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

Injectable hydrogels activated with copper sulfide nanoparticles for enhancing spatiotemporal sterilization and osteogenesis in periodontal therapy

Developing biomaterials capable of promoting bone regeneration in bacteria-infected sites is of utmost urgency for periodontal disease therapies. Here we produce a hybrid hydrogel by integrating CuS nanoparticles (CuSNPs), which could kill bacteria through photothermal therapy (PTT) triggered by a near infrared (NIR) light, and a gelatin methacryloyl (GelMA) hydrogel, which is injectable and biocompatible. Specifically, CuSNPs were precipitated by chitosan (CS) firstly, then grafted with methacrylic anhydride (MA) to form CuSNP@CS-MA, which was photo-crosslinked with GelMA to synthesize hybrid hydrogels (GelMA/CuSNP). The hybrid hydrogels exhibited a broad-spectrum antibacterial property that could be spatiotemprorally manipulated through applying a NIR light. Their mechanical properties were adjustable by controlling the concentration of CuSNPs, enabling the hydrogels to become more adapted to the oral diseases. Meanwhile, the hybrid hydrogels showed good cytocompatibility in vitro and improved hemostasis in vivo. Moreover, they accelerated alveolar osteogenesis and vascular genesis, successfully treating periodontis in four weeks in a rat model. GelMA/CuSNP hydrogels showed a broad-spectrum sterilization ability via PTT in vitro and outstanding antibacterial property in vivo, suggesting that the hybrid hydrogels could function in the challenging, bacteria-rich, oral environment. Such injectable hybrid hydrogels, capable of achieving both facilitated osteogenesis and NIR-inducible sterilization, represent a new biomaterial for treating periodontitis.

Exploring the Efficacy of Novel Therapeutic Strategies for Periodontitis: A Literature Review

Periodontitis, a prevalent oral condition, is facing difficulties in therapeutic approaches, sometimes leading to failure. This literature review was conducted to investigate the diversity of other therapeutic approaches and their potential contributions to the successful management of the disease. This research scrutinized the alterations in microbial diversity and imbalances in crucial microbial species, which contribute significantly to the pathogenesis of periodontitis. Within the limitations of this study, we highlight the importance of understanding the treatment plan's role in periodontitis disease, opening the way for further research and innovative treatment plans to mitigate the impact of periodontitis on oral health. This will aid both healthcare professionals and patients in preventing and effectively treating periodontitis, ultimately improving oral health outcomes and overall systemic health and well-being.

The Role of Photobiomodulation on Dental-Derived Stem Cells in Regenerative Dentistry: A Comprehensive Systematic Review

BACKGROUND

Photobiomodulation therapy involves exposing tissues to light sources, including light-emitting diodes or low-level lasers, which results in cellular function modulation. The molecular mechanism of this treatment is revealed, demonstrating that depending on the light settings utilized, it has the potential to elicit both stimulatory and inhibitory reactions.

OBJECTIVE

The current systematic review aimed to evaluate the impact of photobiomodulation therapy on dental stem cells and provide an evidence-based conclusion in this regard.

METHODS

This systematic review was performed and reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) revised guidelines. PICO(S) components were employed to define the inclusion criteria. Web of Science, Scopus, Medline as well as grey literature, and google scholar were searched up to September 2021 to retrieve relevant papers.

RESULTS

Photobiomodulation therapy showed promising effects on the proliferation, viability, and differentiation of dental stem cells. This finding was based on reviewing related articles with a low risk of bias.

CONCLUSION

Despite the positive benefits of photobiomodulation therapy on dental stem cells, the current data do not provide a definitive conclusion on the best physical parameters for enhancing cell viability, proliferation, and differentiation.

Clinical and microbiological efficacy of indocyanine green-based antimicrobial photodynamic therapy as an adjunct to non-surgical treatment of periodontitis: a randomized controlled clinical trial

OBJECTIVES

The aim of the present randomized clinical trial (RCT) with a parallel arm design was to evaluate the clinical and microbiological efficacy of repeated ICG-aPDT as an adjunct to full-mouth subgingival debridement in the treatment of periodontitis.

MATERIALS AND METHODS

Twenty-four periodontitis patients were treated with full-mouth ultrasonic subgingival debridement (FMUD). Initial sites with probing depth (PD) > 4 mm were randomly assigned to receive the test (ICG-aPDT with an 810 nm diode laser) or the control treatment (off-mode aPDT) one and four weeks after FMUD. Clinical parameters were registered after 3 and 6 months. The presence of the main periodontal pathogens in subgingival samples was assessed with real-time PCR.

