157 subgingival plaques were successfully analyzed by sequencing. Significant improvements were observed in two primary outcomes: PPD at Week 8 and subgingival microbial composition. Compared to the control group, the repeated-PDT group showed a notable improvement in PPD, substantial alterations in the microbial profile, including a reduction in α-diversity and anaerobic bacteria, and an increase in aerobic bacteria at Week 2. Secondary outcomes, such as clinical attachment level and sulcus bleeding index, also showed improvement at Week 8. Furthermore, both the single- and repeated-PDT groups exhibited a decrease in periodontopathogens and an increase in beneficial bacteria compared with baseline.

CONCLUSION

PDT promotes changes in the microbial composition of periodontitis patients' subgingival plaque in a direction favorable to periodontal health, and repeated PDT is a promising adjunctive therapy for periodontal treatment.

Efficacy of Non-Surgical Periodontal Therapy with Adjunctive Methylene Blue and Toluidine Blue O Mediated Photodynamic in Treatment of Periodontitis: A Randomized Clinical Trial

BACKGROUND

This study aimed to examine the efficacy of methylene blue (MB) and toluidine blue O (TBO) photodynamic therapy (PDT) as adjuncts to root surface debridement (RSD).

METHODS

This split-mouth, randomized, controlled clinical trial included eighteen patients, and a total of 332 sites (control = 102, MB = 124 and TBO = 106) were examined. Two sessions of PDT were completed at baseline and two weeks after RSD. Clinical parameters of bleeding on probing (BOP), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) were measured pre- and post-treatment.

RESULTS

PPD and BOP reductions in sites treated by RSD with adjunctive photosensitizers (MB and TBO) were significantly higher than in control sites. RSD with MB showed higher efficacy in improving moderately deep pockets (OR 3.350), while adjunctive TBO showed better results in treating deeper pockets (OR 4.643).

CONCLUSIONS

Results suggested that adjunctive use of MB and TBO to RSD could significantly improve periodontal pocket closure and reduce signs of inflammation. In addition, TBO seems to be more efficient in treating deep periodontal pockets than MB, which is more effective in resolving shallower pockets.

Effectiveness of photodynamic therapy on the treatment of chronic periodontitis: a systematic review during 2008-2023

Objective

This study investigated the effect of photodynamic therapy on chronic periodontitis patients and then evaluated the microbial, immunological, periodontal, and clinical outcomes. The significant effects of photodynamic therapy obtained by in vitro and in vivo studies have made it a popular treatment for periodontal diseases in recent years. Photodynamic therapy is a novel bactericidal strategy that is stronger, faster, and less expensive than scaling and root planing.

Method

This study registered on PROSPERO (CRD42021267008) and retrieved fifty-three randomized controlled trials by searching nine databases (Medline, Embase, Scopus, Open Gray, Google Scholar, ProQuest, the Cochrane Library, Web of Science, and ClinicalTrials.gov) from 2008 to 2023. Of 721 records identified through database searches following title and full-text analysis, and excluding duplicate and irrelevant publications, 53 articles were included in this systematic review. Fifty of the 53 eligible studies fulfilled all the criteria in the Joanna Briggs Institute's (JBI's) Checklist for RCTs; the remaining articles met 9-12 criteria and were considered high quality.

Results

The present study showed that photodynamic therapy in adjunct to scaling and root planing has the potential to improve periodontal parameters such as clinical attachment loss or gain, decrease in bleeding on probing, and probing pocket depth. In addition, photodynamic therapy decreases the rate of periodontal pathogens and inflammation markers, which, in turn, reduces the progression of periodontitis.

Conclusion

Photodynamic therapy is considered a promising, adjunctive, and low-cost therapeutic method that is effective in tissue repair, reducing chronic periodontitis, reducing inflammation, and well-tolerated by patients.

Association of active oxygen-releasing gel and photodynamic therapy in the treatment of residual periodontal pockets in type 2 diabetic patients: A randomized controlled clinical study

BACKGROUND

The aim of this study was to evaluate the effect of active oxygen-releasing gel as an adjuvant, with and without antimicrobial photodynamic therapy (aPDT), in the treatment of residual pockets in periodontal patients with type 2 diabetes mellitus (DM2).

METHODS

Patients with residual pockets with probing depth (PD) ≥4 mm and bleeding on probing (BOP) were divided into the following groups: SI (n = 17)-subgingival instrumentation in a single session; BM (n = 17)-SI followed by local application of active oxygen-releasing gel inside the periodontal pocket for 3 min; BM + aPDT (n = 17)-SI followed by application of BM for 3 min and pocket irrigation with methylene blue, and 660-nm diode laser irradiation at 100 mW for 50 s. The periodontal clinical parameters, serum levels of glycated hemoglobin, and immunological analysis of crevicular fluid were evaluated. All data were submitted to statistical analysis (α = 5%).

RESULTS

A significant reduction in BOP was verified at 90 and 180 days in the BM + aPDT group. The percentage of sites with PD ≥ 4 mm was significantly reduced at 90 days in BM + aPDT and BM, whereas after 180 days only BM showed a significant reduction. In the BM + aPDT group, there was a significant reduction in tumor necrosis factor α levels at 90 days. There were no differences between the treatments.

CONCLUSION

The use of adjuvant active oxygen-releasing gel, with or without aPDT, resulted in the same clinical benefits as SI in the treatment of residual pockets in poorly controlled DM2 patients.

Effects of Antimicrobial Photosensitizers of Photodynamic Therapy (PDT) to Treat Periodontitis

Antimicrobial photodynamic therapy or aPDT is an alternative therapeutic approach in which lasers and different photosensitizing agents are used to eradicate periodontopathic bacteria in periodontitis. Periodontitis is a localized infectious disease caused by periodontopathic bacteria and can destroy bones and tissues surrounding and supporting the teeth. The aPDT system has been shown by in vitro studies to have high bactericidal efficacy. It was demonstrated that aPDT has low local toxicity, can speed up dental therapy, and is cost-effective. Several photosensitizers (PSs) are available for each type of light source which did not induce any damage to the patient and are safe. In recent years, significant advances have been made in aPDT as a non-invasive treatment method, especially in treating infections and cancers. Besides, aPDT can be perfectly combined with other treatments. Hence, this survey focused on the effectiveness and mechanism of aPDT of periodontitis by using lasers and the most frequently used antimicrobial PSs such as methylene blue (MB), toluidine blue ortho (TBO), indocyanine green (ICG), malachite green (MG) (Triarylmethanes), erythrosine dyes (ERY) (Xanthenes dyes), rose bengal (RB) (Xanthenes dyes), eosin-Y (Xanthenes dyes), radachlorin group and curcumin. The aPDT with these PSs can reduce pathogenic bacterial loads in periodontitis. Therefore, it is clear that there is a bright future for using aPDT to fight microorganisms causing periodontitis.

Periodontal disease in down syndrome: Predisposing factors and potential non-surgical therapeutic approaches

BACKGROUND

Periodontal diseases (PDs) have been documented to be significantly more prevalent and severe in patients with Down syndrome (DS). Different immunological and microbiological factors contributed to predisposing these patients to progressive and recurrent PDs.

AIM

The aim of this review was to investigate the altered immunological responses and oral microbiota disorders as well as focus on adjunctive non-surgical methods for the treatment of PDs and its applicability in patients with DS.

