Adjunct aPDT Research Articles

Does Non-surgical Periodontal Therapy With Adjunct Antimicrobial Photodynamic Therapy Help Reduce Periodontal Inflammation and Haemoglobin A1c Levels in Patients With Type-2 Diabetes Mellitus? A Systematic Review and Meta-analysis.

The aim of the present systematic review and meta-analysis was to assess the efficacy of non-surgical periodontal therapy (NSPT) with adjunct photodynamic therapy (aPDT) in reducing periodontal inflammation and haemoglobin A1c (HbA1c) levels in patients with diabetes mellitus (DM). The focused question was 'Does NSPT with adjunct aPDT help reduce periodontal inflammation and HbA1c levels in patients with DM?' The PICO (patient/population, intervention, comparison and outcomes) was formatted as follows: Patients (P): Participants diagnosed with DM; Intervention (I): NSPT with adjunct PDT for the treatment of periodontitis; Control (C): NSPT alone or NSPT with adjunct systemic antibiotic therapy; and Outcome (O): Changes in HbA1c levels. The inclusion criteria comprised RCTs specifically evaluating the impact of NSPT on HbA1c levels in diabetic patients, with a specific focus on interventions involving NSPT with and without adjunct aPDT. The literature search was performed in accordance with the Preferred reporting items for systematic reviews and meta-analysis. Indexed databases were searched without time and language restrictions using various keywords. Forest plots were created to illustrate the effects of the different studies and the global estimation. Five RCTs were included and processed for data extraction. The number of participants ranged from 12 to 45 patients with medically diagnosed type-2 DM. In all RCTs, aPDT was done using a diode laser with wavelengths ranging between 660 and 810 nm. Three and two RCTs had moderate and high RoB, respectively. In two RCTs, NSPT with adjunct aPDT reported no improvement in clinical periodontal parameters. Two studies reported that NSPT with adjunct aPDT significantly reduces periodontal probing depth compared to NSPT alone. Four of the five RCTs reported that NSPT+PDT does not influence HbA1c levels. NSPT with or without adjunct aPDT does not affect HbA1c levels in patients with type-2 DM.

Clinical and Radiographic Outcomes of Adjunctive Phototherapy Versus Antibiotic Therapy Against Peri-Implant Diseases: A Systematic Review and Meta-Analysis.

Background: Peri-implantitis, an inflammatory condition in implant tissues, requires bacterial eradication and implant surface decontamination, with aPDT as a helpful surgical adjunct. Objective:This project was designed to investigate the effect of antibiotic therapy versus aPDT, as adjuncts to conventional mechanical debridement (MD), on the peri-implant clinical and/or radiographic parameters among patients with peri-implant diseases. Methods: A comprehensive search was conducted across electronic databases, including PubMed, Scopus, and Web of Science, up to and including April 2023, without any restriction on the language and year of publication, focusing the following research question: "Does adjunctive aPDT improve the peri-implant clinical and/or radiographic parameters in treating peri-implant diseases compared to antibiotic therapy?" Statistical analysis was performed on peri-implant clinical [plaque index (PI), probing depth (PD), and bleeding on probing (BOP)] and radiographic parameters [marginal bone loss (MBL)]. The study included six randomized controlled trials and one clinical (nonrandomized) study. Results: The systematic review findings indicate that the application of aPDT as an adjunct to MD is equally effective as adjunctive antibiotic therapy in improving peri-implant clinical parameters and radiographic parameters in patients with peri-implant diseases. Only two studies were classified as having a low risk of bias (RoB), two were assessed as having an unclear RoB, and the remaining three studies were determined to have a high RoB. However, the meta-analysis results revealed no statistically significant difference in peri-implant PI, PD, and MBL scores between patients treated with adjunct aPDT or adjunct antibiotic therapy. Notably, there was a statistically significant difference favoring adjunct aPDT in peri-implant BOP values compared to the control group. Conclusions: Despite the limited number of included studies and the significant heterogeneity among them, the findings suggest that aPDT yields comparable peri-implant clinical and radiographic outcomes to adjunctive antibiotic therapy, as adjuncts to MD, for the potential treatment of peri-implant diseases.