RESULTS

Both treatment modalities resulted in significant clinical improvements at 3 and 6 months. The only significant differences in favour of the test group were found at 6 months for a higher PD reduction in initial deep pockets (PD ≥ 6 mm) and a higher percentage of closed pockets (PD ≤ 4 mm/no bleeding on probing). Limited microbiological changes were observed in both groups after treatment with no inter-group difference, except for a more significant reduction in Aggregatibacter actinomycetemcomitans and Parvimonas micra levels in the test group at 3 months.

CONCLUSION

The combination of repeated ICG-aPDT and FMUD provided no benefits except for selective clinical and microbiological improvements compared to FMUD alone.

CLINICAL RELEVANCE

Based on the obtained results, only limited adjunctive effects could be found for the combined use of ICG-aPDT and FMUD. Further, well-designed RCT with larger sample sizes are required to confirm these findings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04671394.

Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP)-Three-Month Interim Results

A single-site, randomized clinical trial was designed to determine the efficacy of regular home use of Lumoral® dual-light antibacterial aPDT in periodontitis patients. For the study, 200 patients were randomized to receive non-surgical periodontal treatment (NSPT), including standardized hygiene instructions and electric toothbrush, scaling and root planing, or NSPT with adjunctive Lumoral® treatment. A complete clinical intraoral examination was conducted in the beginning, at three months, and at six months. This report presents the three-month results of the first 59 consecutive randomized subjects. At three months, bleeding on probing (BOP) was lower in the NSPT + Lumoral®-group than in the NSPT group (p = 0.045), and more patients in the NSPT + Lumoral®-group had their BOP below 10% (54% vs. 22%, respectively, p = 0.008). In addition, patients in the NSPT + Lumoral®-group improved their oral hygiene by visible-plaque-index (p = 0.0003), while the NSPT group showed no statistical improvement compared to the baseline. Both groups significantly reduced the number of deep periodontal pockets, but more patients with a reduction in their deep pocket number were found in the NSPT + Lumoral® group (92% vs. 63%, p = 0.02). Patients whose number of deep pockets was reduced by 50% or more were also more frequent in the NSPT + Lumoral®-group (71% vs. 33%, p = 0.01). Patients with initially less than ten deep pockets had fewer deep pockets at the three-month follow-up in the Lumoral® group (p = 0.01). In conclusion, adjunctive use of Lumoral® in NSPT results in improved treatment outcomes at three months post-therapy.

Immune senescence and periodontitis: From mechanism to therapy

Periodontitis is one of the most prevalent infectious inflammatory diseases, characterized by irreversible destruction of the supporting tissues of teeth, which is correlated with a greater risk of multiple systemic diseases, thus regarded as a major health concern. Dysregulation between periodontal microbial community and host immunity is considered to be the leading cause of periodontitis. Comprehensive studies have unveiled the double-edged role of immune response in the development of periodontitis. Immune senescence, which is described as age-related alterations in immune system, including a diminished immune response to endogenous and exogenous stimuli, a decline in the efficiency of immune protection, and even failure in immunity build-up after vaccination, leads to the increased susceptibility to infection. Recently, the intimate relationship between immune senescence and periodontitis has come into focus, especially in the aging population. In this review, both periodontal immunity and immune senescence will be fully introduced, especially their roles in the pathology and progression of periodontitis. Furthermore, novel immunotherapies targeting immune senescence are presented to provide potential targets for research and clinical intervention in the future.

The Effects of 810 nm Diode Laser and Indocyanine Green on Periodontal Parameters and HbA1c in Patients with Periodontitis and Type II Diabetes Mellitus: A Randomized Controlled Study

The aim of this study was to investigate the effects of adjunctive periodontal therapy of 5 mg/mL indocyanine green irradiation by an 810 nm diode laser (aPDT), supplementary to scaling and root planing (SRP) in patients with periodontitis and type II diabetes mellitus (DM) compared to the SRP alone, on periodontal clinical parameters and glycated hemoglobin A1c (HbA1c). The study was conducted on 49 subjects with type II DM and periodontitis, divided into two groups: the SRP group (n = 25), who followed SRP alone, and the SRP + aPDT group (n = 24), who followed SRP and four weekly sessions of indocyanine green irradiation by an 810 nm diode laser. Plaque Index (PI), Bleeding on Probing Index (BOP), probing depth (PD), clinical attachment loss (CAL) and HbA1c were investigated at baseline and after 6 months. At 6 months, both SRP alone and SRP + aPDT generated significant reductions in all the investigated parameters; SRP + aPDT produced more significant reductions for BOP, PD and CAL (p < 0.001) but not for PI and HbA1c, than SRP alone. aPDT with indocyanine green therapy was well tolerated, with two subjects reporting slight discomfort. Therefore, aPDT with indocyanine green might represent a good adjunctive periodontal treatment option for SRP in patients with type II DM and periodontitis.

