Efficacy of photodynamic therapy and periodontal treatment in patients with gingivitis and fixed orthodontic appliances: Protocol of randomized, controlled, double-blind study

Evaluation of a new mouthwash formulated with Chlorhexidine and Cymenol after a scaling and root planing treatment in grade I and II periodontal patients

BACKGROUND

Periodontal disease (PD) is a chronic inflammatory disease of multifactorial origin that affects the supporting tissues of the tooth. According to WHO in 2022, severe periodontal disease will affect around 19% of the adult population worldwide. Its risk factors include the presence of periodontopathogenic bacteria in biofilm and the susceptibility of the host's immune system, among others. Preterm birth is defined as birth occurring before 37 weeks of gestational age. It also has a multifactorial origin and it's associated with risk factors such as intrauterine and extrauterine infections. There is a possibility that periodontal disease in pregnant women increases the risk of preterm birth through hematogenous pathways or the presence and intervention of inflammatory mediators.

MATERIAL AND METHODS

Through a systematic review of existing scientific articles from 2014 to 2024, five randomized clinical trials were selected, including a total of 1984 pregnant patients diagnosed with periodontal disease. Half of these patients received non-surgical treatment, while the other half did not, aiming to evaluate a possible association between periodontal disease and/or its treatment and the occurrence of preterm birth. The risk of bias was assessed using the Cochrane "RoB 2" tool, and finally, a meta-analysis was conducted to compare the results obtained in the selected studies.

RESULTS

Four articles showed a trend favoring non-surgical periodontal treatment as a preventive measure for preterm birth. These articles accounted for 92.2% of the total weight, while the remaining 7.85% corresponded to the single article that did not favor the treatment. However, none of the articles showed statistically significant results.

CONCLUSIONS

There is no demonstrated association between periodontal disease in pregnant women and the incidence of preterm birth. On the other hand, there is a slightly favorable trend towards non-surgical periodontal treatment during pregnancy as a measure to reduce the incidence of preterm birth, but it's not statistically significant. To obtain a definitive answer, more randomized clinical trials following similar study and design parameters are needed.

Microbiological and Imaging-Based Evaluations of Photodynamic Therapy Combined with Er:YAG Laser Therapy in the In Vitro Decontamination of Titanium and Zirconia Surfaces

The oral cavity's soft and hard tissues create a conducive environment for microbial proliferation and biofilm development, facilitating the colonization of prosthodontic and implant materials such as titanium (Ti) and zirconia (Zr). This study aimed to compare the efficacy of conventional decontamination methodologies (i.e., chemical and mechanical, using 0.12% digluconate chlorhexidine (CHX) solution-treatment and airflow) to adjunctive laser-based interventions on Ti and Zr substrates inoculated with Staphylococcus (S.) aureus ATCC 25923. Additionally, this investigation sought to elucidate the impact of these treatments on temperature variations and surface integrity, analyzing the laser irradiation effects on these prevalent dental materials. Experimental configurations were delineated for both Ti and Zr samples across four groups: (1) a conventional treatment group (CV); (2) a photodynamic therapy group (PDT); (3) an Er:YAG laser treatment group (Er); (4) a combined PDT and Er:YAG treatment group (PDTEr). Also, a negative control group (C) that received no treatment was considered. The decontamination of the inoculated disc samples was evaluated by quantifying the microbial colonies in colony-forming units per milliliter (CFU/mL). Temperature variations on the surface of the samples were determined during laser treatments. Surface modifications were investigated using scanning electron microscopy (SEM) and optical coherence tomography (OCT). For statistical analysis, Fisher 95% confidence intervals, Hsu's MCB method, and the Kruskal-Wallis test were applied. With regard to the 105 CFU/mL of the negative control group, results indicated average values equal for each study group to (1) 2.66 CFU/mL for Ti and 2 CFU/mL for Zr for the CV group; (2) 0.33 CFU/mL for Ti and 1 CFU/mL for Zr for the PDT group; (3) 1.25 CFU/mL for Ti and 0 CFU/mL for Zr for the Er group; (4), and 0 CFU/mL for both Ti and Zr for the PDTEr group. Therefore, the combined PDT and Er:YAG treatment (PDTEr) and the singular PDT modality outperformed conventional decontamination methods in eradicating S. aureus biofilms from both Ti and Zr surfaces. Notably, the PDTEr regime achieved a comprehensive elimination of microbial colonies on treated substrates. Surface examination employing OCT demonstrated discernible alterations in the surface morphology of samples subjected to Er:YAG and combined PDT and Er:YAG treatments. Temperature checks during treatments showed no major changes, suggesting the applied laser methods are safe. In conclusion, PDTEr and PDT eliminated bacteria more effectively, but Zr surfaces were more resilient, making them better for microbe-controlling applications. Also, the study demonstrated that the (less costly but lower resolution) OCT method can replace SEM for such investigations.

