The impact of antimicrobial photodynamic therapy on peri-implant disease: What mechanisms are involved in this novel treatment?

Abstract

According to the American Academy of Implant Dentistry, 3 million Americans have dental implants, and this number is growing by 500,000 each year. Proportionally, the number of biological complications is also increasing. Among them, peri-implant disease is considered the most common cause of implant loss after osseointegration. In this context, microorganisms residing on the surfaces of implants and their prosthetic components are considered to be the primary etiologic factor for peri-implantitis. Some research groups have proposed combining surgical and non-surgical therapies with systemic antibiotics. The major problem associated with the use of antibiotics to treat peri-implantitis is that microorganisms replicate very quickly. Moreover, inappropriate prescription of antibiotics is not only associated with potential resistance but also and most importantly with the development of superinfections that are difficult to eradicate. Although antimicrobial photodynamic therapy (aPDT) was discovered several years ago, aPDT has only recently emerged as a possible alternative therapy against different oral pathogens causing peri-implantitis. The mechanism of action of aPDT is based on a combination of a photosensitizer drug and light of a specific wavelength in the presence of oxygen. The reaction between light and oxygen produces toxic forms of oxygen species that can kill microbial cells. This mechanism is crucial to the efficacy of aPDT. To help us understand conflicting data, it is necessary to know all the particularities of the etiology of peri-implantitis and the aPDT compounds. We believe that this review will draw attention to new insights regarding the impact of aPDT on peri-implant disease.

Adjunctive photodynamic therapy improves the outcomes of peri‐implantitis: a randomized controlled trial

“…Indeed, a wide variety of lasers and photosensitizer agents is available, and the most optimal parameters remain to be determined, as highlighted by systematic reviews . In addition, the exact mechanisms of action of PDT with respect to the different available photosensitizers remain mostly unknown . Furthermore, the type of mechanical debridement, the use of preoperative antibacterial mouthwash, laser type, laser wavelength, the photosensitizer used, preoperative dental hygiene, diet, smoking, alcohol consumption, etc.…”

Main Predictors and Treatments of Peri-Implantite: Brief Review.

“…Long-term follow-up of consecutively treated cases appears to be a realistic path for accumulating more information [1]. This can be useful in establishing the magnitude and stability presitivity on the improvements that can be made.…”

“…The peri-implantite is developed from mucositis lesions, while others remain resistant and present only mucositis in response to the accumulation of plaque microorganisms [1][2][3]. The term periimplantite is used because of clinical, histological and microbiological similarities with periodontitis.…”

“…The prevalence of implants with bone loss ranging from 1.0 to 3.0 mm was estimated. Bone loss was used as a surrogate parameter for peri-implantitis, since the prevalence of peri-implantitis was not reported in most studies or when reported, the diagnostic criteria were unclear or of doubtful quality [1][2][3][4][5][6].…”

Effect of Photodynamic Therapy Using Toluidine Blue on Eikenella corrodens and Aggregatibacter actinomycetemcomitans Biofilms Adhered to Titanium Discs: An In Vitro Study

“…(18)(19)(20) aPDT consists of three components including a light source, a photosensitive agent, and free radicals. (21) Once the photosensitive agent is stimulated by its optimal wavelength, it turns from the low-energy state to a highly energized one. The high triple state half-life causes an interaction between the photosensitive agent and oxygen in tissues and produces free radicals, which lead to bacterial destruction.…”