Clinical and Radiographic Outcomes of Adjunctive Photodynamic Therapy for Treating Peri-Implant Mucositis Among Cigarette Smokers and Diabetics: A Systematic Review and Meta-Analysis.

Objective: This systematic review aimed to assess the influence of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical debridement (MD) on peri-implant clinical and radiographic outcomes among cigarette smokers and diabetics with peri-implant mucositis (piM). Methods: Randomized controlled trials, assessing the clinical and radiographic parameters of aPDT versus MD alone among smokers and diabetics with piM, were included in the study. Meta-analyses were conducted to calculate the standard mean difference with a 95% confidence interval. The methodological quality of the included studies was assessed utilizing the modified Jadad quality scale. Results: The meta-analyses found statistically significant differences between the impact of adjunct aPDT and MD alone on the peri-implant plaque index (PI), probing depth (PD), and bleeding on probing among smokers and diabetics with piM at the final follow-up visit. However, no significant differences were found between the impact of adjunct aPDT and MD alone on the peri-implant crestal bone loss among smokers and diabetics with piM at the final follow-up. Conclusions: The application of aPDT as an adjunctive to MD demonstrated improved scores of the peri-implant clinical parameters among smokers and diabetics with piM in comparison with MD alone.

Short-term influence of antimicrobial photodynamic therapy as an adjuvant to mechanical debridement in reducing soft-tissue inflammation and subgingival yeasts colonization in patients with peri-implant mucositis

ObjectiveThe objective of this short-term follow-up study was to evaluate the influence of antimicrobial photodynamic therapy (aPDT) as an adjuvant to mechanical debridement (MD) in reducing soft-tissue inflammation and subgingival yeasts colonization (SYC) in patients with peri‑implant mucositis (PiM). MethodsIndividuals diagnosed with PiM were included. Demographic data was collected using a questionnaire. Peri-implant plaque index (PI), bleeding index (BI), probing depth (PD), crestal bone levels and SYC were measured at baseline. Therapeutically, these individuals were divided into test and control groups. In the control-group patients underwent MD and in the test-group patients underwent MD with adjunct single session of aPDT. Clinical peri‑implant parameters and SYC were reassessed after 12-weeks. Correlation between age, gender and duration of implants with SYC and clinical peri‑implant status was assessed using logistic regression models. P < 0.05 was selected as an indicator of statistical significance. ResultsThe test and control-groups comprised of 24 and 23 individuals, respectively. In the test and control groups, toothbrushing twice daily was reported by 7 (29.2%) and 5 (21.7%) individuals, respectively. None of the individuals had ever used a dental floss. At baseline, there was no difference in peri‑implant PI, BI, PD and CBL in the test and control groups. At follow-up, peri‑implant PI (P < 0.01), BI (P < 0.01) and PD (P < 0.01) were significantly higher in the control compared with the test-group. At baseline, SYC in the test and control groups were 1865.3 ± 403.4 CFU/ml and 1963.7 ± 512.4 CFU/ml, respectively. At 90 days’ follow-up, SYC in the test and control groups were 1472 ± 202.7 and 1538.4 ± 331.7 CFU/ml, respectively. There was no significant difference in SYC in both groups when baseline values were compared with 90 days’ follow-up. ConclusionOne session of aPDT after MC with adjunct aPDT is effective in reducing soft tissue inflammation but not SYC in patients with PiM.