Photodynamic therapy in periodontitis: A narrative review

BACKGROUND

Periodontitis, a chronic infectious disease, is primarily caused by a dysbiotic microbiome, leading to the destruction of tooth-supporting tissues and tooth loss. Photodynamic therapy (PDT), which combines excitation light with photosensitizers (PS) and oxygen to produce antibacterial reactive oxygen species, is emerging as a promising adjuvant treatment for periodontitis.

METHODS

This review focuses on studies examining the antibacterial effects of PDT against periodontal pathogens. It also explores the impact of PDT on various aspects of periodontal health, including periodontal immune cells, human gingival fibroblasts, gingival collagen, inflammatory mediators, cytokines in the periodontium, vascular oxidative stress, vascular behavior, and alveolar bone health. Clinical trials assessing the types of PSs and light sources used in PDT, as well as its effects on clinical and immune factors in gingival sulcus fluid and the bacterial composition of dental plaque, are discussed.

RESULTS

The findings indicate that PDT is effective in reducing periodontal pathogens and improving markers of periodontal health. It has shown positive impacts on periodontal immune response, tissue integrity, and alveolar bone preservation. Clinical trials have demonstrated improvements in periodontal health and alterations in the microbial composition of dental plaque when PDT is used alongside conventional treatments.

CONCLUSIONS

PDT offers a promising adjunctive treatment for periodontitis, with benefits in bacterial reduction, tissue healing, and immune modulation. This article highlights the potential of PDT in periodontal therapy and emphasizes the need for further research to refine its clinical application and efficacy.

A Retrospective Histological Study on Palatal and Gingival Mucosa Changes during a Rapid Palatal Expansion Procedure

The most common inflammatory reactions in the oral mucosa are found at the gingival level. The treatment of these inflammations requires, first of all, the removal of the causative factor; often, this maneuver is sufficient. The aim of this retrospective study was to evaluate clinical and histopathological changes that occur in terms of gingival and palatal mucosa enlargement during palatal expansion treatment and their evolution during treatment. Twenty-five (n = 25) research participants, aged between thirteen and twenty-six years old, were examined in this retrospective study. At the end of the treatment, fragments of tissue from the affected level were obtained via incisional biopsy and sent to the histopathology laboratory for a specialized examination. The changes identified were specific to mechanical traumatic injuries, thus excluding hyperplasia from other etiologies (infectious, tumoral, or non-mechanical traumatic). The examined fragments showed hyperplasia. The histopathological examination revealed the mechanical character of the lesion, strengthening the causal relationship between the insertion of the expander and the occurrence of hyperplasia of the palatal mucosa. The type of palatal expander influenced the degree of inflammation, with the severity of hyperplasia being more pronounced in the case of mini-implant-anchored rapid palatal expander (MARPE) usage than in the case of tooth-borne rapid palatal expander (RPE) usage. The analysis of the distance between the expander and the palatal mucosa did not provide conclusive results; the incidence and severity of the reaction were variable in patients with the same distance between the expander and the palatal or gingival mucosa.

