Efficacy of photodynamic therapy and periodontal treatment in patients with gingivitis and fixed orthodontic appliances

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/cm2. 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.

The Oral Microbiota: Community Composition, Influencing Factors, Pathogenesis, and Interventions

“…As in that clinical trial, the combination of PDT and photobiomodulation therapy accelerated the healing process after oral mucositis, reducing the remission time from 15 to 11 days (Pires Marques et al, 2020). Clinical trials of pulpitis (da Mota et al, 2015), periapical periodontitis (Moreira et al, 2015), oral leukoplakia ), peri-implantitis (Al Habashneh et al, 2015, and adverse biofilm changes caused by orthodontic brackets (Rosa et al, 2020) showed that PTD was more effective than traditional treatments. However, further clinical trials are required to establish whether PTD can be used as an alternative mechanical debridement process in the prevention of oral infectious diseases (Javali et al, 2019).…”

Evaluation of methylene blue based photodynamic inactivation (PDI) against intracellular B-CoV and SARS-CoV2 viruses under different light sources in vitro as a basis for new local treatment strategies in the early phase of a Covid19 infection

“…The dye is used for example systemic for the treatment of methaemoglobinemia [16] , septic shock [17] , as an antimalarial agent [18] , as a neuroprotective drug [19] , in local application in colonoscopy [20] , for visualization of organ structures during surgery, for antimicrobial photodynamic therapy in dentistry [21] and for photo-deactivation of viruses in human fresh plasma [ 22 , 23 ]…”

Proposal of a Model for Periodontal Prevention During Orthodontic Treatment

“…We have not found in the literature any other data on the general lowering of the periodontal pathogenic load using the water jet. Some recent studies have proposed other ways to reduce the bacterial load during orthodontic treatment, such as photobiomodulation, photodynamic therapy, and probiotics [24][25][26][27][28], but the use of a water jet is easier in our opinion overall for the patient. It also seems that the use of the eco-friendly non-electric device is even more performing for this purpose.…”