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

The aim was to assess the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical instrumentation (MI) in reducing Enterococcus faecalis (E faecalis) and Candida albicans (C albicans) counts from C-shaped root-canals. Teeth with C-shaped canals as identified on cone beam computed tomographic images were included. Following incubation with E faecalis and C albicans, samples were divided into 4 groups a four follows: Group-1: MI with adjunct aPDT; Group-2: aPDT alone; Group-3: MI alone; and Group-4: no treatment. The pulp chambers of these teeth were exposed and coronal pulp was mechanically derided using sterile endodontic excavators. Using flexible files, all canals were debrided up to size #30K-files with intermittent irrigation with 2.5% sodium hypochlorite irrigation. In Groups 1 and 3, methylene-blue was injected in all canals and aPDT was performed using a 600nm diode laser. Sample-size estimation was done on data from a pilot investigation and group-comparisons were done using one way analysis of variance and Bonferroni post-hoc adjustment tests. P < .05 was considered statistically significant. Sixty periodontally hopeless mandibular second molars with C-shaped canals were included. There was a statistically significant reduction CFU/mL of E faecalis (P < .001) and C albicans (P < .001). At post-operative microbial assessments in Group-1. There was no difference CFU/mL of E faecalis and C albicans at post-operative microbial assessments in Groups 2-4. MI with adjunct aPDT is more effective in reducing count of E faecalis and C albicans from C-shaped root canals.

Role of antimicrobial photodynamic therapy in reducing whole salivary oral yeasts colonization in type-2 diabetic and non-diabetic patients with and without dental implants.

The aim was to assess the impact of antimicrobial photodynamic therapy (aPDT) in reducing whole salivary oral yeasts colonization in type-2 diabetic and non-diabetic patients with dental implants. Type-2 diabetic and self-reported non-diabetic patients were included. Participants were divided into the following groups: Group-1: Type-2 diabetic patients with dental implants; Group-2: Non-diabetic patients with dental implants; Group-3: Type-2 diabetic patients without dental prostheses; Group-4: Non-diabetic patients without dental prostheses. In each group, participants were subdivided into 2-sub-groups. In the test-subgroup, participants received routine oral hygiene maintenance instructions (OHMI) and underwent full mouth disinfection using aPDT; and in the control-group, participants received OHMI alone. Unstimulated whole saliva samples were collected, hemoglobin A1c levels were measured and yeast colonization was assessed at baseline and at 3-months' follow-up in all groups. Sample-size estimation was done and group-comparisons were done. P-values <0.01 were considered statistically significant. At baseline, the mean oral yeasts colonization was significantly higher among patients in Group-1 (P < 0.001) and 3 (P < 0.001) compared with individuals in groups 2 (P < 0.001) and 4 (P < 0.001). At baseline and at 3-months of follow-up, the mean HbA1c levels and oral yeasts colonization were significantly higher among patients in Group-1 (P < 0.001) and 3 (P < 0.001) compared with individuals in groups 2 (P < 0.001) and 4 (P < 0.001). In the short-term, routine OHMI with adjunct aPDT is more effective in reducing whole salivary oral yeasts counts than OHMI alone in patients with and without dental implants.

Effectiveness of mechanical debridement with and without adjunct antimicrobial photodynamic for treating peri-implant mucositis among prediabetic cigarette-smokers and non-smokers.

The aim of the present study was to compare the effectiveness of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) for treating peri-implant mucositis among prediabetic cigarette-smokers and non-smokers. Prediabetic and non-diabetic smokers and non-smokers with peri-implant mucositis were included. Patients with peri-implant mucositis were divided into 4 groups as follows: Group-1: Prediabetic smokers with peri-implant mucositis; Group-2: Prediabetic non-smokers with peri-implant mucositis; Group-3: Systemically-healthy smokers with peri-implant mucositis; and Group-4: Systemically-healthy non-smokers with peri-implant mucositis. Hemoglobin A1c levels were measured in all groups prior to MD with adjunct aPDT. Peri-implant plaque index (PI), bleeding on probing (BOP) and probing depth (PD) were assessed at baseline and at 4- and 12-weeks of follow-up. Sample-size estimation was done and data normality was assessed. Group-comparisons were performed. and P < 0.01 was selected as an indicator of statistical significance. Fifteen, 15, 15 and 15 individuals were included in groups 1, 2, 3 and 4, respectively. At baseline, peri-implant PI, BOP and PD were comparable in all groups. In prediabetic smokers and non-smokers, there was no significant difference in peri-implant PI, BOP and PD at 4- and 12-weeks' follow-up. Among non-diabetic smokers and non-smokes MD with adjunct PDT significant reduced PI (P < 0.01) and PD (P < 0.01) at 4- and 12-weeks' follow-up. The outcomes of MD with adjunct aPDT for the treatment of peri-implant mucositis are compromised in smokers and non-smokers with prediabetes. In non-diabetic smokers and non-smokers, MD with aPDT is effective for treating peri-implant mucositis.

