Antimicrobial photodynamic therapy adjuvant to non-surgical periodontal therapy in patients with diabetes mellitus: A meta-analysis

Efficacy of adjunctive local periodontal treatment for type 2 diabetes mellitus patients with periodontitis: A systematic review and network meta-analysis

OBJECTIVES

To investigate the effectiveness of different adjunctive local treatments combined with non-surgical periodontal therapy (NSPT) to reduce pocket depth (PD), gain clinical attachment level (CAL), and/or reduce glycated hemoglobin (HbA1c) in individuals with both type 2 diabetes mellitus (T2DM) and periodontitis in a systematic review and network meta-analysis.

DATA SOURCES

Publications were searched in Cochrane databases, EMBASE, Google Scholar, MEDLINE, PubMed, opengrey.eu, and www.

CLINICALTRIALS

gov up to May 29, 2024 with no language restriction.

STUDY SELECTION

Only randomized controlled trials (RCTs) were included. Network meta-analysis utilized frequentist models.

DATA

The network meta-analysis of 30 RCTs involving 1224 patients revealed that, in short-term (2-3 months) and medium-term (4-6 months), adjunctive local treatment involving statins or metformin significantly outperformed scaling and root planning (SRP) with/without additional interventions such as photodynamic and laser therapies (PDT/LT), phytotherapy, doxycycline, bisphosphonates, antibiotics, antiseptics, or placebo for reducing PD and/or gaining CAL. In the long-term (>6 months), statins yielded the most significant additional PD reduction and CAL gain, followed by antibiotics, compared to SRP with antiseptics or placebo. Only PDT/LT demonstrated significantly greater HbA1c reduction in the short term compared to SRP with/without statins, antiseptics, or placebo.

CONCLUSION

This study moderately supports that adding metformin or statins locally to NSPT may enhance PD reduction and CAL gain compared to SRP with/without placebo.

CLINICAL SIGNIFICANCE

Clinicians are guided to optimize adjunctive therapies, enhancing the health of patients with type 2 diabetes and periodontitis. A strategic approach is proposed to tackle systemic and oral health challenges simultaneously.

The effect of antimicrobial photodynamic therapy adjunct to non-surgical periodontal therapy on the treatment of periodontitis in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

The purpose of the present systematic review and meta-analysis was to assess the impact of antimicrobial photodynamic therapy adjunct to non-surgical periodontal treatment on individuals with type 2 diabetes mellitus.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were carried out in six databases without restriction regarding publication year. Studies comparing periodontal clinical parameters among individuals submitted to non-surgical periodontal therapy associated with antimicrobial photodynamic therapy and a control group of individuals submitted to only non-surgical periodontal treatment were included. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided.

RESULTS

Two hundred and five studies were identified and 11 studies were included. The meta-analysis demonstrated that antimicrobial photodynamic therapy adjunctive to periodontal therapy, in individuals with diabetes, resulted in a greater reduction of bleeding on probing at 6 months and in probing depth at 3 and 6 months in comparison to periodontal treatment alone (p<0.05). The included studies exhibited low risk of bias.

CONCLUSION

Antimicrobial photodynamic therapy adjunct to periodontal therapy contributes to the improvement of periodontal clinical parameter bleeding on probing and probing depth in individuals with type 2 diabetes mellitus.

Laser treatments as an adjunct to non-surgical periodontal therapy in subjects with periodontitis and type 2 diabetes mellitus: a systematic review and meta-analysis

OBJECTIVES

Periodontal disease and diabetes have an extensively investigated bidirectional correlation. Non-surgical periodontal treatment (NSPT) was proven to contribute to glycemic control. Moreover, it may benefit from the association of adjunctive therapies. The aim of the present systematic review is to assess the clinical efficacy of NSPT in association with laser (LT) or photodynamic therapy (PDT) in controlled or uncontrolled diabetic patients, and to grade the level of evidence.

MATERIALS AND METHODS

Randomized controlled clinical trials with at least 3-month follow-up were searched in MEDLINE via OVID, EMBASE, and Cochrane Central, screened for inclusion, and grouped based on the performed treatments, follow-up time, type of diabetes, and level of glycemic control.

RESULTS

Eleven RCTs with 504 total subjects were included. The adjunct of PDT showed a statistically significant 6-month difference in PD changes (with low certainty of evidence), but not in CAL changes, while a significant difference in 3-month PD and CAL changes was found with the adjunct of LT (low certainty of evidence). Patients treated with PDT registered a higher decrease in HbA1c levels at 3 months, but no significant difference was noted at 6 months; LT also led to better HbA1c changes at 3 months with a moderate certainty of evidence.

CONCLUSION

Despite the promising short-term HbA1c decrease, the results should be interpreted with caution due to the small effect sizes and the statistical heterogeneity, and further evidence from well-designed RCTs is needed to support the routine use of PDT or LT in adjunct to NSPT.

Effect of non-surgical periodontal therapy with adjunct photodynamic therapy on periodontal and glycemic statuses in prediabetic patients with periodontal disease

OBJECTIVE

Studies have shown that non-surgical periodontal therapy (NSPT) helps reduce periodontal inflammation and glycemic levels in patients with type-2 diabetes mellitus; however, the role of NSPT with adjunct photodynamic therapy on glycemic status and periodontal parameters in prediabetic patients remains unclear. The aim of the present study was to assess the effect of NSPT with and without adjunct PDT on periodontal and glycemic statuses in prediabetic patients with periodontal disease.

METHODS

Prediabetic (Group-1) and non-diabetic (Group-2) patients diagnosed with periodontal inflammation were included. In both groups, patients were randomly assigned to test and control-groups. In the test- and control groups, patients underwent NSPT with and without adjunct PDT, respectively. The following parameters were assessed at baseline and at four weeks' follow-up: plaque index (PI); gingival index (GI), probing depth (PD), clinical attachment loss (CAL) and hemoglobin A1c (HbA1c). Collection of demographic data and assessment of full mouth marginal bone loss was performed at baseline. Level of significance was set at P < 0.05.

RESULTS

At baseline, there was no difference in PI, GI and PD among patients with and without prediabetes. At 3-weeks' follow up there was no difference in PI, GI and PD among patients without prediabetes. PI (P < 0.01), GI (P < 0.01) and PD (P < 0.01) were significantly higher in the control-group compared with the test-group at 3-weeks' follow-up in patients without prediabetes. The HbA1c levels were significantly higher in patients with prediabetes throughout the study duration compared with individuals without prediabetes.

CONCLUSION

One session of NSPT with or without PDT reduce periodontal inflammation but do not influence glycemic levels in prediabetic patients.

Next-Generation Examination, Diagnosis, and Personalized Medicine in Periodontal Disease

Periodontal disease, a major cause of tooth loss, is an infectious disease caused by bacteria with the additional aspect of being a noncommunicable disease closely related to lifestyle. Tissue destruction based on chronic inflammation is influenced by host and environmental factors. The treatment of periodontal disease varies according to the condition of each individual patient. Although guidelines provide standardized treatment, optimization is difficult because of the wide range of treatment options and variations in the ideas and skills of the treating practitioner. The new medical concepts of “precision medicine” and “personalized medicine” can provide more predictive treatment than conventional methods by stratifying patients in detail and prescribing treatment methods accordingly. This requires a new diagnostic system that integrates information on individual patient backgrounds (biomarkers, genetics, environment, and lifestyle) with conventional medical examination information. Currently, various biomarkers and other new examination indices are being investigated, and studies on periodontal disease-related genes and the complexity of oral bacteria are underway. This review discusses the possibilities and future challenges of precision periodontics and describes the new generation of laboratory methods and advanced periodontal disease treatment approaches as the basis for this new field.

