Is adjunctive photodynamic therapy more effective than scaling and root planing alone in the treatment of periodontal disease in hyperglycemic patients? A systematic review

A histological evaluation of the mice oral mucosal tissue wounds excised with diode laser, Er:YAG laser, and cold scalpel

Laser has been considered to show many favorable characteristics, including wound healing acceleration, hemostasis, biostimulation, and microbial inhibition. Previous studies have investigated the effect of laser treatment during the process of wound healing, with conflicting results. To date, there is still no unified conclusion on the effect and application principle of clinical laser therapy. This study evaluated the incision morphology, wound healing speed, and histological changes in mice oral mucosal wounds excised with diode laser, Er:YAG laser, and cold scalpel. The results showed that compared with the cold scalpel group, laser treatments caused more tissue thermal damage and carbonization, which led to a healing delay. However, lasers also showed some advantages, including hemostasis, regular incision, and immune response mobilization, suggesting that lasers may be beneficial in some specific cases, such as reducing intraoperative accidents and wound tissue laceration and controlling bleeding and postoperative infection. This study provides a theoretical basis for clarifying the effect of laser treatments and their clinical application principle.

Superparamagnetic Iron Oxide Nanoparticles Protect Human Gingival Fibroblasts from Porphyromonas gingivalis Invasion and Inflammatory Stimulation

Introduction

Modulating the inflammatory response of human gingival fibroblasts (hGFs) is important for the control of periodontal inflammation because it is a key event in the pathogenesis of periodontitis. Here, we aimed to determine whether polyglucose sorbitol carboxymethyl ether (PSC)-coated superparamagnetic iron oxide nanoparticles (SPIONs) protect hGFs against invasion and inflammatory stimulation by Porphyromonas gingivalis (P. gingivalis).

Methods

First, we determined the cytotoxicity and antimicrobial activity of PSC-SPIONs. Then, their effects on invasion of hGFs by P. gingivalis were evaluated by counting invading P. gingivalis, fluorescence staining, and transmission electron microscopy. The effect of PSC-SPIONs on inflammation in hGFs induced by P. gingivalis lipopolysaccharide was evaluated by measurement of reactive oxygen species (ROS), and enzyme-linked immunosorbent assays, quantitative reverse transcription-polymerase chain reaction, and Western blotting of key indicator molecules. The effects of dimercaptosuccinic acid (DMSA)-coated SPIONs and the free form of PSC alone were also tested and compared with those of PSC-SPIONs.

Results

PSC-SPIONs (25 μg/mL) are cytocompatible with hGFs and exhibit no antimicrobial effects on P. gingivalis. However, they inhibit invasion of hGFs by P. gingivalis at 15 μg/mL. They also decrease ROS production and inflammatory cytokine secretion by hGFs at 5, 15, and 25 μg/mL, by downregulating activation of the nuclear factor-kappa B signaling pathway. Furthermore, PSC alone does not inhibit inflammation, while DMSA-SPIONs do. This indicates that the nanosize effects of PSC-SPIONs, rather than their coating material, play the dominant role in their anti-inflammatory activity.

Conclusion

PSC-SPIONs protect hGFs against P. gingivalis invasion and inflammatory stimulation. Thus, they have potential for clinical application in control of periodontal inflammation.

Effectiveness of antimicrobial photodynamic therapy as an adjunct to mechanical instrumentation in reducing counts of Enterococcus faecalis and Candida albicans from C-shaped root canals

BACKGROUND/PURPOSE

The aim was to assess the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical instrumentation (MI) in reducing Enterococcus faecalis (E faecalis) and Candida albicans (C albicans) counts from C-shaped root-canals.