Bibliometric analysis on research trends for contribution of photodynamic therapy in periodontitis

BACKGROUND

The objective of this bibliometric was to ascertain the research trend regarding the application of photodynamic therapy as a treatment modality for periodontal disease.

METHODS

An online search was administered using the Scopus database to retrieve all the relevant research literature published from 2003 till 26^th Dec 2022. After applying the inclusion criteria articles pertinent to the topic were manually selected. Data was saved as CSV. Data was read using VOSviewer software and further analysis was performed using Microsoft excel.

RESULTS

From a total of 545 articles, 117 scientific papers relevant to the field were evaluated. The keen interest of researchers was identified by an increase in the number of publications over the course of time, with the highest citations n=827 attained during the year 2009. Brazil, India, and USA made significant contribution by publishing highest number of papers. Organizations from the USA produced the highest publications which attained high citations. Author Sculean A. published the highest number of papers. Journal of periodontology was the leading journal, by publishing highest number of papers (n=15), followed by Journal of Clinical Periodontology.

CONCLUSION

This bibliometric analysis provided detailed information regarding the total number of publications from 2003 to 2022 and the number of citations attained. Brazil has been identified as the leading country, whilst all the leading organizations which contributed significantly, were from USA. The Journal of Periodontology published the highest number of papers which had been highly cited. Sculean A, affiliated with University of Bern, Switzerland published the highest number of papers.

Orthodontic Treatment of Palatally Impacted Maxillary Canines with the Use of a Digitally Designed and 3D-Printed Metal Device

The purpose of this article is to present a computer designed and 3D-printed metal device, which was used for the surgical exposure and orthodontic treatment of maxillary palatally impacted canines. In two cases which presented a palatally impacted canine, a Cone-Beam Computed Tomography (CBCT) was acquired and an intraoral scanning was performed, to determine the exact location of the canine. Based on a digital model, a device leaning on the teeth and mucosa was designed to serve as a guiding tool for the oral surgeon to expose the crown of the canine and help the orthodontist to provide proper traction. The device was then 3D-printed in biocompatible dental alloy and placed in the patients' mouth. After the surgical exposure of the canine's crown in both cases, a gold chain apparatus was bonded on and it was mounted on the metal projection of the device through an elastic chain. Within 3 months of traction, the crown of the canines appeared in the patients' palate to the exact location that was predicted and guided. A 3D-designed and manufactured metal device, with information acquired by CBCT and intraoral scanning, can be used for the exposure and traction of palatally impacted canines.

The results of the index comparative evaluation of photodynamic therapy and ultraviolet irradiation in the treatment of chronic gingivitis

In this clinical study, the effect of photodynamic therapy and ultraviolet radiation on the effectiveness of the treatment of periodontal diseases was examined according to the results of an index assessment. Clinical examination of 95 patients of both sexes aged from 18 to 32 years revealed chronic generalized catarrhal gingivitis (K05.1). The main index criteria for comparative parameters in all study groups were: simplified OHI-S hygiene index, Mullemann-Cowell bleeding index, PMA index. The indices were measured before and after treatment with subsequent control examinations in 1 month, 3 months, 6 months. The patients were divided into three groups and each group underwent standard periodontal treatment aimed at stopping the inflammatory process and preventing its further development. In the first group, the treatment was supplemented with the use of the FotoSan LED lamp with a wavelength of 630 nm, in the second the “Quasar” ultraviolet irradiator was used, in the third (control) group, the complex of therapeutic measures was carried out without physiotherapeutic procedures. According to the results of the study, the use of photodynamic therapy significantly accelerates the regenerative processes of periodontal epithelial tissue and reduces the number of treatment sessions.

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.

