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

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.

Terapia fotodinâmica como adjuvante ao tratamento periodontal não cirúrgico / Photodynamic therapy adjuvant to non-surgical periodontal treatment

O tratamento convencional da doença periodontal é feito pela raspagem e alisamento radicular (RAR). No entanto, este procedimento apresenta limitações como, dificuldade de acesso a áreas de furcas, bolsas profundas e sítios distais de molares. Nesse sentido, a terapia fotodinâmica (TFD) poderia ser benéfica, pois não induz resistência bacteriana e surge como um método de redução microbiana por necrose celular, por meio da associação de uma fonte de luz (laser) e um agente fotossensibilizante. Esta técnica apresenta mínimos efeitos colaterais e sistêmicos, sendo capaz de aumentar o conforto do paciente reduzindo a necessidade de retalhos, o tempo de tratamento e o risco de bacteremias. A despeito dessas qualidades, estudos clínicos controlados ainda são requeridos para que se estabeleça um protocolo de uso da TFD que seja efetivo, seguro e que proporcione benefícios significativos quando comparado à terapia convencional. O objetivo deste trabalho é fazer uma revisão de literatura sobre os efeitos da TFD como adjuvante ao tratamento periodontal não-cirúrgico.

The conventional treatment of periodontitis is accomplished by scaling and root planning (SRP). However, this procedure has limitations, difficulty to access furcations areas, deep and distal sites of molars. On the other hand, photodynamic therapy (PDT), could be beneficial, because it does not induc bacterial resistance and comes as a method of microbial reduction, cellular necrosis by the association of a light (laser) and a photosensitizing agent. This technique has minimal systemic side effects and, is able to increase patient comfort by minimizing need for flaps, treatment time and the risk of bacterial infections. Despite those qualities, controlled clinical studies are still necessary to establish a protocol for PDT use that is effective, safe and that provides significant benefits when compared to conventional therapy. This work aims to review the literature on PDT as an adjuvant to non-surgical periodontal treatment.