Abstract
Experimental studies in animals and in vitro have shown the usefulness of photodynamic therapy (PDT) as an adjunct to periodontal treatment. The aim of this study was to evaluate the long-term clinical and microbiological effects of PDT associated with nonsurgical periodontal treatment. Three sites in each of 33 patients with chronic periodontitis were randomly allocated in a split-mouth design to a treatment group: (1) scaling and root planing (SRP group); (2) SRP and irrigation with toluidine blue O (TBO group); and (3) SRP, irrigation with TBO and low-level laser irradiation (PDT group). Clinical parameters including visible plaque index, bleeding gingival index, bleeding on probing, probing depth, gingival recession and clinical attachment level were measured at baseline, and after 60, 90 and 180 days. Additionally, subgingival plaque samples were collected for microbiological analysis by PCR. Intergroup and intragroup statistical analyses were performed. All treatment groups showed an improvement in all clinical parameters, and a significant reduction in the proportion of sites positive for periodontopathogens at 60, 90 and 180 days compared to baseline (p < 0.05). None of the periodontal parameters showed a significant difference among the groups (p > 0.05). At 180 days, PDT treatment led to a significant reduction in the percentage of sites positive for all bacteria compared to SRP alone (p < 0.05). Within the limits of this study it may be concluded that PDT as an adjunct to periodontal treatment produced statistically significant reductions in some of the key periodontal pathogens but produced no statistically significant benefit in terms of clinical outcome.
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References
Kaldahl WB, Kalkwarf KL, Patil KD (1993) A review of longitudinal studies that compared periodontal therapies. J Periodontol 64:243–253
Adriaens PA, Edwards CA, DeBoever JA, Loesche WJ (1988) Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth. J Periodontol 59:493–503
Matia JI, Bissada NF, Maybury JE, Ricchetti P (1986) Efficiency of scaling of the molar furcation area with and without surgical access. Int J Periodontics Restorative Dent 6:24–35
Sherman PR, Hutchens LH, Jewson LG, Moriarty JM, Greco GW, McFall WT (1990) The effectiveness of subgingival scaling and root planing. I. Clinical detection of residual calculus. J Periodontol 61:3–8
Cobb CM (1996) Non-surgical pocket therapy. Ann Periodontol 1:443–490
Kaner D, Bernimoulin JP, Hopfenmüller W, Kleber BM, Friedmann A (2007) Controlled-delivery chlorhexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial. J Clin Periodontol 34:880–891
Lopes BMV, Theodoro LH, Melo RF, Thompson GMA, Marcantonio RAC (2010) Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with erbium:YAG laser and scaling and root planing. J Periodontol 81:682–691
Wilson M, Burns T, Pratten J, Pearson GJ (1995) Bacteria in supragingival plaque samples can be killed by low-power laser light in the presence of a photosensitizer. J Appl Bacteriol 78:569–574
Usacheva MN, Teichert MC, Biel MA (2001) Comparison of the methylene blue and toluidine blue photobactericidal efficacy against gram-positive and gram-negative microorganisms. Lasers Surg Med 29:165–173
Chan Y, Lai C-H (2003) Bactericidal effects of different laser wavelengths on periodontopathic germs in photodynamic therapy. Lasers Med Sci 18:51–55
Matevski D, Weersink R, Tenebaum HC, Wilson B, Ellen RP, Lepine G (2003) Lethal photosensitization of periodontal pathogens by a red-filtered xenon lamp in vitro. J Periodontal Res 38:428–435
Bhathi M, MacRobert A, Meghji S, Henderson B, Wilson M (1998) A study of the uptake of toluidine blue O by Porphyromonas gingivalis and the mechanism of lethal photosensitization. Photochem Photobiol 68:370–376
Maisch T (2007) Anti-microbial photodynamic therapy: useful in the future? Lasers Med Sci 22:83–91
Kömerick N, Nakanish H, MacRobert AJ, Henderson B, Speight P, Wilson M (2003) In vivo killing of Porphyromonas gingivalis by toluidine blue-mediated photosensitization in an animal model. Antimicrob Agents Chemother 47:932–940
Sigusch BW, Pfitzner A, Albrecht V, Glockmanne E (2005) Efficacy of photodynamic therapy on inflammatory signs and two selected periodontopathogenic species in a beagle dog model. J Periodontol 76:1100–1105
de Almeida JM, Theodoro LH, Bosco AF, Nagata MJH, Oshiiwa M, Garcia VG (2007) Influence of photodynamic therapy on the development of ligature-induced periodontitis in rats. J Periodontol 78:566–575
de Almeida JM, Theodoro LH, Bosco AF, Nagata MJH, Bonfante S, Garcia VG (2008) Treatment of experimental periodontal disease by photodynamic therapy in rats with diabetes. J Periodontol 79:2156–2165
Qin YL, Luan XL, Bi LJ, Sheng YQ, Zhou CN, Zhang ZG (2008) Comparison of toluidine blue-mediated photodynamic therapy and conventional scaling treatment for periodontitis in rats. J Periodontal Res 43:162–167
de Almeida JM, Theodoro LH, Bosco AF, Nagata MJH, Oshiiwa M, Garcia VG (2008) In vivo effect of photodynamic therapy on periodontal bone loss in dental furcations. J Periodontol 79:1081–1088
