Photodynamic therapy associated with full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis: a randomized-controlled clinical trial

Abstract

Background:Photodynamic therapy (PDT) is a method of microbial reduction which can benefit periodontal treatment in areas of difficult access, such as deep pockets and furcations. The aim of this randomized controlled clinical trial was to evaluate the effects of PDT as an adjunct to full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis. Material and Methods:Twenty-two patients with at least one pocket with a probing depth (PD) of ≥7 mm and one pocket with a PD of ≥5 mm and bleeding on probing (BOP) on each side of the mouth were included, characterizing a split mouth design. The control group underwent full-mouth ultrasonic debridement and the test group received the same treatment associated with PDT. The PDT was performed on only one side of the mouth and the initial step consisted of subgingival irrigation with 0.005% methylene blue dye. Two minutes after applying the photosensitizer, the low power laser - AsGaAl (Photon Lase III - PL7336, DMC, São Carlos -São Paulo, Brazil) was applied (660 nm, 100 mW, 9 J, 90 seconds per site, 320 J/cm2, diameter tip 600 µm).The following clinical parameters were evaluated: plaque index, gingival index, BOP, gingival recession (GR), PD, and clinical attachment level (CAL). All parameters were collected before, 1, 3 and 6 months after treatment.Results:An improvement in BOP, PD and CAL was observed after treatment, in both groups, but without any difference between them. After 6 months, the PD decreased from 5.11±0.56 mm to 2.83±0.47 mm in the test group (p<0.05) and from 5.15±0.46 mm to 2.83±0.40 mm in the control group (p<0.05). The CAL changed, after 6 months, from 5.49±0.76 mm to 3.41±0.84 mm in the test group (p<0.05) and from 5.53±0.54 to 3.39±0.51 mm in the control group (p<0.05).Conclusion:Both approaches resulted in significant clinical improvements in the treatment of severe chronic periodontits, however, the PDT did not provide any additional benefit to those obtained with full-mouth ultrasonic debridement used alone.

Effect of Antimicrobial Photodynamic Therapy as an Adjunct to Nonsurgical Treatment of Deep Periodontal Pockets: A Clinical Study

“…Similar results were reported by many previous studies. 9,23,24,30 Our findings confirm the results of a recent study by Balata et al 36 who reported that aPDT did not add any additional effect to SRP in terms of CAL gain.…”

The Effect of Photodynamic Therapy in the Treatment of Chronic Periodontitis: A Review of Literature

“…In each group no statistically significant difference was observed clinically after the treatment. 25 In 2013, Souza et al studied the impacts of microbial PDT on the level of transforming growth factor (TGF) β 1 in GCF on patients. In that study they chose 50 patients with bilateral grade III furcation involvement in mandibular molars.…”

Is Photodynamic Therapy an Effective Treatment for Periodontal and Peri-Implant Infections?

“…Eight out of the 18 studies have reported statistically significantly higher improvements in probing depth (PD) reduction and/or clinical attachment (CAL) gain following SRP + PDT compared to SRP alone, [21][22][23][24][25][26][27][28] _ENREF_22while the rest of 10 studies have failed to reveal statistically significant differences in these parameters. 29,[30][31][32][33][34][35][36][37][38] An additional improvement for the reduction of bleeding on probing (BOP) following the use of PDT was reported in 5 out of the 19 papers. 22,26,28,31,32 Changes of microbiological parameters were evaluated in 8 of 18 studies.…”