Antibacterial efficiency of adjuvant photodynamic therapy and high-power diode laser in the treatment of young permanent teeth with chronic periapical periodontitis. A prospective clinical study

BACKGROUND

The study aimed at determining antibacterial efficiency of adjuvant photodynamic therapy (PDT) and high-power diode laser (DL) in the treatment of chronic periapical periodontitis (CPP) in young permanent teeth.

METHODS

Forty-four young permanent teeth with CPP were randomly divided into three groups (PDT, DL and control). Each tooth underwent standard chemo-mechanical treatment, while within tested groups was additionally treated by PDT or DL. Bacterial identification and quantification were provided by MALDI-TOF spectrometry and plate counting assay, performed after accessing the canal, following chemo-mechanical preparation, and after PDT or DL procedure where applicable.

RESULTS

Thirty-nine young permanent teeth with CCP (patients age 9.77 ± 1.43) completed the study. Before the treatments, 202 isolates belonging to 13 genera/species, including Streptococcus (36), Actinomyces (34), Peptostreptococcus micros (27), Veillonella (25) and Enterococcus faecalis (22), were recovered. Chemo-mechanical treatment reduced CFU count in the all three groups (p < 0.001), but complete eradication was not observed for any of isolated species. Adjuvant PDT and DL completely eradicated isolates of 8 and 6 bacterial genera/species, resulting in complete bacterial elimination from 53.8% and 30.8% of root canals, respectively. In the rest canals, total Δlog CFUs were 4.71 and 4.58.

CONCLUSION

The results indicated that both PDT and DL could be performed as adjuvants to standard endodontic treatment of the young permanent teeth with CPP.

The in vitro effect of antimicrobial photodynamic therapy with toluidine blue and indocyanine green on microleakage of class V cavities

INTRODUCTION

Considering the importance of disinfecting dentin and enamel after cavity preparation and the possible effect of disinfection methods on induction of various reactions in the tooth structure the aim of the present study was to evaluate microleakage of composite resin restoration after disinfecting the prepared dentin and enamel surface with antimicrobial photodynamic therapy (aPDT) with toluidine blue (TBO) and indocyanine green (ICG).

MATERIALS AND METHODS

Standard class V cavities were prepared on buccal surface of 71 human premolar teeth. The samples were randomly divided into 3 groups based on disinfection method: Group 1: conventional disinfection method with Phosphoric acid 37% as the control; Group 2: aPDT with TBO and diode laser with wavelength of 635 nm; Group 3: aPDT with ICG and diode laser with wavelength of 808 nm. All the cavities were restored with composite resin (3M™ Filtek™ Z250). After thermocycling and immersing in 0.5% basic fuchsin, the samples were prepared for microleakage evaluation under a stereomicroscope. Data was analyzed with Kruskal-Wallis and Wilcoxon signed-rank tests at P < 0.05.

RESULTS

There were no significant differences in the microleakage of occlusal and gingival margins between the TBO and control groups (P > 0.05). Also, the microleackage of occlusal margins between groups was not significantly different (P > 0.05) but microleackage of gingival margins of ICG group was lower than two other groups in a meaningful way (P < 0.05).

CONCLUSION

Photodynamic therapy with ICG as disinfecting agent in cavity preparations before composite resin restorations decreases the microleackage of gingival margins.

Periodontal and Peri-Implant Health Status in Traditional vs. Heat-Not-Burn Tobacco and Electronic Cigarettes Smokers: A Systematic Review

The aim of the present systematic review was to evaluate and possibly differentiate the effects of traditional cigarettes, heat-not-burn tobacco, and electronic cigarettes on periodontal and peri-implant health status. Electronic cigarettes and heat-not-burn tobacco have become very popular in recent years and have been proposed to consumers as a safer alternative to conventional tobacco smoke, although their effect on periodontal and peri-implant health remains unclear. The study protocol was developed according to PRISMA guidelines, and the focus question was formulated according to the PICO strategy. A literature search was conducted across PubMed/MEDLINE and the COCHRANE library from 2003 to April 2022. From the 1935 titles initially identified, 18 articles were finally included in the study and extracted data were qualitatively synthesized. It may be carefully concluded that e-cigarettes may cause attenuated clinical inflammatory signs of periodontitis and, hypothetically, of peri-implantitis when compared to conventional tobacco smoke. Both alternative smoking products, containing nicotine, may likewise exert negative effects on periodontal and peri-implant health, as demonstrated by in vitro studies. Further investigations are needed to assess the impact of electronic cigarettes and heat-not-burn tobacco products on periodontal and peri-implant health status.

New Metallophthalocyanines Bearing 2-Methylimidazole Moieties-Potential Photosensitizers against Staphylococcus aureus

Newly developed tetra- and octasubstituted methimazole-phthalocyanine conjugates as potential photosensitizers have been obtained. Synthesized intermediates and final products were characterized by the MALD-TOF technique and various NMR techniques, including 2D methods. Single-crystal X-ray diffraction was used to determine the crystal structures of dinitriles. The studied phthalocyanines revealed two typical absorption bands—the Soret band and the Q band. The most intense fluorescence was observed for octasubstituted magnesium(II) phthalocyanine in DMF (Φ_FL = 0.022). The best singlet oxygen generators were octasubstituted magnesium(II) and zinc(II) phthalocyanines (Φ_∆ 0.56 and 0.81, respectively). The studied compounds presented quantum yields of photodegradation at the level between 10⁻⁵ and 10⁻⁶. Due to their low solubility in a water environment, the liposomal formulations were prepared. Within the studied group, octasubstituted zinc(II) phthalocyanine at the concentration of 100 µM activated with red light showed the highest antibacterial activity against S. aureus equal to a 5.68 log reduction of bacterial growth.

Advances on Hydrogels for Oral Science Research

Hydrogels are biocompatible polymer systems, which have become a hotspot in biomedical research. As hydrogels mimic the structure of natural extracellular matrices, they are considered as good scaffold materials in the tissue engineering area for repairing dental pulp and periodontal damages. Combined with different kinds of stem cells and growth factors, various hydrogel complexes have played an optimistic role in endodontic and periodontal tissue engineering studies. Further, hydrogels exhibit biological effects in response to external stimuli, which results in hydrogels having a promising application in local drug delivery. This review summarized the advances of hydrogels in oral science research, in the hopes of providing a reference for future applications.

Excited state and reactive oxygen species against cancer and pathogens: a review on sonodynamic and sono-photodynamic therapy

Photodynamic and sonodynamic therapy are therapies having great potential in the treatment of bacterial infections and cancer. Their background is associated with photo- and sonosensitizers - substances that can be excited when exposed to light or ultrasound. These sensitizers belong to a variety of compounds groups, including porphyrins, porphyrazines, and phthalocyanines. Releasing the energy when returning to the ground state can occur in the manner of transferring it to oxygen molecules, leading to reactive oxygen species able to disrupt membranes of bacterial and cancer cells, leaving the organism's cells unaffected. In recent years, the number of reports on numerous sensitizers being effective has been constantly growing. Therefore, the development of this field may prove beneficial for dealing with cancer and microbes. This review describes the development of photodynamic and sonodynamic therapy, as well as their combination, with emphasize on sonodynamic therapy and its potential in the treatment of cancer and bacterial infections.

