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Tonon CC, de Souza Rastelli AN, Bodahandi C, Ghosh G, Hasan T, Xu Q, Greer A, Lyons AM. Superhydrophobic Tipped Antimicrobial Photodynamic Therapy Device for the In Vivo Treatment of Periodontitis Using a Wistar Rat Model. ACS APPLIED MATERIALS & INTERFACES 2023; 15:50083-50094. [PMID: 37862708 PMCID: PMC10800031 DOI: 10.1021/acsami.3c12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Limited options exist for treatment of periodontitis; scaling and root planing (SRP) are not sufficient to eradicate P. gingivalis and the resulting inflammatory disease. Chlorhexidine (CHX), used as an adjuvant to SRP, may reduce bacterial loads but leads to pain and staining, while evidence for its efficacy is lacking. Antibiotics are effective but can lead to drug-resistance. The rising concern of antibiotic resistance limits the future use of this treatment approach. This study evaluates the efficacy of a novel superhydrophobic (SH) antimicrobial photodynamic therapy (aPDT) device as an adjuvant to SRP for the treatment of periodontitis induced in a Wistar rat in vivo model relative to CHX. The SH-aPDT device comprises an SH silicone rubber strip coated with verteporfin photosensitizer (PS), sterilized, and secured onto a tapered plastic optical fiber tip connected to a red diode laser. The superhydrophobic polydimethylsiloxane (PDMS) strips were fabricated by using a novel soluble template method that creates a medical-grade elastomer with hierarchical surface roughness without the use of nanoparticles. Superhydrophobicity minimizes direct contact of the PS-coated surface with bacterial biofilms. Upon insertion of the device tip into the pocket and energizing the laser, the device generates singlet oxygen that effectively targets and eliminates bacteria within the periodontal pocket. SH-aPDT treatment using 125 J/cm2 of red light on three consecutive days reduced P. gingivalis significantly more than SRP-CHX controls (p < 0.05). Clinical parameters significantly improved (p < 0.05), and histology and stereometry results demonstrated SH-aPDT to be the most effective treatment for improving healing and reducing inflammation, with an increase in fibroblast cells and extracellular matrix and a reduction in vascularization, inflammatory cells, and COX-2 expression. The SH-aPDT approach resulted in complete disease clearance assessed 30 days after treatment initiation with significant reduction of the periodontal pocket and re-formation of the junctional epithelium at the enamel-cementum junction. PS isolation on a SH strip minimizes the potential for bacteria to develop resistance, where the treatment may be aided by the oxygen supply retained within the SH surface.
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Affiliation(s)
- Caroline Coradi Tonon
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom St, Boston, MA 02114, United States
| | - Alessandra Nara de Souza Rastelli
- Department of Restorative Dentistry, School of Dentistry, Araraquara, Sao Paulo State University-UNESP, 1680 Humaita St., Araraquara, SP 14801-903, Brazil
| | - Chathuna Bodahandi
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, 365 Fifth Avenue, New York, NY 10016, United States
- Department of Chemistry, College of Staten Island, City University of New York, Staten Island, New York 10314, United States
| | - Goutam Ghosh
- SingletO2 Therapeutics LLC, VentureLink, Room 524B, 211 Warren St, Newark, NJ 07103, United States
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom St, Boston, MA 02114, United States
- Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - QianFeng Xu
- SingletO2 Therapeutics LLC, VentureLink, Room 524B, 211 Warren St, Newark, NJ 07103, United States
| | - Alexander Greer
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, 365 Fifth Avenue, New York, NY 10016, United States
- SingletO2 Therapeutics LLC, VentureLink, Room 524B, 211 Warren St, Newark, NJ 07103, United States
- Department of Chemistry, Brooklyn College, City University of New York, Brooklyn, NY 11210, United States
| | - Alan M. Lyons
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, 365 Fifth Avenue, New York, NY 10016, United States
- Department of Chemistry, College of Staten Island, City University of New York, Staten Island, New York 10314, United States
- SingletO2 Therapeutics LLC, VentureLink, Room 524B, 211 Warren St, Newark, NJ 07103, United States
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Ferreira JA, Kantorski KZ, Dubey N, Daghrery A, Fenno JC, Mishina Y, Chan HL, Mendonça G, Bottino MC. Personalized and Defect-Specific Antibiotic-Laden Scaffolds for Periodontal Infection Ablation. ACS APPLIED MATERIALS & INTERFACES 2021; 13:49642-49657. [PMID: 34637255 DOI: 10.1021/acsami.1c11787] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Periodontitis compromises the integrity and function of tooth-supporting structures. Although therapeutic approaches have been offered, predictable regeneration of periodontal tissues remains intangible, particularly in anatomically complex defects. In this work, personalized and defect-specific antibiotic-laden polymeric scaffolds containing metronidazole (MET), tetracycline (TCH), or their combination (MET/TCH) were created via electrospinning. An initial screening of the synthesized fibers comprising chemo-morphological analyses, cytocompatibility assessment, and antimicrobial validation against periodontopathogens was accomplished to determine the cell-friendly and anti-infective nature of the scaffolds. According to the cytocompatibility and antimicrobial data, the 1:3 MET/TCH formulation was used to obtain three-dimensional defect-specific scaffolds to treat periodontally compromised three-wall osseous defects in rats. Inflammatory cell response and new bone formation were assessed by histology. Micro-computerized tomography was performed to assess bone loss in the furcation area at 2 and 6 weeks post implantation. Chemo-morphological and cell compatibility analyses confirmed the synthesis of cytocompatible antibiotic-laden fibers with antimicrobial action. Importantly, the 1:3 MET/TCH defect-specific scaffolds led to increased new bone formation, lower bone loss, and reduced inflammatory response when compared to antibiotic-free scaffolds. Altogether, our results suggest that the fabrication of defect-specific antibiotic-laden scaffolds holds great potential toward the development of personalized (i.e., patient-specific medication) scaffolds to ablate infection while affording regenerative properties.
