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Brinar S, Skvarča A, Gašpirc B, Schara R. The effect of antimicrobial photodynamic therapy on periodontal disease and glycemic control in patients with type 2 diabetes mellitus. Clin Oral Investig 2023; 27:6235-6244. [PMID: 37672083 PMCID: PMC10560165 DOI: 10.1007/s00784-023-05239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES This study is aimed at determining the effect of concomitant antimicrobial photodynamic therapy (aPTD) on periodontal disease and glycaemic control in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS Twenty-four patients with T2DM were enrolled in the study. Periodontal clinical parameters were assessed by measuring probing pocket depth (PPD), clinical attachment loss (CAL), gingival recession (GR), full-mouth bleeding score (FMBS), full-mouth plaque score (FMPS), and full-mouth sulcus bleeding score (FMSBS). Glycated haemoglobin A1c (HbA1c) was measured. To determine the presence of the following periodontal pathogenic bacteria, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, subgingival plaque samples were taken from two periodontal pockets per jaw with the greatest PPD using paper tips. Patients were randomly divided into the test and control group. In the test group, full-mouth disinfection was performed in combination with aPTD. In the control group, only full-mouth disinfection was performed. RESULTS The results showed an improvement in periodontal clinical parameters in both groups. The difference between the groups in favour of the test group was statistically significant for BOP. The HbA1c level decreased in both groups. The difference was not statistically significant. The results of the microbiological analysis suggest that the presence of periodontal pathogenic bacteria is lower with additional antimicrobial photodynamic therapy with statistically significant difference for T. forsythia. CONCLUSIONS Additional aPDT causes a significant reduction in BoP in the proportion of positive sites for periodontal pathogens. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05816941. CLINICAL RELEVANCE aPTD is a noninvasive adjunctive therapy that can positively influence the periodontal treatment outcome.
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Affiliation(s)
- Sara Brinar
- Department of Oral Medicine and Periodontology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Community Health Centre Murska Sobota, Murska Sobota, Slovenia
| | - Aleš Skvarča
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Boris Gašpirc
- Department of Oral Medicine and Periodontology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Schara
- Department of Oral Medicine and Periodontology, University Medical Center Ljubljana, Ljubljana, Slovenia.
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Park GH, Lee SY, Lee JB, Chang BS, Lee JK, Um HS. Effect of photodynamic therapy according to differences in photosensitizers on Staphylococcus aureus biofilm on titanium. Photodiagnosis Photodyn Ther 2023; 41:103317. [PMID: 36738904 DOI: 10.1016/j.pdpdt.2023.103317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aimed to evaluate the antimicrobial effect of photodynamic therapy (PDT) against Staphylococcus aureus biofilm on a titanium surface and to compare the differences in the effect of PDT using toluidine blue O (TBO) and methylene blue (MB) as a photosensitizer. METHODS The bacterial strain S. aureus ATCC 25,923 was used. Sandblasted and acid-etched (SLA) disks were divided into the following six groups: phosphate buffer saline (PBS), TBO, MB, PBS with laser (PBS + L), TBO with laser (TBO + L), and MB with laser (MB + L). The laser group samples were irradiated by a cold diode laser for 60 s. After treatment, the number of surviving bacteria was calculated by counting the colony-forming units (CFUs) and confocal laser scanning microscopy (CLSM) was applied to observe the bacteria on the disk surface. RESULTS The TBO + L and MB + L groups showed significantly lower CFU/ml than the other groups (p < 0.01). The TBO + L group showed significantly lower CFU/ml than the MB + L group (p = 0.032). There was no significant difference between the PBS, TBO, MB, and PBS + L groups. Within the limitations of this in vitro study, PDT with TBO and MB can effectively reduce S. aureus biofilm on SLA titanium surfaces. TBO is more effective than MB as a photosensitizer. PDT with TBO may be applied to the treatment of peri‑implant disease in the future.
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Affiliation(s)
- Geun Hee Park
- Department of Periodontology, Gangneung-Wonju National University College of Dentistry, Gangneung 25457, South Korea
| | - Si Young Lee
- Department of Microbiology and Immunology, Gangneung-Wonju National University, Gangneung 25457, South Korea; Research Institute of Oral Sciences, Gangneung-Wonju National University College of Dentistry, Gangneung 25457, South Korea
| | - Jong-Bin Lee
- Department of Periodontology, Gangneung-Wonju National University College of Dentistry, Gangneung 25457, South Korea; Research Institute of Oral Sciences, Gangneung-Wonju National University College of Dentistry, Gangneung 25457, South Korea
| | - Beom-Seok Chang
- Department of Periodontology, Gangneung-Wonju National University College of Dentistry, Gangneung 25457, South Korea; Research Institute of Oral Sciences, Gangneung-Wonju National University College of Dentistry, Gangneung 25457, South Korea
| | - Jae-Kwan Lee
- Department of Periodontology, Gangneung-Wonju National University College of Dentistry, Gangneung 25457, South Korea; Research Institute of Oral Sciences, Gangneung-Wonju National University College of Dentistry, Gangneung 25457, South Korea.
| | - Heung-Sik Um
- Department of Periodontology, Gangneung-Wonju National University College of Dentistry, Gangneung 25457, South Korea; Research Institute of Oral Sciences, Gangneung-Wonju National University College of Dentistry, Gangneung 25457, South Korea.
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Lin Y, Chen H, Li Z, Lin Y, Liao S, Zeng Y, He J. A comparative evaluation of lasers and photodynamic therapy in the nonsurgical treatment of peri-implant diseases: A Bayesian network meta-analysis. Photodiagnosis Photodyn Ther 2022; 40:103106. [PMID: 36122647 DOI: 10.1016/j.pdpdt.2022.103106] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE We conducted this Bayesian network meta-analysis (NMA) to evaluate the safety and efficacy of different lasers and PDT compared to conventional mechanical debridement (CMD) for peri-implant treatment. METHODS The Web of Science, Cochrane Library and PubMed databases were searched for randomized clinical trials (RCTs) assessing the clinical effectiveness of adjunctive PDT, different lasers, and CMD until January 1st, 2022. Clinical outcomes were the changes in pocket probing depth (PPD), marginal bone loss (MBL), and clinical attachment level (CAL). RESULTS Twenty-three studies, including 4 types of lasers, were included. Compared to that with CMD alone, PPD reduction was significantly more efficient in the diode laser (LD)+CMD groups (MD, 0.53; 95%CI, 0.13-0.93) and the PDT+CMD groups (MD, 0.83; 95%CI, 0.32-1.34) than in the CMD group in the follow-up period. Moreover, PDT+CMD treatment also showed a significantly better marginal bone level gain (MD, 0.32; 95%CI, 0.06-0.57). No significant effect on ΔCAL was observed among the different treatment strategies. Despite no differences in PPD reduction, MBL and CAL gains were found among the adjunctive laser treatment groups, PDT+CMD had the highest ranking probability of the most effective treatment in these clinical indices of periodontitis. The certainty of evidence for all outcomes was judged as very low to moderate. CONCLUSIONS Within the limits of this NMA, we found that adjunctive PDT achieved a small additional benefit on PPD reduction and MBL gain compared with CMD alone and had the highest probability of being ranked first on the changes in PPD, MBL and CAL. PDT+CMD may represent an alternative method for peri‑implant treatment. Further high-quality RCTs are needed to assess the influence of potential confounders on the efficacy of lasers and PDT.
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Affiliation(s)
- Yao Lin
- Jieyang Medical Research Center, Jieyang People's Hospital, Tianfu Road 107 Rongcheng district, Jieyang, Guangdong 522000, PR China
| | - Hongpeng Chen
- Jieyang Medical Research Center, Jieyang People's Hospital, Tianfu Road 107 Rongcheng district, Jieyang, Guangdong 522000, PR China
| | - Zhenxuan Li
- the Department of Stomatology, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, PR China
| | - Yingying Lin
- Jieyang Medical Research Center, Jieyang People's Hospital, Tianfu Road 107 Rongcheng district, Jieyang, Guangdong 522000, PR China
| | - Shuanglin Liao
- The Key Laboratory of Sepsis Translational Medicine, Guangdong Medical University, Zhanjiang, Guangdong, PR China
| | - Yayan Zeng
- Jieyang Medical Research Center, Jieyang People's Hospital, Tianfu Road 107 Rongcheng district, Jieyang, Guangdong 522000, PR China.
| | - Junbing He
- Jieyang Medical Research Center, Jieyang People's Hospital, Tianfu Road 107 Rongcheng district, Jieyang, Guangdong 522000, PR China.
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Rahman B, Acharya AB, Siddiqui R, Verron E, Badran Z. Photodynamic Therapy for Peri-Implant Diseases. Antibiotics (Basel) 2022; 11:antibiotics11070918. [PMID: 35884171 PMCID: PMC9311944 DOI: 10.3390/antibiotics11070918] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Peri-implant diseases are frequently presented in patients with dental implants. This category of inflammatory infections includes peri-implant mucositis and peri-implantitis that are primarily caused by the oral bacteria that colonize the implant and the supporting soft and hard tissues. Other factors also contribute to the pathogenesis of peri-implant diseases. Based on established microbial etiology, mechanical debridement has been the standard management approach for peri-implant diseases. To enhance the improvement of therapeutic outcomes, adjunctive treatment in the form of antibiotics, probiotics, lasers, etc. have been reported in the literature. Recently, the use of photodynamic therapy (PDT)/antimicrobial photodynamic therapy (aPDT) centered on the premise that a photoactive substance offers benefits in the resolution of peri-implant diseases has gained attention. Herein, the reported role of PDT in peri-implant diseases, as well as existing observations and opinions regarding PDT, are discussed.