MATERIAL AND METHODS

A literature review was conducted addressing the following topics: (1) the altered immunological responses, (2) orofacial disorders related to DS patients, (3) oral microbiota changing, and (4) adjunctive non-surgical treatment and its efficacy in patients with DS.

RESULTS

Due to the early onset of PDs in children with DS, the need for prompt and effective treatment in these patients is essential.

DISCUSSION AND CONCLUSION

So, investigating underlying factors may open a new window to better understand the pathology of PDs in DS people and thus, find better strategies for treatment in such group. Although non-surgical treatments such as photodynamic therapy and probiotic consumption represented acceptable outcomes in different examined patients without DS, data about the application of these convenience and no need for local anesthesia methods in patients with DS is limited.

Antimicrobial photocatalysis using bio-hydrothermally synthesized Zinc oxide nanoparticles in the management of periodontitis: a prospective split-mouth, double-blind, randomized, controlled clinical trial

BACKGROUND

The antimicrobial activity of metallic nanoparticles (NPs) has been confirmed to fight a broad spectrum of microorganisms, through antimicrobial effects that are amplified when these particles are irradiated with light of the proper wavelength. This is the first study to use phytoconjugated Zinc oxide (ZnO) NPs containing traces of active biomolecules derived from Emblica officinalis (E. officinalis) plant extract in antimicrobial photocatalysis (PCT) during non-surgical periodontal therapy.

OBJECTIVES

This study aimed to evaluate the effects of repeated PCT application in the treatment of periodontitis, using a gel containing bio-hydrothermally synthesized ZnO NPs and visible light as an adjunct to scaling and root planing (SRP).

METHODOLOGY

In total, 16 systemically healthy volunteers with stage 3 grade B generalized periodontitis were recruited for this prospective double blind, randomized placebo-controlled trial. After receiving SRP, the subjects received the following interventions in a split-mouth design at baseline, 1 week and 1 month: Group 1 - Placebo gel + Sham PCT; Group 2 - Nano ZnO gel + Sham PCT; Group 3 - Placebo gel + PCT; and Group 4 - Nano ZnO gel + PCT. The site-specific profile of Porphyromonas gingivalis in the subgingival plaque and clinical parameters (Plaque Index, Gingival Index, Gingival Bleeding Index, Probing pocket Depth and Clinical Attachment Level) were assessed at baseline, 1 month and 3 months.

RESULTS

All interventions tested caused participants' clinical and microbiological parameters to generally improve after 3 months. Subjects who received the Nano ZnO gel + PCT combination showed a sustained and progressive improvement in their treatment outcomes, a result that presented statistically significant differences from the outcomes obtained through the remaining interventions, at all time points during the study period.

CONCLUSIONS

The repeated application of PCT using bio-hydrothermally synthesized ZnO NPs can effectively complement SRP in the non-surgical treatment of Periodontitis.

Application of Different Wavelengths of LED Lights in Antimicrobial Photodynamic Therapy for the Treatment of Periodontal Disease

Therapeutic light has been increasingly used in clinical dentistry for surgical ablation, disinfection, bio-stimulation, reduction in inflammation, and promotion of wound healing. Photodynamic therapy (PDT), a type of phototherapy, has been used to selectively destroy tumor cells. Antimicrobial PDT (a-PDT) is used to inactivate causative bacteria in infectious oral diseases, such as periodontitis. Several studies have reported that this minimally invasive technique has favorable therapeutic outcomes with a low probability of adverse effects. PDT is based on the photochemical reaction between light, a photosensitizer, and oxygen, which affects its efficacy. Low-power lasers have been predominantly used in phototherapy for periodontal treatments, while light-emitting diodes (LEDs) have received considerable attention as a novel light source in recent years. LEDs can emit broad wavelengths of light, from infrared to ultraviolet, and the lower directivity of LED light appears to be suitable for plaque control over large and complex surfaces. In addition, LED devices are small, lightweight, and less expensive than lasers. Although limited evidence exists on LED-based a-PDT for periodontitis, a-PDT using red or blue LED light could be effective in attenuating bacteria associated with periodontal diseases. LEDs have the potential to provide a new direction for light therapy in periodontics.

The effect of antimicrobial photodynamic therapy on periodontal disease and glycemic control in patients with type 2 diabetes mellitus

OBJECTIVES

This study is aimed at determining the effect of concomitant antimicrobial photodynamic therapy (aPTD) on periodontal disease and glycaemic control in patients with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

Twenty-four patients with T2DM were enrolled in the study. Periodontal clinical parameters were assessed by measuring probing pocket depth (PPD), clinical attachment loss (CAL), gingival recession (GR), full-mouth bleeding score (FMBS), full-mouth plaque score (FMPS), and full-mouth sulcus bleeding score (FMSBS). Glycated haemoglobin A1c (HbA1c) was measured. To determine the presence of the following periodontal pathogenic bacteria, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, subgingival plaque samples were taken from two periodontal pockets per jaw with the greatest PPD using paper tips. Patients were randomly divided into the test and control group. In the test group, full-mouth disinfection was performed in combination with aPTD. In the control group, only full-mouth disinfection was performed.

RESULTS

The results showed an improvement in periodontal clinical parameters in both groups. The difference between the groups in favour of the test group was statistically significant for BOP. The HbA1c level decreased in both groups. The difference was not statistically significant. The results of the microbiological analysis suggest that the presence of periodontal pathogenic bacteria is lower with additional antimicrobial photodynamic therapy with statistically significant difference for T. forsythia.

CONCLUSIONS

Additional aPDT causes a significant reduction in BoP in the proportion of positive sites for periodontal pathogens.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT05816941.

CLINICAL RELEVANCE

aPTD is a noninvasive adjunctive therapy that can positively influence the periodontal treatment outcome.

Adjunctive effects of photodynamic therapy using indocyanine green in residual pockets during periodontal maintenance therapy: A split-mouth randomized controlled trial

BACKGROUND

Prospective studies have reported conflicting results regarding the adjunctive effect of antimicrobial photodynamic therapy (aPDT) on clinical and microbiological parameters in individuals under periodontal maintenance therapy (PMT). This study aimed to evaluate the clinical and microbiological adjunctive effects of aPDT using indocyanine green (ICG) in residual sites with probing depth (PD) ≥5 mm during PMT in comparison with scaling and root planing (SRP) alone.

METHODS

A split-mouth randomized controlled clinical trial was conducted with 24 individuals in a PMT program. Contralateral quadrants with eligible residual sites were randomly assigned to either SRP + aPDT (test group) or SRP alone (control). aPDT included ICG dye and diode laser (909 nm) performed together with SRP and repeated 15 days after. Periodontal clinical parameters, periodontal inflamed surface area (PISA) index, and subgingival biofilm samples were collected at baseline (T1), 3 (T2), and 6 months later (T3). Microbiological analyses were performed by quantitative real-time polymerase chain reaction.

RESULTS

Significant improvements were observed in all clinical and microbiological parameters in both groups from T1 to T3. However, no significant differences were observed regarding plaque index, PD, and clinical attachment level. Test group showed significantly greater reductions in bleeding on probing (BOP), PISA index, and Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans levels, when compared with controls.

CONCLUSIONS

Both treatments resulted in significant clinical periodontal improvements, but with no significant differences between groups except from inflammation parameters. aPDT using ICG resulted in significant reductions in BOP and PISA index, as well as in P. gingivalis and A. actinomycetemcomitans levels.

