Is mechanical curettage with adjunct photodynamic therapy more effective in the treatment of peri-implantitis than mechanical curettage alone?

Clinical and radiographic peri-implant outcomes with riboflavin loaded Poly-L-glycolic acid nanoparticles incorporated in aloe-vera gel treating peri-implantitis in chronic hyperglycemic patients

AIM

The objective of the current study was to compare the effectiveness of antimicrobial photodynamic therapy (PDT) versus Poly-L-glycolic acid nanoparticles loaded riboflavin incorporated in aloe vera gel (PGA/RF/AV) on periimplant parameters and bacterial counts in chronic hyperglycemic patients having periimplantitis.

METHODS

One hundred and two diabetic patients undergoing mechanical debridement (MD) were equally divided into three groups: Group 1: PGA/RF/AV+ MD, Group 2: PDT + MD, and Group 3: MD alone. Periimplant parameters [Bleeding on probing (BoP), probing depth (PD), plaque index (PI), marginal bone level (MBL)] were recorded in all three groups. Periimplant plaque samples were studied to record the levels of Tannerella forsythia (Tf) and Porphyromonas gingivalis (Pg). The recordings were taken at baseline, 3 months and 6 months post treatment.

RESULTS

All three groups showed a reduction in severity of periimplantitis measured in terms of PD, PI, MBL and BoP. A statistically significant reduction in PD, PI and MBL was found in patients in Group 2 whereas participants of Group 1 were found to have a significant decrease in BoP. A statistically significant decline in the numbers of both the bacterial species was seen in Group 2 at the three-month follow-up whereas at the six-month follow-up, a statistically significant reduction was observed in treatment Group 2 in the levels of Tf species only.

CONCLUSION

Riboflavin-loaded nanocarrier incorporated in aloe vera gel showed greater clinical efficacy than PDT alone in the treatment of periimplantitis in chronic hyperglycemic individuals.

Clinical and Radiographic Outcomes of Adjunctive Photodynamic Therapy for Treating Peri-Implant Mucositis Among Cigarette Smokers and Diabetics: A Systematic Review and Meta-Analysis

Objective: This systematic review aimed to assess the influence of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical debridement (MD) on peri-implant clinical and radiographic outcomes among cigarette smokers and diabetics with peri-implant mucositis (piM). Methods: Randomized controlled trials, assessing the clinical and radiographic parameters of aPDT versus MD alone among smokers and diabetics with piM, were included in the study. Meta-analyses were conducted to calculate the standard mean difference with a 95% confidence interval. The methodological quality of the included studies was assessed utilizing the modified Jadad quality scale. Results: The meta-analyses found statistically significant differences between the impact of adjunct aPDT and MD alone on the peri-implant plaque index (PI), probing depth (PD), and bleeding on probing among smokers and diabetics with piM at the final follow-up visit. However, no significant differences were found between the impact of adjunct aPDT and MD alone on the peri-implant crestal bone loss among smokers and diabetics with piM at the final follow-up. Conclusions: The application of aPDT as an adjunctive to MD demonstrated improved scores of the peri-implant clinical parameters among smokers and diabetics with piM in comparison with MD alone.

Clinical and radiographic outcomes of adjunctive photodynamic therapy for treating peri-implantitis among diabetics and cigarette smokers: a systematic review of randomized controlled trials

Photodynamic therapy (PDT) has been suggested as an adjunctive therapeutic approach for peri-implantitis. This systematic review aimed to assess the clinical and radiographic outcomes of adjunctive PDT (aPDT) for the treatment of peri-implantitis among diabetics and cigarette smokers. Randomized controlled trials (RCTs), which assessed the clinical and radiographic outcomes of aPDT versus other intervention(s) and/or MD alone among diabetics and smokers with peri-implantitis, were considered eligible for the review. Meta-analysis was performed for calculating the standard mean difference (SMD) with a 95% confidence interval (CI). The methodological quality of the included studies was evaluated using the modified Jadad quality scale. The meta-analysis revealed no significant differences between the influence of aPDT and other intervention/MD alone on the peri-implant PI among diabetics at the final follow-up. However, statistically significant improvements in the peri-implant PD, BOP, and CBL were observed after the application of aPDT among diabetics. Similarly, no significant differences were found between the influence of aPDT and other interventions/MD alone on the peri-implant PD among smokers with peri-implant diseases at the final follow-up. However, statistically significant improvements in the peri-implant PI, BOP, and CBL were observed after the application of aPDT among smokers. Significant improvements in the peri-implant PD, BOP, and CBL among diabetics and the peri-implant PI, BOP, and CBL among smokers after the application of aPDT at the final follow-up. However, large-scale, well-designed, and long-term RCTs are recommended in this domain.

