Scope of antimicrobial photodynamic therapy in Orthodontics and related research: A review

Efficient Strategies to Use β-Cationic Porphyrin-Imidazolium Derivatives in the Photoinactivation of Methicillin-Resistant Staphylococcus aureus

Bacterial resistance to antibiotics is a critical global health issue and the development of alternatives to conventional antibiotics is of the upmost relevance. Antimicrobial photodynamic therapy (aPDT) is considered a promising and innovative approach for the photoinactivation of microorganisms, particularly in cases where traditional antibiotics may be less effective due to resistance or other limitations. In this study, two β-modified monocharged porphyrin-imidazolium derivatives were efficiently incorporated into polyvinylpyrrolidone (PVP) formulations and supported into graphitic carbon nitride materials. Both porphyrin-imidazolium derivatives displayed remarkable photostability and the ability to generate cytotoxic singlet oxygen. These properties, which have an important impact on achieving an efficient photodynamic effect, were not compromised after incorporation/immobilization. The prepared PVP-porphyrin formulations and the graphitic carbon nitride-based materials displayed excellent performance as photosensitizers to photoinactivate methicillin-resistant Staphylococcus aureus (MRSA) (99.9999% of bacteria) throughout the antimicrobial photodynamic therapy. In each matrix, the most rapid action against S. aureus was observed when using PS 2. The PVP-2 formulation needed 10 min of exposure to white light at 5.0 µm, while the graphitic carbon nitride hybrid GCNM-2 required 20 min at 25.0 µm to achieve a similar level of response. These findings suggest the potential of graphitic carbon nitride-porphyrinic hybrids to be used in the environmental or clinical fields, avoiding the use of organic solvents, and might allow for their recovery after treatment, improving their applicability for bacteria photoinactivation.

Photodynamic antimicrobial therapy (AmPDT) using 1,9-Dimethyl-Methylene Blue zinc chloride double salt - DMMB and λ640 ± 5ηm LED light in patients undertaking orthodontic treatment

Orthodontic treatment involves the use of apparatuses that impairs oral hygiene making patients susceptible to periodontal diseases and caries. To prevent increased antimicrobial resistance AmPDT has shown itself a feasible option. The aim of this investigation was to assess the efficiency of AmPDT employing 1,9-Dimethyl-Methylene Blue zinc chloride double salt - DMMB as a photosensitizing agent combined with red LED irradiation (λ640 ± 5 ηm) against oral biofilm of patients undertaking orthodontic treatment. Twenty-one patients agreed to participate. Four biofilm collections were carried out on brackets and gingiva around inferior central incisors; first was carried out before any treatment (Control); second followed five minutes of pre-irradiation, the third was immediately after the first AmPDT, and the last after a second AmPDT. Then, a microbiological routine for microorganism growth was carried out and, after 24-h, CFU counting was performed. There was significant difference between all groups. No significant difference was seen between Control and Photosensitizer and AmpDT1 and AmPDT2 groups. Significant differences were observed between Control and AmPDT1 and AmPDT2 groups, Photosensitizer and AmPDT1 and AmPDT2 groups. It was concluded that double AmPDT using DMBB in nano concentration and red LED was capable to meaningfully decrease the number of CFUs in orthodontic patients.

Antimicrobial efficacy, optical properties and flexural strength following antimicrobial photodynamic therapy over vacuum-formed orthodontic retainers

BACKGROUND AND AIMS

Vacuum-formed retainers (VFRs) are widely used in dental practices because of their superior esthetics. However, simultaneous maintenance of their hygiene, mechanical and optical properties is challenging. This study aimed to evaluate and compare the disinfection efficacy of antimicrobial photodynamic therapy (aPDT), chlorhexidine (CHX), sodium hypochlorite (NaOCl) and water over VFRs specimens, along with their effect on flexural strength and color stability.