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Affiliation(s)
- Betul Rahman
- Periodontology Unit, Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates; (B.R.); (A.B.A.)
| | - Anirudh Balakrishna Acharya
- Periodontology Unit, Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates; (B.R.); (A.B.A.)
| | - Ruqaiyyah Siddiqui
- College of Arts and Sciences, University City, American University of Sharjah, Sharjah P.O. Box 26666, United Arab Emirates;
| | - Elise Verron
- CNRS, UMR 6230, CEISAM, UFR Sciences et Techniques, Université de Nantes, 2, rue de la Houssinière, BP 92208, CEDEX 3, 44322 Nantes, France;
| | - Zahi Badran
- Periodontology Unit, Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates; (B.R.); (A.B.A.)
- Correspondence:
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Sivieri-Araujo G, Strazzi-Sahyon HB, Jacomassi DP, Dos Santos PH, Cintra LTA, Kurachi C, Bagnato VS. Effects of methylene blue and curcumin photosensitizers on the color stability of endodontically treated intraradicular dentin. Photodiagnosis Photodyn Ther 2021; 37:102650. [PMID: 34838697 DOI: 10.1016/j.pdpdt.2021.102650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/02/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Photodynamic therapy with photosensitizers can reduce the microbial load. However, few studies have evaluated the effects of photosensitizers on the color stability of endodontically treated intraradicular dentin. This in vitro study investigated the effects of methylene blue and curcumin photosensitizers used in photodynamic therapy on the color stability of intraradicular dentin. METHODS Sixty human incisors were divided into three experimental groups according to the photosensitizer solutions used and their concentrations: methylene blue (25 mg/L), curcumin (1000 mg/L), and curcumin (1500 mg/L). The color stability of endodontically treated intraradicular dentin was evaluated using a portable reflectance spectrophotometer before and after the samples been storage in 2 mL of the photosensitizer solutions during 5 min (n = 20). Color stability data were subjected to a normality test, and statistical analysis was performed using the one-way analysis of variance and Tukey least significant difference test (α = 0.05). RESULTS Samples treated with 25 mg/L methylene blue photosensitizer showed a higher level of color alteration than those stored in 1000 mg/L curcumin (p = .03322). However, there was no significant difference in the color alteration profiles between the samples treated with 25 mg/L methylene blue and 1500 mg/L curcumin (p = .36428). Furthermore, there was no difference in the color alteration profiles between the dentin samples immersed in 1000 mg/L and 1500 mg/L curcumin photosensitizer solutions (p = .45321). CONCLUSIONS Methylene blue and curcumin photosensitizers influenced the color stability of endodontically treated intraradicular dentin, and this color alteration exceeded the clinical acceptability threshold. Samples treated with 25 mg/L methylene blue showed the highest level of color alteration.
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Affiliation(s)
- Gustavo Sivieri-Araujo
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Henrico Badaoui Strazzi-Sahyon
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Denis Pablo Jacomassi
- Optic Group, Physics Institute of São Carlos - IFSC, University of São Paulo - USP, São Carlos, SP, Brazil.
| | - Paulo Henrique Dos Santos
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Luciano Tavares Angelo Cintra
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Cristina Kurachi
- Optic Group, Physics Institute of São Carlos - IFSC, University of São Paulo - USP, São Carlos, SP, Brazil.
| | - Vanderlei Salvador Bagnato
- Optic Group, Physics Institute of São Carlos - IFSC, University of São Paulo - USP, São Carlos, SP, Brazil.
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Theodoro LH, da Rocha TE, Wainwright M, Nuernberg MAA, Ervolino E, Souza EQM, Brandini DA, Garcia VG. Comparative effects of different phenothiazine photosensitizers on experimental periodontitis treatment. Photodiagnosis Photodyn Ther 2021; 34:102198. [PMID: 33578028 DOI: 10.1016/j.pdpdt.2021.102198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Letícia Helena Theodoro
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil.
| | - Tiago Esgalha da Rocha
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil.
| | - Mark Wainwright
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
| | | | - Edilson Ervolino
- Department of Basic Sciences, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil.
| | - Eduardo Quintão Manhanini Souza
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil.
| | - Daniela Atili Brandini
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil.
| | - Valdir Gouveia Garcia
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil; Latin American Institute of Dental Research and Education (ILAPEO), Curitiba, PR, Brazil.
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Efficacy of antimicrobial photodynamic therapy (aPDT) for nonsurgical treatment of periodontal disease: a systematic review. Lasers Med Sci 2021; 36:1573-1590. [PMID: 33438165 DOI: 10.1007/s10103-020-03238-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
Although the standard treatment for periodontal disease is based on scaling and root planing (SRP), the use of antimicrobial photodynamic therapy (aPDT) has been studied as a complement to obtain better clinical results. The purpose of this study was to evaluate the effect of aPDT as adjuncts to SRP, compared with SRP alone, on clinical parameters of chronic periodontal patients. Only randomized controlled trials with at least 3-month follow-ups, of SRP alone and in association with aPDT, were included. The MEDLINE (PubMed), Google Scholar, and LILACS databases were searched for articles published up to July 2020. Random-effects meta-analyses were conducted for clinical attachment level (CAL) and probing pocket depth (PPD) change after treatment. Of 141 potentially relevant papers, 22 were included. The association between SRP and aPDT promoted a significant CAL gain and PPD reduction. Periodontal treatment was partially improved by aPDT, and a favorable effect of indocyanine green-mediated aPDT was observed, and high concentrations of phenothiazine chloride presented clinical improvement as well.
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Ghodke PS, Hegde R, Ansari W, Muglikar S, Dholkawala AS. A Study to Evaluate the Efficacy of an 810-nm Diode Laser in the Maintenance of Dental Implants: A Peri-Implant Sulcular Fluid Analysis. J ORAL IMPLANTOL 2020; 46:381-388. [PMID: 32069361 DOI: 10.1563/aaid-joi-d-19-00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Biological implant failures are primarily related to biofilm, which can lead to peri-mucositis and, further on, peri-implantitis. The 810-nm diode laser has an affinity for pigmented chromophores, so its use in the peri-implant sulcus has a significant bactericidal effect on the black-pigmented anaerobes such as Porphyromonas gingivalis. Therefore, it can be used to eliminate or reduce the bacterial count in the peri-implant sulcular fluid (PISF), thus increasing the life of the implants and reducing the chances of failure. The purpose of this study was to evaluate the efficacy of the 810-nm diode laser for the maintenance of dental implants and its use as a regular in-office tool for limiting the microbiological count in the PISF. Twenty patients undergoing implant treatment at the Department of Periodontology and Oral Implantology were randomly selected for the study. PISF samples were collected before and after the sulcus was lased with an 810-nm diode laser and sent for quantitative microbiological analysis using universal bacterial count, and the quantity of P gingivalis was evaluated using real-time polymerase chain reaction (PCR). The analysis revealed that after diode application, the median percentage drop in the microbial count was 76.67% and the median percentage drop in P gingivalis count was 99.28%. The use of an 810-nm diode laser resulted in the following outcomes: (1) drastic reduction in the total bacterial count around the implant and (2) significant reduction in the P gingivalis count, as evaluated by real-time PCR.
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Affiliation(s)
- Prerna Sanjay Ghodke
- Department of Periodontology and Oral Implantology, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, India
| | - Rashmi Hegde
- Department of Periodontology and Oral Implantology, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, India
| | - Waqas Ansari
- Department of Periodontology and Oral Implantology, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, India
| | - Sangeeta Muglikar
- Department of Periodontology and Oral Implantology, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, India
| | - Alia S Dholkawala
- Abeda Inamdar Senior College of Arts, Science and Commerce, Azam Campus, Pune, India
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Zago LHDP, de Annunzio SR, de Oliveira KT, Barbugli PA, Valdes BR, Feres M, Fontana CR. Antimicrobial photodynamic therapy against metronidazole-resistant dental plaque bactéria. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 209:111903. [PMID: 32531689 DOI: 10.1016/j.jphotobiol.2020.111903] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/15/2020] [Accepted: 05/18/2020] [Indexed: 01/06/2023]
Abstract
The antimicrobial photodynamic therapy (aPDT) has stood out as an alternative and promising method of disinfection and has been exploited for the treatment of oral bacteria. In this study, we evaluate in vitro the action of aPDT, mediated by methylene blue, chlorin-e6, and curcumin against clinical subgingival plaques that were resistant to metronidazole. The sensitivity profile of the samples to metronidazole was analyzed by the agar dilution method. Cell viability in the planktonic and biofilm phase was assessed by CFU / mL. The composition of the biofilm was evaluated by the checkboard DNA-DNA Hibrydization technique. Photosensitizers internalization was qualitatively assessed by confocal fluorescence microscopy (CLSM). The aPDT mediated by the three photosensitizers tested was able to reduce the totality of the planktonic microbial load and partially reduce the biofilm samples. The analysis performed by CLSM showed that the photosensitizers used in the application of aPDT were able to permeate the interior of the biofilm. The aPDT has been shown to be useful in a supportive and effective approach to the treatment of periodontal disease.
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Affiliation(s)
| | - Sarah Raquel de Annunzio
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, 14800-903 Araraquara, SP, Brazil
| | | | - Paula Aboud Barbugli
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, 14800-903 Araraquara, SP, Brazil; São Paulo State University (Unesp), School of Dentistry, 14801-903 Araraquara, SP, Brazil
| | - Belen Retamal Valdes
- Guarulhos University, Dental Research Division, Department of Periodontology, 07011-040 Guarulhos, SP, Brazil.
| | - Magda Feres
- Guarulhos University, Dental Research Division, Department of Periodontology, 07011-040 Guarulhos, SP, Brazil
| | - Carla Raquel Fontana
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, 14800-903 Araraquara, SP, Brazil.
