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

Abstract

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) ≥5 mm 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 180 days. After 180 days of follow-up, there were statistically significant reductions in PD from 5.75 ± 0.91 to 3.47 ± 0.97 mm in the UPD group and from 6.15 ± 1.27 to 3.71 ± 1.63 mm 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.

The Effects of 810 nm Diode Laser and Indocyanine Green on Periodontal Parameters and HbA1c in Patients with Periodontitis and Type II Diabetes Mellitus: A Randomized Controlled Study

“…The adjunct aPDT therapy, with various photosensitizers, was previously investigated in DM subjects; the data suggest that, even if the clinical periodontal improvements were significant when compared to SRP alone, the HbA1c reduction as additional benefit were modest. Nevertheless, the found studies [ 32 , 33 , 34 , 35 ] had significant heterogeneity regarding the energy source, the used laser power, irradiation sessions and also concentrations for photosensitizers.…”

Diabetes: Oral Health Related Quality of Life and Oral Alterations

“…Through a diabetes treatment satisfaction questionnaire Vora et al in their study evaluated differences between glargine/glulisine once daily or insulin aspart/aspart protamine [32]. Evaluation about quality of life and public health costs on diabetic patients with the use of antimicrobial photodynamic therapy (aPDT) and ultrasonic periodontal debridement (UPD) did not show additional benefits for the treatment of chronic periodontitis [33]. Goodson et al evaluated salivary glucose concentration and other oral factors, like dental caries and gingivitis on diabetic patients.…”

Antimicrobial photodynamic therapy mediated by methylene blue in surfactant vehicle on periodontopathogens

“…This in vitro study was carried out in order to verify if the alteration of the formulation of the conventional photosensitizer would alter its photochemical characteristics to the point of having an impact APDT on its efficiency, thus indicating the potential for clinically relevant benefits. In this study, the parameters used were selected from a bibliographic survey, the most cited in the literature being the data used and in pilot studies of our group (5,(15)(16)(17). The causative etiological factor of periodontal disease is the presence of biofilm.…”