Andersen R, Loebel N, Hammond D, Wilson M (2007) Treatment of periodontal disease by photodisinfection compared to scaling and root planing. J Clin Dent 18:34–38
Braun A, Dehn C, Krause F, Jepsen S (2008) Short-term clinical effects of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial. J Clin Periodontol 35:877–884
Sigusch BW, Engelbrecht M, Völpel A, Holletschke A, Pfister W, Schütze J (2010) Full-mouth antimicrobial photodynamic therapy in Fusobacterium nucleatum-infected periodontitis patients. J Periodontol 81:975–981
Chondros P, Nikolidakis D, Christodoulides N, Rossler R, Gutknecht N, Sculean A (2009) Photodynamic therapy as adjunct to non-surgical periodontal treatment in patients on periodontal maintenance: a randomized controlled clinical trial. Lasers Med Sci 24:681–688
Christodoulides N, Nikolidakis D, Chondros P, Becker J, Schwarz F, Rössler R, Sculean A (2008) Photodynamic therapy as an adjunct to nonsurgical periodontal treatment: a randomized, controlled clinical trial. J Periodontol 79:1638–1644
Polansky R, Hass M, Heschl A, Wimmer G (2009) Clinical effectiveness of photodynamic therapy in the treatment of periodontitis. J Clin Periodontol 36:575–580
Ashimoto A, Chen C, Bacher I, Slots J (1996) Polymerase chain reaction detection of 8 putative periodontal pathogens in subgingival plaque of gingivitis and advanced periodontitis lesions. Oral Microbiol Immunol 11:266–273
Benkirane RR, Guillot E, Mouton C (1995) Immunomagnetic PCR and DNA probe for detection and identification of Porphyromonas gingivalis. J Clin Microbiol 33:2908–2912
Guillot E, Mouton C (1997) PCR-DNA probe assays for identification and detection of Prevotella intermedia sensu strictu and Prevotella nigrescens. J Clin Microbiol 35:1876–1882
Badersten A, Nilvéus R, Egelberg J (1981) Effect of nonsurgical periodontal therapy. I. Moderately advanced periodontitis. J Clin Periodontol 8:57–72
Badersten A, Nilvéus R, Egelberg J (1984) Effect of nonsurgical periodontal therapy. III. Single versus repeated instrumentation. J Clin Periodontol 11:114–120
Badersten A, Nilvéus R, Egelberg J (1984) Effect of nonsurgical periodontal therapy. II. Severely advanced periodontitis. J Clin Periodontol 11:63–76
Badersten A, Nilvéus R, Egelberg J (1987) 4-year observations of basic periodontal therapy. J Clin Periodontol 14:438–444
Fernandes LA, de Almeida JM, Theodoro LH, Bosco AF, Nagata MJ, Martins TM, Okamoto T, Garcia VG (2009) Treatment of experimental periodontal disease by photodynamic therapy in immunosuppressed rats. J Clin Periodontol 36:219–228
Lulic M, Leiggener Gorog I, Salvi GE, Ramseier CA, Matheos N, Lang NP (2009) One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized-controlled clinical trial. J Clin Periodontol 36:661–666
Braham P, Herron C, Street C, Darveau R (2009) Antimicrobial photodynamic therapy may promote periodontal healing through multiple mechanisms. J Periodontol 80:1790–1798
Aimetti M, Romano F, Torta I, Caposio P, Romagnoli R (2004) Debridement and local application of tetracycline-loaded fibres in the management of persistent periodontitis: results after 12 months. J Clin Periodontol 31:166–172
Soukos N, Wilson M, Burns T, Speight PM (1996) Photodynamic effects of toluidine blue on human oral keratinocytes and fibroblasts and Streptococcus sanguis evaluated in vitro. Lasers Surg Med 18:253–259
Malik Z, Hanania J, Nitzan Z (1990) Bactericidal effects of photoactivated porphyrins – an alternative approach to antimicrobial drugs. J Photochem Photobiol 5:281–293
Usacheva M, Teichert MC, Biel MA (2003) The interaction of lipopolysaccharides with phenothiazine dyes. Lasers Surg Med 33:311–319
Socransky SS, Haffajee AD, Cugini MA (1998) Microbial complexes in subgingival plaque. J Clin Periodontol 25:134–144
Wilson M (2004) Lethal photosensitisation of oral bacteria and its potential application in the photodynamic therapy of oral infections. Photochem Photobiol Sci 3:412–418
Wainwright M (1998) Photodynamic antimicrobial chemotherapy (PACT). J Antimicrob Chemother 42:13–18
Hujoel PP, De Rouen TA (1992) Validity issues in split-mouth trials. J Clin Periodontol 19:625–627
Quirynen M, De Soete M, Dierickx K, Van Steenberghe D (2001) The intra-oral translocation of periodontopathogens jeopardises the outcome of periodontal therapy. A review of the literature. J Clin Periodontol 28:499–507
Acknowledgments
Glaucia Helena G. Soares received a scholarship from São Paulo State Foundation for Research (FAPESP 2007/039001). The authors would like to thank Bruno Theodoro Luciano, graduate student at the Institute of International Relations, University of Brasilia, DF, Brazil, for the English translation and review. The authors report no conflicts of interest related to this study.
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Theodoro, L.H., Silva, S.P., Pires, J.R. et al. Clinical and microbiological effects of photodynamic therapy associated with nonsurgical periodontal treatment. A 6-month follow-up. Lasers Med Sci 27, 687–693 (2012). https://doi.org/10.1007/s10103-011-0942-x
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DOI: https://doi.org/10.1007/s10103-011-0942-x