Photodynamic Therapy for Treatment of Disease in Children—A Review of the Literature

Photodynamic therapy is a mode of treatment whereby local irradiation of an administered photosensitizer with light of a specific wavelength generates cytotoxic reactive oxygen species. Despite the upward trend in the popularity of this method in adults, it is not yet commonly used in the treatment of children. Due to certain limitations, underdeveloped treatment regimens and potential side effects, the use of photodynamic therapy in the pediatric population is still in the initial phases of evaluation in clinical trials. Method: This study is a review of articles in English from the databases PubMed and Web of Science retrieved by applying the search term “photodynamic therapy in children” from 2000–2020. Results: Based on the literature review, we analyze selected pediatric clinical cases in which photodynamic therapy was used for treatment in children. Examples of photodynamic therapy for treatment of dermatological diseases, diseases of the mucosa of the upper respiratory tract, halitosis, eye diseases and brain tumors are described. The paper describes the effectiveness of anti-cancer photodynamic therapy, including its use in antibacterial therapy. Conclusions: The results of the analysis suggest the potential of photodynamic therapy for the treatment of various diseases in children.

The Oral Microbiota: Community Composition, Influencing Factors, Pathogenesis, and Interventions

The human oral cavity provides a habitat for oral microbial communities. The complexity of its anatomical structure, its connectivity to the outside, and its moist environment contribute to the complexity and ecological site specificity of the microbiome colonized therein. Complex endogenous and exogenous factors affect the occurrence and development of the oral microbiota, and maintain it in a dynamic balance. The dysbiotic state, in which the microbial composition is altered and the microecological balance between host and microorganisms is disturbed, can lead to oral and even systemic diseases. In this review, we discuss the current research on the composition of the oral microbiota, the factors influencing it, and its relationships with common oral diseases. We focus on the specificity of the microbiota at different niches in the oral cavity, the communities of the oral microbiome, the mycobiome, and the virome within oral biofilms, and interventions targeting oral pathogens associated with disease. With these data, we aim to extend our understanding of oral microorganisms and provide new ideas for the clinical management of infectious oral diseases.

Evaluation of methylene blue based photodynamic inactivation (PDI) against intracellular B-CoV and SARS-CoV2 viruses under different light sources in vitro as a basis for new local treatment strategies in the early phase of a Covid19 infection

The local antiviral photodynamic inactivation (PDI) may prove to be a helpful tool reducing the viral load in the nose and throat area in the early phase of a Covid19 infection. Both the infectivity and the prognosis of SARS-CoV-2 infections in the early phase can depend on the viral load in this area. The aim of our study was to find a simplified PDI therapy option against corona viruses in this region with low dose methylene blue (MB) as photosensitizer and use of LED light instead of laser. As a substitute for SARS-CoV2 viruses we started with BCoV infected U373 cells first. We used an 810nm diode laser with 300mW/cm2 and 100J/cm2 light dose as well as a 590 nm LED and a broadband LED with irradiation intensity of 10,000 lx each (irradiation time 2.5 and 10 min) and concentrations of the sensitizer of 0.001% and 0.0001%. The 0.001% MB sensitizer experiments showed similar results with all exposures. The logarithmic reduction factor varied between ≥ 5.29 and ≥ 5.31, (0.001% MB sensitizer) and ≥ 4.6 and ≥ 5.31 (0.0001% MB) respectively. Extending the LED irradiation time from 2 to 5 and 10 minutes did not change these results. In contrast approaches of BCoV-infected cells in the dark, treated with 0.001% and 0.0001% MB sensitizer alone, a lot of residual viruses could be detected after 10 minutes of incubation (RF 0.9 and RF 1.23 for 0.001% MB and 0.0001% MB respectively) In our SARS-CoV-2 experiments with VERO E6 infected cells the irradiation time was reduced to 1, 2 and 3 minutes for both concentrations with increasing broadband LED radiation intensity from 20 to 50 and 100.000 lx. (RF 4.67 for 0.001% and 0.0001% respectively). This showed a minimum concentration of 0.0001%MB and a minimum radiation intensity of 20,000 lx leads to a 99.99% reduction of intracellular and extracellular viruses after one minute exposure.