MATERIALS AND METHODS

Fabricated VFRs of thicknesses 1 mm and 2 mm were contaminated with S. mutans and C. albicans. Brain Heart Infusion agar was used to seed Streptococcus Mutans whereas Candida Albicans was seeded in Sabourand Dextrose Agar. The contaminated retainers were divided into four groups and decontaminated using four different treatment protocols: aPDT, CHX, NaOCl and water, with 10 specimens per group. Microbial viability following decontamination, was assayed using MTT. To assess the color stability, pre and post decontamination color difference of 10 specimens was recorded using a spectrophotometer by blinding technique. The flexural strength of 10 specimens was measured using a universal testing machine by a standardized 3-point flexural strength (FS) test.

RESULT

aPDT showed the highest reduction in the viability of S. mutans (28%) and C. albicans (20%) species in 1 mm thickness group while the second highest reduction following disinfection with CHX (40%) in followed by NaOCl disinfection (50%). On comparison between 1 mm and 2 mm, a statistically significant difference was noted for S. mutans in aPDT (p = 0.033) and NaOCl (p = 0.028) groups, and for C. albicans, a significant difference was noted within NaOCl (p = 0.001) and CHX (p = 0.043) groups. For FS, a statistically significant difference (p < 0.05) was observed between aPDT and the rest of the groups, whereas there was no statistically significant difference in the flexural strength between the CHX, NaOCl and water groups (p > 0.05) in both 1 mm and 2 mm specimens. Between 1 mm and 2 mm specimens, no statistically significant difference in the mean color difference was noted after any disinfection protocol (p > 0.05).

CONCLUSION

Antimicrobial photodynamic therapy showed a remarkable reduction in candidal and bacterial viability over VFRs. aPDT treated VFR specimens showed increased flexural strength and a higher color difference post treatment compared to other reagents.

Randomized and Controlled Clinical Studies on Antibacterial Photodynamic Therapy: An Overview

The emergence of drug-resistant bacteria is considered a critical public health problem. The need to establish alternative approaches to countering resistant microorganisms is unquestionable in overcoming this problem. Among emerging alternatives, antimicrobial photodynamic therapy (aPDT) has become promising to control infectious diseases. aPDT is based on the activation of a photosensitizer (PS) by a particular wavelength of light followed by generation of the reactive oxygen. These interactions result in the production of reactive oxygen species, which are lethal to bacteria. Several types of research have shown that aPDT has been successfully studied in in vitro, in vivo, and randomized clinical trials (RCT). Considering the lack of reviews of RCTs studies with aPDT applied in bacteria in the literature, we performed a systematic review of aPDT randomized clinical trials for the treatment of bacteria-related diseases. According to the literature published from 2008 to 2022, the RCT study of aPDT was mostly performed for periodontal disease, followed by halitosis, dental infection, peri-implantitis, oral decontamination, and skin ulcers. A variety of PSs, light sources, and protocols were efficiently used, and the treatment did not cause any side effects for the individuals.

Effects of curcumin-mediated photodynamic treatment on lipid degradation of oysters during refrigerated storage

BACKGROUND

Oyster's lipid degradation leads to a decrease in edible and nutritional value. Curcumin-mediated photodynamic treatment (PDT) is an innovative non-thermal technology, although evaluation of the oyster's lipid degradation has been scarce. In the present study, we investigated peroxide value, thiobarbituric acid reactive substance, triacylglycerol and free fatty acids to evaluate the effect of curcumin-mediated PDT on lipid degradation of oysters during refrigerated storage.

RESULTS

The results showed that curcumin-mediated PDT could delay oyster's lipid degradation. Next, the activities of enzymes were detected to determine the mechanisms behind the effects of curcumin-mediated PDT. It was revealed that the activities of lipase, phospholipase A₂ (PLA₂ ), phospholipase C (PLC), phospholipase D (PLD) and lipoxygenase (LOX) were significantly inhibited after curcumin-mediated PDT (P < 0.05). Furthermore, 16 s rRNA analysis established that the relative abundances of Pseudoalteromonas and Psychrilyobacter were reduced by 51.58% and 43.82%, respectively, after curcumin-mediated PDT.