Is a single session of antimicrobial photodynamic therapy as an adjuvant to non-surgical scaling and root planing effective in reducing periodontal inflammation and subgingival presence of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in patients with periodontitis?

OBJECTIVE

The aim was to assess the influence of a single session of antimicrobial photodynamic therapy (aPDT) as an adjunct to non-surgical scaling and root planing (SRP) in reducing periodontal inflammation and subgingival presence of Porphyromonas gingivalis (P. gingivalis) and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) in patients with periodontitis.

METHODS

Patients diagnosed with periodontitis were included. Information regarding age and gender was recorded using a questionnaire. All patients underwent full mouth non-surgical SRP and the following parameters were assessed at baseline: (a) marginal bone loss (MBL); (b) probing depth (PD) (c) clinical attachment loss (CAL); and (d) presence of supra-and subgingival bleeding and plaque (GI and PI). Identification of A. actinomycetemcomitans and P. gingivalis was performed using polymerase chain reaction. For aPDT (test-group), methylene-blue (MB) (0.005%) was used as photosensitizer and it was applied over and inside the buccal pockets of teeth. Using a Diode laser at 660 nm and 150 mW, irradiation was performed All clinical parameters except for MBL and microbiological evaluations were re-assessed at 3-months of follow-up. Level of significance was set at P<0.05.

RESULTS

At 3-months of follow-up A. actinomycetemcomitans and P. gingivalis were identified in significantly lower number of patients in groups 1 and 2 compared with their respective baseline values. Number of patients in whom A. actinomycetemcomitans and P. gingivalis were identified at 3-months of follow-up were similar in both groups. At baseline, there was no statistically significant difference in PI, GI, PD, CAL and MBL among patients in groups 1 and 2. In groups 1 and 2, scores of PI (P<0.001), GI (P<0.001) and PD (P<0.001) were significantly higher at baseline compared with their respective 3-months' follow-up scores.

CONCLUSION

One application of aPDT with non-surgical SRP is ineffective in managing periodontal inflammation and presence of P. gingivalis and A. actinomycetemcomitans in periodontitis patients.

Effect of photodynamic therapy on resin-dentin bonding interface using different illumination time

OBJECTIVES

The aim of the present study was to evaluate the effect of photodynamic therapy(PDT) on the resin-dentin bonding interface using different illumination time.

METHODS

Seventy completed, isolated molar teeth were collected for this study, sixty of them were used in microtensile bond strength tests. These teeth were initially divided randomly in two main groups(n=30) by the random number table method upon the type of using illumination or not respectively. Then these groups followed by dividing each category in five subgroups(n=6): group A, group B1,group B2, group B3, group B4, group a, group b1, group b2, group b3, group b4. After different treatment, the remaining teeth were made specimens which were observed the fracture modes and interfaces under a stereomicroscope and a scanning electron microscope(SEM). The dentin permeability of the specimens were evaluated by a laser scanning confocal microscope(LSCM). To detect significance difference between means of different groups analysis of variance(ANOVA) was performed followed by LSD-t tests.

RESULTS

There was a significant statistical difference in the microtensile bond strength of the different illumination time of PDT between four experimental groups and the control (P<0.05).

CONCLUSION

With the increase of the illumination time in PDT, the bonding strength between resin and dentin decreased gradually.

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.

Indocyanine-mediated antimicrobial photodynamic therapy promotes superior clinical effects in stage III and grade C chronic periodontitis among controlled and uncontrolled diabetes mellitus: A randomized controlled clinical trial

BACKGROUND

The aim of this randomized controlled clinical trial was to evaluate the efficacy of indocyanine-green mediated antimicrobial photodynamic therapy (ICG-aPDT) in the treatment of stage III grade C periodontitis in terms of clinical, microbiological, and immune-inflammatory parameters in patients with well-controlled and poorly-controlled form of type-2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

Subjects with a diagnosis of chronic periodontitis according to the new classification and case definition of periodontitis [probing depth (PD): ≥6 mm, interdental clinical attachment loss (CAL): ≥5 mm and bone loss extending to mid-third of root and beyond (≥3 mm)] were recruited. Subjects were grouped on the basis of well-controlled and poorly-controlled diabetic status. Two subgroups were made according to the treatment modality (RSD versus ICG-aPDT/RSD) in each group. A split-mouth design was used in which one site was designated for control (RSD alone treatment) while the other contralateral site was chosen for test treatment (ICG-aPDT/RSD) in all the patients. Periodontal parameters included the measurement of plaque score (PS), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL) and alveolar bone levels (ABL). Identification of Porphyromonas gingivalis and Tannarella forsythia through PCR was executed using species specific primers. Gingival crevicular fluid samples were then analyzed using enzyme-linked immunosorbent assay for the quantification of interleukin (IL)-17 and interferon (IFN)-γ. All the clinical, microbiological, and immunological parameters were assessed using repeated measure ANOVA for intra and inter-group comparisons. The p-value significance was set at 0.05.

RESULTS

The mean age of the 50 patients was 44.7 ± 7.4 years. Systemic parameters suggest no significant change between the times in either HbA1c or serum CRP levels in any of the groups. A statistically significant reduction for BOP was noted for ICG-aPDT group for non-diabetic subjects at 3 months follow up only, while a significant reduction was seen at both 3 months and 6 months among well-controlled and poorly-controlled T2DM subjects (p<0.05). For PD and CAL, a significant improvement was seen for ICG-aPDT group among non-diabetic and well-controlled T2DM subjects at both 3- and 6-months follow up, while a significant reduction was seen at only 3 months among poorly-controlled T2DM subjects. A significant reduction was seen for ICG-aPDT group compared to RSD group for both bacteria in all the three groups at 6 months follow up (p<0.05).

CONCLUSION

ICG-aPDT significantly improved clinical and antimicrobial parameters in well-controlled and poorly-controlled T2DM having stage III and grade C periodontitis. Glycemic status did not have negative impact in the reduction of periodontal parameters in either types of T2DM.

TRIAL REGISTRATION

The present RCT was registered in the clinicaltrials.gov under the identifier: NCT04857346.

Effect of ultrasonic scaling with adjunctive photodynamic therapy on the treatment of gingival inflammation among diabetic patients undergoing fixed orthodontic treatment

BACKGROUND

The aim of the present clinical trial was to evaluate the effect of methylene blue-mediated antimicrobial photodynamic therapy (aPDT) on the gingival and immunological parameters in diabetic adolescent patients undergoing fixed orthodontic treatment.

METHODS

The selected 40 participants were randomized equally into two groups; Group I (ultrasonic scaling + oral hygiene instructions) and Group II (ultrasonic scaling/oral hygiene instructions + aPDT). Serum HbA1c levels was assessed for all the participants at chairside. Plaque index (Pi), and bleeding on probing (BOP) were analyzed. Moreover, the assessment of crevicular fluid matrix metalloproteinase 8 (MMP-8) and macrophage inflammatory protein 1 alpha (MIP-1α) was performed using enzyme-linked immunosorbent assay technique. All measurements were recorded at baseline, 6 weeks, and 12 weeks follow-up periods, respectively. Intergroup comparisons for p-value were computed using Mann-Whitney test and Wilcoxon singed ranks test to compute p-value for intra-group comparisons. Stepwise logistic regression analysis was used to identify explanatory variables for reduction in plaque scores and bleeding on probing, after controlling for the effects of other covariates. Odds ratios and 95% confidence intervals were used to assess the direction and strength for associations. Significance level was set at 5% for all analyses.