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Affiliation(s)
- Jessica A Ferreira
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Karla Z Kantorski
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
- Post-Graduate Program in Oral Sciences (Periodontology Unit), School of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, 97105-900, Brazil
| | - Nileshkumar Dubey
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Arwa Daghrery
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - J Christopher Fenno
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Yuji Mishina
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Gustavo Mendonça
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
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Efficacy of antimicrobial photodynamic therapy (aPDT) for nonsurgical treatment of periodontal disease: a systematic review. Lasers Med Sci 2021; 36:1573-1590. [PMID: 33438165 DOI: 10.1007/s10103-020-03238-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
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.
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Varma SR, AlShayeb M, Narayanan J, Abuhijleh E, Hadi A, Jaber M, Abu Fanas S. Applications of Lasers in Refractory Periodontitis: A Narrative Review. J Int Soc Prev Community Dent 2020; 10:384-393. [PMID: 33042878 PMCID: PMC7523935 DOI: 10.4103/jispcd.jispcd_241_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The purpose of the study is to evaluate the various lasers in dentistry and to investigate if it can be used for treatment of refractory periodontitis. METHODS The study followed partially the PRISMA guidelines as it is a narrative review. A number of articles were selected from a period of 1980 to 2020 from databases, PubMed, PubMed central, Cochrane and Scopus. Articles related to the effects of lasers on periodontitis both refractory and aggressive were investigated. RESULTS After reviewing the literature, 70 articles were found, related to application of lasers in periodontal diseases. Out of the 70, 11 articles pertained to the effect of laser for the treatment of Refractory and inflammatory periodontitis. 5 articles related to experimental animal models, one pertaining to in-vitro and six studies related to in-vivo in human cohorts. DISCUSSION It was found that lasers if used in controlled parameters by incorporating laser assisted treatment such as Photodynamic therapy and low level laser therapy can be of use as an adjunct therapy for treatment of refractory periodontitis. The use of different wavelengths in the initial and maintenance phase of periodontal disease plays a positive role. The presence of in-vitro and animal model studies is one of the limitation to this study. The available studies have shown marked reduction in inflammation and better clinical and microbiological parameters. The drawback of this study is the limited literature involving laser management for refractory periodontitis in human cohorts. CONCLUSION Different wavelengths of laser and choice of laser assisted periodontal treatment plays an important role in the overall progress and prognosis of periodontal disease activity.
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Affiliation(s)
- Sudhir Rama Varma
- Department of Periodontics, College of Dentistry, Ajman University, Ajman, UAE
| | - Maher AlShayeb
- Department of Oral Surgery, College of Dentistry, Ajman University, Ajman, UAE
| | - Jayaraj Narayanan
- Department of Basic Sciences, University of Science and Technology of Fujairah, Fujairah, UAE
| | - Eyas Abuhijleh
- Department of Orthodontics, University of Science and Technology, Fujairah, UAE
| | - Abdul Hadi
- Department of Restorative Dentistry, University of Science and Technology, Fujairah, UAE
| | - Mohammad Jaber
- Department of Oral Surgery, College of Dentistry, Ajman University, Ajman, UAE
| | - Salim Abu Fanas
- Department of Periodontics, College of Dentistry, Ajman University, Ajman, UAE
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Alves da Collina G, Freire F, da Silva Barbosa V, Bento Correa C, Reis Nascimento H, Ratto Tempestini Horliana AC, Teixeira da Silva DDF, Araujo Prates R, Pavani C. Photodynamic antimicrobial chemotherapy action of phenothiazinium dyes in planktonic Candida albicans is increased in sodium dodecyl sulfate. Photodiagnosis Photodyn Ther 2020; 29:101612. [DOI: 10.1016/j.pdpdt.2019.101612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/19/2019] [Accepted: 12/02/2019] [Indexed: 12/18/2022]
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Hamblin MR, Abrahamse H. Oxygen-Independent Antimicrobial Photoinactivation: Type III Photochemical Mechanism? Antibiotics (Basel) 2020; 9:antibiotics9020053. [PMID: 32023978 PMCID: PMC7168166 DOI: 10.3390/antibiotics9020053] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 01/04/2023] Open
Abstract
Since the early work of the 1900s it has been axiomatic that photodynamic action requires the presence of sufficient ambient oxygen. The Type I photochemical pathway involves electron transfer reactions leading to the production of reactive oxygen species (superoxide, hydrogen peroxide, and hydroxyl radicals), while the Type II pathway involves energy transfer from the PS (photosensitizer) triplet state, leading to production of reactive singlet oxygen. The purpose of the present review is to highlight the possibility of oxygen-independent photoinactivation leading to the killing of pathogenic bacteria, which may be termed the "Type III photochemical pathway". Psoralens can be photoactivated by ultraviolet A (UVA) light to produce DNA monoadducts and inter-strand cross-links that kill bacteria and may actually be more effective in the absence of oxygen. Tetracyclines can function as light-activated antibiotics, working by a mixture of oxygen-dependent and oxygen independent pathways. Again, covalent adducts may be formed in bacterial ribosomes. Antimicrobial photodynamic inactivation can be potentiated by addition of several different inorganic salts, and in the case of potassium iodide and sodium azide, bacterial killing can be achieved in the absence of oxygen. The proposed mechanism involves photoinduced electron transfer that produces reactive inorganic radicals. These new approaches might be useful to treat anaerobic infections or infections in hypoxic tissue.
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Affiliation(s)
- Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa;
- Correspondence:
| | - Heidi Abrahamse
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa;
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