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Rosa EP, Murakami-Malaquias-Silva F, Schalch TO, Teixeira DB, Horliana RF, Tortamano A, Tortamano IP, Buscariolo IA, Longo PL, Negreiros RM, Bussadori SK, Motta LJ, Horliana ACRT. Efficacy of photodynamic therapy and periodontal treatment in patients with gingivitis and fixed orthodontic appliances: Protocol of randomized, controlled, double-blind study. Medicine (Baltimore) 2020; 99:e19429. [PMID: 32243363 PMCID: PMC7220758 DOI: 10.1097/md.0000000000019429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/14/2022] Open
Abstract
It is known that the presence of orthodontic brackets predisposes for a change in the biofilm, facilitating the development of gingivits. The sites are difficult to access with a toothbrush and periodontal curette, worsening inflammation, in addition, a gingival hyperplasia is associated with poor hygiene. The objective of this study is to evaluate the impact of photodinamyc therapy (PDT) as an adjuvant treatment, considering clinical immunoregulatory and microbiological parameters. This randomized, controlled, double-blind clinical study will include 34 patients, both genders, having used fixed appliance for more than 12 months, with gingivitis. Participants will be divided into two groups: G1 (n = 17)- Scaling and Root Planing + PDT placebo and G2 (n = 17)- Scaling and Root Planing + PDT. In G2 the following dosimetric parameters will be used: methylene blue 0.005%, λ= 660 nanometers (nm), 9 Joules (J) per site, irradiance= 3.5Watts (W)/ centimeters (cm), radiant exposure= 318J/cm. All participants will receive oral hygiene guidance prior the curetes scaling. The clinical periodontal data to be analyzed are plaque index, gingival index and probing depth. Crevicular fluid, from 4 pre-determined sites and saliva, will be collected and analysed for IL-6, IL-1β, IL-8, TNF-α and IL-10 cytokines using ELISA (Enzyme immunoabsorption assay) method. Total Bacteria count will also be performed, by qPCR and Universal16SrRNA gene. All analysis will be realized using in the baseline (T0), 7 (T1) and 21 (T2) days after treatment. Oral health-related quality of life will be assessed using the OHIP-14 questionnaire at times T0 and T2. If sample distribution is normal, the Student T-test will be applied if it is not normal, the Mann-Whitney test will be used. The data will be presented in terms of ± PD and The significance level will be set at p < 0.05. Our results may improve quality of life and add data to establish a therapeutic alternative for gingivitis during the orthodontic treatment. Registration: clinicaltrials.gov NCT04037709. https://clinicaltrials.gov/ct2/show/NCT04037709 - Registered in July 2019.
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Affiliation(s)
- Ellen Perim Rosa
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, UNINOVE, São Paulo, Brazil
| | | | - Tânia Oppido Schalch
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, UNINOVE, São Paulo, Brazil
| | - Daniela Bezerra Teixeira
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, UNINOVE, São Paulo, Brazil
| | | | - Andre Tortamano
- Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Priscila Larcher Longo
- Postgraduate Program of Aging Science -São Judas Tadeu University - São Paulo, SP, Brazil
| | - Renata Matalon Negreiros
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, UNINOVE, São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, UNINOVE, São Paulo, Brazil
| | - Lara Jansiski Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, UNINOVE, São Paulo, Brazil
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CONDOR D, CULCITCHI C, BARU O, CZINNA J, BUDURU S. A review of antimicrobial photodynamic therapy (aPDT) in periodontitis. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction:Periodontitis is an inflammatory disease caused by a multitude of pathogens, that eventually affects the entirety of all periodontal tissues and may lead to tooth mobility or even tooth loss. The destruction of said tissues occurs via 2 pathways: a direct pathway (defense mechanisms belonging to the pathogens) and an indirect pathway (the host’s immune system). Therapy is complex and requires strict follow-ups in order to prevent relapse. Aim: Our objective was to determine whether or not aPDT can be considered to be an effective adjunctive approach to the current standard initial treatment method when dealing with periodontitis (scaling/root planing). Methods: We performed an electronical search of the PubMed and ScienceDirect data bases starting from January 2014 and up to May 2019. Eligibility criteria included English-language systematic reviews and randomized clinical trials which evaluated the efficiency of aPDT, and that had been carried out on human subjects with permanent dentition. We excluded studies and reviews that were focused on the microbiology and/or immunology in photodynamic therapy and also those that used other LASER treatment modalities than aPDT. Results: Current literature displays many opinions regarding periodontal therapy with adjunctive aPDT, but it seems to be mainly regarded as a safe, effective and easy-to-use approach. Conclusion: aPDT seems to be efficient in the treatment of periodontitis when carried out additionally to classical scaling/root planing. Residual pockets seem to respond well to aPDT, as opposed to subsequent debridement flap elevation and its consequences on hard and soft tissues. However, further studies with a stricter treatment protocol and subsequent follow-ups are required in order to obtain a firmer conclusion.
Key words: periodontitis LASER, periodontitis aPDT, periodontitis photodynamic therapy,
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Affiliation(s)
- Daniela CONDOR
- Department of Periodontology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, .“Stomestet” Dental Clinic, Cluj-Napoca, Romania
| | - Cristian CULCITCHI
- Department of Periodontology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, .“Stomestet” Dental Clinic, Cluj-Napoca, Romania
| | - Oana BARU
- “Stomestet” Dental Clinic, Cluj-Napoca, Romania
| | - Julia CZINNA
- “Zahnärztin Dr.-medic stom. (RO). Marta Czinna” Dental Office, Düsseldorf, Germany
| | - Smaranda BUDURU
- Department of Prosthodontics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, .“Stomestet” Dental Clinic, Cluj-Napoca, Romania
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12
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Affiliation(s)
- Andrea Mombelli
- Division of Periodontology School of Dental Medicine University of Geneva Geneva Switzerland
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13
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Plotino G, Grande NM, Mercade M. Photodynamic therapy in endodontics. Int Endod J 2018; 52:760-774. [PMID: 30548497 DOI: 10.1111/iej.13057] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 12/06/2018] [Indexed: 01/14/2023]
Abstract
Photodynamic therapy (PDT) is a treatment modality that was initiated in 1900; however, it was not until the last decade that PDT regained attention for its several favourable features during the treatment of microbial infections in endodontics. Recently, several papers advocated its use for root canal treatment. The concept of photodynamic inactivation requires microbial exposure to either exogenous or endogenous photosensitizer molecules, followed by visible light energy, typically wavelengths in the red/near-infrared region that cause the excitation of the photosensitizers resulting in the production of singlet oxygen and other reactive oxygen species that react with intracellular components and consequently produce cell inactivation and death. Recently, PDT has been suggested as a promising effective adjunct to standard antimicrobial intracanal cleaning and shaping for the treatment of periapical lesions. Current publications tested PDT in terms of bacterial load reduction in vivo, in vitro and ex vivo, showing promising results. The purpose of this article was to review the existing literature on PDT in the endodontic field regarding its mechanism of action, photosensitizers and light sources, limitations and clinical procedures. Although positive results have been demonstrated in vitro, there are considerably fewer in vivo investigations. In conclusion, more in vivo studies are needed on the use of antimicrobial PDT in root canal treatment.
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Affiliation(s)
| | - N M Grande
- Catholic University of Sacred Heart, Rome, Italy
| | - M Mercade
- Department of Dentistry, Universitat de Barcelona, Barcelona, Spain.,Researcher IDIBELL Institute, Barcelona, Spain
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Aluminum phthalocyanine nanoparticles activation for local fluorescence spectroscopy in dentistry. BIOMEDICAL PHOTONICS 2018. [DOI: 10.24931/2413-9432-2018-7-3-4-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Early diagnosis of caries and tooth enamel microcracks is of great importance for preventing the destruction of healthy tooth enamel. Inorder to detect microcracks in the enamel and pathogenic microflora foci that can cause caries, nanoform of aluminum phthalocyanine (AlPc) can be used as a marker. In a colloidal solution, the nanoparticles do not fluoresce, unlike their molecular form. To convert the particle into its molecular form, it is necessary to have a solvent or specific environment (bacteria, macrophages, etc.). That is why the hydrophobic nanoparticles of aluminum phthalocyanine (nAlPc) can act as markers for detecting hidden pathogenic microflora during fluorescent diagnostics. Further reduction of the diagnosis time and increase the efficiency can be achieved by using biologically compatible surfactants as additional activators of nAlPc.In order to carry out local fluorescence spectroscopy of enamel microcracks and pathogenic microflora foci on the enamel surface, a model compound containing surfactants, auxiliary components and nAlPc colloid at a concentration of 10 mg/l was prepared.Studies on the interaction of the model compound with nAlPc and Protelan MST-35 with tooth enamel ex vivo have shown this surfactant to be a promising auxiliary activator of the nanoparticles, allowing conducting local fluorescence spectroscopy of the tooth enamel surface 3 min after application. In addition, statistical processing of the results showed the effectiveness of using the model compound for local fluorescence spectroscopy of the enamel surface in order to detect the enamel microcracks and the pathogenic microflora accumulation foci that can lead to the development of a cariogenic process.