In-vitro assessment of the efficiency of cold atmospheric plasma on decontamination of titanium dental implants

Background

The aim of the current study was to comparatively assess the efficiency of three different adjunctive therapy options (cold atmospheric plasma, [CAP], photodynamic therapy [PDT] and chemical decontamination via 35% phosphoric acid gel [PAG]) on decontamination of titanium implant surfaces in-vitro.

Materials and methods

Implants were inserted in concavities of four mm in depth mimicking a bone defect at the implant recipient site. In each model, two implants were inserted in the fourth and one implant in the third quadrants. After contamination with E. faecalis, the first group has been treated with CAP for 3 min, the second group with 35% PAG (and the third group with PDT. After treatment, quantification of bacterial colonization was assessed by quantification via colony forming units and qualitatively by fluorescence microscopy and scanning electron microscopy.

Results

With a mean value of 1.24 × 10⁵ CFU/ml, the CAP treated implants have showed the least microorganisms. The highest number of CFU was found after PDT with mean value of 8.28 × 10⁶ CFU/ml. For the implants that were processed with phosphoric acid, a mean value of 3.14 × 10⁶ CFU/ml could be detected. When the groups were compared, only the CAP and PDT groups differed significantly from each other (p = 0.005).

Conclusion

A complete cleaning of the micro-textured implant surface or the killing of the bacteria could not be achieved by any of the investigated treatment options, thus bacteria in the microstructure of the titanium surface cannot be completely reached by mechanical and physico-chemical processes.

Clinical relevance

The main goal of the adjunctive peri-implantitis treatment is the decontamination of the implant surface. However, there is still an ongoing need to define the most appropriate adjunctive therapy method. Due to its antimicrobial effects, CAP combined with mechanical debridement could be a feasible treatment modality in the management of peri-implantitis.

Efficacy of Adjunctive Antimicrobial Photodynamic Therapy to Mechanical Debridement in the Treatment of Peri-implantitis or Peri-implant Mucositis in Smokers: A Systematic Review and Meta-analysis

This systematic review and meta-analysis aimed to determine whether adjunctive use of antimicrobial photodynamic therapy (a-PDT) in peri-implant diseases improves clinical outcomes in smokers. An electronic search was performed in MEDLINE (through PubMed), Scopus, Cochrane Library, Embase, Web of Science and Google Scholar. The primary outcome measures were bleeding on probing (BOP) and pocket depth (PD). Plaque index (PI) was the secondary outcome. Four RCTs, (188 participants) comprised of 118 cigarette smokers, 38 E-cig smokers and 32 water pipe smokers with follow-up periods ranged from 6 weeks to 6 months were recruited. All trials applied diode laser in one session with wavelengths ranged from 660 to 670 nm. There was a significant difference between mechanical debridement (MD)+a-PDT and MD alone groups in PD (WMD = -1.26 mm, 95% CI: -2.19 to -0.32, P = 0.01) and PI (WMD = -10.60%, 95% CI: -14.46 to -6.74, P < 0.001) at 3-month follow-up. However, a great amount of heterogeneity was observed (PD: χ² = 199.19, I² = 98%, P < 0.001 and PI: χ² = 25.63, I² = 84.4%, P < 0.001). Due to methodological heterogeneity and small number of studies, this systematic review was unable to reach conclusive evidence in regards of adjunctive a-PDT efficacy in improving clinical parameters in smokers.

Effectiveness of antimicrobial photodynamic therapy as an adjunct to open flap debridement in patients with aggressive periodontitis

AIM

The aim of the present clinical trial was to evaluate the clinical efficacy of photodynamic therapy (PDT) as an adjunct to open flap debridement (OFD) in the treatment of generalized aggressive periodontitis (GAP).

MATERIALS AND METHODS

The subjects recruited for the study were divided into two groups: 'control group' received treatment through OFD, whereas the test participants were treated with OFD and adjunctive PDT. The clinical periodontal parameters were plaque index (PI), full mouth probing depth (FMPD) and full mouth relative attachment loss (FMRA). The microbial levels of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Tannarella forsythia (Tf) were analyzed. All parameters were assessed at baseline and 3 months.

STATISTICAL ANALYSIS

The observed values for all the parameters were reported in mean and standard deviation (mean ± SD). In order to analyse the mean values and inter-group comparisons, the Mann-Whitney U test was employed. The p-value was set at <0.05 to establish a significant difference among the reported values.