RESULTS

All 40 individuals completed the clinical trial. There was a statistically significant reduction in Pi and BOP in both Group I and Group II from baseline to 12 weeks of follow up (P<0.05). However, there was slight reduction in the plaque scores in Group-II as compared to Group-I at 12 weeks visit (P<0.05). There was also a statistically significant difference for BOP when Group-I was compared with Group-II on 12 weeks follow up assessment (P<0.05). HbA1c assessment indicated no statistically significant difference either within or between groups at any time point (P>0.05). Both MMP-8 and MIP-1α reported a significant decrease for both Groups I and II at 6 weeks and 12 weeks follow-up periods in comparison to baseline (P<0.05). Inter-group comparison indicated a statistically significant difference noted at both 6 weeks follow up that was maintained at 12 weeks follow up (P<0.05). The logistic regression analysis revealed that even after controlling the mean BMI as a predictor, the change of biomarker levels along with the improvement in plaque scores and bleeding on probing was not significant (p> 0.05).

CONCLUSION

aPDT significantly improved bleeding on probing and proinflammatory biomarkers among diabetic adolescent patients undergoing fixed orthodontic therapy.

Botulinum Toxin A Injection in Treatment of Upper Limb Spasticity in Children with Cerebral Palsy: A Systematic Review of Randomized Controlled Trials

BACKGROUND

Cerebral palsy (CP) is the most common cause of childhood disability globally. Botulinum toxin A injections are widely used to manage limb spasticity in children with CP. Intramuscular botulinum toxin A has been used in the upper limbs of children with CP to manage preoperative and postoperative pain, facilitate nursing, and achieve functional and/or cosmetic improvement of hand position. These goals are achieved primarily through reduction of spasticity. The aim of this review was to assess the evidence for the effect of botulinum toxin A injections used to manage upper limb spasticity in children with spastic CP. Specifically, we examined the role of botulinum toxin A as an adjunctive treatment to other physical therapy modalities. Additionally, we analyzed the associated complications.

METHODS

The literature extraction process involved 4 phases: identification, screening, eligibility, and inclusion. We used a combination of Google Scholar, PubMed, and ScienceDirect. The choice of the search terms was based on the Medical Subject Headings. We extracted the relevant studies using a combination of words or terms related to (1) patient population, (2) pathology, (3) clinical intervention, and (4) anatomical distribution of pathology. Studies were included if they were randomized controlled trials conducted on children and/or adolescents with CP targeting the upper extremities in which botulinum toxin A was used as an adjunctive treatment to a primary intervention.

RESULTS

The literature extraction process yielded 15 randomized controlled trials for inclusion in this review. The total number of participants enrolled in the included studies was 499, with 255 in the intervention group (51%) and 244 controls (49%). All participants in the eligible studies had unilateral spastic CP except for those in 4 studies (27%) with 198 participants (40%) that included a heterogeneous sample of unilateral and bilateral spastic CP. The mean age of participants in the intervention group ranged from 2.6 to 10.7 years among the individual studies. The mean age of participants in the control group ranged from 3.1 to 10.55 years among the individual studies. This review indicated that botulinum toxin A had a positive effect on the degree of spasticity and cosmetic appearance of the injected upper limb. The results with respect to functional gains and quality of life were either conflicting or not significant.

CONCLUSIONS

Randomized controlled trials of botulinum toxin A injection in the treatment of upper limb spasticity in children with CP used variable outcome measures and yielded mixed results. Overall, there is some evidence to support the use of botulinum toxin A as an adjuvant treatment to other physical therapy regimens or placebo to reduce spasticity in the short term. There is insufficient evidence to support its use as an adjunctive treatment to improve upper limb function or quality of life. The complications were acceptable and did not outweigh the clinical gains incurred.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The effect of antimicrobial photodynamic therapy on shear bond strength of orthodontic bracket: An in vitro study

OBJECTIVES

The aim of this study was to evaluate the effect of antimicrobial photodynamic therapy (aPDT) with methylene blue (MB) and indocyanine green (ICG) on bond strength of orthodontic brackets to enamel.

MATERIALS AND METHODS

A total of 45 non-carious and sound human premolar teeth were used in this study. All teeth were examined under a stereomicroscope at ×10 magnification. The samples were divided to 3 groups including no treatment (control group), aPDT with MB and 660 nm diode laser and aPDT with ICG and 808 nm diode laser. After aPDT procedure, orthodontic brackets were bonded to enamel surfaces. Then, the samples were thermocycled for 5000 cycles between 5° and 55° C in water bath. The brackets were then debonded using a universal testing machine. The adhesive remnant index (ARI) score and SEM microscope evaluation were assessed. One-way analysis of variance (ANOVA) with Post-hoc test were used to compare the SBS values among groups.

RESULTS

The highest SBS mean value was presented in group 1 (control) (31.98 ± 6.36). Whereas, the lowest SBS mean value was observed in group 3 (aPDT with ICG) (24.11 ± 5.78). There were significant differences in SBS values between control and aPDT groups (P < 0.05). Some superficial porosity and irregularity was presented following aPDT on surface of enamel when examined by scanning electron microscope. The mode of failure was mostly score 0 and score 1 in all groups.

CONCLUSION

MB and ICG mediated antimicrobial photodynamic therapy both reduced the bond strength of orthodontic brackets compared to control group.

Impact of riboflavin mediated photodynamic disinfection around fixed orthodontic system infected with oral bacteria

PURPOSE

The aim of this laboratory study was to investigate the amount of bacterial destruction through riboflavin mediated photodynamic therapy (PDT) around fixed orthodontic devices by using the two strains of bacteria Streptococcus mutans and Streptococcus sanguinis.

MATERIALS AND METHODS

A total of 80 metallic brackets were divided into four groups consisting of 20 brackets each. Group-I: riboflavin + LED irradiation; Group-II: riboflavin alone; Group-III: immersion in 0.2 % chlorhexidine gluconate solution and Group-IV: not submitted to any treatment. All metallic brackets were immersed in the standard bacterial solutions and incubated at 48 h. All samples were subjected to MTT assay for microbial cell viability testing after treatment. After 24 h of incubation, biofilms adhered on the mesh of metallic brackets after treatment were assessed by confocal laser microscopy. The total CFU/mL was estimated, and the results were log-transformed (log₁₀) and analyzed using one-way analysis of variance and Tukey-Kramer test. P-value was set to <0.05 that indicated statistical significance.

RESULTS

The samples from group-IV showed the highest amount of relative biofilm viability compared to any other group while group-I (PDT) showed the least viability of the two bacterial strains studied (p < 0.05). Group-I showed no significant difference when compared with group-III (chlorhexidine) (p > 0.05). The biofilms on the samples from group-II and group-IV were largely viable indicating thick green staining across the mesh of the brackets. Among the group-III samples, there were predominantly dead cells as compared to the live cell staining. A considerable amount of red staining was observed with noticeable less green staining in group-I samples.