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Borekci T, Meseli SE, Noyan U, Kuru BE, Kuru L. Efficacy of adjunctive photodynamic therapy in the treatment of generalized aggressive periodontitis: A randomized controlled clinical trial. Lasers Surg Med 2018; 51:167-175. [DOI: 10.1002/lsm.23010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2018] [Indexed: 12/13/2022]
Affiliation(s)
| | - Suleyman Emre Meseli
- Faculty of Dentistry; Department of Periodontology, Istanbul Aydin University; Istanbul Turkey
| | - Ulku Noyan
- Oral and Dental Healthcare Department; Acıbadem Hospitals; Istanbul Turkey
| | - Bahar Eren Kuru
- Faculty of Dentistry; Department of Periodontology, Yeditepe University; Istanbul Turkey
| | - Leyla Kuru
- Faculty of Dentistry; Department of Periodontology, Marmara University; Istanbul Turkey
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Moslemi N, Rouzmeh N, Shakerinia F, Bahador A, Soleimanzadeh Azar P, Kharazifard MJ, Paknejad M, Fekrazad R. Photodynamic Inactivation of Porphyromonas gingivalis utilizing Radachlorin and Toluidine Blue O as Photosensitizers: An In Vitro Study. J Lasers Med Sci 2018; 9:107-112. [PMID: 30026895 DOI: 10.15171/jlms.2018.21] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction:Porphyromonas gingivalis is one of the major pathogens in the development and progression of periodontal disease. Antimicrobial photodynamic therapy (aPDT) is a new approach which is sorted in non-invasive phototherapy for bacterial elimination. This in vitro study was conducted to compare photodynamic inactivation using Radachlorin and Toluidine blue O (TBO) as photosensitizers on P. gingivalis. Methods: Bacterial suspensions (200 µL) of P. gingivalis were exposed to either TBO with concentration of 0.1 mg/mL associated with portable light-emitting diode (LED) device (peak wavelength: 630 nm, output intensity: 2.000 mW/cm2, tip diameter: 6.2 mm) or 0.1% Radachlorin® and laser irradiation (InGaAlP, Peak wavelength: 662±0.1% nm, output power: 2.5 W, energy density: 6 J/cm2, fiber diameter: 2 mm). Those in control groups were subjected to laser irradiation or LED alone, Radachlorin® or TBO alone, and one group received neither photosensitizer nor light irradiation. Then counting of colony forming units (CFU) was performed to determine the bactericidal effects in each subgroup. Results: LED-based aPDT reduced the colony count of P. gingivalis more than that of TBO (P<0.001) or LED group (P=0.957). Also, laser-based aPDT had a great reduction in colony count of P. gingivalis in comparison with Radachlorin® (P<0.001) or laser irradiation alone (P=0.28). In addition, the colony count reduction of laser-based aPDT was significantly more than LED-based aPDT (P<0.05). Conclusion: Considering the results of this study, the viability of P. gingivalis was more affected by the combination of laser and Radachlorin® 0.1% in comparison with LED and TBO 0.1.
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Affiliation(s)
- Neda Moslemi
- Laser Research Center of Dentistry, Dental Research Institute, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Nina Rouzmeh
- Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abbas Bahador
- Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Javad Kharazifard
- Dental Research Center, Dental Research Institute, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Paknejad
- Dental Research Center, Dental Research Institute, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Fekrazad
- Department of Periodontics, Dental Faculty, AJA University of Medical Sciences, Tehran, Iran
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Effect of aPDT on Streptococcus mutans and Candida albicans present in the dental biofilm: Systematic review. Photodiagnosis Photodyn Ther 2018; 21:363-366. [PMID: 29408292 DOI: 10.1016/j.pdpdt.2018.01.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/10/2017] [Accepted: 01/22/2018] [Indexed: 11/22/2022]
Abstract
To evaluate the effect of aPDT on S. mutans and C. albicans present in the dental biofilm, using methylene blue as a photosensitizer in different pre-irradiation times. The searches were made on Pubmed, Web of Science, Bireme, Scopus and Cochrane Library, and were complemented by screening the references of selected articles in the attempt to find any article that did not appear in the database search. The searches were performed by two researchers and limited to studies involving human subjects published in the English language. Inclusion criteria included in vitro studies with aPDT; studies that used methylene blue as a photosensitizer; studies that used low power laser; studies that evaluated S. mutans or C. albicans. Studies published in a non-English language, patents, in vivo or in situ studies; case reports, serial case, reviews and animal studies were not included. Studies published before 1996 were also not included. Initially, the search resulted in 68 published studies. 16 records were excluded because they were duplicated. The analysis of titles and abstracts resulted in the exclusion of 48 of the published studies, resulting in 4 studies included in the systematic review. The aPDT was effective in three of the four papers selected for the systematic review and the pre-irradiation time used was 5 or 15 min. This therapy had satisfactory results in both C. albicans and S. mutans when using methylene blue as a photosensitizer.
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Oruba Z, Łabuz P, Macyk W, Chomyszyn-Gajewska M. Periopathogens differ in terms of the susceptibility to toluidine blue O-mediated photodynamic inactivation. Photodiagnosis Photodyn Ther 2017; 20:28-34. [DOI: 10.1016/j.pdpdt.2017.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/13/2017] [Accepted: 08/13/2017] [Indexed: 10/19/2022]
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The potential of photodynamic therapy (PDT)-Experimental investigations and clinical use. Biomed Pharmacother 2016; 83:912-929. [PMID: 27522005 DOI: 10.1016/j.biopha.2016.07.058] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/30/2016] [Accepted: 07/31/2016] [Indexed: 12/13/2022] Open
Abstract
Photodynamic therapy (PDT) is an intensively studied part of medicine based on free radicals. These reactive species, extremely harmful for whole human organism, are used for eradication numerous diseases. Specific structure of ill tissues causes accumulation free radicals inside them without attack remaining healthy tissues. A rapid development of medicine and scientific research has led to extension of PDT towards treatment many diseases such as cancer, herpes, acne and based on antimicrobials. The presented review article is focused on the aforementioned disorders with accurate analysis of the newest available scientific achievements. The discussed cases explicitly indicate on high efficacy of the therapy. In most cases, free radicals turned out to be solution of many afflictions. Photodynamic therapy can be considered as promising treatment with comparable effectiveness but without side effects characteristic for chemotherapy.
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Castro dos Santos NC, Andere NMRB, Araujo CF, de Marco AC, dos Santos LM, Jardini MAN, Santamaria MP. Local adjunct effect of antimicrobial photodynamic therapy for the treatment of chronic periodontitis in type 2 diabetics: split-mouth double-blind randomized controlled clinical trial. Lasers Med Sci 2016; 31:1633-1640. [DOI: 10.1007/s10103-016-2030-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/12/2016] [Indexed: 11/25/2022]
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de Oliveira PGFP, Silveira e Souza AMM, Novaes AB, Taba M, Messora MR, Palioto DB, Grisi MFM, Tedesco AC, de Souza SLS. Adjunctive effect of antimicrobial photodynamic therapy in induced periodontal disease. Animal study with histomorphometrical, immunohistochemical, and cytokine evaluation. Lasers Med Sci 2016; 31:1275-83. [DOI: 10.1007/s10103-016-1960-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/09/2016] [Indexed: 12/14/2022]
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The Antimicrobial Photodynamic Therapy in the Treatment of Peri-Implantitis. Int J Dent 2016; 2016:7692387. [PMID: 27429618 PMCID: PMC4939177 DOI: 10.1155/2016/7692387] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/05/2016] [Accepted: 04/17/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction. The aim of this study is to demonstrate the effectiveness of addition of the antimicrobial photodynamic therapy to the conventional approach in the treatment of peri-implantitis. Materials and Methods. Forty patients were randomly assigned to test or control groups. Patients were assessed at baseline and at six (T1), twelve (T2), and twenty-four (T3) weeks recording plaque index (PlI), probing pocket depth (PPD), and bleeding on probing (BOP); control group received conventional periodontal therapy, while test group received photodynamic therapy in addition to it. Result. Test group showed a 70% reduction in the plaque index values and a 60% reduction in PD values compared to the baseline. BOP and suppuration were not detectable. Control group showed a significative reduction in plaque index and PD. Discussion. Laser therapy has some advantages in comparison to traditional therapy, with faster and greater healing of the wound. Conclusion. Test group showed after 24 weeks a better value in terms of PPD, BOP, and PlI, with an average pocket depth value of 2 mm, if compared with control group (3 mm). Our results suggest that antimicrobial photodynamic therapy with diode laser and phenothiazine chloride represents a reliable adjunctive treatment to conventional therapy. Photodynamic therapy should, however, be considered a coadjuvant in the treatment of peri-implantitis associated with mechanical (scaling) and surgical (grafts) treatments.
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Damante CA, Ducati P, Ferreira R, Salmeron S, Zangrando MSR, de Rezende MLR, Sant’Ana ACP, Greghi SLA, Magalhães AC. In vitro evaluation of adhesion/proliferation of human gingival fibroblasts on demineralized root surfaces by toluidine blue O in antimicrobial photodynamic therapy. Photodiagnosis Photodyn Ther 2016; 13:303-307. [DOI: 10.1016/j.pdpdt.2015.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 08/03/2015] [Accepted: 08/24/2015] [Indexed: 01/19/2023]
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Annaji S, Sarkar I, Rajan P, Pai J, Malagi S, Bharmappa R, Kamath V. Efficacy of Photodynamic Therapy and Lasers as an Adjunct to Scaling and Root Planing in the Treatment of Aggressive Periodontitis - A Clinical and Microbiologic Short Term Study. J Clin Diagn Res 2016; 10:ZC08-12. [PMID: 27042576 DOI: 10.7860/jcdr/2016/13844.7165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/05/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Aggressive periodontitis comprises a group of rare, severe, rapidly progressive form of periodontitis. Conventional treatment includes mechanical debridement augmented with adjunctive antimicrobial therapy. Development of antibiotic resistance has led to use of lasers. Photodynamic therapy (PDT) is a novel non-invasive therapeutic approach with increased site and pathogen specificity. This study compares PDT and Lasers as an adjunct to conventional Scaling in the treatment of patients with aggressive periodontitis. MATERIALS AND METHODS Fifteen untreated aggressive periodo-ntitis patients were randomly assigned in a split mouth design for one of the following treatment modalities: 1) SRP alone; (2) SRP + Diode Laser irradiation with 810 nm at 1W, continuous mode for 30 sec per tooth; (3) SRP + PDT on "0" day; (4) SRP + PDT on "0", 7(th) and 21(st) day. The clinical parameters included PI, BOP, PPD, CAL recorded at the baseline & 3(rd) month. The site with greatest probing pocket depth (PPD) was selected from each quadrant for bacterial sampling and cultured for Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis & Prevotella intermedia. RESULTS Statistically significant reduction in clinical & microbial parameters was seen. Sites 4 showed a greater reduction compared to other groups. CONCLUSION Photodynamic therapy is a valuable treatment modality adjunctive to conventional scaling and root planing.