A Novel Piezoelectric-Assisted Non-Surgical Periodontal Treatment: A Prospective Case Series

The purpose of this study was to evaluate the clinical efficacy of a non-surgical periodontal treatment using a piezoelectric power-driven device with a novel insert. Plaque index (PlI), bleeding on probing (BoP), probing depth (PD), recession depth (Rec) and clinical attachment level (CAL) were assessed at 6 weeks, 3 months and 6 months. Furthermore, tooth mobility and furcation involvement were recorded and chewing discomfort and dental hypersensitivity were evaluated. Eighteen stage I to IV periodontitis patients providing 437 teeth and 2622 sites in total were analyzed. At six weeks, CAL gain (0.4; p < 0.0001), PD reduction (0.4; p < 0.0001) and Rec increase (0.1; p = 0.0029) were statistically significant. Similarly, the mean number of sites with PD > 4 mm and absence of BoP significantly decreased between baseline and 6 weeks (-12.7; p < 0.0001). At this time point, the patient's chewing discomfort was also significantly diminished (1.4; p = 0.0172). Conversely, no statistically significant changes were observed between 6 weeks and 3 months and between 3 months and 6 months for any of the clinical variables evaluated. In conclusion, within the limitation of this study, mechanical piezo-assisted non-surgical periodontal treatment in conjunction with an innovative tip resulted significantly efficacious to reduce pathological periodontal pockets, to gain clinical attachment and to reduce gingival inflammation.

Clinical applications of antimicrobial photodynamic therapy in dentistry

Given the emergence of resistant bacterial strains and novel microorganisms that globally threaten human life, moving toward new treatment modalities for microbial infections has become a priority more than ever. Antimicrobial photodynamic therapy (aPDT) has been introduced as a promising and non-invasive local and adjuvant treatment in several oral infectious diseases. Its efficacy for elimination of bacterial, fungal, and viral infections and key pathogens such as Streptococcus mutans, Porphyromonas gingivalis, Candida albicans, and Enterococcus faecalis have been investigated by many invitro and clinical studies. Researchers have also investigated methods of increasing the efficacy of such treatment modalities by amazing developments in the production of natural, nano based, and targeted photosensitizers. As clinical studies have an important role in paving the way towards evidence-based applications in oral infection treatment by this method, the current review aimed to provide an overall view of potential clinical applications in this field and summarize the data of available randomized controlled clinical studies conducted on the applications of aPDT in dentistry and investigate its future horizons in the dental practice. Four databases including PubMed (Medline), Web of Science, Scopus and Embase were searched up to September 2022 to retrieve related clinical studies. There are several clinical studies reporting aPDT as an effective adjunctive treatment modality capable of reducing pathogenic bacterial loads in periodontal and peri-implant, and persistent endodontic infections. Clinical evidence also reveals a therapeutic potential for aPDT in prevention and reduction of cariogenic organisms and treatment of infections with fungal or viral origins, however, the number of randomized clinical studies in these groups are much less. Altogether, various photosensitizers have been used and it is still not possible to recommend specific irradiation parameters due to heterogenicity among studies. Reaching effective clinical protocols and parameters of this treatment is difficult and requires further high quality randomized controlled trials focusing on specific PS and irradiation parameters that have shown to have clinical efficacy and are able to reduce pathogenic bacterial loads with sufficient follow-up periods.

Antimicrobial photodynamic therapy in treatment of aggressive periodontitis (stage III, grade C periodontitis): A comparison between photodynamic therapy and antibiotic therapy as an adjunct to non-surgical periodontal treatment

BACKGROUND

Treatment of aggressive periodontitis (stage III, grade C periodontitis) represents a challenge. The aim of the study was to compare the long-term results of antimicrobial photodynamic therapy (aPDT) and antibiotic therapy as an adjunct to conventional non-surgical therapy in patients with aggressive periodontitis.

MATERIALS AND METHODS

Twenty subjects with untreated aggressive periodontitis (stage III, grade C periodontitis) were divided into two groups: the test group (TG) received non-surgical therapy and two sessions of aPDT using a laser (HELBO TheraLite laser) with a wavelength of 670 nm associated with HELBO Blue photosensitizer, and the control group (CG) received non-surgical therapy and antibiotics (amoxicillin 500 mg and metronidazole 400 mg, 7 days). Clinical parameters of probing depth, clinical attachment level and bleeding on probing (BOP) were assessed at baseline, 3, 6, 9 and 12 months after treatment.

RESULTS

The mean probing pocket depths at baseline were 3.68 mm in TG and 3.51 mm in CG. These values decreased to 2.77 mm (p < 0.05) and 2.54 mm (p < 0.05) 3 months after treatment and stayed decreased after 12 months. Clinical attachment levels at baseline were 3.88 mm in TG and 3.70 mm in CG. These values decreased to 3.06 mm (p < 0.05) and 2.80 mm (p < 0.05) after 3 months and stayed decreased after 12 months. We also found a decrease in BOP after 3, 6, 9 and 12 months in TG and in CG.

CONCLUSIONS

aPDT and antibiotics as an adjunct to non-surgical periodontal treatment lead to a comparable improvement in long term periodontal parameters.

The Effect of Photodynamic Therapy on the Early Outcome of Implants Placed on Patients with Periodontitis

Background: Immediate implant is a subtype of implant that is placed following tooth extraction within the socket without further delay. These implants are known to preserve the alveolar bone and minimize the total number of surgical interventions in a patient. 4 Photodynamic therapy (PDT) augments nonsurgical periodontal therapy using antibacterial mechanisms. PTD can be more effective in conjunction with scaling and root planing (SRP). The aim of this study is to assess the effects of PDT on the early outcomes of implants placed on patients with periodontitis with and without SRP at 9 months of follow-up. Materials and methods: A total of 23 implants were placed in 14 patients, with 11 in the test group and 12 in the control group. SRP was carried out prior to immediate implant placement in control sites, and PDT adjunctive to SRP (SRP + PDT) was performed in test sites before immediate implant placement. Plaque index, gingival index, probing pocket depth, clinical attachment level, and radiovisiographs were procured at baseline, 3 months, 6 months, and 9 months. Primary stability was examined at the time of implant placement, and the healing index was recorded a week later. Results: At the end of the 9 months of the study period, (SRP + PDT) group had a mean marginal bone loss of 0.95 mm, and the control group had 1.08 mm. Clinical parameters such as plaque index, gingival index, clinical attachment level, and probing depth showed definitive improvement after 9 months, compared with the baseline, but when the test and control groups were compared, the difference was statistically significant for plaque index and probing depth. The implants in both groups were followed up for a period of 9 months. There was an improvement in marginal bone loss but was not statistically significant. The survival of immediate implants in the PDT group was not different from those in the scaling and root planing group. Conclusion: The effect of PTD can be beneficially used as an adjunct to SRP. However, the effects were not significant. Photodynamic therapy can be effectively used as an adjunct to SRP owing to the better outcomes using PDT.

Open flap debridement compared to repeated applications of photodynamic therapy in the treatment of residual pockets. A randomized clinical trial

BACKGROUND

The aim of the present study was to compare repeated applications of antimicrobial photodynamic therapy (aPDT) to open flap debridement (OFD) in the treatment of residual periodontal pockets in non-furcation sites.