Clinical and microbiological effects of photodynamic therapy applied in non-surgical treatment of periodontitis

Background/Aim. Treatment of periodontitis undergoes several treatment phases. Non-surgical periodontal treatment (NSPT) represents the basic treatment stage, and it is applied to all the patients undergoing periodontal treatment. Adjunctive antimicrobial photodynamic therapy (aPDT) is one of several contemporary and relatively new possibilities with a role to inactivate microorganisms responsible for the occurrence and progression of the disease. The aim of this study was to comparatively analyze the clinical and microbiological effects of the NSPT alone, as well as combined with aPDT. Methods. A split-mouth method design was used in a prospective randomized controlled trial. The following clinical parameters were registered and monitored: plaque index (PI), bleeding on probing, probing depth (PD), and clinical attachment level (CAL). The presence of microorganisms Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Treponema denticola was detected by the polymerase chain reaction (PCR) method. Samples were tested before the therapy, as well as three months after the therapy. Therapeutic modalities of NSPT and NSPT with adjunct aPDT were examined. Results. All of the analyzed clinical parameters proved statistically significant improvement after the application of both treatment modalities (p &lt; 0.001). Microbiological analyses showed that the total number of microorganisms was statistically significantly lower after the application of both methods (p &lt; 0.001). Following the treatment, there was a statistically significantly reduced number of microorganisms Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Treponema denticola (p &lt; 0.001). NSPT combined with aPDT led to a statistically significant improvement of both clinical parameters and microbiological status compared to NSPT applied on its own. Conclusion. The study showed improvement of all clinical indicators after the application of both treatment modalities. The total number of microorganisms was reduced as well as the number of specific microorganisms. Combining aPDT with NSPT led to a statistically significantly higher reduction in the number of microorganisms compared to NSPT alone.

Efficacy of mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implantitis among moderate cigarette-smokers and waterpipe-users.

The aim was to assess the efficacy of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of peri-implantitis among cigarette-smokers and waterpipe-users. Patients diagnosed with peri-implantitis were included. Demographic data was collected using a questionnaire. Individuals in the test- and control-groups underwent MD with adjunct aPDT and MD alone, respectively. Peri-implant clinical (plaque-index [PI], bleeding on probing [BOP] and probing depth [PD]) and radiographic (crestal bone loss [CBL]) inflammatory parameters were measured at baseline and at 6- and 12-months follow-up. Sample-size estimation was performed, and statistical analysis was done. P-values <0.05 were considered statistically significant. Ninety-eight male patients with peri-implantitis (34 cigarette-smokers, 32 waterpipe-users and 32 never-smokers) were included. At baseline, there was no difference in the peri-implant PI, PD and CBL in all groups; and BOP levels were significantly high among never-smokers (n = 16) (P < 0.01) than cigarette-smokers (n = 17) and waterpipe-users (n = 16). There was no difference in PI, BOP, PD and CBL among cigarette-smokers (n = 17) and waterpipe-users (n = 16) that underwent MD alone at 3- and 6-months' follow-up compared with baseline. Compared with baseline, PI (P < 0.05) and PD (P < 0.05) were significantly lower among cigarette-smokers (n = 17) and waterpipe-users (n = 16) that underwent MD + aPDT at 3-months' follow-up. At 6-months' follow-up, PI, BOP and PD were significantly lower in never-smokers (n = 16) than their respective baseline and 3-months' follow up outcomes. MD with adjunct aPDT is effective for the treatment of peri-implantitis. Routine oral hygiene maintenance plays a role in the overall success of MD with or without aPDT in patients with peri-implantitis.

