Effect of photodynamic therapy as an adjunctive to mechanical debridement on the nonsurgical treatment of peri-implant mucositis: A randomized controlled clinical trial

Abstract

Background: The use of photodynamic therapy (PDT) has been evaluated as an adjunctive technique for bacterial decontamination of implants with peri-implantitis. Given the controversies over the efficacy of the application of PDT to treat peri-implant diseases, the present clinical study aimed to evaluate the posttherapeutic clinical parameters and cytokine levels in peri-implant crevicular fluid in patients with peri-implant mucosal inflammation, receiving mechanical debridement (MD) alone or in association with PDT. Materials and Methods: In this double-blinded randomized clinical trial, 52 patients with peri-implant mucosal inflammation were selected and they were randomly assigned to 2 treatment groups: a MD group and an MD + PDT group using an 805 nm laser and indocyanine green (ICG). Although the decrease in bleeding on probing was the primary outcome, pocket depth, PUS, pain on probing, clinical attachment level, gingival recession, tumor necrosis factor-α, interleukin (IL)-1β, IL-6 and matrix metalloproteinase-8 were also evaluated at baseline, 2-week, and 3-month postintervention. Repeated measure analysis of variance was used to analyze inter-group differences and a P ≤ 0.05 was considered for significant differences between tested parameters. Results: Statistically significant improvements (P < 0.001) were detected for all variables after comparison of baseline data with those collected at each time interval of the study. Nevertheless, the inter-group comparisons of these variables between the baseline, 2-week, and 3-month intervals did not reveal any significant decrease in sites treated with either MD alone or MD + PDT. Conclusion: The application of PDT using 805-nm laser and ICG as an adjunct therapy to MD did not provide any additional improvements in the clinical or biologic parameters of peri-implant mucosal inflammation.

Efficacy of adjunctive photodynamic therapy to conventional mechanical debridement for peri-implant mucositis

“…CMD in the control groups was performed using either sterile hand curettes or titanium curettes. In contrast, the PDT + CMD groups underwent laser exposure for either 10 s [ 19 , 20 ] or 60s [ 16 – 18 , 21 , 23 ] after the introduction of various PSs into the pockets surrounding each implant via a blunt needle. Follow-up periods ranged from 3 months to 12 weeks.…”

“…Follow-up periods ranged from 3 months to 12 weeks. Among the included studies, two used indocyanine green as the PS [ 18 , 21 ], two employed phenothiazine chloride [ 19 , 20 ], and three utilised methylene blue [ 16 , 18 , 23 ]. The primary outcome measures included PD, BOP, and PI.…”

“…All studies [ 16 – 21 , 23 ] incorporated PD as an outcome measure. The combined data, as depicted in Fig.…”

“…Importantly, PDT does not result in scarring post-treatment and reduces the risk of recurrence [ 28 ], rendering it a highly promising therapeutic approach. While PDT has been explored as a treatment for p-iM [ 29 ], studies have confirmed its efficacy in this context [ 16 – 21 , 23 , 30 – 33 ]. However, there is still controversy regarding the effectiveness of PDT in improving certain indicators for pi-M patients due to variations in study populations, duration of irradiation, and the use of PSs.…”

“…While several randomized controlled trials (RCTs) have demonstrated the effectiveness of PDT in addressing p-iM, there exist certain controversies surrounding its efficacy for this condition. Some studies have reported the efficacy of PDT in effectively treating p-iM [ 16 – 20 ], while others have indicated that PDT has no significant impact on bleeding and plaque index associated with p-iM [ 21 ]. Hence, a comprehensive meta-analysis is warranted to assess the role of PDT as an adjunct to conventional mechanical debridement (CMD) in managing p-iM.…”