METHODS

Forty-six subjects with a diagnosis of Stage III or IV Grade C periodontitis, that had been previously treated, participated in the study.  Residual pockets were divided between two groups: 1) aPDT group: received ultrasonic periodontal debridement followed by immediate application of aPDT, and repeated on1st, 2nd, 7th and 14th days; and 2) OFD group: treated by modified papilla preservation technique, where granulation tissue and visible calculus were removed with hand curettes and an ultrasonic device. Clinical, immunological and microbiological parameters were evaluated before and after treatment.

RESULTS

Both treatments were effective reducing clinical parameters of disease. OFD resulted in a greater mean probing pocket depths (PPD) reduction in deep pockets (p = 0.001). However, aPDT resulted in a lower occurrence of gingival recession (GR), dentin hypersensitivity and analgesic intake. Reduction in Porphyromonas gingivalis was observed in both groups. Only the OFD group had a significant reduction in Aggregatibacter actinomycetemcomitans. aPDT group had greater increase in IL-10 levels and a greater reduction of IL-1β at 14 days when compared to the OFD group (p<0.05).

CONCLUSION

OFD was superior in reducing PPD in deep pockets compared to the aPDT. However, OFD resulted in greater GR.  Both treatments lowered P. gingivalis levels but only OFD reduced levels of A. actinomycemtemcomitans. This article is protected by copyright. All rights reserved.

Some Natural Photosensitizers and Their Medicinal Properties for Use in Photodynamic Therapy

Despite significant advances in early diagnosis and treatment, cancer is one of the leading causes of death. Photodynamic therapy (PDT) is a therapy for the treatment of many diseases, including cancer. This therapy uses a combination of a photosensitizer (PS), light irradiation of appropriate length and molecular oxygen. The photodynamic effect kills cancer cells through apoptosis, necrosis, or autophagy of tumor cells. PDT is a promising approach for eliminating various cancers but is not yet as widely applied in therapy as conventional chemotherapy. Currently, natural compounds with photosensitizing properties are being discovered and identified. A reduced toxicity to healthy tissues and a lower incidence of side effects inspires scientists to seek natural PS for PDT. In this review, several groups of compounds with photoactive properties are presented. The use of natural products has been shown to be a fruitful approach in the discovery of novel pharmaceuticals. This review focused on the anticancer activity of furanocoumarins, polyacetylenes, thiophenes, tolyporphins, curcumins, alkaloid and anthraquinones in relation to the light-absorbing properties. Attention will be paid to their phototoxic and anti-cancer effects on various types of cancer.

Treatment effects and periodontal status of chronic periodontitis after routine Er:YAG laser-assisted therapy

BACKGROUND

Routine preclinical interventions for patients with chronic periodontitis such as supragingival cleaning and subgingival curettage, establishing a balanced occlusal relationship, and irrigation with 3% hydrogen peroxide can relieve the symptoms to some extent. However, there is room for improvement in the overall effect. For example, Er:YAG lasers can quickly increase the temperature of the irradiated tissue, effectively eliminate dental plaque and calculus, reduce periodontal pockets, adjust periodontal microecology, and reduce the gingival sulcus. The content of factors in the liquid, and then achieve the purpose of treatment.

AIM

The aim was evaluate the effect of Er:YAG laser-assisted routine therapy on the periodontal status in chronic periodontitis.

METHODS

Between October 2018 and January 2020, 106 patients with chronic periodontitis in our hospital were randomly assigned to either the study or control group, with 53 patients in each group. The control group underwent routine therapy, and the study group underwent Er:YAG laser therapy in addition to routine therapy. We evaluated the treatment outcome in both groups. Periodontal status was determined by clinical attachment loss (CAL), gingival index (GI), periodontal probing depth (PD), dental plaque index (PLI), and sulcular bleeding index (SBI), inflammatory factors in the gingival crevicular fluid, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-8], and colony forming units (CFUs).

RESULTS

Total effectiveness in the study group (94.34%) was higher than that in the control group (79.25%, P < 0.05). The clinical parameters in the study group (PD, 5.28 ± 1.08 mm; CAL, 4.81 ± 0.79 mm; SBI, 3.37 ± 0.59; GI, 1.38 ± 0.40; PLI, 2.05 ± 0.65) were not significantly different from those in the control group (PD, 5.51 ± 1.14 mm; CAL, 5.09 ± 0.83 mm; SBI, 3.51 ± 0.62; GI, (1.41 ± 0.37; PLI, 1.98 ± 0.70) before treatment (P > 0.05). However, after treatment, the parameters in the study group (PD, 2.97 ± 0.38 mm; CAL, 2.71 ± 0.64 mm; SBI, 2.07 ± 0.32; GI, 0.51 ± 0.11; PLI, 1.29 ± 0.34) were lower than those in the control group (PD, 3.71 ± 0.42 mm; CAL, 3.60 ± 0.71 mm; SBI, 2.80 ± 0.44; GI, 0.78 ± 0.23; PLI, 1.70 ± 0.51) (P < 0.05). Differences in crevicular TNF-α, IL-6, and IL-8 levels in the study (TNF-α, 7.82 ± 3.43 ng/mL; IL-6, 11.67 ± 2.59 ng/mL; IL-8, 12.12 ± 3.19 pg/mL) and control groups (TNF-α, 9.06 ± 3.89 ng/ml, IL-6, 12.13 ± 2.97 ng/mL, IL-8, 10.99 ± 3.30 pg/mL) before therapy (P > 0.05) were not significant. Following treatment, the parameters were significantly lower in the study group (TNF-α, 2.04 ± 0.89 ng/mL; IL-6, 4.60 ± 1.26 ng/mL; IL-8, 3.15 ± 1.08 pg/mL) than in the control group (TNF-α, 3.11 ± 1.07 ng/mL; IL-6, 6.25 ± 1.41 ng/mL; IL-8, 4.64 ± 1.23 pg/mL, P < 0.05). The difference in the CFU of the study group [(367.91 ± 74.32) × 10⁴/mL and control group (371.09 ± 80.25) × 10⁴/mL] before therapy was not significant (P > 0.05). The CFU decreased in both groups following therapy, however, the CFU values were lower in the study group [(36.09 ± 15.26) × 10⁴/mL] than in the control group [(45.89 ± 18.08) ×10⁴/mL] (P < 0.05).

CONCLUSION

Combining Er:YAG lasers with routine measures significantly improved the overall periodontal therapy outcomes by improving periodontal status and reducing oral levels of inflammatory factors and CFUs.

LASER in periodontal treatment: is it an effective treatment or science fiction?

There are several studies that evaluate the use of lasers in periodontal treatment in non-surgical or surgical therapy. However, while several studies showed clinically beneficial effects of some lasers in periodontal treatment, there are few clinical reports of additional advantages of lasers as adjunctive treatments in periodontology. The aim of this paper is to demonstrate and critically analyze the level of scientific evidence of effects of low-level lasers and high-power lasers in periodontology. A narrative review of the studies was carried out in each topic and type of laser or periodontal treatment. In nonsurgical periodontal therapy the results showed that there is an additional clinical benefit when using a diode laser (DL) associated with scaling and root planing (SRP) in patients with moderate to severe periodontitis. The Er:YAG laser seems to be the most suitable for nonsurgical periodontal therapy and promotes the same clinical effects as conventional therapy. In periodontal surgery vaporization of the gingival or mucosal tissue can be carried out with DL, CO2, Nd:YAG, Er:YAG and Er,Cr:YSGG lasers. Photobiomodulation (PBM), mediated by low-level lasers associated with non-surgical periodontal therapy, promotes additional benefits in the short term and accelerates the bone and gingival tissue repair process and also reduces postoperative symptoms of periodontal surgery. The effect of antimicrobial Photodynamic Therapy is relevant in the initial reevaluation periods. Studies have shown controversial results of the use of lasers in periodontics, and this fact may be due to the lack of standard parameters of irradiation in each clinical application.