Effectiveness of scaling and root planning with and without adjunct antimicrobial photodynamic therapy in the treatment of chronic periodontitis among cigarette-smokers and never-smokers: A randomized controlled clinical trial.

The aim of the present short-term randomized clinical trial was to assess the efficacy of scaling and root planing (SRP) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of chronic periodontitis (CP) among cigarette-smokers and never-smokers. Demographic information was collected using a questionnaire. Cigarette-smokers (group-1) and never-smokers (group-2) with CP were included. Treatment wise, these individuals were divided into two subgroups as follows: (a) SRP alone and (b) SRP with adjunct aPDT. Periodontal parameters (plaque index [PI], bleeding on probing [BOP], clinical attachment loss [AL] and probing pocket depth≥4 mm [PD] were measured at baseline and at 1 month and 3 months' follow-up. Group comparisons were done using the Kruskall-Wallis test. Eighty-three male patients with CP (Group-1: 42 cigarette-smokers and; Group-2: 41 never-smokers) were included. In group-1, individuals that received SRP alone and SRP with adjunct aPDT had a mean history of cigarette smoking of 11.7 ± 0.3 and 12.5 ± 0.4 pack years. At baseline, PI, BOP, PD and clinical AL were comparable among all individuals in groups 1 and 2. At 1 month and 3 months' follow-up, PI (P < 0.05), PD (P < 0.05) and clinical AL (P < 0.05) were higher among all individuals in group-1 compared with group-2. In Group-2, PI, BOP, PD and clinical AL were comparable among all individuals at 1 month and 3 months' follow-up. Outcomes of SRP with or without aPDT for the treatment of CP are compromised in cigarette-smokers. Among never-smokers with CP, outcomes of SRP with or without aPDT are comparable. The significance of aPDT in this regard remains questionable.

Effectiveness of mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of periodontal inflammation among patients with prediabetes

AimThe aim of the present study was to assess the effectiveness of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of periodontal inflammation among patients with prediabetes. MethodsDemographic information was collected using a questionnaire. Hemoglobin A1c (HbA1c) levels were measured at baseline and at 3 and 6 months’ follow-up. TreatmentIndividuals were randomly divided into 2 groups as follows: (a) Group-1, participants underwent full-mouth MD; and Group-2: participants underwent full-mouth MD with adjunct aPDT. In groups 1 and 2, full-mouth plaque index (PI), bleeding on probing (BOP) and probing pocket depth (PPD) were measured at baseline and at 3 and 6 months’ follow-up. In both groups, full-mouth digital intraoral radiographs were also taken. Sample-size was estimated and statistical analysis was performed with level of significance set as P<0.05. ResultsIn total, 70 prediabetic male individuals (35 patients in group-1 and 35 in group-2) were included. At baseline, PI, BOP, number of sites with PPD ≥4mm were comparable among individuals in groups 1 and 2. In groups 1 and 2, PI (P<0.05), BOP (P<0.05), number of sites with PPD ≥4mm (P<0.05) were significantly higher at baseline compared with 3 months’ follow-up. There was no statistically significant difference in PI, BOP, number of sites with PPD ≥4mm at 3 and 6 months’ follow-up. At 6 months’ follow-up, PI, BOP, number of sites with PPD ≥4mm were comparable to their respective baseline values. There was no statistically significant difference in CBL in both groups at 3 and 6 months’ follow-up. There was no statistically significant difference in HbA1c levels among individuals in groups 1 and 2 at all-time intervals. ConclusionIn the short-term, MD is effective in reducing periodontal inflammation among patients with prediabetes. The contribution of adjunct aPDT in this regard is insignificant.