CONCLUSION

This laboratory investigation revealed that riboflavin mediated PDT significantly reduced the amounts of S. mutans and S. sanguinis around the orthodontic brackets.

Comparative effects of different phenothiazine photosensitizers on experimental periodontitis treatment

AIM

The aim of the present study was to compare the effects of the phenothiazine photosensitizers methylene blue (MB), toluidine blue-O (TBO) and butyl toluidine blue (BuTB) in antimicrobial photodynamic therapy (aPDT), as adjuvant therapy to scaling and root planing (SRP) in the treatment of experimental periodontitis (EP) in rats.

MATERIAL AND METHODS

120 Wistar rats underwent ligation around the lower left molar. After seven days, the ligature was removed. The animals were separated into the following groups (n = 15): EP, no treatment; SRP, SRP and irrigation with saline solution; MB, SRP and deposition of MB; TBO, SRP and deposition of TBO; BuTB, SRP and deposition of BuTB; MB-aPDT, SRP and aPDT with MB; TBO-aPDT, SRP and aPDT with TBO and; BuTB-aPDT, SRP and aPDT with BuTB. The aPDT session was performed after SRP, with deposition of the photosensitizer and irradiation with a diode laser (DL; InGaAlP, 660 nm, 40 mW, 60 s, 2.4 J). Histological and histometric analysis was performed.

RESULTS

BuTB-aPDT group had a lesser extent of the inflammatory process compared to the EP, SRP, MB and TBO at all experimental periods (p < 0.05). At 15 days, the aPDT treated groups had a greater bone tissue structure than groups EP and SRP (p < 0.05) The BuTB showed lower Alveolar Bone Loss (ABL) compared to the TBO-aPDT group at 30 days (p < 0.05).

CONCLUSION

aPDT using the photosensitizer BuTB proved to be the adjuvant therapy that most favored the reduction of inflammatory infiltrate in the furcation area and ABL.

Efficacy of photodynamic therapy, photobiomodulation and antimicrobial agent on the shear bond strength of composite restorations to hypomineralized teeth

PURPOSE

The aim of this study was to investigate the adhesive bond strength and fracture analysis of resin based restorations to carious dentin of hypomineralized molars (HMs) after disinfecting with photodynamic therapy (PDT), Nd:YAG and chlorhexidine (CHX).

MATERIALS AND METHODS

Sixty carious HM molars were investigated. After removal of all carious infected tissue, the cavities were condition with methylene blue initiated PDT, a 1064 nm wavelength Nd:YAG laser or 2.0% CHX gel. Non-carious dentin from HM was used as a control without performing any disinfection or conditioning technique. All samples were bonded using a one-step one-coat adhesive bond over the dentin surface, packed with composite and light cured. All specimens were subjected to thermocycling at 5°C and 60°C with a dwell time of 30 s for 10,000 cycles. Bonded specimens were placed on a universal testing machine with a flat loading head. The debonded surface were viewed under light optical microscope to estimate the type of failure including adhesive, cohesive, and admixed.

RESULTS

The highest mean SBS was seen in the non-carious HM (control group). The mean score for control group was 17.64 ± 2.96 MPa. The lowest bond strength value was displayed for Group-PDT (11.37 ± 3.66 MPa) and Group-Nd:YAG (12.69 ± 2.45 MPa). Affected dentin disinfected with the Group-CHX (15.71 ± 3.04 MPa) bonded with composite showed statistically significantly higher SBS values compared to the laser groups (p < 0.05). No statistically significant difference was noted with specimens disinfected with PDT and Nd:YAG laser showed comparable SBS scores (p > 0.05). Fracture analysis showed equal incidence of adhesive and cohesive failures in control group and Group-CHX. Moreover, a significant number of failures in group-PDT were related to adhesive. Whereas in group 4, admixed type failures were common.

CONCLUSION

Caries infected hypomineralized teeth demonstrated lower bond strength values compared to non-carious hypomineralized teeth. Adhesive bond strength of hypomineralized teeth was highest with chlorhexidine compared to other laser treatment strategies.

Role of antimicrobial photodynamic therapy in reducing whole salivary oral yeasts colonization in type-2 diabetic and non-diabetic patients with and without dental implants

OBJECTIVE

The aim was to assess the impact of antimicrobial photodynamic therapy (aPDT) in reducing whole salivary oral yeasts colonization in type-2 diabetic and non-diabetic patients with dental implants.

METHODS

Type-2 diabetic and self-reported non-diabetic patients were included. Participants were divided into the following groups: Group-1: Type-2 diabetic patients with dental implants; Group-2: Non-diabetic patients with dental implants; Group-3: Type-2 diabetic patients without dental prostheses; Group-4: Non-diabetic patients without dental prostheses. In each group, participants were subdivided into 2-sub-groups. In the test-subgroup, participants received routine oral hygiene maintenance instructions (OHMI) and underwent full mouth disinfection using aPDT; and in the control-group, participants received OHMI alone. Unstimulated whole saliva samples were collected, hemoglobin A1c levels were measured and yeast colonization was assessed at baseline and at 3-months' follow-up in all groups. Sample-size estimation was done and group-comparisons were done. P-values <0.01 were considered statistically significant.

RESULTS

At baseline, the mean oral yeasts colonization was significantly higher among patients in Group-1 (P < 0.001) and 3 (P < 0.001) compared with individuals in groups 2 (P < 0.001) and 4 (P < 0.001). At baseline and at 3-months of follow-up, the mean HbA1c levels and oral yeasts colonization were significantly higher among patients in Group-1 (P < 0.001) and 3 (P < 0.001) compared with individuals in groups 2 (P < 0.001) and 4 (P < 0.001).

CONCLUSION

In the short-term, routine OHMI with adjunct aPDT is more effective in reducing whole salivary oral yeasts counts than OHMI alone in patients with and without dental implants.

Antibacterial effectiveness of scaling and root planing with and without photodynamic therapy against Campylobacter rectus counts in the oral biofilm of patients with periodontitis

BACKGROUND

It is hypothesized that scaling and root planning (SRP) with adjunct photodynamic therapy (PDT) is more effective in reducing Campylobacter rectus (C. rectus) from the oral biofilm (OB) among patients with periodontitis, than SRP alone. The objective was to compare the effectiveness of SRP with and without adjunct PDT in reducing OB C. rectus counts of patients with periodontitis.

METHODS

Chronic gastritis patients diagnosed with periodontitis were included. Therapeutically, the patients were divided into 2-groups. Patients in the test- and control-groups underwent SRP with and without adjunct PDT, respectively. In both groups, full-mouth plaque index (PI), bleeding on probing (BOP), probing depth (PD) and marginal bone loss (MBL) were measured and subgingival OB counts of C. rectus were measured at baseline and 12-weeks after treatment. Data normality was assessed and group-comparisons were done using the paired t-test and Man-Whitney U tests. A type-1 error rate of 5 % was used.

RESULTS

Thirty patients with periodontitis were included. All patients had Grade-B/Stage-II periodontitis. All participants were male with no significant difference in age. At baseline PI, BOP, PD and MBL were comparable in both groups. Counts of C. rectus in the subgingival OB samples were similar in both groups at baseline. At 12-weeks of follow-up, PI (P < 0.01), GI (P < 0.01) and PD (P < 0.01) were significantly higher in the control- compared with the test-group compared with baseline. The percentages of C. rectus -positive individuals were higher in the control- than the test-group at 12-weeks' (P < 0.01). At 12-weeks' follow-up the percentages of C. rectus -positive patients were comparable with their respective baseline percentages in the control-group.