Clinical Efficacy of Repeated Applications of Local Drug Delivery and Adjunctive Agents in Nonsurgical Periodontal Therapy: A Systematic Review

The aim of this systematic review is to compare the clinical efficacy of repeated applications of local drug delivery and adjunctive agents (LDAs) in nonsurgical periodontal therapy (NSPT) compared to subgingival mechanical debridement (SMD) alone. The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, EMBASE, Web of Science, hand-searched literature and grey literature databases were searched for randomized controlled clinical trials (RCTs) with a minimum of 6-month follow-up. The outcomes of interest were changes in probing pocket depth and clinical attachment level as well as patient-centred outcomes. Of 1094 studies identified, 16 RCTs were included in the qualitative analysis. Across 11 different adjuncts analysed, only two studies utilizing minocycline gel/ointment and antimicrobial photodynamic therapy (aPDT) with indocyanine green photosensitizer had statistically significant differences in primary outcomes when compared to their control groups. Only one study on aPDT methylene blue 0.005% had compared single versus multiple applications against its control group. A mean range of 0.27-3.82 mm PD reduction and -0.09-2.82 mm CAL gain were observed with repeated LDA application. Considerable clinical heterogeneity and methodological flaws in the included studies preclude any definitive conclusions regarding the clinical efficacy of repeated LDA applications. Future RCTs with a direct comparison between single and repeated applications should be conducted to confirm or refute the clinical advantages of repeated LDA application in the nonsurgical management of periodontitis.

Effects of multiple sessions of antimicrobial photodynamic therapy (aPDT) in the treatment of periodontitis in patients with uncompensated type 2 diabetes: A randomized controlled clinical study

BACKGROUND

The aim of this study was to compare, through clinical and microbiological analysis, the use of multiple applications of aPDT as an adjuvant therapy to non-surgical periodontal treatment of stage III and IV grade C periodontitis in type 2 diabetic (DM2) patients.

METHODS

Thirty-four patients with non-compensated DM2 and periodontitis were randomly divided into two groups: SRP Group (n = 17): scaling and root planing (SRP); and SRP+aPDT Group (n = 17): SRP followed by 3 consecutive aPDT applications, immediately, 48 and 96 h after in pockets with probing depth (PD) ≥5 mm. In SRP+aPDT, after 1 min of irrigation with methylene blue (10 mg/ml), the sites were irradiated with a 660 nm diode laser for 50 s (157 J/cm², 4.7 J, 100 mW). Porphyromonas gingivalis (P. gingivalis) and Prevotella intermedia (P. intermedia) were quantified by real-time qPCR. Periodontal clinical and microbiological data (baseline, 90 and 180 days) were statistically analyzed (α = 5%).

RESULTS

There was a significant reduction in PD and bleeding on probing at 90 and 180 days post-treatment in both groups (p<0.05). The SRP+aPDT group presented a significant reduction in the number of residual pockets at 90 and 180 days (p<0.05). The SRP+aPDT group presented reduced PD means in deep pockets 180 days post-treatment (p<0.05). No differences were observed in P. gingivalis and P. intermedia levels (p>0.05).

CONCLUSION

The results of present study indicate that the use of multiples aPDT sessions as adjuvant therapy in the periodontal treatment of uncompensated diabetic patients with periodontitis promotes additional clinical benefits.

Clinical efficacy of single and multiple applications of antimicrobial photodynamic therapy in periodontal maintenance: A systematic review and network meta-analysis

BACKGROUND

At present the clinical efficacy of single (S) versus multiple (M) applications of antimicrobial photodynamic therapy (aPDT) is controversially discussed.

AIM

To systematically evaluate the clinical efficacy of adjunctive S and M applications of aPDT to subgingival debridement (SD) in the treatment of residual periodontal pockets.

METHODS

An electronic search was carried out for randomized controlled clinical trials (RCTs) reporting on SD with the adjunctive use of S- or M-aPDT applications.

RESULTS

Statistically significantly higher improvement in bleeding on probing (BOP) and probing depth (PD) reduction was found for SD + S-aPDT versus SD, with Mean difference (MD) = -16.8 (95% CI: -30.7 to -2.91; p = 0.02) and 0.4, (95% CI: 0.02 to 0.78, p = 0.04), respectively. Regarding BOP, there was also a statistically significant difference when SD + M-aPDT was compared with SD alone, with a MD of -5.13 (95% CI: -7.20 to -3.07; p < 0.00001). For all parameters, SD + S-aPDT demonstrated the best treatment ranking of probability results, followed by SD + M-aPDT and SD alone.

CONCLUSIONS

Within their limits, the present data indicate that in periodontal patients enrolled in maintenance: a) single and multiple adjunctive applications of aPDT following SD resulted in statistically significant BOP reduction compared to SD alone, and b) repeated applications of aPDT did not seem to result in superior outcomes compared to single applications.

Central Regulatory Role of Cytokines in Periodontitis and Targeting Options

BACKGROUND

Periodontitis is an immune-inflammatory disease that leads to the progressive destruction of bone and connective tissue in the periodontal area. The cytokine network plays a primary role in tissue homeostasis, the recruitment of immune cells to control the pathogenic impact and the regulation of osteoclastic function, thus modulating the intensity and duration of the immune response. This review provides an update on the main cytokines implicated in the pathogenesis and progression of periodontitis and their targeting potential in order to enrich current treatment options.

METHODS

A structured search of bibliographic databases (PubMed, MEDLINE, Scopus) was performed for peer-reviewed cytokine studies focused on periodontitis the last ten years. A qualitative content analysis was performed in screened papers and a critical discussion of main findings is provided.

RESULTS

An altered cytokine profile has been detected in periodontitis patients and the interplay of pro-inflammatory and/or anti-inflammatory cytokines has been associated with disease pathogenesis. Among the most prominent pro-inflammatory cytokines, TNF-α, IL-1β, IL-17, IL-6 and the chemokines CXCL-6, CXCL-8 are overexpressed in periodontitis patients and correlate with disease progression. On the other hand, the anti-inflammatory IL-4 and IL- 11 levels are reduced while IL-12 and IFN-γ expression play a dual role in periodontal disease. Current periodontitis treatment strategies include selective antibiotics, antimicrobial photodynamic therapy and probiotics, which can modulate the cytokine network and when applied in combination with specific anti-cytokine agents can exert additional beneficial effects.

CONCLUSION

It is evident that cytokines play a central regulatory role in the inflammatory process and immune cell response that underlies bone destruction in periodontitis. Specific cytokine targeting should be considered as a complementary therapeutic scheme to current periodontal management.