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Affiliation(s)
- Sreedhar Annaji
- Reader, Department of Periodontics, Coorg Institute of Dental Sciences , Virajpet, India
| | - Indranil Sarkar
- Post Graduate Student, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
| | - Padma Rajan
- Professor and Head of Department, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
| | - Jagdish Pai
- Professor, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
| | - Sachin Malagi
- Reader, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
| | - Radhika Bharmappa
- Senior Lecturer, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
| | - Vinesh Kamath
- Senior Lecturer, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
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Mathur S, Kothiwale SV, Nag BP, Mathur T, Bhansali A, Khatri RK. Effect of gallium-arsenic laser on photosensitized periodontopathic anaerobic organisms: An in vitro study. J Indian Soc Periodontol 2016; 20:369-373. [PMID: 28298816 PMCID: PMC5341309 DOI: 10.4103/0972-124x.186935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The mainstay of periodontal therapy is mechanical removal of subgingival plaque. There is considerable interest in supplementing it with the use of antibiotics and antiseptics. Many drawbacks are associated with these adjunctive pharmacological regimens such as development of resistance to antibiotics and disruption of microflora of the gastrointestinal tract. Hence, alternate means of killing subgingival bacteria are clearly desirable. One such method is the use of laser. AIM This study aimed to investigate antibacterial capabilities of gallium-arsenic (Ga-As) laser on photosensitized periodontopathic organisms. The three bacteria selected for the study were Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella intermedia. SETTINGS The subjects for the study were selected from the patients visiting the Department of Periodontics, Karnataka Lingayat Education Society's Institute of Dental Sciences, Belgaum. DESIGN In vitro study design. MATERIALS AND METHODS Subgingival plaque samples collected from chronic periodontitis patients were cultured anaerobically for 72 h. Predetermined number of colonies of each bacterium was taken and was then divided into cases and control groups. Both groups were photosensitized using toluidine blue O (TBO) dye and the case groups were irradiated with Ga-As laser. Bacterial colonies were then serially diluted and were incubated for subculture. After incubation period, the number of viable bacterial count was performed. STATISTICAL ANALYSIS Wilcoxon-signed rank test was carried out to determine significance of reduction on subsequent dilution within the bacterial group. Mann-Whitney U-test was performed to determine the significance of reduction between cases and control of particular bacterial group. RESULTS The results revealed substantial reduction in the viable bacterial count. F. nucleatum was found to be most sensitive to killing by laser irradiation followed by P. intermedia and then P. gingivalis. Further, the TBO dye per se did not have any significant bactericidal effect. CONCLUSION Photodynamic Therapy may prove to be a promising method for eradicating periodontopathic bacteria in near future.
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Affiliation(s)
- Setu Mathur
- Department of Periodontics, Government Dental College and Hospital, Jaipur, Rajasthan, India
| | | | - Buddhi Prakash Nag
- Department of Pathology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Tanu Mathur
- Department of Conservative and Endodontics, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan, India
| | - Ashoka Bhansali
- Department of Periodontics, CSMSS Dental College, Aurangabad, Maharashtra, India
| | - Rohit Kumar Khatri
- Department of Endodontics, Government Dental College and Hospital, Jaipur, Rajasthan, India
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Pessoa L, Galvão V, Damante C, Sant'Ana ACP. Removal of black stains from teeth by photodynamic therapy: clinical and microbiological analysis. BMJ Case Rep 2015; 2015:bcr2015212276. [PMID: 26701991 PMCID: PMC4691879 DOI: 10.1136/bcr-2015-212276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 11/03/2022] Open
Abstract
Black-pigmented bacteria (BPB) are Gram-negative anaerobic, non-motile, proteolytic rods strongly implicated in the pathogenesis of periodontal disease. Although pigments are produced in vitro, black pigmentation is rarely found clinically. However, it may compromise aesthetics and contribute to gingival inflammation. The aim of this report is to describe a clinical case of a 10-year-old boy showing black pigmentation covering all teeth and to propose an alternative therapy for removal of black pigmentation, based on photodynamic therapy (PDT). In order to perform microbiological analysis, plaque samples were collected before and after PDT, and analysed by real-time-PCR (RT-PCR). The results showed a significant reduction in BPB levels after therapy, along with clinical evidence of absence of black pigmentation and reduction in gingival bleeding, although the plaque index remained unaltered. This case showed that PDT is effective for eliminating black pigmentation caused by BPB, without recurrence during a follow-up period of 7 months.
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Affiliation(s)
- Larissa Pessoa
- Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | - Carla Damante
- Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Souza E, Medeiros AC, Gurgel BC, Sarmento C. Antimicrobial photodynamic therapy in the treatment of aggressive periodontitis: a systematic review and meta-analysis. Lasers Med Sci 2015; 31:187-96. [DOI: 10.1007/s10103-015-1836-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/05/2015] [Indexed: 01/12/2023]
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Kikuchi T, Mogi M, Okabe I, Okada K, Goto H, Sasaki Y, Fujimura T, Fukuda M, Mitani A. Adjunctive Application of Antimicrobial Photodynamic Therapy in Nonsurgical Periodontal Treatment: A Review of Literature. Int J Mol Sci 2015; 16:24111-26. [PMID: 26473843 PMCID: PMC4632741 DOI: 10.3390/ijms161024111] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/26/2015] [Accepted: 10/08/2015] [Indexed: 12/14/2022] Open
Abstract
Periodontal disease is caused by dental plaque biofilms, and the removal of these biofilms from the root surface of teeth plays a central part in its treatment. The conventional treatment for periodontal disease fails to remove periodontal infection in a subset of cases, such as those with complicated root morphology. Adjunctive antimicrobial photodynamic therapy (aPDT) has been proposed as an additional treatment for this infectious disease. Many periodontal pathogenic bacteria are susceptible to low-power lasers in the presence of dyes, such as methylene blue, toluidine blue O, malachite green, and indocyanine green. aPDT uses these light-activated photosensitizer that is incorporated selectively by bacteria and absorbs a low-power laser/light with an appropriate wavelength to induce singlet oxygen and free radicals, which are toxic to bacteria. While this technique has been evaluated by many clinical studies, some systematic reviews and meta-analyses have reported controversial results about the benefits of aPDT for periodontal treatment. In the light of these previous reports, the aim of this review is to provide comprehensive information about aPDT and help extend knowledge of advanced laser therapy.
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Affiliation(s)
- Takeshi Kikuchi
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Aichi 464-8651, Japan.
| | - Makio Mogi
- Department of Medicinal Biochemistry, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi 464-8650, Japan.
| | - Iichiro Okabe
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Aichi 464-8651, Japan.
| | - Kosuke Okada
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Aichi 464-8651, Japan.
| | - Hisashi Goto
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Aichi 464-8651, Japan.
| | - Yasuyuki Sasaki
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Aichi 464-8651, Japan.
| | - Takeki Fujimura
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Aichi 464-8651, Japan.
| | - Mitsuo Fukuda
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Aichi 464-8651, Japan.
| | - Akio Mitani
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Aichi 464-8651, Japan.
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Arısan V, Karabuda ZC, Arıcı SV, Topçuoğlu N, Külekçi G. A randomized clinical trial of an adjunct diode laser application for the nonsurgical treatment of peri-implantitis. Photomed Laser Surg 2015; 33:547-54. [PMID: 26382562 DOI: 10.1089/pho.2015.3956] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE In this radiographic and microbiologic split-mouth clinical trial, efficacy of a diode laser as an adjunct to conventional scaling in the nonsurgical treatment of peri-implantitis was investigated. BACKGROUND DATA Eradication of pathogenic bacteria and infected sulcular epithelium presents a significant challenge in the nonsurgical treatment of peri-implantitis. MATERIALS AND METHODS Ten patients (mean age, 55.1 years; SD, 11.4) with 48 two piece, rough-surface implants and diagnosed with peri-implantitis were recruited (NCT02362854). In addition to conventional scaling and debridement (control group), crevicular sulci and the corresponding surfaces of 24 random implants were lased by a diode laser running at 1.0 W power at the pulsed mode (λ, 810 nm; energy density, 3 J/cm(2); time, 1 min; power density, 400 mW/cm2; energy, 1.5 J; and spot diameter, 1 mm); (laser group). Healing was assessed via periodontal indexes (baseline and after 1 and 6 months after the intervention), microbiologic specimens (baseline and after 1 month), and radiographs (baseline and after 6 months). RESULTS Baseline mean pocket depths (4.71, SD, 0.67; and 4.38, SD 0.42 mm) and marginal bone loss (2.71, SD 0.11; and 2.88, SD 0.18 mm) were similar (p = 0.09 and p = 0.12) between the control and laser groups, respectively. After 6 months, the laser group revealed higher marginal bone loss (2.79, SD 0.48) than the control groups (2.63, SD 0.53) (p < 0.0001). However, in both groups, the microbiota of the implants was found unchanged after 1 month. CONCLUSIONS In this clinical trial, adjunct use of diode laser did not yield any additional positive influence on the peri-implant healing compared with conventional scaling alone.