CONCLUSION

Curcumin-mediated PDT could delay oyster's lipid degradation by inhibiting the activities of lipase, PLA₂ , PLC, PLD and LOX, as well as by changing the oyster's microbial composition, reducing the relative abundance of Pseudoalteromonas and Psychrilyobacter. © 2021 Society of Chemical Industry.

Photodynamic inactivation of planktonic Staphylococcus aureus by sodium magnesium chlorophyllin and its effect on the storage quality of lettuce

Photodynamic inactivation (PDI) is a fast and effective non-heat sterilization technology. This study established an efficient blue light-emitting diode (LED) PDI with the photosensitizer sodium magnesium chlorophyllin (SMC) to eradicate Staphylococcus aureus in food. The antibacterial mechanisms were determined by evaluating DNA integrity, protein changes, morphological alteration, and the potency of PDI to eradicate S. aureus on lettuce was evaluated. Results showed that planktonic S. aureus could not be clearly observed on the medium after treatment with 5.0 μmol/L SMC for 10 min (1.14 J/cm2). Bacterial cell DNA and protein were susceptible to SMC-mediated PDI, and cell membranes were found to be disrupted. Moreover, SMC-mediated PDI effectively reduced 8.31 log CFU/mL of S. aureus on lettuce under 6.84 J/cm2 radiant exposure (30 min) with 100 μmol/L SMC, and PDI displayed a potent ability to restrain the weight loss as well as retard the changes of color difference of the lettuce during 7 day storage. The study will enrich our understanding of the inactivation of S. aureus by PDI, allowing for the development of improved strategies to eliminate bacteria in the food industry.

Photodynamic Therapy in Orthodontics: A Literature Review

Treatment of malocclusions using fixed orthodontic appliances makes it difficult for patients to perform hygiene procedures. Insufficient removal of bacterial biofilm can cause enamel demineralization, manifesting by visible white spot lesions or periodontal diseases, such as gingivitis periodontitis or gingival hyperplasia. The classic methods of preventing the above problems include, in addition to proper hygiene, ultrasonic scaling, periodontal debridement, and oral rinses based on chlorhexidine. New alternative methods of reducing plaque around brackets are being developed. There is a growing interest among researchers in the possibility of using photodynamic therapy in orthodontics. A literature search for articles corresponding to the topic of this review was performed using the PubMed and Scopus databases and the following keywords: ‘photodynamic therapy’, ‘orthodontics’, and ‘photosensitizer(s)’. Based on the literature review, two main directions of research can be distinguished: clinical research on the use of photodynamic therapy in the prevention of white spot lesions and periodontal diseases, and ex vivo research using a modified orthodontic adhesive by adding photosensitizers to them. Methylene blue is the most frequently used photosensitizer in clinical trials. The effectiveness of antimicrobial photodynamic therapy is mainly compared to the ultrasonic scaler as a single therapy or as an adjunct to the ultrasonic scaler. In their conclusions, the researchers most often emphasize the effectiveness of antimicrobial photodynamic therapy in reducing microbial levels in patients treated with fixed appliances and the possibility of using it as an alternative to routine procedures aimed at maintaining a healthy periodontium. The authors suggest further research on the use of photodynamic therapy to prove the validity of this method in orthodontics. It should also not be forgotten that proper hygiene is the basis for maintaining oral cavity health, and its neglect is a contraindication to orthodontic treatment.

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.