Role of mechanical curettage with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implant mucositis in cigarette smokers: A randomized controlled clinical trial

ObjectiveThe aim of the present 12-weeks follow-up randomized clinical trial was to investigate the outcome of mechanical curettage (MC) with or without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of peri-implant mucositis in cigarette smokers. MethodsTherapeutically, subjects with peri-implant mucositis were divided into 2 groups: (a) Group-A: MC+aPDT; and (b) Group-B: MC alone (control group). In both groups, peri-implant plaque index (PI), bleeding on probing (BOP) and probing pocket depth (PPD) were gauged at baseline and after 12-weeks follow-up. Group comparisons were performed using the Kruskall-Wallis test. P-values less than 0.05 were considered statistically significant. ResultsFifty-four male patients (28 in Group-A and 26 in Group-B) were included. The mean age of individuals in groups A and B were 50.6±0.8 and 52.2±0.5years, respectively. In groups A and B the participants were smoking 16.5±2.7 and 14.2±1.7 cigarettes daily since 25.2±6.5 and 24.6±4.3years, respectively. Periimplant PI, BOP and PPD were comparable among individuals in both groups at baseline. At 12-weeks follow-up, there was a significant reduction in PI (P<0.001) and PPD (P<0.001) among patients in groups A and B compared with their respective baseline values. At 12-weeks follow-up, PI (P<0.001) and PPD (P<0.001) were significantly higher among patients in Group-B compared with Group-A (P<0.001). BOP was comparable in both groups at baseline and at 12-weeks follow-up. ConclusionIn cigarette smokers, MC with adjunct aPDT is more effective in the treatment of peri-implant mucositis compared with MC alone.

Efficacy of periimplant mechanical curettage with and without adjunct antimicrobial photodynamic therapy in smokeless-tobacco product users

ObjectiveThe aim was to investigate the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjuvant to mechanical curettage (MC) in the treatment of periimplant mucositis in smokeless tobacco (ST) product users. MethodsForty-eight ST product users with periimplant mucositis were randomly divided into 2 groups. In the test-group, participants underwent periimplant MC with adjunct aPDT; and in the control-group, the patients underwent MC alone. Periimplant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were measured at baseline and after 3-months of follow-up. Statistical analysis was performed using the Kruskal-Wallis test. Level of significance was set at P<0.05. ResultsAt baseline, periimplant PI, BOP and PD were comparable among individuals in the test- and control groups. At 3-months follow-up, scores of periimplant PI (P<0.05), BOP (P<0.05) and PD (P<0.05) were statistically significantly higher among patients in the control-group compared with the test-group. At 3-months follow-up, the percentages of sites of PI, BOP and PD were statistically significantly higher in the control-sites as compared to the test-sites. ConclusionAmong patients with periimplant mucositis, MC with adjunct aPDT is more effective in reducing periimplant inflammation in ST product users as compared to MC alone; however, the present result should be interpreted with caution as they were based on a short-term follow-up. Further long-term studies are needed in this regard.

Effect of mechanical debridement with adjunct antimicrobial photodynamic therapy in the treatment of peri-implant diseases in type-2 diabetic smokers and non-smokers

ObjectiveThe aim of the present 6-month follow-up study was to assess the effect of mechanical debridement (MD) with adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of peri-implant diseases in type-2 diabetic smokers and non-smokers. MethodsPatients were divided into 2 groups: (a) Group-1: type-2 diabetic smokers; and (b) Group-2: type-2 diabetic non-smokers. In both groups, hemoglobin A1c (HbA1c) levels and peri-implant bleeding on probing (BOP) and probing depth (PD) ≥4mm were measured at baseline and after 6 months of follow-up. Group comparisons were performed using the Kruskall-Wallis test and for multiple comparisons Bonferroni post hoc test was used. Level of significance was set at P<0.05. ResultsSixty-four individuals (33 in Group-1 and 31 in Group-2) were included. At baseline, BOP and PD≥4mm were comparable among individuals in groups 1 and 2. The mean age of individuals in groups 1 and 2 were 52.6±0.8 and 54.4±1.2years, respectively. The mean duration of type-2 DM among patients in groups 1 and 2 was 8.2±0.3years and 10±0.2years, respectively. In Group-1, the participants were smoking 6.3±1.5 cigarettes daily since 12.7±3.3years. At 6-months follow-up, there was no statistically significant difference in BOP and PD≥4mm among patients in groups 1 and 2 compared with the respective baseline values. HbA1c levels were comparable in all groups at all time intervals ConclusionOutcomes of the treatment of periimplant diseases using MD with adjunct aPDT are comparable among type-2 diabetic smokers and non-smokers.