The influence of delivery power losses and full operating parametry on the effectiveness of diode visible-near infra-red (445-1064 nm) laser therapy in dentistry-a multi-centre investigation

The development of protocols for laser-assisted therapy demands strict compliance with comprehensive operating parametry. The purpose of this investigation was to examine the accuracy of correlation between laser control panel and fibre emission power values in a selection of diode dental lasers. Through retrospective analysis using successive systematic review and meta-analysis, it is clear that there is inconsistency in the details, and possible inaccuracies in laser power applied and associated computed data. Through a multi-centre investigation, 38 semi-conductor ("diode") dental laser units were chosen, with emission wavelengths ranging from 445 to 1064 nm. Each unit had been recently serviced according to manufacturer's recommendations, and delivery fibre assembly checked for patency and correct alignment with the parent laser unit. Subject to the output capacity of each laser, four average power values were chosen using the laser control panel-100 mW, 500 mW, 1.0 W, and 2.0 W. Using a calibrated power meter, the post-fibre emission power value was measured, and a percentage power loss calculated. For each emission, a series of six measurements were made and analysed to investigate sources of power losses along the delivery fibre, and to evaluate the precision of power loss determinations. Statistical analysis of a dataset comprising % deviations from power setting levels was performed using a factorial ANOVA model, and this demonstrated very highly significant differences between devices tested and emission power levels applied (p < 10-142 and < 10-52 respectively). The devices × emission power interaction effect was also markedly significant (p < 10-66), and this confirmed that differences observed in these deviations for each prior power setting parameter were dependent on the device employed for delivery. Power losses were found to be negatively related to power settings applied. Significant differences have emerged to recommend the need to standardize a minimum set of parameters that should form the basis of comparative research into laser-tissue interactions, both in vitro and in vivo.

Immunomodulation in the Treatment of Periodontitis: Progress and Perspectives

Periodontitis is one of the most common dental diseases. Compared with healthy periodontal tissues, the immune microenvironment plays the key role in periodontitis by allowing the invasion of pathogens. It is possible that modulating the immune microenvironment can supplement traditional treatments and may even promote periodontal regeneration by using stem cells, bacteria, etc. New anti-inflammatory therapies can enhance the generation of a viable local immune microenvironment and promote cell homing and tissue formation, thereby achieving higher levels of immune regulation and tissue repair. We screened recent studies to summarize the advances of the immunomodulatory treatments for periodontitis in the aspects of drug therapy, microbial therapy, stem cell therapy, gene therapy and other therapies. In addition, we included the changes of immune cells and cytokines in the immune microenvironment of periodontitis in the section of drug therapy so as to make it clearer how the treatments took effects accordingly. In the future, more research needs to be done to improve immunotherapy methods and understand the risks and long-term efficacy of these methods in periodontitis.

Indocyanine green-mediated antimicrobial photodynamic therapy as an adjunct to periodontal therapy: a systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review and meta-analysis was to evaluate the efficacy of indocyanine green-mediated photodynamic therapy (ICG-PDT) as an adjunct to non-surgical periodontal therapy (NSPT), in the management of chronic periodontitis.

MATERIALS AND METHODS

Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Embase via OVID, Web of Science) were searched for randomised controlled trials comparing NSPT with ICG-PDT to NSPT without laser therapy. Primary outcome measures were changes in probing pocket depth (PPD) and clinical attachment level (CAL). Clinical outcomes were extracted and pooled from 7 eligible trials and meta-analyses conducted using mean difference with standard deviations.

RESULTS

For PPD, adjunctive ICG-PDT resulted in a mean additional reduction of 1.17 mm (95% CI: 0.67-1.66 mm) at 3 months and a mean additional reduction of 1.06 mm (95% CI: 0.54-1.57 mm) at 6 months. For CAL, adjunctive ICG-PDT resulted in a mean additional gain of 0.70 mm (95% CI: 0.17-1.23 mm) at 3 months and a mean additional gain of 1.03 mm (95% CI: 0.83-1.24 mm) at 6 months. No adverse events were reported in any studies.

CONCLUSIONS

The adjunctive use of ICG-PDT in NSPT results in improved treatment outcomes at 3 and 6 months post-therapy. Further investigation is needed to evaluate variables such as different photosensitiser concentrations and adjusting parameters associated with the light source.