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Affiliation(s)
- Volkan Arısan
- 1 Department of Oral Implantology, Faculty of Dentistry, Istanbul University , Capa- Fatih, Istanbul, Turkey
| | - Zihni Cüneyt Karabuda
- 1 Department of Oral Implantology, Faculty of Dentistry, Istanbul University , Capa- Fatih, Istanbul, Turkey
| | - Selahattin Volkan Arıcı
- 1 Department of Oral Implantology, Faculty of Dentistry, Istanbul University , Capa- Fatih, Istanbul, Turkey
| | - Nursen Topçuoğlu
- 2 Department of Oral Microbiology, Faculty of Dentistry, Istanbul University , Capa- Fatih, Istanbul, Turkey
| | - Güven Külekçi
- 2 Department of Oral Microbiology, Faculty of Dentistry, Istanbul University , Capa- Fatih, Istanbul, Turkey
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Garapati C, Clarke B, Zadora S, Burney C, Cameron BD, Fournier R, Baugh RF, Boddu SH. Development and characterization of erythrosine nanoparticles with potential for treating sinusitis using photodynamic therapy. Photodiagnosis Photodyn Ther 2015; 12:9-18. [DOI: 10.1016/j.pdpdt.2015.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 12/31/2022]
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Habiboallah G, Mahdi Z, Mahbobeh NN, Mina ZJ, Sina F, Majid Z. Bactericidal effect of visible light in the presence of erythrosine on Porphyromonas gingivalis and Fusobacterium nucleatum compared with diode laser, an in vitro study. Laser Ther 2015; 23:263-71. [PMID: 25705082 DOI: 10.5978/islsm.14-or-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/15/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Recently, photodynamic therapy (PDT) has been introduced as a new modality in oral bacterial decontamination. Besides, the ability of laser irradiation in the presence of photosensitizing agent to lethal effect on oral bacteria is well documented. Current research aims to evaluate the effect of photodynamic killing of visible blue light in the presence of plaque disclosing agent erythrosine as photosensitizer on Porphyromonas gingivalis associated with periodontal bone loss and Fusobacterium nucleatum associated with soft tissue inflammation, comparing with the near-infrared diode laser. MATERIALS AND METHODS Standard suspension of P. gingivalis and F. nucleatum were exposed to Light Emitting Diode (LED) (440-480 nm) used to photopolymerize composite resine dental restoration in combination with erythrosine (22 µm) up to 5 minutes. Bacterial sample were also exposed to a near-infrared diode laser (wavelength, 830 nm), using identical irradiation parameters for comparison. Bacterial samples from each treatment groups (radiation-only group, erythrosine-only group and light or laser with erythrosine group) were subcultured onto the surface of agar plates. Survival of these bacteria was determined by counting the number of colony forming units (CFU) after incubation. RESULTS Exposure to visible blue light and diode laser in conjugation with erythrosine significantly reduced both species examined viability, whereas erythrosine-treated samples exposed to visible light suggested a statically meaningful differences comparing to diode laser. In addition, bactericidal effect of visible light or diode laser alone on P. gingivalis as black-pigmented bacteria possess endogenous porphyrins was noticeably. CONCLUSION Our result suggested that visible blue light source in the presence of plaque disclosing agent erythrosine could can be consider as potential approach of PDT to kill the main gram-negative periodontal pathogens. From a clinical standpoint, this regimen could be established as an additional minimally invasive antibacterial treatment of plaque induced periodontal pathologies.
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Affiliation(s)
- Ghanbari Habiboallah
- Department of Periodontics, School of Dentistry and Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zakeri Mahdi
- School of Dentistry and Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naderi Nasab Mahbobeh
- Department of Medical Bacteriology & Virology, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Faghihi Sina
- School of Dentistry and Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zakeri Majid
- School of Dentistry and Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Passanezi E, Damante CA, de Rezende MLR, Greghi SLA. Lasers in periodontal therapy. Periodontol 2000 2014; 67:268-91. [DOI: 10.1111/prd.12067] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2014] [Indexed: 12/12/2022]
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Moslemi N, Soleiman-Zadeh Azar P, Bahador A, Rouzmeh N, Chiniforush N, Paknejad M, Fekrazad R. Inactivation of Aggregatibacter actinomycetemcomitans by two different modalities of photodynamic therapy using Toluidine blue O or Radachlorin as photosensitizers: an in vitro study. Lasers Med Sci 2014; 30:89-94. [PMID: 24981641 DOI: 10.1007/s10103-014-1621-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 06/22/2014] [Indexed: 12/24/2022]
Abstract
Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) is one of the periodontopathogens strongly associated with aggressive periodontitis. The aim of this investigation was to compare the effect of laser and light-emitting diode on the photodynamic inactivation of A. actinomycetemcomitans. Eighty-four samples of bacterial suspensions (200 μL) were prepared and divided in seven groups: control group (no treatment), laser group (indium-gallium-aluminum-phosphate laser with wavelength of 662 ± 0.1 nm, energy density of 6 j/cm(2), and irradiation time of 34 s), light-emitting diode (LED) group (wavelength 625-635 nm, energy density 6 j/cm(2), time of irradiation 30 s), Toluidine blue O (TBO) group (0.1 mg/mL), Radachlorin group (0.1 %), Radachlorin + laser group (after pre-irradiation time of 10 min, laser was irradiated), and TBO + LED group (after preirradiation time of 10 min, LED was irradiated). Then, 100 μL of each sample was cultured in brain heart infusion (BHI) plates and incubated for 48-72 h in microaerophilic atmosphere for colony counting. Application of Radachlorin + laser resulted in a significant decrease in the concentration of A. actinomycetemcomitans (P values <0.05). Photodynamic therapy with laser + Radachlorin was more effective than that of LED + TBO in suppression of this microorganism (P value <0.05). Within the limits of this study, it can be concluded that photodynamic inactivation using laser and Radachlorin was more effective than that of LED and TBO in eradication of A. actinomycetemcomitans.
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Affiliation(s)
- Neda Moslemi
- Laser Research Center of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Singh AK, Bettasso AM, Bae E, Rajwa B, Dundar MM, Forster MD, Liu L, Barrett B, Lovchik J, Robinson JP, Hirleman ED, Bhunia AK. Laser optical sensor, a label-free on-plate Salmonella enterica colony detection tool. mBio 2014; 5:e01019-13. [PMID: 24496794 PMCID: PMC3950520 DOI: 10.1128/mbio.01019-13] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/19/2013] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED We investigated the application capabilities of a laser optical sensor, BARDOT (bacterial rapid detection using optical scatter technology) to generate differentiating scatter patterns for the 20 most frequently reported serovars of Salmonella enterica. Initially, the study tested the classification ability of BARDOT by using six Salmonella serovars grown on brain heart infusion, brilliant green, xylose lysine deoxycholate, and xylose lysine tergitol 4 (XLT4) agar plates. Highly accurate discrimination (95.9%) was obtained by using scatter signatures collected from colonies grown on XLT4. Further verification used a total of 36 serovars (the top 20 plus 16) comprising 123 strains with classification precision levels of 88 to 100%. The similarities between the optical phenotypes of strains analyzed by BARDOT were in general agreement with the genotypes analyzed by pulsed-field gel electrophoresis (PFGE). BARDOT was evaluated for the real-time detection and identification of Salmonella colonies grown from inoculated (1.2 × 10(2) CFU/30 g) peanut butter, chicken breast, and spinach or from naturally contaminated meat. After a sequential enrichment in buffered peptone water and modified Rappaport Vassiliadis broth for 4 h each, followed by growth on XLT4 (~16 h), BARDOT detected S. Typhimurium with 84% accuracy in 24 h, returning results comparable to those of the USDA Food Safety and Inspection Service method, which requires ~72 h. BARDOT also detected Salmonella (90 to 100% accuracy) in the presence of background microbiota from naturally contaminated meat, verified by 16S rRNA sequencing and PFGE. Prolonged residence (28 days) of Salmonella in peanut butter did not affect the bacterial ability to form colonies with consistent optical phenotypes. This study shows BARDOT's potential for nondestructive and high-throughput detection of Salmonella in food samples. IMPORTANCE High-throughput screening of food products for pathogens would have a significant impact on the reduction of food-borne hazards. A laser optical sensor was developed to screen pathogen colonies on an agar plate instantly without damaging the colonies; this method aids in early pathogen detection by the classical microbiological culture-based method. Here we demonstrate that this sensor was able to detect the 36 Salmonella serovars tested, including the top 20 serovars, and to identify isolates of the top 8 Salmonella serovars. Furthermore, it can detect Salmonella in food samples in the presence of background microbiota in 24 h, whereas the standard USDA Food Safety and Inspection Service method requires about 72 h.