RESULTS

A statistically significant improvement for BOP was observed in PDT group in comparison to the control group at 3 months only (p < 0.05). A significant reduction in the microbiological levels for Aa, Pg and Tf in both the study groups was observed. However, no significant differences in microbial levels were observed at any time point when the control and test groups were compared to each other.

CONCLUSION

PDT in conjuction with OFD plays a significant role in reducing the microbial load and improving the clinical periodontal parameters in patients with GAP. Moreover, it is regarded as a safe treatment regimen as no side effects have been reported regarding its use in GAP.

Levels of procalcitonin in saliva and peri-implant crevicular fluid in patients with peri-implant diseases and health

OBJECTIVE

To evaluate the levels of procalcitonin in saliva and peri-implant crevicular fluid (PICF) among healthy and peri-implant disease patients and correlate these levels with clinical and radiographic peri-implant parameters.

DESIGN

Three groups of 20 participants each [Group-1: healthy, Group-2: peri-implant mucositis, and Group-3: peri-implantitis] were selected. Peri-implant plaque index, bleeding on probing, probing depth and crestal bone loss was assessed. PICF and saliva samples were evaluated for procalcitonin levels and analyzed using enzyme-linked immunosorbent assay. Kruskal-Wallis test was performed for comparisons among the study groups. Multiple comparisons were considered for Post hoc two-group comparisons using Bonferroni-corrections. The Spearman rank correlation coefficient analysis was used to analyze the correlation between procalcitonin levels of both fluids and clinical peri-implant parameters.

RESULTS

Group-3 demonstrated significantly higher values for peri-implant plaque index, bleeding on probing, probing depth, and crestal bone loss as compared to Group-1 and Group-2. Participants of both Group-2 and Group-3 reported significantly increased procalcitonin levels in saliva and PICF in comparison to Group-1. Significant positive correlations were found between PICF procalcitonin levels and bleeding on probing, probing depth, and crestal bone loss in Group-3 and significant positive correlation was found between PICF and bleeding on probing in Group-2. For salivary procalcitonin levels, a significant positive correlation was observed between procalcitonin and bleeding on probing in Group-3.

CONCLUSIONS

The outcome of this study suggests that procalcitonin might play a role in peri-implant inflammation, and higher procalcitonin levels is suggestive of a probable surrogate biomarker for peri-implant diseases.

Peripheral giant cell granuloma associated with a dental implant

BACKGROUND

Peripheral giant cell granuloma (PGCG) is an uncommon pathology that affects gingival or alveolar mucosa. Although PGCG can be associated with dental implants, little is known about this lesion and implant osseointegration as well as its etiopathogenesis and the treatments available. This study sought to report a rare case of PGCG associated with dental implant, emphasizing its clinical and histopathological aspects.

CASE PRESENTATION

A 53-year-old man had an exophytic, reddish lesion, around a crown attached to a dental implant located in the left mandible. Radiographically, there was bone loss around the implant. After excisional biopsy, histological examination revealed a submucosal proliferation of multinucleated giant cells rendering the diagnosis of peripheral giant cell granuloma. Patient has been under follow-up for 6 months with no recurrence.

CONCLUSIONS

Peri-implant lesions must be completely removed to prevent recurrence of PGCG and implant failure, even in cases suspected to be reactive. Besides, histological examination must be performed on all peri-implant reactions to achieve the appropriate diagnosis and, consequently, the best treatment and follow up.

Effect of Different Laser Wavelengths on Periodontopathogens in Peri-Implantitis: A Review of In Vivo Studies

Nowadays, many studies are examining the effectiveness of dental lasers in the treatment of peri-implantitis; however, most of them only report periodontal parameter changes. The authors of this review tried to address the question: “What is the effect of different laser wavelengths on oral bacteria that cause peri-implantitis?” An electronic search of PubMed and Cochrane Central Register of Controlled Trials was performed. The following search terms were used: (peri-implantitis OR periimplantitis) OR/AND (microbial OR microbiologic) AND (laser OR Er:YAG OR erbium OR diode OR Nd:YAG OR neodymium-doped OR Er,Cr:YSGG OR chromium-doped). Initially, 212 studies were identified. After screening the titles and abstracts and excluding studies according to predefined inclusion criteria, seven publications were included in the review. Three studies about the effect of aPDT (antimicrobial photodynamic therapy) reported a decrease in the different bacterial strains associated with peri-implantitis, e.g., A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. denticola, T. forsythia, F. nucleatum, and C. rectus. Two studies showed that the high-power diode laser may have some effect on peri-implant pathogens. Two articles about the Er:YAG laser reported a lowering in the count of oral pathogens; however, it was hard to determine if this was due to the use of the laser. aPDT has the ability to decrease the count of peri-implant pathogens, whereas Er:YAG laser application shows no significant effect on oral bacteria in the long term.