Carbon Nanodots in Photodynamic Antimicrobial Therapy: A Review

Antibiotic resistance development in bacteria is an ever-increasing global health concern as new resistant strains and/or resistance mechanisms emerge each day, out-pacing the discovery of novel antibiotics. Increasingly, research focuses on alternate techniques, such as antimicrobial photodynamic therapy (APDT) or photocatalytic disinfection, to combat pathogens even before infection occurs. Small molecule "photosensitizers" have been developed to date for this application, using light energy to inflict damage and death on nearby pathogens via the generation of reactive oxygen species (ROS). These molecular agents are frequently limited in widespread application by synthetic expense and complexity. Carbon dots, or fluorescent, quasi-spherical nanoparticle structures, provide an inexpensive and "green" solution for a new class of APDT photosensitizers. To date, reviews have examined the overall antimicrobial properties of carbon dot structures. Herein we provide a focused review on the recent progress for carbon nanodots in photodynamic disinfection, highlighting select studies of carbon dots as intrinsic photosensitizers, structural tuning strategies for optimization, and their use in hybrid disinfection systems and materials. Limitations and challenges are also discussed, and contemporary experimental strategies presented. This review provides a focused foundation for which APDT using carbon dots may be expanded in future research, ultimately on a global scale.

Role of Probiotics in Oral Health Maintenance Among Patients Undergoing Fixed Orthodontic Therapy: a Systematic Review of Randomized Controlled Clinical Trials

The aim was to assess the role of probiotics in oral health maintenance among patients undergoing fixed orthodontic therapy (OT). An unrestricted search of indexed databases was performed until April 2020 using the following Mesh-terms: (1) probiotic and (2) orthodontic. Randomized controlled clinical trials (RCTs) evaluating the influence of probiotic therapy (PT) towards oral health maintenance/improvement in patients undergoing fixed OT were included. Data screening, selection, and extraction were performed; and the risk of bias was assessed using the Cochrane Collaboration's tool. All evaluations were performed by 2 independent researchers; and disagreements were resolved via discussion. Nine RCTs were included. Eight studies reported that PT improves oral health in patients undergoing fixed OT. Seven studies showed that PT reduces the counts of oral pathogenic bacteria in the oral biofilm and/or saliva. One study reported that PT reduces halitosis in patients undergoing fixed OT. One study found that PT reduces the scores of plaque index (PI) and gingival index (GI); and one study reported that PT has no significant influence on PI and GI in patients undergoing fixed OT. One study reported that PT does not prevent the formation of white spot lesions during fixed OT. Three and 6 studies had a moderate and low risk of bias, respectively. A power analysis was performed in 4 studies. In conclusion, probiotics exhibit antimicrobial activity against oral pathogenic bacteria; however, due to the limitations of the studies assessed, further well-designed RCTs are needed.

Synthesized OH-radical rich bacteria cellulosic pockets with photodynamic bacteria inactivation properties against S. ureus and E. coli

Inulin as an external carbon source was used as the fructose substitute to Gluconacetobacter xylinus (ATCC 10245) bacterial strain in a successful synthesis of cellulosic pockets to be used in drug delivery and storage. It was observed that inulobiose trans conformation was in agreement with ϕ = Ψ = ω = 180° and angular rotation of ϴ (C1-C2-0-CI''), ϴ (C2-0-C 1'-C2') and ϴ (0-C1'-C2'-0') respectively. A bacterial susceptibility test revealed a successful inactivation of Staphylococcus aureus and Escherichia coli in the presence of photons. Fourier Transform Infrared Spectroscopy analysis confirmed an OH absorption was verified at 3423 cm^-1. Pocket drug uptake test revealed a highly absorbent structure with the thermal stability directly proportional to the increase in drug uptake, while the increase in the degree of polymerization resulted in the increase in antioxidant activity and rate of bacterial inactivation. HYPOTHESIS: Inulin as an inert polysaccharide is neutral to cellular activity, therefore, could not be an agent for bacteria inactivation.

Inactivation of microbes on fruit surfaces using photodynamic therapy and its influence on the postharvest shelf-life of fruits

In this study, the disinfection effect of curcumin-mediated photodynamic therapy on the contact surfaces of fresh fruit was investigated. Our results showed that the optimum concentration of curcumin and the energy density required were 0.5 μM and 7.2 J/cm², respectively. Photodynamic therapy showed an excellent disinfection rate for the fresh fruits with a reduction of more than 80% in the total bacteria and coliform counts. The photodynamic therapy inhibited species that belonged to the categories of gram-negative and facultative anaerobic bacteria, except for two species of the Trichoderma fungus. Importantly, photodynamic therapy prolonged the shelf-life of grapes for two days at room temperature. Therefore, photodynamic therapy should be commercialized as a high efficiency and non-thermal sterilization technology for use in the food industry.