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Affiliation(s)
- Atul K. Singh
- Department of Food Science, Molecular Food Microbiology Laboratory, Purdue University, West Lafayette, Indiana, USA
| | - Amanda M. Bettasso
- Department of Food Science, Molecular Food Microbiology Laboratory, Purdue University, West Lafayette, Indiana, USA
| | - Euiwon Bae
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Bartek Rajwa
- Bindley Bioscience Center, Purdue University, West Lafayette, Indiana, USA
| | - Murat M. Dundar
- Computer & Information Science Department, Indiana University, Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Mark D. Forster
- Indiana State Department of Health, Indianapolis, Indiana, USA
| | - Lixia Liu
- Indiana State Department of Health, Indianapolis, Indiana, USA
| | - Brent Barrett
- Indiana State Department of Health, Indianapolis, Indiana, USA
| | - Judith Lovchik
- Indiana State Department of Health, Indianapolis, Indiana, USA
| | | | - E. Daniel Hirleman
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, USA
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Theodoro LH, Pires JR, Fernandes LA, Gualberto Júnior EC, Longo M, de Almeida JM, Garcia VG. Effect of antimicrobial photodynamic therapy on periodontally infected tooth sockets in rats. Lasers Med Sci 2013; 30:677-83. [DOI: 10.1007/s10103-013-1400-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 07/15/2013] [Indexed: 12/14/2022]
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Single or repeated antimicrobial photodynamic therapy as adjunct to ultrasonic debridement in residual periodontal pockets: clinical, microbiological, and local biological effects. Lasers Med Sci 2013; 30:27-34. [PMID: 23660738 PMCID: PMC4289155 DOI: 10.1007/s10103-013-1337-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/22/2013] [Indexed: 02/06/2023]
Abstract
This study aims to assess in residual periodontal pockets the clinical, microbiological, and local biological effects of antimicrobial photodynamic therapy (PDT), delivered after ultrasonic instrumentation either once or twice in a 1-week interval. A single center, three-arm randomized longitudinal study was carried out for 6 months. Twenty-eight systemically healthy patients on periodontal maintenance with residual pockets (pocket depth (PD) ≥5 mm, clinical attachment loss ≥2 mm, and bleeding upon probing (BOP+)) were included. Residual pockets on three teeth, separated from each other by at least two other teeth, served as study sites. After ultrasonic debridement, they were randomly assigned to either PDT delivered twice within 1 week (group A), PDT delivered only once (group B), or sham treatment without activating the laser (group C). Methylene blue was applied with a blunt irrigator tip into the pockets. Sites were irradiated with laser light at a wavelength of 670 nm using a light-diffusing tip introduced into the pocket. Initial PD was 5.9 ± 0.9, 6.3 ± 1.3, and 6.3 ± 1.5 mm in groups A, B, and C, respectively, differences being nonsignificant. PD was significantly reduced in all groups. At month 3, PD was significantly lower in groups A (2.9 ± 1.1 mm; p = 0.04) and B (2.8 ± 1.1 mm; p = 0.03) compared to group C (3.5 ± 1.2 mm). At month 6, none of the sites in group A had persisting pockets PD >4 mm and BOP+, whereas two sites in group B and four sites in group C stayed in this category. Detection frequencies of the studied microorganisms at >1,000 and >100.000 cells/ml did not change significantly from baseline to months 3 or 6 in any group. A significant overall decrease was observed from baseline to month 6 for C-reactive protein, serum amyloid A, fibrinogen, procalcitonin, and α-2 macroglobulin. When looking at the groups separately, C-reactive protein was significantly lower only if the laser had been activated twice (p < 0.05). Other differences between groups were not significant. A single or double episodes of PDT had some additional benefit over ultrasonic instrumentation alone.
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Light-activated disinfection using a light-emitting diode lamp in the red spectrum: clinical and microbiological short-term findings on periodontitis patients in maintenance. A randomized controlled split-mouth clinical trial. Lasers Med Sci 2012; 29:1-8. [DOI: 10.1007/s10103-012-1225-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/25/2012] [Indexed: 10/27/2022]
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Photodynamic therapy in dentistry: a literature review. Clin Oral Investig 2012; 17:1113-25. [DOI: 10.1007/s00784-012-0845-7] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 09/17/2012] [Indexed: 01/25/2023]
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Marotti J, Tortamano P, Cai S, Ribeiro MS, Franco JEM, de Campos TT. Decontamination of dental implant surfaces by means of photodynamic therapy. Lasers Med Sci 2012; 28:303-9. [PMID: 22790655 PMCID: PMC3536948 DOI: 10.1007/s10103-012-1148-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 06/22/2012] [Indexed: 11/24/2022]
Abstract
Several implant surface debridement methods have been reported for the treatment of peri-implantitis, however, some of them can damage the implant surface or promote bacterial resistance. Photodynamic therapy (PDT) is a new treatment option for peri-implantitis. The aim of this in vitro study was to analyze implant surface decontamination by means of PDT. Sixty implants were equally distributed (n = 10) into four groups and two subgroups. In group G1 there was no decontamination, while in G2 decontamination was performed with chlorhexidine. G3 (PDT − laser + dye) and G4 (laser, without dye) were divided into two subgroups each; with PDT performed for 3 min in G3a and G4a, and for 5 min in G3b and G4b. After 5 min in contact with methylene blue dye (G3), the implants were irradiated (G3 and G4) with a low-level laser (GaAlAs, 660 nm, 30 mW) for 3 or 5 min (7.2 and 12 J). After the dilutions, culture media were kept in an anaerobic atmosphere for 1 week, and then colony forming units were counted. There was a significant difference (p < 0.001) between G1 and the other groups, and between G4 in comparison with G2 and G3. Better decontamination was obtained in G2 and G3, with no statistically significant difference between them. The results of this study suggest that photodynamic therapy can be considered an efficient method for reducing bacteria on implant surfaces, whereas laser irradiation without dye was less efficient than PDT.
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Affiliation(s)
- Juliana Marotti
- Department of Prosthodontics and Dental Materials, Medical Faculty, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Garcia VG, Longo M, Fernandes LA, Junior ECG, dos Santos Santinoni C, Bosco ÁF, Nagata MJH, Theodoro LH. Treatment of experimental periodontitis in rats using repeated adjunctive antimicrobial photodynamic therapy. Lasers Med Sci 2012; 28:143-50. [DOI: 10.1007/s10103-012-1099-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 04/09/2012] [Indexed: 12/27/2022]
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Giannopoulou C, Cappuyns I, Cancela J, Cionca N, Mombelli A. Effect of photodynamic therapy, diode laser, and deep scaling on cytokine and acute-phase protein levels in gingival crevicular fluid of residual periodontal pockets. J Periodontol 2011; 83:1018-27. [PMID: 22181685 DOI: 10.1902/jop.2011.110281] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is an ongoing controversy on the benefits of treatment protocols, including dental lasers and photodynamic therapy (PDT). The purpose of this study is to compare the local biologic effects of PDT, diode soft laser (DSL) therapy, and conventional deep scaling and root planing (SRP) in residual pockets. METHODS Thirty-two individuals were included based on a history of previous treatment for periodontitis and the persistence of sites with probing depths >4 mm and bleeding on probing. Residual pockets were debrided with an ultrasonic device and then randomly assigned either to PDT, DSL, or SRP. Gingival crevicular fluid was collected before treatment, after 14 days, and at 2 and 6 months. Levels of 13 cytokines and nine acute-phase proteins were measured using a bead-based multiplexing analysis system. RESULTS Treatment with PDT, DSL, or SRP led to significant changes in several cytokines and acute-phase proteins: Compared with baseline, levels of interleukin-17, basic fibroblast growth factor, granulocyte colony-stimulating factor, granulocyte macrophage colony-stimulating factor, and macrophage inflammatory protein 1-α were lower 14 days and 2 months after treatment. Except for granulocyte colony-stimulating factor, these differences remained significant throughout the observation period. The levels of five acute-phase proteins (α-2 macroglobulin, haptoglobin, serum amyloid P, procalcitonin, and tissue plasminogen activator) were significantly higher at 6 months than at baseline. No significant differences were observed among the three treatment modalities at any time point for any biochemical parameter. CONCLUSIONS Levels of several cytokines and acute-phase proteins significantly changed after treatment regardless of treatment modality. There was no evidence for a specific DSL- or PDT-enhanced expression of inflammatory mediators.
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Prates RA, Yamada AM, Suzuki LC, França CM, Cai S, Mayer MPA, Ribeiro AC, Ribeiro MS. Histomorphometric and microbiological assessment of photodynamic therapy as an adjuvant treatment for periodontitis: a short-term evaluation of inflammatory periodontal conditions and bacterial reduction in a rat model. Photomed Laser Surg 2011; 29:835-44. [PMID: 21916615 PMCID: PMC3231969 DOI: 10.1089/pho.2010.2984] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the short-term effects of photodynamic therapy (PDT) in periodontal tissue when it is used as an adjuvant treatment for periodontitis. BACKGROUND DATA PDT has been used as an adjuvant in the combat of local infections, such as periodontitis, and combines a photosensitizer (PS) with a light source to induce reactive oxygen species (ROS) and kill microbial cells. METHODS Fifty healthy male rats were used in this study. Periodontitis was induced by placing a cotton ligature around the upper left second molar in a subgingival position. Posterior maxillas were removed and histologically prepared with hematoxylin & eosin (H&E) staining techniques. PDT was performed with a diode laser (λ=660 nm) with an output power of 100 mW. Methylene blue aqueous solution (100 μM) was used as the PS while control group used phosphate buffered saline (PBS). Collagen organization, inflammatory infiltrate, and bone loss were evaluated. Bacterial samples were collected before and immediately after treatment to determine bacterial reduction. RESULTS The experimental group that was treated with PDT presented better periodontal healing, as measured by collagen organization, inflammatory infiltrate, and bone loss. Significant bacterial reduction was achieved following treatment with or without PDT compared to control, with a higher microbial reduction observed in the PDT group. CONCLUSIONS PDT used as an adjuvant treatment showed effective short-term control of periodontitis infection.
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Affiliation(s)
- Renato A Prates
- Center for Lasers and Applications, Instituto de Pesquisas Energéticas Nucleares, IPEN-CNEN/SP, Cidade Universitária , São Paulo, SP, Brazil.