CLINICAL RELEVANCE

Indocyanine green-based photosensitisers may be a novel, clinically efficacious agent for use in the management of periodontitis.

The feasibility of phage therapy for periodontitis

Periodontitis, a chronic progressive inflammation caused by plaque biofilm, is the main cause of tooth loss in adults. For certain refractory periodontitis cases, it is difficult to achieve a good curative effect using the existing periodontal treatment approaches, which may be due to periodontal pathogenic mechanism in the affected periodontal tissue that the host cannot resist and eliminate. Various pieces of evidence collectively revealed that most studies are focusing on phages in periodontal disease. Several studies have reported periodontitis treatment using phage therapy, highlighting its features including specificity, rapid propagation, and effectiveness on bacteriophage biofilms. In this study, we focus on these reports, aiming to lay the foundation for improved periodontal treatment approaches.

Removal of nonimpacted third molars alters the periodontal condition of their neighbors clinically, immunologically, and microbiologically

Considering the adverse effects of nonimpacted third molars (N-M3s) on the periodontal health of adjacent second molars (M2s), the removal of N-M3s may be beneficial to the periodontal health of their neighbors. This study aimed to investigate the clinical, immunological, and microbiological changes of the periodontal condition around M2s following removal of neighboring N-M3s across a 6-month period. Subjects with at least one quadrant containing an intact first molar (M1), M2, and N-M3 were screened and those who met the inclusion criteria and decided to receive N-M3 extraction were recruited in the following investigation. M2 periodontal condition was interrogated before M3 extraction (baseline) and at 3 and 6 months postoperatively. Improvements in clinical periodontal indexes of M2s in response to their adjacent N-M3 removal, along with changes in inflammatory biomarkers among gingival crevicular fluid (GCF) and the composition of subgingival plaque collected from the distal sites of the M2s of the targeted quadrant were parallelly analyzed. Complete data of 26 tooth extraction patients across the follow-up period were successfully obtained and subsequently applied for statistical analysis. Compared to the baseline, the periodontal condition of M2s was significantly changed 6 months after N-M3 removal; specifically, the probing depth of M2s significantly reduced (P < 0.001), the matrix metalloproteinase (MMP)-8 concentration involved in GCF significantly decreased (P = 0.025), and the abundance of the pathogenic genera unidentified Prevotellaceae and Streptococcus significantly decreased (P < 0.001 and P = 0.009, respectively). We concluded that N-M3 removal was associated with superior clinical indexes, decreased GCF inflammatory biomarkers, and reduced pathogenic microbiome distribution within the subgingival plaque. Although the retention or removal of N-M3s continues to be controversial, our findings provide additional evidence that medical decisions should be made as early as possible or at least before the neighboring teeth are irretrievably damaged.

The diode laser as coadyuvant therapy in the non-surgical conventional treatment of peri-implant mucositis: A systematic review and meta-analysis

Background

The present study systematically reviewed randomized controlled trials (RCT) to investigate the effect of diode laser therapy in the management of peri-implant mucositis.

Material and Methods

The electronic databases were searched until January 2020. Outcome measures were bleeding on probing (BOP), plaque index (PI) and probing depth (PD). The addressed PICO question was: Is the diode laser therapy effective reducing the signs of inflammation as an adjunctive element in the non-surgical treatment of peri-implant mucositis?.

Results

Eight randomized clinical trials (RCTs) were included in the systematic review for qualitative synthesis and three in the meta-analysis for quantitative synthesis. All studies included in the quantitative synthesis have low risk of bias according to the Cochrane collaborations’ tool. Diode laser as coadyuvant therapy significantly reduced plaque index (SMD: -1.24; -0.47/-1.53) but not in bleeding on probing (SMD: -0.84; -0.31/-1.53) or probing pocket depth (SMD: -1.36; -0.28/-1.69). Non-statistically significant reductions in peri-implant bleeding on probing and in probing pocket depth were also observed in the test groups of most studies included in the meta-analysis.

Conclusions

The results should be interpreted cautiously due to the great heterogeneity in the methodology of the studies included in the systematic review. However the meta-analysis suggests that the use of diode lasers, as an adjunct in conventional non-surgical treatment of peri-implant mucositis, is promising in reducing the clinical signs of peri-implant mucositis, especially reducing the perii-implant plaque index.

Key words:Peri-implant diseases, peri-implant mucositis, laser therapy, diode laser.

Applications of Lasers in Refractory Periodontitis: A Narrative Review

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.