Antimicrobial photodynamic therapy in the treatment of aggressive periodontitis: a systematic review and meta-analysis

A Modern Approach to Treat Molar/Incisor Pattern Periodontitis-Review

Molar-incisor pattern periodontitis (MIPP) is a severe form of periodontal disease characterized by rapid attachment loss and bone destruction affecting the molars and incisors. Formerly referred to as aggressive periodontitis, the terminology for this condition was revised after the 2017 workshop on the classification of periodontal and peri-implant diseases and conditions. Despite the modification in nomenclature, the treatment strategies for MIPP remain a critical area of investigation. The core principles of MIPP treatment involve controlling local and systemic risk factors, managing inflammation, and arresting disease progression. Traditional non-surgical periodontal therapy, including scaling and root planing, is commonly employed as an initial step together with the prescription of antibiotics. Surgical intervention may be necessary to address the severe attachment loss. Surgical techniques like resective and regenerative procedures can aid in achieving periodontal health and improving esthetic outcomes. This review article aims to provide an overview of the current understanding and advancements in the treatment modalities of MIPP. Through an extensive analysis of the existing literature, we discuss various modern therapeutic approaches that have been explored for managing this challenging periodontal condition.

Treatment of Periodontitis Affecting Human Primary Teeth-A Systematic Review

The aim of this systematic review is to report the treatment options (Intervention) and outcomes (O) for primary teeth affected by periodontitis (Population) and if the treatment of primary teeth can prevent the spread of periodontitis to permanent teeth (Outcomes). The following databases were searched for papers published before December 2022: PubMed, Embase, Web of Science, and Ebscohost. Studies on children affected by periodontitis involving the primary teeth were included and those on children who presented with periodontitis as a manifestation of systemic disease were excluded. Narrative synthesis and methodological quality assessments were performed for the included studies. Three interventional studies (without a control group) that evaluated treatments involving scaling and root planing (SRP with antibiotics) and extraction were included (total n = 60 patients). Additionally, twelve case reports/case series articles (n = 19 patients) were identified. The diagnoses ranged from aggressive periodontitis to juvenile periodontitis and pre-pubertal periodontitis. Based on a limited number of published studies, it was found that the early treatment of periodontitis affecting the primary teeth using SRP and systemic antibiotics resulted in favorable improvements in PD and CAL. Limited evidence suggests that SRP and the extraction of the primary teeth involved have the potential to prevent periodontitis affecting permanent teeth. Future trials are required to standardize the treatment protocols and to confirm these findings.

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.

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.

Is antimicrobial photodynamic therapy an effective treatment modality for aggressive periodontitis? A systematic review of in vivo human randomized controlled clinical trials

BACKGROUND

Limitations of scaling and root planing (SRP) have directed research to utilize additional therapies to enhance conventional techniques. The present systematic review was conducted to evaluate and present a comprehensive overview on effectiveness of antimicrobial photodynamic therapy (aPDT) in the management of aggressive periodontitis (AgP).

METHODOLOGY

The PRISMA statement guidelines and Cochrane Collaboration recommendations were followed to conduct this systematic review. The review protocol is registered in PROSPERO (CRD 42019143316). A structured electronic and manual search strategy was implied to gather the relevant published data on in vivo human RCTs from their earliest records until 31st October 2019. Relevant data was extracted from the eligible studies, analysed and impartially appraised for its quality.

RESULTS

Eleven papers met the eligibility criteria and included in this review. The data on standardized study protocol, ideal photosensitizer (PS) dye-wavelength combination, optimal parameters was inconclusive and a high risk of bias in majority of the studies noted, which are fundamental in establishing a standardized and replicable protocol.

CONCLUSION

Ultimately researchers should conduct well-designed and robust RCTs performed by trained clinicians in order to determine the effectiveness of aPDT, if any, after acknowledging the drawbacks highlighted in this systematic review.

A review of antimicrobial photodynamic therapy (aPDT) in periodontitis

Introduction:Periodontitis is an inflammatory disease caused by a multitude of pathogens, that eventually affects the entirety of all periodontal tissues and may lead to tooth mobility or even tooth loss. The destruction of said tissues occurs via 2 pathways: a direct pathway (defense mechanisms belonging to the pathogens) and an indirect pathway (the host’s immune system). Therapy is complex and requires strict follow-ups in order to prevent relapse. Aim: Our objective was to determine whether or not aPDT can be considered to be an effective adjunctive approach to the current standard initial treatment method when dealing with periodontitis (scaling/root planing). Methods: We performed an electronical search of the PubMed and ScienceDirect data bases starting from January 2014 and up to May 2019. Eligibility criteria included English-language systematic reviews and randomized clinical trials which evaluated the efficiency of aPDT, and that had been carried out on human subjects with permanent dentition. We excluded studies and reviews that were focused on the microbiology and/or immunology in photodynamic therapy and also those that used other LASER treatment modalities than aPDT. Results: Current literature displays many opinions regarding periodontal therapy with adjunctive aPDT, but it seems to be mainly regarded as a safe, effective and easy-to-use approach. Conclusion: aPDT seems to be efficient in the treatment of periodontitis when carried out additionally to classical scaling/root planing. Residual pockets seem to respond well to aPDT, as opposed to subsequent debridement flap elevation and its consequences on hard and soft tissues. However, further studies with a stricter treatment protocol and subsequent follow-ups are required in order to obtain a firmer conclusion. Key words: periodontitis LASER, periodontitis aPDT, periodontitis photodynamic therapy,

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.