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Biel MA, Sievert C, Usacheva M, Teichert M, Balcom J. Antimicrobial photodynamic therapy treatment of chronic recurrent sinusitis biofilms. Int Forum Allergy Rhinol 2011; 1:329-34. [PMID: 22287461 PMCID: PMC3270367 DOI: 10.1002/alr.20089] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 06/21/2011] [Accepted: 07/12/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic recurrent sinusitis (CRS) is an inflammatory disease of the facial sinuses and nasal passages that is defined as lasting longer than 12 weeks or occurring more than 4 times per year with symptoms usually lasting more than 20 days. The National Institute for Health Statistics estimates that CRS is one of the most common chronic conditions in the United States, affecting an estimated 37 million Americans. The potential etiologies of CRS include bacteria, viruses, allergies, fungi, superantigens, and microbial biofilms. In clinical practice there is a significant subpopulation of patients with CRS who remain resistant to cure despite rigorous treatment regimens including surgery, allergy therapy, and prolonged antibiotic therapy. The reason for treatment failure is thought to be related to the destruction of the sinus mucociliary defense by the chronic sinus infection resulting in the development of secondary antibiotic-resistant microbial colonization of the sinuses and biofilm formation. Antimicrobial photodynamic therapy (aPDT) is a nonantibiotic broad-spectrum antimicrobial treatment that has been demonstrated to eradicate antibiotic-resistant bacteria and biofilms. The objective of this study was to demonstrate the effectiveness of a noninvasive aPDT treatment method of eradicating antibiotic resistant biofilms/microorganisms known to cause CRS in an in vitro model. METHODS Antibiotic-resistant planktonic bacteria and fungi and polymicrobial biofilms of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) were grown on silastic sheets and treated with a methylene blue photosensitizer and 670 nm non-thermal-activating light. Cultures of the planktonic microorganisms and biofilms were obtained before and after light treatment to determine efficacy of planktonic bacteria and biofilm reduction. RESULTS The in vitro CRS planktonic microorganism and biofilm study demonstrated that aPDT reduced the CRS polymicrobial biofilm by >99.9% after a single treatment. CONCLUSION aPDT can effectively treat CRS polymicrobial antibiotic-resistant bacteria, fungi, and biofilms in vivo. Human clinical studies are currently planned to assess the safety and efficacy of this treatment for CRS.
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Affiliation(s)
- Merrill A Biel
- Ear, Nose and Throat Specialty Care of Minnesota, Minneapolis, MN; Advanced Photodynamic Technologies, Inc., Minneapolis, MN, USA.
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Umeda M, Tsuno A, Okagami Y, Tsuchiya F, Izumi Y, Ishikawa I. Bactericidal effects of a high-power, red light-emitting diode on two periodontopathic bacteria in antimicrobial photodynamic therapy in vitro. ACTA ACUST UNITED AC 2011; 2:268-74. [PMID: 25426898 DOI: 10.1111/j.2041-1626.2011.00071.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Light-emitting diodes have been investigated as new light activators for photodynamic therapy. We investigated the bactericidal effects of high-power, red light-emitting diodes on two periodontopathic bacteria in vitro. METHODS A light-emitting diode (intensity: 1100 mW/cm(2) , peak wavelength: 650 nm) was used to irradiate a bacterial solution for either 10 or 20 s. Bacterial solutions (Porphyromonas gingivalis or Aggregatibacter actinomycetemcomitans) at a concentration of 2.5 × 10(6) c.f.u./mL were mixed with an equal volume of either methylene blue or toluidine blue O (0-20 μg/mL) and added to titer plate wells. The plate wells were irradiated with red light-emitting diode light from a distance of 22 or 40 mm. The contents were diluted, and 50 μL was smeared onto blood agar plates. After 1 week of culturing, bacterial c.f.u. were counted. RESULTS The light-emitting diode energy density was estimated to be approximately 4 and 8 J/cm(2) after 10 and 20 s of irradiation, respectively. Red light-emitting diode irradiation for 10 s from a distance of 22 mm, combined with methylene blue at concentrations >10 μg/mL, completely killed Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. CONCLUSION High-power, red light-emitting diode irradiation with a low concentration of dye showed effective bactericidal effects against two periodontopathic bacteria.
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Affiliation(s)
- Makoto Umeda
- Department of Hard Tissue Engineering, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan Division of Oral and Maxillo Facial Surgery, National Center for Global Health and Medicine, Tokyo, Japan Department of Research and Development, J. Morita Manufacturing Corporation, Kyoto, Japan Department of Pharmacy, Tokyo Medical and Dental University Hospital, Faculty of Dentistry, Tokyo, Japan International Research Center for Molecular Science in Tooth and Bone Diseases, Tokyo Medical and Dental University, Tokyo, Japan Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
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Pesevska S, Nakova M, Gjorgoski I, Angelov N, Ivanovski K, Nares S, Andreana S. Effect of laser on TNF-alpha expression in inflamed human gingival tissue. Lasers Med Sci 2011; 27:377-81. [DOI: 10.1007/s10103-011-0898-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 02/14/2011] [Indexed: 11/29/2022]
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Street CN, Pedigo LA, Loebel NG. Energy dose parameters affect antimicrobial photodynamic therapy-mediated eradication of periopathogenic biofilm and planktonic cultures. Photomed Laser Surg 2010; 28 Suppl 1:S61-6. [PMID: 20666581 DOI: 10.1089/pho.2009.2622] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study evaluated the in vitro efficacy of a commercially available aPDT system in eradication of the periopathogens Porphyromonas gingivalis, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans in both planktonic and biofilm cultures. BACKGROUND DATA Antimicrobial photodynamic therapy (aPDT) is an effective antibacterial approach in vitro; however, few data are available regarding effective light-energy parameters. MATERIALS AND METHODS Planktonic and biofilm cultures of periopathogens were exposed to a methylene blue-based formulation and irradiated with a 670-nm nonthermal diode laser. Energy doses were varied from 2.3 to 9.4 J/cm(2) through adjustments in illumination time and a constant power density. Controls consisted of no treatment, light only, and photosensitizer only. Temperature changes were recorded in experimental samples before and after illumination. RESULTS aPDT with an energy dose of 9.4 J/cm(2) was effective in eradicating P. gingivalis, F. nucleatum, and A. actinomycetemcomitans in biofilm and planktonic form. Reductions from control in planktonic cultures at this energy dose were 6.8 +/- 0.7, 5.2 +/- 0.6, and 1.9 +/- 0.6 log(10), respectively, whereas biofilm reductions were 4.5 +/- 1.2, 3.4 +/- 1.1, and 4.9 +/- 1.4 log(10). Decreasing the treatment time produced an energy dose-dependent killing effect in both models. Changes in sample temperature did not exceed 3 degrees C under these exposure parameters. CONCLUSION This study demonstrated that three important periopathogens are susceptible to aPDT-mediated killing, regardless of whether they are present in planktonic or biofilm form. Furthermore, a clear energy dose-dependence exists with this treatment that should to be taken into account when determining optimal treatment times in clinical application.
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Affiliation(s)
- Cale N Street
- Ondine Research Laboratories, Bothell, Washington 98011, USA.
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Goulart RDC, Bolean M, Paulino TDP, Thedei G, Souza SL, Tedesco AC, Ciancaglini P. Photodynamic Therapy in Planktonic and Biofilm Cultures of Aggregatibacter actinomycetemcomitans. Photomed Laser Surg 2010; 28 Suppl 1:S53-60. [DOI: 10.1089/pho.2009.2591] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rosangela de Carvalho Goulart
- Departamento de Química, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Mayte Bolean
- Departamento de Química, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Sérgio L.S. Souza
- Faculdade de Odontologia de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Antonio Cláudio Tedesco
- Departamento de Química, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Pietro Ciancaglini
- Departamento de Química, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
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Abstract
AbstractPhotodynamic antimicrobial therapy (PACT) involves the utilisation of photosensitizers activated by exposure to visible light in order to eradicate microbes (this method has already been applied in photodynamic therapy of tumours). Photodynamic effect of the particular photosensitive substance (PS) is attributed to its ability to penetrate susceptible microorganisms, to absorb the light of certain wavelength, and to generate reactive cytotoxic oxygen products. The target microorganisms for photoinactivation are bacteria, fungi, viruses and protozoa. Photodynamic antimicrobial therapy is proposed as a potentially topical, non-invasive approach suitable for treatment of locally occurring infection. The fact that bacteria are becoming increasingly resistant to antibiotics and antiseptics has lead to an increased interest in the development of new alternative eradication methods, such as PACT. Research and development of photosensitive substances are aimed at finding effective antimicrobial substances, which would have a broad-spectrum potency.
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Azarpazhooh A, Shah PS, Tenenbaum HC, Goldberg MB. The effect of photodynamic therapy for periodontitis: a systematic review and meta-analysis. J Periodontol 2010; 81:4-14. [PMID: 20059412 DOI: 10.1902/jop.2009.090285] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The purpose of this review was to evaluate the effectiveness of photodynamic therapy (PDT) for periodontitis in adults as a primary mode of treatment or as an adjunct to non-surgical treatment of scaling and root planing (SRP) compared to a conventional non-surgical SRP treatment. METHODS MEDLINE, EMBASE, CINAHL, other relevant databases, and the International Pharmaceutical Abstracts were searched from their inception until May 2009 for randomized controlled trials of PDT compared to a placebo, no intervention, or non-surgical treatment in an adult population. Data on changes in clinical attachment level (CAL), probing depth, gingival recession, and full-mouth plaque or bleeding scores were extracted and meta-analyzed, and the pooled mean difference (MD) was reported. RESULTS Five studies were included in this review. These studies had a small sample size for some of the performed analysis with a moderate to high risk of biases. There were clinical heterogeneities among included studies. PDT as an independent treatment or as an adjunct to SRP versus a control group of SRP did not demonstrate statistically or clinically significant advantages. Combined therapy of PDT + SRP indicated a probable efficacy in CAL gain (MD: 0.34; 95% confidence interval [CI]: 0.05 to 0.63) or probing depth reduction (MD: 0.25 mm; 95% CI: 0.04 to 0.45 mm). CONCLUSIONS PDT as an independent treatment or as an adjunct to SRP was not superior to control treatment of SRP. Therefore, the routine use of PDT for clinical management of periodontitis cannot be recommended. Well-designed clinical trials are needed for proper evaluation of this therapy.
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Affiliation(s)
- Amir Azarpazhooh
- Community Dental Health Services Research Unit and Division of Endodontics, University of Toronto, 124 Edward St., Toronto, ON M5G 1G6, Canada.
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