Efficacy of periimplant mechanical curettage with and without adjunct antimicrobial photodynamic therapy in smokeless-tobacco product users

OBJECTIVE

The aim was to investigate the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjuvant to mechanical curettage (MC) in the treatment of periimplant mucositis in smokeless tobacco (ST) product users.

METHODS

Forty-eight ST product users with periimplant mucositis were randomly divided into 2 groups. In the test-group, participants underwent periimplant MC with adjunct aPDT; and in the control-group, the patients underwent MC alone. Periimplant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were measured at baseline and after 3-months of follow-up. Statistical analysis was performed using the Kruskal-Wallis test. Level of significance was set at P<0.05.

RESULTS

At baseline, periimplant PI, BOP and PD were comparable among individuals in the test- and control groups. At 3-months follow-up, scores of periimplant PI (P<0.05), BOP (P<0.05) and PD (P<0.05) were statistically significantly higher among patients in the control-group compared with the test-group. At 3-months follow-up, the percentages of sites of PI, BOP and PD were statistically significantly higher in the control-sites as compared to the test-sites.

CONCLUSION

Among patients with periimplant mucositis, MC with adjunct aPDT is more effective in reducing periimplant inflammation in ST product users as compared to MC alone; however, the present result should be interpreted with caution as they were based on a short-term follow-up. Further long-term studies are needed in this regard.

Efficacy of scaling and root planing with and without adjunct antimicrobial photodynamic therapy on the expression of cytokines in the gingival crevicular fluid of patients with periodontitis: A systematic review

BACKGROUND

The aim of the present review was to study the efficacy of scaling and root planing (SRP) with and without adjunct antibacterial photodynamic therapy (aPDT) on the expression of cytokines in the gingival crevicular fluid (GCF) of patients with periodontitis.

METHODS

In order to address the focused question: "What is the efficacy of SRP with and without aPDT on the expression of cytokines in the GCF of patients with periodontitis" an electronic search without time or language restrictions was conducted up to and including July 2016 in indexed databases using various key words. The exclusion criteria included reviews, laboratory and experimental studies, case reports, commentaries, letters to the editor, interviews, updates, studies where intervention group received aPDT without previous SRP, and studies where local delivery of antibiotics was used as adjunctive therapy to aPDT.

RESULTS

Six randomized control trials were included in the present systematic review. All studies included a control group which received only SRP. Results from 34% of studies reported lower cytokine levels among individuals receiving adjunct aPDT to SPT compared to patients receiving SRP alone. Selective cytokines reduction in the GCF following SRP with adjunct aPDT compared with SRP alone was reported in 50% of the studies. In one study SRP with adjunct aPDT failed to reduce GCF cytokine concentration.

CONCLUSION

From the literature reviewed the efficacy aPDT as adjunct to SRP in downregulating GCF cytokines remains debatable. Further well-designed studies are needed in this regard.

Efficacy of periimplant mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of periimplant diseases among cigarette smokers and non-smokers

OBJECTIVE

The aim was to assess the efficacy of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in reducing periimplant inflammation among cigarette-smokers and non-smokers.

METHODS

Cigarette-smokers and non-smokers were randomly divided into 2 groups. In the test-group, participants underwent full mouth scaling and periimplant MD with adjunct aPDT; and in the control-group, the participants underwent full mouth scaling and periimplant MD alone. Periimplant bleeding on probing (BOP), probing depth (PD) and crestal bone loss (CBL) were measured at baseline and at 6- and 12-months follow-up. Statistical analysis was performed using the Kruskal-Wallis test. P-values<0.05 were considered statistically significant.

RESULTS

Eighty-four smokers (41 patients in the test group and 43 in the control group) and 82 non-smokers (40 patients in the test group and 42 in the control group) were included. Among smokers and non-smokers, periimplant PD was significantly higher in the control-group compared with the test-group (P<0.05) at 6-months of follow-up. There was no statistically significant difference in BOP, PD and CBL among smokers and non-smokers in the test- and control-groups at 12-months of follow-up. BOP was comparable among smokers at all time intervals.

CONCLUSION

In the short-term, MD with adjunct aPDT is more effective in reducing periimplant probing depth than MD alone in smokers and non-smokers. However, in the long-term outcomes of MD either with or without aPDT among smokers and non-smokers are comparable.