CONCLUSION

Compared with SRP alone, adjuvant use of PDT is more efficient in eliminating C. rectus in the OB and reducing clinical parameters in patients with grade-B/Stage-II periodontitis.

Effect of adjunctive diode laser in the non-surgical periodontal treatment in patients with diabetes mellitus: a systematic review and meta-analysis

This study aimed to systematically review and analyze the present randomized clinical trials (RCTs) regarding the clinical efficacy of a diode laser (DL) adjuvant to scaling and root planning (SRP) in patients with chronic periodontitis (CP) who have diabetes mellitus (DM). Five databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trails, Web of Science, and Chinese BioMedical Literature Databases) were searched. A meta-analysis was implemented to evaluate periodontal parameters including probing depth (PD) and clinical attachment level (CAL) as primary outcomes. Hemoglobin A1c (HbA1c), plaque index (PI), and the gingival index (GI) were also observed as secondary outcomes. Independent scanning of 239 papers resulted in 9 RCTs. Moderate evidence demonstrated that the test groups showed significant benefits for PD reduction, CAL gain, and HbA1c reduction after 3 and 6 months. Significant differences in PI and GI reduction were not found except for GI reduction within 1 month. The collective evidence suggested that the DL with SRP had significant improvements in clinical results compared to SRP alone. Based on our results, the DL could be a recommended therapy for patients with CP who have DM.

Influence of root debridement with adjunct photodynamic therapy on periodontal parameters and gingival crevicular fluid cortisol levels among patients with and without type-2 diabetes mellitus

OBJECTIVE

The aim of the present study was to assess the influence of scaling and root planing (SRP) with adjunct antimicrobial photodynamic therapy (aPDT) on periodontal parameters and gingival crevicular fluid (GCF) cortisol levels in type-2 diabetic and non-diabetic patients with periodontitis.

METHODS

One hundred and twenty-eight patients with periodontitis (64 with and 64 without type-2 diabetes mellitus, respectively) were included. In the test- and control-groups, patients underwent SRP with and without aPDT, respectivey. In both groups, plaque and gingival indices (PI and GI), probing depth (PD), clinical attachment loss (CAL), marginal bone loss (MBL) and GCF volume and cortisol levels were assessed at baseline and three and six-months after SRP with or without aPDT. The aPDT was performed at baseline using methylene blue and photobiomodulation. The Kruskall-Wallis test was used to assess data normality; and group-comparisons were done. P-values, which were below 0.01 indicated statistical significance.

RESULTS

Sixty-four type-2 diabetic patients with and 64 non-diabetic patients with periodontitis were included. All individuals had Stage-III/Grade-C periodontitis. Among patients with type-2 diabetes mellitus (DM), there was no statistically significant difference in hemoblobin A1c, PI, GI, PD, CAL and MBL at baseline and at 3- and 6-months intervals. Amongst diabetic patietns, there was no difference in the GCF volume and cortisol levels in the test- and control-groups at all time intervals. In non-diabetic patients, there was a significqnt reductionin GCF volume and cortisol levels when SRP was done with aPDT than when SRP was carried out as the sole treatment strategy CONCLUSION: Among non-diabetic patients, SRP with aPDT helps reduce periodontal inflammation and GCF cortisol levels for up to 6-months; however poorly-controlled DM compromises the beneficial effects of this treatment strategy.

Impact of photodynamic therapy on the push-out bond strength of fiber posts to root dentin: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

This systematic review documents the up-to-date evidence on the efficacy of photodynamic therapy (PDT) on the push-out bond strength of fiber posts cemented to root dentin.

MATERIALS AND METHODS

The focused PICO question was: "What impact does PDT have on the push-out bond strength of fiber posts cemented to root dentin?" This systematic review followed the guidelines and recommendations reported in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines chart. An electronic search was performed in MEDLINE/PubMed, SCOPUS, Web of Science, and Embase from January 1980 up to and including January 2020. Heterogeneity was calculated for push-out bond strength by means of the Chi-square test and I² statistics. For meta-analyses, if the I² was higher than 50 %, a random effects model was used, otherwise a fixed effects model for I² ≤50 % was applied. A p-value <0.05 was set for significant heterogeneity. Forest plots were computed reporting standard mean differences (SMD) of outcomes and 95 % confidence intervals (CI).

RESULTS

In total, ten studies were included, all of wich demonstrated medium risk of bias. All studies tested the push-out bond strength by means of a universal testing machine with applying a load ranging between 0.5 and 1 mm/min speed. Of the 10 studies, nine (90 %) indicated that PDT had no effect on push-out bond strength of fiber posts to root dentin. Only one study indicated that PDT significantly improved the bond strength when compared with other control groups. The overall mean difference for push out bond strength showed no statistically significant difference between PDT and the control group (SMD = -1.11 [-3.25, 1.02], Z=-1.02, p = 0.305).

CONCLUSION

This systematic review concludes that PDT has no effect on improving the push-out bond strength of fiber posts to root dentin.

Clinical peri-implant health and biological bone marker levels in tobacco users treated with photodynamic therapy

BACKGROUND

What impact does tobacco smoking have on photodynamic therapy (PDT) outcome is still unknown. The aim of the present clinical trial was to evaluate the clinical, radiographic, and biological bone markers after provision of PDT in cigarette, e-cigarette, and never-smokers with peri-implantitis (PI) at 6 months post treatment.

MATERIALS AND METHODS

Twenty-five healthy patients with PI were divided into three groups: Group I: cigarette smokers; Group II: e-cigarettes users; Group III: never-smokers. Full-mouth mechanical debridement with adjunctive methylene blue-mediated PDT was performed. Clinical recordings included peri-implant plaque index (Pi), bleeding on probing (BOP) and probing depth (PD). Peri-implant sulcular fluid was collected for the assessment of biological bone biomarkers including receptor activator of nuclear factor-ligand (RANK-L) and osteoprotegrin (OPG). All assessments were performed at baseline, 3 months and 6 months. P-value of <0.05 was considered significant.

RESULTS

BOP in Group II and III significantly reduced at 3 months (p < 0.05). Group I showed significant reduction only at 6 months (p < 0.05). Mean PD showed no statistically significant difference between the groups at any time-point. Inter-group comparison showed Group III demonstrating statistically significantly reduced mean RANK-L levels at both 3 and 6 months (p < 0.05). A slight increase in the OPG levels were observed at 3 months and followed by a slight decrease at 6 months for all the study groups when compared with baseline values, however, these values did not show statistical significance (p > 0.05).

CONCLUSION

Adjunctive PDT helped in reducing the clinical peri-implant inflammation. However, no significant change was observed for biological bone biomarkers among tobacco smokers.

Adjunctive Use of Lasers in Peri-Implant Mucositis and Peri-Implantitis Treatment: A Systematic Review

BACKGROUND

The aim of this systematic review is to compare the effectiveness of lasers in the treatment of implant mucositis and peri-implantitis compared to conventional treatment (non-surgical or surgical: resective or regenerative).

