Photodynamic Therapy by Mean of 5-Aminolevulinic Acid for the Management of Periodontitis and Peri-Implantitis: A Retrospective Analysis of 20 Patients

Abstract

Periodontitis and peri-implantitis are common in the population worldwide. Periodontal diseases affect approximately 50% of adults, while mucositis affects 80% of patients with implants, turning into peri-implantitis at a rate varying from 28 to 58%. If standardized treatments for all degrees and variety of periodontal diseases are known and codified, a consensus on the treatment of peri-implantitis still has to be found. Photodynamic therapy (PDT) has been used successfully in the medical field and was recently introduced as supportive therapy in dentistry. This paper reviews the results on 20 patients, 10 affected by periodontal disease (grades II to III) and 10 by peri-implantitis. Application of 5% 5-aminolevulinic acid gel (ALAD), as a support of causal therapy, in periodontal pockets and areas of peri-implantitis favored the maintenance of severely compromised teeth and significantly improved compromised implant conditions. Between baseline and 6 months, all teeth and implants remained functional. All patients confirmed that the scaling and root planning (SRP)+ALAD-PDT was not painful, and all perceived a benefit after the treatment at all timing points. For periodontal patients, a significant decrease in PPD after 3 (p < 0.001) and 6 months after SRP+ALAD-PDT respect baseline values were observed. For the implant patients, the SRP+ALAD-PDT was correlated to a decrease in PPD and BOP, and a slight increase in the number of exposed threads. However, the results were statistically significant only for PPD (p < 0.001).

The Involvement of Photobiology in Contemporary Dentistry—A Narrative Review

“…Park et al [ 82 ] demonstrated the feasibility of toluidine blue O (TBO)-mediated PDT as a noninvasive supplementary method for the treatment of periodontitis. Many bacteria, including certain oral microbes, can be inactivated by PDT, according to some in vitro investigations [ 83 , 84 , 85 , 86 ]. Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Prevotella intermedia , and Streptococcus sanguis , all of which have been linked to periodontal disease, were demonstrated to be strongly inhibited by aPDT under a variety of settings [ 87 ].…”

5-Aminolevulinic Acid and Red Led in Endodontics: A Narrative Review and Case Report

“…They observed that the sites treated with the combination of SRP and ALAD gel showed a significant reduction in the total bacterial loading compared to the treated sites with SRP alone. Furthermore, Rossi et al [ 89 ] also considered the photodynamic therapy based on ALAD gel a support for the conventional treatment, favoring the maintenance of severely compromised teeth and the improvement of compromised implant conditions.…”

“…5-aminolevulinic acid (5-ALA) is an intrinsic photosensitizing agent different from phenothiazine derivatives such as toluidine blue and methylene blue, as it is converted in situ into an endogenous substance essential for the formation of the heme group, protoporphyrin IX (PpIX) a powerful photosensitizing agent [ 85 ]. This ALA photosensitizing agent and its derivatives have been used for many years with excellent efficacy in antibacterial therapy and in many cancerous and pre-cancerous diseases, in dermatology and in disease of the oral cavity [ 86 , 87 , 88 , 89 ]. Moreover, it is a natural molecule that has been extensively studied in other research fields such as agriculture and biotechnology [ 90 ].…”

Photodynamic Therapy with Aminolevulinic Acid Enhances the Cellular Activity of Cells Cultured on Porcine Acellular Dermal Matrix Membranes Used in Periodontology

“…This thermosensitive gel containing 5% of 5-delta aminolevulinic acid (ALAD), associated with red-LED irradiation (ALAD-PDT), has shown antimicrobial activity against Gram-negative and positive bacteria against C. albicans and oral biofilm [9][10][11]. Clinical case reports have recently been published that show the application of ALAD-PDT during root canal disinfection in endodontic treatments and in periodontology [12,13]. In particular, for the treatment of periodontal pockets and peri-implantitis sites, the addition of this protocol respects the traditional gold standard scaling root planning (SRP), and was associated with a reduction in the total bacterial load.…”