Oxygen-Independent Antimicrobial Photoinactivation: Type III Photochemical Mechanism?

Since the early work of the 1900s it has been axiomatic that photodynamic action requires the presence of sufficient ambient oxygen. The Type I photochemical pathway involves electron transfer reactions leading to the production of reactive oxygen species (superoxide, hydrogen peroxide, and hydroxyl radicals), while the Type II pathway involves energy transfer from the PS (photosensitizer) triplet state, leading to production of reactive singlet oxygen. The purpose of the present review is to highlight the possibility of oxygen-independent photoinactivation leading to the killing of pathogenic bacteria, which may be termed the "Type III photochemical pathway". Psoralens can be photoactivated by ultraviolet A (UVA) light to produce DNA monoadducts and inter-strand cross-links that kill bacteria and may actually be more effective in the absence of oxygen. Tetracyclines can function as light-activated antibiotics, working by a mixture of oxygen-dependent and oxygen independent pathways. Again, covalent adducts may be formed in bacterial ribosomes. Antimicrobial photodynamic inactivation can be potentiated by addition of several different inorganic salts, and in the case of potassium iodide and sodium azide, bacterial killing can be achieved in the absence of oxygen. The proposed mechanism involves photoinduced electron transfer that produces reactive inorganic radicals. These new approaches might be useful to treat anaerobic infections or infections in hypoxic tissue.

Advancing antimicrobial strategies for managing oral biofilm infections

Effective control of oral biofilm infectious diseases represents a major global challenge. Microorganisms in biofilms exhibit increased drug tolerance compared with planktonic cells. The present review covers innovative antimicrobial strategies for controlling oral biofilm-related infections published predominantly over the past 5 years. Antimicrobial dental materials based on antimicrobial agent release, contact-killing and multi-functional strategies have been designed and synthesized for the prevention of initial bacterial attachment and subsequent biofilm formation on the tooth and material surface. Among the therapeutic approaches for managing biofilms in clinical practice, antimicrobial photodynamic therapy has emerged as an alternative to antimicrobial regimes and mechanical removal of biofilms, and cold atmospheric plasma shows significant advantages over conventional antimicrobial approaches. Nevertheless, more preclinical studies and appropriately designed and well-structured multi-center clinical trials are critically needed to obtain reliable comparative data. The acquired information will be helpful in identifying the most effective antibacterial solutions and the most optimal circumstances to utilize these strategies.

Oral microbiological control by photodynamic action in orthodontic patients

BACKGROUND

Orthodontics involves diagnosis and treatment of dental and skeletal malocclusions. Orthodontic apparatus may repair these malocclusions but may also impair oral hygiene making patients prone to develop both periodontal diseases and caries. Antimicrobial agents may be used to prevent this.To avoid increased antimicrobial resistance to available drugs, A-PDT (Antimicrobial Photodynamic Therapy) appears as a viable alternative.

OBJECTIVE

This work aimed to evaluate the efficacy of A-PDT on reducing the number of colony forming units (CFU) through the use of phenothiazine compound (methylene blue+ toluidine blue) as a photosensitizer, associated with red LED (λ640±5ηm) irradiation in orthodontic patients.

METHODOLOGY

Twenty-one patients consented to participate in the study. Three biofilm collections were performed around the brackets and gums of the inferior central incisors; first before any intervention (Control); second after 5min of pre-irradiation and the last one immediately after AmPDT. Subsequently, a microbiological routine for microorganism growth period were performed and CFU counting after a 24h done.

RESULTS

The data showed that the AmPDT was able to reduce CFU count around 90% when compared to Control group (p=0.007) and also between the A-PDT and Photosensitizer groups (p=0.010). However, there were no differences between the Control and Photosensitizer groups.

CONCLUSION

A-PDT associated with the use of phenothiazine compounds and red LED was able to significantly reduce the number of CFUs in orthodontic patients.