METHODS

Sources of PubMed, Cochrane and Google Scholar search engines were used on articles published from 1997 to 2020 in English, with selected keyword criteria applied. Nine randomized controlled trials (RCTs) were selected.

RESULTS

All included studies were considered of "high quality" according to the quality assessment scale. The comparative assessment of the RCTs was done twice for each RCT based on the type of treatment and according to wavelength. There is strong scientific evidence that, regarding non-surgical treatment, adjunct laser application can provide better results only in the short term (three months). Regarding the surgical approach, the method of decontamination plays a subordinate role. All wavelengths/applications presented similar results.

CONCLUSION

Within the limitations of this study, the adjunctive use of lasers in the treatment of peri-implant inflammation is effective for up to three months; there is no strong evidence regarding the long term benefit compared to conventional treatment.

Effect of photodynamic therapy on the morphological changes of periapical inflammation: An experimental study in rats

AIM

We aimed to explore the morphological changes with photodynamic therapy (PDT) in experimentally produced periapical lesions in rats, and to investigate if PDT used as an adjunct to conventional root canal debridement helps to enhance healing the inflammatory response around root apex of rats.

MATERIALS AND METHODS

Sixty adult Sprague-Dawley male rats (70-90 days/140-160 g) were experimented. Pulp was removed from the mesial root of the first maxillary molar and left open to oral environment to allow the formation of periapical lesion. The rats were numbered and randomly divided into two groups: (i) PDT group (n = 30) received a single session of PDT with conventional debridement and, (ii) Control group (n = 30) received conventional debridement but with no PDT. PDT application involved the use of methylene blue photosensitizer for 5 min inside the root canals and irradiated with diode laser of 805 nm and 20 W power output for 90 s and sealed. After 4 weeks, the experimental rats were sacrificed by cervical dislocation. The maxillary first molar was then collected along with the surrounding tissue for further processing. Hematoxylin and eosin and immunohistochemical staining were used to observe the morphological effects. Proliferating Cell Nuclear Antigen (PCNA), STRO-1 and CD-44 were used as the primary antibodies for the immunohistochemical study.

RESULTS

A reduction in inflammatory cells, which were mainly composed of lymphocytes, was observed in the periapical lesions after PDT. The number of PCNA-positive cells increased to approximately twice in the PDT as compared to the control group. These PCNA-positive cells included STRO-1 and CD-44 positive cells, indicating enhancement of wound healing and reduction in inflammatory cells.

CONCLUSION

The findings of the present experimental study indicate that PDT application induced proliferation of PCNA-positive cells, which included STRO-1 and CD44-positive cells. This suggests that PDT may help to enhance healing periapical lesion, indicating the potential of PDT in the treatment of periapical periodontitis.

Effectiveness of mechanical debridement with and without antimicrobial photodynamic therapy against oral yeasts in children with gingivitis undergoing fixed orthodontic therapy

OBJECTIVE

The aim was to assess the effectiveness of mechanical debridement (MD) and antimicrobial photodynamic therapy (aPDT) against oral yeasts in children with gingivitis undergoing fixed orthodontic therapy (FOT).

METHODS

Individuals undergoing orthodontic treatment were included. Patients were randomly divided into 2-groups. In the test-group, patients underwent MD with adjuvant aPDT; and in the control-group, patients underwent MD alone. Demographic information was recorded using a questionnaire. An ultrasonic scaler was used to perform MD and aPDT was done using methylene blue and visible light. In both groups, gingival index, unstimulated whole salivary flow rate and oral yeasts counts were measured at baseline and compared at 6-months' follow-up. Group comparisons were performed and P < 0.05 was selected as an indicator of statistical significance.

RESULTS

Eighteen (10 males and 8 females) and 18 individuals (9 males and 9 females) were included in the test- and control groups. The mean age of individuals in the test and control groups were 16.6 ± 0.5 and 16.8 ± 0.4 years, respectively. At 6-months' follow-up, the GI was comparable among patients in the test- and control-group. In the test-group, the CFU/ml of oral yeasts were significantly higher at baseline compared with 6-months' follow-up (P < 0.05). In the control-group, there was no statistically significant difference in the CFU/ml of oral yeasts at baseline and 6-months' follow-up.

CONCLUSION

aPDT is a useful adjuvant to MD in reducing whole salivary oral yeasts counts among adolescents undergoing orthodontic treatment. In the sort-term, MD with and without aPDT is useful in reducing GI in adolescents undergoing orthodontic treatment.

Antimicrobial efficacy of 0.8% Hyaluronic Acid and 0.2% Chlorhexidine against Porphyromonas gingivalis strains: An in-vitro study

Objective:

The aim of the present in-vitro study was to assess antimicrobial efficacy of 0.8% hyaluronic acid (HA) and 0.2% Chlorhexidine gluconate (CHX) against Porphyromonas gingivalis (P. gingivalis).

Methods:

The study was performed between December 2018 and March 2019 at the College of Dentistry at the Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. The P. gingivalis biofilms were formed and grown for 72 hours at 37°C under anaerobic conditions on glass slides coated with human saliva. The slides were individually positioned and exposed to 0.8% HA or 0.2% CHX. Therapeutically, the biofilms were divided into 3 groups as follows: (a) negative group; (b) 0.8% HA group and (c) 0.2% CHX group. P-values less than 0.05 were considered statistically significant.

Results:

In the 0.8% HA group, P. gingivalis CFUs/ml were significantly higher at baseline than at 24- (P<0.05), 48 (P<0.05) and 72 hours (P<0.05) intervals. In the 0.2% CHX group, P. gingivalis CFUs/ml were significantly higher at baseline than at 72 hours interval (P<0.05). In the CHX group, there was no difference in P. gingivalis CFUs/ml between baseline, 24- and 48-hours intervals. At 48- and 72-hours intervals, the P. gingivalis CFUs/ml were significantly higher in the 0.2% CHX group compared with the 0.8% HA group.

Conclusion:

In-vitro, 0.8% HA is more effective in reducing the P. gingivalis CFUs/ml compared with 0.2% CHX.

Antimicrobial Photodynamic Therapy Using a Chloro-Aluminum Phthalocyanine Adjuvant to Nonsurgical Periodontal Treatment Does Not Improve Clinical Parameters in Patients with Chronic Periodontitis

Background and objective: To evaluate the effects of antimicrobial photodynamic therapy (aPDT) with chloro-aluminum phthalocyanine (AlClFc) adjuvant to scaling and root planing (SRP) on periodontal clinical parameters of patients with chronic periodontitis. Materials and methods: Fifty-four periodontal sites were randomly distributed into two groups: 27 in the test group (SRP+aPDT)-using a low-power laser application Photon Lase III (DMC Equipamentos Ltda, São Carlos, São Paulo, Brazil) with operational parameters of 660 nm and 100 mW for 15 sec, and 27 in the control group (SRP). SRP was performed in a single session and the periodontal clinical parameters such as visible plaque index, bleeding on probing (BOP), probing depth (PD), and clinical attachment level were assessed at the baseline (T₀) and 3 months after aPDT (T₃). Results: Regarding BOP, a decrease in both treatment groups, the test group (p = 0.003) and control group (p = 0.001), was reported between T₀ and T₃. A reduction in PD and clinical insertion gain for both treatment groups (p < 0.05) after 3 months of therapy was observed, although nonsignificant (p > 0.05) in intergroup comparison. Conclusions: aPDT with AlClFc adjuvant to SRP did not provide additional benefits in reducing PD and clinical insertion gain.