Effect of mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implant diseases in prediabetic patients

ObjectiveThere are no studies that have assessed the efficacy of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of periimplant diseases in patients with prediabetes. The aim of the present 6-month follow-up study was to assess the effect of MD with and without adjunct aPDT in the treatment of periimplant diseases in patients with prediabetes. MethodsTreatment: wise, patients were divided into 2 groups: (a) test-group (n=30): patients underwent MD+aPDT; and (b) control group (n=30): patients underwent MD alone. Hemoglobin A1c (HbA1c) levels and periimplant bleeding on probing (BOP) and probing depth (PD) ≥4mm were measured at baseline and after 3 and 6 months in both groups. Group comparisons were performed using the Kruskall-Wallis test and for multiple comparisons Bonferroni post hoc test was used. Level of significance was set at P<0.05. ResultsSixty individuals (30 in the test-group and 30 in the control-group) were included. At 3-months follow-up, BOP and PD ≥4mm were statistically significantly higher in the control-group compared with the test-group. At-6-months follow-up, there was no statistically significant difference in BOP and PD ≥4mm between the test and control-groups. At 6-months follow-up, BOP and PD ≥4mm in the test- and control-groups were comparable to their respective values at 3-months follow-up. HbA1c levels were comparable in all groups at all time intervals. ConclusionIn the short-term, MD with adjunct aPDT is more effective in the treatment of periimplant inflammation compared to MD alone in prediabetic patients.

Efficacy of periimplant mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of periimplant diseases among cigarette smokers and non-smokers

ObjectiveThe aim was to assess the efficacy of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in reducing periimplant inflammation among cigarette-smokers and non-smokers. MethodsCigarette-smokers and non-smokers were randomly divided into 2 groups. In the test-group, participants underwent full mouth scaling and periimplant MD with adjunct aPDT; and in the control-group, the participants underwent full mouth scaling and periimplant MD alone. Periimplant bleeding on probing (BOP), probing depth (PD) and crestal bone loss (CBL) were measured at baseline and at 6- and 12-months follow-up. Statistical analysis was performed using the Kruskal-Wallis test. P-values<0.05 were considered statistically significant. ResultsEighty-four smokers (41 patients in the test group and 43 in the control group) and 82 non-smokers (40 patients in the test group and 42 in the control group) were included. Among smokers and non-smokers, periimplant PD was significantly higher in the control-group compared with the test-group (P<0.05) at 6-months of follow-up. There was no statistically significant difference in BOP, PD and CBL among smokers and non-smokers in the test- and control-groups at 12-months of follow-up. BOP was comparable among smokers at all time intervals. ConclusionIn the short-term, MD with adjunct aPDT is more effective in reducing periimplant probing depth than MD alone in smokers and non-smokers. However, in the long-term outcomes of MD either with or without aPDT among smokers and non-smokers are comparable.

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.