Effectiveness of Antimicrobial Photodynamic Therapy in the Treatment of Periodontitis: A Systematic Review and Meta-Analysis of In Vivo Human Randomized Controlled Clinical Trials

This systematic review and meta-analysis evaluated antimicrobial photodynamic therapy (aPDT) efficacy in periodontitis. The review protocol was conducted in accordance with PRISMA statements, Cochrane Collaboration recommendations and is registered in PROSPERO (CRD 42020161516). Electronic and hand search strategies were undertaken to gather data on in vivo human RCTs followed by qualitative analysis. Differences in probing pocket depth (PPD) and clinical attachment level (CAL) were calculated with 95% confidence intervals and pooled in random effects model at three and six months. Heterogeneity was analyzed, using Q and I² tests. Publication bias was assessed by visual examination of the funnel plot symmetry. Sixty percent of 31 eligible studies showed a high risk of bias. Meta-analysis on 18 studies showed no additional benefit in split mouth studies in terms of PPD reduction (SMD 0.166; 95% CI −0.278 to 0.611; P = 0.463) and CAL gain (SMD 0.092; 95% CI −0.013 to 0.198; P = 0.088). Similar findings noted for parallel group studies; PPD reduction (SMD 0.076; 95% CI −0.420 to 0.573; P = 0.763) and CAL gain (SMD 0.056; 95% CI −0.408 to 0.552; P = 0.745). Sensitivity analysis minimized heterogeneity for both outcome variables; however, intergroup differences were not statistically significant. Future research should aim for well-designed RCTs in order to determine the effectiveness of aPDT.

Microbiologic Profiles of Patients with Dental Prosthetic Treatment and Periodontitis before and after Photoactivation Therapy-Randomized Clinical Trial

Fixed prosthodontic dental restorations can potentially affect the periodontal tissues and vice versa, the periodontium can influence the longevity and esthetic appearance of dental restorations. We proposed an investigation on total bacterial load, specific periodontal pathogens, and periodontal clinical parameters in patients with dental fixed prosthesis and different degrees of periodontal tissue loss that followed photoactivation therapy (PDT) adjunctive to scaling and root planing. The study was conducted on 160 subjects, which were randomly assigned to scaling and root planing (SRP) alone (52 subjects, 256 sites), SRP and chlorhexidine rinsing (58 subjects, 276 sites), and SRP plus PDT (50 subjects, 318 sites). Periodontal parameters (plaque index, bleeding on probing, probing depth, and clinical attachment loss), followed by total bacterial load and specific periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) were examined in each patient at baseline, one and six months after. PDT exerted significant improvements both in clinical and microbiological load after one month, and these results were maintained 6 months after when compared to chlorhexidine rinsing or SRP alone, especially in severe periodontitis cases. Photoactivation therapy as an adjunctive periodontal therapeutic method was efficient in offering supplementary periodontal improvements in the clinical and microbiological parameters of patients with fixed dental prosthesis, particularly in severe periodontitis cases.

Subgingival instrumentation for treatment of periodontitis. A systematic review

OBJECTIVES

To evaluate the efficacy of subgingival instrumentation (PICOS-1), sonic/ultrasonic/hand instruments (PICOS-2) and different subgingival instrumentation delivery protocols (PICOS-3) to treat periodontitis.

METHODS

Systematic electronic search (CENTRAL/MEDLINE/EMBASE/SCOPUS/LILACS) to March 2019 was conducted to identify randomized controlled trials (RCT) reporting on subgingival instrumentation. Duplicate screening and data extraction were performed to formulate evidence tables and meta-analysis as appropriate.

RESULTS

As only one RCT addressed the efficacy of subgingival instrumentation compared with supragingival cleaning alone (PICOS-1), baseline and final measures from 9 studies were considered. The weighted pocket depth (PD) reduction was 1.4 mm (95%CI: 1.0 1.7) at 6/8 months, and the proportion of pocket closure was estimated at 74% (95%CI: 64-85). Six RCTs compared hand and sonic/ultrasonic instruments for subgingival instrumentation (PICOS-2). No significant differences were observed between groups by follow-up time point or category of initial PD. Thirteen RCTs evaluated quadrant-wise versus full-mouth approaches (PICOS-3). No significant differences were observed between groups irrespective of time-points or initial PD. Five studies reported patient-reported outcomes, reporting no differences between groups.

CONCLUSIONS

Nonsurgical periodontal therapy by mechanical subgingival instrumentation is an efficacious means to achieve infection control in periodontitis patients irrespective of the type of instrument or mode of delivery. Prospero ID: CRD42019124887.

Clinical and Microbiological Evaluation of Local Doxycycline and Antimicrobial Photodynamic Therapy during Supportive Periodontal Therapy: A Randomized Clinical Trial

The aim of this study was to evaluate the clinical and microbiological effects of subgingival instrumentation (SI) alone or combined with either local drug delivery (LDD) or photodynamic therapy (PDT) in persistent/recurrent pockets in patients enrolled in supportive periodontal therapy (SPT). A total of 105 patients enrolled in SPT were randomly treated as follows: group A (n = 35): SI +PDT and 7 days later 2nd PDT; group B (n = 35): SI+LDD; group C (n = 35): SI (control). Prior intervention, at 3 and 6 months after therapy, probing pocket depths, clinical attachment level, number of treated sites with bleeding on probing (n BOP), full mouth plaque and bleeding scores (gingival bleeding index, %BOP) were recorded. At the same time points, 8 periodontopathogens were quantitatively determined. All three treatments resulted in statistically significant improvements (p < 0.05) of all clinical parameters without statistically significant intergroup differences (p > 0.05). Several bacterial species were reduced in both test groups, with statistically significantly higher reductions for LDD compared to PDT and the control group. In conclusion, the present data indicate that: (a) In periodontal patients enrolled in SPT, treatment of persistent/recurrent pockets with SI alone or combined with either PDT or LDD may lead to comparable clinical improvements and (b) the adjunctive use of LDD appears to provide better microbiological improvements for some periodontal pathogens than SI alone or combined with PDT.

Rose bengal-mediated photodynamic inactivation against periodontopathogens in vitro

BACKGROUND

The main goal of periodontal therapy is to eliminate the spread of infection in the periodontium. Antimicrobial photodynamic therapy (aPDT) is a bactericidal method that has been recently introduced for controlling periodontal infection. The aim of this in vitro study was to evaluate the effect of aPDT using a combination of medium-power blue light-emitting diodes (LEDs) and rose bengal (RB) on selected key periodontopathogens.

METHODS

Porphyromonas gingivalis ATCC33277, Aggregatibacter actinomycetemcomitans ATCC29523 and Fusobacterium nucleatum ATCC10953 were used in the experiments. Each bacterial suspension was irradiated with a blue LED (BL) (450-470 nm, output power density of 1.2 W/cm²) for 20-60 s (6-18 J/cm²), treated with RB (1 min), or subjected to a combination of RB treatment and BL irradiation (40 s, 12 J/cm²). All bacterial suspensions were serially diluted, plated and incubated anaerobically or microaerobically, and the numbers of colony-forming units (CFUs) were counted on day 7. One-way analysis of variance (ANOVA) and Tukey's HSD tests were used for statistical analysis.

RESULTS

Treatment with BL irradiation from 6 to 18 J/cm² did not significantly reduce the number of CFUs, whereas treatment with RB alone induced a low-to-high reduction in the bacterial CFUs in a dye concentration-dependent manner. Furthermore, the difference in the effects obtained with 16 μg/mL and 160 μg/mL RB was not statistically significant. Treatment with the BL at 12 J/cm² combined with 160 μg/mL RB yielded maximal log reductions of 3.03, 4.2 and 2.23 in P. gingivalis, A. actinomycetemcomitans and F. nucleatum CFUs, respectively.