Repeated application of photodynamic and antibiotic therapy as an adjunct to root surface debridement in patients with grade C and stage III or IV aggressive periodontitis

PURPOSE

To evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) and antimicrobial therapy on clinical and immunological outcomes of periodontal treatment in patients with periodontitis grade C and stage III or IV.

MATERIAL AND METHOD

The patients recruited in the current research fulfil the clinical case definition of periodontitis 'grade C' in terms of onset of the infection and stage III or IV that defines degree and severity of the disease. One-stage full-mouth ultrasonic debridement (UD) was performed and randomly divided in two groups: Group-I - four applications of aPDT, and Group-II - combination of metronidazole (MTZ) and amoxicillin (AMX) 3 tablets each for 7 days. Whole-mouth periodontal parameters were recorded at baseline, 3-, 6-months after completion of treatment. Gingival crevicular fluid samples were obtained for assessment of inflammatory interleukin (IL)-10 and IL-17 at the same time points.

RESULTS

Seventeen healthy patients completed the study protocol and revealed similar clinical findings at baseline. Bleeding scores significantly reduced in group-I at 3 months post treatment (p < 0.05). It could be seen that group-I showed statistically significant reduction of deep periodontal pockets and gain in CAL in patients with GAP at 3 months (p < 0.05). This difference was maintained at 6 months of follow-up (p < 0.001). Group-II was capable of increasing the levels of IL-10 and reducing IL-17 in GCF at both time periods compared to Group-I (p < 0.05). Group-I did not have significant effect on either cytokine levels in GCF (p > 0.05).

CONCLUSION

Antimicrobial photodynamic therapy improved severe deep periodontal pockets. However, the combination of antimicrobial therapy helped in reducing proinflammation in grade C and stage III or IV periodontitis.

Ozone application as adjunctive therapy in chronic periodontitis: Clinical, microbiological and biochemical aspects

Background/purpose

The application of ozone as an adjunctive treatment represents a new approach in the management of chronic periodontitis. The purpose of this study was to evaluate the clinical, biochemical and microbiological efficacy of ozone treatment as an adjunct to scaling and root planing (SRP) in generalized chronic periodontitis (GCP) patients.

Materials and methods

Eighteen patients (9 males and 9 females; aged from 28 to 47 years, mean age of 40 ± 6.51 years) with GCP were recruited in the study. In a split mouth design, two quadrants in each patient were randomly allocated to SRP-alone or SRP-ozone therapy (SRP + OT) groups by coin toss method. Subgingival plaque and gingival crevicular fluid (GCF) samples were collected at baseline, following 1st and 3rd months. The clinical parameters were monitored at baseline and after 3 months. Microbiological parameters were analyzed by quantitative-PCR and GCF biomarkers were determined by ELISA. Results were analyzed statistically.

Results

Statistically significant improvements in all clinical parameters were accompanied by a reduction in microbiological and biochemical parameters in both treatment groups. SRP treatment resulted in a significant reduction of Porphyromonas gingivalis (Pg) at 1st month and Tannerella forsythia (Tf) and Prevotella intermedia (Pi) at 3 months. Following SRP treatment the interleukin (IL)-8 levels were significantly reduced at month 1. There were no significant differences between two treatments for any of the parameters.

Conclusion

Within the limitations of this study, adjunctive ozone therapy did not provide additional benefits to clinical, microbiological and biochemical parameters over SRP in chronic periodontitis patients.

Effects of root debridement and adjunctive photodynamic therapy in residual pockets of patients on supportive periodontal therapy: A randomized split-mouth trial

BACKGROUND

The study aims to compare the effects of adjunctive photodynamic therapy (PDT) with scaling and root debridement alone on periodontal parameters and inflammatory cytokines in residual pockets of patients undergoing maintenance therapy.

METHODS

27 subjects, each with at least 2 residual pockets ≥5mm, were recruited for this randomized, split-mouth controlled trial, providing total of 72 sites. Probing pocket depth (PPD), recession, clinical attachment loss (CAL), plaque and bleeding on probing of all sites were examined at baseline, 3 and 6 months. Gingival crevicular fluids (GCFs) were collected to determine levels of IL-1β, IL-6, IL-8, TNF-α and MMP-8 via enzyme-linked immunosorbent assay. At baseline, all sites received subgingival instrumentation and polishing. In addition, test sites received a single application of PDT using Fotosan^® with toluidine blue O solution photosensitizer. At 3 and 6 months, site level analysis was performed for changes in clinical parameters and cytokine level.