Current Knowledge on Correlations Between Highly Prevalent Dental Conditions and Chronic Diseases: An Umbrella Review

Introduction

Studies have investigated the relationships between chronic systemic and dental conditions, but it remains unclear how such knowledge can be used in clinical practice. In this article, we provide an overview of existing systematic reviews, identifying and evaluating the most frequently reported dental–chronic disease correlations and common risk factors.

Methods

We conducted a systematic review of existing systematic reviews (umbrella review) published between 1995 and 2017 and indexed in 4 databases. We focused on the 3 most prevalent dental conditions and 10 chronic systemic diseases with the highest burden of disease in Germany. Two independent reviewers assessed all articles for eligibility and methodologic quality using the AMSTAR criteria and extracted data from the included studies.

Results

Of the initially identified 1,249 systematic reviews, 32 were included for qualitative synthesis. The dental condition with most frequently observed correlations to chronic systemic diseases was periodontitis. The chronic systemic disease with the most frequently observed correlations with a dental condition was type 2 diabetes mellitus (T2DM). Most dental–chronic disease correlations were found between periodontitis and T2DM and periodontitis and cardiovascular disease. Frequently reported common risk factors were smoking, age, sex, and overweight. Using the AMSTAR criteria, 2 studies were assessed as low quality, 26 studies as moderate quality, and 4 studies as high quality.

Conclusion

The quality of included systematic reviews was heterogeneous. The most frequently reported correlations were found for periodontitis with T2DM and for periodontitis with cardiovascular disease. However, the strength of evidence for these and other disease correlations is limited, and the evidence to assess the causality of these disease correlations remains unclear. Future research should focus on the causality of disease links in order to provide more decisive evidence with respect to the design of intersectoral care processes.

Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis

Background

Glycemic control is vital in the care of type 2 diabetes mellitus (T2DM) and is significantly associated with the incidence of clinical complications. This Bayesian network analysis was conducted with an aim of evaluating the efficacy of scaling and root planning (SRP) and SRP + adjuvant treatments in improving glycemic control in chronic periodontitis (CP) and T2DM patients, and to guide clinical practice.

Methods

We searched the Pubmed, Embase, Cochrane Library and Web of Science databases up to 4 May 2018 for randomized controlled trials (RCTs). This was at least three months of the duration of study that involved patients with periodontitis and T2DM without other systemic diseases given SRP. Patients in the control group did not receive treatment or SRP combination with adjuvant therapy. Outcomes were given as HbA1c% and levels fasting plasma glucose (FPG). Random-effects meta-analysis and Bayesian network meta-analysis were conducted to pool RCT data. Cochrane’s risk of bias tool was used to assess the risk of bias.

Results

Fourteen RCTs were included. Most were unclear or with high risk of bias. Compared to patients who did not receive treatment, patients who received periodontal treatments showed improved HbA1c% level, including SRP (the mean difference (MD) -0.399 95% CrI 0.088 to 0.79), SRP + antibiotic (MD 0.62, 95% CrI 0.18 to 1.11), SRP + photodynamic therapy (aPDT) + doxycycline (Doxy) (MD 1.082 95% CrI 0.13 to 2.077) and SRP + laser (MD 0.66 95% CrI 0.1037, 1.33). Among the different treatments, SRP + aPDT + Doxy ranked best. Regarding fasting plasma glucose (FPG), SRP did not show advantage over no treatment (MD 4.91 95% CI − 1.95 to 11.78) and SRP with adjuvant treatments were not better than SRP alone (MD -0.28 95% CI -8.66, 8.11).

Conclusion

The results of this meta-analysis seem to support that periodontal treatment with aPDT + Doxy possesses the best efficacy in lowering HbA1c% of non-smoking CP without severe T2DM complications. However, longer-term well-executed, multi-center trails are required to corroborate the results.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0829-y) contains supplementary material, which is available to authorized users.

Effects of a full-mouth disinfection protocol on the treatment of type-2 diabetic and non-diabetic subjects with mild-to-moderate periodontitis: one-year clinical outcomes

OBJECTIVES

This study compared the clinical effects of a full-mouth disinfection (FMD) protocol for the treatment of mild-to-moderate periodontitis in type 2 diabetic and non-diabetic subjects for up to 1 year. Secondary aim was to evaluate the effects of this therapy on the salivary levels of periodontal pathogens between diabetics and non-diabetics.

MATERIAL AND METHODS

Twenty-six type 2 diabetic subjects and 28 non-diabetic subjects with mild-to-moderate periodontitis received full-mouth scaling and root planing within 24 h, application of chlorhexidine digluconate (CHX) gel in pockets and tongue plus CHX rinses for 14 days. Clinical monitoring was performed at baseline, 3, 6, and 12 months post-therapy. Salivary levels of red complex bacterial species were evaluated at baseline, 6, and 12 months post-therapy by qPCR.

RESULTS

Intention-to-treat analyses were performed for seven diabetics and three non-diabetics that did not return for the 12-month evaluation. Most clinical parameters improved significantly at 3, 6, and 12 months post-therapies for both groups (p < 0.05). Overall, there were no significant differences in clinical parameters between groups after therapy (p > 0.05). At 1 year, 39.3% and 50.0% of the non-diabetic and diabetic subjects, respectively, achieved the desired clinical endpoint for treatment (≤ 4 sites with probing depth ≥ 5 mm) (primary outcome variable) (p > 0.05). FMD did not promote changes in the salivary levels of pathogens in either of the groups (p > 0.05). Levels of T. forsythia were lower in diabetic than in non-diabetic subjects at 6 months post-therapy (p < 0.05).

CONCLUSIONS

Type 2 diabetic subjects and systemically healthy subjects with mild-to-moderate periodontitis responded similarly to the proposed FMD protocol for up to 1 year.

CLINICAL RELEVANCE

There is a general thought that diabetics do not answer as well as non-diabetics to periodontal treatments. However, this study showed that diabetics and non-diabetics respond equally to the FMD protocol.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02643771.

Systematic review and meta-analysis of double-blind, placebo-controlled, randomized clinical trials using probiotics in chronic periodontitis

AIM

The aim of the present study was to evaluate the efficacy of probiotics as an adjunct to scaling and root planning (SRP) in the treatment of chronic periodontitis (CP).

METHODS

The focused question of the study was: Does adjunctive use of probiotics yield better clinical periodontal outcomes compared to placebo/no treatment group in the treatment of CP? Electronic and manual literature searches were conducted up to December 2017 using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register. Forest plots were computed reporting weighted mean difference (WMD) of outcomes and 95% confidence intervals (CI).

RESULTS

Seven clinical studies were included. Four studies showed additional benefits in reducing periodontal probing depth (PPD) and gaining clinical attachment level (CAL), whereas, three studies showed comparable clinical periodontal outcomes between probiotics and SRP/placebo. Significant heterogeneity was observed for PPD reduction and CAL gain. The overall mean difference for CAL gain between probiotics and placebo/SRP was significant (WMD = 1.41, 95% CI = 0.15-2.67, P = .028) at follow up.

CONCLUSION

Adjunctive probiotics could result in additional benefits in CAL gain in CP. Nevertheless, further high-quality randomized clinical trials with microbiological outcomes are warranted to obtain strong conclusions in this regard.