CONCLUSION

Within the limits of this study, the three periodontal pathogens, especially A. actinomycetemcomitans, were susceptible to photodynamic inactivation by the combination of the BL and RB. RB-mediated aPDT may offer a viable alternative tool for periodontal pathogen treatment, especially for A. actinomycetemcomitans eradication. aPDT may be a valuable tool for the treatment of periodontal diseases, particularly those in which A. actinomycetemcomitans is a dominating pathogen.

Efficacy of antimicrobial photodynamic therapy (aPDT) for nonsurgical treatment of periodontal disease: a systematic review

Although the standard treatment for periodontal disease is based on scaling and root planing (SRP), the use of antimicrobial photodynamic therapy (aPDT) has been studied as a complement to obtain better clinical results. The purpose of this study was to evaluate the effect of aPDT as adjuncts to SRP, compared with SRP alone, on clinical parameters of chronic periodontal patients. Only randomized controlled trials with at least 3-month follow-ups, of SRP alone and in association with aPDT, were included. The MEDLINE (PubMed), Google Scholar, and LILACS databases were searched for articles published up to July 2020. Random-effects meta-analyses were conducted for clinical attachment level (CAL) and probing pocket depth (PPD) change after treatment. Of 141 potentially relevant papers, 22 were included. The association between SRP and aPDT promoted a significant CAL gain and PPD reduction. Periodontal treatment was partially improved by aPDT, and a favorable effect of indocyanine green-mediated aPDT was observed, and high concentrations of phenothiazine chloride presented clinical improvement as well.

Impact of Local Drug Delivery of Minocycline on the Subgingival Microbiota during Supportive Periodontal Therapy: A Randomized Controlled Pilot Study

The aim of this study was to examine the effect of adjunct local minocycline administration on the microbiological parameters of subgingival plaque samples in the residual periodontal pockets. Ten chronic periodontitis patients under a supportive periodontal therapy regimen were recruited. After subgingival debridement, either 2% minocycline gel, Periocline™, (Test Group) or a placebo (Control Group) was administered to the selected sites once a week for three weeks. Subgingival plaque was collected at baseline, and at four weeks and eight weeks. The microbiological composition was analyzed by 16S ribosomal RNA sequencing. In the Test Group, α-diversity (evenness) decreased compared to the baseline (p = 0.005) and was lower compared to the control group at four weeks (p = 0.003). The microbial community composition between the two groups was significantly different at four weeks (p = 0.029). These changes were attributable to a decrease in the bacteria associated with periodontitis and an increase in the bacteria associated with periodontal health. Additionally, the improvement in bleeding on probing continued at eight weeks; however, there were little microbial effects of 2% minocycline gel observed at eight weeks. The control group demonstrated no change throughout the eight-week experimental period. Thus, local minocycline administration can change the subgingival microbial community of residual periodontal pockets.

Transgingival photodynamic therapy (tg-aPDT) adjunctive to subgingival mechanical instrumentation in supportive periodontal therapy. A randomized controlled clinical study

BACKGROUND

Recent data from preclinical studies and case series suggest that transgingival irradiation with diode lasers may represent a novel modality for antimicrobial photodynamic therapy (aPDT). However, at present, there is lack of data from controlled clinical studies on the use of transgingival antimicrobial photodynamic therapy (tg-aPDT) in the treatment of periodontitis.

OBJECTIVE

To evaluate the clinical effects of tg-aPDT used in conjunction with nonsurgical mechanical instrumentation during supportive periodontal therapy (SPT).

MATERIALS AND METHODS

Forty stage II and III periodontitis patients enrolled in SPT were randomly assigned to two groups of equal size. At baseline, study sites had to show sites with pocket probing depth (PPD) of ≥ 5 mm and Bleeding on Probing (BOP). Full mouth and site-specific Plaque-Index scores (PI), BOP, PPD, and Clinical Attachment Level (CAL) were recorded at baseline (BL), three months (3 M), and 6 months (6 M), respectively. The primary outcome variable was the change in the number of sites with BOP. Treatment was performed under local anaesthesia after random allocation to one of the following groups 1) Subgingival scaling and root planing (SRP) + tg-aPDT (test) or 2) SRP alone (control).

RESULTS

Thirty-nine patients completed the study. Full mouth PI and BOP improved over six month, however without statistically significant difference between the groups. At 6 M, BOP-levels were statistically significantly lower in test sites (25.0 %) compared to the control sites (65.0 %), (p < 0.025). PPD improved in both groups with comparable mean values at 3 M (PPD test: 5.21 ± 0.92 mm; PPD control: 4.45 ± 1.36 mm) and 6 M (PPD test: 5.11 ± 1.10 mm; PPD control: 4.35 ± 1.14 mm). Additionally, CAL slightly improved in both groups with comparable mean values at 3 M (CAL test: 6.79 ± 1.72 mm; CAL control: 5.30 ± 2.43 mm) and 6 M (CAL test: 6.26 ± 1.70 mm; CAL control: 5.50 ± 2.33 mm).

CONCLUSIONS

Within its limits, the present results appear to indicate that the use of tg-aPDT adjunctive to SRP may represent a new modality for controlling inflammation and further bleeding in residual periodontal pockets.

Treating periodontitis-a systematic review and meta-analysis comparing ultrasonic and manual subgingival scaling at different probing pocket depths

BACKGROUND

Mechanical plaque removal has been commonly accepted to be the basis for periodontal treatment. This study aims to compare the effectiveness of ultrasonic and manual subgingival scaling at different initial probing pocket depths (PPD) in periodontal treatment.

METHODS

English-language databases (PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Medline, and ClinicalTrials.gov, by January, 2019) were searched. Weighted mean differences in primary outcomes, PPD and clinical attachment loss (CAL) reduction, were estimated by random effects model. Secondary outcomes, bleeding on probing (BOP), gingival recession (GR), and post-scaling residual dental calculus, were analyzed by comparing the results of each study. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The GRADE approach was used to assess quality of evidence.

RESULTS

Ten randomized controlled trials were included out of 1434 identified. Initial PPD and follow-up periods formed subgroups. For 3-months follow-up: (1) too few shallow initial pocket studies available to draw a conclusion; (2) the heterogeneity of medium depth studies was so high that could not be merged to draw a conclusion; (3) deep pocket studies showed no statistical differences in PPD and CAL reduction between ultrasonic and manual groups. For 6-months follow-up: (1) too few shallow initial PPD studies to draw a conclusion; (2) at medium pocket depth, PPD reduction showed manual subgingival scaling better than ultrasound. No statistical differences were observed in CAL reduction between the two approaches; (3) for deep initial PPD studies, both PPD and CAL reduction showed manual subgingival scaling better. GR results indicated no statistical differences at medium and deep initial pocket studies between the two methods. BOP results showed more reduction at deep pocket depths with manual subgingival scaling. No conclusion could be drawn about residual dental calculus.

CONCLUSION

When initial PPD was 4-6 mm, PPD reduction proved manual subgingival scaling was superior, but CAL results showed no statistical differences between the two means. When initial PPD was ≥6 mm, PPD and CAL reductions suggested that manual subgingival scaling was superior.

