Adjunctive Application of Antimicrobial Photodynamic Therapy in Nonsurgical Periodontal Treatment: A Review of Literature.

Takeshi Kikuchi,Makio Mogi,Iichiro Okabe,Takeki Fujimura,Kosuke Okada,Yasuyuki Sasaki,Hisashi Goto,Mitsuo Fukuda,Akio Mitani

doi:10.3390/ijms161024111

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.

Highlights

Photodynamic therapy (PDT) utilizes singlet oxygen and free radicals produced by a light-activated photosensitizer to kill microbes
APDT with a diode laser adjunctive to scaling and root planning (SRP) had a beneficial effect with a moderate level of certainty
There was no evidence of effectiveness for the use of antimicrobial photodynamic therapy (aPDT) as an alternative to SRP

Summary

Introduction

Photodynamic therapy (PDT) utilizes singlet oxygen and free radicals produced by a light-activated photosensitizer to kill microbes. The ground state photosensitizer absorbs light, resulting in a singlet state that can lose energy by fluorescence or undergo intersystem crossing to a triplet state with longevity. The latter state leads to a photochemical reaction that induces singlet oxygen, free radicals, and superoxide, which are cytotoxic, thereby inducing microbial killing [1] (Figure 1). The initial application of PDT for selective toxicity was attempted more than a hundred years ago [2,3,4]. The discovery of antibiotics caused considerable stagnation for applications of PDT to infectious diseases in the 1940s. While PDT can eliminate antibiotic-resistant microbes [5], there is no information about microbes developing resistance to PDT [6]

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