Diabetes has become a global epidemic. Its complications can have a significant impact on quality of life, longevity, and public health costs. The presence of diabetes might impair the prognosis of periodontal treatments due to its negative influence on wound healing. Antimicrobial photodynamic therapy (aPDT) is a local approach that can promote bacterial decontamination in periodontal pockets. The aim of this study was to investigate the local effect of adjunct aPDT to ultrasonic periodontal debridement (UPD) and compare it to UD only for the treatment of chronic periodontitis in type 2 diabetic patients. Twenty type 2 diabetic patients with moderate to severe generalized chronic periodontitis were selected. Two periodontal pockets with probing depth (PD) and clinical attachment level (CAL) ≥5mm received UPD only (UPD group) or UPD plus adjunct aPDT (UPD + aPDT group). Periodontal clinical measures were collected and compared at baseline and 30, 90, and 180days. After 180days of follow-up, there were statistically significant reductions in PD from 5.75 ± 0.91 to 3.47 ± 0.97mm in the UPD group and from 6.15 ± 1.27 to 3.71 ± 1.63mm in the UPD + aPDT group. However, intergroup analysis did not reveal statistically significant differences in any of the evaluated clinical parameters (p > 0.05). The adjunct application of aPDT to UPD did not present additional benefits for the treatment of chronic periodontitis in type 2 diabetic patients. The ClinicalTrials.gov identifier of the present study is NCT02627534.

Efficacy of periimplant mechanical debridement with and without adjunct antimicrobial photodynamic therapy in patients with type 2 diabetes mellitus

ObjectiveThere are no studies that have assessed the efficacy of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of periimplant inflammation in patients with type 2 diabetes mellitus (T2DM). The aim of the present 12-month follow-up study was to assess the efficacy of MD with and without adjunct aPDT in the treatment of periimplant inflammation in patients with T2DM. MethodsSixty-seven patients with diagnosed periimplant inflammation and T2DM were included. Treatment-wise, the patients were divided into 2 groups: (a) test-group (n=34): patients receivedMD+aPDT; and (b) control group (n=33): patients received MD only. Periimplant bleeding on probing (BOP), probing depth (PD) ≥4mm and mesial and distal marginal bone loss (MBL) were measured at baseline and after 6 and 12 months of therapy in both groups. The Kruskal-Wallis test was used to compare the periimplant BOP, PD, MBL and HbA1c levels in both groups. P-values less than 0.05 were considered statistically significant. ResultsMean preoperative hemoglobin A1c (HbA1c) for patients in the control group and test group were 8.5% and 8.8%, respectively. In the control group, there was no significant difference in HbA1c levels at all follow-up durations. Among patients in test group, there was a significant decrease (P<0.05) in HbA1c levels at 6 and 12 months of follow-up. Both PD and BOP were significantly lower in the test group compared to the control group at all follow-up durations. At 6 and 12 months of follow-up, there was no significant difference in MBL in both groups. ConclusionIn patients with T2DM, MD with adjunct aPDT is more effective in the treatment of periimplant inflammation compared with MD alone.

Efficacy of mechanical debridement with adjunct antimicrobial photodynamic therapy for the management of peri-implant diseases: a systematic review.

The aim was to assess whether or not mechanical debridement with adjunct antimicrobial photodynamic therapy (aPDT) is effective for the management of peri-implant diseases. The addressed focused question was "Is mechanical debridement with adjunct aPDT more effective in treating peri-implant diseases as compared to when mechanical debridement is used alone?" PubMed/MEDLINE and Google-Scholar databases were searched from 1994 till April 2014 using different combinations of the following keywords: antimicrobial photodynamic therapy; bone loss; light activated disinfection; mechanical debridement; and peri-implant diseases. Review articles, case-reports, commentaries, letters to the editor, unpublished articles and articles published in languages other than English were excluded. Twelve studies (six clinical and six experimental) were included. In the clinical and experimental studies, 15-80 implants and 18-150 implants respectively were used. Laser wavelengths, duration of irradiation and power output ranged between 625 nm-830 nm, 10 s-300 s, and 30 mW-200 mW, respectively. Four studies reported mechanical debridement with adjunct aPDT to be effective in the treatment of peri-implant diseases; however, the benefits of aPDT were comparable with conventional treatments. Two studies reported aPDT to reduce bacteria more than when the laser and the photosensitizer were applied alone. In two studies, chemical disinfection and aPDT showed comparable outcomes in terms of bacterial disinfection. In two experimental studies, aPDT was shown to improve bone to implant contact and re-osseointegration. Efficacy of mechanical debridement with adjunct aPDT for the management of peri-implant diseases remains debatable.