Commercial Local Pharmacotherapeutics and Adjunctive Agents for Nonsurgical Treatment of Periodontitis: A Contemporary Review of Clinical Efficacies and Challenges

Periodontal infections tend to be site-specific, mostly confined to the periodontal pocket. With the surge of antibiotic-resistant bacteria, the trend is shifting towards other therapeutic modalities, especially locally delivered approaches that include other pharmacotherapeutic drugs and medical devices. This narrative review aimed to provide insights into the clinical efficacy of local drug delivery and adjunctive agents used in nonsurgical management of periodontitis. Electronic (PubMed/MEDLINE, CENTRAL, and EMBASE) and bibliographic searches of past systematic reviews were carried out to identify previous publications on the topic. Only relevant literature and randomized controlled trials published in English were selected. In addition, a literature review was developed based on the selected articles. Experimental drugs or agents were excluded. This review highlights the clinically proven and commercially available therapeutic agents related to the management of periodontal disease with comparisons of their clinical efficacies and challenges. A vast array of commercial local pharmacotherapeutic agents had been clinically tested, but the methodologies and clinical results varied within and between each agent used, causing difficulty in drawing conclusions and providing support to the superiority of one agent over another. Considering the benefit-cost ratio with the modest clinical results, the long-term usefulness of these agents remains debatable.

Clinical outcomes of adjunctive indocyanine green-diode lasers therapy for treating refractory periodontitis: A randomized controlled trial with in vitro assessment

BACKGROUND/PURPOSE

It is still challengeable to treat periodontal pockets refractory to mechanical debridement. This study is to evaluate the potential of indocyanine green (ICG)-diode laser-based photothermal therapy (PTT) for solving this dilemma.

METHODS

Bone marrow-derived mesenchymal stem cells (BMSCs) and periodontal ligament cells (PDLCs) were incubated with phosphate-buffered saline, chlorhexidine, or ICG, non-irradiated or irradiated with 810-nm diode lasers, and the cell viability was evaluated. Patients with teeth refractory to mechanical periodontal debridement on different quadrants were recruited. At baseline (T0), all examined teeth received scaling and root planing, and those on the test quadrant (PTT group) received ICG-diode laser treatment. The outcome was evaluated using clinical parameters and cytokines in the gingival crevicular fluids at 4-6 weeks (T1) and 6 months (T2).

RESULTS

In ICG-treated cultures, the viability of BMSCs and PDLCs was recovered on day 4, and laser irradiation inhibited the metabolic activities of BMSCs. 22 patients with 30 control teeth and 35 PTT-treated teeth were examined. All examined teeth showed modest reductions in probing pocket depth (PPD), clinical attachment loss (CAL), bleeding upon probing (BOP), and plaque score at T1 and T2 and significant reductions in IL-1β and MMP-8 at T2. Compared with controls, BOP was reduced more prominently, IL-1β and MMP-8 were significantly lower, and reductions in PPD and CAL were slightly greater in the PTT group at T1 (0.05-0.19 mm).

CONCLUSION

ICG-diode laser-based PTT is compatible to periodontium and assists in faster resolution of gingival inflammation in periodontal pockets refractory to mechanical debridement.

Clinical and microbiological effects of multiple applications of antibacterial photodynamic therapy in periodontal maintenance patients. A randomized controlled clinical study

BACKGROUND

At present, very limited data are available on the clinical and microbiological outcomes obtained following repeated application of aPDT following one single mechanical debridement.

OBJECTIVE

To evaluate clinically and microbiologically the outcomes following one single session of subgingival mechanical debridement (scaling and root planing; e.g. SRP) followed by 1x immediate application of aPDT and 2 x subsequent use of aPDT without SRP.

MATERIALS AND METHODS

Forty patients diagnosed with generalized chronic periodontitis that were enrolled in periodontal maintenance (supportive periodontal therapy) program, were randomly assigned to one of the two treatments: 1. SRP by means of ultrasonic and hand instruments followed by one single session of SRP followed by 1x immediate application of aPDT and 2 x subsequent applications of aPDT without SRP (test) or 2. SRP alone (control). The following clinical parameters were recorded at baseline, at 3 and 6 months: Full-Mouth Plaque Scores (FMPS), Full-Mouth Bleeding Scores (BOP), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL) and Gingival Recession (RC). Additionally, microbiological samples were evaluated at baseline and six months after treatment. The primary outcome variable was BOP.

RESULTS

Both treatments improved statistically significantly (p < 0.05) the FMPS, PPD and CAL values, while no statistically significant changes occurred in terms of RC. In the test group, BOP decreased statistically significantly (p < 0.05) after 3 and 6 months, while in the control group the respective values decreased statistically significantly only at 3 months. Both treatments reduced statistically significantly the total bacteria counts (TBC) after 6 months (p < 0.05). At 6 months, the use of SRP and aPDT resulted in a statistically significant decrease in the number of all tested bacteria except A. actinomycetemcomitans while the use of SRP alone resulted only in a statistically significant decrease in the numbers of P. gingivalis, T. denticola and T. forsythia.

CONCLUSIONS

In periodontal patients enrolled in a maintenance program one single session of SRP followed by 3x application of aPDT, enhanced the clinical and microbiological outcomes compared to SRP alone.

Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial

AIM

This randomized placebo-controlled clinical trial evaluated the effect of Bifidobacterium animalis subsp. lactis (B. lactis) HN019-containing probiotic lozenges as adjuvant to scaling and root planing (SRP) in patients with generalized chronic periodontitis.

MATERIALS AND METHODS

Forty-one chronic periodontitis patients were recruited and monitored clinically, immunologically, and microbiologically at baseline (before SRP) and 30 and 90 days after SRP. All patients were randomly assigned to a Test (SRP + Probiotic, n = 20) or Control (SRP + Placebo, n = 21) group. The probiotic lozenges were used twice a day for 30 days. The data were statistically analysed.

RESULTS

The Test group presented a decrease in probing pocket depth and a clinical attachment gain significantly higher than those of the Control group at 90 days. The Test group also demonstrated significantly fewer periodontal pathogens of red and orange complexes, as well as lower proinflammatory cytokine levels when compared to the Control group. Only the Test group showed an increase in the number of B. lactis HN019 DNA copies on subgingival biofilm at 30 and 90 days.

CONCLUSION

The use of B. lactis HN019 as an adjunct to SRP promotes additional clinical, microbiological, and immunological benefits in the treatment of chronic periodontitis (NCT03408548).

Effect of photodynamic therapy in the reduction of halitosis in patients with multiple sclerosis: clinical trial

Smell and odours play a vital role in social interaction. Halitosis is a social problem that affects one third of the population, causing a negative impact on the quality of life. There is little knowledge on the prevalence and management of halitosis in multiple sclerosis (MS) patients. The present study aims to evaluate the presence of halitosis in patients with MS when compared to a control group, and also evaluate treatment of the problem with antimicrobial photodynamic therapy (aPDT). This is a case-control clinical study in which 60 patients were evaluated: 30 MS patients in treatment at the Specialties Clinic School of Medicine, and 30 healthy patients, matched in age and gender for the control group. Data was collected on the duration of the disease as well as the degree of disability and medication use in the MS group. For all patients, halitosis was assessed with Oral Chroma™. Individuals with halitosis underwent treatment with tongue scraping and aPDT. The photosensitizer was methylene blue (0.005%) and a THERAPY XT-EC^® laser (660 nm, 9 J, 100 mW for 90 s per point, 320 J cm^-2, 3537 mW cm^-2) was used. Six points 1 cm apart from each other were irradiated in the tongue dorsum. There was a positive correlation between the disability and disease duration. No parameter was correlated with halitosis. Patients with MS have higher levels of SH₂ compounds when compared to the control group (p = 0.003, Mann-Whitney), but after aPDT both groups significantly reduced the levels to under the halitosis threshold. The aPDT scraping treatment was effective in the immediate reduction of halitosis in both groups.