RESULTS

Based on mixed model analysis, at 3 months, test sites showed significant reduction in CAL (p=0.016) and PPD (p=0.027) (from 6.14±0.28mm to 5.49±0.20mm and 5.42±0.16mm to 4.65±0.18mm respectively) compared to control sites (from 6.32±0.24mm to 6.08±0.17mm and 5.32±0.13mm to 5.15±0.15mm respectively). At 6 months, these differences were no longer significant (p=0.510). Adjunctive PDT did not offer additional reduction in levels of GCF cytokines.

CONCLUSIONS

A single application of PDT to residual pockets provided a modest improvement of CAL and PPD over 3 months. Application of adjunctive PDT may lead to faster resolution of residual pockets and may be recommended for periodontal patients with slower healing capacity.

The application of antimicrobial photodynamic therapy (aPDT) in dentistry: a critical review

In recent years there have been an increasing number of in vitro and in vivo studies that show positive results regarding antimicrobial photodynamic therapy (aPDT) used in dentistry. These include applications in periodontics, endodontics, and mucosal infections caused by bacteria present as biofilms. Antimicrobial photodynamic therapy is a therapy based on the combination of a non-toxic photosensitizer (PS) and appropriate wavelength visible light, which in the presence of oxygen is activated to produce reactive oxygen species (ROS). ROS induce a series of photochemical and biological events that cause irreversible damage leading to the death of microorganisms. Many light-absorbing dyes have been mentioned as potential PS for aPDT and different wavelengths have been tested. However, there is no consensus on a standard protocol yet. Thus, the goal of this review was to summarize the results of research on aPDT in dentistry using the PubMed database focusing on recent studies of the effectiveness aPDT in decreasing microorganisms and microbial biofilms, and also to describe aPDT effects, mechanisms of action and applications.

Preparation, X-ray Structures, Spectroscopic, and Redox Properties of Di- and Trinuclear Iron-Zirconium and Iron-Hafnium Porphyrinoclathrochelates

The first hybrid di- and trinuclear iron(II)-zirconium(IV) and iron(II)-hafnium(IV) macrobicyclic complexes with one or two apical 5,10,15,20-tetraphenylporphyrin fragments were obtained using transmetalation reaction between n-butylboron-triethylantimony-capped or bis(triethylantimony)-capped iron(II) clathrochelate precursors and dichlorozirconium(IV)- or dichlorohafnium(IV)-5,10,15,20-tetraphenylporphyrins under mild conditions. New di- and trinuclear porphyrinoclathrochelates of general formula FeNx₃((Bn-Bu)(MTPP)) and FeNx₃(MTPP)₂ [M = Zr, Hf; TPP = 5,10,15,20-tetraporphyrinato(2-); Nx = nioximo(2-)] were characterized by one-dimensional (¹H and ¹³C{¹H}) and two-dimensional (COSY and HSQC) NMR, high-resolution electrospray ionization mass spectrometry, UV-visible, and magnetic circular dichroism spectra, single-crystal X-ray diffraction experiments, as well as elemental analyses. Redox properties of all complexes were probed using electrochemical and spectroelectrochemical approaches. Electrochemical and spectroelectrochemical data suggestive of a very weak, if any, long-range electronic coupling between two porphyrin π-systems in FeNx₃(MTPP)₂ complexes. Density functional theory and time-dependent density functional theory calculations were used to correlate spectroscopic signatures and redox properties of new compounds with their electronic structures.

Polymeric Nanoparticle-Based Photodynamic Therapy for Chronic Periodontitis in Vivo

Antimicrobial photodynamic therapy (aPDT) is increasingly being explored for treatment of periodontitis. Here, we investigated the effect of aPDT on human dental plaque bacteria in suspensions and biofilms in vitro using methylene blue (MB)-loaded poly(lactic-co-glycolic) (PLGA) nanoparticles (MB-NP) and red light at 660 nm. The effect of MB-NP-based aPDT was also evaluated in a clinical pilot study with 10 adult human subjects with chronic periodontitis. Dental plaque samples from human subjects were exposed to aPDT—in planktonic and biofilm phases—with MB or MB-NP (25 µg/mL) at 20 J/cm²in vitro. Patients were treated either with ultrasonic scaling and scaling and root planing (US + SRP) or ultrasonic scaling + SRP + aPDT with MB-NP (25 µg/mL and 20 J/cm²) in a split-mouth design. In biofilms, MB-NP eliminated approximately 25% more bacteria than free MB. The clinical study demonstrated the safety of aPDT. Both groups showed similar improvements of clinical parameters one month following treatments. However, at three months ultrasonic SRP + aPDT showed a greater effect (28.82%) on gingival bleeding index (GBI) compared to ultrasonic SRP. The utilization of PLGA nanoparticles encapsulated with MB may be a promising adjunct in antimicrobial periodontal treatment.