METHODS

Teeth with C-shaped canals as identified on cone beam computed tomographic images were included. Following incubation with E faecalis and C albicans, samples were divided into 4 groups a four follows: Group-1: MI with adjunct aPDT; Group-2: aPDT alone; Group-3: MI alone; and Group-4: no treatment. The pulp chambers of these teeth were exposed and coronal pulp was mechanically derided using sterile endodontic excavators. Using flexible files, all canals were debrided up to size #30 K-files with intermittent irrigation with 2.5% sodium hypochlorite irrigation. In Groups 1 and 3, methylene-blue was injected in all canals and aPDT was performed using a 600 nm diode laser. Sample-size estimation was done on data from a pilot investigation and group-comparisons were done using one way analysis of variance and Bonferroni post-hoc adjustment tests. P < .05 was considered statistically significant.

RESULTS

Sixty periodontally hopeless mandibular second molars with C-shaped canals were included. There was a statistically significant reduction CFU/mL of E faecalis (P < .001) and C albicans (P < .001). At post-operative microbial assessments in Group-1. There was no difference CFU/mL of E faecalis and C albicans at post-operative microbial assessments in Groups 2-4.

CONCLUSION

MI with adjunct aPDT is more effective in reducing count of E faecalis and C albicans from C-shaped root canals.

LASER in periodontal treatment: is it an effective treatment or science fiction?

There are several studies that evaluate the use of lasers in periodontal treatment in non-surgical or surgical therapy. However, while several studies showed clinically beneficial effects of some lasers in periodontal treatment, there are few clinical reports of additional advantages of lasers as adjunctive treatments in periodontology. The aim of this paper is to demonstrate and critically analyze the level of scientific evidence of effects of low-level lasers and high-power lasers in periodontology. A narrative review of the studies was carried out in each topic and type of laser or periodontal treatment. In nonsurgical periodontal therapy the results showed that there is an additional clinical benefit when using a diode laser (DL) associated with scaling and root planing (SRP) in patients with moderate to severe periodontitis. The Er:YAG laser seems to be the most suitable for nonsurgical periodontal therapy and promotes the same clinical effects as conventional therapy. In periodontal surgery vaporization of the gingival or mucosal tissue can be carried out with DL, CO2, Nd:YAG, Er:YAG and Er,Cr:YSGG lasers. Photobiomodulation (PBM), mediated by low-level lasers associated with non-surgical periodontal therapy, promotes additional benefits in the short term and accelerates the bone and gingival tissue repair process and also reduces postoperative symptoms of periodontal surgery. The effect of antimicrobial Photodynamic Therapy is relevant in the initial reevaluation periods. Studies have shown controversial results of the use of lasers in periodontics, and this fact may be due to the lack of standard parameters of irradiation in each clinical application.

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.

Effectiveness of Riboflavin and Rose Bengal Photosensitizer Modified Adhesive Resin for Orthodontic Bonding

This study aimed to evaluate the effect of riboflavin (RF) and Rose Bengal (RB) photosensitizer modified adhesive resin on the degree of conversion (DC), and antimicrobial capacity after bonded to tooth surface. Different concentrations of RB and RF were prepared by homogenization method. An ultraviolet light source A (UVA) (375 nm wavelength, 3 mW/cm² power) was used for 30 min irradiation. FTIR was performed for control and test adhesives to analyze the DC. Antibacterial testing was performed using the MTT assay. Metal brackets were bonded using the modified adhesives and subjected for SEM examination. The surfaces of teeth and metal brackets were examined at ×10 magnification for assessing adhesive remnant index (ARI) after PDT, 24 h and thermocycling. For DC, control group, 0.1% RB and RF after PDT showed the highest value. SEM imaging indicated lowest growth of Streptococcus mutans over 0.5% of RB-PDT and RF-PDT as compared to the control group. The MTT assay outcomes reported that the activity of S. mutans substantially decreased with the addition of a high amount of either RB or RF (p < 0.01). Mean ARI scores showed a significant difference between all groups. This study concluded that 0.1% of either RB or RF after PDT can be used for bonding orthodontic brackets to the tooth surface with substantial antibacterial properties.

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.

Role of probiotics for the treatment of peri-implant mucositis in patients with and without type-2 diabetes mellitus

The hypothesis was that probiotic therapy (PT) does not offer additional benefits to mechanical debridement (MD) for treatment of diabetic subjects with peri-implant mucositis (PM). This study compared the influence of PT as an adjunct to MD for the treatment of PM in type2 diabetic and non-diabetic patients over a 12-month follow-up period. Patients with and without type-2 diabetes were encompassed. Based upon treatment-procedure, PM patients were categorized into 2 groups: (a) Non-surgical + PT; and (b) Group-2: Non-surgical MD alone. Demographics and education statuses were recorded. Gingival (GI) and plaque (PI) indices, crestal bone loss (CBL) and probing depth (PD were measured at baseline and after 6- and 12-months. Significant differences were detected with P<0.01. The HbA1c was significantly higher in diabetic patients at all time durations than patients without type-2 diabetes (P<0.001). Baseline GI, PI, PD and CBL) were comparable in all groups. In patients with type-2-diabetes, there was no difference in PI, GI, PD and CBL at 6- and 12-months' follow-up. In patients without type-2 diabetes, there was a significant reduction in PI (P<0.01), GI (P<0.01), and PD (P<0.01) at 6-months and 1-year follow-up than their values at baseline. In patients without type-2 diabetes, MD with or without adjunct PT reduces soft tissue inflammatory parameters in patients with PM.

Photodynamic therapry with curcumin in the reduction of enterococcus faecalis biofilm in bone cavity: rMicrobiological and spectral fluorescense analysis

BACKGROUND

Antimicrobial photodynamic therapy (PDT) has emerged as a therapeutic strategy to conventional procedures using antibiotics.

OBJECTIVE

To evaluate the antimicrobial effectiveness of PDT using blue light emitting diode (LED) associated with curcumin on biofilms of Enterococcus faecalis in bovine bone cavities and also to analyze the presence of these biofilms through spectral fluorescence.

MATERIALS AND METHODS

Standardized suspensions of E. faecalis (ATCC 29212) were incubated in artificial bone cavities for 14 days at 36 °C ± 1 °C for biofilm formation. The test specimens were distributed among the four experimental groups (n = 10): L-C- (control), L + C- (LED for 5 min), L-C+ (curcumin for 5 min) and L + C+ (PDT). Aliquots were collected from the bone cavities after treatments and seeded on BHI agar for 24 h at 36 °C ± 1 °C for CFU count. Before and after each treatment the specimens were submitted to spectral fluorescence, whose images were compared in the Image J program. The log10 CFU/mL results were submitted to the Kruskal-Wallis test (5%) and the biofilm fluorescence spectroscopy results were submitted to the Wilcoxon test (5%).

RESULTS

All treatments presented statistical difference when compared to the control, and PDT was responsible for the largest reduction (1.92 log10 CFU/mL). There was a reduction in the fluorescence emitted after the treatments, with greater statistical difference in the PDT group.

CONCLUSION

PDT was efficient in the reduction of E. faecalis biofilms. In all groups post treatment there was a significant reduction of biofilms in the fluorescence spectroscopy images with greater reduction in the PDT group.

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.

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.

Tetracyclines: light-activated antibiotics?

Tetracyclines are well established antibiotics but show phototoxicity as a side effect. Antimicrobial photodynamic inactivation uses nontoxic dyes combined with harmless light to destroy microbial cells by reactive oxygen species. Tetracyclines (demeclocycline and doxycycline) can act as light-activated antibiotics by binding to bacterial cells and killing them only upon illumination. The remaining tetracyclines can prevent bacterial regrowth after illumination has ceased. Antimicrobial photodynamic inactivation can be potentiated by potassium iodide. Azide quenched the formation of iodine, but not hydrogen peroxide. Demeclotetracycline (but not doxycycline) iodinated tyrosine after light activation in the presence of potassium iodide. Bacteria are killed by photoactivation of tetracyclines in the absence of oxygen. Since topical tetracyclines are already used clinically, blue light activation may increase the bactericidal effect.